Anti-abortion centers across the country are receiving tens of millions of tax dollars to talk women out of ending their pregnancies, a nearly fivefold increase from a decade ago that resulted from an often-overlooked effort by mostly Republican-led states.
The nonprofits known as crisis pregnancy centers are typically religiously affiliated and counsel clients against having an abortion as part of their free but limited services. That practice and the fact that they generally are not licensed as medical facilities have raised questions about whether it's appropriate to funnel so much tax money their way.
An Associated Press tally based on state budget figures reveals that nearly $89 million has been allocated to such centers across about a dozen states this fiscal year. A decade ago, the annual funding for the programs hovered around $17 million in about eight states.
Estimates of how many abortions have been prevented by such programs are unknown because many states only require reports of how many clients were served. Similarly, as abortion rates have declined across the U.S. for years, there is no way to know the extent to which the pregnancy centers have played a role.
Trying to pinpoint exactly how many pregnancy centers receive taxpayer dollars also is difficult because each state has a different system to distribute the money.
"It's bad governing. We're supposed to be monitoring our taxpayer money and we don't know where the money is going," said Julie von Haefen, a Democratic state representative in North Carolina, which has sent millions in public money to pregnancy centers. "These clinics don't provide medical care. They act like they do, but they don't."
What is clear is that taxpayer funding for the centers has spiked in recent years as more Republican-led states have passed legislation severely limiting access to abortion.
The centers have also been accused of providing misleading information about abortion and contraception — for example, suggesting that abortion leads to mental health problems or breast cancer.
"What we have found is that they're providing misleading information about the risks of abortion and not providing the actual prevalence of when that happens, because abortion is quite safe," said Andrea Swartzendruber, a University of Georgia public health professor who has helped map the location of crisis pregnancy centers nationwide. "They'll claim that abortion will lead to breast cancer, when it in fact does not. Or they'll say abortion leads to abortion PTSD. They make up this post-abortion syndrome."
The pregnancy centers often pop up close to abortion clinics with the goal of luring pregnant women away.
Supporters hope to expand the number of centers if the U.S. Supreme Court overturns or significantly restricts abortion rights in a case to be decided later this year.
That momentum is already building in Texas, where a state law that effectively bans abortion at about six weeks — before many women know they are pregnant — has been in effect since September. State lawmakers recently gave a hefty funding boost to programs offering abortion alternatives, dedicating $100 million over the next two years.
Programs in Texas and other states typically offer counseling and classes in parenting skills, as well as clothing and food. Proponents argue that these are essential social services offered to women who would otherwise remain pregnant but were unaware of the help they could receive.
"We have seen women still steadily seeking out resources and services," said Chelsey Youman, Texas state director and national legislative adviser for Human Coalition, a top contractor under the state's alternatives-to-abortion program. "Women are saying, 'All right, abortion isn't available after my child has a heartbeat, so what is out here?'"
The new law, Youman said, has helped refocus the crisis pregnancy centers' efforts on both women who have accepted the new restrictions and need help, as well as those who are wavering on whether to cross state lines to get an abortion.
Most centers offer pregnancy tests and pregnancy-related counseling. Some also offer limited medical services such as ultrasounds. Because the centers are not licensed health care facilities, they are exempt from certain government regulations, such as minimum staffing levels.
Last year, Tennessee lawmakers allocated money for several ultrasound machines to be placed in pregnancy centers. The website of one center includes a disclaimer stating that any information provided "is an educational service and should not be relied on as a substitute for professional and/or medical advice."
At a recent dedication of an ultrasound machine in Murfreesboro, about 30 miles (48 kilometers) south of Nashville, Republican Gov. Bill Lee and anti-abortion supporters said the state-funded purchase was critical in swaying patients who were considering the procedure.
"This is really about serving women who have a crisis and want information," Lee said.
The first state to enact an official abortion-alternatives program was Pennsylvania in the mid-1990s. The funding grew out of a deal in the Legislature between abortion rights supporters and abortion opponents.
Then-Gov. Robert P. Casey, an anti-abortion Democrat, signed the crisis pregnancy center funding into law, barely a year after his administration fought to the Supreme Court to win a landmark 1991 ruling allowing states to impose restrictions on abortion.
Under the deal, Pennsylvania began subsidizing the program to appease opponents of a preexisting program that subsidized Planned Parenthood's services for women's health. Republican majorities in the Legislature have enforced the agreement ever since, including for the past eight years under Democratic Gov. Tom Wolf, who supports abortion rights. It received $7.2 million in the current fiscal year.
If money for the program were cut from the budget, "then we would ax that line item that goes to Planned Parenthood, as well," said state Rep. Kathy Rapp, a Republican who chairs the health committee in the House.
By 2001, Pennsylvania also became the first state to receive approval to use $1 million from the federal Temporary Assistance for Needy Families program to help fund the pregnancy centers.
The Pennsylvania Health Department then contracted with a nonprofit known as Real Alternatives to oversee the program and distribute money. The Pennsylvania-based group eventually was selected to oversee similar programs in Michigan and Indiana, where it says it has since served more than 408,000 women.
The Campaign for Accountability, a Washington-based watchdog organization, has launched multiple complaints against Real Alternatives, including allegations that the group failed to meet its own goals and misspent taxpayer money.
Pennsylvania Auditor General Eugene DePasquale declared in 2017 that a lack of government oversight allowed Real Alternatives for decades to use tax dollars to expand their work in other states. The state instructed the group to change the way it pays subcontractors when its contract was renewed.
In Michigan, Gov. Gretchen Whitmer vetoed the state's annual $700,000 budget for abortion alternatives in 2019 following a complaint from the Campaign for Accountability, which argued that Real Alternatives had provided services to only about 3,700 pregnant women instead of the 9,000 outlined in its contract. Michigan had funded the program since 2013.
"Michiganders deserve comprehensive family planning programs that are evidence-based and support a person's full range of reproductive health options," Whitmer said in a letter to the watchdog group, thanking them for raising the complaint.
In Georgia, critics point to lax reporting requirements that require abortion-alternative programs to disclose only their total expenses and the amount of money dispersed to providers.
Despite the transparency concerns, the push to expand alternative programs continues across the country.
Arizona does not have an official alternatives-to-abortion program, but in 2019 lawmakers set aside $2.5 million for three years to develop a phone help line designed to steer pregnant women away from abortions.
In Tennessee, the GOP supermajority in the Legislature recently signed off on giving $3 million to the Human Coalition to set up call centers to serve as "virtual clinics" in Nashville, Memphis and Knoxville. Their goal is to direct people to pregnancy centers or government services.
Arkansas is the first state to require patients seeking an abortion to first call an information hotline to learn about possible pregnancy assistance before they can undergo the procedure. The program is set to be implemented in 2023.
Florida, Georgia, Louisiana, Minnesota, Missouri, North Carolina, North Dakota, Ohio and Oklahoma have all funded crisis pregnancy centers for years. But no state has acted as ambitiously as Texas.
In 2005, Texas created its own program with $5 million taken from its federal welfare dollars, allowing a variety of nonprofits to apply for grants. It quickly expanded under the Republican-controlled Legislature as crisis pregnancy centers, adoption agencies and maternity homes clamored for more money.
By 2020, the state's abortion-alternatives contractors provided roughly 1 million goods such as diapers and food, gave 331,000 counseling sessions, taught 314,000 parenting classes, made 217,800 referrals to government assistance programs and provided 56 adoption services, according to the latest annual report.
This year, Texas lawmakers dedicated a record $100 million in state tax dollars to fund the project over the next two years.
State Rep. Debra Howard said the money could be better spent on state-supervised women's health programs that offer annual exams, disease screenings and family planning services.
"The exponential increase in funding is unparalleled," the Austin Democrat said. "It's certainly not something we've seen for other programs that are in the category for women's health."
Additional reporting by the Associated Press.
