Featured photo: Salem Pregnancy Center in Winston-Salem is what is known as a crisis pregnancy center, or an organization that offers limited healthcare to women who are pregnant, often working to dissuade them from accessing abortions.

This story was originally published by Carolina Public Press, story by Grace Vitaglione

When Kayla Cyrus first walked into the Your Choice Pregnancy Clinic in Fuquay-Varina in 2017, she said she felt welcomed.

“Everyone’s smiling,” Cyrus said of her time at the clinic. “They’re all dressed up in their Sunday best. Christian music is being played in the background, like there are Bible verses everywhere, and it’s in a house.”

Cyrus needed proof of her pregnancy to qualify for Medicaid, and the center advertised free pregnancy tests. The staff continued to discuss abortion with Cyrus, even though she hadn’t mentioned it.

“In my head, I was like: ‘I think I repeated several times to them that I am not interested in an abortion, and these people are not listening to me. They’re still showing me stuff about abortion,’” she said.

The staff also brought up Christianity, Cyrus said. “I’m actually Muslim, and they were trying to talk to me about Christianity as well, I felt very violated,” she said.

In the end, Cyrus got her free pregnancy test. She now works as a community organizer at El Pueblo. 

Cyrus said, “The thing that really caught me off guard was the lack of follow-up. Whether you’re interested in abortion or not, they don’t give you the information that you need. They don’t follow up afterwards.”

The center she visited is often called a crisis pregnancy center or an anti-abortion center. According to an article in the International Journal of Women’s Health, such centers are “nonprofit organizations that present themselves as healthcare clinics” offering free services such as ultrasounds. In reality, the article states, these centers discourage their clients from accessing abortions, often through “propaganda not supported by medical evidence.”

A 2019 study by the anti-abortion Charlotte Lozier Institute said U.S. such pregnancy centers “remain beacons of help and hope in the midst of uncertainty,” offering diapers and services like prenatal and parenting counseling at virtually no cost.

Your Choice Pregnancy Clinic is a member of the Carolina Pregnancy Care Fellowship, or CPCF, a network of multiple crisis pregnancy centers across the state. CPCF received millions of dollars in block grant allocations under state budgets enacted in 2017, 2021 and 2023, with little oversight of their practices and little accountability for the taxpayer money they are spending, critics said. This latest funding for CPCF — $12.5 million over the next two fiscal years — comes amid a new ban on abortions after 12 weeks that took effect in July.

Your Choice Pregnancy Clinic in Fuquay-Varina, N.C. Photo: Matt Ramey / Carolina Public Press

While there are 14 abortion clinics in North Carolina, there were at least 93 anti-abortion crisis pregnancy centers across the state in 2021, according to Pro-Choice North Carolina. Cyrus said more people might turn to these centers for pregnancy services due to North Carolina’s recent limits on access to abortion.  Taxpayers have funded these centers since 2013, but the funding has steadily increased over the last several years, with supporters saying it provides pregnancy resources for women. Reproductive rights advocates and Democratic lawmakers have long scrutinized the lack of accountability for the taxpayer money spent on these centers, pointing to what they say is a lack of transparency around how the centers use the money and media reports of funds spent on religious material.

Historical context

The first of these centers in the U.S. opened in Hawaii in 1967, after the state legalized abortion, according to an article in the International Journal of Women’s Health. Now the country has over 2,500 operational CPCs. 

The N.C. General Assembly began using taxpayer money to fund these centers in 2013. Back then, the Carolina Pregnancy Care Fellowship, which also goes by the name LifeLink Carolina, was allocated $300,000. That amount grew to roughly $6.2 million in 2021 under the state budget. That’s doubled in the most recent budget: CPCF was allocated $12.5 million over the next two fiscal years. Yet, critics say, there’s been little oversight of where this money goes and how many people it helps.

Pro-Choice N.C. reported in 2020 that few of these centers saw a high number of clients. The organization tracked attendance using documents that the CPCF centers file with the state. The report found that while the network claims around 70 members, data was only provided for 35.

Only two CPCF centers in the state reported a relatively high number of clients. One of those is where Cyrus visited, which also goes by the name Hand of Hope Pregnancy Resource Center. That location in Fuquay-Varina saw 928 clients from October 2019 to June 2020; LifeLine Pregnancy Center in Wilmington saw 1,024 clients over that same nine-month period, the report found.

Pro-Choice N.C. found the remaining 33 CPCF centers saw an average of fewer than two clients per business day in that time. The report said those differences in numbers might be due to the extra services offered at the two outliers, including parenting classes and support groups.

This map shows the locations of crisis pregnancy centers identified by Pro-Choice N.C. around the state in 2020, which was at the time called NARAL Pro-Choice N.C. Image: Courtesy of Pro-Choice NC

“It really is not clear what benefit that the centers are having, particularly if they’re not seeing a lot of people and they certainly aren’t necessarily offering medical care,” said Pro-Choice N.C. Executive Director Tara Romano.

She said it’s true that women like Cyrus can access a free pregnancy test at some centers, and others may get ultrasounds, although Romano said they’re often considered nondiagnostic, or nonmedical, ultrasounds. These nonmedical fetal ultrasounds provide “keepsake” images or determine the sex of the fetus but are not recommended by the American Pregnancy Association

State Rep. Julie von Haefen, D-Wake County, has been watching the budget allotments to these centers since she was elected in 2018. She said clients might get some diapers or baby clothes, but that’s not worth millions of dollars from the state, and it isn’t lasting help. 

Other crisis pregnancy centers received direct allocations under the fiscal 2023-25 state budget. The biggest share of grants outside of the CPCF network was $1.56 million for the Carolina Maternity Home Association Inc. in Greensboro. 

State Sen. Natasha Marcus, D-Mecklenburg County, said the restrictions on abortion mean women who want to access the procedure have to make quick decisions, and crisis pregnancy centers might tell women to “wait a couple weeks” before acting, until it’s too late.

The American College of Obstetricians and Gynecologists, a large association of OB-GYN doctors, warned in an issue brief last year that crisis pregnancy center staff members have been known to cause delays for people seeking confirmation of pregnancy, a tactic to discourage abortion. These centers remain “unregulated and unchecked,” and policymakers should only fund legitimate health care organizations, the issue summary said.

Ultrasound room at Your Choice Pregnancy Clinic in Fuquay-Varina, N.C. Photo: Matt Ramey / Carolina Public Press

Legislative landscape: ‘Handouts without oversight’

The process behind how this funding is used isn’t transparent, critics say. Most of the $12.5 million budget allocated to CPCF for fiscal years 2023-25 is to cover grants for centers around the state to get medical equipment and training around pregnancy. The centers apply for grants through a process created and operated by the CPCF. The CPCF is required by law to report to the legislature on how much each grantee is getting and how the funding is being used.

But von Haefen said past grant funding reports from CPCF are vague. She also pointed to reports from the Human Coalition, a Texas-based anti-abortion group that received millions in North Carolina funds in past years and in this latest budget. She said one of the coalition’s reports included a certain monetary amount for “personnel” but without explanation for whom or for how many staffers.

“Whether you’re for or against abortion, it’s just wasteful spending, and it’s just handouts without any oversight,” she said.

The 2023-25 fiscal budget will allocate $3 million over the next two fiscal years to the Human Coalition, despite the group failing to meet grant reporting requirements in the past, Rewire News Group found

The N.C. Department of Health and Human Services recommended against further funding the Human Coalition’s program in North Carolina in 2019. Despite that, the legislature continued to direct funding toward the organization, based on the budget.

NCDHHS told Carolina Public Press in a statement that since funding comes from the General Assembly, it’s up to the legislature to decide if an organization continues to receive funds even if it fails to submit reports or submit them incomplete.

Case for supporting these centers

Tonya Nelson, founder and CEO of the Hand of Hope Pregnancy Centers, said most of their clients come in for information about abortion and to get ultrasounds. Hand of Hope Pregnancy Centers has locations in Fuquay-Varina, Raleigh and Fayetteville. She said their staff includes ultrasound technicians, or sonographers, who went through schooling for that service.

In response to the claim that the centers don’t help women, Nelson said, “I think that’s a totally ignorant response from somebody who will not take the time to investigate what it is we actually do. …We do exit surveys on every single one of the women and men that we serve. And our satisfaction rate is over 99%.”

She also said the center staff asks clients if they have religious beliefs first before talking about religion with them and that they don’t force religion onto clients.

Both von Haefen and Marcus said they haven’t seen many lawmakers openly support the funds. Von Haefen said state Rep. Dean Arp, R-Union County, most commonly pushes back when she opposes this funding. The counterargument she usually gets is how she could be against something that’s helping people, von Haefen said. But the centers don’t provide any evidence to show how they’re helping, she said.

Arp did not reply to CPP’s repeated requests for comment.

Separation of church and state

Baby clothes available to pregnant people at Your Choice Pregnancy Clinic in Fuquay-Varina, N.C. Photo: Matt Ramey / Carolina Public Press

Romano said crisis pregnancy centers are often “pretty upfront” about their ties to Christianity. 

Mountain Area Pregnancy Services’ website states its mission: “To be a relevant Christ-centered outreach ministry partnering with the churches of WNC by caring for, counseling and educating women and men regarding, or impacted by, an at-risk pregnancy.”

The 2023-25 state budget stipulates that the funds cannot be used for religious purposes. Rewire News reported the state previously had issues with centers spending money on religious materials, which didn’t align with federal rules against using government money for inherently religious activity. According to Rewire, NCDHHS found in 2018 that CPCF had misspent about $50,000 in public funding for religious purposes over five years, but DHHS didn’t inform the state legislature. 

“After the Rewire Newsinvestigation, the agency vowed to increase oversight. It added a 1,100-word swath of the statute banning the use of federal funds for ‘explicitly religious materials,’” the article stated.

Changing landscapes

Romano said the recent expansion of Medicaid in North Carolina will hopefully mean more low-income women have access to legitimate health care. But she’s worried it won’t be enough — especially since she said it seems as if not much is being done to address North Carolina’s high maternal death rate among pregnant women, she said.

“It just seems like leadership in the General Assembly doesn’t really care about women’s health care,” she said.


Editor’s Note: While this article uses “women” to refer to the group of people most likely impacted by these centers, CPP also realizes that transgender people who don’t identify as female but have the ability to be pregnant may be affected.


Have a question about this story? Do you see something we missed? Send an email to [email protected].

This article first appeared on Carolina Public Press and is republished here under a Creative Commons license.

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