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Rewire investigation sheds light on CPCs receiving public funding in Texas

A Rewire investigation sheds light on the tactics used by antiabortion-rights crisis pregnancy centers (CPCs) that receive funding under Texas' Alternatives to Abortion program.

For the analysis, Rewire used records requests to access publicly available documents on the program, including financial records and narratives of unidentified client visits.

Program details

According to Rewire, Alternatives to Abortion is administered by the Texas Pregnancy Care Network (TPCN), which oversees and disperses funding to more than 40 subcontractors, including CPCs, maternity homes and other social services providers. Under TPCN's guidelines, subcontractors may not "promote, refer, or provide abortions or abortifacient contraceptives to clients." CPCs compromise the largest single category of subcontractors.

The state estimates that Alternatives to Abortion will see more than 200,000 visitors in 2016, up from about 22,000 in 2015.

Program spending

According to Rewire, the TPCN's "sole purpose" appears to be administering the state's Alternatives to Abortion Program. The network's federal tax filing shows that it received hardly any income aside from what the state gave it.

Through Alternatives to Abortion, the state gave more than $2 million to CPCs in 2015. The program's budget has since doubled, which means the figure is expected "to be significantly" higher this year, according to Rewire. The analysis found that the program charges the state $762,500 monthly. Meanwhile, the state has halted or reduced funding to many programs that support women and children.

Most of Alternatives to Abortion's funding is spent on "counseling," according to Rewire. The state Health and Human Services Commission has not defined what the term means in this context. TPCN Executive Director John McNamara, who is also a spokesperson for the commission, noted that participants in the program provide information in line with the state's Woman's Right to Know Act -- a statute that requires abortion providers to give medically unfounded claims regarding a link between abortion and breast cancer.

Overall, according to the Rewire analysis, about one-quarter of the program's funding goes toward "concrete assistance," such as infant supplies and parenting classes. As of April 2016, the program also had spent about $739,000 on publicity and advertising. The program follows the state's September-to-August financial calendar.

Rewire's document analysis found that Alternatives to Abortion does not measure success using key public health indicators, such as improved health outcomes among visitors. Further, the program does not seek cost savings relative to other programs that focus on public health outcomes. Rather, the program gauges success based on "unique visitors" to certain websites and number of clients, according to Rewire.

In addition, Rewire's survey of the websites of Alternatives to Abortion's funding recipients found that most of the CPCs presented false and misleading information. For instance, while abortion is known to be a very safe procedure, many sites implied that it is dangerous. Further, many sites said they offer no-cost ultrasounds, but did not disclose that the ultrasounds are not intended for medical purposes. Critics say the ultrasounds are used to discourage abortions.

Analysis of client narratives

Will Francis, government relations director at the Texas chapter of the National Association of Social Workers, noted that in several of the client narratives Rewire reviewed, pregnant women shared details that should have prompted the CPCs to offer counseling that extended beyond prioritizing a continued pregnancy.

Based on the accounts, Francis said the CPCs' actions 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," Francis said, adding, "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."

Separately, state Rep. Donna Howard (D), a former president of the Texas Nurses Association, said, "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." She continued, "My concern is that that's not the case with these facilities."

Calling on Texas officials to redirect funding to facilities that have demonstrated success aiding women and families, Howard added, "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 ... That's a real problem."

According to Rewire, experts also expressed concern about how Alternatives to Abortion CPCs acted when women disclosed sexual and physical violence. For instance, staff at a CPC persuaded a woman to continue her pregnancy, despite her emotional distress and comments about how the man involved in the pregnancy "was not a nice person." In another case report, CPC staff did not discuss the full range of legal options for a woman who said she had been raped, such as guidance on reporting the crime to the police.

Chris Kaiser, director of public policy and general counsel at the Texas Association Against Sexual Assault, said of the findings, "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 ... because the act of assault is taking away autonomy." He added, "To eliminate options for rape survivors is really the opposite of what we need to be doing."

Rewire's analysis of the client cases also indicated that program participants have been utilizing religion when dealing with clients, which edges up on what they are legally allowed to do. In one case, according to the client narrative, a woman who came to a CPC said she would seek abortion care "because she was not in a relationship with the" man involved in the pregnancy and "had no job and no means of supporting herself or" a child. A "Spiritual Mentor" at the center told the woman that "relationships are a gift, not to be used or substituted for our relationship with God."

According to Rewire, Texas law bars faith-based recipients of state funding from using such funding for "inherently religious" activities, such as prayer. Further, TPCN guidelines state that recipients of Alternatives to Abortion funds may only provide religious counseling if such counseling is done by "a different counselor than the one who delivers Program services, thus keeping the services completely separate."

Tina Hester -- executive director of Jane's Due Process, a not-for-profit that helps pregnant teenagers in Texas -- said, "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" (Coutts, Rewire, 10/19).