As abortion access shrinks in the South, tax dollars flow to fake clinics

Billboard by Birthright International, an anti-abortion organization

Anti-abortion crisis pregnancy centers use billboards to mislead people seeking abortions or other reproductive health care services. The fake clinics outnumber abortion clinics 3 to 1 in the United States and are funded by taxpayer dollars in 16 states, including six in the South. (Photo by mad mags via Flickr.) 

Since the U.S. Supreme Court struck down the constitutional right to an abortion in its Dobbs v. Jackson Women's Health Organization ruling in June, at least 66 clinics in 15 states have stopped offering abortions, according to the Guttmacher Institute, a reproductive rights research and policy organization. In the South, 22 clinics have closed across eight states.

As options for abortion care shrink, pregnant people may encounter so-called "crisis pregnancy centers," or CPCs: anti-abortion organizations that have proliferated in recent years.

These organizations pose as health care centers, offering ultrasounds and pregnancy tests, but many have no medical professionals on staff. Often backed by religious groups, they aim to dissuade people from getting abortions, peddle potentially dangerous misinformation about abortion and contraception, and even hound patients after visits with anti-abortion messages, according to Dr. Anna Lowell, a family physician in Florida and a member of the Reproductive Health Access Project, which works with primary care clinicians to ensure equitable access to sexual and reproductive health care. 

"What concerns me is a lot of patients that seek abortion services, the ones that are going to be impacted the most after this Dobbs decision, are folks with low income, folks who have been already marginalized due to health care in general," Lowell said. "They might be lured into these centers because they offer a lot of free services. If they are already in a position of financial hardship, they might end up at one of these centers before getting to a clinic that can actually respect them, their decisions, their autonomy, and help them get the comprehensive care that they deserve."

There are at least 2,555 CPCs in the United States, where they outnumber abortion clinics by 3 to 1. The Southeast is home to 902 CPCs, or 35% of the national total, according to a database created by Andrea Swartzendruber and Danielle Lambert, associate professors of epidemiology and biostatistics at the University of Georgia College of Public Health. Texas has the region's most at 198, followed by Florida with 151, and Georgia and North Carolina, which each have 89.

The four Southern states with the most CPCs all fund them with taxpayer dollars. Arkansas and Louisiana are the other Southern states that fund CPCs; their legislatures each recently approved $1 million for them in the 2022-23 fiscal year. In all, 16 states nationwide allocate tax money to CPCs through programs that aim to provide abortion alternatives.

Exactly how much money goes to CPCs in each state is unclear, and some legislatures purposefully shroud the funding. An AP investigation published early this year found that $89 million went to CPCs in a dozen states during fiscal year 2021-22 alone. The AP also found that state governments in Florida, Georgia, Louisiana, North Carolina, and Texas have collectively given CPCs $282.3 million since 2010.

Pennsylvania was the first state to fund CPCs through its abortion alternatives program, and to date has given over $100 million to them, according to a report from the National Committee for Responsive Philantrophy. About 75% of U.S. CPCs are connected to four national anti-abortion organizations: Birthright International, an organization founded in 1968 by a Canadian housewife; Care Net, an evangelical Christian network of CPCs based in Virginia; Heartbeat International, an international anti-abortion association that supports the world's largest network of CPCs; and the National Institute of Family and Life Advocates, a legal organization founded in 1993 that represents CPCs.

Shifting funds to CPCs

At least 10 states — including Louisiana, North Carolina, and Texas in the South — support CPCs with funds from the Temporary Assistance to Needy Families welfare program, which is intended for low-income families, according to a 2021 report published by Equity Forward, an investigative research organization focused on human rights. In 2019, for example, North Carolina redirected $650,000 to CPCs from the Maternal and Child Health Services program, as Facing South previously reported. In fiscal year 2020-21, the Texas legislature diverted $6 million of TANF funds to CPCs. 

In Louisiana, the state legislature has shifted $1.3 million from the TANF program to the state's Alternatives to Abortion program since 2016, according to a report published earlier this year by Lift Louisiana, a reproductive rights advocacy group. The report found that the state anti-abortion program distributed $7.5 million to Caring to Love Ministries between 2011 and 2020 and $3.8 million to the Family Values Resource Institute between 2013 and 2020. In turn, the two anti-abortion organizations subcontracted with 19 CPCs.  

"We're concerned they're going to funnel even more funding into these pregnancy resource centers without actually requiring them to provide any real medical services that people may need," said Lift Louisiana co-founder Michelle Erenberg. 

TANF funds are not the only ones being diverted to CPCs. In Florida, for example, $1.5 million of the $2 million legislative budget for the Florida Pregnancy Support Services program — created in 2004 to discourage abortions in the state — came from the state's rape crisis program trust fund from 2011 to 2019, according to a report published last year by Floridians for Reproductive Freedom.

"Until taxpayers can be assured that these centers conform to ethical standards of licensed medical facilities, offer sound medical advice, and do not lead to harm, the state of Florida should refrain from directly or indirectly funding anti-abortion pregnancy centers," the report concluded.

State-funded CPCs are now getting some attention from federal lawmakers. Last month, U.S. Sen. Elizabeth Warren of Massachusetts along with five other Senate Democrats and independent Bernie Sanders sent a letter to Heartbeat International requesting information on how its CPCs are collecting, protecting, and using data over concerns that it could be deployed in abortion-related prosecutions.

"After luring pregnant people — many in desperate situations — to affiliate CPC facilities by using a variety of false and misleading tactics, Heartbeat International then collects a significant amount of their personal health care information, which in many cases does not appear to be protected by the Health Insurance Portability and Accountability Act (HIPAA)," the letter stated. "We fear that, in the wake of the Supreme Court's Dobbs v. Jackson Women's Health Organization decision that stripped women of their right to an abortion, this information may be used to put women's health and freedom to choose in jeopardy, and to put them and their health care providers at risk of criminal penalties."