Check out all of Rewire‘s coverage of the 2011 Summer of Trust / Summer of Choice convergence in Germantown, MD here.
About 220 people “Walked for Choice” on Sunday July 31 in the beastly Maryland sun in support of Dr. Leroy Carhart. Spirits were high and people had come from as far away as California as well as from Mississippi, Illinois, Kansas, Virginia, Florida and numerous other places. A good core of unapologetic young women and others turned out from the Germantown area, a number of them expressing their gratitude that Dr. Carhart came to their community.
A number of abortion-rights young people I spoke to went into the anti-abortion rallies and activities over the last couple of days — both to find out their plans as well as just to figure out what makes them tick. They were shocked by the level of fanaticism, including the demonizing language used to describe Dr. Carhart and the use of religious and priestly authority to spread anti-woman hate.
The Washington Post did an article that describes how the anti-abortion folks sent someone in to Carhart’s clinic in order to be “saved” from abortion by them. This woman was then broadcast at their rally proclaiming how they converted her to the “pro-life” movement. Here is just an excerpt from their article:
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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-Gazettereported 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.
“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.
Rep. Marsha Blackburn (R-TN) justified her recent subpoenas of a prominent later abortion provider and first responders in the community where he works by pointing to “public reports” that people who sought abortion care from the doctor required hospital transfers.
Hospital transfers are not necessarily a cause for alarm, multiple sources told Rewire. In fact, the rare instances signal a continued commitment to appropriate patient care that begins in an abortion clinic. A patient may not require further treatment upon arrival at the hospital, indicating a proactive clinic rather than a dangerous one. Regardless of the circumstances, anti-choice activists often hijack so-called emergencies to fuel their coverage of the alleged dangers of abortion care.
Freestanding clinics manage most immediate abortion-related complications, including those that occur during later abortions, said Dr. Daniel Grossman, a provider and professor in the department of obstetrics, gynecology, and reproductive services at the University of California, San Francisco.
Abortion-related complications are rare throughout all stages of pregnancy. The even rarer event that such complications necessitate a hospital transfer doesn’t indicate the work of a bad abortion provider, Grossman explained in an interview with Rewire.
“There are sometimes things that happen that are unforeseeable,” he said.
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Grossman, his University of California, San Francisco colleague Dr. Ushma Upadhyay, and other reproductive health care practitioners and policy experts studied just how often those unforeseeable instances occur in a review of nearly 55,000 abortions covered under the fee-for-service California Medicaid program from 2009-2010. The state data allowed researchers to track subsequent follow-up care sought after an abortion.
Among all abortions, about one of 5,491, or 0.03 percent, involved ambulance transfers to emergency departments on the day of the procedure, the researchers found.
For procedures in the second trimester or later, major complications that required hospital admissions, blood transfusions, or surgery amounted to 34 cases, or 0.41 percent.
Many hospitals don’t provide abortions, which essentially forces providers to perform the procedure at a freestanding clinic or turn away patients, Grossman said. Providers would not do something unsafe, he stressed, “but that puts a lot of pressure on them because they don’t have that option of deciding to do the procedure of a higher-risk patient in a hospital.”
Data supports Grossman’s assessment about abortion and clinic safety. Abortion care is one of the safest medical procedures performed in the United States, according to Planned Parenthood and the American Congress of Obstetricians and Gynecologists. “The rate of complications increases as a woman’s pregnancy continues, but these complications remain very unlikely,” the groups said in a joint fact sheet.
Blackburn, the chair of the U.S. House of Representatives’ Select Investigative Panel on Infant Lives, framed such instances differently when she shifted the panel’s focus from fetal tissue research practices to later abortion care, issuing subpoenas in mid-May to Dr. LeRoy Carhart and various local and state entities in Maryland.
“Public reports indicate at least five women have been sent to the hospital since December while seeking an abortion in this clinic,” Blackburn said in a press release. Blackburn expressed concern for “the sake of the women who have been rushed from that clinic to the hospital with increasing frequency.”
Blackburn Allegations Rooted in Dubious Sources
Blackburn’s press release cited the five hospital transfers since December 2015, but her subpoenas demand documentation dating back to 2010—signaling a deeper scope to her investigation.
The National Abortion Federation (NAF), the professional association of abortion providers, countered Blackburn’s basis for the subpoenas.
“Abortion opponents have been targeting Dr. Carhart for years because he is a very vocal and visible abortion provider,” NAF spokesperson Melissa Fowler told Rewire in an email. Following the 2009 murder of Dr. George Tiller, Carhart arguably became the country’s most prominent provider of later abortion care.
The Maryland Board of Physicians, one of the targets of Blackburn’s subpoenas, indicates that Carhart is in good standing. The board’s online practitioner profile system lists no Maryland disciplinary actions, no pending charges, and no reported malpractice judgments and arbitration awards within the past ten years. Malpractice settlements are another measure of provider competence, and Carhart hasn’t had three or more malpractice settlements of at least $150,000 in the past five years, according to the system. Additionally, the courts have not reported “convictions for any crime involving moral turpitude,” which the board defines as “conduct evidencing moral baseness” and determines on an individual basis under common law.
Absent allegations on the board’s website, the “public reports” smearing Carhart appear to come from anti-choice news outlets. In March, LifeSiteNews.com cited eyewitness accounts from anti-choice activists in reporting that Carhart sent a fourth woman to the hospital in four months. A leader of the radical anti-choice group Operation Rescue covered the same allegationsfor LifeNews.com.
The same website in 2013 alleged that the Washington Post downplayed the death of a young womanwho sought a later abortion at the clinic. However, the Maryland medical examiner’s office found that the woman died of natural causes from a rare complication that can also occur in conjunction with childbirth, and state health officials found “no deficiencies” in the care she received at the clinic. Blackburn’s subpoenas include Adventist HealthCare Shady Grove Medical Center, formerly Shady Grove Adventist Hospital, where the woman died.
Anti-choice organizations and their reports have played a prominent role in the current congressional inquiry. Troy Newman, Operation Rescue’s president, and David Daleiden founded the Center for Medical Progress (CMP), the anti-choice front group that triggered the select panel’s investigation into allegations that Planned Parenthood profited from fetal tissue donations obtained from abortions.
Blackburn’s select panel spokesperson denied that the subpoenas are based on information from anti-choice sources.
“The subpoenas we issued are not based on the sources you have cited,” the spokesperson told Rewire in an email. “However, due to confidentiality agreements, we are not at liberty to disclose the identities of our sources.”
Anti-Choice Activists Hijack Emergencies
Although Blackburn’s evidence may come from different sources, the fact remains that Operation Rescue and other radical anti-choice activists are known for surveilling abortion clinicsand making repeated records requests, all to report similar claims about botched abortions necessitating hospital transfers.
duVergne Gaines, director of the Feminist Majority Foundation’s National Clinic Access Project, said surveillance tactics enable anti-choice activists not only to photograph and video emergency responders, but also follow up with Freedom of Information Act and equivalent state-level requests for records, including 9-1-1 tapes, if state laws permit their release.
“They collect data,” Gaines said in an interview. “They put that up on the websites themselves, on their own Facebook pages, and have no real knowledge about what or why an ambulance may have been contacted.”
Hospital transfers in some instances have nothing to do with the procedure. Contrary to initial anti-choice accounts, the Lincoln, Nebraska Journal Starreported that a woman transferred in 2015 from a local Planned Parenthood to a hospital “wasn’t suffering complications from an abortion, but had instead sought help at the clinic after being assaulted at her home nearby.”
At times, anti-choice activists may manufacture emergency scenarios, Gaines said. “The most obvious example is alleging that a minor is inside being forced to undergo a procedure against her will, and that can happen if they see a minor go in [to a clinic],” she said.
Rewirereported in March that police appeared at a Mississippi clinic and threatened to charge a single mother with fetal homicide after her daughter, a minor seeking a legal abortion, signed a bogus Life Dynamics document stating that she was being coerced into the procedure.
The prominent anti-choice group uses the document to deceive and intimidate patients and providers by threatening legal action should they go through with obtaining or providing abortion care.
NAF President Vicki Saporta said that many of her group’s members have experienced anti-choice tactics such as staking out clinics for emergency vehicles, placing calls to summon emergency responders, and trailing ambulances to hospitals with the aim of gathering confidential patient information. Preferred tactics depend on the local anti-choice community, she said.
Saporta pointed to a crisis pregnancy center that opened in the same complex as the Germantown, Maryland, clinic where Carhart practices. A Germantown Pregnancy Choices, which comes up as the Maryland Coalition for Life when entered into Google Maps, operates within less than 200 feet of the clinic. The Maryland Coalition for Life cited eyewitness accounts and a videoin March to support allegations that an underage girl required a hospital transfer “due to medical emergencies related to a late term abortion.”
Anti-choice activists targeting clinics over safety share a common denominator. “Once their bogus claims are investigated, for the most part, no action is taken because nothing is actionable,” Saporta said.