Since the U.S. Supreme Court’s reversal of Roe v. Wade, access to OB-GYN care has sharply declined in states with abortion restrictions, bringing an often-overlooked industry into focus — unregulated pregnancy clinics.

Also known as crisis pregnancy centers, UPCs have grown into a billion-dollar enterprise operating in all 50 states, bolstered by over $320 million in taxpayer funding allocated by anti-choice state legislatures since the Dobbs decision.

This rapid expansion demands urgent scrutiny, compelling state lawmakers to investigate how these funds are distributed, who is responsible for oversight, and what safeguards exist to prevent deceptive practices that prey on vulnerable women.

Hawaiʻi legislators have recognized one of the most urgent needs for UPC industry oversight — patient privacy. Recently, six representatives introduced House Concurrent Resolution 144 to investigate whether UPCs comply with patient privacy regulations.

This legislation acknowledges that UPCs — the first of which opened in Hawaiʻi in 1967 — operate outside regulatory frameworks governing other medical providers, creating significant risks for women’s health and privacy.

Keep Data Confidential

While UPCs present themselves as medical providers, UPCs operate outside the regulations that govern traditional healthcare providers. For example, UPCs misleadingly claim to keep client data “confidential” through Health Insurance Portability and Accountability Act compliance.

In reality, because the vast majority of UPCs appear to not engage in applicable transactions, HIPAA lacks the authority to address UPC misconduct. This regulatory blind spot is leaving women at risk, and state legislators must fulfill their responsibility to protect constituents by closing this dangerous loophole.

These concerns are not merely statistical. When organizations present the appearance of medical legitimacy without corresponding accountability, real harm follows. Women nationwide face a troubling gap between the confidentiality these centers promise and the actual legal protections they receive — a dangerous disparity demanding legislative intervention.

The Electronic Frontier Foundation recently called on attorneys general in Arkansas, Florida, Missouri, North Carolina, Nebraska, Oklahoma, Tennessee, and Texas to investigate privacy violations at UPCs.

Additionally, the Campaign for Accountability called for investigations into UPCs in six additional states — Idaho, Louisiana, Minnesota, New Jersey, Pennsylvania, and Washington, alleging violations of consumer protection laws. State legislators can support and expand these efforts through decisive legislative action, as modeled by legislators in Hawaiʻi.

Academic research has also sounded the alarm. The Journal of the American Medical Association highlights that 91% of UPCs promote the provision of “medical” services, while Health Affairs exposed how UPCs misleadingly claim HIPAA protections they are not accountable to. State legislators must implement evidence-based oversight before more women fall victim to this regulatory blind spot.

At this critical juncture in reproductive healthcare access, the stakes could not be higher. As quality reproductive healthcare declines and health care costs rise nationwide, leaving UPCs as the only option for many women, health providers and privacy experts are in agreement that UPCs must be held to the same standards of all other free medical clinics.

State legislators must follow Hawaiʻi’s lead and take legislative action to fulfill their responsibility to constituents by investigating where taxpayer funding is allocated, scrutinizing oversight mechanisms, implementing safeguards against deceptive practices, and holding UPCs accountable for fraudulent privacy claims that endanger women and girls.