“Those are the centers that states rely on to assist expecting moms and dads,” Mike Johnson, the speaker of the US House of Representatives, told anti-abortion protesters at the March for Life in January. The Louisiana Republican praised the centers for providing “the important material support that expecting and first-time mothers get from these centers”.

Earlier this year, under Johnson’s leadership, the House passed a bill that would block the Department of Health and Human Services from restricting funding for anti-abortion pregnancy centers. State governments are also in the midst of sending vast sums of taxpayer dollars to programs that support anti-abortion pregnancy centers. Since the demolition of Roe, at least 16 states have agreed to send more than $250m towards “alternative to abortion” programs in 2023 through 2025. Those programs funnel money towards anti-abortion pregnancy centers, maternity homes and assorted other initiatives meant to dissuade people from abortions.

Still, abortion rights supporters say, much of the anti-abortion pregnancy center industry remains shrouded in mystery – including their finances.

“Stewards of both taxpayer and charitable funds should insist on a real impact analysis of the industry, whether investments that are being made are achieving their desired outcomes and are cost-effective,” said Jenifer McKenna, the crisis pregnancy center program director at Reproductive Health and Freedom Watch, the group behind the analysis of tax documents. “Taxpayers deserve performance standards and hard metrics for use of their dollars on these centers.”

The analysis by Reproductive Health and Freedom Watch examined 990 tax documents, which most US tax-exempt organizations must file annually, from 1,719 anti-abortion pregnancy centers in fiscal year 2019 and from 1,469 in fiscal year 2022. The analysis confirms that the anti-abortion pregnancy center industry is growing: while the centers’ revenue in 2022 exceeds $1.4bn, it was closer to $1.03bn in 2019, even though more centers were included in the earlier analysis.

Centers reported receiving hundreds of millions of dollars in donations from private funders between 2018 and 2022. While only a relatively small fraction of the centers reported receiving grants from state and federal governments in both 2022 and 2019, that number is on the rise, according to the Reproductive Health and Freedom Watch analysis memo. In 2022, the centers said they received $344m in such grants, but they received less than $97m in 2019.

Just 21 centers identified the federal grants that they received in 2022, the analysis found. Those grants included the Fema-funded Emergency Food and Shelter Program, which is primarily meant for organizations that alleviate hunger and homelessness, and the Temporary Assistance for Needy Families, a program for low-income families.

This accounting does not represent the full financial picture of the anti-abortion pregnancy center industry. More than 2,500 anti-abortion pregnancy centers are believed to dot the United States – a number that far outstrips the number of abortion clinics in the country.

‘What did they do with all that money?’

Much of the modern, publicly available information on anti-abortion pregnancy centers comes from one of their biggest cheerleaders: the Charlotte Lozier Institute, which assembles reports on the industry and operates as an arm of Susan B Anthony Pro-Life America, one of the top anti-abortion organizations in the United States.

In 2019, the Charlotte Lozier Institute said that 2,700 anti-abortion pregnancy centers provided consulting services to 967,251 new clients on-site. In 2022, the Institute said 2,750 centers provided consulting services for 974,965 new clients – an increase of 0.08%.

Even though the US supreme court overturned Roe at the halfway point of 2022, it did not appear to result in a crush of new clients – despite anti-abortion advocates’ argument that the pregnancy centers need an infusion of funding to handle post-Roe clients.

“The new client numbers alone don’t fully tell the story,” a bevy of Charlotte Lozier Institute scholars – Moira Gaul, Jeanneane Maxon and Michael J New – said in an email to the Guardian, adding that anti-abortion centers and groups have seen an increase in violence following the fall of Roe. (The abortion clinics that remain post-Roe have also faced rising violence. That has not stoppered the demand for their services, as rates of abortions have risen since Roe’s demise.)

Anti-abortion pregnancy centers are seeing a dramatic rise in calls for certain kinds of help. Data from the Charlotte Lozier Institute reports show that centers handed out 64% more diapers, 52% more baby clothing and 43% more wipes in 2022, compared to 2019. Demand for new car seats and strollers also increased by about a third.

All of these items would presumably go to new parents. The fall of Roe led to an estimated 32,000 more births, particularly among young women and women of color, a 2023 analysis found.

The total dollar value of these goods and services was about $358m, according to the Charlotte Lozier Institute report. Reproductive Health and Freedom Watch found that the roughly 1,500 centers included in the group’s 2022 analysis reported expenses of more than $1.2bn on their 990 tax documents.

“They took in – according to the 990s – $1.4bn, and they spent $1.2bn on expenditures,” McKenna said. “What did they do with all that money? There’s so many questions begged by their own reporting.”

The Charlotte Lozier scholars said there were other expenses not listed in the report, such as maternity clothing, property-related payments, fundraising, marketing and staff salaries. Data from their report indicates that, between 2019 and 2022, the number of volunteers who work at the centers fell while the number of paid staffers rose. (Volunteers still make up the overwhelming bulk of the workforce.)

“Most non-profits prefer to use staff when possible. Centers are attracting more professionals that desire to help women,” the scholars said. “Many centers are now in a place where they can pay them so they are less reliant on volunteers.”

The institute’s report on anti-abortion pregnancy centers in 2022 is a very different document to the reports that it released to cover the centers in 2019 and 2017. The earlier reports span dozens of pages; the 2022 report is only four. A longer report is now in the works, the Charlotte Lozier scholars said, which will include information about government funding of centers.

A lack of regulation

Although anti-abortion pregnancy centers may appear to be local mom-and-pop organizations, in reality many are affiliated with national organizations like NIFLA, Care Net and Heartbeat International. These centers thrive in a kind of regulatory dead zone, providing medical services like ultrasounds. But many are not licensed as medical facilities, leaving them unencumbered by the rules or oversight imposed on typical medical providers.

“They are changing their names a lot and changing their names in ways like including ‘clinic’ or ‘medical’ or ‘healthcare’ into their names and dropping things like ‘Care Net’ and other types of wording that might instantly identify them as a CPC,” said Andrea Swartzendruber, an associate professor at the University of Georgia College of Public Health who tracks anti-abortion pregnancy centers.

These centers, she said, are “changing their names in ways that make them seem more like medical clinics”.

The Charlotte Lozier Institute scholars said “calls for governmental regulation are nothing new” post-Roe and that “such efforts have been ongoing for decades”.

“They have been found to be politically motivated and have been largely unsuccessful,” the scholars said. “Abortion facilities are in need of far greater government regulation.”

Anti-abortion pregnancy centers’ taxes can also be deeply intricate. The analysis by Reproductive Health and Freedom Watch found that the centers used a variety of tax codes to describe themselves, frequently describing themselves as organizations that provide “family services” or “reproductive healthcare”. They were sometimes listed as organizations that work to outlaw abortions, or as explicitly Christian, religious organizations.

The National Committee for Responsive Philanthropy, a charity watchdog group, has previously found that many centers share tax identification numbers with much larger organizations that do multiple kinds of charity work, such as non-profits run by Catholic dioceses. By sharing numbers, these organizations are effectively collapsed into one legal and tax entity, the committee said.

The Charlotte Lozier Institute scholars told the Guardian that “this is not our understanding at all”. NIFLA, Care Net and Heartbeat International do not share tax identification numbers with affiliated centers, they said.

Just because these particular groups do not share tax identification numbers does not preclude centers from sharing them with other organizations. For example, Care Net is affiliated with a string of Florida pregnancy centers – which, rather than sharing Care Net’s tax ID, are instead listed on tax documents for a wide-ranging charity run by a local Catholic diocese.

Anti-abortion pregnancy centers tend to be faith-based. Given the industry’s religious bent, courts have proven reluctant to restrict centers in order to avoid treading on their free speech rights.

In 2018, the US supreme court ruled to toss a California law that would have forced centers to disclose whether they were a licensed medical provider. Then, last year, a federal judge in Colorado paused a law that would have banned “abortion reversal”, an unproven drug protocol that aims to halt abortions and is often offered by anti-abortion pregnancy centers. (The first randomized, controlled clinical study to try to study the “reversal” protocol’s effectiveness suddenly stopped in 2019, after three of its participants went to the hospital hemorrhaging blood.)

“More regulation could lead to better reporting, which would also then help with reducing all of these risks,” said Teneille Brown, a University of Utah College of Law professor who studies anti-abortion pregnancy centers. “Then the consumers could get some sense of like, ‘Oh, this clinic has had a bunch of violations,’ and if there were regulation, they could actually even shut them down.”

Source: Guardian