Anti-Abortion Pregnancy Centers Outnumbered Abortion Clinics Even Before “Dobbs”

Savannah McNally was 24 years old, and in the middle of a divorce, trying to sell her house, wrapping up her service in the Navy and figuring out a way to finish college. She was also pregnant.

“It was pretty much instantly a feeling of dread. I didn’t want to be pregnant. I don’t want kids,” McNally recalled. “I was crying and screaming, ‘This is not going to happen.’”

It was July 2022, and she was living in Texas, which had only just begun to enforce a near-total ban on abortion.

She ordered medication to induce an abortion but wanted first to make sure the home tests she’d taken were accurate. She found a center online that advertised its free ultrasounds, and she hoped it would give her information about how far along she was. McNally went twice to the center, where she was careful never to mention that she planned to terminate her pregnancy. At her second visit, she was told she was just shy of seven weeks — early enough, she thought to herself, that she could safely terminate her pregnancy at home. Then, a woman wearing a white coat and a physician’s assistant badge told her an abortion could send her to the hospital.

“She told me I would be able to see all of its fingers and toes and its little body would be completely formed if I had an abortion,” McNally said. “I’ve been through miscarriage with my mom and had a couple of myself. That’s not accurate.”

McNally left the center furious. The decision to have an abortion was one she had thought about carefully. And yet it felt like nobody at the center had listened to her or considered her perspective — instead, she felt judged, misinformed and unheard.

Her boyfriend, terrified by what he had heard, was no longer supportive of her decision to end the pregnancy. McNally was shaken, too. It took her a week and a half to recover from the visit before she felt comfortable finally taking the medication to induce her abortion.

McNally didn’t realize until later what had happened. Instead of visiting a medical clinic, she’d found herself at an anti-abortion center, a type of facility gaining increasing prominence as abortion bans shutter health clinics across the country.

In states like Texas, pregnant people have turned in larger numbers to these anti-abortion centers — also known as crisis pregnancy centers — that have come under fire from medical professionals for presenting inaccurate information about pregnancy and that deliberately aim to dissuade people from getting abortions. Since the Supreme Court reversed federal abortion protections in the case Dobbs v. Jackson Women’s Health Organization, states with restrictions on the procedure have poured tens of millions of dollars into expanding the reach of anti-abortion centers. Texas, where McNally lived at the time, is a leader. It has long allocated state dollars to support these centers, and in 2023, its legislature approved $140 million to support anti-abortion centers over the next two years.

Many of these anti-abortion centers have websites and names similar to those of actual abortion clinics, but they don’t always disclose that they do not refer for or provide abortions. They are often situated near or next to actual clinics. In some cases, center volunteers, who are not medical professionals, wear white coats, the standard uniform for doctors.

Repeated studies have found people who seek care at anti-abortion centers are told untrue information about pregnancy and abortion, including inaccurate readings of sonogram imagery and false claims about abortion’s physical and psychological side-effects.

But as clinics close, anti-abortion centers are often the only affordable option for people figuring out how to navigate their pregnancies — especially for those without health insurance or a regular doctor, or who don’t know how to find financial support in paying for a screening at a reproductive health clinic.

That can have significant consequences, researchers said, leading pregnant patients to believe they are too far along in their pregnancies to travel out of state for abortions, giving them an inaccurate sense of the relative risks of abortion versus pregnancy, and making their health data vulnerable in a state where seeking an abortion — or helping someone look for the procedure — is under heightened legal scrutiny.

“Crisis pregnancy centers could have profound impacts on individuals’ outcomes in terms of the reproductive decisions they make,” said Carly Thomsen, an assistant professor of gender, sexuality and feminist studies at Middlebury College, who researches these centers. “There could be severe health consequences, or consequences for people’s life outcomes.”

The impact is perhaps most visible in Texas, the largest state to ban abortion, which has seen the most abortion clinics close since Dobbs. The state-funded network of anti-abortion centers saw 125,416 clients in the 2023 fiscal year, per a state report. That’s an increase of about 12,000 from the previous year, and a figure that could grow as the state invests more in expanding these centers’ reach.

Even prior to Dobbs, anti-abortion centers outnumbered abortion clinics and other family planning facilities. As of 2021, The Crisis Pregnancy Center Map, a project run by University of Georgia epidemiologists Andrea Swartzendruber and Danielle Lambert, counted more than 2,500 centers. Of those, 198 were in Texas, and the vast majority received state funding.

“In places that have, since Dobbs, basically criminalized or prohibited abortion completely, these centers are now the only — I don’t want to say resource — but the only seemingly available resource for women who are in need of services related to pregnancy, unplanned or otherwise,” said Alisa von Hagel, a professor at the University of Wisconsin who studies the anti-abortion movement.

Representatives from abortion funds in Texas — nonprofits that help people pay for the procedure in other states — said they hear regularly from pregnant clients who want an abortion that they’ve already been to an anti-abortion center, largely because it was the only option they could find for an ultrasound. It was a concern even prior to Texas banning abortion. Now, several said, it’s taken on more significance, in part because of the legal risks of seeking an abortion, and in part because of the expense associated with traveling out of state for care.

“Crisis pregnancy centers are one of the only places people can get free ultrasounds to confirm the pregnancy to proceed with pursuing an out-of-state abortion,” said Jaylynn Farr Munson, the development and communications director of the Austin-based Fund Texas Choice. “When you Google, ‘I’m pregnant and I need help in Texas,’ a crisis pregnancy center is one of the first things that comes up.”

Getting an ultrasound isn’t necessary to confirm a pregnancy or receive an abortion. But patients often believe getting one could help them better know what kind of care they need, said Andrea Gallegos, who runs abortion clinics in New Mexico and Illinois, and frequently sees patients from Texas. She’s turned some away because the ultrasound reading they received before coming was inaccurate — and in fact, they were past the gestational limit at which her clinic provided abortions.

“We’ve had patients just getting to us, only to find out we can’t see them,” Gallegos said. “They don’t know what they’re going to do next because it took so much already, just finding their way to us.”

With anti-abortion centers’ foothold growing, Kathy Kleinfeld, who operates a reproductive health clinic in Houston, has directed her staff to explain to callers on the phone what these facilities do and don’t offer.

Services at Kleinfeld’s clinic aren’t free, though the staff directs patients who need support to local abortion funds, who can typically help cover the cost. Though her clinic is the rare option in Texas to still counsel people about abortion, it’s only open from Tuesday through Friday. Some patients can’t make those days work, and as a result, make an appointment at an anti-abortion center instead.

Kleinfeld recalled a patient who’d been told she appeared to be eight weeks pregnant. But when medical personnel at her facility followed up, they saw a drastically different reading: The woman was about 20 weeks along, far enough that many abortion clinics would no longer be able to provide care.

Medical privacy is also a concern at anti-abortion centers, which are not held to the same regulatory standards as health clinics. Many do not have licensed medical professionals on staff, and people who receive care there aren’t guaranteed the same level of privacy conferred under the federal law Health Insurance Portability and Accountability Act (HIPAA).

“We don’t know what happens with your data,” Kleinfeld said. “You’re really vulnerable going to a place like that.”

When McNally visited the anti-abortion center, she gave them her name, and they had at least some information about her pregnancy. Weeks after her visit, they kept calling her, trying to follow up on what she had done with her pregnancy. She couldn’t shake the fear: Who were these people who had her medical data? What would they do with it?

She only stopped worrying once she finally moved out of Texas, relocating with her boyfriend — who she later married — to Virginia.

“It made me feel vulnerable,” she said. “I had exposed myself to someone and given them access to my body.”