The anti-abortion “social safety net”

When the last abortion clinic in Texas closes its doors for good, Prestonwood Pregnancy Center will remain.

So will Agape, with locations in Round Rock, Austin, Cedar Park, and Taylor. So will the Pregnancy Help Center, operating in Texas’s Brazoria County since 1990.

These are pregnancy resource centers, also known as crisis pregnancy centers, and for many years, their main mission has been to convince people not to have abortions (the three centers above did not respond to Vox’s request for comment). But now that the Supreme Court has overturned Roe v. Wade, abortion bans are either in effect or imminent in Texas and more than 20 other states around the country. In the coming months and years, pregnancy resource centers will have a bigger role to play — one that has researchers and reproductive justice advocates worried.

While many centers offer supplies like baby clothes and diapers, they’ve also been criticized for misleading pregnant people and spreading false claims about the dangers of abortion. In one congressional investigation, 87 percent of centers gave false or misleading medical information. Some centers have also been found to encourage people to delay an abortion decision until they are past the gestational limit, sometimes by misrepresenting state laws; one Texas woman even says she was told she could she could continue carrying an ectopic pregnancy — which are highly dangerous and almost never viable — if she was “careful.”

“It’s dangerous because they position themselves as legitimate health care centers,” said Onyenma Obiekea, policy analyst for the Black Women for Wellness Action Project, a reproductive justice advocacy group. “You earn the trust of community members only to offer this disinformation.”

As anti-abortion advocates and lawmakers plan for a post-Roe future, they’re increasingly talking about services people will need to get through unplanned pregnancy, childbirth, and parenting: things like diapers, formula, and help with food and rent.

For a lot of conservatives, the go-to solution for providing those resources is pregnancy centers. In Texas and at least eight other states, the centers already get government funding, and experts expect that funding to grow as the facilities move into providing more kinds of services, like adoption. The centers are part of a kind of parallel social safety net, created by anti-abortion groups and suffused with anti-abortion values, that’s likely to get larger and stronger in the years to come.

Though the centers don’t seem to serve large numbers of clients — yet — they do offer “basic things that financially struggling people need,” said Katrina Kimport, a professor at Advancing New Standards in Reproductive Health (ANSIRH), a group at the University of California San Francisco, who has studied the centers. However, critics say that in addition to spreading misinformation, they also promulgate a narrow vision of heterosexual, two-parent family life that may not be achievable or desirable for the people they aim to serve. At least as it stands now, “this is inadequate care.”

Inadequate though it may be, the anti-abortion safety net is about to see an influx of power and money. Americans on both sides of the issue will have to reckon with what that means.

Anti-abortion pregnancy centers are a big part of the right’s post-Roe plan

Abortion opponents have long been criticized for ignoring the needs of babies after they’re born, as well as the harms of having to carry an unplanned pregnancy to term. Leading up to the end of Roe, however, conservative lawmakers and activists have started to speak more loudly and publicly about what abortion bans are going to mean for people facing pregnancies they didn’t intend. “We are certainly going to have to provide women’s health at a higher level,” Louisiana state Rep. Rick Edmonds, a Republican and a pastor, told the Louisiana Illuminator last month. “We are going to see more babies, not less. So we have to find a way to add resources.”

It’s a concern for rank-and-file conservatives too. In a recent poll conducted for the Land Center for Cultural Engagement at Southwestern Baptist Theological Seminary, 62 percent of people who identified as “pro-life” agreed with the statement that a state that restricts abortion also “has a responsibility to increase support/options for women who have unwanted pregnancies.”

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The attitude is a change for Republicans, who have often opposed government programs for parents and children. “The political winds are definitely shifting,” said Patrick Brown, a fellow at the Ethics and Public Policy Center (EPPC), a conservative think tank. There’s “a lot more room to run on what the government should be doing and what it should be spending money on.”

Historically, however, the states that will ban abortion now that Roe has fallen also have the weakest support for children and families, often as a result of decisions made by Republican legislators. Reversing that, if lawmakers want to, will be no easy task.

In some cases, conservatives are supporting policies that have been progressive priorities in the past, including an expanded child tax credit or child allowance (a version of which Republican Sen. Mitt Romney (R-UT) introduced in June) and extended Medicaid coverage for people after they give birth. (Some Republicans remain staunchly opposed to such policies, with one Mississippi state legislator recently arguing that “we need to look for ways to keep people off, not put them on” Medicaid.)

Then there are pregnancy resource centers.

The centers have been around since the 1960s, proliferating after 1973, when Roe established the right to an abortion nationwide. They were founded, mostly by evangelical or other Christian groups, on the idea that “one-on-one ministry to people who were pregnant could talk people out of abortion,” Kimport said. Given that the centers’ original mission was to stop abortion, you might imagine that many would close after the fall of Roe since the procedure will now be banned across much of the country.

However, it’s already clear from public statements by the centers themselves and anti-abortion lawmakers that these facilities aren’t going anywhere. Instead, “what we will see is an attempt by abortion opponents and anti-abortion legislators to propose that these centers are the appropriate way for people who would want but cannot obtain an abortion to receive services,” Kimport said.

That’s already happening. “If at some point Roe v. Wade is overturned, we’re going to have to step up and fund places like these centers to be able to reach out to all those women who are now going, ‘I need help,’” Arkansas state Rep. Cindy Crawford, a Republican, told the Associated Press in March. Edmonds, the Louisiana representative, is backing a bill that would earmark $1 million from the state budget to help the centers build an online service network.

That’s on top of money that the centers already get from Louisiana and other states around the country as part of “alternatives to abortion” programs, which have been around since the 1990s and have grown in recent years. The largest, in Texas, received $100 million over two years in the latest budget cycle, and abortion opponents hope to see that grow further. “We always are working toward the increase in funding for the alternatives to abortion program,” said Amy O’Donnell, director of communications for the group Texas Alliance for Life.

“Our goal is to help women remove obstacles that they may face in going through an unplanned pregnancy so that they can successfully give birth to the baby and then keep that baby with support or place that baby for adoption, if that’s their choice,” O’Donnell said. “With that, we recognize that they’re going to need support both before and after birth.”

Critics say the anti-abortion safety net … isn’t one

Pregnancy resource centers do offer some forms of support to the people who visit them. In a small study published in 2020, Kimport found that women who visited the centers got things like baby clothes and prenatal vitamins, as well as services like pregnancy tests. Especially for low-income people, the centers can fill some of the gaps in states where more conventional social services, from Medicaid to food stamps, have been cut to the bone.

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However, researchers and reproductive-rights advocates have deep concerns about the idea that pregnancy resource centers could step in to become a substitute for the right to an abortion.

At the most basic level, the centers do not provide abortion, which is something a lot of people want. Reproductive rights groups argue that support during an unplanned pregnancy is no substitute for the choice of whether to carry that pregnancy to term. “There’s nothing that a crisis pregnancy center can offer that is equal to getting an abortion,” said Morgan Moone, strategic data and advocacy manager for the New Orleans-based Reproductive Justice Action Collective (ReJAC). “Abortion is providing opportunity; it’s providing autonomy over an individual’s body.”

Moreover, people who are seeking abortion may not be interested in goods and services to help them carry the pregnancy to term instead. Kimport’s research suggests that pregnancy resource centers are not especially popular. During a two-year period of recruiting study participants at prenatal clinics, she and her team were able to find only 21 people who had been to such a center and were willing to talk about the experience (and only a handful who had visited one but didn’t want to talk).

The majority of people who had visited the centers were not considering abortion; they just needed assistance continuing a wanted pregnancy. After Texas passed the restrictive abortion law SB 8, abortions among Texans fell by only about 10 percent, suggesting that most people in the state who wanted abortions found a way to get them — they did not visit a pregnancy center for support in giving birth and raising a child.

Another concern is the actual services that pregnancy resource centers provide. Research from the University of Georgia has found that while the centers sometimes present themselves as medical providers and offer services like ultrasounds, they also often spread misinformation about abortion, such as the false claim that it causes breast cancer. The centers often are not staffed by medical personnel. One 2007 study conducted by the NARAL ProChoice Maryland Fund found that just 18 percent of Maryland centers had staff with medical training. In addition, anti-abortion centers may spread misinformation about sexually transmitted infections and contraception, or provide no information at all.

“That’s harmful,” said Obiekea, of the Black Women for Wellness Action Project. “This is information about your health.”

The centers are also not subject to the same ethical and privacy regulations that govern medical clinics. The centers can collect and store data on clients’ sexual and reproductive history, test results, ultrasounds, and more, according to Time. That data could then be turned over to law enforcement to sue or prosecute abortion providers or even pregnant people themselves.

Most pregnancy resource centers remain affiliated with churches or other Christian groups, and Christian religious messages are typically part of their counseling. Anti-abortion advocates say the centers are still open to all, regardless of religion: “There are some who may look for an open-door opportunity to share their Christian views, but they are also very happy to navigate around that,” O’Donnell said. According to Kimport, however, while people don’t have to be Christian to visit a center, hearing the religious messages is typically “not optional.”

Moreover, the centers’ programming is often “informed by a normative idea of gender, of families, that may or may not conform to what the clients want, are interested in, or are even able to achieve,” Kimport said. That includes “an expectation of monogamy, of marriage, of a two-parent home,” and of a male breadwinner and “female caretaker and primary caregiver,” which may not be realistic or desirable for many Americans. Overall, “it’s not a client-centered safety net,” Kimport said. “It is much more top-down-directed, and directed by people who, to the best of my knowledge, do not have experience in the delivery of basic services.”

Then there’s the fact that diverting state funding to pregnancy resource centers can take away from the existing social safety net. In at least 10 states, for example, the centers receive money from the federal Temporary Assistance for Needy Families program — money that would otherwise go to non-religiously affiliated welfare programs for kids and parents in poverty. Such programs aren’t perfect; they, too, can employ a top-down approach that fails to center families’ needs.

But pregnancy resource centers are not set up to act as a substitute. “These centers have not historically been tied into existing structures of the social safety net,” Kimport said. They typically don’t have social workers on staff and are not well-versed in navigating the complex web of government services available for low-income families. “People are not getting any kind of wraparound care.”

Leah M. Willingham/AP

The centers also aren’t always subject to the same kinds of reporting and transparency requirements that govern social safety net programs, leading some to question how they’re really spending their money. A 2018 investigation by the Austin Chronicle found that at a number of Texas centers, the overwhelming majority of state money was spent on counseling rather than on any kind of tangible goods like baby clothes or food.

Some say it’s impossible to know how effective pregnancy resource centers will be as a part of the social safety net until they actually enter their new, post-Roe role. As Brown, the EPPC fellow, put it, “you can’t know until it’s live.”

One thing, however, is clear: The anti-abortion movement is about to have its biggest chance in decades to shape American public policy, and pregnancy resource centers — along with churches and other religiously affiliated organizations like a Dallas-area “maternity ranch” for pregnant people and single moms — are a major part of the movement’s vision.

Given this, some hope the centers can adapt to their new role and get better at supporting people, by offering more postpartum help, for example, or doing a better job of working with other services. “To the extent that this is the delivery system that states have decided to invest in, I hope the centers can grow from that,” Kimport said.

Reproductive rights and justice organizations have also made some efforts to create resource centers of their own. All Options Pregnancy Center in Bloomington, Indiana, for example, offers diapers and wipes alongside referrals to abortion clinics and funding resources.

Other advocates are working on providing information on all of people’s reproductive options, including abortion, even as it gets more difficult to access. “When we find ourselves at the crossroads of moments like this, where there’s a lot of confusion, where there’s a lot of fear, where there’s a lot of emotion, it’s easy to not know where to turn,” said Moore of ReJAC, the New Orleans reproductive justice group. To combat that feeling, the organization is working on raising awareness around where and when people can still get abortions, as well as how they can help others with money or transportation.

The Black Women for Wellness Action Project, meanwhile, is backing a California bill that would fund community-based organizations that provide medically accurate sexual and reproductive health information. “It’s a challenge,” Obiekea said of the post-Roe landscape, but “not one that we’re backing down from.”

“We absolutely believe in the power of an informed public,” Moore said. “It’s something that we believe is critical in ensuring that people can make the best decisions for their bodies, for their families, for their communities.”