Nine states, six of them in the South, have passed admittedly unconstitutional abortion bans this year with the express aim of challenging the right to terminate a pregnancy as established in the U.S. Supreme Court's 1973 Roe v. Wade decision.
But "heartbeat bills" aren't the only effort that legislatures are taking to restrict access to reproductive health care.
Nationwide, 14 states are sending tax dollars to so-called "crisis pregnancy centers" (CPCs), which pose as legitimate medical facilities offering free pregnancy testing and ultrasounds when in fact their true function is to dissuade people from seeking abortion, often by providing them with false information. Many women enter CPCs believing they are visiting a clinic that will provide them with counseling and resources for abortion and leave feeling manipulated and ashamed. The organizations intentionally target low-income women and women of color.
Of the states directly funding CPCs through the budgeting process, five are in the South: Florida, Georgia, Louisiana, North Carolina, and Texas. The Guttmacher Institute, a nonprofit research organization that studies reproductive health, classifies those states — along with all of the others in the region — as either "hostile," "very hostile," or "leaning hostile" on abortion rights.
CPCs in the United States can be traced back to 1967, when a man named Robert Pearson established one in Hawaii after the state legalized abortion. He also published an instruction manual for operating anti-abortion pregnancy centers with neutral facades. The movement took off the following year with the establishment of Canada-based Birthright International, a CPC network that today operates hundreds of chapters on three continents. Other major CPC networks operating in the U.S. include Care Net, Heartbeat International, and the National Institute of Family and Life Advocates.
In 1996, Missouri and Pennsylvania became the first states to fund CPCs. That year, Missouri's Democrat-controlled legislature appropriated $900,000 to CPCs, while Pennsylvania's Republican-controlled legislature used $2 million in federal grant money to launch its anti-abortion Project Women in Need.
The first Southern state to fund the organizations was Louisiana in 2003, when the legislature, then controlled by Democrats, budgeted $1.5 million to an abortion alternatives program that partners with CPCs and other anti-choice organizations. Louisiana's most recent budget earmarked $1.26 million for the program. In 2005, Florida began funding over 100 CPCs through its state Pregnancy Support Services Program; last year, Florida's Republican-controlled state legislature passed and former Florida Gov. Rick Scott (R) signed into law a bill requiring the state Department of Health to permanently contract with the Florida Pregnancy Care Network, a CPC umbrella organization that gets $4 million a year from the state. In 2006, the GOP-controlled Texas legislature created the Alternative to Abortions program, which has spent $73.2 million to date. In the 2017 fiscal year, the program provided over $9 million to one CPC network alone.
North Carolina's Republican-controlled legislature got involved in funding CPCs in 2013, sending $250,000 in grant money to Carolina Pregnancy Care Fellowship, a CPC network. Four years later, the state began directly appropriating funds to the network, allocating $2.3 million the first year alone. That same year, the state's Department of Health and Human Services launched a pilot partnership with Raleigh's chapter of Human Coalition, a Texas-based CPC. Though the text of the budget instructed that the $300,000 allocated to the group must be used for "nonsectarian purposes only," Human Coalition's website openly states: "Abortion is a stain on America. And the God who gives us life will not hold us guiltless."
In 2016, the Georgia legislature created the Positive Alternatives to Pregnancy and Parenting Grant Program that functions similarly to programs that fund CPCs in Florida and Texas. The legislation states that the grant money should be sent to nonprofits that "encourage childbirth instead of voluntary termination of pregnancy."
Meanwhile, Louisiana and Texas are funding CPCs in part with monies meant to help families living in poverty. Both states divert money to their respective CPC grant programs from Temporary Assistance for Needy Families (TANF) funds, which are supposed to provide cash benefits to struggling low-income families with children. And North Carolina has redirected $650,000 to CPCs from federal Maternal and Child Health Services grants, which are supposed to improve the health of low-income women.
Besides setting aside money for CPCs in their budgets, 32 states help fund the centers through the "Choose Life" license plate program, with West Virginia the only Southern state without one. The license plates have faced multiple challenges from pro-choice advocates. For example, the North Carolina chapter of the ACLU filed a lawsuit in 2011 challenging the constitutionality of the state offering an anti-abortion license plate without also offering a pro-choice alternative, but it lost at the appeals level. In 2010, Virginia became the first — and still only — Southern state to offer a counter "Trust Women/Respect Choice" license plate option, which generates $15 for the Virginia League of Planned Parenthood per each sale.
Despite the conclusion of the North Carolina Department of Health and Human Services that Carolina Pregnancy Care Fellowship had misspent $50,000 on explicitly religious materials, the state legislature now wants to give even more public money to CPCs. It recently passed a budget that proposes increasing Human Coalition funding to $3.4 million over the next two years, with an additional $1 million for other CPCs in the state. Democratic Gov. Roy Cooper vetoed the budget, citing its lack of Medicaid expansion; his own recommended spending plan did not include CPC funding. With legislative Republicans now lacking the numbers to override Cooper's veto on a party-line vote, negotiations are continuing, with a final budget deal possibly weeks away.
Earlier this year, the watchdog group Campaign for Accountability filed a request calling on Cooper, Attorney General Josh Stein, and Health and Human Services Department Secretary Mandy Cohen to investigate and terminate the department's contract to fund the Human Coalition, arguing that giving the group public money violates the U.S. and state constitutions due to the organization's religious nature.
"Given that the state has appropriated a total of $600,000 in grants to the organization — and may consider continuing or even expanding the pilot program in 2019 — an investigation into Human Coalition's use of public funds is imperative," wrote Campaign for Accountability attorney Alice C.C. Ruling.