US pregnancy centers that discourage women from having abortions are adding more health services – and may be poised for further expansion.
The expansion—from testing and treating sexually transmitted infections to even primary care—has been unfolding for years. It gained momentum after the Supreme Court overturned the decision Roe v. Wade three years ago clearing the way for states to ban abortion.
This push could get more momentum with the help of Planned Parenthood closure of some clinics and considering closing others following Medicaid changes. Planned Parenthood is not only the nation's largest abortion provider, but also offers cancer screenings, STI testing and treatment, and other reproductive health services.
“Ultimately, we want to replace Planned Parenthood with the services we offer,” said Heather Lawless, founder and director of the Reliance Center in Lewiston, Idaho. She said about 40% of patients at the anti-abortion center are there for reasons unrelated to pregnancy, including some who use a nurse practitioner as their primary caregiver.
The changes have upset abortion rights groups, who, in addition to opposing anti-abortion messages, they say they lack responsibility; stop birth control; and most offer only a limited number of ultrasound tests, which cannot be used to diagnose fetal abnormalities because the people performing them are not properly trained. An increasing number also offer unproven methods of reversing abortion with pills.
Because most centers don't accept insurance, federal laws limiting the release of medical information don't apply to them, although some say they comply with it anyway. They also are not required to follow the standards required by Medicaid or private insurers, although those that offer certain services are usually required to have medical directors who meet state licensing requirements.
“There are serious questions about whether this industry has the clinical infrastructure to provide the health care services it now advertises,” said Jennifer McKenna, a senior adviser at Reproductive Health and Freedom Watch, a project funded by liberal political organizations that studies pregnancy centers.
Perhaps best known as “crisis pregnancy centers.” These centers, mostly privately funded and religiously affiliated, expanded services such as diaper banks in anticipation of the 2022 Supreme Court decision Dobbs v. Women's Health Organization of Jackson.
When abortion bans went into effect, the centers expanded health, education and other programs, said Moira Gaul, a research fellow at the Charlotte Lozier Institute, the research arm of SBA Pro-Life America. “They are committed to serving their communities for the long term,” she said in a statement.
In Sacramento, California, for example, over the past two years, the Alternatives Pregnancy Center has added family practice physicians, a radiologist and a high-risk pregnancy specialist, as well as nurses and physician assistants. Alternatives, an affiliate of Heartbeat International, one of the largest associations of pregnancy centers in the United States, is the sole provider of care for some patients.
When The Associated Press asked to interview a patient who had received only non-pregnancy services, the clinic provided Jessica Rose, a 31-year-old woman who took a rare step toward detransition after seven years of living as a man, during which she underwent hormone therapy and a double mastectomy.
For the past two years, she has received all her medical care at Alternatives, which has an obstetrician-gynecologist who specializes in hormone therapy. Few, if any, pregnancy centers advertise that they provide detransition assistance. Alternatives has treated four such patients in the past year, although that is not its main mission, said director Heidi Matzke.
“APC gave me a space that aligned with my beliefs and also saw me as a woman,” Rose said. She said other clinics “tried to make me think detransitioning wasn't something I wanted to do.”
As of 2024, there were more than 2,600 anti-abortion pregnancy centers operating in the U.S., up from 87 in 2023, according to the Crisis Pregnancy Centers Map, a project led by University of Georgia public health researchers who are concerned about aspects of the centers' operations. Last year, 765 clinics offered abortions, down 40 from 2023, according to the Guttmacher Institute.
Over the years, pregnancy centers have received an influx of taxpayer funds. Nearly 20 states, mostly led by Republicans, now funnel millions of public dollars to these organizations. Texas alone sent $70 million to pregnancy centers this fiscal year, and Florida contributed more than $29 million to its “Pregnancy Support Services Program.”
This increase in resources is unfolding as Republicans ban on family planning from receiving Medicaid funds under tax and spending law President Donald Trump signed the agreement in July. Although federal law already blocked the use of taxpayer funds for most abortions, Medicaid reimbursement for other health care services accounted for a significant portion Planned Parenthood's income.
Planned Parenthood said its affiliates could be forced to close up to 200 clinics.
Some of them have already closed or reorganized. They have reduce the number of abortions in Wisconsin and eliminated Medicaid services in Arizona. Independent group of clinics in Maine primary health care stopped for the same reason. Uncertainty deepens pending changes to Medicaid This is expected to lead to an increase in the number of uninsured Americans.
Some abortion rights advocates fear it will create new health care deserts, where pregnancy centers become the only option for more women.
Caitlin Joshua, founder of the abortion rights group Abortion in America, lives in Louisiana, where Planned Parenthood closed its clinics in September.
She's concerned that women seeking care at pregnancy centers as a result of the closures won't get what they need. “These centers need to be regulated. They need to provide accurate information,” she said, “and not just get a message they didn't ask for.”
Thomas Glessner, founder and president of the National Institute of Family and Life Advocates, a network of 1,800 centers, said the centers do have government oversight through their medical directors. “Their criticism,” he said, “comes from a political agenda.”
In recent years, five Democratic state attorneys general have issued warnings that centers that advertise to people seeking abortions are not providing them or referring patients to clinics that do. And the Supreme Court agreed to consider whether a government investigation into the organization that runs the New Jersey centers is stifling its free speech.
Choices Health Services in Joplin, Mo., where a Planned Parenthood clinic closed last year, shifted from focusing solely on abortion prevention to a broader sexual health mission about 20 years ago when it began offering STI treatment, said its executive director, Carolyn Schrage.
The donor-funded center partners with law enforcement in locations where authorities may encounter pregnant adults, according to Arkansas State Police and Schrage.
She estimates that more than two-thirds of his work does not involve pregnancy.
Hayley Kelly first encountered Choices volunteers in 2019 at a regular weekly dinner they held for dancers at the strip club where she worked. She had been going to the center for STI testing for years. Then in 2023, when she was uninsured and struggling with drug addiction, she wanted to confirm the pregnancy.
She expected the staff to be upset that she was leaning toward abortion, but she said they were simply answering questions. As a result, she had this child, and later another one.
“It's an amazing place,” Kelly said. “I tell everyone I know, 'You can go there.'
The center, like others, does not provide contraception, a standard offering at sexual health clinics that experts say is a public health best practice.
“Our focus is on eliminating sexual risk,” Schrage said, “not just reducing it.”
