INTRODUCTION: Receiving over $250 million in state government support since 2022, crisis pregnancy centers (CPCs) have expanded following the Supreme Court’s overturn of Roe v. Wade, particularly in states with policies limiting abortion services. As a result, patients may have an increasingly difficult time distinguishing between CPCs and legitimate abortion providers, which may represent a significant barrier to care especially for patients looking for out-of-state abortion services. The National Abortion Federation (NAF) offers membership for providers whose abortion services meet their standardized requirements. However, it is unclear whether these providers sufficiently guarantee their services for patients unfamiliar with the NAF or if these providers clearly list their NAF membership on their website.The purpose of this study was to perform a website content analysis on NAF member facility websites to evaluate how each facility demonstrates the legitimacy of its services.

METHODS: First, a list of 438 NAF member names and websites was compiled from the NAF’s “Find a Provider” page. Hospitals and Planned Parenthoods were excluded from this study, in addition to facilities that were closed, did not have a website, or did not offer abortion services. The 290 remaining NAF member websites were independently reviewed by two coders, with a third coder to resolve any discrepancies. All websites were evaluated for the following variables: mentions of the right to choose, inclusions of the NAF logo or certification, warnings about CPCs and misinformation, and where each member advertised their abortion services on their website (homepage or subpage). Websites were also assessed for explicit statements guaranteeing the clinic’s legitimacy. State abortion policies were categorized as being protective, neutral, restrictive, and most-restrictive (banned) based on classifications by the Guttmacher Institute. Protective and restrictive states that have a shared border with at least one most-restrictive state were labeled Protective-Bordering-Most-Restrictive (PBMR) and Restrictive-Bordering-Most-Restrictive (RBMR) respectively. Finally, a series of logistic regression analyses were performed to compare the aforementioned variables between different state classifications.

RESULTS: Through our analysis, we found that 91% of providers mentioned the right to choose, although only 62% had it on their homepage. 96% of clinics that offer procedural abortions advertised it on their homepage, compared to 81% for medical abortions and 84% for abortion pills by mail. 63% of clinics in protective states advertised their NAF membership compared to 79% of clinics in restrictive states (OR = 0.5, p < 0.01). Meanwhile, clinics in protective states were more likely than those in restrictive states to warn about CPCs (OR = 2.7, p < 0.01). This same disparity in CPC warnings was also observed when comparing clinics in PBMR and RBMR states (OR = 3.1, p < 0.01). While no significant differences were found nationally, clinics in PBMR states were considerably more likely to provide legitimacy statements than clinics in RBMR states (OR = 3.3, p < 0.05).

DISCUSSION: In conclusion, our study suggests that most NAF members clearly advertise their abortion services, especially for procedural abortions. Most NAF members also clearly mention the right-to-choose and their NAF membership. However, relatively few facilities provide guarantees of their legitimacy or warnings about CPCs, especially in RBMR states. Overall, our study suggests patients in restrictive states that are unfamiliar with the NAF may have a harder time identifying legitimate clinics than patients in protective states. Furthermore, patients in restrictive states may also be less informed about CPCs. Because of our results, moving forward we will be interested in assessing how abortion providers without NAF affiliations are able to demonstrate the legitimacy of their services.