Debra Rosen: The Silent Surveillance State
By Debra Rosen
Last month, legislators in Missouri captured national headlines when they debated House Bill 807, a new bill to create a state-run registry of pregnant women “at risk of seeking an abortion.” The bill appears to clear the way for unregulated pregnancy clinics (UPCs) – also known as anti-abortion ‘crisis pregnancy centers’ – to run the registry.
Even more chilling– while many UPCs claim HIPAA compliance on their websites or tell clients they follow privacy laws, the deeply personal health information UPC clients are asked to give UPCs does not appear to be protected by HIPAA.
Based on the services they promote, UPCs may already be compiling databases of those they deem “at risk of seeking an abortion.” A study published in the December 2024 edition of JAMA found an alarming 91.3% of UPCs advertise “medical” services that directly indicate pregnancy status, including pregnancy tests (84%), ultrasounds (76.7%), and the controversial “abortion pill reversal” procedure (30.4%). Meanwhile, a search using the same ChoiceWatch database as the study reveals additional services UPCs could use to track clients seeking abortion: “pre-abortion” screenings (14.6%), “post-abortion healing” (51.3%), and “pregnancy options” counseling (54.6%).
In a January 2025 message to their affiliates, two of the nation’s largest UPC affiliate networks openly admitted that UPCs are not covered entities under HIPAA—meaning clients have zero legal privacy protections. These same networks cautioned their centers against misleading clients about HIPAA protections, warning that doing so would “create confusion.”
So, while UPCs collect intensely personal data—pregnancy test results, ultrasound images, abortion inquiries, date of last menstrual period—nothing is stopping them from storing, sharing, or even weaponizing this information.
And UPC clients should know— nothing is stopping anti-abortion legislators and law enforcement from accessing their data, either.
Last November, Missouri voters reclaimed the right to abortion, but if Missouri Attorney General Andrew Bailey wanted a list of every woman and girl in the state who was labeled “at risk of seeking an abortion” he could get it today—straight from one of 91 UPCs in Missouri.
Now, imagine what that means in states where abortion is completely banned and law enforcement is hell-bent on enforcing those bans.
Think Texas Attorney General Ken Paxton, who’s already hunting for people to prosecute under Texas’ abortion ban. Or Alabama Attorney General Steve Marshall, who’s openly threatening to charge anyone who helps Alabama residents leave the state for an abortion. Or the multiple anti-abortion attorneys general who are actively challenging HIPAA protections for reproductive health care, making it easier than ever to track, target, and punish people for seeking care.
Whether or not Missouri House Bill 807 passes, one disturbing fact remains—unregulated pregnancy clinics already have a national database of women and girls who could be labeled as “at risk of seeking an abortion.”
The UPC industry has been reluctant to provide details on what they do with this data but the little we know is concerning. According to a promotional video for Next Level – client data management software owned by UPC affiliate network Heartbeat International – “the data collected will actually benefit everyone, it will be open to everyone.”
So, just how many women and girls might be included in these databases? No one knows. But consider this: the largest UPC networks in the U.S.—Care Net, Heartbeat International, and NIFLA—boast a staggering 2,750 centers that, in a single year, claim to have administered 703,835 pregnancy tests, 546,683 ultrasounds, and “after abortion support” for 20,863 people. Heartbeat International appears to be tracking at least 1,875 women and girls who “started” the highly controversial abortion pill reversal protocol in 2023—essentially identifying them as individuals who had attempted an abortion.
UPCs are on the ground in all 50 states. If Missouri House Bill 807 is any indication of what’s to come, the future of reproductive privacy in America looks increasingly grim—where unregulated pregnancy clinics, emboldened lawmakers, and anti-abortion law enforcement work hand in hand to track, target, and control those seeking care. The question is no longer if these databases will be weaponized, but when.
Debra Rosen serves as Executive Director of Reproductive Health and Freedom Watch, an organization dedicated to exposing and countering efforts to obstruct access to reproductive and maternal health care.
