In 2015, 19-year-old Sarah* faced an unplanned pregnancy with an abusive partner. Sarah, who asked to be referred to by a pseudonym to protect her identity, was desperate and looking for resources to access an abortion in her hometown of Volusia County, Florida, where the closest Planned Parenthood was over 40 miles away in Orlando. A quick Google search led her to Grace House Pregnancy Center, a local center that presented itself as a women’s health center with reproductive health options. But soon after she arrived, she realized she had walked into a faith-based anti-abortion center whose objective was to manipulate her into continuing her pregnancy.
There are more than 2,500 anti-abortion centers in the U.S., otherwise referred to as crisis pregnancy centers. Anti-abortion centers now outnumber abortion clinics by a factor of 3:1. According to Guttmacher, the number of abortion clinics has increased in the Northeast and the West in recent years, but decreased in the Midwest and the South. In Texas, “Alternatives to Abortion” programs, which include anti-abortion centers, provided roughly 2.7 million services in 2021, including distributing 200,000 non-medical goods like diapers, car seats, clothing, and formula, offering 860,000 counseling sessions, and teaching 200,000 parenting classes, according to their latest annual report. In 2021, they served over 126,000 people.
Anti-abortion centers centers initially lure already vulnerable pregnant people by using search engine optimization strategies like including keywords such as “Pregnancy Help” in the center’s name and falsely advertising altruistic, cost-efficient care. These tactics are underwritten and supported by “Alternatives to Abortion” legislation that uses state tax revenue and federal funding from the Temporary Assistance for Needy Families (TANF) program to manipulate people into continuing unwanted pregnancies. According to Equity Forward, at the start of 2021, at least 13 states had a state agency-operated “Alternatives to Abortion” program, which includes anti-abortion centers and receives state or federal funding. Of the 13 states that receive state or federal funding for the programs, 10 of them will become abortion deserts—where abortion will be entirely banned or severely limited and criminalized once Roe is overturned.
As the country continues to prepare for a post-Roe reality, abortion advocates say anti-abortion centers will further endanger people in abortion deserts with limited options for abortion care.
“One of the most haunting parts of my experience trying to navigate what health care I needed was how it was a building I passed in my hometown a million times, and I had no idea it was connected to the big billboards about unplanned pregnancies, or that it was a part of a larger scheme,” Sarah said.
Sarah said she had no exposure to any type of sex education growing up in Florida and the website seemed like a blessing. It promised free pregnancy tests, counseling, and assistance with parenting, adoption, and abortion.
“I knew immediately that I needed to access an abortion, but didn’t really know what that would look like,” Sarah said. “I went in under the impression that they would help me navigate that, and it became very clear early on that was not the case. I felt so trapped.”
When Sarah walked in, she was the only patient present. As soon as she arrived, she had to fill out an intake form that asked if she attended church, what her faith was, how many sexual partners she had, and to rank what her options were among continuing the pregnancy, adoption, and abortion.
“It was those kinds of questions that were making me feel like maybe this isn’t a full-on health center,” Sarah said.
After seeing that Sarah wanted an abortion, they took her into a counseling session for about 20 minutes before letting her have a pregnancy test. During the session, she expressed that she was in an abusive relationship. Instead of providing useful resources to deal with an abusive relationship, Sarah said the counselor told her that having the child would give her a purpose, help with her depression, and cause her abusive partner to “grow up” and be a better person. While she waited for the results from the pregnancy test, the counselor continued to spread misinformation about abortions, telling her that it would cause infertility, while comparing people who have more than one sexual partner to “a used piece of duct tape.”
“I thought I had accidentally gone to a church facility, that’s what I thought the extent of it was because it’s incredibly faith-based,” Sarah said. “At one point the woman started praying over my stomach without my consent.”
When Sarah received the results of the test, they told her she was earlier in her pregnancy than she actually was—a strategy to prolong the pregnancy until she was at a stage where abortion would no longer be legal in the state. Sarah eventually went to Orange County for the abortion and since then has been working with Floridians for Reproductive Freedom to expose anti-abortion centers and the damage they cause.
“It was terrifying and full of shame,” Sarah said. “I was crying on my way out, and the woman at the desk said, ‘This is what happens when you have sex.’ I just wanted to be in a world where people who get pregnant have options and know that their own agency will be respected.”
While these centers purport to offer sonograms and other health care resources, they do not actually provide medical care. According to research by Equity Forward, their staff are often volunteers lacking any background in medical care. The offices, however, will appear “medicalized” where volunteers wear white coats, have minimal medical licensing, and offer non-diagnostic ultrasounds. Even worse, the centers use “earn while you learn” programs, which are implemented with federal TANF funding. During the programs, patients have to sit through hours of parenting classes, taking time out of their paying jobs, in order to earn “baby bucks”—tokens that can be exchanged for diapers, baby clothes, baby food, and other supplies in the center’s shop. Ironically, federal funding is barred from supporting abortion care due to the Hyde Amendment.
“Diverting [TANF] funds to the centers, who then mostly spend those funds on overhead costs and staffing needs, instead of directly giving money for people in need is outrageous,” said Ashley Underwood, the director of Equity Forward. “It’s disgusting, and so harmful. We are in the midst of a pandemic, we’re in the midst of an infant formula shortage, and it is so dehumanizing to think that funds are going to these centers which could be going to actual people who need real assistance for which TANF was designed to help.”
Underwood is also concerned about patients’ privacy. Since these centers are not legitimate medical care facilities, they are not bound by medical privacy laws, meaning that the intimate information shared on intake forms could be used against patients, especially as more states continue to pass laws criminalizing abortion care.
“There is a real concern about the surveillance tactics of it,” Underwood said. “Even in states where abortion will be protected, anti-abortion centers still exist. We have to think about what sort of strategies they will be using to manipulate people crossing state lines to receive care. There’s just several layers of concern here.”
For those seeking an abortion who are afraid of being tricked into entering an anti-abortion center, there are several ways to identify them. Advertisements that ask if you’re pregnant, scared, and need help is one sign that it’s not a legitimate clinic. Other tell-tale signs include being listed online as a “pregnancy help center” or “resource center.” Anti-abortion centers also do not offer any birth control options like condoms or the pill. People can avoid falling into these traps by first visiting abortionfinder.org to find an abortion provider in their area. They can also check to see if the anti-abortion center is listed on the Crisis Pregnancy Center Map, or The Fake Clinic Database.
Underwood hopes legislators and advocates will focus on why public dollars are being used to fund these programs, and she encourages legislators to divert federal funding to resources that actually support parenthood, like extended maternity leave, accessible child care, and abortion care.
“We really have to ask ourselves, why are we funding deception and corruption when we can be funding things such as direct financial support for people who are parents, who are pregnant, and also why are we spending money on these programs that deliberately mislead people about abortion?” Underwood said. “We are doing a lot of damage by funding these programs.”