Crisis Pregnancy Centers: Money for Nothing
Despite unprecedented taxpayer investment, state-funded crisis pregnancy centers deliver few services
"They won't tell you this wherever they do these things, but it's a very big risk. You may never be able to conceive children. There's about a 90% chance you may never be able to have children down that road."
That was one of the misleading and deceptive messages imparted to Laura Gorsky and Breanne Wenke by crisis pregnancy center counselors during a March visit to the TruCare pregnancy resource center in South Austin. While there, Gorsky and Wenke were also sold a slew of other medically unproven information about abortion, including negative mental side effects and emotional distress, false claims debunked by the American Psychological Association. The procedure, they were warned, was "very painful," and they would "hear the vacuum sucking the fetus out."
The CPC counselor went on to conflate the abortion pill with Plan B, saying the pill acts to stop a woman from being impregnated, a dangerous medical lie. Even though the women told the counselor that the father was out of the picture and disinterested, she pressed them to inform him of the pregnancy and reminded them "God had a plan." She advised them to take the weekend and strongly consider their options.
In the end, Gorsky and Wenke evaded harm as they were undercover, posing as abortion-seeking women for NARAL Pro-Choice Texas. But what they found – a disturbing and manipulative interaction – aligns with other experiences women have undergone at some of the state's nearly 200 crisis pregnancy centers. Often using vague language and even positioning themselves near abortion clinics to confuse vulnerable women, CPCs lure clients with the promise of comfort, care, and an ear to listen.
An attempt to elucidate services at CPCs recently found little support at the nation's highest court. On June 26, the U.S. Supreme Court ruled that a California law requiring centers to inform patients that abortions are not provided at the locations, and to disclose if they do not possess a state medical license, is a violation of the First Amendment. A blow to those fighting for more transparency at the deceptive centers, the ruling sent the case back down to lower courts for further consideration.
For the pro-choice community in Texas, the SCOTUS ruling reinforced the fact that the actual goal of CPCs – largely Christian-based nonmedical clinics – is to deter women from seeking abortion, by any means necessary, including scare tactics and false medical information. And they seem to be getting away with it. Perhaps more troubling: Not only does the state heavily underwrite dozens of these fake clinics, officials are giving them an unprecedented investment over the next two years.
Since its implementation in 2006, the Alternatives to Abortion program has included maternity homes and adoption centers, but the vast majority of the program's roughly 55 participants are crisis pregnancy centers. Siphoning money from the Temporary Assistance for Needy Families (TANF) – funds intended to help indigent families – as well as general revenue, Republican lawmakers have steadily maintained or increased funding to the A2A program since its inception, even while slashing family planning funding and cutting vital reproductive health options, such as cancer screenings and preventative care.
In fact, Texas accounts for nearly half of the $40.5 million in state funding of fake clinics in 14 states across the country, according to a nationwide analysis by Rewire.News. The Texas program initially got $2.5 million in 2008, $4 million in 2010, and $5.15 million by 2014. And since 2015, when the Chronicle last dug into the program ("Millions for Propaganda … Nothing for Women's Health," April 17, 2015), lawmakers have only ratcheted up their investments. The Legislature infused the A2A program with $18 million for the 2016-17 biennium. But that sizable chunk of taxpayer dollars is still only half of what they ended up giving CPCs the following legislative session.
Breathing "Dirty Air"
Despite numerous media and advocacy reports showing glaring systemic problems with the program, including religious proselytizing and paltry institutional oversight, the Republican-dominated Legislature voted to grant the Alternatives to Abortion program a record level of taxpayer funding last year. For 2018-19, the program received a stunning $20 million increase, doubling the previous allotment, and bringing its two-year total to $38.3 million. That's nearly eight times its initial $5 million two-year starting budget. Since 2006, A2A has been allocated a whopping $93.2 million.
Surely stinging to state agencies that have faced financial cuts over the years, the extra funds were not even part of the Health and Human Services Commission's budget request. Instead, they were prompted by far-right anti-choice Freedom Caucus member Rep. Matt Krause, R-Ft. Worth. As an amendment to the budget, Krause diverted those $20 million in funds from the Texas Commission for Environmental Quality's air quality assessment and planning program to A2A. (Initially, the plan was to strip funds from the Department of Agriculture, but the pushback among the rural caucus proved too forceful.) "So we are just throwing more money at the [A2A program] that they didn't even specifically request?" asked Rep. Eddie Lucio III during the House floor debate. "I have a hard time believing [the TCEQ] has more money than they know what do with." Rep. Rafael Anchia, D-Dallas, called the move "robbery" and said the TCEQ program is in "desperate need," pointing to the importance of air quality in pulling cities out of non-attainment status, which some federal funds are contingent upon. "This is not a pro-life amendment," said Rep. Anchia. "This is a pro-birth amendment. After that, you're on your own. You're going to have to breathe dirty air."
One of the key components affected by the hefty financial diversion is the Texas Emissions Reduction Plan, which saw a $41 million drop in funding from 2016-17 to 2018-19, according to TCEQ figures. The program grants monetary incentives to owners and operators of heavy-duty vehicles to replace or repower those vehicles with newer models that have less air emissions. The program, aimed at reducing smog, is particularly vital in areas in Texas that are not meeting the National Ambient Air Quality Standards for ozone. If Texas fails to submit an approvable plan to come into attainment, it could face federal sanctions, including loss of highway funds and more costly and stringent permitting.
"No matter what you think of abortion, you shouldn't be taking money from air quality programs that work," said Cyrus Reed, conservation director of Sierra Club's Lone Star chapter, during a recent interview. "If you care about fetuses and pregnant women, you should care that they are breathing in dirty air."
Capitol leadership and insiders allayed Reed and environmental advocates with promises that the massive divestment would be shifted back before session end, assuring them the funding move was merely "GOP primary politics." However, those guarantees never materialized, leaving Reed and others lobbying the Lege to fully fund the program months before next session. While Texas has made some solid progress on the clean air front, Reed stresses nearly half the state's population live in areas that at times violate clean air standards. The Texas Emissions Reduction Plan, he says, has been wildly successful in curbing air pollution. Indeed, the air quality program reduced nitrogen oxide emissions by an estimated 182,000 tons since 2001, according to documents from TCEQ.
Big Money, Few Services
Meanwhile, funding toward the A2A program has shown a heavy investment in anti-choice persuasion rather than tangible services, let alone legitimate health care. While proponents of the program enjoy touting its ostensibly myriad services for women – baby and maternity clothes, childbirth and parenting classes, food pantries – to justify its existence, the overwhelming bulk of services provided by state-funded CPCs fall under "counsel time," as records obtained by the Chronicle under a public information request from the Health and Human Services Commission show. "Counseling" at CPCs entails a stated mission to deter women from choosing abortion, and as evidence has shown, includes conversations rife with scare tactics and medical misinformation.
Counselors not only push adoption and parenthood on women who come through the doors, but also feed them lies about abortion, including the false threat of breast cancer – rejected by the American College of Obstetricians and Gynecologists and eight other medical organizations – according to state and national investigations by NARAL Pro-Choice. Some counselors even shame rape survivors: At a state-funded CPC in Texas, counselors handed an investigator posing as a person who was pregnant as a result of a sexual assault a pamphlet titled "Protecting Yourself from Rape & Date Rape" that blames sexual assault survivors for the rape. "If you are afraid of rejection, or of being called a 'prude' or a 'goody-goody,' or if you can't say no to verbal or even physical pressure, you are a setup for unwanted sex and its many consequences," it reads. CPCs routinely instill fear by peddling the debunked "post-abortion stress syndrome," inflate complication rates; and provide negative or false information about contraception, encouraging women to practice abstinence. And state data makes clear having those conversations are a priority.
For instance, since 2015, Austin LifeCare on West Anderson Lane received more than $200,000 for services; of that, nearly half went toward counseling. A sample: From 2015-16, just $725 was spent on baby clothing while $33,000 paid for counseling. Despite the uneven investment, LifeCare excitedly boasted about "shelves full of baby boy clothes" in their "newly renovated baby boutique" on Facebook earlier this year. Likewise, of the $56,000 the state gave the Pregnancy Help Center of Williamson County over the past three years, more than half was used for counsel time. From 2016-17, some $14,000 went to counseling – just $138 went to the maternity clothing pantry.
Similarly, St. John Paul II Life Center on West 38th Street has gotten around $120,000 in taxpayer dollars since 2015, with more than half flowing to counseling, according to provider summary records. While $18,000 was spent on counseling from 2015-16, less than $1,000 went to food and maternity clothing combined. Overtly Catholic, the center claims on its website that they've served "1000+ moms with only three percent choosing abortion and another 12 making adoption plans!" Elsewhere, they encourage "prayer for those threatened or hurt by abortion." While they peddle their advanced OB-GYN health care, don't expect to find actual comprehensive care – there or at most any CPC – they're strongly against offering contraception.
"Making a pregnant woman's access to services conditional on listening to misinformation and religious proselytizing should not be a policy of the state government and certainly should not be funded at the expense of air quality and other social programs," said Blake Rocap of NARAL Pro-Choice Texas. "The unfortunate truth is that women's health is so politicized that even fiscally conservative lawmakers who would rant about waste and abuse in any other realm have no problem with this, just so they can win the political patronage of their tribe."
The St. John Paul II Life Center also heavily advertises state-of-the-art ultrasounds, another strategy employed by several CPCs to lure women through the door. But those sonograms aren't medical, meaning they will not count toward the state-mandated ultrasound needed 24 hours prior to an abortion. The deception ends up delaying women from abortion and pushing them further into their pregnancy. Young girls and women who are clients of local nonprofit Jane's Due Process report CPC counselors told them they were either too far along in their pregnancies for abortion or completely misinformed them of their gestational age in order to delay their abortions. One "Jane," already a parent, went to a CPC for the free sonogram instead of an abortion clinic because she didn't have the $115 needed for a required ultrasound. While the CPC gave her diapers for her son, the nonmedical ultrasound postponed her from the procedure another two weeks. To top it off, the CPC counselor scared her into thinking she would be "killing" her baby.
Often operating under the guise of medical clinics, some CPCs include "choice" in their name to further mislead women. (For example, First Choice Pregnancy Resource Center and Life Choices Medical Clinic are among state-funded CPCs.) In a biting segment on HBO's Last Week Tonight With John Oliver, former abortion clinic worker turned anti-choice poster child Abby Johnson is heard highlighting the strategy before an annual anti-abortion conference in 2012: "We want to appear neutral on the outside. The best call, the best client you ever get is one that thinks they're walking into an abortion clinic. Okay? Those are the best clients that could ever walk in your door or call your center – the ones that think you provide abortions."
While the U.S. Supreme Court vindicated reproductive health providers by striking down major portions of House Bill 2, the draconian law left in its wake a string of shuttered clinics that have struggled to reopen. Prior to HB 2, Texas was home to more than 40 abortion clinics; after the law went into effect, that number was cut by more than half. The roughly 170 crisis pregnancy centers in Texas far overshadow the 21 actual clinics standing today. With Texas leading the country in "abortion deserts" – places where patients must trek more than 100 miles to get care – it's no wonder women may find themselves at the doorstep of a CPC along the way.
With coercion and deception as part and parcel of the game plan, CPCs also enjoy a lack of regulation and oversight within the Alternatives to Abortion program. While most public health programs are required to be evaluated on their state cost savings and health care outcomes, the A2A program, overseen by the anti-abortion nonprofit Texas Pregnancy Care Network, only reports back with how many clients are served and anecdotal stories of those clients' positive experiences. Abortion clinics, bound to a litany of rules and regulations, see (at least) annual inspections from the Department of State Health Services, while CPCs are not licensed or regulated by the state. John McNamara, head of the nonprofit, is relatively well compensated: He made $325,000 over 2014-15, according to 990 tax forms.
"It's quite disturbing to be putting that amount of money into basically a referral service with no direct care for pregnant women, especially when we know we have a deep need for family planning services," says Rep. Donna Howard, D-Austin, a former president of the Texas Nurses Association. Howard opposed the increased investment on the House floor, saying the move to divert money from TCEQ was a violation of taxpayer trust. "And we have no idea what the real outcomes of this program are," she said. "At no point in time has there been any metrics that indicate a need for a financial expansion. Some legislators continue to make the decision to fund the Alternatives to Abortion program based on ideology rather than looking at what evidence-based programs actually improve the lives of Texas women and their families."
Dismantling a System
While the state fills the coffers of anti-choice crisis pregnancy centers, it still hasn't repaired the damage it inflicted on women's health care, making the lucrative investment in CPCs all the more distressing to health care advocates like Howard. In 2011, the state dramatically cut the family planning budget by two-thirds, $74 million, in an ideological maneuver leading to 80 health clinics closing or discontinuing family planning services. A couple of years later it booted Planned Parenthood from a Medicaid program (now called "Healthy Texas Women"), which left 50,000 women without basic preventive health care such as cancer screenings and annual exams. A drastic provider shortage, even with increased legislative investment in women's health, has made returning to the same levels as before the cuts nearly impossible.
A report released in late April by the Health and Human Services Commission reveals the state still isn't serving the number of women it did prior to those massive reductions. While data shows that the family planning and Healthy Texas Women programs served more women in 2017 than in 2016, the state changed up its reporting methodology, making direct comparisons more difficult to quickly discern. However, an analysis by the Center for Public Policy Priorities finds that clients served in 2017 are still substantially down by tens of thousands of women from 2010, even after all of the new legislative investment. In 2017, 46% of all Healthy Texas Women providers didn't serve any women. "It's so quick to dismantle a system but much slower to build it back even when money is on the table," says Stacey Pogue, senior policy analyst at CPPP.
Adding insult to injury, the state doled out millions in taxpayer dollars from the Family Planning Program and the Healthy Texas Women program to the Heidi Group, a Round Rock-based nonprofit that runs a network of crisis pregnancy centers headed by a vehement anti-choice activist. The Christian-based group once vied to oversee the Alternatives to Abortion program, losing out to TPCN. While no longer part of A2A, it has gotten thousands in state funds over the years. Unsurprisingly, the ill-equipped and unqualified organization failed at its mission, serving fewer than 3,500 patients when their goal was to serve more than 17,000. The gross mismanagement led government watchdog Campaign for Accountability to file a criminal complaint. As a result of public outcry and failure to meet basic goals, HHSC yanked $4 million from the original $5.1 million FPP contract with the Heidi Group for 2017.
While it seemed like the health commission had learned its lesson, the reality was that they were ready to double down on their investment. According to documents obtained by the Texas Freedom Network, HHSC at the end of August 2017 renewed its contracts with the Heidi Group under both the FPP – for $5.1 million each in 2018 and 2019 – and the Healthy Texas Women program – $1.6 million a year. In fact, TFN notes, the group's founder, Carol Everett, signed the contract renewal just three days after signing off on the contract amendment that nixed the 2017 funding. "It's hard to see how this is not a racket funded at the expense of taxpayers and especially women," said Kathy Miller, president of the Texas Freedom Network, earlier this year. "Millions of dollars that could go to helping women who need health care will instead go to a demonstrably unqualified anti-abortion group pushing a political agenda."
Given the track record of questionable investments, advocates are skeptical – cautiously optimistic at best – about the $20 million in A2A funds that are now earmarked for "services for new parents until the child's third birthday" and for connecting pregnant mothers to financial assistance programs such as Medicaid, CHIP, and food stamps. The HHSC also plans to expand job training and placement for mothers under the program. However, legislators like Howard are being left in the dark about the details, and it's unclear if those funds will just end up flowing to CPCs or other unqualified providers.
"Obviously these are programs that could help, but the real question is how are they actually going to be providing the services, what does this really mean, and how are they ramping this up?" says Howard. "We have nothing right now indicating how this is going to be done."
With an unprecedented state investment, crisis pregnancy centers stand to gain even more money under the anti-choice Trump administration. Newly proposed rules about who gets Title X funding – a $260 million program meant to help low-income women obtain preventive care including contraception – opens the door for unqualified providers like CPCs and faith-based groups to win federal funds, while making it nearly impossible for organizations like Planned Parenthood to get them. "These rules signal how the administration is seeking to reshape policies related to women's health," says Kami Geoffray of the Women's Health and Family Planning Association of Texas, which currently administers the Title X funds. "They want the network to add more entities that have not historically participated in Title X." Under the potential rules, that includes providers that have objections to contraception; emphasize natural family planning and abstinence education only; and that don't refer patients to abortion. (The public comment period for those rules, published June 1, ends July 31.)
The Texas Health and Human Services Commission is currently competing with the Coalition to get their hands back on those funds, removed from their grasp under the Obama administration. Applicants likely won't know who wins until later this fall. In the meantime, the federal regime promises an uphill battle for reproductive rights: Leading the U.S. Department of Health & Human Services office in charge of the Title X money is Trump appointee Diane Foley – former president of Life Network, an organization that supports "alternatives to abortion" and runs two CPCs in Colorado. According to Foley, abortion is "a lot" like the Holocaust and slavery. "What about what was happening in Europe during the World Wars?" she asked during a bible school event in 2016, comparing the fate of a fetus to the suffering of millions of humans in concentration camps. "Were there groups of people that were determined they weren't worth as much? Absolutely."