Get Real! Why Can’t I Stop Being Afraid of Pregnancy

Heather Corinna

Just like some people have pervasive or seemingly illogical fears about heights or small spaces, some phobias are pregnancy-based, about becoming pregnant, being pregnant and/or giving birth.

This article is published in partnership with

lucyinthesky asks:

I have a problem, and I’m ready to crack with the stress of it. I’ve been on birth control (Yaz) for a year, to help with my acne, though I don’t always take it at the same time every day. Sometimes I’ve missed pills or taken them over 12 hours late. That shouldn’t really matter, though, because I’m not sexually active. My boyfriend and I have decided to wait until we get married to have sex. We only ever make out. Still, I find myself worrying about pregnancy risks even though there are no apparent ways to get pregnant from what we do. Some small part of my mind will whisper things like, “What if he has pre-ejaculate that seeps through his clothes onto you? What if he had a nocturnal emission that night he stayed over?” Nobody else I know seems to have this constant paranoia. I don’t understand why I spend half my time worrying about a pregnancy that most people understand is impossible. I’m not sure what I’m asking here, other than, have you ever seen this before – a girl terrified of something happening when it isn’t even likely? Is there any way I can help myself and get peace of mind? Thanks.

Heather Corinna replies:

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Not only have we seen this before, it’s something we see at Scarleteen often. At our message boards, at least once or twice a week a user comes to us feeling exactly like you are. I promise, it’s not just you. Over the years, I’ve looked and looked for some kind of study on pervasive pregnancy worries when there’s not a likely risk, or when it’s been made clear someone is not pregnant, and when someone also really knows they’re not pregnant, but I’ve yet to find anything, beyond information on false or “hysterical pregnancy,” which isn’t what this is. So, I’m afraid I can’t offer you much of anything clinical, but I can certainly offer you my observations from seeing this over the years.

Some people do have a phobia specifically about pregnancy, birth or parenting, tocophobia (sometimes spelled tokophobia or parturiphobia). In other words, just like some people have pervasive or seemingly illogical fears about heights or small spaces, some phobias are pregnancy-based, about becoming pregnant, being pregnant and/or giving birth. This is more common than most people think, especially in people who can actually become pregnant. Given what a huge deal and big life-changers pregnancy, childbirth and parenting are, that’s not that surprising. This phobia, like any, is best addressed with a qualified therapist who treats phobias. If you feel this may be the case with you, it is something you’ll want to seek treatment for to feel better. That’s going to be particularly important if you ever do want to become pregnant, because even wanted pregnancy can be very emotionally difficult for someone with a pregnancy phobia.

Sometimes people may also have anxieties like this because they have an underlying general anxiety disorder that presents with sex, other innimacy and/or pregnancy. The teens and twenties already tend to be full of big worries and heavy pressures, and sex and/or pregnancy certainly gives us some reasonable things to have big concerns about, but your generation is also often reported as having higher rates of anxiety than previous generations, particularly for young people who have come of age in the burbs and/or in higher income brackets. I certainly feel we see more young people reporting anxiety of all types over the last few years than we have in years previous. As well, many people of your generation have been exposed to a lot of intentional fear-factoring about sex and pregnancy in your sex education, in the media and through other cultural messaging, which can really play on a person’s existing anxieties.

My best advice for someone who thinks or knows they may have an anxiety disorder or phobia is to start at a general or psychological healthcare provider‘s office. It never hurts to go, have a chat, and just see what a doctor says. In the case this is about anxiety as a whole, or a specific phobia, you probably won’t feel better without treatment, whether that’s talk therapy, a support group, medication or another way of managing anxiety, as well as qualified care to help you learn how to manage anxiety triggers and stress. For someone with anxiety or phobias, just taking away a given thing triggering them can help some, but often they’ll just wind up being triggered by other things that replace that one.

For those who don’t have anxiety in any area BUT this one, and who aren’t thought to have a phobia that is situational, there can be a few different things that may be going on, and a few different routes to feel better.

Do you feel well-informed about how pregnancy realistically happens? Paranoia is about illogical fear, but if a person doesn’t know what is and isn’t real, they may not be paranoid, but validly afraid of something they just don’t know they don’t need to be afraid of.

The idea that a pregnancy could happen by pre-ejaculate seeping through clothing is not sound. For a pregnancy to happen, a lot of factors need to be in play. You need to have an available ovum (egg) to fertilize, for one, which very rarely happens when someone is using a combined birth control pill properly. (However, you would probably feel at least a little better if you started taking your pills properly.) There also needs to be enough sperm and semen to create a pregnancy. While the typical idea is that it only takes one sperm, that’s not actually true. It only takes one to fertilize an ovum, but it takes a few hundred “helper” sperm for that one to do so. Seminal fluid is also important: it balances out the acidic nature of the vagina, keeps sperm viable and aids in their motility. Just like you’d have a hard time taking a long swim in a tiny rain puddle, sperm have a hard time swimming without enough fluid, too. Additionally, pre-ejaculate often does not contain any sperm at all, and when it does pull trace sperm from the urethra, it’s not usually enough to create a pregnancy.

But for all of that to even matter, there would have to be direct contact between your vulva or vagina and semen. If you two are wearing clothes, that can’t happen. Even with minimal clothing, it’s still unlikely with a full ejaculation, and I feel comfortable saying it’s not possible when we’re only talking about pre-ejaculate. Pre-ejaculate is a very small amount of fluid, certainly not enough to seep through two sets of clothing and then still get into your vagina. Same goes with wet dreams. Someone sleeping over who has one in the same bed won’t create a risk of pregnancy unless they happened to have that emission while their penis was inside your vagina.

Not knowing what your sex education has been, I can’t know what you do and don’t know about pregnancy, so let’s be sure you have those bases covered. Even if it doesn’t help with how you’re feeling, it is something you’ll want to know. Here are a couple links to get started with:

Did you already know all of that already, but find that you still feel really scared about becoming pregnant? Do you also feel like you’re pretty sure you don’t have any kind anxiety disorder or phobia, something you’ve verified with a qualified healthcare provider?

One common denominator I often discover with feelings like yours, when I can really talk to someone about them deeply, is that it they can often be traced back to sexual guilt or shame. I once counseled a young woman who was absolutely convinced, despite many negative pregnancy tests, menstrual periods and even an ultrasound that confirmed she wasn’t pregnant that she was pregnant. At a certain point, she knew it wasn’t reasonable, but she also just could not seem to let those feeling go. In talking with her, she eventually voiced that because her family and culture was so strongly unaccepting of someone unmarried having sex, she felt she deserved to be punished, to pay some kind of price for choosing to have sex. So, she had convinced herself she must be pregnant because that’s the kind of “punishment” women who have sex that isn’t socially sanctioned get, and she wasn’t worthy of being spared. This is one common thread I’ve seen in women having these kinds of pervasive and unfounded fears, especially for women who have grown up with very socially or religiously conservative communities or views or with sexual shaming.

I don’t know what your background has been like or how you feel about whatever kinds of sex you are engaging in. But if you feel that in some way it’s very much not okay for you to be having whatever kinds of sex you are having, or moving towards other kinds of sex, or people you care about or are strongly influenced by feel that way, this could be part of the issue.

You voice that you and your boyfriend are saving sex for marriage and that you are not sexually active, but if you are having some kinds of sex — like the dry humping, or oral sex — some of these feelings may be coming up because those things are kinds of sex. That’s a lot more obvious once people have had intercourse and know it’s only so different, but it’s still something people can intuitively feel because you know when you aren/or a partner are having sexual feelings and desires and know when you’re putting them into action. If your personal values are such that you feel sex needs to be saved for marriage, it’d be understandable that having some kinds of sex may not be making you feel good because it may be outside your values, and only be something you’re rationalizing as being within them. Sometimes when we rationalize things in a way that isn’t sound, while our brains may accept those rationalizations, our deeper feelings don’t fall for it.

I don’t personally share those kinds of ideas about sex and marriage, so please be sure that I’m not making judgments here or suggesting you’ve done something wrong or bad. But if you have different values than I do in this regard, which you clearly may given what you’ve said, you may need to check in with yourself to be sure what you’re doing does fit with what your own values and sexual ideals are. This might also be something to talk with your boyfriend about, because even if you’re feeling okay about this, if he isn’t, his conflict might be something you’re reacting to. If you feel like those values aren’t really yours, but the values of others, then you may want to spend some time trying to clarify what your own values are, and some time letting go of values you may have grown up with, but don’t share as you’re coming into your own.

Something else that often comes up in discussions with other women feeling like you have been are problems with the interpersonal context it’s happening in. In other words, these feelings can be emotional cues that a relationship isn’t a good one, or isn’t the right one for a given person at a given time in their lives. How supportive and responsive is your boyfriend being to these fears you’re having? Has he suggested you two spend time talking them through, maybe step back with any kind of sex, made clear that there’s no pressure on you to do anything sexual, even just making out, if you don’t feel okay about it yet? If he hasn’t, some of your feelings may be about feeling pressured or unsupported, or worrying that soon enough, you will have valid reasons to be afraid of an unwanted pregnancy.

The very best advice I feel I can ever give someone feeling like you are if this isn’t about overall anxiety or a phobia is to suggest you think deeply about if any kind of sex or intimate contact is truly right for you right now. It may not be, and your feelings here may be intuitive cues about that. If one isn’t trying to create a pregnancy, the primary reason for having any kind of sex tends to be about feeling good, physically and emotionally, for yourself and also in relationship to the person you’re having sex of any kind with. If how you wind up feeling before, during and/or after is mostly not good, but instead worried, terrified and freaked out, and/or isolated in your concerns, then it really doesn’t make much sense to have any kind of sex or making out that’s eliciting those feelings because you’re getting very little, if any, of the good parts.

It might help to sit down and make a list of pros and cons: of the ways physical intimacy makes you feel good, the ways it doesn’t, with positive feelings or one side and negative feelings on the other. I’d also include what you have experienced as good outcomes and as bad ones, or what COULD be good ones and could be bad ones. Then you can look at all of those things on paper, and perhaps better assess if this is right for you right now or not. There’s so often a lot swimming around in our heads about sex and relationships that being able to see it on paper, in black and white, can be very helpful.

A lot of young people have the idea that when it comes to any kind of sex, once a person starts having that kind of sex, in general or in a specific relationship, they’re either tacitly agreeing to have that kind of sex ever after. But in the reality of many people’s lives, and certainly in healthy relationships and self-care, that’s not how it goes. Instead, there will be times in our lives, in certain relationships, even just from day-to-day, where we’ll want to be sexual and feel good about it, and times when we won’t. We’ll have times we choose to be sexual and times we choose not to. Those choices tend to be made not just around what our own sexual or interpersonal desires are, and those of someone else, but also around what we think we and others can handle based on the whole context of our lives. For instance, sometimes we can’t afford birth control or just don’t want to deal with it; sometimes we’re so tired from other demanding areas of our lives we just don’t feel we can be fully present with sex; sometimes we’re grappling with challenging feelings from something else going on that the various risks, positive and negative, sex of any kind can pose just feel like too much for us.

There’s never anything wrong with determining that any given time in our lives isn’t a right one for physical intimacy with others. It doesn’t mean we’re immature, that we don’t really love someone, that we’re somehow deficient: it just means we’re recognizing — usually because of maturity, wisdom and love — that sex or intimacy isn’t something that’s always right at every time, but which, instead, tends to require a unique set of circumstances that we’re just not always in, or which isn’t always available to us.

Often when we give the suggestion that taking any kind of sex off the table for a bit might be best, one common reaction we hear is that someone feels they just can’t do that because they may lose or jeopardize a relationship in which some kind of sex either feels like it’s required or is tacitly required.

If you feel that way, this fear may be really useful in learning something about healthy relationships. Having any kind of sex or physical contact — even just something like making out — because you feel you have to to keep someone around isn’t a recipe for a healthy, happy relationship or a healthy sexuality and sense of self, for either person. It certainly isn’t for the person engaging in any kind of physical contact they either don’t really want or don’t feel ready to handle, but it also isn’t for the other person, either. Healthy people who want sex with other people to actually be about both people are not going to tend to want a sexual partner who doesn’t fully want to be doing what they are with them, or who is only doing so out of feelings of obligation or fear.

I can’t know what you want in a romantic or sexual relationship. But I’m willing to bet that you’d probably like those relationships to have a dynamic where you and any partner are only doing things that matter and can have deep impact which you and they really want to do and that you and they feel good about, since that’s what most of us want.

By all means, everyone doesn’t have the same level of maturity, the same level of really seeing past their own wants, and not everyone is emotionally healthy or really ready for intimacy with other people. Some people we might pair up with may not be respectful and fair if we voice we don’t want to do something sexual or physical. What I’d advise in that case is that you do yourself a good turn and only choose partners who don’t behave like that. If you feel like those are the only partners available to you, something I’ve also heard some young women voice, then I’d say your best bet is to wait until you have better choices, because you will. However hungry I may be, if all that’s available to me is food that’s rotten or poisoned, it’d be better for me to just go without eating, and I’d say the same is true here.

As well, we all get to decide what kind of relationships we want, so if someone really wants a sexual relationship, they may voice that one that isn’t what they want and need at a given time. They get to do that, and if and when they do, the answer isn’t to make yourself do things you don’t want or feel you can handle. Rather, it’s to acknowledge your different needs or readiness, part ways amicably, and both seek out relationships that are a better fit for each of you.

Writer and teacher Pema Chodron wrote, about stress and anxiety, that “Everything that occurs is not only usable and workable but it is actually the path itself. We can use everything that happens to us as the means for waking up.” What she means by that is that often, pervasive worries like this are valuable cues for us to potentially recognize ways we need to grow or change how we’re living our lives we might not have recognized otherwise. Maybe in your case this just is not the right time of life, relationship or overall situation for you to be sexual. Maybe this specific relationship has something in it that isn’t quite right, needs to be talked out, or just doesn’t suit you. Maybe it’s about taking a look at feelings of guilt and either clarifying or adjusting your values so they fit you better, or, if you feel your values now are authentic to you, living in greater alignment with those values. Maybe it’s a cue that you’re carrying too much stress in your whole life in general, and need to find some ways to manage it better, or a cue that you have an anxiety disorder or phobia you need qualified help to manage.

I’m sorry I can’t give you an easy answer here, because I hate for anyone to suffer this way. But I just can’t know which of any of the possibilities here is the case for you, or if this is about something I haven’t identified here at all. Sometimes getting to the root of fears is really challenging and takes some time and introspection. I’d encourage you to invest time and energy in thinking about all of this, ideally giving yourself that time without doing anything that triggers those fears at the same time. Ask for any help and perspective you need: again, maybe that’s asking a counselor, maybe talking to your boyfriend or friends, maybe talking to a parent, doctor, religious leader or community member. You’re going to be the expert in finding your best sources of counsel and support. I’d also encourage you to try and consult your own instincts and to put trust in them: they really can tell us an awful lot, and so often, we’re taught to give those feelings less weight than they deserve.

I’m going to leave you a few extra links that might help, along with my very best wishes. If you want to talk more about this, you’re more than welcome to come over to our message boards, and I’d be glad to talk more with you.

Culture & Conversation Human Rights

Let’s Stop Conflating Self-Care and Actual Care

Katie Klabusich

It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.

As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.

I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.

International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.

“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”

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In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.

The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.

The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.

“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”

The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.

Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”

Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:

Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.

It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.

We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.

I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.

Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.

Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.

Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.

My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.

It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.

Over the past year I’ve noticed a spike in articles on how much of the emotional labor burden women carry—at the Toast, the Atlantic, Slate, the Guardian, and the Huffington Post. This category of labor disproportionately affects women of color. As Minaa B described at the Huffington Post last month:

I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.

The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

While her words ring true for me, they are certainly more weighted and applicable for those who don’t share my white and cisgender privilege. As covered at Ravishly, the Feminist Wire, Blavity, the Root, and the Crunk Feminist Collective recently, self-care for Black women will always have different expressions and roots than for white women.

But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.

Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”


“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.