Tag: fertility and infertility

How a medication abortion, also known as an ‘abortion pill,’ works | CNN

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While the fate of mifepristone, one of two drugs used for medication abortions, is in the hands of the US Supreme Court, the drug continues to be available in states where abortion is legal.

“While many women obtain medication abortion from a clinic or their OB-GYN, others obtain the pills on their own to self-induce or self-manage their abortion,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

“A growing body of research indicates that self-managed abortion is safe and effective,” he said.

Mifepristone blocks the hormone progesterone, which is needed for a pregnancy to continue. The drug is approved to end a pregnancy through 10 weeks’ gestation, which is “70 days or less since the first day of the last menstrual period,” according to the FDA.

In a medication abortion, a second drug, misoprostol, is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, creating cramping and bleeding. Approved for use in other conditions, such as preventing stomach ulcers, the drug has been available at pharmacies for decades.

Together, the two drugs are commonly known as the “abortion pill,” which is now used in more than half of the abortions in the United States, according to the Guttmacher Institute, a research group that supports abortion rights.

“Some people do this because they cannot access a clinic — particularly in states with legal restrictions on abortion — or because they have a preference for self-care,” said Grossman, who is also the director of Advancing New Standards in Reproductive Health, a research group that evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman’s health.

READ MORE: With US Supreme Court abortion drug hearing looming, study shows how self-managed abortion became more common post-Dobbs

What happens during a medication abortion? To find out, CNN spoke with Grossman. This conversation has been condensed and edited for clarity.

CNN: What is the difference between a first-trimester medication abortion and a vacuum aspiration in terms of what a woman experiences?

Dr. Daniel Grossman: A vacuum aspiration is most commonly performed under a combination of local anesthetic and oral pain medications or local anesthetic together with intravenous sedation, or what is called conscious sedation.

An injection of local anesthetic is given to the area around the cervix, and the cervix is gently dilated or opened up. Once the cervix is opened, a small straw-like tube is inserted into the uterus, and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure is done before nine weeks or so, there’s nothing in the tissue that would be recognizable as a part of an embryo.

The aspiration procedure takes just a couple of minutes. Then the person is observed for one to two hours until any sedation has worn off. We also monitor each patient for very rare complications, such as heavy bleeding.

A medication abortion is a more prolonged process. After taking the pills, bleeding and cramping can occur over a period of days. Bleeding is typically heaviest when the actual pregnancy is expelled, but that bleeding usually eases within a few hours. On average people continue to have some mild bleeding for about two weeks or so, which is a bit longer than after a vacuum aspiration.

Nausea, vomiting, fever, chills, diarrhea and headache can occur after using the abortion pill, and everyone who has a successful medication abortion usually reports some pain.

In fact, the pain of medication abortion can be quite intense. In the studies that have looked at it, the average maximum level of pain that people report is about a seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be brief, peaking just as the pregnancy is being expelled.

The level of cramping and pain can depend on the length of the pregnancy as well as whether or not someone has given birth before. For example, a medical abortion at six weeks or less gestation typically has less pain and cramping than one performed at nine weeks. People who have given birth generally have less pain.

CNN: What can be done to help with the pain of a medication abortion?

Grossman: There are definitely things that can be used to help with the pain. Research has shown that ibuprofen is better than acetaminophen for treating the pain of medication abortion. We typically advise people to take 600 milligrams every six hours or so as needed.

Some people take tramadol, a narcotic analgesic, or Vicodin, which is a combination of acetaminophen and hydrocodone. Recent research I was involved in found medications like tramadol can be helpful if taken prophylactically before the pain starts.

Another successful regimen that we studied combined ibuprofen with a nausea medicine called metoclopramide that also helped with pain. Other than ibuprofen, these medications require a prescription.

Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps with the pain of medication abortion. It works through pads put on the abdomen that stimulate the nerves through mild electrical shocks, thus interfering with the pain signals. That’s something people could get without a prescription.

Pain can be an overlooked issue with medication abortion because, quite honestly, as clinicians, we’re not there with patients when they are in their homes going through this. But as we’ve been doing more research on people’s experiences with medication abortion, it’s become quite clear that pain control is really important. I think we need to do a better job of treating the pain and making these options available to patients.

CNN: Are there health conditions that make the use of a medication abortion unwise?

Grossman: Undergoing a medication abortion can be dangerous if the pregnancy is ectopic, meaning the embryo is developing outside of the uterus. It’s rare, happening in about two out of every 100 pregnancies — and it appears to be even rarer among people seeking medication abortion.

People who have undergone previous pelvic, fallopian tube or abdominal surgery are at higher risk of an ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can raise risk, as does smoking, a history of infertility and use of infertility treatments such as in vitro fertilization (IVF).

If a person is on anticoagulant or blood thinning drugs or has a bleeding disorder, a medication abortion is not advised. The long-term use of steroids is another contraindication for using the abortion pill.

Anyone using an intrauterine device, or IUD, must have it removed before taking mifepristone because it may be partially expelled during the process, which can be painful.

People with chronic adrenal failure or who have inherited a rare disorder called porphyria are not good candidates.

CNN: Are there any signs of trouble a woman should watch for after undergoing a medication abortion?

Grossman: It can be common to have a low-grade fever in the first few hours after taking misoprostol, the second drug in a medication abortion. If someone has a low-grade fever — 100.4 degrees to 101 degrees Fahrenheit — that lasts more than four hours, or has a high fever of over 101 degrees Fahrenheit after taking the medications, they do need to be evaluated by a health care provider.

Heavy bleeding, which would be soaking two or more thick full-size pads an hour for two consecutive hours, or a foul-smelling vaginal discharge should be evaluated as well.

One of the warning signs of an ectopic pregnancy is severe pelvic pain, particularly on one side of the abdomen. The pain can also radiate to the back. Another sign is getting dizzy or fainting, which could indicate internal bleeding. These are all very rare complications, but it’s wise to be on the lookout.

We usually recommend that someone having a medication abortion have someone with them during the first 24 hours after taking misoprostol or until the pregnancy has passed. Many people specifically choose to have a medication abortion because they can be surrounded by a partner, family or friends.

Most people know that the abortion is complete because they stop feeling pregnant, and symptoms such as nausea and breast tenderness disappear, usually within a week of passing the pregnancy. A home urine pregnancy test may remain positive even four to five weeks after a successful medication abortion, just because it takes that long for the pregnancy hormone to disappear from the bloodstream.

If someone still feels pregnant, isn’t sure if the pregnancy fully passed or has a positive pregnancy test five weeks after taking mifepristone, they need to be evaluated by a clinician.

People should know that they can ovulate as soon as two weeks after a medication abortion. Most birth control options can be started immediately after a medication abortion.

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March 25, 2024
In country with world’s lowest fertility rate, doubts creep in about wisdom of ‘no-kids zones’ | CNN

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Seoul
CNN
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For a country with the world’s lowest fertility rate – one that has spent hundreds of billions of dollars trying to encourage women to have more babies – the idea of barring children from places like cafes and restaurants might seem a little counterproductive.

But in South Korea, “no-kids zones” have become remarkably popular in recent years. Hundreds have sprung up across the country, aimed largely at ensuring disturbance-free environments for the grown-ups.

There are nearly 80 such zones on the holiday island of Jeju alone, according to a local think tank, and more than four hundred in the rest of the country, according to activist groups.

Doubts, though, are beginning to creep in about the wisdom of restricting children from so many places, fueled by concerns over the country’s growing demographic problems.

In addition to the world’s lowest birthrate, South Korea has one of the world’s fastest aging populations. That has left it with a problem familiar to graying nations across the world, namely: how to fund the pension and health care needs of a growing pool of retirees on the tax income generated by a slowly vanishing pool of workers.

And South Korea’s problem is more acute than most.

Last year, its fertility rate dropped to a record low of 0.78 – not even half the 2.1 needed for a stable population and far below even that of Japan (1.3), currently the world’s grayest nation. (And even further below the United States, which at 1.6 faces aging problems of its own).

With young South Koreans already facing pressure on multiple fronts – from sky-high real estate costs and long working weeks to rising economic anxiety – critics of the zones say the last thing the country needs is yet one more thing to make them think twice about starting a family.

The government, they point out, should know this better than anyone. After all, it’s spent more than $200 billion over the past 16 years trying to encourage more people to have children. Critics suggest that, rather than throwing more money at the problem, it needs to work on changing society’s attitudes towards the young.

With polls suggesting a majority of South Koreans support no-kids zones, shifting those mindsets won’t be easy. But there are signs opinions may be shifting.

In recent weeks, a pushback against the zones has gained momentum thanks to Yong Hye-in, a mother and a lawmaker for the Basic Income Party who, in a show of defiance to mark Children’s Day, took her 2-year-old son to a meeting of the National Assembly – where babies are not usually allowed.

“Everyday life with children is not easy,” she told the assembled lawmakers in an impassioned speech, during which she was pictured both cuddling her son and letting him wander around the podium. “Our society must be reborn into one where children are included.”

That speech gained media coverage across the world, but it is not the only sign attitudes may slowly be changing.

Jeju island – a tourist hotspot off the southern tip of the Korean peninsula – recently debated the country’s first-ever bill aimed at making such zones illegal (though if passed it would apply only to the island).

The move by its provincial council comes amid growing concerns that the age limits imposed by many guesthouses and campsites on the tourism-dependent island may be damaging its reputation for hospitality.

As Bonnie Tilland, a university lecturer who specializes in South Korean culture, puts it: “Families with children who travel to Jeju on holiday are disgruntled if they drive to a scenic café only to be told that their children are not allowed.”

Other critics say the problem goes deeper than lost business opportunities. Some see no-kids zones as an unjustifiable act of age discrimination that runs contrary to the Korean constitution.

In 2017, the National Human Rights Commission of Korea judged that no-kids zones violated the right to equality and called for businesses to end the practice in what was the first official statement on the matter by a state institution. It cited clause 11 of the constitution, which bans discrimination on the basis of gender, religion or social status, and pointed to a UN convention stipulating that “No child should be treated unfairly on any basis.”

The ruling came in response to a petition by a father of three who was turned away from an Italian restaurant on Jeju. But it is not legally binding and critics say the ongoing popularity of no-kids zones highlights how hard it will be to change people’s mindsets.

South Korea’s embrace of no-kids zones is widely thought to date back to an incident in 2012, in which a restaurant diner carrying hot broth accidentally scalded a child.

The incident caused a stir online, after the child’s mother made a series of posts on social media attacking the diner.

Initially, there was much public sympathy for the mother as the case appeared to have parallels to other incidents in which establishments had been forced to pay compensation following accidents involving children.

But the public’s mood began to change after security camera footage emerged showing the child running around moments beforehand, Tilland said. Many began to blame the mother for not reining in her child’s behavior.

“Then discussion unfolded over the next few years on social media about the rights and responsibilities of parents and guardians of young children in public spaces and private businesses,” said Tilland, who used to teach at Yonsei University in Seoul but is now with Leiden University in the Netherlands.

By 2014, she says, no-kids zones had become a familiar sight, “most commonly in cafes but also in some restaurants and other businesses.”

Over the years, the zones have grown in popularity, with a survey in 2021 by Hankook Research finding that more than 7 in 10 adults were in favor, and fewer than 2 in 10 against (the rest were undecided).

And it is not only childless adults who back them. In South Korea, so widely acknowledged is the right to some peace and quiet that even many parents see the zones as reasonable and justified.

“When I’m out with my child, I see a lot of situations that may make me frown,” said Lee Yi-rang, a mother of a two-year-old boy.

“It’s not difficult to find parents who don’t control their children, causing damage to facilities and other people. That makes me understand why there are no-kids zones,” she said.

Mother-of-two Lee Ji-eun from Seoul agrees. She thinks it’s a decision best left “to the business owners” – and if a parent “doesn’t like that, then they can seek a kids-allowed zone.”

Not all parents are so understanding. Kim Se-hee, also from Seoul, said she feels “attacked when I see a blatant no-kids sign like that posted at a shop.”

“There’s so much hatred against mothers already in Korea with terms like ‘mom-choong’ (‘mother bug,’ a derogatory term for mothers who care only about their children to the disregard of others) and I think no-kids zones validate that kind of negative sentiment toward moms,” she said.

Meanwhile, it would be wrong to suggest that it is only the youngest in society who are subject to such “zoning” requirements.

On Jeju, it’s not unusual to see signs at camping grounds or guest houses stipulating both lower and upper age limits for would-be guests. There are “no-teenager zones” and “no-senior zones”, for example, and even plenty of zones targeting those somewhere in between.

So numerous have the “no-middle-aged zones” become that they have collectively been dubbed “no-ajae zones,” in reference to a slang term for “uncle.”

One restaurant in Seoul rose to notoriety after “politely declining” people over 49 (on the basis men of that age might harass female staff), while in 2021, a camping ground in Jeju sparked heated debate with a notice saying it did not accept reservations from people aged 40 or above. Citing a desire to keep noise and alcohol use to a minimum, it stated a preference for women in their 20s and 30s.

Other zones are even more niche.

Among those to have caused a stir on social media are a cafe in Seoul that in 2018 declared itself a “no-rapper zone,” a “no-YouTuber zone” and even a “no-professor zone”.

But most such zones follow a similar logic – that of preventing disturbance to other customers. For instance, no-YouTuber zones became popular in response to a trend known as “mukbang” (based on words for “eating” and “broadcast”) in which some livestreamers would show up at restaurants without prior consent to film themselves eating.

Tilland says the appeal of such zones is complex, but derives in part from the strong pro-business sentiment in the country. A common mindset is that it is only natural that business owners should have a say on who they accept as clientele, she says.

As for no-kids zones specifically, she has another theory.

“Koreans in their 20s and 30s, in particular, tend to have a strong concept of personal space, and are increasingly less tolerant of both noisy children in their midst and noisy older people,” Tilland said.

But such mindsets need to be re-examined if the country is to get a grip on its population problems, Tilland says, arguing they “reflect a worrying intolerance for anyone existing in public places who is different from oneself.”

“Deep-rooted attitudes that every category of people belongs in ‘their place’ – and for mothers this is home with children, not out participating in public life – are one of the reasons young women are reluctant to have children,” she said.

See why South Korea has the world’s lowest fertility rate

Lawmaker Yong came to a similar realization after giving birth in 2021.

She had suffered postpartum depression and stayed at home for the first nearly 100 days of her child’s life. When she finally felt well enough to take her child for a walk the experience was alienating.

“When we tried to go into a cafe nearby, we were immediately denied entry because it was a no-kids zone,” she recalled in an interview with CNN. “I was helplessly in tears. It felt like society didn’t want people like me.”

She says many new mothers feel this way, citing a case being investigated by the labor ministry in which a working mother, a computer programmer at a leading tech firm, killed herself and left a suicide note asking, “Is a working mom a sinner?”

“I am doing politics to create a society where working working moms don’t have to (feel like) a sinner,” Yong said.

Her ultimate aim is to make childcare the “responsibility of society as a whole, not of individual caregivers and parents,” which she believes is the only way to overcome the population crisis.

One way she hopes to bring about this change is by pushing for an equality bill that would outlaw discrimination based on age.

But legislation isn’t the only way, she says. She thinks the government and local authorities can achieve much simply by guiding businesses away from no-kids zones and learning from other countries where families with young children are fast-tracked through queues at public places like museums and zoos.

There may be other ways to compromise too.

Barista Ahn Hee-yul says he has faced situations in a cafe he once worked for where parents appeared unable to keep their children from causing a nuisance, yet he appreciates the need to strike a balance between the needs of parents and non-parents.

“I suggest no-kids times, instead of no-kids zones,” he said, suggesting that venues for instance allow children until 5 p.m., after which it’s adults only.

“In the end, they’re just kids. It’s the best middle ground I could think of.”

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June 24, 2023
Kourtney Kardashian says she’s ‘overwhelmed with gratitude’ following epic pregnancy announcement | CNN

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CNN
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Kourtney Kardashian and Blink 182 drummer Travis Barker have a lot to be grateful for.

The reality star and Poosh founder revealed she was pregnant in a video on Instagram Saturday in which she’s seen in the audience at a Blink 182 concert holding a sign that read, “Travis I’m pregnant.”

Kardashian posted more behind-the-scenes photos from the concert on Sunday, showcasing her growing baby bump.

“Overwhelmed with gratitude and joy for God’s blessing and plan,” she captioned the post, which features a photo of Barker playfully holding his drumsticks over Kardashian’s belly.

Kardashian and Barker got engaged in October 2021 and wed last year in multiple ceremonies.

Following a not-technically-legal walk down the aisle in Las Vegas after the Grammy Awards in April 2022, the pair exchanged vows at the Santa Barbara Courthouse in May and wrapped up the wedding festivities with a lavish Italian ceremony at Dolce & Gabbana designers Domenico Dolce and Stefano Gabbana’s private villa.

This will be Kardashian and Barker’s first child together, but they each have children from previous relationships.

Kardashian shares three children – Mason, Penelope and Reign – with her former longtime partner Scott Disick. Barker is father to Landon, daughter Alabama and stepdaughter Atiana, whom he shares with ex-wife Shanna Moakler.

The two have shared a bit about their fertility journey on Hulu’s reality series, “The Kardashians.”

Kardashian told The Wall Street Journal in September 2022 she had paused in vitro fertilization treatments leading up to getting married because it was “a lot” and she wanted to focus on planning her wedding ceremony.

On Sunday, Barker added to the chorus in the joyous comment section of Kardashian’s post with his own message of gratitude, saying, “God is great.”

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June 18, 2023
Infertility affects a ‘staggering’ 1 in 6 people worldwide, WHO says | CNN

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CNN
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An estimated 1 in 6 people globally are affected by infertility, according to a new report from the World Health Organization, which emphasizes that the condition is common.

Rates of infertility – defined as not being able to conceive after a year of having unprotected sex – are similar across all countries and regions, Monday’s WHO report says.

“In our analysis, the global prevalence of lifetime infertility was 17.5%, translating into 1 out of every 6 people experiencing it in their lifetime,” Dr. Gitau Mburu, a scientist of fertility research at WHO, said Monday.

“Lifetime prevalence of infertility does not differ by income classification of countries,” he said. “Lifetime prevalence was 17.8% in high-income countries and 16.5% in low- and middle-income countries, which, again, was not a substantial or significant difference.”

Yet there are differences in how much people are spending on fertility treatments and how accessible such treatments are, according to the report.

“People in the poorest countries were found to spend a significantly larger proportion of their income on a single cycle of IVF or on fertility care compared with wealthier countries,” Mburu said, “exemplifying that this is an area with high-level risk of inequality in access to health care.”

Global public health groups typically call attention to overpopulation as a major public health concern, so the spotlight that the WHO report turns on infertility not only is surprising but is welcome, said Dr. David Keefe, reproductive endocrinologist and infertility specialist at the NYU Langone Fertility Center in New York.

“That report did not surprise me in terms of the content, because it’s been known for some time that infertility is much more prevalent than anyone wants to think about: Having a child and having a family is kind of a universal dream or aspiration for people from every country, from every region. What surprised me was the World Health Organization coming out in support of it,” said Keefe, who was not involved with the WHO research.

“It was a welcome acknowledgment of the other foot dropping on the population front,” he said. “The acknowledgment that this is a worldwide problem and that additional attention must be devoted to it in terms of policy and strategy is welcome.”

The WHO report – described as the “first of its kind in a decade” – includes an analysis of infertility data from 1990 through 2021. The data came from 133 previously published studies on infertility prevalence.

“The purpose of this analysis was to generate updated data on the global and regional estimates of infertility prevalence by analyzing all available data from different countries, making sure that we take into account different study approaches,” Mburu said.

Based on that data, the researchers estimate that lifetime prevalence of infertility – representing the proportion of people who have ever experienced infertility in their reproductive life – was 17.5% in 2022.

The period prevalence of infertility, meaning the proportion of people with infertility at any given point currently or in the past, was found to be 12.6% in 2022.

Although the data showed some variation in infertility prevalence across regions – with the highest lifetime prevalence at 23.2% in the Western Pacific, compared with the lowest at 10.7% in the Eastern Mediterranean – those regional differences were not either substantial or conclusive based on the data, according to WHO’s report.

The researchers also did not determine whether global infertility rates have been increasing or decreasing over time.

“The data which we analyzed for this report was from 1990 to 2021, and during that period, we did not see evidence of increasing rates of infertility. However, the way the data was arranged, it was not really organized to answer that question,” Dr. James Kiarie, head of contraception and fertility care at WHO, said Monday. “We cannot, based on the data we have, say that infertility is increasing or constant – so we must say that probably the jury is still out on that question.”

Over time, various factors can affect a person’s fertility, and age is one of the most important, said Dr. Emre Seli, chief scientific officer for the maternal and infant health nonprofit March of Dimes. Seli, who is also a professor at Yale School of Medicine and medical director of Yale Fertility Center, was not involved in the new report.

“Fertility decreases as the age of the female partner increases,” he said.

“Fertility is really an emotionally taxing issue for those who are affected by it. It is a major source of stress to want to have a child and not be able to,” Seli said. “Most of my patients are women, and they do become affected by this at many levels, and they do suffer from lack of adequate research as well as lack of adequate insurance coverage to undergo the treatments that they need.”

Infertility, affecting the male or female reproductive system, can be treated with medicine, surgery or assisted reproductive technologies such as in vitro fertilization or IVF, during which an egg and sperm are joined in a lab dish and put into a womb once the fertilized egg becomes an embryo.

“Infertility is a major and a widespread health issue affecting a staggering 1 in 6 people globally over the duration of their reproductive lives,” Dr. Pascale Allotey, director of the Sexual and Reproductive Health and Research Department at WHO, said Monday.

Despite that, solutions for the prevention, diagnosis and treatment of infertility remain “underfunded” and “inaccessible” to many patients due to high costs, Allotey said.

“Infertility is an important public health concern because it can have wide-reaching negative impacts on the lives of the people affected,” she said. “WHO is calling for universal access to affordable high-quality fertility care, improved data to enable infertility to be meaningfully addressed in health policy and programs, and greater efforts to ensure this issue is no longer sidelined in health research and policy.”

Mburu added that infertility can also have effects on mental health, raising risks of anxiety, depression and intimate partner violence.

“Our message is that infertility needs to be included as a priority in responding to the needs of populations in different countries,” Mburu said. “This is because people have a right to expect to obtain the highest possible standard of mental, social and physical health as defined by WHO.”

The new data from WHO reinforces that more people need fertility coverage and access to high-quality care than was previously thought, said Dr. Asima Ahmad, an endocrinologist and fertility expert who serves as chief medical officer and co-founder of Carrot Fertility, a company that helps employers set up fertility benefits. She added that inequities emerge in who has such access to care, such as Black women who tend to experience inequities in access.

“These inequities, I’m not surprised that they exist on a global level, because we already see the inequities in the United States domestically, with how infertility impacts different populations and how some populations have limited access. And even with the access that they finally get, they, for example, will have a lower rate of success or even a higher rate of miscarriage,” said Ahmad, who was not involved in the new WHO report.

“A lot of people don’t have access to clinically vetted evidence-based information around what causes infertility, how to recognize it, and then when you do find out that you have it, how to treat it,” she said. “The other, which is one of the biggest barriers that we see, is financial access to fertility. In the United States, a lot of that access comes through the employer providing, for example, fertility benefits, but on a global level, that’s not necessarily the case, and finances tends to be the biggest barrier.”

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April 3, 2023
This community’s quarter century without a newborn shows the scale of Japan’s population crisis | CNN

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Tokyo
CNN
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When Kentaro Yokobori was born almost seven years ago, he was the first newborn in the Sogio district of Kawakami village in 25 years. His birth was like a miracle for many villagers.

Well-wishers visited his parents Miho and Hirohito for more than a week – nearly all of them senior citizens, including some who could barely walk.

“The elderly people were very happy to see [Kentaro], and an elderly lady who had difficulty climbing the stairs, with her cane, came to me to hold my baby in her arms. All the elderly people took turns holding my baby,” Miho recalled.

During that quarter century without a newborn, the village population shrank by more than half to just 1,150 – down from 6,000 as recently as 40 years ago – as younger residents left and older residents died. Many homes were abandoned, some overrun by wildlife.

Kawakami is just one of the countless small rural towns and villages that have been forgotten and neglected as younger Japanese head for the cities. More than 90% of Japanese now live in urban areas like Tokyo, Osaka and Kyoto – all linked by Japan’s always-on-time Shinkansen bullet trains.

That has left rural areas and industries like agriculture, forestry, and farming facing a critical labor shortage that will likely get worse in the coming years as the workforce ages. By 2022, the number of people working in agriculture and forestry had declined to 1.9 million from 2.25 million 10 years earlier.

Yet the demise of Kawakami is emblematic of a problem that goes far beyond the Japanese countryside.

The problem for Japan is: people in the cities aren’t having babies either.

“Time is running out to procreate,” Prime Minister Fumio Kishida told a recent press conference, a slogan that seems so far to have fallen short of inspiring the city dwelling majority of the Japanese public.

Amid a flood of disconcerting demographic data, he warned earlier this year the country was “on the brink of not being able to maintain social functions.”

The country saw 799,728 births in 2022, the lowest number on record and barely more than half the 1.5 million births it registered in 1982. Its fertility rate – the average number of children born to women during their reproductive years – has fallen to 1.3 – far below the 2.1 required to maintain a stable population. Deaths have outpaced births for more than a decade.

And in the absence of meaningful immigration – foreigners accounted for just 2.2% of the population in 2021, according to the Japanese government, compared to 13.6% in the United States – some fear the country is hurtling toward the point of no return, when the number of women of child-bearing age hits a critical low from which there is no way to reverse the trend of population decline.

All this has left the leaders of the world’s third-largest economy facing the unenviable task of trying to fund pensions and health care for a ballooning elderly population even as the workforce shrinks.

Up against them are the busy urban lifestyles and long working hours that leave little time for Japanese to start families and the rising costs of living that mean having a baby is simply too expensive for many young people. Then there are the cultural taboos that surround talking about fertility and patriarchal norms that work against mothers returning to work.

Doctor Yuka Okada, the director of Grace Sugiyama Clinic in Tokyo, said cultural barriers meant talking about a woman’s fertility was often off limits.

“(People see the topic as) a little bit embarrassing. Think about your body and think about (what happens) after fertility. It is very important. So, it’s not embarrassing.”

Okada is one of the rare working mothers in Japan who has a highly successful career after childbirth. Many of Japan’s highly educated women are relegated to part-time or retail roles – if they reenter the workforce at all. In 2021, 39% of women workers were in part-time employment, compared to 15% of men, according to the OECD.

Tokyo is hoping to address some of these problems, so that working women today will become working mothers tomorrow. The metropolitan government is starting to subsidize egg freezing, so that women have a better chance of a successful pregnancy if they decide to have a baby later in life.

New parents in Japan already get a “baby bonus” of thousands of dollars to cover medical costs. For singles? A state sponsored dating service powered by Artificial Intelligence.

Whether such measures can turn the tide, in urban or rural areas, remains to be seen. But back in the countryside, Kawakami village offers a precautionary tale of what can happen if demographic declines are not reversed.

Along with its falling population, many of its traditional crafts and ways of life are at risk of dying out.

Among the villagers who took turns holding the young Kentaro was Kaoru Harumashi, a lifelong resident of Kawakami village in his 70s. The master woodworker has formed a close bond with the boy, teaching him how to carve the local cedar from surrounding forests.

“He calls me grandpa, but if a real grandpa lived here, he wouldn’t call me grandpa,” he said. “My grandson lives in Kyoto and I don’t get to see him often. I probably feel a stronger affection for Kentaro, whom I see more often, even though we are not related by blood.”

Both of Harumashi’s sons moved away from the village years ago, like many other young rural residents do in Japan.

“If the children don’t choose to continue living in the village, they will go to the city,” he said.

When the Yokoboris moved to Kawakami village about a decade ago, they had no idea most residents were well past retirement age. Over the years, they’ve watched older friends pass away and longtime community traditions fall by the wayside.

“There are not enough people to maintain villages, communities, festivals, and other ward organizations, and it is becoming impossible to do so,” Miho said.

“The more I get to know people, I mean elderly people, the more I feel sadness that I have to say goodbye to them. Life is actually going on with or without the village,” she said. “At the same time, it is very sad to see the surrounding, local people dwindling away.”

If that sounds depressing, perhaps it’s because in recent years, Japan’s battle to boost the birthrate has given few reasons for optimism.

Still, a small ray of hope may just be discernible in the story of the Yokoboris. Kentaro’s birth was unusual not only because the village had waited so long, but because his parents had moved to the countryside from the city – bucking the decades old trend in which the young increasingly plump for the 24/7 convenience of Japanese city life.

Some recent surveys suggest more young people like them are considering the appeals of country life, lured by the low cost of living, clean air, and low stress lifestyles that many see as vital to having families. One study of residents in the Tokyo area found 34% of respondents expressed an interest in moving to a rural area, up from 25.1% in 2019. Among those in their 20s, as many as 44.9% expressed an interest.

The Yokoboris say starting a family would have been far more difficult – financially and personally – if they still lived in the city.

Their decision to move was triggered by a Japanese national tragedy twelve years ago. On March 11, 2011, an earthquake shook the ground violently for several minutes across much of the country, triggering tsunami waves taller than a 10-story building that devastated huge swaths of the east coast and caused a meltdown at the Fukushima Daiichi Nuclear Power Plant.

Miho was an office worker in Tokyo at the time. She remembers feeling helpless as daily life in Japan’s largest city fell apart.

“Everyone was panicking, so it was like a war, although I have never experienced a war. It was like having money but not being able to buy water. All the transportation was closed, so you couldn’t use it. I felt very weak,” she recalled.

The tragedy was a moment of awakening for Miho and Hirohito, who was working as a graphic designer at the time.

“The things I had been relying on suddenly felt unreliable, and I felt that I was actually living in a very unstable place. I felt that I had to secure such a place by myself,” he said.

The couple found that place in one of Japan’s most remote areas, Nara prefecture. It is a land of majestic mountains and tiny townships, tucked away along winding roads beneath towering cedar trees taller than most of the buildings.

They quit their jobs in the city and moved to a simple mountain house, where they run a small bed and breakfast. He learned the art of woodworking and specializes in producing cedar barrels for Japanese sake breweries. She is a full-time homemaker. They raise chickens, grow vegetables, chop wood, and care for Kentaro, who’s about to enter the first grade.

The big question, for both Kawakami village and the rest of Japan: Is Kentaro’s birth a sign of better times to come – or a miracle birth in a dying way of life.

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March 18, 2023
China to offer free fertility treatment in bid to boost record low birth rate | CNN

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Hong Kong
CNN
—

China is planning to offer free fertility treatment to citizens under its national insurance scheme in a bid to reverse its plummeting birth rate.

The National Healthcare Security Administration said on Friday it would extend its coverage to help shoulder the costs for families trying to conceive.

It said the new coverage would include assisted reproductive technology (ART) techniques and also cover labor analgesia to ease pain in childbirth. The most commonly performed ART procedure is in vitro fertilization (IVF).

The administration described China’s falling population as one of the biggest obstacles to national development and stressed it had already added ovulation-inducing drugs to its coverage, to help “reduce the burden of infertility.”

The expanded coverage is part of a wider attempt by Chinese authorities to persuade more people to get married and have more children.

The country’s birthrate has been falling for years and last year the country recorded its first population decline in more than 60 years.

The country’s population fell to 1.411 billion in 2022, a drop of 850,000 people from the previous year, according to China’s National Bureau of Statistics (NBS).

At the same time, the birthrate fell to a record low of 6.77 births per 1,000 people. Some 9.56 million babies were born in 2022, compared with 10.62 million in 2021.

An increasing number of women in China are delaying marriages and choosing not to have children, often citing financial constraints, and the need to prioritize careers, according to Chen Wei, a professor at China’s Renmin University. Options covering costly procedures such as IVF may help to alleviate some of these pressures, said Chen. The average cost associated with IVF in cities such as Shanghai is between $4,500 to $5,000.

China has 539 ART-approved medical institutions and 27 sperm banks as of June 2021, and each year these facilities facilitate more than one million IVF cycles, according to experts from the country’s National Clinical Research Center for Obstetrics and Gynecology.

Policymakers are increasingly concerned about the impact China’s growing demographic crisis could have on economic growth.

China introduced a highly controversial “one child” policy decades ago in an attempt to address fears of overpopulation and alleviate poverty, but decided to scrap it in 2015 amid concerns a rapidly aging population and shrinking workforce could threaten economic and social stability.

Initially, it allowed couples to have up to two children, but later further loosened the policy to allow up to three.

Chinese authorities are also moving to drop restrictions on registering the births of children born to unmarried parents in a country where unwed mothers still face stigma.

In February, the provincial health commission of Sichuan – which is home to over 83 million people – said it would allow single parents to register the birth of their children, a move that granted them access to benefits previously reserved for married couples. These benefits included maternity insurance that covers prenatal healthcare, childbirth-related medical expenses and paid maternity leave.

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February 8, 2023
Tosca Musk, Elon’s sister, has a business venture of her own — and it’s all about romance and female sexuality | CNN

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Atlanta, Georgia
CNN
—

Tosca Musk strides onto the red carpet at a Regal Cinemas, statuesque in a white pant suit and glistening burgundy silk top.

A hush comes over a group gathered outside the theater’s doors. Some whip out cell phones and start recording her every move.

It’s a chilly October night in Atlanta, and the fans are here for the premiere of “Torn,” the second in a trilogy of romantic fantasy movies based on books by author Jennifer Armentrout. The group of mostly female fans range in age from their twenties to their seventies, and some flew in from Boston, Detroit and other cities.

This is a big night for Musk and her five-year-old streaming service Passionflix, the backer of the movie. It’s their first public film premiere since the pandemic started.

She floats from one group to another, chatting effortlessly with Passionflix’s superfans, known as Passionistas. Her older brother, Elon Musk, may be the most famous sibling in the family, but he’s not the only one who’s founded a company.

Musk, 48, is the force behind Passionflix, which adapts romance novels into movies and streams them to a devoted niche audience. Romance novels are the most popular genre of books in the United States, and Musk is tapping into that market with stories about sultry, powerful female leads and handsome men with chiseled abs. She directs some of the films herself.

“Passionflix focuses on adapting romance novels exactly as the fan and the author envision it,” Musk says in a separate CNN interview. “We focus on connection, communication and compromise – and remove the shame from sexuality, specifically for women, because it empowers women to both acknowledge and ask for pleasure.”

Days earlier, on the set of a Passionflix movie, “The Secret Life of Amy Bensen,” Musk provides a few glimpses into life with her famous family.

Perched on a navy blue couch in a room tucked inside a warehouse in suburban Atlanta, she chooses her words carefully when asked about her older brother, who was on the verge of his Twitter acquisition.

The Musk children – Elon, Tosca and another brother, middle child Kimbal – were born in South Africa and spent time in Canada before coming to the United States. Their father, Errol, is an engineer and property developer, while their glamorous mother, Maye, is a model.

Tosca Musk attended film school at the University of British Columbia in Vancouver and moved to California after graduation. For three months, she worked for one of Elon Musk’s companies, Zip2.

“I realized every time I stepped out of the film world, I was just not happy,” she says. “It just wasn’t my thing.”

After a brief stint at the Los Angeles office of Canadian media company Alliance Atlantis, she began directing and producing films while still in her twenties.

Musk produced romance films for the Lifetime and Hallmark channels and in 2005 launched a comic web series, Tiki Bar TV, which was hailed by Apple CEO Steve Jobs as ahead of its time in the emerging field of vodcasts – or video podcasting.

Then came Passionflix. Its origin story is a classic tale of when one door closes, another one opens.

About five years ago, Musk got an email from a woman who wanted her to turn her script into a movie. Musk loved the script, but there wasn’t much interest from production companies.

“People weren’t really that interested because it was too risque … It was an adult movie with a little bit of reincarnation, things like that,” she says. “It just wasn’t one of those things that regular network television wanted to do.”

But Musk met the woman, Joany Kane, in Los Angeles, and they bonded over their shared passion for romance novels. During that conversation, Kane brought up the idea of turning romance novels into movies and creating a streaming platform for them.

And with that, Passionflix was born – with Musk at the helm and Kane as a co-founder.

“We had no investors. We had to go out and find every investor. So it was a matter of going out and pitching every single person,” Musk says. “We pitched every friend, every family member, everybody just for that small bit of angel investment. It was hard. The first money in is always the hardest money.”

Musk declines to say whether her brother Elon was one of her original investors. But she says she can always count on her two brothers, including restaurateur Kimbal Musk, to give her advice on her business ventures. She tries not to ask unless she really needs to.

“I get advice from them to a certain degree when I ask for it. But no unsolicited advice,” she says. “If I ask for advice, I have no doubt that he (Elon) will give it to me. And then I have to take it, because he’s going to be right. So you have to really want to know what you want to ask. But most of the time when I’m with my family, we talk about family things.”

So what does she think about her brother’s new role as CEO of Twitter – and the flurry of headlines surrounding it?

No comment.

Passionflix’s first film was “Hollywood Dirt,” based on a best-selling novel by Alessandra Torre about a Southern woman who finds romance with a Hollywood star when he comes to her small town to film a movie.

“During that shooting of that movie, we were struggling,” Musk says. “Are we going to get money? Are we going to be able to finish it? We were not really sure. We basically were just sort of piecing the dollars together.”

In May 2017, Musk played a trailer of the movie at a romance novel convention and asked attendees to prepay $100, as founding members, for a two-year Passionflix subscription. About 4,000 people signed up, Musk says, and she and Kane used that to show potential investors they were onto something.

“Trying to raise money for a female-driven platform on romance was just not high on anybody’s priority list at the time,” she says. “But as soon as we showed there was that many people that would come on board, the investors just started flying in.”

Passionflix has since produced more than two dozen feature-length and short films, according to the Internet Movie Database.

The company remains lean – it has a core team of seven people who each wear a lot of hats. In addition to producing its own content, Passionflix also licenses films for its platform.

“I think the biggest challenge for Passionflix is we can’t produce enough content to satiate the fans,” Musk says. “It’s a struggle with so many streaming platforms, when people want original content all the time.”

With more than 200 streaming services now competing for viewers, such niche markets face a myriad of challenges, says Dan Rayburn, a streaming media expert and consultant.

Creating, licensing and marketing content is very costly, he said. And while romance is the biggest-selling genre of books in the US, that doesn’t necessarily mean its popularity translates to movies.

“That’s comparing apples to oranges. Books are different,” Rayburn says. “This business is beyond tough. It’s highly competitive and requires an absolute large sum of money.”

Passionflix charges a subscription fee of $5.99 a month. The company does not disclose its subscriber numbers. Musk says subscribers are in the “six figures,” but declines to offer specifics.

Rayburn says it’s hard to determine the company’s profitability without knowing its expenses, including production and licensing costs.

“OK, if you don’t have subscriber numbers, what’s the usage? How many hours per month do people watch it? How much are you spending on content licensing?”

A deep dive into Passionflix’s online movie catalog reveals a mix of contemporary romance, fantasy romance, paranormal romance, erotic fan fiction and related sub-genres.

The films, which stream on the Passionflix site and on Amazon Prime Video, are rated on an escalating steaminess scale Musk calls a “barometer of naughtiness.”

The five categories: Oh So Vanilla, for wholesome romcoms; Mildly Titillating; Passion and Romance; Toe Curling Yumminess; and NSFW (Not Safe for Work). The latter category has risque plot lines and more sex – think “Fifty Shades of Grey.”

But Musk says that even the naughtiest Passionflix movies don’t reach the soft-core porn threshold.

“When we first started Passionflix, somebody asked us if we’re going to rate using MPAA,” she says, referring to the Motion Picture Association of America’s movie ratings such as PG-13, R, etc. “I don’t actually like any of those ratings. They’re not specific to women. I wanted something that could rate our shows and create more of a tongue-in-cheek conversation.”

Musk says she’s a romantic at heart and is a big fan of the genre.

“Love is amazing, it’s incredibly powerful. I love to tell stories of love, all kinds of love,” she says. “So parental love, friend love, family love, and love between any kind of couple.”

That broad range of romantic genres, and its sexy content, are what sets Passionflix apart from channels such as Hallmark and Lifetime Movie Network, says romance novelist Tamara Lush. She believes the romance genre has been especially popular during the pandemic because people seek comfort in stories with happy-ever-after endings.

“Hallmark is romance-centered but the stories are very, very sweet. Passionflix tells a wider range of stories, and the ones romance readers want to watch,” Lush says.

“The popularity of ‘Bridgerton,’ ‘After’ and ’365 Days’ on Netflix should tell streaming services all they need to know: that romance is a lucrative and sure bet for viewers.”

Passionflix’s original subscribers, known as founding members, get access to movie premieres and filming sets.

Last month in Atlanta, about four dozen of them piled into the Regal theater for the premiere of “Torn.” Following the movie, Musk hosted a question-and-answer session with the lead actors, followed by an after-party at a bar across the street. Fans and actors mingled over drinks.

Debbie Parziale, 67, says she flew in from Boston for the event. One of the founding members, she says she spent the pandemic years curled up on her couch, watching Passionflix movies.

“I love Tosca’s premise of empowering women and making sex not such a taboo subject,” she says. “She’s so true to the romance novels. When you read a book and watch one of her movies, it’s the book you read.”

Amanda Cromer, 32, says she signed up for Passionflix at a romance book convention. She loves the camaraderie that comes with being part of the Passionistas. The group has a virtual book club, called Passion Squad.

As one of the original members, Cromer can visit sets and interact with the actors. Cromer, who lives in a suburb of Atlanta, says that during a visit to the set of “Torn” she became an extra in a cafe scene.

“I love the empowerment the movies bring,” says Cromer, who attended last month’s “Torn” premiere with her mother.

“They choose books with strong female leads. They’ve done such a good job of portraying the female persona as a strong independent female, and not a timid person.”

Back on the set of her latest romance movie, Tosca Musk moves from one sparsely furnished room to another.

Musk lives in suburban Atlanta with her two children, 9-year-old twins who were conceived through in vitro fertilization using an anonymous sperm donor.

She’s getting ready to fly to Italy with the twins to film “Gabriel’s Redemption,” the third book in a series by Sylvain Reynard about a Dante scholar and his passionate affair with a younger graduate student. She says they plan to enjoy lots of gelato in Florence and visit Oxford, England, so the kids can see some of the locations where the Harry Potter movies were filmed.

As a single mother, Musk says she marvels at the path that led her to a job she loves.

She hopes Passionflix will help convince the film industry’s big names that adopting romance novels into movies is a worthy investment.

“The entertainment world is controlled mostly by men. At the end of the day, the decisions tend to sway toward the male audience as opposed to the female audience,” she says. “They also tend to be more about the victimization of women than they are about sexually free or sexually empowered stories about women.”

And for Musk, there’s also a simpler reason for her filmmaking ventures.

“I’m a storyteller at heart,” she says. “I just want to be able to tell stories.”

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November 20, 2022
Fertility app fined $200,000 for leaking customer’s health data | CNN Business

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CNN
—

The company behind a popular fertility app has agreed to pay $200,000 in federal and state fines after authorities alleged that it had shared users’ personal health information for years without their consent, including to Google and to two companies based in China.

The app, known as Premom, will also be banned from sharing personal health information for advertising purposes and must ensure that the data it shared without users’ consent is deleted from third-party systems, according to the Federal Trade Commission, along with the attorneys general of Connecticut, the District of Columbia and Oregon.

Wednesday’s proposed settlement targeting Premom highlights how regulators have stepped up their scrutiny of fertility trackers and health information in the wake of the US Supreme Court’s decision last year striking down federal protections for abortion.

The sharing of personal data allegedly affected Premom’s hundreds of thousands of users from at least 2018 until 2020, and violated a federal regulation known as the Health Breach Notification Rule, according to an FTC complaint against Easy Healthcare, Premom’s parent company.

Premom didn’t immediately respond to a request for comment.

As part of the alleged violation, Premom collected and shared personally identifiable health information with Google and with a third-party marketing firm in violation of Premom’s own privacy policy, which had promised to share only “non-identifiable data” with others, according to the complaint.

In addition, Premom allegedly shared location information and device identifiers — such as WiFi network names and hardware IDs — with two China-based data analytics companies, known as Jiguang and Umeng, according to the complaint. That information, the FTC alleged, “could be used to identify Premom’s users and disclose to third parties that these users were utilizing a fertility app,” according to an FTC complaint filed against Easy Healthcare, Premom’s parent company.

Since the Supreme Court’s decision in Dobbs v. Jackson, a wave of anti-abortion legislation has raised the prospect that fertility apps, search engines and other technology platforms could be forced to hand over user data in potential prosecutions of abortion-seekers.

“Now more than ever, with reproductive rights under attack across the country, it is essential that the privacy of healthcare decisions is vigorously protected,” said DC Attorney General Brian Schwalb in a statement. “My office will continue to make sure companies protect consumers’ personal information to protect against unlawful encroachment on access to effective reproductive healthcare.”

Samuel Levine, director of the FTC’s consumer protection bureau, said the agency “will not tolerate health privacy abuses.”

“Premom broke its promises and compromised consumers’ privacy,” Levine said in a statement. “We will vigorously enforce the Health Breach Notification Rule to defend consumer’s health data from exploitation.”

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April 12, 2021
The crisis pregnancy center next door: How taxpayer money intended for poor families is funding a growing anti-abortion movement | CNN

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CNN
—

A few blocks from the Ohio State University campus in Columbus, America’s battle over abortion is playing out under one roof.

On one side of a squat single-story office building, a Planned Parenthood clinic offers reproductive health care and refers patients for abortions. Next door is a branch of Pregnancy Decision Health Center, a crisis pregnancy center that offers counseling and support for pregnant women – but also works to dissuade them from terminating their pregnancies and has been accused of promoting misinformation about abortion.

Of the two neighboring organizations, only Planned Parenthood provides medical services such as Pap smears, birth control and STD treatments.

But the crisis pregnancy center is the one receiving money from the state government. Ohio has funneled nearly $14 million in taxpayer funds to the center and others like it over the last decade, according to government records – even as state leaders have cut funding that previously went to Planned Parenthood for programs such as breast and cervical cancer screenings. 

Ohio isn’t alone. More than a dozen states devote some of their budget to funding crisis pregnancy centers, a CNN review found. About half of those states distribute federal money intended to help needy families to the centers.

Some of the organizations that receive money have been accused of spreading abortion misinformation or using the funds to advocate anti-abortion causes instead of helping women. 

“Public dollars should go to promoting public health,” said Ashley Underwood, the director of Equity Forward, an abortion rights advocacy group. Crisis pregnancy centers, she said, “solely exist to deter people from getting abortion services.”

Since the US Supreme Court overturned Roe v. Wade this summer, a wave of abortion restrictions has swept the country, leaving millions of women with easier access to crisis pregnancy centers than abortion care. Crisis pregnancy centers far outnumbered abortion clinics across the US even before the court’s ruling, and anti-abortion groups are now planning to expand. 

Pregnancy center leaders and their state government allies say the organizations deserve taxpayer funds because they provide pregnant women with resources like free diapers and ultrasounds. But some of the centers also lie to women about the safety and potential risks of abortion, according to multiple studies, abortion rights activists, and women who have been to the centers. 

That kind of deception isn’t typical in any other area of health care, said Dr. Amy Addante, an Illinois OB-GYN who performs abortions and has been a vocal critic of crisis pregnancy centers.

“The purpose of these centers is to try to stop someone from having an abortion,” said Addante. “I cannot think of any other medical decision or any other aspect of health care where there is a group of individuals whose only intent is to stop you from receiving that health care.”

Big open windows invite patients and passersby into the waiting room at the Pregnancy Decision Health Center (PDHC). With velvety green chairs, leafy plants, and a coffee station that greets visitors as they come in the door, the crisis pregnancy center could pass for an upscale dental office or spa.

Outside, PDHC’s sign towers over the neighboring Planned Parenthood, literally casting a shadow over the clinic’s entrance. Inside, the contrast is even starker: Planned Parenthood’s waiting room looks run-down – old chairs crowd the small space, faded informational posters cover the walls, and daylight is blocked by signage on the windows and mirrored doors meant to protect patients’ privacy.

Multiple times a week, patients looking for Planned Parenthood mistakenly walk through PDHC’s doors, according to a Planned Parenthood clinician, Jennifer, who asked CNN not to use her last name out of security concerns. Some patients have told Planned Parenthood that PDHC employees told them abortion wasn’t safe or said PDHC tried to delay them and make them late for their Planned Parenthood appointments.

“They’ve provided an array of misinformation, whether it’s about abortion care or even about contraceptive services,” said Lillian Williams, the vice president of health services of Planned Parenthood of Greater Ohio.

Ayla Krueger, a 23-year-old Columbus resident, visited PDHC earlier this month with a friend who was seeking an STD test. She said that during their hour-and-a-half visit, an employee claimed that condoms were only 50% effective, the spread of STDs could only be prevented if people followed “God’s plan” of avoiding sex before marriage, and that if a woman who has an STD gets an abortion, “your STDs travel up your cervix into your organs and could kill you.”

“I was dumbfounded,” Krueger said of the encounter. “My heart was breaking, thinking about girls who don’t understand what they’re walking into there… and possibly getting coerced.”

Experts said that the center’s rhetoric was not medically accurate. “We do worry about ascending infections in abortions and pregnancy, but the risk is really, really low,” said Dr. Jonas Swartz, an OB-GYN and professor at Duke University Medical Center. “Crisis pregnancy centers regularly overstate the risk of abortions and this is just one example of that.”

The center also offers “abortion pill reversal,” according to its website, annual reports and pamphlets at the office. Abortion reversal is a medically dubious, unproven treatment that purports to undo a medication abortion but has been denounced by medical groups and found to be dangerous by researchers. A clinical trial that attempted to study abortion reversal was halted prematurely in 2019 when several participants suffered hemorrhaging.

Kathy Scanlon, PDHC’s president, declined an interview request and didn’t respond to CNN’s questions about Krueger’s allegations or abortion pill reversal.

“Every woman deserves care and compassion when facing an unexpected pregnancy,” Scanlon wrote in an email, adding that the center provides “practical pregnancy care and support ranging from free pregnancy tests and ultrasounds to parenting education classes and much-needed baby items” such as diapers and car seats.

Research has found that crisis pregnancy centers commonly disseminate misinformation. A study released last year by The Alliance, an abortion rights advocacy group, found that almost two-thirds of crisis pregnancy centers in nine states promoted false or biased information about abortion on their websites. That included false claims that abortions increased the risk of cancer or infertility.  More than a third of clinics also advertised that they offered abortion pill reversal – and state-funded clinics were more likely than privately-funded ones to offer the unproven procedure and less likely to offer prenatal care, according to the study. 

Similarly, a 2012 academic study of crisis pregnancy centers in North Carolina found that 86% of centers promoted false or misleading medical information on their websites. 

Crisis pregnancy center leaders say they are working to help women. Peggy Hartshorn, who founded the Columbus center and is now the chair of Heartbeat International, one of the largest global networks of crisis pregnancy centers, said the allegations that the groups spread misinformation are “a false narrative.”

She said that the information her centers provide to clients is “very well-researched, medically referenced – we document everything with multiple sources.”

“Deep down in their hearts, women do not want to have abortion,” Hartshorn said. “Pregnancy centers are good for America, they really are.”

In Ohio, a new six-week abortion ban that went into effect after the Supreme Court decision, is currently on hold amid court battles. The Planned Parenthood clinic near Ohio State University doesn’t perform abortions – it refers patients to a Planned Parenthood surgical center on the other side of town that does.

That facility, too, has a state-funded crisis pregnancy center operating across the street. On a recent afternoon, a handful of protesters lined the clinic’s fence with signs depicting bloody fetuses and shouted “you are already a mother” and “abortion is murder” whenever a patient came within earshot. One protester – wearing a reflective vest and holding a clipboard, similar to Planned Parenthood volunteers – tried to direct patients away from the abortion clinic and to the crisis pregnancy center across the street. The center told CNN the protesters weren’t affiliated with their organization.

It’s not rare for pregnancy centers to operate near abortion clinics. More than 100 pregnancy centers around the country are located within 200 meters of an abortion clinic or Planned Parenthood location, according to a CNN analysis. Some – in states like Delaware, Indiana and Michigan – are next door to clinics. 

Abortion rights advocates say the intention is to mislead women and block them from accessing abortion.  

“The purpose of co-locating near a legitimate provider is to intercept someone seeking legitimate health care and divert them into walking through their doors instead,” said Tara Murtha, the co-author of a report about pregnancy centers and a spokesperson for the Women’s Law Project. “It’s basically an obstacle course and a systemic barrier to abortion care.”

Despite the groups’ apparent spreading of misinformation, at least 18 states have funded crisis pregnancy centers with taxpayer money, according to a CNN review of government records and statements from state agencies. The largest is Texas, which has sent more than $200 million to the groups over the last decade. 

More than a half-dozen states bankroll crisis pregnancy centers at least partly with funds from Temporary Assistance to Needy Families (TANF), a federal welfare program. Those federal funds are sent to states as a block grant, which gives state officials wide latitude in how to spend it, including on programs like “alternatives to abortion” grants for crisis pregnancy centers. 

Research has shown that a smaller percentage of poor families are now receiving cash assistance from the TANF program than in previous decades.

While about 68% of families with children in poverty received cash assistance through TANF in 1996, when the program was created, that percentage declined to just 21% by 2020, according to a study by the Center on Budget and Policy Priorities, a nonpartisan think tank. The percentage was even lower in some of the GOP-dominated states that use TANF funding to support crisis pregnancy centers, such as Texas and Louisiana.

“When you look at successes in reducing poverty by strengthening the safety net, cash assistance is the most effective way to help families,” said Aditi Shrivastava, who co-authored the study. “We are seeing states spend less of their money directly on cash assistance, and we don’t think that is what the program should be doing.”

In the wake of the Supreme Court overturning Roe v. Wade, some states are piloting new efforts to fund crisis pregnancy centers. Lawmakers in Arkansas and Iowa approved state funding for such groups for the first time this year.

The states have argued that crisis pregnancy centers deserve taxpayer funding because they provide services to pregnant women in need. 

“If we are going to be the most pro-life state in the union, we have to be prepared when those mothers come to a facility and they need help,” Arkansas state Rep. Robin Lundstrum said at a legislative hearing about the state’s new program earlier this year.

In Columbus, Pregnancy Decision Health Center is receiving more than $528,000 from the state government in the current fiscal year, according to government records. All of that comes from federal TANF funds. The funding amounts for about a fourth of the center’s total revenue, while the rest comes from private donations, according to the group’s most recent tax records available.

Despite the large amounts of money, there’s little oversight of how the taxpayer dollars are being used. 

Many of the appropriations are written into spending bills passed by GOP-dominated state legislatures. Pennsylvania, for example, has sent more than $70 million over the last decade to crisis pregnancy centers through Real Alternatives, an anti-abortion group that distributes state funding to crisis pregnancy centers. 

A 2017 report by the state auditor general found that Real Alternatives used hundreds of thousands of dollars of the money it received from Pennsylvania “to fund its activities in other states,” in what the auditor said was an example of the group “siphoning funds intended to benefit Pennsylvania women.” Real Alternatives denied the allegations in a statement, saying that they had “no basis in fact or law.”

Michigan, which had contracted with Real Alternatives to distribute funding for crisis pregnancy centers, canceled its contract after Gov. Gretchen Whitmer vetoed the funding for it in 2019. In a letter about the veto, Whitmer thanked a watchdog group that had issued a report accusing the organization of only helping a fraction of the pregnant women it had agreed to support.

Real Alternatives, which also receives TANF money from Indiana, said the Michigan report was “riddled with inaccuracies, distortions, half-truths and defamatory statements.”

A bill in the Ohio legislature that would have required crisis pregnancy centers receiving state funding to provide their clients with only medically accurate information died in committee in multiple recent legislative sessions. The state’s GOP legislative leaders did not respond to requests for comment.

Meanwhile, some of the same red states that have bankrolled crisis pregnancy centers have stripped funding from Planned Parenthood. In Ohio, for example, the group never received state funding for abortions, but for years it received money for other services like cancer screenings, STD prevention and treatment, and sex education for teens.

In 2016, however, Ohio lawmakers banned the state from funding any organization that performs abortions, and the law went into effect after it was upheld by a federal appeals court in 2019. That meant that Planned Parenthood affiliates in Ohio lost about $600,000 a year in state funding, and led to the cancellation of some of their non-abortion health programs.

While Planned Parenthood does receive some additional reimbursements through Ohio’s Medicaid program for providing non-abortion health care to people on Medicaid plans, it no longer receives state grants.

Planned Parenthood also lost additional federal funding under Title X, a program that funds birth control and reproductive health services, under a Trump administration rule. But the organization started receiving that money again this year after the Biden administration reversed the rule.

Maria Gallo, a sexual and reproductive health epidemiologist at Ohio State University, said that state funding for crisis pregnancy centers shows how conservative lawmakers prioritize anti-abortion rhetoric over medical care for women.

“It’s dangerous in part because they are legitimizing (crisis pregnancy centers),” Gallo said. “They are legitimizing that as a source of medical care when they’re not licensed medical facilities.”

Crisis pregnancy centers drastically outnumber abortion clinics in the United States. There were 790 abortion clinics operating in 2021, compared with about 2,600 crisis pregnancy centers, according to a database compiled by Reproaction, an abortion-rights group.

That disparity is only likely to grow in the wake of the Supreme Court decision. Hartshorn, the chair of Heartbeat International, said the organization has created an online training program to help people open new pregnancy centers, especially in places without existing ones.

“We need more people, we need more places, and we need more paths to pregnancy health,” Hartshorn said.

A study by the National Center for Responsive Philanthropy found that the groups have taken in more and more money in recent years: They received over $1 billion in revenue in 2019, the most recent year data was available, compared to about $771 million in 2015. 

Several women who went to state-funded crisis pregnancy centers told CNN they felt misled and manipulated by the groups, and disturbed that they were getting taxpayer money.

Last year, a woman who asked to be identified by her middle name, Eve, had just lost her job when she suspected she might be pregnant. She and her boyfriend went to Women’s Care Center in Columbus after finding the group on Google. Money was tight, and she chose the center – which is receiving more than $700,000 from the state of Ohio in the current fiscal year – because it promised free pregnancy testing. 

Eve’s test was positive, and she asked the staff about an abortion. She said they handed her a pamphlet that warned her the procedure could cause infertility – though abortion doesn’t typically affect a person’s ability to become pregnant in the future. For three hours, Eve said the staff pressured her to carry the pregnancy to term.

“It became very clear that they were against abortion really quickly,” said Eve, who left the center feeling upset and later got an abortion. The center didn’t respond to questions about Eve’s visit but said in an email they are “absolutely committed to accuracy, excellence and transparency in all we do.”

One day, Eve said she hopes to have kids. But at the time, she didn’t feel financially or emotionally stable enough to have a baby.

“Nobody wants to make a decision to have an abortion,” Eve said. “And they made me feel really guilty and bad about it.”

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December 31, 1969