Pressure, pain and panic

Where only first names appear, names have been changed to protect the identities of the sources.

In a cluttered teenage girl's bedroom, posters of punk rock bands like Television and The Stooges pepper the walls. Oddball trinkets and doodads line a dresser, clothes spilling from the drawers. In the center of the scene, a timid looking brunette sits on a bed, clutching what appears to be a sandwich: "Hello," a rosy-faced Juno MacGuff mutters into her novelty hamburger phone, "I need to procure a hasty abortion."

Scores of Blazers saw "Juno" at the movies during its holiday tenure last winter, and many of them would later add the film to the 'Favorite Movies,' category in their Facebook profiles, but for some students - most no older than the movie's 16-year-old malcontent heroine - the scenes of dingy clinic waiting rooms, pro-life activists toting posters outside clinics and intimidating walks of shame down health-room halls hit all too close to home. In the movie, MacGuff faced pressure from both pro-choice and pro-life members of her community (in the form of a friend Leah and a schoolmate Su-Chin) while she dealt with a pregnancy, but was ultimately forced to craft her personal life decision from two opposing camps.

Teenage pregnancy and promiscuity, always constant fixtures in the eye of the media, seem to have returned as serious concerns for Americans after what appeared to be a brief hiatus in the late 1990s. According to a report issued by the Center for Disease Control and Prevention in December 2007, the general rate of decline for teenage pregnancy has slowed since 2005 despite the efforts of sexual education programs across the country. More recently, according to a March 11 article published on CNN, approximately one in four teenage girls was diagnosed with a sexually transmitted disease (STD) in 2008.

Each day, another teenage girl struggles with an unplanned pregnancy or a terrifying diagnosis and is forced to review her options. Some girls, like sophomore Rahel Gebryesus's best friend, enlist the help of parents and friends to help them cope, but others are left alone. Gebreyesus stood beside her best friend as she went through an unplanned pregnancy marked by frequent visits to a Shady Grove health care center last year. In Maryland, dozens of agencies work every day to spread awareness for teen sexual health and administer treatment and medicinal care to women facing unplanned pregnancies or STDs. Some of these groups, such as Planned Parenthood, take a bi-partisan approach to sexual education, while other groups like Birthright International advocate a specifically pro-life agenda to their young clientele. Both groups seek to aid young women in need, but they are very different in both practice and ideology.

Shelter from the storm

Planned Parenthood, a nationwide pregnancy clinic organization, prides itself on a completely private, nurturing system when it comes to teen sex health education. According to Tait Sye, a communications representative from the Planned Parenthood national office, this mission translates into a compassionate and politically neutral health care center. "We put the safety and wishes of the patient foremost, what we do is serve the patients," Sye says. Parenthood offers its clientele birth control, gynecological examinations, HIV/AIDS testing and pregnancy options counseling among several other services.

Kylie, a sophomore, spent time at a Planned Parenthood-modeled bi-partisan health clinic in Silver Spring as she waited for the results of an HIV/AIDS test with several good friends. While she appreciated the holistic and non-judgmental environment, she was nervous and frightened, feeling lost before the trained staff and dozens of other girls waiting for help. More a clinic than a counseling service, Kylie believes the feel of the health center was efficient but impersonal. "The place was very quiet," she says, "the nurses were nice. [But they] looked at you like they knew exactly what you were there for."

On the other end of the spectrum, crisis pregnancy centers (CPCs) such as the Birthright International group - an organization that maintains eight locations in Maryland alone - train volunteers to provide emotional support and counseling for young women working through an unplanned pregnancy, but offer no abortion or birth control services and few other medical options. Sue, a representative from the Hagerstown Birthright clinic in Maryland who refused to be further identified, described the group's mission as exclusive but honest. "At Birthright, we believe the women have the right to make up their mind, but every woman has the right to give birth and every child the right to be born. The most important thing we give in the area is love and support."

With over 400 chapters nationwide and a forty-year legacy, Birthright International has weathered all the years of the abortion rights argument, but maintains in their philosophy that they do not engage in the public debate on abortion, according to the group's website. Even if the groups themselves are not political, Birthright is endorsed by pro-life organizations such as Ramah International and Maryland Right to Life, and the clinics are open with their affiliation to the pro-life community.

Hot topic

In recent months, some of the more active pro-choice legislative arms in the area (such as the National Abortion and Reproductive Rights Action League [NARAL]) have voiced clear opinions that CPCs and licensed medical clinics should never be compared as similar facilities. Cathy McLeod, the Prince George's County representative from Maryland Right to Life and the general liaison between CPCs and the Maryland Right to Life lobby, highlights the institutions as compassionate, caring groups especially designed for young women in need. "I've had the opportunity to work with many directors of the CPCs, and most are very professional women," she says. "They have backgrounds in management and social work and there are teams of volunteers contributing their own resources. They are very organized institutions, they pride themselves on not being connected with state funding, and to date, they've helped over 30,000 women who want to choose life. The picture painted by [the pro-choice lobbyists] that these women lack credentials and that their intentions aren't honorable couldn't be farther from the truth."

Sye conversely notes that many CPCs are problematic in that their limited information and services can often lead women seeking non-political aid astray. "I can't speak for all the CPCs, but some aren't licensed, some aren't health care facilities," he says. "Many CPCs are also volunteer-staffed, and exempt from state regulations, comparatively, Planned Parenthood clinics are licensed health clinics staffed by caring physicians and nurse practitioners. They're not comparable entities."

Despite antagonism from both sides of the debate, both CPCs and licensed clinics alike make a point to acknowledge that the fundamental issue at stake is the treatment of the clientele. Both groups act out of a desire to make their patients comfortable and content in the face of a fearful situation.

For Gebryesus, clinics will always be a symbol of pain and discomfort.

While in a clinic waiting room, Gebryesus observed a disparity in the way girl clients were treated as they waited for help. "They were a little more forceful and annoyed with the girls who were alone," she says. Gebryesus and her friend both arrived with a parent. The clinic Gebryesus visited did not provide abortion services, and both girls noted an abundance of baby magazines.

According to Dyan Aretakis, a specialist in adolescent and reproductive health based out of the University of Virginia medical center, it is not unusual for a young woman to come in for a gynecological exam having already visited a CPC. "Generally, [the CPC's] pregnancy tests are accurate, but they do limit their counseling about abortion services and do not provide the whole range of options; they tend not to talk to [the girls] about contraception or delivery," she says.

Aretakis' office functions as a primary care center; the office provides young women with reproductive exams, gynecological aid and general adolescent health assessments. In the arena of CPCs, Aretakis is frank: "They're not health care centers. I don't look to them as health care centers. I see them as a sidewalk counseling service with little professional background," she says. "They might work for a particular child, but they don't work for everyone. They're basically free pregnancy tests for kids."

According to the NARAL web site, the negative aspect of some CPCs' marketing begins with advertising; volunteers are not medically trained and the facilities offer no medical treatment, but organizations like Birthright advertise themselves as medical institutions. In NARAL's incendiary 2008 report on CPCs, leaders extorted the groups for "providing false or misleading health information in the hope of convincing women not to have abortions," and "targeting vulnerable young, poor and minority women."

Questionable intent

Within the Birthright community, a sense of open welcome is the basis for the clinic's appeal. Established in 1968 by Louise Summerhill, a Canadian mother and housewife, the group has been primarily powered by volunteers since its origin. According to the organization's philosophy, the group does not judge or attempt to coerce women who seek the clinic's services. In its statement of principle, the Harford County Maryland Branch's website proposes "to dedicate and commit itself to the conviction that human life, from conception to natural death, must be protected, loved and cherished." Representatives continue to cite on the page that Birthright offers free and confidential support to troubled women despite ethnicity, race or economic status.

Personal client testimonials paper Birthright leaflets and many branch's websites, many of women praising Birthright for helping them "keep their children."

But the Birthright Center in Bel Air, Maryland offers a prime example of a rift between philosophy and implementation: the group supports a pro-life agenda while also advocating non-judgmental, bi-partisan support and a pressure-free environment. On the group's web site, leaders affirm that Birthright's philosophy believes "it is the right of every woman to give birth and the right of every child to be born."

Gebreyesus believes she may have experienced some of this subtle pressure firsthand while visiting a clinic with a friend. "In terms of pressure, I know my friend felt really uncomfortable with the nurses," Gebryesus says. While her friend and her parents had already made the decision not to abort before they had begun the process of visiting clinics, Gebreyesus does believe that some agenda pushing might have been done while her friend went into a one-on-one meeting with the clinic's caretakers. "It could definitely have been there," she says, noting also that when her friend emerged from the room she described the nurses as "[neither] sympathetic or empathetic. I guess they'd just seen it too many times."

According to NARAL's report, the disparities don't end here. CPCs frequently offer false information or anti-choice propaganda to their clients, including pamphlets proclaiming statistics linking abortion and cancer, or misrepresenting the physical risk associated with abortion. Such groups also emphasize the risks of "Post-Abortion Stress Syndrome," a medical problem that is not officially recognized by the American Medical Association. "A lot of these CPCs give out false information like the higher risk of breast cancer, or other intimidating information," says Sye. In defense of this claim, Sye references a 2006 report by Congressman Henry Waxman that found that 87 percent of federally funded CPCs gave women false and misleading information.

According to the Parenthood website, some CPCs attempt to attract clients through opening up shop in close proximity to other clinics, often times using similar names. "[There's] a tactic of opening up an identical clinic right across the street," says Sye.

In the defense of CPCs, McLeod argues that the clinics are always upfront about their pro-life affiliations and many are not endorsed by the state, licensing them as completely individual, volunteer-run entities. "These CPCs tell people they do not provide abortion," she says. "They're very forthcoming, many have disclaimer forms that clients must sign. In a truth in advertising issue, they're doing nothing wrong."

McLeod also argues that NARAL, being a government-recognized pro-choice lobby, has managed to spin some statistics. "Many of the NARAL report claims say that these statistics aren't factual at all when some CPCs say 'some studies show there is a risk…'. Much of the time, there is a link- hotly controversial issues in the medical community will support both statements, and to say there is no link at all between abortion and breast cancer is at this point inaccurate," she says.

Politically, both ends of this "clinic debate," might appear to have reached a stalemate as pro-life lobbies and pro-choice lobbies alike recognize one another's biases, but Aretakis alleges that some distinctly negative CPC fall-out can occasionally be traced through her patients. "I see lots of parents upset about their children going there, as they may have wanted them to consider abortion," she says. "But if the daughters have been taken by this message, they're convinced that it's murder and unwilling to listen to any other options. The parents are more upset than anyone."

Waiting in pain

Even if right-to-life or right-to-choose pressure isn't obviously apparent at some bi-partisan clinics, some Blazers forced to visit local health facilities still recall unpleasant experiences. Claire, a senior, experienced firsthand the unpleasantness of a sexual health clinic focused on pregnancy.

Claire went into a chapter of the American Women's Association as moral support for a friend undergoing an abortion procedure, but was distressed by the feel of the health space. "There was a waiting room, but they take you in the back room to talk with you and examine you," she says. "There were steps because if you're not dilated enough, girls have to walk around. People brought their mothers in."

She also remembers hearing whispered stories in the waiting room about unsanitary and disturbing ways in which fetuses were disposed of. "She was really scared and nervous, she thought the doctor would be mean about it," Claire says of her friend.

Gebryesus remembers the post-pregnancy as a time of emotional fall-out from her friend. "She talked to me a lot, [about] how depressed she got sometimes," Gebryesus says. "She felt ashamed about what she did, and sometimes she would start crying."

The issue of teen pregnancy will always be a difficult subject and a frightening ordeal, but groups like Parenthood and NARAL attest that it needn't be an experience filled with pressures and problems beyond the ones that exist already in the simple shock of the process. "[We want] to ensure pregnant women receive honest, comprehensive support when considering their full range of options," the NARAL pamphlet states.

If rattled by the experience, Gebryesus believes that standing alongside her friend while she made some of the most difficult choices of her life was the best thing she could have done. "I know who she is as a person, and I still love her," she says. "She got through it."

According to the Planned Parenthood web site, between approximately 2,300-4,500 CPCs exist in the United States alone. More CPCs exist than clinics like Planned Parenthood.

If you or someone you know is facing an unplanned pregnancy or requires testing, screening or emotional aid, contact a local facility. Be aware that CPCs such as Birthright seek to aid specifically those women who wish to keep their pregnancies and do not seek abortion information. See contact information below:

Gaithersburg Center- Planned Parenthood
19650 Clubhouse Road #104
Gaithersburg, MD 20879

Silver Spring Center- Planned Parenthood
1400 Spring Street #450
Silver Spring, MD 20910

Birthright Crisis Care Center
12247 Georgia Ave.
Silver Spring MD, 20902