Last month, during an Indiana state legislative hearing, Republican Sen. Jeff Raatz from Richmond, a small city in the eastern part of the state, discussed a resolution he filed declaring that the state’s general assembly “strongly supports pregnancy care centers in their unique, positive contributions to the individual lives of women, men, and babies—both born and unborn,” the Indiana Capital Chronicle reported. “We have hospitals in rural Indiana that have no OGBYNs,” Raatz said during the session. “Why not have an innocent individual stand alongside someone and help them make decisions and connect them with resources?” Abortion is banned in Indiana with limited exceptions.

Raatz was expressing a sentiment shared by many abortion opponents who insist that even as reproductive health clinics shutter their doors and states with abortion bans experience shortages in obstetric care, crisis pregnancy centers can fill the gap to support pregnant people. Anti-abortion crisis pregnancy centers, which are often affiliated with churches or faith-based charities, have proliferated in the last half-century and have become even more influential—largely due to government funding—since the Supreme Court’s Dobbs decision two years ago. Since then, states increased funding to centers by $500 million, The 19th reported last year. Currently, 18 states directly fund crisis pregnancy centers, according to the anti-abortion think tank Charlotte Lozier Institute. An analysis by the national research firm Health Management Associates reveals they’ve also received federal funding, totaling $429 million between 2017 and 2023.

For years, doctors, lawmakers, and reproductive rights groups have accused many of them of masquerading as abortion clinics to attract clients who may be considering the procedure and then dissuade them from going through with it. In Jacksonville, Florida, for instance, in a case I reported on for Reveal in 2022, state authorities investigated a pregnancy center volunteer accused of telling clients she was a doctor. She had performed ultrasounds on several women without a medical license, providing them with inaccurate information about their pregnancies. The women were later able to receive care at the nearby abortion clinic. Unlike medical clinics that must comply with various state and federal levels of oversight, these centers are also vastly unregulated, even as more of them offer medical services like ultrasounds and STI testing.

Add to this,concerns about patient privacy protections, another aspect of the lack of regulation. Most centers do not need to comply with HIPAA because they are not regulated like medical clinics. In addition to pregnancy tests, most now also offer free ultrasounds, a strategy that centers use to change women’s minds by offering a “window to the womb,” according to the National Institute of Family and Life Advocates, a pregnancy center trade association. In areas where there still are clinics that provide abortion services, many of these centers have opened nearby in an attempt to intercept patients. More than 2,500 centers currently operate across the country, compared to nearly 800 abortion clinics.

“Republicans have felt obligated to show some kind of concern for abortion seekers or people who have unplanned pregnancies.”

“Republicans have felt obligated to show some kind of concern for abortion seekers or people who have unplanned pregnancies,” saysMary Ziegler, a professor at UC Davis School of Law and one of the leading historians on abortion. This is where pregnancy centers step in as a way for many conservative states to provide services to pregnant or postpartum women, Ziegler says.The centers “have emerged as the thing that the movement is willing to do to actually help people who are new parents.”

As abortion restrictions continue to curtail access to basic reproductive health care, and the largely unregulated crisis pregnancy center industry’s presence has drastically expanded*,* some lawmakers from Florida to Hawaii are pushing back with legislation. In Florida, for instance, state Rep. Kelly Skidmore watched as the state budget for anti-abortion pregnancy centers ballooned with few regulations over the Florida Pregnancy Care Network, the nonprofit tasked by the state to oversee and disburse the funds to these centers. She filed a bill this year to repeal the $29.4 million provided to centers in Florida. “That is an inappropriate use of taxpayer money and it should be eliminated,” Skidmore says. In Washington, DC, Democratic lawmakers are sponsoring the Stop Anti-Abortion Disinformation Act. Known as the SAD Act, the proposal would allow the Federal Trade Commission to collect penalties from centers that are found to have included disinformation in their advertising.

“Fighting back against misinformation and deceptive practices is an important tool to protect access to safe and reliable reproductive care,” Sen. Elizabeth Warren (D-Mass.), one of the co-sponsors of the bill, said in a statement. With a Republican majority in Congress, the measure will likely fail, but as The 19th reported recently, “Its introduction could shine a light on centers, which have become even more influential since the fall of Roe v. Wade.”

Each state has a different strategy for attempting to address some of the issues. In Hawaii, for instance, lawmakers recently filed a bill to launch an investigation into centers’ compliance with patient privacy regulations. The bill referenced the Electronic Frontier Foundation’s recent letters to attorneys general in Arkansas, Florida, Missouri, and Texas, asking them to investigate patient privacy practices at centers. South Carolina was also grappling with this question at a state Senate committee hearing during which lawmakers discussed allowing tax breaks for residents who donate to the centers. Some legislators called for stronger oversight over state-funded centers, which have received $8 million in the last three years. “I think we deserve to know what they’re using their money on,” Rep. Heather Bauer, a Democrat, said in the hearing, as the South Carolina Daily Gazette reported. “How many people have they helped? What kind of resources and programming are they giving these people? And I’d like to see evidence of what outcomes they have for pregnant women in our state.”

Centers inNorth Carolina received $7.5 million in taxpayer dollars last year. The state is one of the few in the South that still provides abortion services and currently limits access to the procedure to 12 weeks. Democratic lawmakers have filed a proposal to divert funds going to centers to other programs serving mothers and babies. “That’s my core concern,” said Sen. Sophia Chitlik, one of the Democratic lawmakers sponsoring the bill. “This is taking money away from health and human services organizations who are actually doing the work to support pregnant women in crisis across our state.” The North Carolina bill would also require the state to conduct an audit of the organization that oversees the centers’ taxpayer budget and create new reporting requirements for them.

The pregnancy center industry has often successfully dodged efforts to regulate their practices by invoking First Amendment protections. The most notable case took place in 2018 when the US Supreme Court, in a 5-4 decision, ruled that a California law requiring pregnancy centers to disclose if they weren’t a licensed medical provider had violated their free speech rights. “Governments must not be allowed to force persons to express a message contrary to their deepest convictions,” Justice Clarence Thomas wrote in his majority opinion. “Freedom of speech secures freedom of thought and belief. This law imperils those liberties.”

At the Indiana Senate meeting, State Sen. Shelli Yoder, a Democrat from Bloomington, spoke in opposition tothe bill, noting language in the resolution that encouraged state and federal agencies to help centers obtain “medical equipment.” “I know we all want good quality health care for pregnant women, moms, babies,” she said. “That is something we all can agree on. That’s why we need to be thoughtful about where we invest our resources.” The resolution advanced along party lines and was forwarded to the House.

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