When Monica Gonzales* stepped into a center advertised as a helpful resource for navigating an unplanned pregnancy, she was handed a Bible.
As a 19-year-old undergraduate college student with ambitious career goals, Gonzales knew she wasn’t ready to be a mother. So when her pregnancy test came back positive, Gonzales felt alone, isolated, scared. She confided in a friend, who referred her to the Brazos Valley Coalition for Life Pregnancy Center in Bryan, TX. Gonzales hoped the center would provide her with some clarity.
Instead, says Gonzales, they brokeher trust.
Determined to make the right choice for her future, she explained her situation to two counselors who seemed eager to persuade the vulnerable teenager to carry her pregnancy to term, no matter what. Gonzales was told if she underwent an abortion she would likely get cancer and that having children in the future would be very difficult. She was told it wasn’t right to choose abortion—you’re not thinking about this clearly, they said, you need to wait. Gonzales was then given a Bible and told her religion should and would play a major part in her decision.
“I felt frustrated. It’s like they weren’t listening to me at all,” she recalled later in an interview with the Current.
“They gave me false information, they didn’t respect my opinion of what I wanted to do, they didn’t think I had the self-determination to make this choice for myself,” said Gonzales. When she told the counselors she was considering abortion, “They really tried to appeal to me emotionally, religiously, with anything they could to convince me that I was making the wrong decision”
The pressure didn’t stop there. For weeks after the visit, the counselors called nearly every day and left phone messages with Gonzales. They even showed up at her dorm at Texas A&M, brochures and Bible in hand. Gonzales says she faced borderline harassment.
“[The counselor] wanted to know if I was still going to have an abortion, I told her that I didn’t want to talk to her. I asked her to leave, and I told her to never come back. I told her that I made my decision,” she said.
Days later, she was still finding pamphlets and fliers underneath her door.
To varying degrees, scenes like this one play out all across Texas. Crisis pregnancy centers (CPCs) attract pregnant women with promises of non-judgmental counseling, free pregnancy testing and maternity assistance like baby clothing and food. While some may offer limited ultrasound, most CPCs fail to deliver any reproductive health services, like birth control, pap smears or STD testing. Counselors like the ones Gonzales interacted with aren’t required to have state licensing and the centers themselves don’t fall under the direct purview of a state regulatory agency, which is problematic as some CPCs also have a record of contract violations.
*Pseudonym used to protect anonymity
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In essence, CPCs are—oftentimes not clearly labeled—anti-choice centers, functioning with the mission to deter women from abortion. Historically controversial, CPCs have come under heavy criticism for misleading women when it comes to facts about abortion and its effects. Usually Christian-affiliated and functioning under the umbrella of a national anti-choice group like CareNet, Heartbeat International or Birthright International, CPCs are known to proselytize and conflate religious belief with educational information.
And taxpayers are picking up the check.
Of the more than 100 crisis pregnancy centers in Texas, about 30 receive more than $36 million in state funding combined.
A ‘Disheartening’ Investment
With one hand making drastic slashes to women’s health care and creating unprecedented obstacles to abortion access, the other hand of the Texas Legislature this session quietly increased funding for CPCs, bringing their state tab up to $5.15 million in 2014, from the $4.15 million designated for 2013. Created during the 2005 Texas Legislative session by former state Sen. Tommy Williams (R-Woodlands), the Alternatives to Abortion program diverted $5 million away from Temporary Assistance for Needy Families (TANF) funding—federal welfare subsidies meant to assist low-income, struggling households—and into Alternatives to Abortion, a statewide program for “pregnancy support services that promote childbirth.” Under the budget rider, the fund recipients are prohibited from referring their clients to any group that provides abortion or from associating with any organization that provides abortion. In later years, legislators redirected money from the family planning budget to pay for the Alternatives to Abortion program.
Since then, lawmakers have steadily funneled more than $36 million away from family planning and preventative women’s health care and into the Alternatives to Abortion program. According to general appropriations figures, from 2009 to 2013, Texas legislators consistently upped the dollar amount CPCs receive, setting a financial record this past legislative session. Over the next two years, CPCs will see an additional $10.3 million in taxpayer money from the state budget.
Comparatively—with the exception of a slight increase from 2009 to 2010—legislators have chipped away at family planning funding since 2006, notably slashing $74 million, or two-thirds, of family planning dollars from the budget in 2011, in a move aimed at punishing Planned Parenthood, which offers abortion-related information in addition to a host of other women’s and reproductive health services. Those cuts left some 147,000 women without access to basic reproductive health services and led to the closure of more than 50 family planning clinics—the majority of which were not Planned Parenthood—according to ongoing research conducted by The Texas Policy Evaluation Project at The University of Texas at Austin. Today, an estimated additional 26 state-funded (therefore, already prohibited from offering abortion care) clinics have ceased operations. Slicing further into the depleted funds, in 2012 the state declined $30 million in federal Medicaid dollars to keep Planned Parenthood out of a crucial preventative heath program geared toward low-income women.
By the state’s own calculations, the cuts are expected to cause an extra 24,000 unplanned births for women living in poverty over the next two years. The Texas Health and Human Services Commission estimates the burden on taxpayers through Medicaid infant care will cost $136 million. While legislators managed to restore $60 million in women’s health funding through the primary care program this past legislative session, reproductive health leaders are skeptical that will trickle back to specialized women’s health providers.
To get a sense of the Legislature’s decline in support for women’ health, in the five years before the Alternatives to Abortion program was created, family planning funding hovered between about $65-$80 million a year. After its inclusion in the state budget, those funds did not edge past $55 million. As birth control and other contraceptive methods to prevent unplanned pregnancies were washed away in the wave of shuttered clinics, some legislators point to the irony in subsidizing organizations that are ideologically opposed to birth control and often offer abstinence-only education, lending nothing in the way of unexpected pregnancy prevention.
“It’s very disheartening that our state is investing more money in crisis pregnancy centers while cutting back in other strategies we know make the difference in actually preventing unplanned pregnancies,” state Rep. Mike Villarreal (D-San Antonio) said from his district office.
Villarreal and other Democrats suggested legislation meant to prevent unplanned pregnancy, like sex education funding, and restoring family planning dollars, during the floor debate on House Bill 2, Texas’ new anti-abortion law that is expected to further weaken the women’s heath care safety net.
A GOP majority sunk all Democratic-led amendments, giving Villarreal and others pause in believing those Republicans’ ostensible objective of reducing unplanned pregnancy. The opportunity for consensus has diminished in the past couple of election cycles, says Villarreal.
“Since 2010 we’ve seen less flexibility on the Republicans’ part to collaborate on women’s health issues. If anything, we’ve seen the party become much more extreme in effectively making women’s choice illegal,” he said.
Instead of oversight directly from the state’s health commission, the Texas Pregnancy Care Network, an anti-abortion nonprofit, is in charge of monitoring and disbursing state funds to Texas’ more than 40 crisis pregnancy and maternity centers.
TPCN has come under scrutiny for inefficiencies and wastefulness. A report by reproductive rights advocacy organization NARAL Pro-Choice Texas shows TPCN failed to meet its own benchmarks, falling 35 percent short of its projected, self-identified goals in its first two years and overestimating its budget needs by $500,000 in 2010 while creating no new social services. The subcontractor also uses state money to purchase materials produced by religious organizations or available free from other sources, the report indicates.
“We’ve discovered they weren’t using that taxpayer money well and weren’t meeting their own goals in serving women,” says Heather Busby, NARAL’s executive director. “And at the same time, they’re getting an increase in public funding and aren’t being held accountable.”
In a recent attempt to obtain documents from TPCN, NARAL hit a brick wall. A Public Information Act request came up largely unresponsive, with portions of an Office of Inspector General performance audit redacted due to alleged “trade secrets.” Messages left for TPCN executive director John McNamara were not returned by press time.
“The same lawmakers that want overregulation of abortion clinics ask for zero regulation or oversight of these crisis pregnancy centers, it’s just a stark comparison there,” says Busby. “One is a medical clinic and the other is a religiously affiliated organization that is not beholden to give medically accurate information.”
A Right to No Facts
Of the six San Antonio-area CPCs, North SA’s A Woman’s Haven is the only one supported by state funding. The center touts “more than 35 years experience serving women facing an unplanned pregnancy” and advertises free, confidential and non-judgmental counseling and pregnancy tests at no cost in a pressure-free environment.
In total, A Woman’s Haven received more than $54,500 from the state since 2007, according to records obtained from the state Department of Health and Human Services. While CPCs tout aiding women with material assistance as a key contribution, the numbers reflect a different story. The CPC billed the state thousands in unlicensed “counsel” time over the years, but their reimbursements for food, baby clothing and furniture were comparatively scarce, revealing a disproportionate picture of their services. For instance, from 2008-2009 the CPC received $9,460 for counsel time and $1,764 for clothing—the most they asked for in this category since their induction into the Alternative to Abortion program. The food pantry received $21 dollars and the furniture stockpile saw no money from the state that same year.
In an effort to get a first-hand experience, the Current visited A Woman’s Haven for information about what a woman facing a crisis pregnancy should do and received factually inaccurate information. The center counselor provided an “A Woman’s Right to Know” pamphlet and drew attention to the supposed link between cancer and abortion as well as the relationship between abortion and difficulties in later pregnancy, false correlations often pedaled by the anti-choice movement. According to TPCN site visit records obtained from HHSC, A Woman’s Haven has been providing its clients with the brochure since at least 2009.
“This is important,” said the center counselor. “The connection between breast cancer and abortion—that’s something you need to know if you’re going to make that decision.”
Within the pages of “A Woman’s Right to Know,” created at the direction of 2003 legislation from one of the key authors of Texas’ new anti-abortion law and offered through the state’s Department of Health Services, a section outlines the threat of breast cancer for women who have undergone abortions. While women who carry their pregnancies to term may be less likely to develop this form of cancer in the future, women “do not get the same protective effect” if their pregnancies end in abortion. The brochure simultaneously notes that while further study is needed, “The risk may be higher if your first pregnancy is aborted.” As per Texas law, abortion doctors are required to give their patients a copy of this booklet.
However, leading medical organizations, including the non-partisan Texas Medical Association, refute such connections. In a letter sent to the HHSC, the Association calls information in the pamphlet “factually inaccurate and not science-based,” pointing to, among other factual discrepancies, the purported link between breast cancer and abortion. Both the National Cancer Institute and the American College of Obstetricians and Gynecologists (ACOG) agree that abortions, “have not been shown to increase a woman’s chance of developing breast cancer,” they write. (The American Cancer Society and the American Medical Association also concur.) TMA additionally counters the brochure’s claim of increased risks in an otherwise healthy pregnancy among women who have experienced abortion, pointing out the statement fails to offer references and cannot be found in peer-reviewed medical literature.
Representing some 47,000 physicians and medical students, TMA requested a “more rigorous approach to reviewing these materials to help ensure that language is rooted in science and evidence-based clinical literature.”
“When it comes to abortion, our policy supports informed and nonjudgmental counseling between the patient and the physician,” wrote TMA Chair of Maternal and Perinatal Health Committee, Dr. Yasser Zeid. “Unfortunately, the existing materials do not reflect these principles.”
State and federal investigations show the misinformation is a systemic pattern among CPCs. A 2006 U.S. Congressional investigation found that the “vast majority” of such federally funded pregnancy resource centers under review, “misrepresented the medical consequences of abortion,” and “often grossly exaggerating the risks,” of abortion’s link to cancer, future infertility and mental health effects. NARAL Pro-Choice Texas conducted undercover investigations of their own in 2009, reporting that all the taxpayer-funded CPCs visited repeated the false link between abortion and breast cancer and that 67 percent of centers cited false information about the efficacy of condoms in preventing sexually transmitted diseases.
On the legislative front, state Rep. Sarah Davis (R-Houston), a breast cancer survivor herself and the lone GOP dissenter in this summer’s abortion law vote, attempted to correct the errors. Davis’ bill was left pending in committee, but during a September political conference, she vowed to reintroduce the legislation next session.
Profit From Plates
Atop the increased state funding, CPCs are seeing an additional stream of money thanks to anti-choice legislation filed in 2011. Senate Bill 257 allowed for the creation and purchase of controversial “Choose Life” license plates from the Texas Department of Motor Vehicles. For $30, anyone with a car and an anti-choice point of view can wear their abortion ideology on their back-end bumper. While contention centered on the plates’ message, the controversy was not purely politically cosmetic.
The legislation also set up a special account, administered by the state Attorney General, directing $22 of the sale price to flow to any nonprofit organization that provides material assistance to pregnant women considering adoption without charging for services. The nonprofit must not contract with, affiliate with, or refer to abortion clinics, or (obviously) provide abortions, either. Based on those specific eligibility requirements, the pool of recipients narrow down to mostly CPCs. Further, the account can receive legislative appropriations and private gifts, grants and donations from “any source,” according to the legislation.
During floor debate over the legislation in 2011, then-state Rep. Joaquin Castro (D-San Antonio) described the bill language as “vague” and “disturbing,” and sought to regulate who could be part of the team overseeing fund recipients. State Rep. Villarreal argued unregulated centers shouldn’t see any extra public funding, offering up an amendment that would direct the dollars to regulated maternity homes. Despite these and other arguments, those amendments were tabled and the bill sailed through a Republican majority.
Today, that pot of money, some $39,000, netted from plate sales is set to be allocated to 13 grantees with no match or volunteer requirement strings attached. According to records obtained from the Office of the Attorney General, four of the 13 grant award winners already receive state funding through the Alternatives to Abortion program.
To ensure the money falls into the right hands, state Attorney General Greg Abbott stacked the committee tasked with reviewing the grant applications and making recommendations with anti-choice crusaders with backgrounds working for crisis pregnancy centers. Of the seven-member advisory committee, six have ties with or have headed Texas CPCs, some of which are state-funded. One sits on the advisory board of Texas Alliance For Life, the group that lobbied hard to make the plates a reality, and another previously served as a regional coordinator for the Gladney Center for Adoption, a soon-to-be recipient of $10,000 from the plate fund—the most generous grant award given.
A notable name in the bunch is Carol Everett, a former abortion clinic director who had a “change of heart” in the ’80s and took over a network of seven CPCs in Dallas. Everett also serves as founder and CEO of Heidi Group, a Christian-based national anti-choice group that once hoped to be the Alternatives to Abortion state contractor, losing out to TPCN. The Round Rock-based CPC network has received thousands in state funds through the Alternatives to Abortion program ($16,175 from September 2009-August 2010 alone). Everett has made a name for herself as a leading figure against the “abortion industry” and even penned a book about it pointedly titled Blood Money: Getting Rich off a Woman’s Right to Choose.
The Current spoke to Joe Pojman, founder and executive director of Texas Alliance for Life, from his office in Austin. TAL spent five Legislative sessions advocating for the plates, finally seeing success in 2011. Pojman said he hoped the money would flow toward organizations that promote adoption services, including pregnancy resource centers. But with millions already directed at CPCs, how could additional funding be rationalized?
“This money is targeted to promote infant adoption, the other state funds are not necessarily targeted to that,” said Pojman.
Pojman refuted the seeming conflict of interest one of his board members may pose to the Choose Life committee as well as the others who work with existing state-funded CPCs. Pojman countered that the advisory committee members simply “recommend” who should be awarded the money, they don’t disburse it. However, the state Attorney General’s website clearly indicates the committee will not only review grant applications but “distribute funds raised” by Choose Life plate sales.
False Advertising
“Are You Pregnant? Need Help? Call us,” reads a vague online description for A Woman’s Haven. A short YouTube video promises “loving friendship” for women who stand at a crossroads in their pregnancy decision. Eclipsed by a placard advertising the name of a medical doctor, the brick and mortar sign outside A Woman’s Haven is barely noticeable. The non-descript advertising by CPCs is nothing coincidental, argue critics.
CPCs seek to replicate advertising of actual health providers in an attempt to lure pregnant women like Gonzales who hope to learn about all their medical options, says NARAL’s Busby. There are no rules to ensure CPCs don’t intentionally—or unintentionally—deceive women about their services.
But some municipalities have taken the matter into their own hands. A handful of cities, like Austin, have tried to adopt transparency ordinances requiring CPCs to post signage explicitly indicating they do not offer abortion or birth control or employ licensed health care providers. Citing an infringement on free speech rights and religious freedom, a coalition of CPCs, represented by the conservative legal advocacy group Liberty Institute, fought back against Austin’s ‘truth in advertising’ measure, unanimously passed in 2010. As a result, councilmembers struck the former two disclosures, determining the latter would better hold up in court. At present, the case is still awaiting a judge’s decision, said Liberty Institute’s Gregg Wooding.
At the state level, six Democratic state Senators, including San Antonio’s Sen. Leticia Van de Putte, co-authored a bill this past session to ensure truthful disclosures and scientifically accurate information be delivered at CPCs. The legislation required the centers to prominently display signage indicating they are not a regulated medical facility. Delivered as an amendment to House Bill 2, it was dismissed by the GOP majority. State legislators have attempted to pass similar bills before, dating back to 2007, when state Rep. Villarreal proposed regulating CPCs. While that measure died in committee, Villarreal argues the need for transparency is even greater now, as the centers see increased funding.
“CPCs advertise themselves as health care providers, they purport to be able to help pregnant women in need of both physical and mental care—that is far from the truth. They are not health care providers in any fashion. They have an agenda,” said Villarreal. “At the least, since they are supported by public dollars, there needs to be transparency about what they do so we can make sure women aren’t being given misinformation, aren’t being misdirected or taken advantage of.”
Considered a purposefully misleading tactic by pro-choice advocates, CPCs are often found in close range to actual medical or abortion clinics. Whether deliberate or not, a CPC named A Choice for Women operates .1 mile, or a two-minute walk, away from the Planned Parenthood on Babcock Road.
‘A World Without Abortion’
With the full impact of Texas’ new anti-abortion law still materializing, as of this month an estimated 12-14 abortion clinics in the state can no longer provide services, signaling an already devastating effect to reproductive health care in the state. Health leaders say many clinics, typically equipped with small staffs and considerable overhead expenses, may end up closing as a result—several of these clinics also provide basic preventative health care. With 76 reproductive health providers financially crippled into closure by massive slashes to family planning funds as well as restrictive abortion legislation, the opportunity for CPCs to fill the void in these communities grows—perhaps, say critics, achieving the exact intention of conservative law makers.
Indeed, as Gov. Rick Perry vowed to make ‘abortion a thing of the past’ during an anti-choice rally at the Capitol earlier this year, alongside him stood a state-funded CPC clinic director, who warned against abortion and declared, “we show [our clients] the love of Jesus Christ. Our hope is to usher them into his kingdom.”
Even more telling, Perry appeared at a ribbon-cutting ceremony for The Source for Women CPC in Houston last September, delivering glowing praise of the center as one of the “cornerstones in the creation of a world without abortion.” After kicking Planned Parenthood out of a life-saving Medicaid program, Perry reported the chain of state-funded CPCs would eventually replace the reproductive health center, proclaiming proudly, “[t]he Source for Women clinics, in fact, will be part of Texas’ own Women’s Health Program, and Planned Parenthood will not be.”
“I don’t think it’s any coincidence that at the same time the state is enacting legislation and putting in place a funding scheme that closes down legitimate, unbiased, full-spectrum reproductive health clinics, they’re also giving more money to biased, religious centers,” said Busby.
“They are taking away women’s options, they’re taking away their access to unbiased, scientific, medically accurate facilities and leaving them with nothing but anti-choice centers to turn to. And I think it’s going be a disaster for the state,” she continued.
After careful consideration, Gonzales followed through with her decision to undergo an abortion. Today, she is a Houston-based attorney married to the man that she once became pregnant by. When she reflects on her choice, one that could have been clouded by the pressure from the CPC, she realizes if not for her steadfast resolve, the counselors could have coerced her into what she viewed as the wrong direction.
“I can’t imagine what it would be like for someone who didn’t have as much support around her or didn’t have a clear idea of what she was going to do,” said Gonzales. “To have someone mislead you about what you should be doing can really impact your right to choose.”
