by Sid Holt
All of this is supported by tens of millions of federal and state dollars. At least eleven states now directly fund pregnancy centers, according to state contracts and contractor websites. Many states refer low-income pregnant women to antiabortion centers on health department websites, as well as in “informed consent” materials that abortion providers distribute to patients.
Few states, however, have any laws regulating how pregnancy centers interact with women. Unlike other mental-health providers, center counselors are generally not bound by professional standards or malpractice laws. In many cases, the antiabortion organizations that run the centers—not state employees—monitor their own work.
South Dakota has gone the farthest. As part of its 2011 legislation, the state required all women seeking an abortion to first visit one of two state-approved antiabortion centers. One is the Care Net in Rapid City—the center that Nicole visited. The other is the Alpha Center in Sioux Falls, run by a longtime anticontraception and antiabortion activist. A district court has put the law on hold and is deciding whether the state has the right to force women to visit antiabortion centers. As the judge evaluates the arguments, women across the state—and country—walk into pregnancy centers in search of free medical services. Some, like Nicole, are savvy about the centers’ true goals. They also know they have no better option.
“Empowering Women for Life”
In Philadelphia, Cathedral Basilica of Saints Peter and Paul, a huge pillared brownstone with a green copper dome, was built without first-floor windows—its nineteenth-century architects feared Protestant passersby would break the glass. As the decades passed and Catholic immigrants flocked to Pennsylvania, however, the church would grow to wield significant political power in the state.
Much of the public debate about abortion as we now recognize it began in Pennsylvania in the 1960s, when the Catholic Church lobbied hard to malign contraception and abortion. In her book, Before Roe, political historian Rosemary Nossiff describes how a lawyer for the Pennsylvania Catholic Conference, William Ball, pushed against the state’s plan to counsel low-income couples on contraception by running full-page ads in fifty newspapers and testifying before legislators. On Sundays, priests sermonized against politicians who veered from the church’s positions. Former representative Stephen Freind told me that Pennsylvania legislators and church lawyers worked side-by-side to draft the nation’s strictest abortion laws, with hopes of overturning Roe v. Wade.
In 1989, Planned Parenthood sued the state—represented by its governor, Bob Casey, an antiabortion Democrat—arguing its restrictions violated women’s constitutional right to abortion. It’s well known that the antiabortion movement won its power when Planned Parenthood v. Casey reached the Supreme Court three years later. The court said states could write abortion laws as long as the restrictions don’t put an “undue burden” on a woman seeking an abortion—a decision that opened the gates for laws now sweeping the country. Fewer people know that the same antiabortion campaigners behind Casey also lobbied for tax dollars for crisis pregnancy centers, paving the way for their current spread.
In the early 1990s, Pennsylvania set aside $1 million for privately run antiabortion centers. The state eventually tapped a nonprofit, Real Alternatives, and a lawyer, Kevin Bagatta, to run it. Before becoming president and CEO of Real Alternatives, Bagatta clerked for William Ball, the lawyer who in 1965 led the charge against the state’s plan to counsel poor women on contraception, at Ball, Skelly, Murren and Connell. That’s the same firm that represented the Pennsylvania Catholic Conference and sent lawyers to help legislators write abortion restrictions. Pennsylvania now pays Bagatta $223,075 per year.
Real Alternatives’ slogan is “Empowering women for life.” The organization holds itself out as a safety net for women so they don’t “choose abortion out of a sense of helplessness, hopelessness, or being completely alone.”
Between 2012 and 2017, Pennsylvania will give Real Alternatives more than $30 million in state and federal funding to support ninety-eight sites, including pregnancy centers, social-service agencies, maternity residences, and three adoption agencies. Real Alternatives reimburses centers for services they provide women (similar to how insurance companies reimburse doctors). Real Alternatives says its sites give pregnant women comprehensive support if they want to parent. And I spoke with women who arrived at centers happily pregnant and appreciated staff’s parenting advice and gifts.
But a close look at Pennsylvania’s pregnancy-center program shows the government money is not going toward the things expectant women need: accurate health information, medical care, and long-term support in raising children. According to Real Alternatives’ contract with the state, it reimburses a center just two dollars each time a woman receives food, clothing, or furniture—a maximum of four times. That’s a twenty-four-dollar cap for an individual pregnant woman’s material needs. Centers may dispense more through donations. Still, the government program gives them the incentive to spend more time providing ideologically driven counseling, which is reimbursed at more than one dollar per minute, than they spend providing direct services.
In order for a woman to receive any material support, the program requires that she receive at least twenty minutes of counseling from staff, usually after taking a pregnancy test. Real Alternatives’ contract with the state relies on debunked studies that imply abortion leads to breast cancer and clinical depression. Centers are not allowed to advocate for birth control, much less dispense it. The contract’s directives advise pregnancy-center staff to make an “assessment of the client’s spiritual needs” by asking questions like, “How does your faith impact the choices you make?” (One quarterly report from a center to Real Alternatives refers to clients with the aliases “Mary” and “Joseph.”)
Some Real Alternatives centers market themselves as secular medical clinics, following the strategies Care Net and Heartbeat outline in their training. On its website, Morning Star Pregnancy Services, for example, offers “ultrasound before abortion” at its three locations in the Harrisburg area. Morning Star and about two dozen other Real Alternatives centers turned down my requests to visit. Kevin Bagatta and his staff declined multiple calls over several months. Real Alternatives is helping spread tax-funded antiabortion centers throughout the country. The organization advised Florida, Minnesota, Nebraska, and North Dakota in establishing state-financed antiabortion centers, and it helped establish Texas’s multi-million-dollar program, which runs on the same model. In 2014, Real Alternatives won a no-bid contract to operate Michigan’s burgeoning program.
“They Know It’s a Baby.”
Last spring, I drove across Arkansas and saw ads promising free pregnancy tests in empty downtowns and busy strip malls. Roadside crosses marked the miles, and I visited one center near a cluster of wooden shanties. Arkansas and Mississippi, two of the country’s poorest states, each have more than forty pregnancy centers and only one surgical abortion provider. Walmart’s cheapest pregnancy test costs about nine dollars—the same amount as its cashiers’ hourly wage—so it’s not hard to imagine why a working woman might pull over for a free test.
In a corporate park in Little Rock, Arkansas, Pregnancy Resource Center shares a secluded cul-de-sac with the state’s only surgical abortion provider. A few years ago, when a doctor who performs abortions moved across town to join the clinic’s staff, the antiabortion center followed. One Saturday, I watched about thirty protestors—mostly white men in T-shirts and shorts—stand on the lawn of the crisis pregnancy center screaming, “You’re killing your baby!”
Every weekend, protestors block the clinic’s driveway, and on some weekends, the police are called, clinic workers and escorts told me. The pregnancy center allows the protestors to stay, and protestors sometimes redirect women into the center. A physician at the clinic told me that patients periodically arrive for their abortion appointments late, after mistakenly first going to the pregnancy center across the cul-de-sac. That Saturday,
women entering the clinic looked over their shoulders, then at the ground, some with tears in their eyes.
About thirty miles north of Little Rock, a billboard displayed between exits (“Pregnant? Need options?”) advertised A Woman’s Place, a pregnancy center in the small town of Cabot that has since been renamed Options Pregnancy Center. Cabot feels neither down-and-out nor especially fancy: Tidy homes and churches fade into a strip of chain stores like Kmart and Popeyes. Down the road, Options Pregnancy Center occupies a brick building beside a salon. Its website and ad in the high-school paper offer “options counseling.” It has an ultrasound machine. The needlepoint sampler in its bathroom says, “You will live with the guilt for the rest of your life knowing you made the choice to kill the precious life God placed in your womb for you to love.”
I first met Options Pregnancy Center’s director, Vikki Parker, at the 2014 Heartbeat conference. In Cabot, Parker and I sit in a meeting room in the center, describing how she started it after her daughter became pregnant at fifteen. “I did my very best as a Christian mom, trying to raise her right, but [unplanned pregnancy] came knocking at my door. When it did, I was devastated,” she tells me. When her grandson was eight months old, she went to her pastor and said she’d heard about crisis pregnancy centers and wanted to start one. “I didn’t know she was sexually active…I was thinking these kids have got to have a safe haven where they’re not going to be judged.”
I see why a girl who’s afraid to talk to her mother about sex might confide in Parker, who exudes warmth and concern. Parker says she doesn’t have to talk girls into continuing their pregnancy, explaining, “They know it’s a baby. They know the part they played in it when they had sex.” Options Pregnancy Center doesn’t provide or refer for contraception because Parker believes the Bible forbids premarital sex and she doesn’t think condoms are effective. She says she does not believe public schools should teach students how to access birth control. (Still, when I ask her whether the young women who arrive at the center generally use contraception, she tells me, “Honestly, I don’t know why they don’t. I mean, it’s so readily available. It’s not like they can’t get it.”)
In 2013, the U.S. Department of Health and Human Services awarded the center a federal grant of $352,125 to teach abstinence education in public schools. Over the years, government funding for abstinence programs has aided the mushrooming of pregnancy centers. Despite proposals by the Obama administration to reduce funding, Congress has continued and even increased it in recent years, explains Monica Rodriguez, president of the nonprofit Sexuality Information and Education Council of the United States. This spring, Congress has already set aside $75 million for the latest abstinence-only-until-marriage program—an increase of 50 percent. The House budget proposed in June would double the program that funds Options Pregnancy Center, while eliminating all funding for health centers that provide birth control.
Options Pregnancy Center hired pastors to lead its public-school lessons. I spoke with two of those pastors and read their curriculum, which only discusses contraceptives in terms of failure rates and emphasizes the “negative emotional consequences” of premarital sex. One of the pastors, Daniel Tyler, told me he teaches the idea that “if you start having sex, you can’t grow emotionally.” He adds, “The stuff we’re saying is stereotypical, like guys thinking about sex all the time…We teach that even the way a girl dresses can draw a guy to think about [sex]. There’s a whole chapter on that.”
The year Options Pregnancy Center won its federal grant, Arkansas had one of the nation’s highest teen birth rates. And those pregnancies “disproportionately impact teen girls” because they “end up doing an overwhelming majority of the child rearing,” according to a 2014 report by Kristen Jozkowski, Ph.D., assistant professor of community health at the University of Arkansas. Less than 2 percent of teen mothers will graduate college by the age of thirty. Yet the federal government invests in programs that specifically forbid teaching teens how to use protection and contraception in the very communities with the highest rates of STIs and pregnancy.
“Don’t You Love Your Daughter?”
It was just before Christmas in 2009 when Arcadia Smith found herself at a Heartbeat and Care Net affiliate near her home in Mississippi. Smith was about a month pregnant. After years of struggling as a single parent, she had finally landed a managerial job at a doctor’s office. She didn’t want to end up homeless again or become too busy to help her seven-year-old daughter with homework.
Smith is not against all abortions but didn’t want one for herself. She decided to place her baby for adoption, she says, to “give the baby to someone who wanted to cherish every moment—the first crawl, the first words.”
At the center, Smith and her boyfriend met with a counselor from a third-party adoption agency that works with pregnancy centers. In the small house, Smith could hear other couples’ conversations through the walls. “I poured my heart out,” she said.
She remembers the counselor asking, “Don’t you love your daughter? Don’t you want to do for this one what you do for your first?”
“It’s not that I don’t like this baby—I’m just afraid for the baby,” Smith recalls saying.
Smith says the counselor asked her boyfriend if he was willing to coparent. When he said he was, the counselor insisted they had no reason to consider adoption. “It shocked me,” Smith says. “I was thinking, But adoption is what you do.”
Smith questioned her boyfriend, saying he might not stick around, regardless of whether they shared a child. But the counselor insisted. “It seems like he wants to be there,” she said, and Smith could always raise the child without him. “I’m a single mother myself. I know how it is,” Smith remembers the counselor saying.
At the Heartbeat conference I attended, a workshop leader instructed pregnancy-center staff to offer their personal stories of hardship to encourage clients to follow their advice. Many pregnancy-center workers have told me their goal is for every woman to mother.
“I don’t know what ‘single mother’ means to her,” Smith told me later. “Maybe to her it means divorced with alimony, with grandparents around, but to me, being a single parent means doing everything. My mother passed away when I was eight. I don’t have a safety net. People don’t understand that to really invest in a child and be there to provide stability, I have to sacrifice every single thing.”
With the adoption counselor and her boyfriend in agreement, Smith was outnumbered. “The counselor looked at me like there was something wrong with me. I was already putting the blame on myself for getting pregnant. There’s so much emphasis on being a good mom. I felt like less of a woman. Maybe I was selfish, a bad person who should be ashamed of myself.”
When I called representatives for both the pregnancy center and the adoption agency to discuss Smith’s story, they each said their organization is a strong advocate for adoption and would never discourage a couple from making that choice. Smith never made adoption plans. And she didn’t tell anyone else about her ambivalence toward her pregnancy. “I thought, If that’s how an adoption counselor reacted, imagine what someone else would say about me not wanting a baby.” She gave birth to a girl in the spring of 2010. Six months later, she and her boyfriend broke up. She “became numb” and “overwhelmed” with postpartum depression. After missing work, she lost her job. “Everything snowballed,” she says. She sometimes looked at her baby daughter and thought, It would be easier if she weren’t here. “It wasn’t that I didn’t love my baby,” she says. “I just hated the situation.”
Months later, she called the center. “Look, where are you when I don’t have a job, I don’t have a car?” she recalls asking. The woman who answered the phone was apologetic. She gave her the number for a counselor at a church who helped her access other services.
Smith is now a single parent of two. “People judge single mothers every step of the way,” she says. “But how would they judge me if I exercised my other options, my right
s? I could’ve had an abortion, given my daughter up for adoption, left her at a hospital.” Whatever decision she made, Smith figures, the reaction would be the same. “I’d wear a label for the rest of my life.”
Matter
WINNER—REPORTING
This is the story of Dr. Sheik Humarr Khan and the fight he led to contain the Ebola epidemic as it spread across Sierra Leone in 2014. Working at a government hospital near the epicenter of the outbreak, Khan fell victim to the disease and was controversially denied a treatment that saved the lives of others. Despite his long experience as a journalist—his reporting on the al-Aqsa Intifada was nominated for an Ellie in 2003—Joshua Hammer writes that when he arrived in Sierra Leone in late 2014, he “had never faced anything so unsettling” as the fear he encountered there. Hammer’s work—and his bravery—won Matter the National Magazine Award for Reporting. Launched in 2012 with $140,000 raised on Kickstarter, Matter has already been nominated for five Ellies.
Joshua Hammer
“My Nurses Are Dead, and I Don’t Know If I’m Already Infected”
Dr. Sheik Humarr Khan, the head of the Kenema Government Hospital’s Ebola ward, didn’t want his head nurse moved into the main isolation unit. Ward A consisted of eight small rooms lining a dingy corridor of exposed wiring, peeling paint, and grimy cement floors. It was narrow and stiflingly hot, crowded with as many as thirty patients. Nurses squeezed between the beds, injecting antibiotics, emptying buckets of diarrhea, and hosing down vomit with chlorine. Some of the sick were delirious; others, catatonic, with a stony-eyed stare that usually signaled that death was imminent. All of them were hooked up to intravenous fluid bags; in a state of disorientation, some would rip the needles out of their arms, spraying their blood in all directions.
