Early pregnancy services at crisis pregnancy centers and abortion facilities in the United States: A mystery caller study and spatial analysis
Awarded 2019
Complex Family Planning Fellowship Research
Kavita Vinekar, MD
University of Pittsburgh

Crisis pregnancy centers (CPCs) provide pregnancy-related services with the intent of dissuading people from seeking abortions. Half of states support CPCs through funding or mandatory referrals. Our study has two aims: (1) to spatially map the distribution and concentration of CPCs and abortion facilities (AFs) in states that do and do not support CPCs, and (2) to employ a mystery caller methodology to characterize early pregnancy service accessibility at CPCs and AFs, in states that fund CPCs compared to those that do not.
In Aim 1, we geocoded facility addresses from comprehensive CPC and AF databases. We calculated county-level concentrations of CPCs and AFs per 10,000 women ages 15-44 years, and used Student’s T testing to compare facility concentrations by state CPC policy. We measured global (Moran’s I) and local (G*) spatial autocorrelation. Univariate and multivariate regression analyses were performed to assess whether state-level CPC-to-AF density ratios differed by policy. Covariates included NARAL abortion policy designation, percentage of reproductive age females, and percentage of rural counties.
In Aim 2, We conducted a national mystery caller study of 445 CPCs and their closest AFs in all fifty states. The primary outcome was difference in wait time to first available pregnancy confirmation appointment between CPCs and their closest AF. Secondary outcomes included call duration, hold times, ultrasound and pregnancy test availability, and cost.
Together, aims 1 and 2 serve as an assessment of the geographic distribution and accessibility of CPCs and AFs nationally, and the role of state policy in these access measures.