Head to the clinic’s website and you’ll find a slideshow of images meant to make you feel welcome — a smiling woman in scrubs with a stethoscope around her neck, a diverse group of young people perhaps planning for their future, a college-aged patient in a flannel shirt looking anxious but hopeful.
In a linked video, a young woman with a tear-stained face gazes at the camera as a warm female voice reassures her: “Sex, fertility, pregnancy, questions about your body? Those are the things we’re here to help you with.”
“We’re here to listen to you,” the voice goes on. “To take every breath with you. Because your health matters to us.”
The young woman takes a deep breath. She smiles in relief.
This is the public face of Obria, a network of facilities in California and other states that purport to offer reproductive health care. Earlier this year, Obria received a $1.7 million federal grant through Title X, a program aimed at providing family planning services to underserved Americans. The program was designed, in part, to help people get affordable contraception like birth control pills and IUDs.
But critics say Obria clinics don’t actually provide those things. Instead, the group encourages “natural family planning,” a method of birth control that relies on tracking the monthly menstrual cycle and is generally less effective than hormonal contraception.
Obria is run by an anti-abortion activist and has long been positioning itself as an anti-abortion competitor to Planned Parenthood. But instead of taking an explicitly religious or ideological tone, its public-facing materials seem calculated to court not just abortion opponents, but a wider millennial audience interested in “wellness” and “natural” remedies.
The group positions itself as “holistic and anti-hormones,” Alice Huling, counsel for the Campaign for Accountability, an anti-corruption watchdog group that has produced a report on Obria, told Vox. “That is obviously something that has general appeal well beyond folks who have the same narrow view of reproductive rights and birth control access.”
Now, thanks to the Trump administration, Obria’s influence is poised to grow. In addition to awarding the group a grant, the administration earlier this year gave Planned Parenthood and other reproductive health care providers an ultimatum: stop performing and referring for abortions, or give up Title X funding. Planned Parenthood decided to exit the Title X program, and now Obria is closer than ever to its goal of supplanting the group in the hearts and minds of Americans — and in the federal budget. For Obria, that means “transforming health care with a compassionate and holistic mindset.”
But for reproductive-health groups and other critics, it means that patients around the country are going to get advice that’s not backed up by science, and may have more unintended pregnancies as a result.
Obria started as a crisis pregnancy center
The organization that became Obria started in the 1980s in California as a crisis pregnancy center, providing anti-abortion counseling to pregnant women. Such centers have been criticized for appealing to patients seeking abortion, then trying to convince them not to have the procedure, sometimes using misleading information to do so — one study found that 80 percent of crisis pregnancy center websites contained at least one item of misinformation.
The center that would grow into Obria went by a variety of names, including Birthright of Mission Viejo, according to the Campaign for Accountability. Obria’s CEO, Kathleen Eaton Bravo, says she became an anti-abortion advocate after having an abortion. Afterwards, she told the website Aleteia in 2016, “I ended up telling God, ‘Just bring me one woman that I can share what I’ve been through and tell her she doesn’t have to do this — that she has options, then maybe I can start to forgive myself.’”
In the 1980s and ’90s, Birthright of Mission Viejo operated under a variety of names. But around 2014, it took the name Obria, and began constructing the neutral public image it projects today. “The Obria medical clinics are now kind of whitewashed,” said Huling. Their websites look like those of any medical provider, with people in scrubs and an absence of overtly religious content. “They talk about homeopathic remedies, as opposed to really pushing a lot of the religious ideology and talk that you hear about at a lot of CPCs,” Huling said.
After 2014, Obria began to expand, with the goal of not just opening its own clinics, but partnering with clinics in other states and rebranding them with the Obria name, Huling said. On its website, Obria says it currently has 45 clinics around the country, with locations in Oregon, Washington, Iowa, Texas, and Georgia as well as California.
As it expanded, Obria also sought government funding. The group applied for Title X funding in 2018 but its application was denied — likely because, according to Huling, it does not provide birth control. But this year, it proposed sharing some of its grant money with non-Obria clinics that do provide birth control, and its application was successful — it now has nearly $2 million of federal funding to continue its work.
It’s not clear exactly how many patients Obria currently serves, but in its 2019 Title X grant application, it asked for funding to see 36,000 California patients over three years, or 12,000 annually. Planned Parenthood, by contrast, until recently served more than a million Title X patients every year.
Obria has more plans to expand, though: According to its website, the group aims to add 200 clinics around the country, and serve “more than 125,000 women,” by 2022.
One of Obria’s main services is “natural family planning”
By law, Title X funding is supposed to help grantees provide low-income and other underserved patients with “a broad range of acceptable and effective family planning methods and services” — and even under President Trump, the Department of Health and Human Services has said that this range should include hormonal contraception.
But Obria CEO Kathleen Eaton Bravo said in an email to supporters earlier this year that the group would “never provide hormonal contraception,” according to the Campaign for Accountability report. To the Campaign for Accountability’s knowledge, the group’s facilities also do not provide condoms, Huling said. Obria has not yet responded to Vox’s request for comment.
What Obria does provide, at least according to its 2019 Title X grant application, is training in natural family planning, also known as the rhythm method or the fertility-awareness-based method of birth control. This method involves tracking the monthly menstrual cycle and avoiding sex — or using a backup method, like condoms — on the most fertile days. There are several ways of tracking the cycle, including following the calendar and taking one’s body temperature daily (it can rise around ovulation), and they are most effective when combined.
According to Planned Parenthood, fertility awareness methods are about 76 to 88 percent effective. Condoms, meanwhile, are about 85 percent effective with typical use and 98 percent effective with perfect use; birth control pills are 99 percent effective with perfect use and 91 percent effective when used as most people use them (with the occasional missed pill, for instance).
Fertility awareness methods can be hard to use because they require a lot from the user. “You have to literally take your temperature the same time every morning, first thing, and if you don’t, then you can’t believe it will be accurate,” Lauren Streicher, a professor of clinical obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, told Vox last year. What’s more, something like a cold can throw the temperature readings out of wack, and menstrual cycles can vary for a variety of reasons.
Still, fertility awareness methods have been gaining popularity in recent years — about 3 percent of contraceptive users employed these methods in 2014, up from 1 percent in 2008. Natural Cycles, an app to help people track their cycles, received FDA approval last year.
One possible reason for the increase in interest is a growing concern about side effects of hormonal birth control, which for some people can include depression and anxiety. As Eliza Brooke wrote at The Goods, these side effects are poorly understood, and patients aren’t always taken seriously when they report them.
Meanwhile, there’s a growing interest in “natural” or “holistic” solutions to health issues, a movement Jezebel’s Molly Osberg calls “wellness creep.” A response, in part, to a medical establishment that really does often ignore women’s concerns, the rhetoric of wellness promotes natural products instead of medicine, regardless of whether there’s any science to back them up: “The promise of the wellness industry and the ideology it’s advanced is that every health problem is ultimately an issue of individual choice, and that a woman’s intuition is the most valuable medical currency,” Osberg writes.
“Natural” alternatives to hormonal birth control fit right into this narrative. Carol-Ann Farkas, an English professor who studies health and pop culture, likens Obria’s endorsement of natural family planning to Gwyneth Paltrow’s embrace of alternative medicine (though she notes there’s no evidence to suggest Paltrow would support Obria’s politics). “There’s the same kind of messages,” Farkas said. “I can steam my vagina and I can use the rhythm method to prevent pregnancy and I’ll be all-natural, and I’ll have my kale smoothie and I will be a better person.”
It’s not clear how many devotees of natural remedies or wellness Obria is drawing in. But Farkas says that Obria’s “very pleasant-looking website” may resonate with people who are confused or frustrated by their experiences with the medical establishment.
“There’s so much information coming from so many different sources, and it has not been part of our education up to this point to be able to sift through all this information to make meaningful decisions,” Farkas said. “You tend to trust those warm, approachable, accessible voices more than the doctor who you have to wait a week and a half to see, and she’s got 10 minutes with you and uses language you don’t understand.”
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Some of Obria’s claims aren’t backed by science
On its website, Obria claims to provide “services with a holistic view characterized by the treatment of the whole person.” But much of the group’s messaging isn’t backed up by science.
Obria pitches many of its services as “for women who don’t want to use hormones,” Huling said. But Obria’s website also prominently advertises “abortion pill reversal,” an unproven technique in which patients are treated with progesterone after the first pill in a regimen of abortion medication.
No controlled studies have shown that the method works, and Huling likens it to experimentation on patients. Progesterone, Huling points out, is a hormone.
In its application for Title X funding, Obria said it planned to use an app called Femm to provide education in fertility awareness, according to the Guardian. Femm, a product of the nonprofit Femm Foundation, initially looks somewhat like Natural Cycles, or any of a number of period-tracker apps on the market. But a few days of use turn up some unusual features.
For one thing, Femm seems to avoid mention of other methods of birth control, like condoms. When I signed up for the app and input some data, like the date of my last period, it told me, “The best way to learn about your cycle in order to avoid pregnancy is to focus on your body without having intercourse for one entire cycle. This will allow you to gain confidence in your own pattern, fertile time, and understanding of cervical mucus before adding in the complication of understanding seminal fluid.”
The app did not mention that use of a condom would also remove the complication of seminal fluid.
At one point, the app also provided me with the “tip” that “consistent lack of ovulation can put women at greater risk for ovarian cancer and bone mineral loss.”
This felt like a veiled criticism of birth control pills, which suppress ovulation. Some research has found that irregular periods are linked to ovarian cancer. Use of birth control pills, however, actually lowers the risk of this type of cancer.
Femm has not responded to Vox’s request for comment about some of its advice. The app’s developers say it has been downloaded more than 400,000 times, the Guardian reports.
While Obria may draw users in with promises of holistic care, critics say its messaging is likely to be harmful to public health. “Whenever you reduce evidence-based, medically sound family planning services,” said Michelle Kuppersmith, director of the reproductive-rights research group Equity Forward, “you end up with more unintended pregnancies.”
“Relying on an app like Femm,” she added, “is only going to lead to poor outcomes for people who do not want to get pregnant.”
Obria wants to replace Planned Parenthood
Many crisis pregnancy centers maintain public-facing websites without explicitly religious or ideological language. But what’s unique about Obria, Kuppersmith said, is its goal “of copying Planned Parenthood and being a nationally recognized chain that people will go to for health care.”
Obria makes its desire to compete with Planned Parenthood explicit on its website: “Some of the main reasons for Planned Parenthood’s success is its national brand recognition and unified front,” the site states. “Effectively offering compassionate, reproductive health care to more Americans requires the same concept.”
Obria may also be working harder than most to appeal to a broad audience, including younger and non-religious Americans. On its website, Obria touts its “modern approach to healthcare,” noting that “nearly three-fourths of millennial women prefer a virtual interaction with a doctor, as opposed to an in-person appointment.” In addition to its work with the Femm app, Obria has an app of its own that allows users to chat with a nurse by video or text.
Whether or not Obria can appeal to large numbers of millennial and younger Americans with its digital strategy remains to be seen. As of this writing, its app had just seven ratings in Apple’s app store. One reviewer praised Obria’s “comprehensive information” and said “I’m glad they’re getting more exposure.” Another cautioned, “This is a Christian ‘Pregnancy Crisis Center’ app that will never help you if you are seeking an abortion and may even mislead you.’”
But in one way, Obria’s plans are working. Around the same time that Obria received its Title X grant, the Trump administration finalized a new rule banning grantees in the program from providing or referring patients for abortions. In response, Planned Parenthood pulled out of the program earlier this month.
That leaves Obria and groups like it in a prime position to take Planned Parenthood’s place providing federally subsidized family planning services to low-income Americans — except that those services won’t include birth control pills, IUDs, or possibly even condoms.
“Now that Obria has Title X money,” Kuppersmith said, “people who traditionally would have gone to a Planned Parenthood for subsidized care might be forced, almost, to go to an Obria.”
Over the years, Planned Parenthood has become perhaps the best-known and most-trusted name in reproductive health care — when patients around the country need an abortion, birth control, or other reproductive health services, they often think of Planned Parenthood first. But by seeking federal funding, courting a millennial audience, and, perhaps, by tapping into trendy “wellness” culture, Obria is hoping to change that, becoming a nationwide brand people look to for care.
“Everyone has an important role to play in this battle,” Obria’s website says, inviting visitors to discover theirs.