Pregnancy centers across the U.S. that discourage women from having abortions have been offering more medical services — and may be poised to expand further.
The expansion – from testing and treating sexually transmitted infections to providing basic medical care – has been happening for years. It gained momentum after the Supreme Court ruled on Roe v. three years ago. Wade repealed it, clearing the way for states to ban abortions.
The push could gain further momentum as Planned Parenthood closes some clinics and considers closing others following changes to Medicaid. In addition to being the nation’s largest abortion provider, Planned Parenthood also offers cancer screenings, STI testing and treatment, and other reproductive health services.
“Ultimately, we want to replace Planned Parenthood with the services we provide,” said Heather Lawless, founder and director of the Reliance Center in Lewiston, Idaho. She said about 40% of the anti-abortion center’s patients are there for reasons unrelated to the pregnancy, including some who apply the nurse as their primary care provider.
The changes have frustrated abortion rights groups, which not only reject the centers’ anti-abortion messages but also say they lack accountability; refuse to offer contraceptives; and most offer only restricted ultrasounds that cannot be used to diagnose fetal abnormalities because the people who perform them do not have this training. A growing number are also offering unproven abortion pill reversal treatments.
Because most centers don’t accept insurance, federal law restricting the sharing of medical information doesn’t apply to them, although some say they comply anyway. They also don’t have to follow standards required by Medicaid or private insurers, although those that offer certain services are generally required to have medical directors who meet state licensing requirements.
“There are really fundamental questions,” said Jennifer McKenna, a senior adviser at Reproductive Health and Freedom Watch, a project funded by liberal political organizations that studies pregnancy centers, “about whether this industry has the clinical infrastructure to provide the medical services that it currently advertises.”
The post-Roe world opened up fresh possibilities
These mostly privately funded and religiously affiliated centers, perhaps best known as “crisis pregnancy centers,” expanded their services such as diaper banks in advance of the Supreme Court’s 2022 ruling in Dobbs v. Jackson Women’s Health Organization.
As abortion bans took effect, centers expanded medical, educational and other programs, said Moira Gaul, a researcher at the Charlotte Lozier Institute, the research arm of SBA Pro-Life America. “They are prepared to serve their communities for the long term,” she said in a statement.
In Sacramento, California, for example, the Alternatives Pregnancy Center has hired primary care physicians, a radiologist and a high-risk pregnancy specialist, as well as nurses and medical assistants in the last two years. Alternatives — a subsidiary of Heartbeat International, one of the largest associations of pregnancy centers in the U.S. — is the sole health care provider for some patients.
When The Associated Press requested an interview with a patient who had only received treatment outside of pregnancy, the clinic provided Jessica Rose, a 31-year-old woman who took the sporadic step of detransitioning after living as a man for seven years while receiving hormone therapy and a double mastectomy.
For the past two years, she has received all medical care at Alternatives, which has a gynecologist who specializes in hormone therapy. There are few, if any, pregnancy centers that advertise that they offer detransitioning assistance. Alternatives has treated four similar patients in the past year, although that is not its primary mission, said Director Heidi Matzke.
“APC gave me a space that aligned with my beliefs and saw me as a woman,” Rose said. She said other clinics “tried to make me believe that detransitioning was not what I wanted to do.”
Pregnancy centers are expanding while health clinics are degenerating
There were more than 2,600 anti-abortion pregnancy centers in the U.S. in 2024, 87 more than in 2023, according to the Crisis Pregnancy Center Map, a project led by health researchers at the University of Georgia who are concerned about aspects of the centers. According to the Guttmacher Institute, 765 clinics offered abortions last year, more than 40 fewer than in 2023.
Over the years, pregnancy centers have received more tax dollars. Nearly 20 states, mostly under Republican leadership, now funnel millions in public money to these organizations. Texas alone donated $70 million to pregnancy centers this fiscal year, while Florida gave more than $29 million to its Pregnancy Support Services Program.
This escalate in resources comes as Republicans have barred Planned Parenthood from receiving Medicaid funding under the tax and spending law signed by President Donald Trump in July. While federal law already blocked the apply of taxpayer money for most abortions, Medicaid reimbursements for other health services accounted for a immense portion of Planned Parenthood’s revenue.
Planned Parenthood said its affiliates could be forced to close up to 200 clinics.
Some had already closed or reorganized. They restricted abortion in Wisconsin and eliminated Medicaid services in Arizona. An independent group of clinics in Maine stopped providing primary care for the same reason. The uncertainty is exacerbated by upcoming Medicaid changes that are expected to leave more Americans uninsured.
Some abortion rights advocates fear this will lead to more devastation in health care by making pregnancy centers the only option for more women.
Kaitlyn Joshua, a founder of the abortion rights group Abortion in America, lives in Louisiana, where Planned Parenthood closed its clinics in September.
She worries that women seeking medical care at pregnancy centers because of these closures won’t get what they need. “These centers should be regulated. They should provide accurate information,” she said, “not just receive a sermon that 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 are under government oversight through their medical directors. “Your criticism,” he said, “springs from a political agenda.”
In recent years, five Democratic attorneys general have warned that centers that promote abortions are not providing them and are not referring patients to clinics that perform abortions. And the Supreme Court has agreed to consider whether a government investigation into an organization that operates centers in New Jersey interferes with its free speech.
Pregnancy centers don’t offer exactly the same services as Planned Parenthood
Choices Medical Services in Joplin, Missouri, where the Planned Parenthood clinic closed last year, shifted from focusing solely on deterring abortions to a broader sexual health mission about 20 years ago when it began offering STI treatment, said its chief executive, Karolyn Schrage.
According to Arkansas State Police and Schrage, the donor-funded center works with law enforcement in locations where authorities may find pregnant adults.
She estimates that more than two-thirds of the work has nothing to do with pregnancy.
Hayley Kelly first met the Choices volunteers in 2019 at a regular weekly dinner they brought to the dancers at the strip club where she worked. Over the years, she went to the center for STI testing. Then, in 2023, when she was uninsured and struggling with drugs, she wanted to confirm a pregnancy.
She assumed the staff wouldn’t like that she was leaning toward abortion, but she said they were just answering questions. She ended up having that baby and then another one later.
“It’s an amazing place,” Kelly said. “I tell everyone I know, ‘You can go there.'”
The center, like others, does not offer contraceptives — standard offerings at sexual health clinics that experts say represent public health best practices.
“Our focus is on eliminating sexual risks,” Schrage said, “not just reducing them.”
