Commentary Abortion

My Latest Reproductive Health Procedure Makes Anti-Choicers Seem Even More Hypocritical

Katie Klabusich

If anti-choicers truly cared about women to the degree they claim, surely they would treat abortion procedures just like any other reproductive health need—and leave decisions about safety and comfort up to women and their doctors.

Over the past decade or so, the public language in anti-abortion lobbying has shifted from “Save the children!” to “For the health of the mother!” Having apparently determined that over-the-top tactics of lying down in front of cars and chaining themselves to clinic doors were turning off the public at large, prominent groups like the National Right to Life now often push for laws they say benefit “everyone involved”—including the pregnant person.

While anti-choice groups still use inflammatory language like “infanticide” and “abortion mill” in their newsletters and blog posts, the emphasis has shifted to passing targeted regulation of abortion provider (TRAP) laws—all under the guise of protecting, as the National Right to Life puts it on its website, “mothers and their unborn children.”

As a reproductive justice advocate who has had a first-trimester abortion, anti-choicers’ language around these laws became even more clearly hypocritical to me following a different, in-office reproductive health procedure I recently underwent to save my life. Given the degree of anti-choice rhetoric about how much stress women undergo to get abortions, I hadn’t even considered the thought of being uncomfortable and emotionally exhausted by any other reproductive health service. After all, the public doesn’t hear much about the thousands of women like me who are at high risk for cervical cancer, and we certainly aren’t a priority of any anti-abortion group I’ve encountered. If anti-choicers truly cared about women to the degree they claim, surely they would treat abortion procedures just like any other reproductive health need—and leave decisions about safety and comfort up to women and their doctors.

An Arbitrary Standard

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

One TRAP law that has been particularly damaging in recent years requires abortion providers to adhere to ambulatory surgical center (ASC) standards. Conveniently omitting that first-trimester abortion only sends a tiny fraction of patients to the hospital in need of follow-up care, anti-choice groups and legislators have continuously maintained that the width of a facility’s hallways, number of parking spaces, and size of the janitorial closets guaranteed through certification as an ASC will be what safeguards the patient’s health during their five-minute procedure.

Dr. Leah Torres, a Salt Lake City, Utah-based OB-GYN specializing in reproductive health, says these laws do exactly the opposite.

“TRAP laws are passed under a false premise of patient safety,” Torres told Rewire. “Patient safety is the top priority of any physician, yet the laws that are passed prohibit me from taking care of people in the safest way I know how. This does, in fact, hurt my patients. Harm is done when physicians’ hands are tied.”

The most famous ASC law was penned in Texas, where its parent omnibus anti-abortion law, HB 2, is winding its way through the appeals courts, due to be heard by the full Fifth Circuit on January 8. Texas is certainly not the only state with this requirement. Anti-abortion groups across the country have pushed laws, such as the model legislation from Americans United for Life, that have proven to close the doors of clinics. Accreditations and building specifications are a matter of public record, so it’s easy to determine whether or not local clinics meet the expensive building requirements to become ASC-certified. If they—like many of the Texas facilities—do not meet those requirements, anti-choicers conceivably know that having the construction done to meet the standards is often a multi-million dollar ordeal that results in closure rather than renovation. 

Occasionally a right-to-lifer will slip and publicly admit that abortion is safer than pregnancy, or that all the talk about “women’s health” is just a façade to divert attention from their intention to close clinics. With those missteps on the record, let’s just be honest about the whole thing: Anti-choice groups and the legislators they back aren’t interested in the health of the patient. Their interest stops at the health of the embryo or fetus. If they cared about the whole health of the patient, that interest would have revealed itself at some point during their more than 40 years in existence as a movement. 

Dr. Torres says she has yet to see someone calling themselves “pro-life” advocating for preventive and life-saving care.

“It is discriminating to profess concern for patient safety for one procedure, for one population—women of reproductive age—and not for all people across all specialties,” says Torres. “It is hypocritical and it feels false, as well as insulting.”

Indeed it does.

Selective Concern

Abortion is, after all, the only reproductive health-care procedure that seems to matter to these groups. Having spent time volunteering and organizing as a clinic defense escort in Chicago, New York, New Jersey, and Los Angeles, I can attest to the very singular focus of the picketers and the groups they represent: With the exception of the occasional anti-contraception sign, all the misinformation-filled pamphlets, screaming, and photoshopped, gory placards are abortion-motivated. This seems curious, as any “life”-focused activist should be interested in the lifesaving services offered at most clinics and doctor’s offices. You never see them screaming on their capitol building’s steps demanding the expansion of preventive care like Pap tests, STI testing, prenatal support, and the like. They aren’t passing out condoms at AIDS walks, or even offering child-care assistance for the children a patient already has. If a National Right to Life, Pro-Life League, or Operation Rescue member is holding a sign somewhere, their only concern is forcing a pregnant person to carry to term.

This gap in empathy and what constitutes “saving a life” exhibited by millions of anti-choicers was particularly evident to me when I went in to my gynecologist this August for a loop electrosurgical excision procedure (LEEP), which removed abnormal tissue on my cervix both for further testing and to hopefully excise any pre-cancerous cells, thus preventing cervical cancer. I am on what I call the “HPV merry-go-round,” having contracted a strain of the human papillomavirus (HPV) in my 20s that my immune system has not yet successfully fought off ten years later. HPV is so common that, according to the Centers for Disease Control and Prevention, “nearly all sexually active men and women get it at some point in their lives,” so I’ve never felt particularly “damaged” by the diagnosis, just frustrated and extremely inconvenienced. 

Most strains don’t cause health problems (especially in men, who often never discover they were or are a carrier). The handful of problematic strains, however, lead to annual HPV-associated cancer diagnoses in approximately 20,000 women and 12,000 men, with cervical cancer in women being the most common (12,109 cases and 4,902 deaths in 2011). As a consequence, preventive treatments such as colposcopies and LEEPs can be literally lifesaving. 

Over the past decade, I’ve gone through occasional stretches with normal Pap test results and just the one doctor’s visit for that year. More often than not, though, I’m back for additional Paps, the now routine-for-me colposcopy to determine just how abnormal or pre-cancerous the cells of my cervix are, and, most recently, a LEEP.

So after three colposcopies and a LEEP—all performed in my doctors’ offices—I’ve had more than my share of “work” done in terms of reproductive health procedures. Personally, I am comfortable saying that my first-trimester abortion was a less stressful appointment and came with less discomfort than the four procedures performed to prevent any developing cervical cancer. My LEEP in August was particularly traumatic because my doctor and her staff had what I will politely describe as a lack of bedside manner. Picturing the cold procedure room where I was left for nearly 90 minutes in only a gown, with no information or counseling from my doctor, makes my pulse race even months later. (According to Torres, the pre-procedure counseling for LEEPs should take place in an office setting with the patient fully clothed.)

When I got home, after having used Twitter heavily during my lengthy wait for the doctor, I checked my feeds. Many people had responded with words of concern and love. Two of my best friends—knowing I have an anxiety disorder and that the lidocaine used to numb my cervix might still be causing heart palpitations in addition to the ones my body was producing on its own—had continued to check in on me while I was on the subway without cell phone service. Everyone, it seemed, was concerned with my health. 

Everyone except the anti-choicers who routinely harass me online for my abortion advocacy, that is. Their silence on my experience—and on the everyday experiences of patients who visit their doctors’ offices for procedures carrying risks similar to abortion—is deafening. They seem to trust medical professionals to perform all manner of non-abortion-related care without bystander intervention; do they not understand that the abortion specialty operates just like the rest of medicine? 

As with other medical fields, best practices for obstetrics and gynecology procedures are governed by associations of medical professionals like the American Congress of Obstetricians and Gynecologists and the National Abortion Federation. Torres says that she spent time developing skills for both LEEPs and first-trimester abortions early on in her career; she considers the “level of surgical skill,” as she put it, required for each to be comparable. 

And the risks for both procedures are comparably negligible, too. The LEEP takes longer because of the time spent waiting for the lidocaine to fully numb the cervix (think the time you spend in the dentist’s chair waiting for the Novocain to kick in before a filling). According to Planned Parenthood, it’s rare to have issues requiring follow-up care after either procedure; the organization’s website counsels patients to watch for similar symptoms, including abnormally heavy bleeding or signs of infection such as fever or vomiting. 

When compared to my LEEP this August, my abortion experience four years earlier at a Planned Parenthood in Chicago was warm, comforting, less painful, and over much more quickly. In fact, I can theoretically see a more understandable case for some of the ASC guidelines being pertinent to the LEEP than to the abortion, as the former felt more invasive—the doctor wears a mask to keep the smoke produced during cauterization out of their eyes, and I was in stirrups more than twice as long. 

Still, no one is demanding legislation to regulate it. Nor, as Torres points out, are they rallying against colonoscopies, which are 40 times as risky as abortion, or dental procedures that require anesthesia.

“There are many riskier procedures done by other specialists in the office and no mention is made of their needing admitting privileges”—another common TRAP law—“or that their procedures require a surgical center,” said Torres. “No one demands [gastro-intestinal] specialists only perform [colonoscopies] in an ASC. Also, if you think about the sedation procedures dentists perform, those medications are also used in surgical procedures in ASCs yet dentists are not required to be in an ASC to use them.” 

In fact, Torres has never seen a law proposed to regulate how she performs any other procedures, including LEEPs, in her office—or how dentists and proctologists and plastic surgeons perform procedures in theirs. 

A LEEP, Torres said, “Saves the life of the patient. I don’t know why those who value life do not advocate for all surgical procedures be performed in ASCs if they are that convinced [ASCs] ‘safer’ and ‘saves lives’ over anything else.” 

She’s not advocating in favor of more of these laws, of course, as they increase the financial and logistic burden on both patients and providers, along with occasionally decreasing safety. She is simply pointing out the reality of which procedures get held up for additional scrutiny. 

“Medically, sometimes the office is safer for a procedure and sometimes the hospital is safer. That [decision] should be made by the medical professional—not the patient, not the lawyers, not the politicians,” said Torres.

“I’m prohibited from performing abortions in Utah hospitals, for example. You’d think that would be the ‘safest’ place, but state laws prohibit facilities receiving state funds from performing abortion—and all Utah hospitals receive state funds. Lots of contradiction,” she continued. “So, if I think I can’t safely perform the abortion in the office, even [one] with ASC standards, then I have to send the patient to another state. This happens all over the country.” 

The Growing Restrictions

Torres couldn’t be more right. Legislators in nearly every part of the country are wasting time and money exhibiting a complete disregard for women’s basic humanity as autonomous persons. Hundreds of laws have been introduced restricting abortions across the country. In fact, since Roe, nearly every state in the union has enacted legislation inserting the state house into exam rooms.

Why do we not trust providers and patients when it comes to one of the safest procedures in medicine? Because, apparently, the patient seeking an abortion has a uterus and presumably was so bold as to have sex, and that means legislators—overwhelmingly rich, white men—have a centuries-old right to dictate what happens next. While no one, not even an anti-abortion “advocate” or legislator, would deny me access to the procedures that have hopefully prevented me from developing cervical cancer, they don’t recognize my right to control the contents of my uterus.

The abortion that I know saved my life? That, anti-choicers feel compelled to weigh in on.

If “pro-life” organizations and legislators truly cared about women’s health, they would be campaigning for wider access to HPV screenings and vaccines. Or, just perhaps, they would stop to consider leaving it up to the experts: the doctors and patients. 

Certainly, the incoming wave of new Republican legislators following the 2014 midterms won’t lead to a lessening of the country-wide trend anytime soon. As Rewire has reported, Americans United for Life is well-funded thanks to wealthy donors like the Koch brothers; its model legislation is ready and waiting for right-wing legislators to introduce this January. Meanwhile, likely Majority Leader Mitch McConnell has promised to introduce a federal 20-week ban in the Senate to match the one the now farther-to-the-right House passed last year. The president is opposed to the ban and would probably veto such legislation, but the national prominence of a bill pushed and passed “for women’s health and safety” gives undue validity to the state-level measures that will follow on its heels. 

Providers like Torres are not opposed to the public discourse and legislator interest in their profession; Torres simply takes issue with the motivation revealed by the way they circumvent evidence and care guidelines from physicians.

“I have no problem with elected representatives involving themselves in public health issues. I think political involvement in health care is necessary,” said Torres. “However, political dictation of how medical care is provided should not occur without the proper medical training and knowledge to support it … Just as I do not walk into a courtroom and start practicing law, they should not interfere with the safe, evidence-based health care [being provided] to their constituents.”

News Law and Policy

Texas Lawmaker’s ‘Coerced Abortion’ Campaign ‘Wildly Divorced From Reality’

Teddy Wilson

Anti-choice groups and lawmakers in Texas are charging that coerced abortion has reached epidemic levels, citing bogus research published by researchers who oppose legal abortion care.

A Texas GOP lawmaker has teamed up with an anti-choice organization to raise awareness about the supposed prevalence of forced or coerced abortion, which critics say is “wildly divorced from reality.”

Rep. Molly White (R-Belton) during a press conference at the state capitol on July 13 announced an effort to raise awareness among public officials and law enforcement that forced abortion is illegal in Texas.

White said in a statement that she is proud to work alongside The Justice Foundation (TJF), an anti-choice group, in its efforts to tell law enforcement officers about their role in intervening when a pregnant person is being forced to terminate a pregnancy. 

“Because the law against forced abortions in Texas is not well known, The Justice Foundation is offering free training to police departments and child protective service offices throughout the State on the subject of forced abortion,” White said.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

White was joined at the press conference by Allan Parker, the president of The Justice Foundation, a “Christian faith-based organization” that represents clients in lawsuits related to conservative political causes.

Parker told Rewire that by partnering with White and anti-choice crisis pregnancy centers (CPCs), TJF hopes to reach a wider audience.

“We will partner with anyone interested in stopping forced abortions,” Parker said. “That’s why we’re expanding it to police, social workers, and in the fall we’re going to do school counselors.”

White only has a few months remaining in office, after being defeated in a closely contested Republican primary election in March. She leaves office after serving one term in the state GOP-dominated legislature, but her short time there was marked by controversy.

During the Texas Muslim Capitol Day, she directed her staff to “ask representatives from the Muslim community to renounce Islamic terrorist groups and publicly announce allegiance to America and our laws.”

Heather Busby, executive director of NARAL Pro-Choice Texas, said in an email to Rewire that White’s education initiative overstates the prevalence of coerced abortion. “Molly White’s so-called ‘forced abortion’ campaign is yet another example that shows she is wildly divorced from reality,” Busby said.

There is limited data on the how often people are forced or coerced to end a pregnancy, but Parker alleges that the majority of those who have abortions may be forced or coerced.

‘Extremely common but hidden’

“I would say that they are extremely common but hidden,” Parker said. “I would would say coerced or forced abortion range from 25 percent to 60 percent. But, it’s a little hard be to accurate at this point with our data.”

Parker said that if “a very conservative 10 percent” of the about 60,000 abortions that occur per year in Texas were due to coercion, that would mean there are about 6,000 women per year in the state that are forced to have an abortion. Parker believes that percentage is much higher.

“I believe the number is closer to 50 percent, in my opinion,” Parker said. 

There were 54,902 abortions in Texas in 2014, according to recently released statistics from the Texas Department of State Health Services (DSHS). The state does not collect data on the reasons people seek abortion care. 

White and Parker referenced an oft cited study on coerced abortion pushed by the anti-choice movement.

“According to one published study, sixty-four percent of American women who had abortions felt forced or unduly pressured by someone else to have an unwanted abortion,” White said in a statement.

This statistic is found in a 2004 study about abortion and traumatic stress that was co-authored by David Reardon, Vincent Rue, and Priscilla Coleman, all of whom are among the handful of doctors and scientists whose research is often promoted by anti-choice activists.

The study was cited in a report by the Elliot Institute for Social Sciences Research, an anti-choice organization founded by Reardon. 

Other research suggests far fewer pregnant people are coerced into having an abortion.

Less than 2 percent of women surveyed in 1987 and 2004 reported that a partner or parent wanting them to abort was the most important reason they sought the abortion, according to a report by the Guttmacher Institute.

That same report found that 24 percent of women surveyed in 1987 and 14 percent surveyed in 2004 listed “husband or partner wants me to have an abortion” as one of the reasons that “contributed to their decision to have an abortion.” Eight percent in 1987 and 6 percent in 2004 listed “parents want me to have an abortion” as a contributing factor.

‘Flawed research’ and ‘misinformation’  

Busby said that White used “flawed research” to lobby for legislation aimed at preventing coerced abortions in Texas.

“Since she filed her bogus coerced abortion bill—which did not pass—last year, she has repeatedly cited flawed research and now is partnering with the Justice Foundation, an organization known to disseminate misinformation and shameful materials to crisis pregnancy centers,” Busby said.  

White sponsored or co-sponsored dozens of bills during the 2015 legislative session, including several anti-choice bills. The bills she sponsored included proposals to increase requirements for abortion clinics, restrict minors’ access to abortion care, and ban health insurance coverage of abortion services.

White also sponsored HB 1648, which would have required a law enforcement officer to notify the Department of Family and Protective Services if they received information indicating that a person has coerced, forced, or attempted to coerce a pregnant minor to have or seek abortion care.

The bill was met by skepticism by both Republican lawmakers and anti-choice activists.

State affairs committee chairman Rep. Byron Cook (R-Corsicana) told White during a committee hearing the bill needed to be revised, reported the Texas Tribune.

“This committee has passed out a number of landmark pieces of legislation in this area, and the one thing I think we’ve learned is they have to be extremely well-crafted,” Cook said. “My suggestion is that you get some real legal folks to help engage on this, so if you can keep this moving forward you can potentially have the success others have had.”

‘Very small piece of the puzzle of a much larger problem’

White testified before the state affairs committee that there is a connection between women who are victims of domestic or sexual violence and women who are coerced to have an abortion. “Pregnant women are most frequently victims of domestic violence,” White said. “Their partners often threaten violence and abuse if the woman continues her pregnancy.”

There is research that suggests a connection between coerced abortion and domestic and sexual violence.

Dr. Elizabeth Miller, associate professor of pediatrics at the University of Pittsburgh, told the American Independent that coerced abortion cannot be removed from the discussion of reproductive coercion.

“Coerced abortion is a very small piece of the puzzle of a much larger problem, which is violence against women and the impact it has on her health,” Miller said. “To focus on the minutia of coerced abortion really takes away from the really broad problem of domestic violence.”

A 2010 study co-authored by Miller surveyed about 1,300 men and found that 33 percent reported having been involved in a pregnancy that ended in abortion; 8 percent reported having at one point sought to prevent a female partner from seeking abortion care; and 4 percent reported having “sought to compel” a female partner to seek an abortion.

Another study co-authored by Miller in 2010 found that among the 1,300 young women surveyed at reproductive health clinics in Northern California, about one in five said they had experienced pregnancy coercion; 15 percent of the survey respondents said they had experienced birth control sabotage.

‘Tactic to intimidate and coerce women into not choosing to have an abortion’

TJF’s so-called Center Against Forced Abortions claims to provide legal resources to pregnant people who are being forced or coerced into terminating a pregnancy. The website includes several documents available as “resources.”

One of the documents, a letter addressed to “father of your child in the womb,” states that that “you may not force, coerce, or unduly pressure the mother of your child in the womb to have an abortion,” and that you could face “criminal charge of fetal homicide.”

The letter states that any attempt to “force, unduly pressure, or coerce” a women to have an abortion could be subject to civil and criminal charges, including prosecution under the Federal Unborn Victims of Violence Act.

The document cites the 2007 case Lawrence v. State as an example of how one could be prosecuted under Texas law.

“What anti-choice activists are doing here is really egregious,” said Jessica Mason Pieklo, Rewire’s vice president of Law and the Courts. “They are using a case where a man intentionally shot his pregnant girlfriend and was charged with murder for both her death and the death of the fetus as an example of reproductive coercion. That’s not reproductive coercion. That is extreme domestic violence.”

“To use a horrific case of domestic violence that resulted in a woman’s murder as cover for yet another anti-abortion restriction is the very definition of callousness,” Mason Pieklo added.

Among the other resources that TJF provides is a document produced by Life Dynamics, a prominent anti-choice organization based in Denton, Texas.

Parker said a patient might go to a “pregnancy resource center,” fill out the document, and staff will “send that to all the abortionists in the area that they can find out about. Often that will stop an abortion. That’s about 98 percent successful, I would say.”

Reproductive rights advocates contend that the document is intended to mislead pregnant people into believing they have signed away their legal rights to abortion care.

Abortion providers around the country who are familiar with the document said it has been used for years to deceive and intimidate patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.

Vicki Saporta, president and CEO of the National Abortion Federation, previously told Rewire that abortion providers from across the country have reported receiving the forms.

“It’s just another tactic to intimidate and coerce women into not choosing to have an abortion—tricking women into thinking they have signed this and discouraging them from going through with their initial decision and inclination,” Saporta said.

Busby said that the types of tactics used by TFJ and other anti-choice organizations are a form of coercion.

“Everyone deserves to make decisions about abortion free of coercion, including not being coerced by crisis pregnancy centers,” Busby said. “Anyone’s decision to have an abortion should be free of shame and stigma, which crisis pregnancy centers and groups like the Justice Foundation perpetuate.”

“Law enforcement would be well advised to seek their own legal advice, rather than rely on this so-called ‘training,” Busby said.

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.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

“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.