AUSTIN, Texas – When a low-income woman searches for reproductive care, she often goes to a Planned Parenthood clinic, where she’s treated as a patient with an array of medical options. Or she might go to a Christian pregnancy center, where she is counseled to carry a pregnancy to term.
But some Christians now see an opening for a third way to reach women – before they become pregnant – that also enables the facilities to compete for federal money Planned Parenthood has decided to relinquish.
Eight independent, Texas-based pregnancy centers merged earlier this year to form a chain called The Source. With Christian women’s health centers in Houston, Dallas, San Antonio and Austin, the nonprofit organization plans to offer a full array of medical services, to include testing for sexually transmitted diseases, first-trimester prenatal care and contraception choices.
That model is similar to that of hundreds of Planned Parenthood clinics. About half of the organization’s 600 clinics provide abortion directly; the rest offer medical services but refer patients to outside providers for abortion.
Planned Parenthood announced in August its plans to forgo about $60 million in Title X family planning funds rather than comply with new Trump administration rules banning participating clinics from referring patients for non-emergency abortions and requiring financial separation from facilities that provide abortions. Title X funds already could not be used to provide abortions.
Now the Source group, which will not refer patients for abortion, plans to vie for the money in 2020.
The decision to provide contraception is a huge cultural shift for Christian centers that, for religious reasons, do not normally offer birth control. But it represents what some in the antiabortion movement say is a much-needed re-branding for pregnancy centers – away from emphasizing ending abortion and toward placing women’s health care front and center. Many younger conservative Christians in particular are concerned with how the movement treats women.
“Even within the pro-life community, there’s a lot of nuance in what we think we should be offering to women,” said Ingrid Skop, an obstetrician-gynecologist who joined the Source board. “It helps to show that not every pro-life activist says, ‘Put an aspirin between your legs and don’t have sex.’ “
Skop said she believes the Source sites can provide a model for pregnancy centers nationwide. But Sarah Wheat, chief external-affairs officer for Planned Parenthood of Greater Texas, is skeptical that the expansion into medical services will take hold elsewhere, given that many antiabortion leaders, especially Catholics, oppose contraception.
“I’ve seen the re-brands,” Wheat said. “So far, I haven’t seen health care.”
Several large pregnancy-center networks recently banned their affiliated centers from providing contraception, because of the belief that it encourages sex outside marriage. By contrast, the Source centers will all offer pills; injections; intrauterine devices, or IUDs; and other contraceptive methods beginning in March, a move that Source chief executive Andy Schoonover said will help reduce unwanted pregnancies by preventing them before they take place.
“Pregnancy centers are reactive. You come with a plan, and they try to talk you out of having an abortion,” he said. “Hopefully we can keep you from having an unplanned pregnancy. If you do [have one], let’s walk through the options.”
– – –
Among a collage of family photographs on his office desk in Austin, Schoonover displays one of his baby, Grace, who died in 2015, 10 1/2 hours after she was born. Schoonover said he and his wife were advised by their doctor to have an abortion and try again after the fetus was diagnosed with a fatal birth defect when his wife was 12 weeks pregnant. Instead, they decided the woman would carry to term.
Schoonover, who has business degrees from the University of Virginia and Stanford University, said he initially declined when he was first asked to direct the Austin center two years ago. But guided by his faith, he said, he reconsidered. He said he understands – to the extent that he can as a man – what women are told by some doctors during pregnancy.
“I’ve got a little bit of skin in the game,” said Schoonover, who was raised Catholic and now attends a Southern Baptist church.
He said he initially balked at the idea of providing contraception, because he feared donors would not approve. He was finally convinced after talking with his medical director, Catherine Browne, an obstetrician-gynecologist. One of the biggest misconceptions Browne said she faces is from people who think providing contraception will encourage women to become promiscuous.
“If I, as a doctor, tell people, ‘Lock up your guns,’ I’m not encouraging violent behavior,” Browne said. “Let’s empower people with education.”
The centers will not provide emergency contraceptive pills such as the Plan B “morning after” pill, because Schoonover said they consider the drugs to be a form of abortion.
The Source’s new medical approach is the latest attempt by the antiabortion movement to re-brand itself, said Laura Hussey, a political science professor at the University of Maryland Baltimore County who will publish a book about the efforts of pregnancy centers to become more women-centered.
In the mid-to-late 1990s, the older “crisis pregnancy centers” began to get licensed as medical clinics because they were adding ultrasounds, Hussey said, but most of them still do not offer the range of services Planned Parenthood provides. She said plans by the Source sites to offer contraception “might create a tension with other pregnancy centers.”
“Not everyone agrees with the need to compete with Planned Parenthood,” she said.
The majority of the nation’s roughly 2,750 pregnancy centers do not provide much in the way of medical services. Most provide counseling and baby supplies, and an estimated 70 percent provide ultrasounds, according to the Charlotte Lozier Institute, a research group that opposes abortion. About a quarter offer testing for sexually transmitted infections or diseases and 5 percent provide prenatal care, according to CLI.
Chuck Donovan, president of CLI, said the institute did not ask centers about contraceptive provision, which he said would be a “rare phenomenon.”
Many pregnancy centers are managed by boards filled with Catholics and evangelical Christians, many of whom have qualms with birth control. The Catholic Church teaches that artificial contraception is sinful. Most evangelical denominations teach that birth control should be reserved for married couples. A small portion of parishioners in both groups believe contraception is morally wrong, according to the Pew Research Center.
Kristan Hawkins, president of the antiabortion group Students for Life of America, said she opposes the idea of a pregnancy center distributing contraception, because she believes using it fundamentally transforms the act of sex.
“The contraceptive mentality is what has led to abortion in America today,” she said. “Loving a woman and empowering her is not putting her on a drug.”
However, she said, the “pro-life movement” must show that it cares more for women, not just babies. “We have a damaged brand,” she said.
Some in the antiabortion movement say women who come to the Source centers for medical services, including contraception, when they are not pregnant may feel more comfortable turning to the centers for help if they become pregnant unexpectedly.
“I think there can still be a barrier for [antiabortion activists] who are singularly focused on saving the baby and haven’t yet understood how caring for mom is so inextricably linked to saving the baby,” said Kelly Rosati, a former vice president at Focus on the Family, a conservative Christian ministry. “Among younger donors, there’s passion for real innovation and moving into health-care systems.”
– – –
Many pregnancy centers have for several decades used a mom-and-pop-shop model, running independently from one another. But by merging eight centers under one umbrella, The Source has been able to raise $2 million, mostly from private donors, to provide the new medical services, even as each center retains its own small budget. The chain hopes to someday overtake the number of Planned Parenthood clinics in the state, which is 40.
Sandwiched between a radio station and a hospice center just off a Central Texas highway, the Source center in Austin sits in the neighborhood of Heritage Hills, a largely Hispanic, working-class area with ranch-style homes and apartment buildings.
Small Bibles and “Our Daily Bread” devotionals are strategically placed on tables throughout the center, which is decorated with mid-century modern furniture. Staffers must sign a statement of faith, although because of government funding requirements, employees are to discuss faith only if a client brings it up. A small box labeled “prayer requests” sits next to the intake window.
The center recently attracted local media attention because it moved into a building that previously housed a local abortion provider. In August, someone spray-painted “liars!” on the center’s exterior walls. Many abortion rights advocates argue that pregnancy centers present deceptive messages in their counseling.
To make sure the Source centers maintain credibility, Schoonover said he has hired “secret shoppers,” people who call the clinics and ask whether they perform abortions, to ensure that staffers do not pretend that they do. When women arrive at a Source site, they must sign a disclaimer saying they understand the center does not provide abortions or refer for them.
When a pregnant woman comes into a clinic, counselors try to be “nondirective” in their approach, said Mary Whitehurst, the Austin center’s executive director. They present the woman with a pamphlet produced by the state with images of a fetus’s stages of development, which Texas requires all women considering abortion to receive. Then the counselors offer a folder from the clinic with three options – adoption, abortion and parenting – and will give additional information as requested, Whitehurst said.
“We are intentional to not undermine that reason she came,” she said. “If I know she’s there because she wants information about abortion, I’ll let her self-direct it. I’m not going to talk to her for 15 minutes about adoption.”
The Austin center sees about 150 women a month, a number Schoonover said the center expects to increase once it provides more medical services. The Source’s San Antonio staff began offering some medical services, such as testing for sexually transmitted infections, testing three years ago and sees about 500 women a month.
On a recent October afternoon, Amna Batool, 31, came to the San Antonio center to ask questions about birth control six weeks after having her third baby. She eventually received an IUD from her obstetrician-gynecologist because of her health insurance, but she made her decision based on the conversation with a nurse at The Source.
Roseanna, a 35-year-old who asked that her last name not be used, arrived for her 20-week prenatal appointment. She was there with her 16-year-old daughter, who was 24 weeks pregnant and receiving medical services at the center.
“They have an answer for every question, or they will find a solution,” Roseanne said.
Danielle Dirkse, 24, said she had planned to relinquish her twins for adoption when she started receiving medical care at the Source center in Austin. But after she miscarried one in the second trimester, she said, seeing the ultrasound images at the center motivated her to keep the other twin.
“I needed a sign I wasn’t going to do adoption,” she said. “It was the best decision ever.”
On a weekday evening in October, Dirkse took notes during a class on “parenting hacks” while she held her daughter, Braeleigh Masters, who was born in August, on her chest. In exchange for her class attendance at the center, she received points she could use on diapers, clothes and other baby gear. Dirkse said she plans to keep returning in the future for well-woman checkups and contraception.