The Supreme Court Case That Could Shield Unregulated Pregnancy Clinics From Oversight

Behind procedural questions in First Choice Women’s Resource Centers v. Platkin lies a sweeping threat to consumer protection, public health and reproductive rights post-Dobbs.

On Dec. 2, the U.S. Supreme Court heard oral arguments in First Choice Women’s Resource Centers v. Platkin, an unregulated pregnancy clinic’s constitutional challenge to the New Jersey attorney general’s subpoena for information about its operations, including donor records. 

On its face, the justices considered procedural questions: whether this case belongs in state or federal court, and whether federal constitutional challenges limit a state’s power to conduct investigations. 

But the case could be about a much bigger question: whether unregulated pregnancy clinics will be immune from any state effort to investigate or regulate their practices going forward.

The implications for women’s rights and the public health could be titanic, as conservatives move to decimate the reproductive health delivery system for low-income and uninsured Americans and position unregulated pregnancy clinics as their only option for care. 

Unregulated pregnancy clinics (UPCs)—also known as crisis pregnancy centers (CPCs)—are religious nonprofit organizations that oppose abortion and contraception. They intercept women and teens seeking reproductive healthcare using deceptive advertising, medical disinformation and claims of free medical services.

Post-Dobbs, they increasingly pose as health clinics while operating free of the health, safety and licensing standards that govern medical offices, and collect vast amounts of data from pregnant people with no privacy protections. UPCs nationwide are taking in billions yet report the value of their services to be only a fraction of their revenue.

In short, the grounds for state investigations into whether UPCs are violating consumer protection laws are legion. Decades of reporting by watchdogs, journalists, advocates and scholars has conclusively documented UPC deception, misconduct and fiscal malfeasance, and increased scrutiny of UPC practices post-Dobbs has exposed shocking revelations about their unregulated medical practices.  

But unregulated pregnancy clinics are part of a coordinated, well-resourced industry that aggressively fights demands for transparency, oversight or accountability. Backed by the extremist groups that overturned Roe, UPCs are weaponizing the First Amendment to block state effort to investigate their activities and impact, regulate their practices, educate consumers about where to find comprehensive care, and to side-step state jurisdiction to press their claims in friendlier federal courts. The First Choice case is just one of scores of UPC efforts to secure free speech and religious liberty protections against state investigation or oversight of their operations—including their medical practices—but the latest to make it to the high Court.

The UPC industry succeeded in fast-tracking the First Choice legal challenge of the New Jersey investigation to the Supreme Court, with a strategic focus on procedural claims and donor privacy. Their strategy aims to inoculate unregulated pregnancy clinics against state oversight, and help ensure this vital part of the antiabortion movement can continue to operate in a regulatory gray zone, with no accountability to patients or the public.

First Choice is represented by Alliance Defending Freedom (ADF), the legal powerhouse behind Dobbs v. Jackson, the case that overturned Roe v. Wade, and some 20 lawsuits challenging UPC accountability efforts.  

Nuts and Bolts of the First Choice Case 

In 2023, New Jersey AG Matthew Platkin launched an investigation into First Choice Women’s Resource Center to determine whether its five pregnancy centers were violating state consumer protection laws. Platkin issued a subpoena for documents related to First Choice advertising, medical claims and services, licenses and staff, privacy practices, affiliations and donor communications and identities, going back to 2013.

Platkin told The Center Square, “First Choice … has for years refused to answer questions about its operations in our state and the potential misrepresentations it has been making. We issued a subpoena in 2023 to ensure that First Choice was complying with all relevant state laws.” 

First Choice challenged the constitutionality of the subpoena in federal court, focusing on the AG’s request for their donor information and arguing that he unfairly targeted them as a faith-based pregnancy center, that his demand for donor lists unconstitutionally chilled their First Amendment rights to free speech and free association, and that federal courts should decide such constitutional challenges.

AG Platkin successfully sued in state court to enforce the subpoena, and the federal district court ruled that First Choice’s claims were not “ripe” for federal court.

First Choice appealed the district court decision to the Third Circuit Court of Appeals, which upheld the lower court’s ruling that the pregnancy center must first litigate its constitutional claims in state court.

First Choice then appealed to the U.S. Supreme Court, which agreed to hear the case and resolve the procedural questions at issue: whether a state investigatory demand with First Amendment implications must first be adjudicated in state court and, if so, whether that effectively deprives the plaintiff of the opportunity to adjudicate their constitutional claims in federal court. 

What Happened at Oral Argument

Erin Hawley, senior counsel and vice president of the “Center of Life and Regulation” at Alliance Defending Freedom, argued the case. Hawley, wife of Sen. Josh Hawley (R-Mo.) and former law clerk for Chief Justice John Roberts, had also served on the ADF team that brought the Dobbs case to the Supreme Court. 

Hawley’s argument focused on the AG’s request for donor information and its implications for donor privacy, and on the importance of access to federal court in cases of state abuse of power.

• She argued that Platkin’s subpoena was a hostile targeting of antiabortion pregnancy centers, citing his creation of a Reproductive Rights Strike Force post-Dobbs and issuing of a consumer alert about anti-abortion pregnancy centers.
• Hawley argued that the AG “seeks to punish and intimidate those who support our pro-life ministry.” She urged the justices to protect donor privacy, noting the ACLU agreed that subpoenas seeking donor information can scare away supporters.
• She asked the Court to find the AG’s “coercive” subpoena to be a violation of the First Amendment and to affirm First Choice’s right to go directly to federal court to litigate their claims.
• Vivek Suri, assistant to the solicitor general for Trump’s Department of Justice, joined to argue that plaintiffs with constitutional challenges always have standing in federal court. 

Sundeep Iyer, chief counsel to the New Jersey attorney general, represented the state. Iyer argued that the question before the Court is whether First Choice sued prematurely, and that the pregnancy center is seeking an exception to the usual procedural rules as it tries to avoid complying with a lawful subpoena, which the Constitution does not permit.

• Iyer argued that the subpoena does not chill the pregnancy center’s First Amendment rights, and that First Choice has never shown actual harm, only that the subpoena “may cause” harm to donors.
• When questioned by Clarence Thomas about the lack of consumer complaints against First Choice, Iyer responded that state governments issue subpoenas “all the time” in the absence of consumer complaints and that review of First Choice websites generated ample facts to indicate the UPC may be violating state consumer protection laws. 
• Following oral argument, AG Platkin said, “States issue literally thousands of these subpoenas every year as a standard part of fraud investigations, and First Choice’s position—which has no grounding in more than a century of history—risks turning those fraud investigations into federal court cases.” (The full transcript is here.)

The Oral Argument Obscured Huge Elephants in the Room

If you only listened to the oral argument in this case, focused on donor privacy, and state and federal jurisdiction, you would miss the real story. Hawley’s singular focus on the donor privacy implications of the AG investigation was strategic, omitting the extensive range of questionable First Choice practices addressed in the subpoena.

It was only toward the end of the 90-minute argument that Iyer named all four areas of First Choice operations the New Jersey AG seeks to investigate: unlicensed practices, untrue medical statements, privacy practices and donor deception. 

In fact, ADF’s focus on donor privacy dodged the fact that AG Platkin’s investigatory subpoena demanded documentation related to a broad array of First Choice operations that may run afoul of consumer protection laws, including: 

• ads, solicitations and marketing strategy.
• web content on client-facing and donor-facing websites.
• medical claims regarding ultrasound, miscarriage, abortion, contraception, sexually transmitted infection, “post-abortion syndrome” and “abortion pill reversal” (APR).
• professional licenses required to perform services offered, licensees who provide medical services, personnel who perform and interpret ultrasound scans and any licenses held by First Choice.
• client communications regarding confidentiality, intake forms and privacy policies.
• training of personnel.
• affiliation with national networks regarding APR, training, marketing, materials.
• any complaints from clients or donors and any legal action against First Choice.
• communications with donors and documentation of donations made.

New Jersey has over 50 unregulated pregnancy clinics operating in over 100 locations, far outnumbering abortion clinics in the state.

A recent study by UNC professor Maria Gallo and colleagues found a significant percentage of reproductive-aged women visit UPCs—including in New Jersey, where 9 percent of women aged 18 to 44 had visited a UPC—raising alarms among the researchers about lack of regulation.

In short, the New Jersey AG’s investigation into First Choice practices is not, as one critic put it, “a fishing expedition.” 

First Choice has two websites: a client-facing site that advertises medical services, and a donor-facing site that identifies First Choice as “an outreach ministry of Jesus Christ through His church.”

A look at the client-facing website and recent revelations about UPC industry medical and privacy practices make it clear that AG investigation is grounded in real and urgent concerns, both for consumer protection and women’s health in New Jersey. 

Unlicensed Practice

The First Choice client-facing website advertises free pregnancy tests, ultrasounds, telehealth nurse consultations and abortion consultations. But First Choice is not an obstetrical medical practice or licensed telehealth provider, does not provide abortion, and will not refer people to medical clinics that do. First Choice does not identify a medical director, physicians, telehealth nurses or other licensed medical professionals responsible for providing or overseeing their medical services. 

Yet, while it does not identify any medical professionals on staff, First Choice offers free ultrasound to identify life-threatening ectopic pregnancies.

This is a national trend.

• A recent study in JAMA found 77 percent of UPCs nationwide advertised ultrasound in 2024.
• The UPC industry’s Charlotte Lozier Institute reports a 23 percent increase in UPC provision of ultrasounds between 2022 and 2024.
• A search of the ChoiceWatch database of UPC websites nationwide shows almost 50 percent advertising ultrasound use fear of ectopic pregnancy in their marketing.

National Institute of Family and Life Advocates (NIFLA)—one of the three major UPC networks in the U.S.—has made ultrasound services the centerpiece of a “medical clinic conversion” program it markets to UPCs. NIFLA is clear that UPC ultrasounds are not a medical or diagnostic service but “an invaluable tool in revealing the personhood of unborn children” and reaching “more abortion-vulnerable women.”

A line-up of “pro-life” groups, including Focus on the Family, Knights of Columbus, Southern Baptist Convention and PreBorn!, fund UPCs to use ultrasound to dissuade pregnant people from choosing abortion. 

Rice professor Carly Thomsen argues that “a sonogram is the precise object that allows CPCs to change their image and potentially expand their reach; the sonogram is understood as a medical device and so is viewed as something that would be available at a medical clinic but not at a religiously motivated and unregulated antiabortion nonprofit organization.”

When Thomsen reached out to her local UPC to ask what training is required for staff performing ultrasounds, she reports:

“I was forwarded to their national organization, Heartbeat International, which, I was informed by the chat line worker, does not require that those performing sonograms in its facilities have any training, licensure, or medical certification for using sonogram machines …”  

NIFLA is explicit that when UPCs use ultrasound to “convert to medical clinic status,” they experience “improve(d) 
credibility within their community which results in an increase of donors.” 

But while NIFLA is training UPCs to use ultrasound to telegraph medical legitimacy, a blockbuster NBC report revealed that NIFLA is also training UPC staff not to scan women they suspect have ectopic pregnancies, calling it their “greatest medical and legal risk.”

Chilling new research from Reproductive Health and Freedom Watch finds that all three major UPC networks are training UPC staff to identify ectopic pregnancies via ultrasound—to shield their centers from legal liability when a woman presents with one.

In light of these shocking revelations about UPC ultrasound and ectopic pregnancy practices, the absence of regulation or verifiable clinical oversight of UPCs advertising ultrasound—including in New Jersey—First Choice’s claim to offer free ultrasound to identify ectopic pregnancies demands investigation.

Untrue Medical Statements

A look at the First Choice client-facing website shows extensive messaging about abortion, with webpages about the “Abortion Pill”; “Abortion Methods, Procedures, and Costs”; “At-Home Abortion”; and “After-Abortion Care”—including a referral to Heartbeat International’s “Abortion Pill Reversal” hotline.

These webpages offer a mixture of false and cherry-picked information, presented in clinical terminology.

• The abortion pill information page details risks without noting how exceedingly rare abortion complications are. Some false claims, such as, “Because of the risk of serious complications, the abortion pill is only available through a restricted program” cite an outdated source.
• A claim on the “after-abortion care” page, “Many credible studies have been done and psychologists are now recognizing PAS (Post-Abortion Stress) as a type of post-traumatic stress disorder,” is false. Only antiabortion researchers, some who have literally been discredited, promote this “syndrome,” while the landmark Turnaway Study conclusively found that obtaining a wanted abortion does not increase risk for depression. The American Psychological Association has also found that abortion is not linked to mental health issues, but restricting access to abortion is linked to long-term psychological effects. 

The First Choice website also makes untrue statements about their medical services, which pose a threat to women seeking abortion care, as well as to women at risk of ectopic pregnancy. The website offers free ultrasounds to “tell you how far along you are … [and] determine how many pills are needed to terminate the pregnancy”—a patently untrue statement given First Choice’s antiabortion mission.

University of Connecticut researchers studying the post-Roe landscape call it “an infodemic,” where false and misleading information is proliferating and creating widespread confusion among people seeking reproductive healthcare. The researchers recognized the central role antiabortion pregnancy centers play in this “abortion infodemic,” using deceptive advertising and medical disinformation to intercept pregnant people seeking healthcare, and extensive digital strategies to sow confusion, undermine evidence-based medicine and obstruct access to real providers, especially in abortion-destination states like New Jersey. 

Privacy Practices

… First Choice operates under no legal requirement to protect client confidentiality.

Because First Choice, like the majority of UPCs nationwide, is not a licensed medical clinic and does not bill for services, it is not a “covered entity” under the federal Health Insurance Portability and Accountability Act (HIPAA).

But, like many other UPCs, First Choice creates the appearance that it is a medical facility; its client-facing homepage features a photo of a woman wearing medical scrubs with a stethoscope draped around her neck, and includes clinical language and promises of confidentiality throughout, leaving women seeking reproductive care to trust their information is legally protected. 

But First Choice operates under no legal requirement to protect client confidentiality. This means First Choice is essentially free to share the sensitive information it is collecting from pregnant people as it wishes—information that 
could be weaponized in pregnancy or abortion-related investigations post-Roe.

Such fears about deceptive and ungoverned data practices by the UPC industry are not theoretical. At least one UPC has shared client data with law enforcement to support the prosecution of a pregnant person. And in 2024, Heartbeat International shared UPC client information in a training video that exposed dozens of clients’ names and personal information to anyone online.

In 2024, the watchdog Campaign for Accountability filed two complaints with AG Platkin about New Jersey UPCs collecting sensitive health data under marketing claims about being HIPAA compliant. The December 2024 complaint identified First Choice Women’s Resource Centers as one of the New Jersey UPCs that was deceptively telegraphing HIPAA compliance on its Notice of Privacy Practices, where it linked to HHS, which governs HIPAA, and stated First Choice is “required by law” to protect their clients’ health data.

While First Choice has now deleted that website claim, in August of 2025 an undercover investigator at the First Choice clinic in Montclair, N.J., was told by staff that First Choice operates under HIPAA.

A Massive Legal and Propaganda Machine Led Up to Oral Argument 

What you would also not know, if you only listened to the oral argument, is that the UPC industry deployed massive public relations and legal resources in the lead up to Supreme Court consideration of the First Choice case.

The PR Machine

Just weeks before oral argument, the Charlotte Lozier Institute (CLI), the UPC industry’s “research arm,” released its latest pregnancy center impact report, claiming 2,775 UPCs nationwide served over 1 million new clients in 2024 and provided $452 million in goods and services.

The report asserts:

“As a decades-long decline in induced abortions reversed course between 2018 and 2024, the documented levels of care and support provided by pregnancy centers during this same period steadily rose.”

CLI provides no independently verifiable data to understand how it documented “increased levels of care and support,” but a comparison of CLI’s 2024 report against UPC industry reports going back to 2009 shows that, by their own numbers, demand for UPC services has remained largely stagnant, even as UPC revenue has surged to a projected $2.2 billion for 2024, fueled in part by millions in taxpayer dollars.

Although CLI stopped reporting total clients served after 2019, industry reports show the average number of new clients per UPC has fallen 25 percent since 2010.

Moreover, CLI’s New Jersey state impact reports show the number of people served by UPCs in that state decreased by 35 percent between 2019 and 2022.

But CLI’s sweeping, unverifiable, even contradictory publication delivered key talking points for a surge of UPC industry op-eds and press statements around the First Choice oral argument.

The Catholic Association’s Ashley McGuire, for example, said that pregnancy resource centers “provide essential medical and material support to mothers and babies valued at more than $450 million annually.” 

Op-eds echoing CLI messages were published by Erin Hawley in USA Today and WORLD, ADF CEO Kristen Waggoner in New York Daily News, Becket Fund for Religious Liberty’s William J. Haun in the Wall Street Journal, First Choice CEO Aimee Huber in NJ.com, Kathleen Parker in The Washington Post, and more. 

UPC industry messaging was also coordinated to echo major arguments in the ADF complaint.

• First, that “New Jersey Attorney General Matthew Platkin has made no secret of his hostility towards pregnancy centers” and that First Choice donors “would be unlikely to donate knowing their information could be exposed to a state official who has a history of hostility toward pro-life viewpoints.”
• Students for Life Action, among others, amplified this message, stating the AG’s actions “make it less likely that people will donate to crisis pregnancy centers.”

UPC industry spokespeople also framed AG Platkin’s “targeting” of First Choice as part of a nationwide pattern of blue-state harassment and post-Dobbs violence.

• The First Choice CEO wrote that Platkin is pursuing “a personal and political vendetta against pregnancy centers … in lockstep with other blue states.”
• Op-eds proclaimed “The Left’s War on Crisis Pregnancy Centers” and “The Supreme Court can stop the blue-state war on pregnancy Centers.”
• Susan B. Anthony Pro-Life America’s CEO told The Center Square that the case “has enormous significance for thousands of pregnancy centers nationwide – who have repeatedly had to defend themselves against Democrats in court and pro-abortion violence.”
• ADF lawyer Lincoln Wilson, told reporters “many of [these centers] have suffered violence and vandalism.”

In framing UPCs as victims of pro-abortion officials and activists, industry spokespeople did not acknowledge that pregnancy center vandalism has dropped off after a surge in the immediate aftermath of the Dobbs ruling, while there has been a massive increase in violence against abortion providers—stalking, blockades, bomb threats and assaults –including a shooting at a South Carolina Planned Parenthood just weeks before the oral argument.

The Legal Machine

A roster of right-wing law groups provided legal and messaging support for Alliance Defending Freedom and the 
First Choice legal challenge, including legal groups suing other states on behalf of UPCs—American Center for Law and Justice, Becket Fund for Liberty and Liberty Counsel—as well as Conservative Legal Defense and Education Fund, First Liberty Institute, Mountain States Legal Foundation, Pacific Legal Foundation, Southeastern Legal Foundation and Washington Legal Foundation.

The CPC industry flooded the Supreme Court with amicus briefs leading up to oral argument, including from: 

• Conservative and libertarian policy and advocacy groups, including Advancing American Freedom, Americans for Fair Treatment, Americans for Prosperity, American Legislative Exchange Council (ALEC), Center for a Free Economy, Citizens United, Legal Insurrection Foundation, National Taxpayers Union and The Manhattan Institute.
• Free speech and religious liberty groups, including Center for Individual Rights, Free Speech Defense and Education Fund, Foundation for Individual Rights and Expression, Institute for Free Speech, Religious Freedom Institute, Robertson Center for Constitutional Law and United States Constitutional Rights Defense Fund.
• Religious organizations, including Catholic, Mormon, Anglican, Evangelical, Lutheran, Jewish and Southern Baptist institutions and congregations, and professional religious groups such as the Christian Medical and Dental Associations and National Religious Broadcasters.
• UPC industry leaders Care Net, Charlotte Lozier Institute, Heartbeat International, NIFLA, Save the Storks and The Justice Foundation, as well as individual UPCs, coalitions and anonymous donors.
• Pro-life organizations, including Americans United for Life, Democrats for Life of America, Life Issues Institute, National Men for Life, Promise of Life Network and Rainbow Pro-Life Alliance.
• State chapters of national conservative and pro-life groups, including from Alabama, Alaska, Arkansas, Connecticut, Georgia, Kansas, Maryland, Missouri, New Jersey, New York, North Carolina, Texas and Wisconsin.
• Conservative women’s groups, including America’s Women, Clare Booth Luce Center for Conservative Women, Concerned Women for America, Eagle Forum and Women for Democracy in America.
• Second Amendment advocates, including Gun Owners of America, Gun Owners Foundation and the Second Amendment Foundation
• 19 Republican-led states
• 32 individual Republican members of Congress

In all, over 150 groups and nearly 100 individuals filed almost 50 amicus briefs in support of First Choice.

Why Are They Working So Hard to Protect UPCs From Transparency and Accountability?

… UPCs are positioning to realize a long-term goal: to ‘replace’ Planned Parenthood and Title X programs and secure federal taxpayer funds to advance an agenda that promotes childbirth and undermines evidence-based healthcare. 

In the past 10 years alone, right-wing legal groups and Republican attorneys general have brought over 30 lawsuits to challenge state efforts to increase UPC transparency and accountability. Alliance Defending Freedom is now vigorously promoting a model bill it created to exempt UPCs from any state or federal regulation. American Center for Law and Justice is sponsoring a slick public relations campaign promoting UPCs in Massachusetts. 

And as UPCs increasingly brand as medical providers, despite being subject to none of the medical oversight required of medical clinics, antiabortion politicians are leaning hard into claims that UPCs are saving taxpayer dollars, enhancing health outcomes for mothers and children and providing quality maternal care—all while resisting any effort to verify their claims, assess their impact, or hold them accountable for how they spend taxpayer dollars or treat people seeking healthcare. 

Why are they working so hard to protect UPCs from transparency and accountability? 

1. Pregnancy centers play a core role in softening the antiabortion movement’s image.

With polls repeatedly showing Americans oppose abortion bans, the political reality that abortion rights have won in almost every state where they’ve been on the ballot, and story after harrowing story emerging about the impact abortion bans are having on the health and very lives of women around the country, the antiabortion movement is centering messaging on UPCs to navigate a mounting backlash post-Dobbs.

2. More fundamentally, UPCs are the grassroots backbone of the anti-choice movement and core to the larger conservative project.

Radical groups including Heartbeat International, Susan B. Anthony Pro-Life America, Students for Life, Turning Point USA and others—many involved in Project 2025—leverage the 50-state UPC network of an estimated 3,000 locations and 100,000 staff and volunteers to influence state policy and, under the guise of providing healthcare, to siphon escalating taxpayer dollars into the movement. 

In fact, the UPC industry is taking in billions in revenue that it does not appear to spend on pregnancy services: UPCs reported $1.7 billion in revenue in 2022, $1.9 billion in 2023, and are on track to report over $2.2 billion in 
2024—but Charlotte Lozier Institute values UPC client services in 2024 at $452 million.

Why did it cost UPCs over $2 billion to provide $452 in services? How did they spend the $1.75 billion they don’t account for in their reporting?

Despite being awash in revenue, and serial reports of fraud, waste and illegal use of taxpayer funds, UPCs are positioning to realize a long-term goal: to “replace” Planned Parenthood and Title X programs and secure federal taxpayer funds to advance an agenda that promotes childbirth and undermines evidence-based healthcare. 

As right-wing politicians decimate the reproductive health delivery system for low-income and uninsured Americans, the UPC industry is ramping up the narrative that their unregulated pregnancy clinics are the answer to the maternal healthcare deserts their policies have created. 

On the eve of the First Choice oral argument, The National Review published an article citing the CLI report to assert that UPCs are maternal health clinics qualified to replace Planned Parenthood:

“Planned Parenthood insisted that women across the country would be left without maternal health care after the organization was defunded earlier this year … but a vast, rapidly growing network is ready to answer the call: Pregnancy centers collectively cared for more than 1 million new patients and provided $452 million in services and material goods to almost 4 million women in 2024 alone according to the Charlotte Lozier Institute’s 2025 National Pregnancy Report.” 

As UPCs step up this campaign to become federally-funded health clinics, their industry is working double time to ensure they can continue to operate in a regulation-free zone, with no accountability to patients or taxpayers.

CPCs target the most vulnerable: young people, uninsured and underinsured people, women of color and immigrants—the very people with the fewest options and greatest barriers to reproductive healthcare.

As our country faces worsening maternity care deserts, provider shortages and devastating cuts to the reproductive healthcare safety net, pregnant women and teens need honest, evidence-based care more than ever—not ideologically driven pseudo-healthcare.

In the wake of the Dec. 2 Supreme Court oral argument, most media observers are predicting the Court will rule for First Choice. If it does, unregulated pregnancy clinics nationwide will be further emboldened to resist any state oversight, including of their medical services.

A bold, innovative, multi-front action by reproductive justice advocates, public health professionals and pro-choice officials is the only way we ensure they can’t succeed.