Victoria Torres Garcia listened as two women spoke to her in a private room about the risks of seeking an abortion. They gave her pamphlets and prenatal pills, claiming that ending her pregnancy with medication would prevent her from conceiving again.
But the college student, then 21, knew what they were saying was bogus.
Garcia had already been pregnant once before and had gotten a medication abortion. Here she was, pregnant again, her own proof that what they were telling her wasn’t true. At the time, she had no way of knowing that she had made an appointment at a crisis pregnancy center (CPC), an organization with the primary mission of turning people away from choosing abortion. (Pro–abortion rights advocates may use the term “CPC,” whereas anti-abortion advocates typically call these sites as “pregnancy care centers.”)
These centers promise free services, including pregnancy tests and ultrasounds, in addition to social resources and products, like baby supplies, typically for low-income people. CPCs provide essentials for pregnant people who may not be able to afford help anywhere else, but research shows these facilities typically only give out supplies and support to those who attend their programming, such as counseling sessions, and are thereby “plugged into the global anti-abortion movement’s sophisticated digital infrastructure,” according to a new study of CPCs in nine states by the Alliance.
But advocates are concerned that amid heightened state-level threats to abortion access, CPCs are poised to be enforcement sites of anti-abortion laws like SB 8 in Texas, in which any public citizen can report an alleged violation of the six-week abortion ban. And while anti-abortion groups argue these centers provide crisis intervention, the coalition in support of abortion rights says the existence of these facilities is a crisis in and of itself.
CPCs are visually difficult to distinguish from other reproductive care facilities because they are often branded with similar names and signage as local abortion clinics, according to the study. They also often have a clinic-like waiting room that makes patients feel as though they are at a medical provider and use similar language that abortion clinics use on their websites. This effectively confuses people who are seeking medical care: 10% of CPCs in the Alliance’s study operated mobile units near abortion clinics to divert patients.
And because so much personal information is gleaned from patients, researchers say these sites are becoming dangerous repositories that can be weaponized in states that have become increasingly hostile to abortion rights.
“Because CPCs are a global network … they’re actually poised to become the surveillance mechanism to enforce these unconstitutional laws,” said Erin Maye Quade, advocacy director at Gender Justice, a Minnesota-based organization that’s part of the Alliance, a coalition of state and regional law and policy members that advocates for reproductive justice.
Through “deceptive and coercive tactics,” CPCs dispense “medical misinformation” and misleadingly present themselves as local support facilities for pregnant people and parents, Maye Quade said. With CPCs outnumbering abortion clinics by a national average of three to one, reproductive justice advocates say the likelihood that someone like Garcia inadvertently ends up at one is high.
“I think people just don’t realize that CPCs are as extensive as they are, that they’re state-funded and they’re causing as much harm as they are,” Maye Quade said.
The Alliance found that CPCs intrude on patients’ privacy, deliberately gathering data on their reproductive, medical, sexual health histories that could later be used to criminalize them. These facilities also provide little to no actual medical care and disperse falsehoods that abortion causes infertility or depressive “post abortion regret,” among other claims, the report found.
Roland Warren, president and CEO of Care Net, one of the nation’s largest pregnancy center networks, told BuzzFeed News that about 60% of its more than 1,100 affiliates are licensed to offer medical services, including consultation with a licensed medical professional, limited diagnostic ultrasound for confirmation of a viable pregnancy, and testing for sexually transmitted infections and diseases.
“Medical services are provided in accordance with all applicable laws, and in accordance with pertinent medical standards, under the supervision and direction of a licensed physician,” Warren said in an email.
The Christian network has “saved more than 823,000 babies from abortion” since 2008, according to Care Net’s website, “equips people to save babies from abortion,” and works to train churches in providing anti-abortion ministry.
“The primary mission of the pregnancy center is to share the compassion, hope, and help of Jesus Christ — both in word and deed — with those facing pregnancy decisions,” Care Net’s Standards of Affiliation webpage states.
People like Garcia inadvertently find CPCs because these networks invest in search engine advertising to effectively target those searching for abortion care, and people are often led there regardless of their search engine or query keyword, the Alliance found.
Care Net countered the claims that it uses misleading advertising: “Care Net-affiliated pregnancy centers are trained to use advertising strategies with Federal Trade Commission standards that are truthful and not misleading according, for example, to the Federal Trade Commission Act, 15 U.S.C. 45.”
For Garcia, Google suggested Aid for Women, a CPC near her Illinois college that had free, same-day appointments for uninsured people like her. At the time, she didn’t know an actual abortion clinic called Women’s Aid Center was just a 15-minute drive away from that facility. (BuzzFeed News has reached out to Aid for Women for comment.)
Her plan was to seek an abortion if a pregnancy were confirmed. As a first-generation college student and a child of a single mother who raised five children, Garcia knew she wanted to finish her bachelor’s degree and build a life for herself. (Now 24, she owns a house, has a full-time job, and works with Illinois-based abortion funds.)
Even though she knew the choice she wanted to make, Garcia said she would go on to experience an aggressive anti-abortion environment at the CPC. After walking through hallways lined with baby supplies, the staffers gave her a urine test and confirmed she was about three weeks pregnant. They overwhelmed her upon delivering her results, she said, telling her she’d “love being a mom” and that adoption was a better “option” than abortion.
“The language they used was very manipulative,” she said. “I didn't know the language they used was something that CPCs end up using in their tactics. At this time, I was just like, I have options. Abortion is an option.”
According to Garcia, the staffers told her they could provide a procedure known as “abortion pill reversal” if she ended up getting a medication abortion and changing her mind. But Maye Quade said this “nonscientific” procedure is the most “dangerous” thing CPCs advertise, the idea that taking the hormone progesterone can undo a medication abortion (a two-pill protocol that ends a pregnancy).
“It’s not a process. It doesn’t exist,” the lead author of a stalled abortion pill reversal study, Mitch Creinin, an OB-GYN at the University of California, Davis, told BuzzFeed News. The trial included 40 people who each took the abortion pill mifepristone. Then they were given either a placebo or progesterone. After three participants began to hemorrhage severely, Creinin stopped the study.
“You’re really under the impression they’re there to help,” Garcia said. “But they’re not. They don’t give you all your options. … I did not feel listened to at all. I felt that I was being talked down to.”
But CPCs outnumber abortion clinics nationwide, the study found, with higher disparities wherever they’re state-funded. Maye Quade said that in Minnesota, the difference translates to eight clinics that provide abortion care versus 90 CPCs across the state.
CPCs obtain taxpayer money in at least 29 states, according to the study, and at least 14 of those states have “alternatives to abortion” (A2A) programs that operate with public funding, according to the Alliance study. States allocate a combination of general revenue and Temporary Assistance for Needy Families (TANF) funding (a federal program aimed to help families with low incomes) toward their A2A programs.
Nearly half of the CPCs in the Alliance’s study were affiliated with a CPC umbrella organizations like Care Net or Real Alternatives. Funding for these umbrella organizations vary widely. In some cases, state government contracts with CPC umbrella organizations, but in other cases, the umbrella networks have no say over whether its affiliate pregnancy centers apply for or receive government funding.
Pennsylvania was the first state to legislate federal and state funding for its A2A program. The state contracts with a CPC network called Real Alternatives, which in turn subcontracts 27 service providers that have 80 centers across the state, Brandon Cwalina, a spokesperson for the Pennsylvania Department of Human Services, told BuzzFeed News.
In a statement to BuzzFeed News, Real Alternatives said its mission is to provide enough social support for pregnant people that having another child isn’t a burden — abortion doesn’t have to be a consideration. The program is prohibited by the Commonwealth of Pennsylvania from promoting abortion, referring a person for an abortion, or counseling a person to have an abortion.
Real Alternatives also said that Pennsylvania’s programs provide social — not medical — services, and they have served 335,000 people in the last 25 years. If necessary, the organization will make referrals to medical providers.
“The value of these organizations is derived from the fact that they provide unique crisis intervention counseling and mentoring services that most medical providers do not provide to women experiencing an Unexpected Pregnancy,” the organization said.
Pennsylvania’s A2A program has received more than $100 million since the 1990s in state funding, according to the Alliance. The state provided $6.26 million for the A2A program in the 2021–2022 fiscal year alone.
“‘Alternatives to abortion’ programs have ballooned over recent years into these multimillion-dollar enterprises that are funded in some cases almost exclusively with tax dollars,” said Molly Bangs, director of Equity Forward, which researches the “web of actors” directing money between states and CPC networks. She added it’s “egregious” that federal money from TANF, a government-funded social safety net, is being used to support anti-abortion organizations.
There’s a lack of transparency among these government subcontractors, she added, making it especially difficult for taxpayers to trace whether their money is potentially going toward anti-abortion efforts. She said the balance sheets for privately funded CPCs are even more difficult to track; since they are often not nonprofit organizations, they do not disclose their donations.
Other abortion battleground states are funneling millions of taxpayer dollars to CPC networks, and the amount is swelling each year. In Minnesota, annual funding of $3.3 million for a five-year period was awarded in 2021 to 27 sites operated by the state’s A2A program, Positive Alternatives. Texas has budgeted more than $100 million over the next two years.
Fewer than 10% of Care Net–affiliated centers received any type of state or federal funding in 2018, according to the network. Care Net also says it provided more than $62 million in free services in 2018, about $40 million of which was spent on health services.
“You have these abortion bans, and everyone is talking about them, and CPCs are doing quiet damage on a local level, traumatizing individuals in our neighborhoods, and we don’t hear about it,” said Crystal Grabowski, a Pennsylvania-based abortion care worker.
And not everyone has a negative experience in these centers. Care Net reported that 97% of clients indicated positive outcomes in an exit survey in 2015. And research has found that many people who went to the centers had already determined they would not have an abortion if they were pregnant. Rather than looking for options, they needed social support, one study found.
“[The CPC] helped us make a hospital appointment, sign up for Medicaid, and even helped us through the process of telling our parents. In addition, Miguel’s counselor was really mentoring him and helping him prepare to become a dad, while my counselor was helping me prepare for motherhood,” Care Net clients Jeanette and Miguel said, according to a testimony provided to BuzzFeed News by the network.
These centers do fill a gap in many communities across the nation where pregnant people with low incomes struggle to access baby supplies, professional services, and emotional support. But while the centers are successful at meeting these needs, support comes with strings attached. The Alliance found that 88% of CPCs in the study promised an “earn to learn” campaign. These programs target low-income pregnant people and parents who are required to attend Bible studies, counseling, and other faith-based sessions to simply access diapers.
And an anti-abortion tone can make patients feel their other health needs are being ignored. This was the experience of Nicolee when she went to Care Net Pregnancy Center in Albuquerque, New Mexico.
Nicolee, who declined to use her full name to protect her privacy, lost her left fallopian tube due to an irregular pregnancy in July 2020. When she suspected she was pregnant again in April 2021, she wanted a medical provider to confirm it and run an ultrasound right away to ensure her remaining tube would be safe.
Like Garcia, the college student, Nicolee observed there were few other patients in the building, which was located next to her local Planned Parenthood. It’s common for CPCs to be across from or bear similar names to actual abortion clinics, Grabowski said, and they work “hand in hand” with anti-abortion protesters who attempt to divert patients away from clinics.
Nicolee told BuzzFeed News she was taken to an examination room and introduced to a “volunteer.” Intake paperwork asked her if she wanted to view an abortion video. She declined. She wasn’t necessarily seeking an abortion, she just wanted to confirm if she was pregnant and learn what her next steps would be to protect her right fallopian tube.
She said she was seated by the window while a CPC staffer sat in front of the door. There was a television and a table with anti-abortion pamphlets. A nurse then left Nicolee alone in the room while the volunteer questioned why she didn’t want to watch the video.
Nicolee said the volunteer repeatedly said it was “God’s plan” that she had had an ectopic pregnancy (when the fertilized egg implants outside of the uterus). Bringing this up triggered her trauma from this experience.
The questions continued: Was she married? Were her parents married? Did she have a job?
Then she was told the site’s ultrasound technician wasn’t available that day, despite Nicolee having called ahead to confirm she’d be able to visit with one. Instead, a staffer told her there wouldn't be an opening for three more weeks.
“Clients always receive honest and open answers,” is the third tenet of Care Net’s “Commitment of Care & Competence.” The sixth commitment reads: “Clients receive accurate information about pregnancy, fetal development, lifestyle issues, and related concerns.”
According to the Alliance, putting off an ultrasound is part of a strategy to delay a patient from accessing abortion care.
“A lot of times, people who are coming from a CPC are really frustrated and have had a lot of their time wasted,” Grabowski said. “People knew they wanted to have an abortion and had weeks of their time wasted and are getting a longer or more expensive procedure, or are no longer eligible for medication abortion.”
The CPC might advise someone to have multiple redundant ultrasounds or fail to offer immediate appointment times, as Nicolee experienced.
“They feel stupid in a time when they should be feeling supported and empowered,” Grabowski said. “I’ll have people who call in, they wanted an abortion when they were four weeks pregnant, and they spent a month communicating back and forth with the CPC … and then they come to me, and they’ve wasted an entire month.”
The Alliance report also found that CPCs target pregnant people of color, who are disproportionately likely to have higher maternal mortality and morbidity rates, according to the CDC. CPCs “blackwash” their websites and publish information in multiple languages to appeal to communities of color, Maye Quade said, adding that 25% of people served at CPCs in Minnesota were Black.
“These are the people who need early prenatal services,” she said. “Getting a lecture about not having an abortion when what you need is blood work and prenatal vitamins. … That is real harm on the people who are eventually delivering babies.”
Nicolee hopes to have kids eventually, so she wanted to make sure her remaining fallopian tube was safe. Instead, she said, the volunteer gave her a handbook about the “light of God.” Then an older woman came in the room and joined the nurse and volunteer as they began praying over her, Nicolee said.
“I felt like I was getting initiated into a cult,” she said.
She left and sobbed in her car.
After her experience at the CPC, Nicolee went back to her research. She found Southwestern Women’s Options, also in Albuquerque, and made an appointment for the next day, when she learned the embryo was traveling beyond her uterus into her remaining fallopian tube. She had to terminate the pregnancy.
If she had waited three weeks to get an ultrasound, as the CPC had tried, she could have lost her right tube and the ability to ever have children. She added that if she had been younger, she could have felt “guilty” for considering abortion. She understands how someone could be scared to speak up, she said, especially if they are a victim or experiencing a crisis.
And rather than find answers from the CPC, she said, “You blame yourself.”
Correction: Care Net National does not receive government funding. A previous version of this post said that the umbrella organization had government contracts.