Partisan battle grows over state funding for antiabortion centers
After every Tennessee abortion clinic shuttered last year, Republican Gov. Bill Lee told state lawmakers they had a "moral obligation" to increase funding for a different service: crisis pregnancy centers.
"It's time to equip them with the resources they need to play a bigger role," Lee said in February, referring to the largely unregulated and often faith-based organizations that aim to deter women from getting abortions.
At Lee's urging, Tennessee lawmakers in April approved $20 million in new annual funding for the centers - echoing a trend of Republican-controlled states seeking to boost funding or add new revenue to the centers in the year since the Supreme Court struck down Roe v. Wade.
This year, GOP-majority legislatures in 12 states passed 25 bills providing at least $250 million in new taxpayer funds or tax credits for crisis pregnancy centers, according to data collected by the Guttmacher Institute and Equity Forward, organizations that support abortion rights. That contrasts with seven similar bills passed in seven states totaling at least $115 million in 2021, before the Supreme Court's decision.
The number of states providing direct taxpayer funding to the centers has increased since 2021 from five states to nine states, according to the Guttmacher Institute. Four states also offer tax credits to the centers after two GOP legislatures passed bills this year, with Mississippi offering up to $10 million in tax breaks for donors.
For more than five decades, crisis pregnancy centers have offered services including pregnancy tests and, more recently, ultrasounds, typically coupled with antiabortion messaging. To supporters, the centers fill health-care gaps for women who weren't expecting to get pregnant while offering an alternative path to abortion. But abortion rights advocates and mainstream medical groups see them as deceptive and accuse them of misleading women into thinking they offer abortion services to get them in the door.
The centers now outnumber abortion clinics nationally by a 3-to-1 margin, according to the University of Georgia's Crisis Pregnancy Center Map, and have flourished in states where there are no longer any abortion clinics, such as Tennessee, which has 60, and Texas, which has 198 centers.
"We have seen that the states that have worked the hardest to either totally ban or severely restrict abortion have also worked to fund crisis pregnancy centers in new ways," said Andrea Swartzendruber, who helps lead the Georgia project, which supports abortion rights and identifies the location of more than 2,500 crisis pregnancy centers nationwide.
Tonya Baker Nelson, founder and chief executive officer of Hand of Hope Pregnancy Centers in North Carolina - where state funding increased from $3 million to $6 million this year - said her centers use state funds to offer women child-care grants or to buy products like car seats.
"It allows us to address some real, tangible needs," Baker Nelson said. "I think it's a wise move for states to support organizations that women turn to for support if they chose life."
But the increase in state funding has alarmed abortion rights supporters, who accuse the centers of misleading pregnant women and point to warnings by medical groups including the American Medical Association, which has called for a halt to public funding and has asked the organizations to "truthfully describe the services they offer."
In Democratic states this past year, lawmakers and governors have cut funding to the centers and have passed laws creating civil penalties for misleading women in an effort to stop them from seeking an abortion.
Pennsylvania Gov. Josh Shapiro (D) last month said he would not renew a $7.2 million contract with a nonprofit organization that distributes funding to the centers, and Minnesota's state legislature and Gov. Tim Walz (D) ended a similar $3.3 million annual grant in June. This year, Vermont, Illinois and Colorado also passed laws giving state attorneys general the power to investigate complaints and levy fines against centers that use deceptive or fraudulent practices.
"We are not trying to close them down," said Illinois state Rep. Terra Costa Howard (D), a lead sponsor of the bill in her state. "We are just trying to get them to stop deceiving women who are already in a scary situation."
Democrat-led efforts to tighten regulations on the centers face significant hurdles. The new laws seeking to rein in what critics call deceptive practices are being challenged in court on First Amendment grounds by antiabortion rights groups.
Thus far, judges have not found widespread fraud or abuse at the centers. In a 2017 ruling, a federal judge struck down a law in Baltimore, writing that "after seven years of litigation and a 1,295-page record before us, the City does not identify a single example of a woman who entered the Greater Baltimore Center's waiting room under the misimpression that she could obtain an abortion there."
And in a pending lawsuit challenging the Illinois law, a federal judge shot down a request last month for the law to go into effect while the court case plays out, saying the evidence of harm the centers are causing was "thread bare."
The rising partisan battle over crisis pregnancy centers has shone a new light on their increasingly prominent role in the antiabortion movement. Although many started out as grass-roots organizations in the 1970s, the centers are now mostly steered by a network of national antiabortion groups, including Heartbeat International, Care Net, and National Institute of Family and Life Advocates, according to industry officials and academic experts who have researched the centers.
"Their practices generally flew under the radar for a very long time and Dobbs flipped the switch," said Tara Murtha, a spokesperson and policy analyst with the Women's Law Project, referring to the Supreme Court decision that ended constitutional protections for abortion. "Suddenly, many people were able to see the role that CPCs are playing as a key arm of the antiabortion movement."
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Republicans boost support
Although the first crisis pregnancy centers opened in the late 1960s, states did not get involved with funding them for several decades.
In 1996, Republicans in Pennsylvania created the nation's first state grant program. The state funds helped the centers flourish there. For every abortion clinic in the state, there are nine crisis pregnancy centers - triple the national average.
A handful of states followed Pennsylvania's lead, but GOP legislatures have significantly increased funding in recent years. In Texas, the state legislature in 2021 voted to bump up its $5 million in annual support to $50 million in each of the next two years.
That trend has accelerated since the Supreme Court's decision to overturn Roe in June 2022. By that year's end, 10 states had passed bills allocating $18.2 million in new funds to the centers.
That support jumped this year in states like Florida, where Republicans increased an annual grant to centers from $4.45 million to $25 million.
"States are recognizing that the centers are providing a service so the government doesn't have to carry the weight of that," said Jor-El Godsey, president of Heartbeat International, adding that in this post-Roe era, the funds will allow centers to help pregnant people "overcome obstacles that are now present because they no longer have abortion as an option . . . so they can take on the role of giving birth, perhaps placing for adoption or choosing to parent."
Despite the influx of state money, most funding to the centers comes from private donations, researchers say. The Charlotte Lozier Institute, a research arm of Susan B. Anthony Pro-Life America, said in a 2020 report that "at least 90 percent of total funding for centers is raised through private donations."
As Republican support for the centers has grown, medical groups have intensified their warnings about the practices in the centers and the role of state money in their operations. Because crisis pregnancy centers are not health clinics, they don't answer to state health regulators and do not have to comply with the federal patient privacy law known as HIPAA.
The American College of Obstetricians and Gynecologists has issued warnings about the "dangers" of the centers, including spreading false claims that abortion increases the risk of cancer, suicide and infertility. The organization also said staff at centers often use "misinformation and manipulation to delay people in finding abortion care until their pregnancies have progressed past the legal limit for abortion."
The group has also criticized centers for promoting an "abortion pill reversal" procedure, which it says is "unproven," "unethical" and "dangerous." Most medication abortions involve a two-step process. The centers encouraged pregnant people to not take the second pill - misoprostol - and instead take doses of progesterone, a hormone typically used to promote the growth of a fetus.
Centers defend the procedure, saying it is safe and effective 60 percent of the time if pregnant women act quickly enough. "I have literally met children whose mothers did the abortion pill reversal process," said Baker Nelson. "We promote it because in our experience, it works."
Critics of the centers cite a variety of concerns over how the state money is used, including a "pay by service" funding mechanism, which grants state money based on how much time is spent with clients and to reimburse the cost of whatever products were provided.
"It's incredibly inefficient. It would be less expensive to just give them the pack of diapers," said Murtha.
Timothy Head, executive director of Faith & Freedom Coalition, which lobbies for state funds for the centers, said clients are not required to sit through religious classes or programs in centers his group works with. However, he said the "admissions process" does includes information on the gestational stages of pregnancy and on the abortion process.
"It's part of the intake process. It's not like they say, 'God says abortions are a sin,'" Head said.
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Blue states push back
As crisis pregnancy centers have expanded across the United States, Democrats have long sought to limit their influence, citing the allegations of deceptive marketing and concerns about the quality of care women receive. But such efforts often run into court challenges.
Democratic-led cities and states have sought for years to investigate crisis pregnancy centers for allegedly deceptive practices. This year, state legislatures in Vermont, Illinois and Colorado passed laws giving the state attorneys general or other state officials the authority to investigate and levy fines.
"These centers have been on my radar for the better part of my life and we've attempted other things over the years," said Illinois state Rep. Kelly Cassidy (D), a co-sponsor of the bill and chairperson of an abortion rights working group within the state legislature. "This time around, we decided to look at it from a consumer fraud approach"
Democrats in Congress have also attempted to rein in what they say are deceptive marketing practices at the centers, with the latest coming last year from Sens. Elizabeth Warren (D-Mass.) and Robert Menendez (D-N.J.), who introduced a bill directing the Federal Trade Commission to prohibit deceptive or misleading advertising from crisis pregnancy centers. If passed, it would direct the commission to create rules for centers and fines they could face.
"CPCs often lure women seeking legitimate reproductive care - including abortions - into their facilities by advertising themselves as comprehensive reproductive health-care providers," Warren said on the Senate floor as she introduced the bill. "But this is flatly untrue."
Some Democratic governors have also pulled funding for the centers.
Shapiro cited the quality of care people were receiving at the centers in his decision to stop taxpayer funding to them and referenced a 2017 state audit that showed the nonprofit was using about 3 percent of the funds for projects outside Pennsylvania.
"For decades, taxpayer dollars have gone to fund Real Alternatives," Shapiro said in an Aug. 9 statement. "My administration will not continue that pattern - we will ensure women in this commonwealth receive the reproductive health care they deserve."
Real Alternatives did not respond to The Washington Post's requests for comment.
Legal battles are pending against many of the Democratic legislative efforts. Lawsuits have been filed in federal district courts challenging the Vermont, Illinois and Colorado bills, arguing they violate the First Amendment. A similar bill that passed in Connecticut in 2021 was challenged in court by an antiabortion group, but the lawsuit was ultimately dropped.
"We make several arguments in the case, but a big one is it violates our free speech rights," said Peter Breen, the lead attorney in the lawsuit that challenges the Illinois law. "We also included a free exercise claim under the religious freedom protections in the First Amendment. The law is not religiously neutral because it targets religiously motivated speech."
But legislators who have proposed the laws say the centers will not be barred from expressing their views on abortion and that no action will be taken against them if they market and present their mission and services accurately to clients before and after they head through their doors.
"As I repeatedly said during the debate, during the [legislative] hearings, if you don't lie, you have nothing to worry about," said Howard, the bill's sponsor.
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