NC lawmakers increase funds for harmful ”crisis pregnancy centers”
In the two-year budget enacted in 2021, the North Carolina General Assembly included allocations of more than $15 million to so-called “crisis pregnancy centers.” Approximately $7 million of those allocations were set to be spent during the second year of the budget, which began on July 1, 2022, and ends June 30, 2023. However, last week in the General Assembly’s budget revisions, this initial allocation received a boost in the form of an additional $3.1 million, for a total of $10 million to be spent in the current fiscal year. This brings the total allocation to “crisis pregnancy centers” during the 2021-2023 biennium to approximately $19 million.
“Crisis pregnancy centers” (CPCs), sometimes called “pregnancy resource centers” or “pregnancy support centers”, are organizations whose purpose is to dissuade pregnant people from having an abortion or even considering an abortion as an option. These centers disguise themselves as medical clinics — for example by offering ultrasounds, pregnancy tests, and testing for sexually transmitted infections — and worse, they target people who have limited health care options with deceptive marketing and the offer of free health care services.
Yet, unlike a medical clinic, CPCs fail to provide the full range of options available to a pregnant person by not providing resources or referrals about abortions and providing medically inaccurate information when they do provide information on this safe and legal procedure. Unlike what people may hear from the clinics, the facts are that abortion does not increase the risk for breast cancer, they do not harm a future pregnancy, and that they do not have a harmful effect on long-term mental health.
In contrast, the outcomes that result from unintended pregnancy — which is either an unwanted pregnancy or one that would be welcome at a later time but not at the time of the pregnancy — include delayed prenatal care, lower birth weight, and a lower likelihood of being breast- or chest-fed for any length of time, among other negative outcomes. Of course, pregnancy itself poses health risks for a pregnant person, not the least of which is the risk of death, an outcome that is nationally much more likely to happen among Black women and other Black people who are pregnant compared to white pregnant people, though this racial disparity has been narrowing in recent years in North Carolina. The American College of Obstetricians and Gynecologists (ACOG) cites that the risk of death associated with childbirth is 14 times higher than the risk of death from abortion, and complications from abortion are rare. Even in this new post-Roe time, abortions are still a safe and legal medical procedure in North Carolina. In fact, pro-choice leaders anticipate a major influx of people from neighboring states and across the South traveling to North Carolina for services in the coming months and years.
There are better places to direct budget money than ethically suspect CPCs
Many in the medical profession as well as some professional organizations have voiced concerns for the practices of CPCs and opposed public funding to support them. CPCs are widely seen as ethically suspect by many in the medical profession (for example, see here), and some organizations, including the American Public Health Association and ACOG, have voiced concerns and expressed opposition about CPCs.
Yet the resounding opposition to CPCs from the public health and medical community has not stopped the North Carolina General Assembly from directing public dollars to support their operation. The amounts received by these centers are well above the budgeted funding levels received by other areas of the budget that include evidence-informed best practices, critical public health services, and wraparound supports for people experiencing hardship.
Instead of spending public dollars on CPCs, funding should be directed to areas such as:
- Increasing funding for the Nurse-Family Partnership
- Increasing funding for local health departments and the NC Division of Public Health to prevent and treat communicable diseases
- Funding to increase the number of mental health treatment beds at hospitals around the state
- Funding for domestic violence/intimate partner violence resource centers and shelters around the state
Ensuring access to quality care in every community is necessary to achieving healthy outcomes throughout the state. It won’t be achieved by public funding for CPCs, which are becoming more common in some communities than full-service health care providers. That is, while there are only 14 abortion clinics in North Carolina, which are concentrated in population centers, the state has nearly 90 CPCs distributed across the state.
Funding needs to address racial health disparities
North Carolina must address the long-standing disparities in maternal and infant health outcomes by race and ethnicity. For example, a Black or African American infant born in North Carolina is more than twice as likely to die before their first birthday compared to a white infant born in the state. This trend has persisted and even worsened over the years, even while the overall infant mortality rate has declined slightly. Similarly, while racial disparities in the North Carolina’s maternal mortality rate have improved in recent years, Black women are still nearly two times as likely to die from pregnancy-related causes compared to white women. These disparities reflect deep inequities in access to resources, as well as additional barriers including racial discrimination and bias that permeates our social, economic, and health care systems. Addressing these big challenges should be a top priority for the state legislature.
A history of reproductive violence
North Carolina, and the nation, have an ugly track record of reproductive violence and coercion. This includes more than four decades of state-sponsored, state-funded, forced sterilization of approximately 7,600 people across North Carolina, who were disproportionately Black women with low incomes. Decades later, a state bipartisan commission recognized the damage of this practice and sought to redress the harm to families.
In addition to state-sponsored violence, interpersonal reproductive violence and coercion disproportionately affects women and their ability to choose their pregnancy outcome. Pregnancy coercion happens when threats or acts of violence occur because a pregnant person is forced to carry a pregnancy to term against their wishes, or forced to terminate a pregnancy when they do not wish. Research shows that women with unintended pregnancies were four times more likely to experience interpersonal violence compared to women with intended pregnancies, and women seeking an abortion were three times more likely to be experiencing interpersonal violence. By failing to provide information and referrals to receive a safe and legal abortion among a suite of options, CPCs may place pregnant people in harmful situations and limit their reproductive choices.
Instead, the General Assembly is choosing to fund CPCs with state taxpayer dollars rather than direct those dollars to informed solutions and the practice of health care that supports the well-being of women and children. CPCs use coercion, fear tactics, and massive marketing efforts as a way to target pregnant people into making a choice without the full scope of options presented to them by a medical professional. Rather than fund special interests, our public dollars should go toward funding access to skilled, licensed medical care in every community. CPCs fail to meet the mark because they use deceit, misinformation, and coercion to restrict reproductive choice. Allocating state funds to bolster evidence-based programs that support maternal and child health is a necessary step to tackling North Carolina’s longstanding health disparities and promoting healthier outcomes.
North Carolina can and must make the decision to stop using public dollars to fund the harmful institutions that CPCs are known to be and instead allow pregnant people to make the best choice for themselves and their families.
