Editor’s note: This is the first report in an ongoing series.

The patient came in with a belly full of blood, Dr. Leilah Zahedi-Spung recalled. Her pregnancy was ectopic, no longer viable, and could have killed her if left untreated. But when she went to a mobile pregnancy help center offering free care in an RV in St. Louis, she was told the pregnancy could be saved.

By the time she saw Zahedi-Spung days later, her fallopian tube had ruptured.

In North Lauderdale, Florida, Ieshia Scott was pregnant and in the throes of postpartum depression. She thought she’d arrived at an abortion clinic. She told the staff she might hurt herself if she had another baby. They told her God would give her strength.

A woman and her partner in Sheboygan, Wisconsin, went to a pregnancy help center by mistake. When they made it to a Planned Parenthood clinic across the street, the pregnant patient handed Dr. Kristin Lyerly a copy of the sonogram. But the scan was not of her uterus. It was her bladder.

All three patients had gone to crisis pregnancy centers, organizations that advertise free pregnancy tests and ultrasounds but dissuade women from pursuing abortions and contraceptive options. Since the U.S. Supreme Court ended national abortion access in June 2022, the centers have seen an infusion of taxpayer dollars in many Republican-led states. But medical experts have urged lawmakers to reconsider the state support, as the centers can endanger public health by “causing delays in accessing legitimate health care,” according to the American College of Obstetricians and Gynecologists. 

States Newsroom conducted a 50-state investigation examining state and federal budgets, as well as the tax records of these organizations, finding that while the magnitude of public funding for them is growing, oversight is not. 

Twenty-one states funneled nearly a half-billion dollars, or $491 million, of taxpayer money to crisis pregnancy center organizations between fiscal years 2022 and 2025. That figure does not include millions some states diverted from federal programs like Temporary Assistance for Needy Families, and it does not include multimillion-dollar tax credit programs launched after federal protections for abortion rights were overturned. 

Nearly $1.3 billion in local, state or federal government grants were awarded to 1,259 crisis pregnancy centers in total between 2019 and 2024, according to States Newsroom’s analysis of tax records. The actual figure may be higher, as digital records are not comprehensive or entirely up to date.

Yet that largesse hasn’t been matched by corresponding regulation. Oversight of taxpayer funding remains weak, either blocked by legislators or ignored by state agencies. 

The centers are most often faith-based nonprofits that say they provide much-needed support for pregnant clients at no cost. An estimated 2,633 crisis pregnancy centers were operating in the United States as of March 31, 2024, according to research from the University of Georgia. 

John Mize, CEO of Americans United for Life, argues that pregnancy centers are important for people who really don’t want an abortion, and for anyone who regrets their abortion to find support. 

“I am strongly of the opinion that most women that have abortions do it because they don’t feel like they have any other option,” Mize said.

But critics and researchers say the pregnancy centers mislead potential clients about their services or pose as medical clinics despite lacking proper licensure. They sometimes promote treatments like abortion pill reversal, which is unproven and potentially dangerous. 

“Often, patients are lured in by this idea of getting free care,” said Dr. Rachel Jensen, Darney-Landy complex family planning fellow at the American College of Obstetricians and Gynecologists. “It’s free, because it’s often subsidized by taxpayer dollars. Free health care sounds amazing. It should be available to all people. But the problem is, then, that the CPCs are unregulated — and they operate outside of ethical principles and best care practices.”

Firsthand accounts: ‘What’s your plan for this pregnancy?’ Comfort, shame and a missed diagnosis

Indiana state Sen. Shelli Yoder, a Democrat, said access to maternal health care in her state continues to decrease while support for crisis pregnancy centers increases. Indiana boosted its budget for the centers from $250,000 in 2021 to $2 million, then doubled it to $4 million by 2024. The state’s maternal mortality rate is among the worst in the country. 

“It’s not that these centers don’t serve a purpose. But they certainly are not a replacement for maternal health care, and they are not health care centers, and yet our state is using taxpayer money to fund them as if they are,” Yoder said. “And we are sending a message to moms, or to women, that they are health care centers, and they are not.”  

Zahedi-Spung was working an emergency room shift in 2019 at a St. Louis hospital, not too far from the pregnancy center housed in an RV and frequently parked in front of a Planned Parenthood clinic. She said she was horrified to learn the patient with the ruptured ectopic pregnancy had been told at the mobile crisis pregnancy center a few days before that it could be saved. A tubal ectopic pregnancy is never viable.

Today, Zahedi-Spung works in Colorado as a high-risk OB-GYN. But that experience in the ER still haunts her.

“They’re a private organization providing medical care without a medical license, so they are not liable for anything they tell anyone,” she said.

Andrea Trudden, spokesperson for Heartbeat International, one of the largest pregnancy center networks in the U.S., said that as of 2025, more than 75% of Heartbeat affiliates offer medical services and are different from pregnancy resource centers, which offer parenting classes and material aid but not medical services.

“Medical affiliates that provide limited obstetrical ultrasound or other services follow applicable state laws, professional standards, and clinical protocols,” Trudden said in a written statement.

According to a report from the Charlotte Lozier Institute, 37% of 2,775 crisis pregnancy centers provided testing for sexually transmitted infections, and 29% provided STI treatment in 2024. The institute, which is the research arm of one of the largest anti-abortion policy groups, Susan B. Anthony Pro-Life America, found that 81% of surveyed centers provided ultrasound services in 2024. The report notes that 28% of paid center staff have medical licenses, along with 12% of volunteers.

The only option for miles

In North Florida’s largely rural Wakulla County, there are no full-time practicing OB-GYNs. Wakulla Pregnancy Center is in Crawfordville, the county seat of about 4,800 people. Many women in the area lack transportation, said the center’s director, Pam Pilkinton. They have to travel about 20 miles north to Tallahassee for prenatal care.

Run by a local ministry, the center has a blue-and-white sign that advertises “Free Pregnancy Tests.” Inside, a cozy living room furnished with sofas leads to a counseling room and donation space, where moms peruse a range of free baby clothes and supplies. Most of the center’s clients have low incomes, and are on Medicaid or uninsured.

When Florida passed a six-week abortion ban in 2023, legislators simultaneously increased state funding for crisis pregnancy centers by 455% — from $4.5 million to $25 million. The following legislative session, they added another $4.5 million. 

The funds go to the Florida Pregnancy Care Network, which manages contracts with more than 100 crisis pregnancy centers across the state. The organization is required to report the amount and types of services provided and the expenditures to the governor and state legislature once a year. But it is not required to make any noncompliance findings public. 

The public money for centers in Florida doesn’t end there. Wakulla Pregnancy Center received a separate allocation in the 2025 budget of $136,000. According to the funding request, $60,000 is allocated for a building asbestos issue, and $58,000 pays for the salary and benefits of the executive director and client coordinator. The rest is for pregnancy tests, educational materials, ultrasound referrals and other supplies. 

But Pilkinton is clear about one point: The center does not provide medical care in this maternal health care desert. 

“We’re not a medical facility, and that is something that we let everyone know up front,” Pilkinton said. “We provide material support, education, information and peer counseling.”

That doesn’t include practices like referring a patient to an OB-GYN for prenatal care after a positive test, for example, “because we’re not a medical facility,” she said.

Wakulla County’s severe maternal hospitalization rates ranked among the worst in the state in 2023 and 2024.

Like in other states, maternal health care has continued to flounder in Florida — and shortages are likely to worsen. Nearly half of 1,500 OB-GYNs who responded to a state survey say they plan to stop delivering babies within the next two years. 

The money Florida allocated for pregnancy centers might have covered more maternity care across the state, said Democratic state Rep. Anna V. Eskamani.

“We do need to strengthen our safety nets when it comes to supporting new moms,” Eskamani said. “Instead of addressing those gaps and investing in those areas, we continue to dole out millions of dollars to these unregulated and often religiously affiliated anti-abortion centers that are not addressing any of these disparities.”

In previous legislative sessions, Eskamani filed bills to repeal state funding and introduce regulation of existing centers. The bills have yet to receive a hearing, but she and her colleagues have filed them again.

“These not-for-profit organizations run with very little federal or state oversight, and sometimes they don’t even have licensed medical staff on site,” she said. “At this point, it’s a blank check.”

Big checks, little oversight

Much of the state funding for pregnancy centers did not exist before the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision ended federal protections for abortion rights in June 2022. 

Conservative-led states — such as Texas — that already allocated tens of millions to pregnancy centers have doubled or tripled their budgets for pregnancy resource groups since 2022. In Missouri, lawmakers have budgeted nearly $50 million since fiscal year 2022 from the general fund and federal block grant dollars. Texas’ allocation ballooned from $140 million in fiscal years 2024 and 2025 to $180 million in 2026 and 2027. 

In southwest Missouri, Republican state Rep. Christopher Warwick’s support of the centers is a focus of his reelection campaign.

“I think it’s important that we fund organizations that are willing to save life,” he said.

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Louisiana lawmakers directed $4 million from the state’s general fund to pregnancy centers for 2025, as part of its Pregnancy and Baby Care Initiative. But an audit found the state doled out the maximum amount per center allowed by state law — $100,800 — to most of the groups without requiring them to fully document how they spent it.

Auditors were concerned Louisiana paid the centers more than the cost of the actual services provided.

In Oklahoma, state auditors discovered in 2022 that an anti-abortion nonprofit called Oklahoma Pregnancy Care Network disbursed less than 7% of the $1.6 million it promised to nonprofits under the state’s Choosing Childbirth program. A month and a half before its contract was scheduled to end, the group had served 524 women, less than 6% of the 9,300 Oklahoma women it initially projected it would serve. An administrator with the nonprofit told The Oklahoman she was unaware there were problems.

Despite those findings, state lawmakers later directed nearly $18 million — a quarter of the state health department’s entire budget — toward Choosing Childbirth through November 2027. More than $4 million of it went to the Oklahoma Pregnancy Care Network. The network did not respond to States Newsroom’s requests for comment.

Inner workings

Lyerly, the OB-GYN in Sheboygan, Wisconsin, said the couple with the mislabeled sonogram came into her Planned Parenthood clinic in the early months of 2022. It wasn’t uncommon for patients with appointments at Planned Parenthood to accidentally go to the crisis pregnancy center across the street. This couple sought an abortion, she said, but came in with the ultrasound image of the woman’s bladder rather than her uterus. On top of the mislabeled ultrasound, they felt misled, because they were told the pregnancy was just a few weeks along when it was much more advanced.

“This was a challenging situation for them, was emotional and frustrating and upsetting to them, and it was so unnecessary,” said Lyerly. She stopped providing abortions in Wisconsin later that year when a state law banning the procedure went back into effect after the Dobbs decision.

Many centers are affiliated with umbrella organizations, including Care Net, Heartbeat International (formerly Alternatives to Abortion International) and National Institute of Family and Life Advocates, but often do not disclose that connection on their website. The parent companies provide guidance for operations, including yearly conferences, along with training for limited ultrasounds and other services. Training and funding for many of these centers’ ultrasound programs also come from national religious groups like Focus on the Family and the Knights of Columbus.

Heartbeat International is the largest of the three, with more than 4,000 affiliated service providers across the U.S. and in more than 100 countries, according to Trudden.

Trudden said Heartbeat International offers professional training and practical resources for affiliates, who determine their own governance, leadership and location and must agree to a set of standards also shared by Care Net and the National Institute of Family and Life Advocates. Those standards include practicing honesty and confidentiality with clients and complying with all legal and regulatory requirements. 

Some pregnancy centers are staffed with licensed professionals trained in sonography. The National Institute of Family and Life Advocates says it has trained more than 6,000 health care professionals “in the medical and legal ‘how to’s’ of limited obstetrical ultrasound.” But at its national conference last year, leaders discouraged centers from performing ultrasounds on women who they suspect have ectopic pregnancies to avoid liability. The guidance came in the wake of a lawsuit against a Massachusetts center, in which the plaintiffs alleged that center staff failed to diagnose an ectopic pregnancy that ruptured, prompting emergency surgery. The clinic reached a settlement with the patient. 

Some centers offer more medical services, like prenatal support and testing and treatment for STIs, such as Idaho’s Stanton Healthcare, which is accredited by the Accreditation Association for Ambulatory Health Care and does not receive any public funding. 

“We have caught ectopic pregnancies. … I can think of three in the last eight months off the top of my head,” said Angela Dwyer, Stanton’s director of client services. 

But advocacy groups such as Campaign for Accountability have raised alarms about how many clinics do not have to follow federal health privacy laws, including the Health Insurance Portability and Accountability Act, known as HIPAA.

Clinics that offer free services and do not bill insurance face no penalty for disclosing a client’s information. 

In contrast, Jessica Scharfenberg, CEO of Healthfirst Network in central Wisconsin, said if any of her 10 reproductive health clinics violated HIPAA, they would face steep federal fines and possible jail time for staffers. 

“If my entity broke HIPAA, we would have federal consequences, even though we also have an internal policy for it,” Scharfenberg said. “They have their internal policies. They break HIPAA, there’s no consequences for it.”

The websites of some centers give the appearance of being HIPAA compliant even though they aren’t, States Newsroom has reported. 

The other two main umbrella organizations did not respond to multiple requests for comment by email and phone. 

‘So much help’

In North Lauderdale, Ieshia Scott would stare at her 6-month-old, unable to hold the baby when she cried. Scott, who also had a 10-year-old, felt overwhelmed by a constant cloud of stress and sadness, all while trying to keep up with college classes.

When she found out she was pregnant again, Scott searched for an abortion clinic in the city, and a pregnancy resource center came up in the search results. That 2018 visit would last nearly three hours, during which she fielded dozens of questions about why she wanted an abortion. Scott had suicidal thoughts and was depressed but felt totally unheard. 

“I really was disregarded,” said Scott, now 36. “I was actually saying to her, like — ‘I don’t know, I might hurt myself, I might hurt the baby.’”

The center didn’t refer her to a psychiatrist, therapist or OB-GYN. The staff member instead reminded her of the Ten Commandments.

“I’m literally telling her, I can’t — I can’t do it. And she was like, ‘You can, you can. And there’s so much help.’”

Mental health is a contributing factor in about 23% of the nation’s maternal deaths, reports from the federal Centers for Disease Control and Prevention show.

Scott eventually went to a clinic to get the care she needed. But she worries for women who can’t. 

More than a dozen states passed abortion bans after Dobbs, and efforts continue nationwide to dismantle what access remains. Several states with abortion bans — including Missouri, South Carolina and Texas — have moved to cut Planned Parenthood out of state Medicaid programs as well, after the U.S. Supreme Court ruled last year that excluding the organization did not violate Medicaid’s provision requiring freedom of choice in providers. Florida legislators are also discussing cutting Planned Parenthood out of the state Medicaid program.

In 2025, at least 51 Planned Parenthood locations closed or limited medical services after losing state and federal support. Those communities lost access not only to abortion services but also to other reproductive and primary medical care. Independent clinics such as Maine Family Planning stopped offering primary care services for about 600 patients because of a funding loss of about $1.9 million, even though none of the Medicaid dollars were used for abortion.

‘Government handouts’

Lawmakers are not only opening public coffers to provide direct financial support to pregnancy centers, but they’re also creating tax breaks, drawing on federal sources and shifting funds meant to help low-income families to aid the anti-abortion organizations — with few regulations.

Some legislators have resisted stronger oversight. 

In Missouri, state Rep. Warwick opposed a colleague’s suggestion to require the centers to report how they spend their donations in a tax credit program, saying he wanted to limit bureaucracy. He said in a February 2025 legislative hearing that the tax credit keeps the state from having to “verify what programs work.” 

“I don’t think they’re funded enough to be able to mishandle their money,” he told States Newsroom in December. “At least not the ones I’m familiar with.”

Warwick proposed raising the tax credit for pregnancy center donations from 70% to 100% in 2025, meaning someone donating to a pregnancy center could reduce their state tax bill by the exact amount donated. 

The credits that Missourians redeemed shot up from about $2 million to an average of more than $7 million per year after lawmakers removed a cap on credits in 2021, according to a fiscal note attached to Warwick’s bill. State officials estimated a 100% tax credit just for pregnancy center donations would cost the state more than $10.7 million in the first year.

Missouri also funnels more than $2 million per year in state and federal dollars to pregnancy resource centers and similar organizations through its Alternatives to Abortion program. That’s in addition to what the centers receive from Missouri’s federal Temporary Assistance for Needy Families fund — $10.3 million in this fiscal year.

Although Warwick’s 100% pregnancy center tax credit failed, he plans to try again in this year’s session. “I don’t think it (a 100% tax credit) would significantly hurt the state, especially when we’re talking about protecting life, protecting the birth of children,” he said.

Nebraska Sen. Joni Albrecht, a Republican who also sponsored a six-week abortion ban, said the centers were a valuable investment when she sought to create a $10 million tax credit program that was revised down to $1 million in 2024. 

Of the 13 pregnancy centers approved for tax credits in Nebraska, four provided less than $150,000 in services, according to tax returns, and one had three consecutive state audit reports with findings of deficiencies in controlling and complying with federal grant funding requirements.

In Montana, a state without an abortion ban, Republican Gov. Greg Gianforte found another way to give taxpayer money to pregnancy centers by donating a portion of his annual salary. In 2020, he pledged to give his salary to nonprofit organizations and charities, and has for the past three years included pregnancy centers in that list for a total of more than $60,000.

Idaho state Sen. Ben Adams, a Republican who sponsored a bill to establish a grant fund of $1 million for crisis pregnancy centers in 2025, told States Newsroom he felt it was important to put resources into helping people choose to have a baby. 

“We have, for a very long time, primarily through the federal government, essentially funded abortion through funding for Planned Parenthood and all these different organizations,” Adams said. “We say we’re going to restrict a woman’s access to abortion and that we’re pro-life. Well then, we actually have to be investing in those folks who are choosing life and show them that we mean it when we say we want them to choose life.”

For decades, the Hyde Amendment, a provision Congress has renewed annually, has prohibited the use of federal funding for abortions, except in cases of rape, incest and to save the mother’s life.

Idaho is one of a few states with an abortion ban that isn’t providing government support for crisis pregnancy centers. Adams’ bill failed by one vote in committee and faced opposition from many constituents, including a former board chairman of a crisis pregnancy center in Idaho who said subsidizing nonprofit entities with taxpayer dollars is not the proper role of government.

“Providing taxpayer funds on either side of this moral question is inappropriate,” said John Crowder in his testimony to the legislative committee, prefacing his comments by saying he is a Christian who believes life begins at conception. “Such decisions to lend financial support should be left to churches and individuals, not the government.”

Based on his knowledge of the finances of that center, Crowder said, it was clear they could meet the goals of their mission with the donations they received and “without government handouts.” 

Stateline reporter Amanda Watford contributed to this report. 

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund.

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

METHODOLOGY: To identify government grant funding received by nonprofit crisis pregnancy centers (CPCs), a team of States Newsroom reporters used multiple data sources. Reporters reviewed state and federal budgets and legislation to identify public funding allocated to CPCs between 2019 and 2025, with a particular focus on the period following the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June 2022, as well as in prior years, as applicable. The team did not include federal funding from sources such as Temporary Assistance for Needy Families in the nationwide analysis, and state tax credit programs were also excluded.

Data reporter Amanda Watford cleaned and analyzed a publicly available dataset of CPCs originally collected by the nonprofit advocacy group Reproductive Health and Freedom Watch. Organizations that appeared to be permanently closed or did not report enough revenue to file a full IRS Form 990 were removed from the States Newsroom analysis. Watford extracted filings from ProPublica’s Nonprofit Explorer for about 2,000 organizations, covering 2019 to 2025. Government grant totals were only available for 217 organizations for 2023 and 2024 due to data infrastructure limitations. A separate analysis using the GivingTuesday 990 database captured basic financial and government grant data for 1,243 organizations between 2019 and 2023. Watford combined the 2019-2023 GivingTuesday data and 2023-2024 ProPublica data. The total amount of government funding provided to CPCs was calculated for each year, yielding a grand total of nearly $1.3 billion across 1,259 CPCs between 2019 and 2024.

This analysis is not comprehensive. Some IRS Form 990 filings were unavailable digitally, and some organizations did not report any government grant funding, so grant funding reported outside the available electronic filings was not fully captured. Financial information available through IRS Form 990 filings is self-reported by organizations to the IRS and is not independently audited. Additionally, there is a lag between when organizations are expected to file returns and when filings are publicly available. Due to these factors, the States Newsroom  findings likely undercount the total amount of public, government funding directed to CPCs. An estimated 2,633 CPCs were operating in the United States in 2024, according to research from the University of Georgia.

For nearly 60 years, crisis pregnancy centers have been a pillar of the anti-abortion movement.

Largely staffed by volunteers or part-time workers, these centers — sometimes referred to as pregnancy resource centers — offer limited services related to pregnancy and are guided by a religious mission to stop people from considering abortion.

States Newsroom conducted a 50-state investigation examining state and federal funding for these centers. Between 2022, when the U.S. Supreme Court overturned federal protections for abortion rights, and the end of fiscal year 2025, 21 states have funneled nearly a half-billion dollars to crisis pregnancy centers. Physicians and researchers told reporters they’re concerned about the magnitude of public money crisis pregnancy centers are receiving while Planned Parenthood clinics and other community clinics offering reproductive health care are defunded.

Read our investigation: Taxpayer dollars flood pregnancy centers. Oversight hasn’t followed.

As part of an ongoing series to shed light on the issue, States Newsroom spoke with dozens of doctors, patients and people who found themselves in crisis pregnancy centers. These are some of their stories.

Alabama

When Valkyrie Brodt, 30, became pregnant for the first time last year, she did an online search to find a clinic that would take someone without insurance. She and her husband were waiting to be approved for health insurance, and she was hoping to find a provider who would confirm her pregnancy and check that it looked healthy so far. In her search results, she found what she thought was a pregnancy-focused medical clinic a couple of blocks from the hospital in her hometown of Huntsville, Alabama. She booked an appointment. 

The couple arrived and began to fill out the clinic’s paperwork, but Brodt said something felt off.

“A lot of the questions were less about medical history and more so faith-based questions, and other questions like, ‘What’s your relationship with the baby’s father?’ ‘What’s your plan for this pregnancy?’ I think it did specifically ask what your religion was.

“At that point I realized, OK, this is clearly a Christian-run kind of place. I grew up Church of Christ, and I have a lot of religious trauma from the way that I grew up. I would not consider myself religious at this point. I’m very open-minded towards people who are religious, no bias other than just not wanting it shoved on me.

“I was also under the impression they were going to do the blood test analysis to confirm pregnancy, but it was just another urine sample. And I was like, well, I’ve already done four of these, and they were all positive.

“Then when they called us back, she (the clinic staffer) literally used the words ‘divide and conquer.’’’

Brodt was taken to one room, while a male counselor took her husband to another room. She said she understands why staff might want to separate them, in case of concerns about possible domestic violence or coercion. But Brodt said she was never asked about the couple’s relationship or whether she felt safe. The counselor confirmed that Brodt wanted to keep the baby, asked more faith-related questions, and told her that if she attended counseling sessions she could earn “baby bucks” to redeem on baby items from their store.

“At one point, towards the end, she (the counselor) said, ‘Well, if you know anybody who’s thinking about getting an abortion, send them our way.’ So it was very clear at that point that that was their goal. They gave us probably three or four different pamphlets, and only one of them was a piece of paper with the pregnancy confirmation on it. The rest was ministry stuff, like faith-based parenting classes.”

The clinic scheduled an ultrasound for her, but she and her husband decided not to go back.

“It felt very predatory to me as a 30-year-old woman that’s married. So I can’t imagine how it would feel to a teen mom or a single mom having to walk in there by herself.” 

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Idaho

Dr. Cate Heil knew people in her hometown who worked at crisis pregnancy centers, and she didn’t have much of an opinion about the centers, other than they seemed like good places for pregnancy counseling. 

That perspective changed.

During her training to become a family medicine physician in Idaho in 2020, she saw a 17-year-old patient who had gone to a pregnancy center, where she received a transabdominal ultrasound. The center told the patient there was “a lot of fluid.” 

“Based on her period, she would’ve been about eight weeks and three days. It didn’t seem like they told her much else. 

“We did a transvaginal ultrasound and saw some concerning things. This patient had a molar pregnancy, which shows up pretty characteristically on ultrasound and is considered a pre-malignancy. Her uterus at supposedly eight weeks was 1 centimeter above her pubic bone, which is much larger than would be expected. She underwent surgery the next week.

“It was concerning to me that this wasn’t recognized as something that’s abnormal. This is not quite an emergency, but it’s something that needs to be managed within a week or so, or needs immediate referral for a surgeon — and that made me nervous.

“Is there other stuff that we’re missing? This is a fairly rare thing, but it’s not unheard of, and it should be able to be recognized by people who are operating an ultrasound, in my opinion. … It made me want to double-check things when someone has gone to a crisis pregnancy center.”

Oregon

Emily Gartman wanted to keep her baby. Unexpectedly pregnant at 21, a friend recommended a pregnancy center, saying nice people would quickly confirm the pregnancy without an appointment. She took a test there, but before the results came back, Gartman said the staff asked her what she would do if she were pregnant. 

They showed her pictures of how an embryo develops into a fetus and told her that it would respond to painful stimuli at 13 weeks, an idea that is not supported by science. Multiple studies have shown that a fetus does not have the capacity to experience pain until at least 24 weeks’ gestation.

“They just kept driving home that if I got an abortion, my baby would be in pain. That it would feel itself being chopped up.

“I was 11 weeks pregnant, and they were clearly trying to make me feel like a piece of s— if I did get an abortion because I was hurting the baby. I wasn’t sure what I wanted to do, but they basically told me if I waited any longer, I wouldn’t have a choice.

“There’s a very high chance that I would’ve kept it. The person I was pregnant by had Marfan syndrome, and the thing I wanted to wait for was an amniocentesis.”

Severe forms of Marfan syndrome, a connective tissue disorder, can cause fatal heart problems. Gartman had wanted more information about her options. An amniocentesis is typically performed between 15 and 20 weeks of pregnancy.

“I ended up having that abortion three days later. I felt like if I didn’t do it right away, I was going to have no choice, and that they’d be right, that I would be a monster.”

Despite many years passing, Gartman, 45, of Portland, said the trauma she endured is one of the main reasons she never had any children. The shame stuck with her, she said, and she thought she had no right to try to have another baby after having an abortion.

“Seeing public money going to these places pisses me off a lot. That’s my money. I don’t want my money being used to do this to someone else.

“My experience with them has been to just tell everybody I know who’s going to go to them to just not do it. I would never set foot in one of those places again.”

North Carolina

After Carley Causey discovered she was pregnant last year, she wanted to know how far along she was. 

So she searched online for a place to “get an ultrasound to try and date how pregnant” she was. 

Causey, 36, said she had originally called an OB-GYN’s office, but she was told that she couldn’t get an appointment for at least seven weeks. 

“Well, most doctors’ offices won’t see you until you’re, like, 12 weeks pregnant. I did call, and they were like, like, not very helpful, because they were like, ‘You’re not far enough along,’” Causey said. 

So she ended up calling a crisis pregnancy center. 

“And this place is totally free. If you wanted to go to the ER and get an ultrasound, that’s like hundreds of dollars. And this is a community resource that charges you nothing, right?” 

Causey said center volunteers told her that it may be too early to do an ultrasound and that she could potentially have an ectopic pregnancy for which she would have to go to the emergency room. But she wanted a transvaginal ultrasound, and she found out that she was almost two months pregnant. 

Causey said her mom used to volunteer at “pregnancy support centers,” and she felt more comfortable going there. And as a Christian woman and family ministries director at a church in Durham, North Carolina, she said she felt awkward going to a place like Planned Parenthood, which she associated with abortion, although it offers a range of medical services. 

“I know that they (pregnancy centers) totally have this reputation of trying to scare women into not having abortions, but that’s just not been my experience with the people who work there,” Causey said. “And I want to give space for that, because I don’t know all these Christian pregnancy centers, but the truth is like, yeah, they do value life, but they also want to provide resources that make it seem possible.” 

Florida

Taylor Biro was sleeping under bridges all over Tallahassee when she found out she was pregnant in 2006. She called a local pregnancy center, telling them she was homeless and seeking an abortion. 

“I was 19 … I was pregnant, and I had no business having a child — I had a lot of difficult things going on around me at the time.

“I remember being very clear. I talked to them on the phone. I told them what I wanted to do. They said, ‘Great, come on in.’

“I went in, and they counseled me — and it ended up not being an actual place that helps, or had any means to help, with abortions. They were more like a faith-based group and wasted a lot of my time. I ended up passing the window when I was able to get an abortion.’’

It was “degrading” when she’d have to attend their classes to earn “mommy bucks” before she could have a few diapers — not even a full pack, she said. 

“Less than a week after I gave birth, I was working at a sandwich shop. I remember standing there taking someone’s lunch order, hoping the pad in my underwear was thick enough to last till my break. For the first five years of my son’s life, I worked four jobs and made less than $11,000 a year. I was exhausted and trying to hold on to some version of myself before all this.”

Being pregnant and giving birth as a homeless teen, Biro experienced violence.

“It forces you to play into relationships that you probably never would have had to endure. You don’t have all the safety nets. It opened me up to domestic violence; it opened me up to sexual violence.”

Biro went on to start her own drop-in center for runaway and homeless youth. She and her team raised money for teens who needed abortions and provided Plan B for those over age 18. 

After her experience with the crisis pregnancy center, she made diapers much more accessible for the new parents who came to the drop-in center, telling them: “You want to take five packs of diapers? Take six.”

She also worked with officers investigating sexual violence and human trafficking of youth, and helped write legislation requiring special training for law enforcement interviewing victims of sexual assault. Biro works with the National LGBTQ Task Force, and also founded Bread and Roses Collective, a team of grant writers for social justice organizations. Her child is now 18.

“It took me years to understand that the shame was never mine to carry. A Christian organization manipulated a homeless teenager into having a child when it was not safe, but (I) should be embarrassed? I know now that my struggle and trauma was not some penance for being young and irresponsible. But that experience, being tricked out of health care, was my origin story.

“It’s strange that even now, I feel compelled to preface it all by saying how much I love my son. As if naming my trauma or the loss of my autonomy could mean I love him less. That guilt buries stories like mine. We hear more about how a child ‘saved’ someone, when the truth is my life had meaning on its own.”

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

Nearly a quarter of pregnant women aren’t getting prenatal care in the early stages of pregnancy, according to a new analysis from the U.S. Centers for Disease Control and Prevention.

The share of pregnant women getting prenatal care had been improving: It rose between 2016 and 2021 to a high of more than 78%, but then declined to 75.5% by 2024, wiping out previous gains.

The trend is worrying because getting care early in pregnancy can improve the likelihood of a healthy pregnancy and baby.

The decrease in early prenatal care held true for nearly all race and ethnic groups, but the drops were sharpest for Native Hawaiian and Other Pacific Islanders, Black women and American Indian and Alaska Native women.

By 2024, less than half of Native Hawaiian and Other Pacific Islander mothers received prenatal care in their first trimester — the first three months of pregnancy.

Anne Markus, a professor at George Washington University’s Milken Institute School of Public Health, said that because the statistically significant decline began around 2021, two events could explain some of the decrease: the COVID pandemic, with its associated stay-at-home orders, and the U.S. Supreme Court’s Dobbs decision in 2022 that dismantled the constitutional right to abortion.

“Both disproportionately affected, and continue to affect, communities of color, and the decline in early entry into prenatal care has been disproportionately bigger for racial and ethnic minorities since 2021,” said Markus, whose work focuses on public policy and access to health care. She was not involved in the analysis.

A lack of early prenatal care has also been disproportionately seen in “very young women who are more likely to have a pregnancy that they do not want,” Markus said. “The Dobbs decision and the fear and uncertainty it generated could be particularly relevant in explaining this disproportionate effect observed in the data.”

The share of women getting late care — beginning in the seventh month of pregnancy or later — or no care at all increased in more than half of states from 2021-2024. Utah saw the biggest rise in late or no care, followed by Massachusetts and Rhode Island. The number of Utah women getting late or no prenatal care jumped 54%, up to nearly 6% of women.

More than 1 in 10 women had late or no prenatal care by 2024 in Florida, Georgia, Hawaii, New Mexico and Texas.

“Geographic and financial barriers to accessing care are often behind late entry to recommended care, including prenatal care,” Markus said.

Late or no prenatal care decreased in six states: Arkansas, New Hampshire, South Carolina, Tennessee, West Virginia and Wisconsin.

The CDC compiled the report based on information from birth certificates, and includes information for all births that occurred in the United States.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

State officials across the country are looking to crack down on fraud and mistakes in the nation’s largest food assistance program, spurred by looming federal rules that will force states with high error rates to pay more.

But the Republican proposals mostly focus on more frequently verifying the eligibility of individual households that participate in the Supplemental Nutrition Assistance Program (SNAP), rather than on broader administrative shortcomings that allow most of the waste and fraud to occur.

Policies such as verifying recipients’ eligibility each month — which can involve cross-checking multiple databases or collecting extra documentation — might increase state agencies’ workloads without lowering error rates. This is especially likely if states don’t boost funding to handle the extra paperwork, investigate fraud or resolve recipient and agency errors.

Eliza Kinsey, an assistant professor at the University of Pennsylvania’s Perelman School of Medicine who focuses on hunger, said staffing shortages, outdated technology and changes to eligibility rules that require oversight are making it harder for state agencies to avoid overpaying or underpaying recipients — the errors that will cost states money under the new federal rules.

“The fact that we’re seeing error rates that are higher really makes sense, given the context of what’s going on in SNAP right now,” Kinsey said.

SNAP, formerly known as food stamps, is a federal-state program that provides recipients with a debit card that can be used to purchase food at grocery stores and other retailers. SNAP errors and fraud often get conflated, but they’re largely separate issues: Errors are unintentional mistakes by SNAP agencies or recipients, while fraud is intentional theft.

SNAP errors occur when the state overpays or underpays SNAP recipients. They’re caused either by unintentional recipient mistakes — forgetting to report a change in how many people live in the household, for example — or by an agency processing error, such as incorrectly calculating a household’s expenses.

States have encountered instances of individual recipient fraud, though they can go uninvestigated when resources are scarce. Large sums, in the millions, have been stolen by sophisticated crime rings that electronically “skim” money from the debit cards that SNAP recipients use to purchase food.

State SNAP error rates include recipient fraud, recipient errors, and state agency errors.

Alabama earned local and national media attention last year when initial U.S. Department of Agriculture data from early 2025 showed it leading the nation in stolen SNAP benefit claims, ahead of much more populous California and New York.

“There’s a lot of talk about SNAP fraud, and a lot of it is misrepresented,” Nancy Buckner, commissioner of the Alabama Department of Human Resources, which administers Alabama’s SNAP program, told state lawmakers at a January budget hearing. “The biggest SNAP fraud in this country are those people that are doing it electronically.”

In recent years, her department noticed SNAP purchases being made in states nowhere near Alabama, she said, including New York, Pennsylvania, Massachusetts and Maine.

“It was obvious to us we don’t have that many Alabama clients shopping in those other states,” she said. This month, Alabama became the second state, behind California, to issue SNAP debit cards to recipients with the kind of microchips that are standard on commercial debit cards. Chipped cards are harder to steal from than those with magnetic strips only.

In the middle of it all, states are staring down massive cuts in federal funding. President Donald Trump’s One Big Beautiful Bill Act puts states on the hook for more administrative costs and forces states to pay a higher share of benefits, in some cases hundreds of millions of dollars, if they have higher error rates.

“The federal government is telling states, you have to pay more in administrative costs, and you have to bring your error rates down simultaneously,” said Kinsey. “It feels like those two changes are in opposition with each other.”

Error prone

Last month, Alabama state lawmakers grilled Buckner, demanding to know her plan for lowering the state’s error rate.

Under Trump’s new law, Alabama’s SNAP administrative costs will rise by $39 million. Meanwhile, the state’s error rate, which Buckner expects to be about 9%, is below the national average, but high enough to allow the feds to force the state to cover 10% of its SNAP benefits starting in fiscal 2028.

All told, Alabama could be on the hook for an additional $200 million or more per year by 2028.

“Is there anything that can be done to prevent running into that $200 million wall?” Alabama state Sen. Greg Albritton, a Republican, asked Buckner during a budget hearing in January. “Right now I think that the train’s got the light on, heading straight for us.”

Buckner said she hoped for some extra wiggle room from the feds, but provided few details on how the department could lower Alabama’s error rate enough to avoid financial penalties.

Currently, the federal government pays for SNAP benefits and splits administration costs 50/50 with states. But starting in October, under the One Big Beautiful Bill Act, all states will be on the hook for 75% of their own administrative costs. And the new law allows the feds to penalize states for their SNAP errors, requiring them to pay from 5%-15% of their SNAP benefit costs if their error rates are over 6%.

The only states under the 6% threshold, per the most recent data available from USDA, which oversees the program, were Idaho, Nebraska, Nevada, South Dakota, Utah, Vermont, Wisconsin and Wyoming.

Republicans say these new rules will reduce the federal government’s investment in SNAP while giving states some “skin in the game” when it comes to being responsible with federal money.

“One of the problems is the federal programs don’t mandate the prevention, detection and prosecution of fraud,” said Dawn Royal, with the United Council on Welfare Fraud, a national membership group focused on fraud in public assistance programs. “And so states are unwilling to spend state money in order to protect federal money.”

In Alabama, the USDA replaced nearly $16 million in stolen benefits from fiscal 2023 to fiscal 2025, according to federal data.

The Alabama Senate is currently considering a bill that would require state agencies to conduct monthly checks of other state databases to make sure SNAP enrollees remain eligible.

Buckner told state lawmakers that increasing eligibility checks for SNAP benefits would “shoot that error rate up, way up.” The state’s Legislative Fiscal Office estimated the additional work for both Medicaid and SNAP under the pending bill could cost $16.7 million per year.

“Monthly reporting is not the answer to that, at all,” she said.

But other states are looking at similar measures.

Lawmakers in states including Idaho, Kansas and Wyoming have introduced bills to require their state SNAP administrators to check eligibility of SNAP recipients more frequently. Missouri, Oklahoma and Utah bills would require verification of citizenship or legal immigration status before approving applicants for SNAP benefits. A Wisconsin bill would require the state’s Democratic governor to bow to a White House demand to turn over state data on SNAP recipients.

And in Arizona, GOP lawmakers wanted to go even further than the new federal requirements. Last week Democratic Gov. Katie Hobbs vetoed a package of Republican bills that would have required the state agency administering SNAP to get its error rate below 3% by 2030 or face financial penalties, and cut an additional 10% from its budget if the state failed to take corrective action.

States target fraud

SNAP fraud has made state and national headlines in recent years, but there’s not a broad consensus on the scale of the problem nor how to address it.

Some SNAP fraud is perpetrated by recipients who lie in order to get SNAP benefits for which they’re not eligible. But there’s also organized electronic SNAP theft, which involves thieves taking control of EBT accounts through electronic methods such as card skimming or cloning, bot attacks and phishing scams. Skimming is a form of theft where devices are illegally installed inside sales terminals at a store and capture card data. That data is then used to make unauthorized purchases or steal from the victim’s account.

In December, a longtime USDA employee was sentenced to two years in prison for her role in what the U.S. Department of Justice called a “sprawling fraud and bribery scheme” that generated more than $66 million in unauthorized SNAP transactions. The same month, two Romanian nationals were indicted for their role in allegedly stealing more than $160,000 in benefits in Oregon and elsewhere. In 2025, California reported more than $100 million in stolen funds from California SNAP recipients’ EBT cards.

States reported replacing more than $360 million in stolen benefits from fiscal 2023-2025, according to federal data. Experts and state officials differ on whether recipients or organized crime rings are the biggest threats to SNAP. But since the federal government stopped reimbursing stolen SNAP benefits at the end of 2024, more states are looking at ways to address fraud.

States including Arkansas, Maryland, Massachusetts, Michigan, New Jersey, Oklahoma and Virginia are joining Alabama and California in rolling out chip cards to make it harder for skimmers to steal SNAP benefits.

“SNAP fraud is rampant,” said Royal, of the United Council on Welfare Fraud. “If anybody tells you that there’s not SNAP fraud out there, they’re trying to pull the wool over your eyes. It exists in all 50 states. It is definitely a plague on the taxpayers.”

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

Editor’s note: If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org.

Cindy Clemishire was 12 years old on Christmas night in 1982 when a traveling evangelist staying with her family first abused her.

According to Clemishire, the sexual abuse continued over the next four years. She eventually told her family and the abuse stopped. But her abuser, Robert Morris, went on to found Gateway Church in Texas, which became one of the largest megachurches in the nation.

When Clemishire sought restitution in 2007, Morris’ attorney offered her $25,000 if she would sign a nondisclosure agreement that would prevent her from speaking publicly about the abuse. She refused.

“Had I agreed to that NDA, Robert would have continued to have power over me,” Clemishire told Texas lawmakers last May, as she urged them to pass a state law that would ban nondisclosure agreements in child sexual abuse civil cases.

“Because I refused to sign that NDA at 37,” she said, “I am able to sit here today at 55 years old and share my story in hopes of helping others.”

Texas Gov. Greg Abbott, a Republican, signed the bill into law last June. Texas joined other states, including California, Missouri and Tennessee, in prohibiting nondisclosure agreements, or NDAs, from being used in civil settlements that involve child — and in some states, adult — sexual abuse.

Morris pleaded guilty to child sex abuse charges in October, publicly admitting what he did to Clemishire.

This year, Clemishire’s home state of Oklahoma, as well as Alabama and Georgia, are considering similar laws.

Oklahoma’s bill was introduced this week. Last month, Alabama lawmakers unanimously passed identical bills in the state House and Senate. If one of the bills passes the other chamber, it will head to the governor’s desk. In Georgia, Republican Gov. Brian Kemp announced during his final State of the State address last month that he would support a version of the law.

Kemp said the bill would “further protect our children, expose abusers, and save lives by preventing the silence imposed on far too many victims.”

Many of the new bills are versions of Trey’s Law, model legislation — first passed in Missouri — named for Trey Carlock, a survivor of child sexual abuse. Carlock died by suicide in 2019 at age 28. Though his abuser was convicted of sexually abusing several boys, Carlock had signed a nondisclosure agreement in a civil settlement that prevented him from speaking about his abuse at Kanakuk, a popular Christian sports camp based in Missouri, and the camp’s role in enabling the abuse.

Elizabeth Phillips, Carlock’s sister, later founded the Trey’s Law movement in his memory. Trey’s Law works to get NDA bans passed at the state and federal levels.

Such bills attempt to address a civil litigation issue that gained increased attention during the #MeToo movement. Organizations such as Kanakuk that are caught up in child abuse allegations sometimes offer financial settlements to abuse survivors in exchange for their signing agreements that legally restrict them from speaking publicly about the abuse or the organization’s role in it.

Critics of these kinds of NDAs say they’re a legal tool — originally intended to protect confidential corporate information — that’s been misused to suppress survivors’ stories and shield organizations that enable abuse.

“NDAs may be presented as legal formalities, but in cases like mine, they are tools that continue the abuse,” Clemishire told Texas lawmakers last year. “They protect the abuser and keep victims in shame. They prevent the children from being protected and they make it harder to stop abuse from happening again.”

State laws vary in their protections. California enacted a law in 2016 banning NDAs for felony sex offenses, child sexual abuse and sexual assault against vulnerable adults, such as older adults and those with disabilities. Tennessee‘s 2018 law voids NDAs in child sexual assault claims. New Jersey, New York and Pennsylvania have placed restrictions on NDAs. Various courts have also struck down some NDAs that appeared to be designed to hide misconduct.

There’s not currently a federal law analogous to Trey’s Law, though Congress has tried to address the issue. The 2022 federal Speak Out Act specifically targets preemptive NDAs used in workplaces. It nullifies nondisclosure contracts that are signed, often as a condition of employment, before a dispute involving sexual assault or sexual harassment happens. But the law doesn’t apply to NDAs signed after allegations are made.

Much of the new state legislation, such as in Oklahoma and Texas, applies retroactively, nullifying older NDAs. Alabama’s bill would only apply to contracts entered into or amended after the measure is signed into law.

It’s difficult to find public detractors for such legislation. It’s one of the few issues that has, so far, united both sides of the political aisle. In the handful of states that have enacted bans on NDAs in sexual assault cases, they’ve passed with unanimous or near-unanimous bipartisan support.

But in Alabama last month, Republican state Sen. Greg Albritton expressed concern that a blanket ban could harm churches and institutions like the Boy Scouts of America that have faced civil allegations that they ignored child abuse or protected abusers.

“That nondisclosure statement is a lifeline, very often, for the institution to continue its efforts in trying to do good,” Albritton told Alabama lawmakers from the Senate floor, adding that he believes NDAs allow organizations to implement reforms and move forward. “If we pass this, we could be doing damage to institutions — including churches, including those not-for-profit organizations — that are doing their best to do good in the communities.

“I would caution that eliminating that tool from civil procedure does more harm to our society than it does good.”

The lawmaker sponsoring Alabama’s bill is another Republican, state Sen. Matt Woods. The Alabama version of Trey’s Law is his first bill in the Senate, after he was elected in a June 2025 special election. He said the bill was brought to his attention by some of Carlock’s relatives who live in his home county.

“We need to allow victims of this terrible act to heal,” Woods told the Alabama Reflector in January.

“The only way they can heal is to be able to disclose what’s happened to them, talk about it, and move on with the healing process.”

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.