Spatial Analyses of Crisis Pregnancy Centers and Abortion Facilities in the United States, 2021 (Pre-Dobbs): Cross-Sectional Study.

Background: Crisis pregnancy centers (CPCs) are religious nonprofit organizations with a primary mission of diverting people from having abortions. One CPC tactic has been to locate near abortion facilities. Despite medical groups' warnings that CPCs do not adhere to medical and ethical standards and pose risks, government support for CPCs has significantly increased.

Objective: This study aims to map CPCs, abortion facilities, and geographical areas in the United States into 4 zones based on their proximity to CPCs and abortion facilities. We sought to describe the number and percentage of reproductive-aged women living in each zone and the proximity of CPCs to abortion facilities.

Methods: Using 2021 data from CPC Map and the Advancing New Standards in Reproductive Health Abortion Facility Database, we determined the ratio of CPCs to abortion facilities. Along with census data, we categorized and mapped US block groups into 4 distinct zones based on locations of block group centroids within 15-mile (1 mile is approximately 1.609 km) radii of CPCs and abortion facilities, namely "no presence," "CPC only," "abortion facility only," and "dual presence." We calculated the number and percentage of block groups and reproductive-aged (15-49 years) women living in each zone. We calculated driving distances and drive times from abortion facilities to the nearest CPC and mapped abortion facilities with CPCs in close proximity. All analyses were conducted nationally and by region, division, and state.

Results: Nationally, the ratio of CPCs to abortion facilities was 3.4, and 54.9% (131,410/239,462) of block groups were categorized in the "dual presence" zone, 26.6% (63,679/239,462) as "CPC only," and 0.8% (63,679/239,462) as "abortion facility only." Most reproductive-aged women (45,150,110/75,582,028, 59.7%) lived in a "dual presence" zone, 26.1% (19,696,572/75,582,028) in a "CPC only" zone, and 0.8% (625,403/75,582,028) in an "abortion facility only" zone. The number of block groups and women classified as living in each zone varied by region, division, and state. Nationally, the median distance from abortion facilities to the nearest CPC was 2 miles, and the median drive time was 5.5 minutes. Minimum drive times were <1 minute in all but 11 states. The percentages of abortion facilities with a CPC within 0.25, 0.5, 1, and 3 miles were 14.1% (107/757), 22.6% (171/757), 36.1% (273/757), and 66.3% (502/757), respectively.

Conclusions: The findings suggest that CPCs' tactic of locating near abortion facilities was largely realized before the 2022 US Supreme Court decision that overturned the federal right to abortion. Research on CPCs' locations and tactics should continue given the dynamic abortion policy landscape and risks posed by CPCs. Tailored programming to raise awareness about CPCs and help people identify and access safe sources of health care may mitigate harm. Increased regulation of CPCs and government divestment may also mitigate CPC harms.