In early 2015, “Angel,” a woman in her 20s living in northeastern Texas, found out that she was seven weeks pregnant. The news came as a blow. She was already having a difficult time raising her four children, who have birth defects and a range of disabilities, on her own. Angel herself battled mental illnesses that resulted from a lifetime of physical and psychological abuse.
To make matters worse, Angel had virtually no support. None of her children’s fathers was present in their lives; Angel had never known her own father and was estranged from her mother.
The young woman went to the Paris Pregnancy Care Center in Paris, Texas, where staff observed that she was “living in a very low socio-economic situation” and felt she had “few options available to her.”
“She stated she was going to have an abortion,” they wrote—using the pseudonym “Angel” to protect the client’s identity—in a report that the clinic filed to the Texas Health and Human Services Commission in July 2015.
While its website advertises “free lab quality medical test[s] and medically accurate information” about pregnancy and abortion, the Paris center is not an abortion provider. In fact, it participates in Texas’ Alternatives to Abortion Program, whose goal, as its name suggests, is to divert women from seeking or obtaining abortion. The program will receive $18.3 million in state funding over two years.
Alternatives to Abortion is not a medical program. Rather, it is a social services program administered by the Texas Pregnancy Care Network, a nonprofit organization based in Lake Hills that distributes funds to more than 40 subcontractors that the network selects and oversees. Those subcontractors operate nearly 100 locations throughout the state—including the center in Paris—providing education and information intended to encourage pregnant “clients” to give birth and to either parent those babies or give them up for adoption. The network’s guidelines say subcontractors must not “promote, refer, or provide abortions or abortifacient contraceptives to clients.”
The subcontractors include maternity homes, broader social services providers, and some specialized organizations, such as a support center for extremely low-weight babies. However, the largest single category consists of “crisis pregnancy centers,” like the Paris facility where Angel found herself. The modus operandi of many of these fake clinics is to trick women into thinking they provide abortions, when their mission is in reality to use misinformation and deception to prevent women from obtaining abortion care. Under Alternatives to Abortion in 2015, the state paid more than $2 million to these fake clinics. This year, the amount is likely to be significantly higher, given that the program’s budget has doubled.
Indeed, far from assisting Angel with her request to access abortion care, staff at the Paris center launched a campaign of persuasion intended to change her mind.
First, they administered an ultrasound. They noted that Angel “struggled with the images shown on screen,” but that she remained “determined to continue as planned.”
Next, they tried to have Angel speak with a clinic staffer who said she’d had an abortion, and could “answer any questions.” Angel declined. She remained “adamant about her decision to have an abortion,” and left.
According to their report to the commission, staff then “prayed for Angel and her unborn child.” They were pleased when the young woman phoned them ten weeks later and made an appointment to come in. When she arrived, they performed another ultrasound, and determined that the fetus was now at 18 weeks’ gestation.
During that visit, Angel wept as she recounted what had happened when she had tried to obtain an abortion.
“Upon arrival at the abortion clinic, there was a crowd of protesters holding graphic signs that made her feel even more hopeless, helpless and overwhelmed,” the clinic wrote. Their interpretation of Angel’s experience was that she was “confused about [the protesters’] approach to share the truth [sic] about abortion.”
Ultimately, after several more conversations with clinic staff, Angel said she had a family member who was willing to adopt the baby. When the clinic filed their report to the commission, Angel’s pregnancy was at 24 weeks’ gestation.
“We are eagerly awaiting ‘his’ or ‘her’ arrival in a few months,” the clinic workers wrote.
Angel’s is one of 40 client narratives contained in hundreds of pages of documents about the Alternatives to Abortion program that Rewire obtained through public records requests.
The materials include detailed financial, statistical, and organizational information, as well as the client narratives, and give a fresh window into the growing program that has, until now, functioned in relative obscurity.
Rewire‘s analysis of the documents shows that the Alternatives to Abortion program does not measure success based on key public health indicators such as improved health outcomes for clients. Nor does it attempt to achieve cost savings relative to other programs focused on public health outcomes. Instead, it measures success based on the number of “unique visitors” to certain websites, as well as on the number of clients who use the service.
We also found that only around a quarter of the funds are being spent on concrete assistance, such as diaper pantries and parenting classes. Most of the money is being spent on “counseling”—a term that the Health and Human Services Commission does not define—and some $739,000 was spent on publicity and advertising by April of this year. The program follows Texas’ September-August financial year.
Most importantly, the client narratives give an insight into how Texas taxpayer funds are being used in some cases to manipulate pregnant women, shame them for past decisions, and steer them toward continuing their pregnancies, no matter how clearly or how many times they voice their desire to choose abortion.
These clients’ narratives were nominated by Alternatives to Abortion sites as cases that either illustrated the “quality and scope” of the provider’s work before it was approved to participate in the program, or “demonstrates the work of the Texas Alternatives to Abortion Services Program with one particular client.”
In other words, they are supposed to be success stories for the publicly funded program.
Because the narratives were written using pseudonyms for client names, it is impossible to independently verify these stories. The executive director of Paris Pregnancy Care Center did not reply to Rewire‘s email seeking an interview for this report. But both the executive director of the Texas Pregnancy Care Network, John McNamara, and a spokesperson for the Texas Health and Human Services Commission told Rewire that they perform frequent on-site monitoring as well as regular “desk reviews” of these centers to verify the reports.
Assuming that these anecdotes accurately reflect real encounters, experts told Rewire that the client stories suggest that counselors at the centers participating in the Alternatives to Abortion program have taken a myopic view of clients, prioritizing the fate of the fetus as the most important aspect of the pregnant person’s life.
“The bottom line is that when people are questioning their pregnancy, they need to be given medically accurate, factual information about all the options available to them,” said Rep. Donna Howard (D-48), a past president of the Texas Nurses Association. “My concern is that that’s not the case with these facilities.”
These findings led Rep. Howard to renew her calls for these funds to go toward programs with a track record of helping pregnant women and infants.
“There is a purposeful direction in Texas of funding programs that are supporting a particular ideological agenda as opposed to programs that have clear evidence-based data to back up what they do,” she told Rewire. “That’s a real problem.”
“Counselors” Shame Women, Persuade Them to Continue Pregnancies
The framework for Alternatives to Abortion was adopted more than a decade ago, when legislation creating very similar programs was passed in at least two other states—Pennsylvania and Missouri.
Texas’ program adopted the same structure, whereby a nonprofit contracts with the state to dole out subcontracts to organizations that provide the services. The Texas Pregnancy Care Network appears to exist for the sole purpose of running Texas’ Alternatives to Abortion Program. Its federal tax filings show that it received virtually no income other than what it was awarded by the state.
Texas’ program has been blossoming in recent years, especially while the state limited access to abortion care and crisis pregnancy centers have proliferated. The legislature more than doubled the program’s funding from 2015-2016—the program now bills the state for $762,500 each month.
With its expanded services, Alternatives to Abortion is now serving record numbers of people. In an email to the state employee who oversees the program, the executive director of the Texas Pregnancy Care Network said that Alternatives to Abortion centers had seen 8,195 clients in the third quarter of last fiscal year. With those numbers, it’s on track to eclipse the nearly 22,000 Texans it saw in 2015, with the state estimating that recipients will bill for more than 200,000 visits in 2016.
At the same time, Texas has frozen or cut funds to numerous other programs that support women and infants.
For instance, the past few years saw Texas lawmakers attempt to legislate abortion providers out of existence in the state through the passage of a draconian law, two provisions of which the U.S. Supreme Court eventually found to be unconstitutional. In the three years when the law was partially in effect, roughly half of the state’s abortion providers were forced to shut their doors, leaving millions of women without access to full reproductive care.
During that same period, Texas has bolstered abortion providers’ ideological competitors through other programs. The state has doubled down on abstinence-only sex education, and has awarded a large contract through its Healthy Texas Women project to a fake clinic run by an anti-choice crusader. And it failed to increase funding for the Nurse-Family Partnership, a respected program based on years of evidence that now receives less than Alternatives to Abortion, at just under $9 million per year.
Rep. Howard believes this is the result of a legislature that has come to be dominated by people so committed to an anti-choice ideology that it has disregarded good public policy or fiscal responsibility.
“If there’s a sincerity about offering programs that are going to help young women who are pregnant and are expecting to have their baby, to help them with prenatal care, with the things they need to know once they have their baby to be successful parents, then we should look at programs that have a track record of success,” she said. “I have no confidence that there are those kinds of outcomes with the program that is getting the funding right now.”
That sense of disquiet was shared by experts who reviewed some of the clients stories contained in the documents that Rewire obtained.
For example, the stories of “Angel,” “Sha’ron,” “Flor,” “Amy,” and “Maria” all disclosed details that ought to have sparked actions to obtain help for these women and girls, going well beyond prioritizing the continuation of their pregnancy, according to Will Francis, government relations director at the Texas chapter of the National Association of Social Workers. He told Rewire that, based on these accounts, the services provided to these individuals did not meet professional standards.
“These clients did not receive the support and the emotional response that a non-biased, true medical professional should have given them,” he said. “In social work, we believe that the client is the one defining the problem. They may talk about homelessness, their trauma from rape, or whatever they want to talk about. The agenda of these centers is that preventing abortion is the most important thing in this picture. A success story for them is a woman who did not get an abortion. Not a woman who gets all these other resources.”
Rewire has learned that there are no guidelines governing what providers who are paid through the Alternatives to Abortion program must cover when they are “counseling” their clients.
A spokesperson for the Health and Human Services Commission told us that the agency does not define “counseling,” even though the financial reports show that it accounts for the single largest expense of the program.
McNamara from the Texas Pregnancy Care Network told Rewire that his organization does not provide any guidance about the content of counseling, but that it “reviews all educational materials, training manuals, and policy and procedure manuals of Providers to ensure that they are providing compassionate client services that are in compliance with Program rules.”
Experts were also concerned by how Alternatives to Abortion providers responded to clients who had experienced sexual and physical violence.
For instance, in one case, “Jane,” who was six months pregnant when she contacted the Children’s Connections center in Lubbock, told the intake worker that “she had gone to a party, drank too much and was raped.” She was supporting herself by working at a bar, and was teetering on the edge of homelessness—staying with “friends” where her living conditions were “unsafe.”
There is no indication that the Children’s Connections workers discussed reporting Jane’s rape to police.
With 27 locations throughout the state, Children’s Connections is the biggest single provider in the Alternatives to Abortion network. Rewire’s message seeking comment from Children’s Connections did not receive a reply.
Three additional client stories from other subcontractors explicitly said that the woman had become pregnant following a rape, and another story detailed the story of a minor who had been “taken advantage of” by a much older family friend. These stories likewise showed that staff focused on the continuation of pregnancy as a primary concern. And of course, in no case was the woman given the option of terminating her pregnancy.
Chris Kaiser, director of public policy and general counsel at the Texas Association Against Sexual Assault, said he found these cases alarming.
“As a general matter, for any victim of rape or sexual assault, a big part of that recovery has to be maximizing that person’s options—including pregnancy—but all life options, because the act of assault is taking away autonomy,” Kaiser told Rewire. “To eliminate options for rape survivors is really the opposite of what we need to be doing.”
Many client stories also either explicitly or implicitly suggested other forms of abuse, but the centers gave no indication that they had properly addressed those issues.
For example, staff at FirstLook in Waxahachie persuaded “Rachel” to continue her pregnancy, even after she cried and told them that she wanted an abortion, because her “boyfriend and father of the baby was not a nice person.” She said she had been planning to go to culinary school to fulfill her dream of becoming a chef, but when she learned she was pregnant, “she felt as if her dreams were crushed and she would be forever connected to person [sic] she did not see as a father for her child,” and that “she never intended to have children with him, much less stay with him.”
Clinic workers performed an ultrasound, and reported that “when she saw the baby’s heart flutter, so did Rachel’s.”
After Rachel’s daughter, Brook, was born, the clinic wrote that she “couldn’t imagine that she could have traded Brook for Culinary School. Brook turned out to be Rachel’s dream job—mother.”
Kaiser said that Rachel’s story raised a number of red flags for intimate partner abuse.
“Reproductive coercion is something that domestic violence perpetrators do frequently to maintain control of their victims,” he said. “If there’s ever a time, statistically, that someone is going to look for help or services outside of that relationship, it’s going to be at the time of pregnancy. Keying in on that opportunity to help women in that situation may be one of the only chances we have to intervene.”
Many of the centers included in the Alternatives to Abortion program say they do provide services in addition to counseling, such as housing assistance and job training. And a spokesperson for the Health and Human Services Commission said that the client stories are not intended to detail every action taken in a case, but rather to offer a snapshot of services provided.
Even so, it’s striking that very few of the narrative accounts mention assessing women’s needs other than parenting or adoption support. And the financial reports provided to Rewire as part of our public records request indicate that only 1 percent of billing for client services under the program was attributed to “referrals.”
Of course, one way to take away a person’s options is to provide them with false information about those options. When Rewire surveyed the websites of recipients of the Alternatives to Abortion funds, we found that the majority of participating crisis pregnancy centers displayed misleading and false information. Crisis pregnancy centers have been caught in numerous federal, state, city, and independent investigations engaging in systematic lies and manipulation to trick women out of obtaining abortion care, steering them toward parenting and adoption.
Of the approximately 20 providers that appeared to be crisis pregnancy centers, Rewire found misleading language on 16 of their websites. That included the type of advertising that is typical for fake clinics: “Pregnant? We can help,” say several; almost all offer “information about abortion” without mentioning that their mission is to persuade women not to have an abortion.
Many sites also included statements wrongly implying that abortion is a dangerous procedure. For example, the site for Pregnancy Resources of Abilene says, “Abortion is not just a simple medical procedure. For many women, it is a life changing event with significant consequences.” In fact, abortion is known to be extremely safe, and in the case of early abortion, it is often very simple. Furthermore, research shows that abortion is not linked to negative consequences for mental health.
And most of the centers also tout the fact that they offer “free” ultrasounds to their clients. However, in almost all cases, these sonograms are non-diagnostic, meaning that they are not intended to be used for medical purposes. Critics say that fake clinics use ultrasounds as part of their anti-choice propaganda.
In an email to Rewire, McNamara said that participating centers are required to “be transparent and accurate with all information they provide and disseminate about Program services,” and that his organization reviews provider websites to ensure they are accurate. He said he was “not currently aware of any Provider websites that contain misleading information,” and noted that his organization mandates that information used by program providers meet the same standards as Texas’ “Woman’s Right to Know Act.” That act requires abortion providers to provide false warnings to women regarding a link between abortion and breast cancer.
Tina Hester, the executive director of Jane’s Due Process, a nonprofit organization that helps pregnant teens in Texas, said she worries about the future of women such as “Angel” who seek help from these centers and are left to deal with the consequences, especially because the program only reimburses participating locations up to a maximum of two years after the birth of a client’s child.
“I wonder how she and her children are doing now. I wonder, did they line her up with a long-acting reversible contraceptive so that she wouldn’t have another pregnancy?” she mused. “We’re giving state money to pray over these girls and browbeat them, and praise them when they have to run the gauntlet of these vicious protesters outside the clinic, and then again when they have the child, but in the end, what have you left her with? If they would just spend a fraction of the time keeping girls from getting pregnant, we’d be in a much better place.”