Parenthood

Pregnancy centers in the U.S. that discourage women from getting abortions have been adding more medical services — and could be poised to expand further.

The expansion — including testing and treatment for sexually transmitted infections (STIs) and even providing primary medical care — has been unfolding for years. It gained steam after the Supreme Court overturned Roe vs. Wade three years ago, clearing the way for states to ban abortion.

The push could get more momentum with Planned Parenthood closing some clinics and considering shutting others after changes to Medicaid. Planned Parenthood is not just the nation’s largest abortion provider, but also offers cancer screenings, sexually transmitted infection testing and treatment, and other reproductive health services.

“We ultimately want to replace Planned Parenthood with the services we offer,” said Heather Lawless, founder and director of Reliance Center in Lewiston, Idaho. She said about 40% of patients at the antiabortion center are there for reasons unrelated to pregnancy, including some who use the nurse practitioner as a primary caregiver.

The changes have frustrated abortion rights groups, who, in addition to opposing the centers’ antiabortion messaging, say they lack accountability; refuse to provide birth control; and offer only limited ultrasounds that cannot be used for diagnosing fetal anomalies because the people conducting them don’t have that training. A growing number also offer unproven abortion-pill reversal treatments.

Because most of the centers don’t accept insurance, the federal law restricting release of medical information doesn’t apply to them, though some say they follow it anyway. They also don’t have to follow standards required by Medicaid or private insurers, though those offering certain services generally must have medical directors who comply with state licensing requirements.

“There are really bedrock questions about whether this industry has the clinical infrastructure to provide the medical services it’s currently advertising,” said Jennifer McKenna, a senior advisor for Reproductive Health and Freedom Watch, a project funded by liberal policy organizations that researches the pregnancy centers.

Post-Roe world opened new opportunities

Perhaps best known as “crisis pregnancy centers,” these mostly privately funded and religiously affiliated centers were expanding services such as diaper banks ahead of the Supreme Court’s 2022 Dobbs vs. Jackson Women’s Health Organization ruling, which overturned Roe.

As abortion bans kicked in, the centers expanded medical, educational and other programs, said Moira Gaul, a scholar at the Charlotte Lozier Institute, the research arm of SBA Pro-Life America. “They are prepared to serve their communities for the long term,” she said in a statement.

In Sacramento, for instance, Alternatives Pregnancy Center in the last two years has added family practice doctors, a radiologist and a specialist in high-risk pregnancies, along with nurses and medical assistants. Alternatives — an affiliate of Heartbeat International, one of the largest associations of pregnancy centers in the U.S. — is some patients’ only health provider.

When the Associated Press asked to interview a patient who had received only non-pregnancy services, the clinic provided Jessica Rose, a 31-year-old woman who took the rare step of detransitioning after spending seven years living as a man, during which she received hormone therapy and a double mastectomy.

For the last two years, she’s received all her medical care at Alternatives, which has an OB-GYN who specializes in hormone therapy. Few, if any, pregnancy centers advertise that they provide help with detransitioning. Alternatives has treated four similar patients over the last year, though that’s not its main mission, director Heidi Matzke said.

“APC provided me a space that aligned with my beliefs as well as seeing me as a woman,” Rose said. She said other clinics “were trying to make me think that detransitioning wasn’t what I wanted to do.”

Pregnancy centers expand as health clinics decline

As of 2024, more than 2,600 antiabortion pregnancy centers operated in the U.S., up 87 from 2023, according to the Crisis Pregnancy Center Map, a project led by University of Georgia public health researchers who are concerned about aspects of the centers. According to the Guttmacher Institute, 765 clinics offered abortions last year, down more than 40 from 2023.

Over the years, pregnancy centers have received a boost in taxpayer funds. Nearly 20 states, largely Republican-led, now funnel millions of public dollars to these organizations. Texas alone sent $70 million to pregnancy centers this fiscal year, while Florida dedicated more than $29 million for its “Pregnancy Support Services Program.”

This boost in resources is unfolding as Republicans have barred Planned Parenthood from receiving Medicaid funds under the tax and spending law President Trump signed in July. While federal law already blocked the use of taxpayer funds for most abortions, Medicaid reimbursements for other health services were a big part of Planned Parenthood’s revenue.

Planned Parenthood said its affiliates could be forced to close up to 200 clinics.

Some already had closed or reorganized. They have cut abortion in Wisconsin and eliminated Medicaid services in Arizona. An independent group of clinics in Maine stopped primary care for the same reason. The uncertainty is compounded by pending Medicaid changes expected to result in more uninsured Americans.

Some abortion rights advocates worry that will mean more healthcare “deserts” where the pregnancy centers are the only option for more women.

Kaitlyn Joshua, a founder of abortion rights group Abortion in America, lives in Louisiana, where Planned Parenthood closed its clinics in September.

She’s concerned that women seeking health services at pregnancy centers as a result of those closures won’t get what they need. “Those centers should be regulated,” she said. “They should be providing information which is accurate, rather than just getting a sermon that they didn’t ask for.”

Thomas Glessner, founder and president of the National Institute of Family and Life Advocates, a network of 1,800 centers, said the centers do have government oversight through their medical directors. “Their criticism,” he said, “comes from a political agenda.”

In recent years, five Democratic state attorneys general have issued warnings that the centers, which advertise to people seeking abortions, don’t provide them and don’t refer patients to clinics that do. And the Supreme Court has agreed to consider whether a state investigation of an organization that runs centers in New Jersey stifles its free speech.

Different services than Planned Parenthood

Choices Medical Services in Joplin, Mo., where the Planned Parenthood clinic closed last year, moved from focusing solely on discouraging abortion to a broader sexual health mission about 20 years ago when it began offering STI treatment, said its executive director, Karolyn Schrage.

The center, funded by donors, works with law enforcement in places where authorities may find pregnant adults, according to Schrage and Arkansas State Police.

Schrage estimates that more than two-thirds of its work isn’t related to pregnancy.

Hayley Kelly first encountered Choices volunteers in 2019 at a regular weekly dinner they brought to dancers at the strip club where she worked. Over the years, she went to the center for STI testing. Then in 2023, when she was uninsured and struggling with drugs, she wanted to confirm a pregnancy.

She anticipated the staff wouldn’t like that she was leaning toward an abortion, but she says they just answered questions. She ended up having that baby and, later, another.

“It’s amazing place,” Kelly said. “I tell everybody I know, ‘You can go there.’”

The center, like others, does not provide contraceptives — standard offerings at sexual health clinics that experts say are best practices for public health.

“Our focus is on sexual risk elimination,” Schrage said, “not just reduction.”

Mulvihill and Kruesi write for the Associated Press.

California and a coalition of other liberal-led states sued the Trump administration Tuesday over a provision in the “Big Beautiful Bill” that bars Planned Parenthood and other large nonprofit abortion providers from receiving Medicaid funding for a host of unrelated healthcare services.

The measure has threatened clinics across the country that rely on federal funding to operate. California Atty. Gen. Rob Bonta, who is helping to lead the litigation, called it a “cruel, backdoor abortion ban” that violates the law in multiple ways.

The states’ challenge comes one day after Planned Parenthood won a major victory in its own lawsuit over the measure in Boston, where a federal judge issued a preliminary injunction blocking the ban from taking effect against Planned Parenthood affiliates nationwide.

Federal law already prohibits the use of federal Medicaid funding to pay for abortions, but the new “defund provision” in the bill passed by congressional Republicans earlier this month goes further. It also bars nonprofit abortion providers that generated $800,000 or more in annual Medicaid revenue in 2023 from receiving any such funding for the next year — including for services unrelated to abortion, such as annual checkups, cancer screenings, birth control and testing for sexually transmitted infections.

Attorneys for the U.S. Department of Justice have argued that the measure “stops federal subsidies for Big Abortion,” that Congress under the constitution is “free to decline to provide taxpayer funds to entities that provide abortions,” and that Planned Parenthood’s position should not hold sway over that of Congress.

In announcing the states’ lawsuit Monday, Bonta’s office echoed Planned Parenthood officials in asserting that the provision specifically and illegally targets Planned Parenthood and its affiliate clinics — calling it “a direct attack on the healthcare access of millions of low-income Americans, disproportionally affecting women, LGBTQ+ individuals, and communities of color.”

Bonta’s office said the measure threatened $300 million in federal funding for clinics in California, where Planned Parenthood is the largest abortion provider, and “jeopardized the stability” of Planned Parenthood’s 114 clinics across the state, which serve about 700,000 patients annually — many of whom use Medi-Cal, the state’s version of Medicaid.

During a virtual news conference Monday, Bonta noted that federal funds already don’t cover abortions. He said the new provision was “punishment for Planned Parenthood’s constitutionally protected advocacy for abortion” and “a direct attack on access to essential healthcare for millions who rely on Medicaid.”

“The Trump administration and Congress are actually gutting essential lifesaving care, like cancer screenings and STI testing, simply because Planned Parenthood has spoken out in support of reproductive rights,” Bonta said. “The hypocrisy is really hard to ignore. A party that claims to be defenders of free speech only seem to care about it when it aligns with their own agenda.”

Bonta added: “Rest assured, California will continue to lead as a reproductive freedom state, and will continue to defend healthcare as a human right.”

In their lawsuit, the states argue that the measure is unlawfully ambiguous and violates the spending powers of Congress by singling out Planned Parenthood for negative treatment, and that it will harm people’s health and increase the cost of Medicaid programs for states by more than $50 million over the next decade.

In its lawsuit, Planned Parenthood also argued that the measure intentionally singled it and its affiliates out for punishment, in violation of their constitutional rights, including free speech.

In granting Planned Parenthood’s request for a preliminary injunction, U.S. District Judge Indira Talwani wrote Monday that she was “not enjoining the federal government from regulating abortion and is not directing the federal government to fund elective abortions or any healthcare service not otherwise eligible for Medicaid coverage.”

Talwani, an Obama appointee, wrote that she also was not requiring the federal government “to spend money not already appropriated for Medicaid or any other funds.”

Instead, Talwani wrote, her order blocks the Trump administration from “targeting a specific group of entities — Planned Parenthood Federation members — for exclusion from reimbursements under the Medicaid program,” as they were likely to prove that “such targeted exclusion violates the United States Constitution.”

In a statement to The Times on Tuesday, White House spokesman Harrison Fields said the “Big, Beautiful Bill” was “legally passed by both chambers of the Legislative Branch and signed into law by the Chief Executive,” and Talwani’s order granting the injunction was “not only absurd but illogical and incorrect.”

“It is orders like these that underscore the audacity of the lower courts as well as the chaos within the judicial branch. We look forward to ultimate victory on the issue,” Fields said.

The White House did not immediately respond to a request for additional comment on the states’ lawsuit.

Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California, joined Bonta during his news conference. She welcomed the states’ lawsuit, saying “an attack this severe requires a multi-pronged response with both short and long term strategies.”

Hicks said it’s particularly important that California is helping to fight back, given the huge stakes for the state.

“California is the most impacted state across the country because of the volume of patients that we have, but also because of the amount of Medicaid that our state takes,” she said. “It speaks to our values. And this defund provision is certainly [an] attack on values — most heavily on California.”

Bonta is leading the lawsuit along with the attorneys general of Connecticut and New York. Joining them are Pennsylvania Gov. Josh Shapiro and the attorneys general of Colorado, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Oregon, Rhode Island, Vermont, Washington, Wisconsin and the District of Columbia.

Bonta noted the lawsuit is the 36th his office has filed against the Trump administration in the last 27 weeks.

July 8 (UPI) — A federal judge has awarded Planned Parenthood a win over the Trump administration, halting a provision in President Donald Trump‘s massive tax cuts and benefits bill that prevents patients from using Medicaid at its healthcare facilities.

Judge Indira Talwani of the U.S. District Court of Massachusetts issued her temporary restraining order Monday evening, ordering the Trump administration to take “all steps necessary to ensure that Medicaid funding continues to be disbursed in the customary manner and timeframes to Planned Parenthood Federation and its members.”

The ruling came hours after Planned Parenthood filed its lawsuit against a provision in Trump’s policy bill that puts in place a one-year ban on Medicaid payments to healthcare nonprofits that provide abortion services while receiving more than $800,000 in Medicaid reimbursements in fiscal year 2023.

The nonprofit family medical provider accused the Trump administration of unlawfully targeting it with the so-called defund provision.

It said the provision’s purpose was to specifically “punish” Planned Parenthood for advocating for and providing legal abortion access outside of the Medicaid program and without using federal funds.

The lawsuit added that the provision was made specifically to target Planned Parenthood as those who would be affected by it are “almost entirely” its members.

“And if there were any doubt, President Trump, Speaker [Mike] Johnson and their allies have been promising to ‘defund Planned Parenthood’ for years now,” the lawsuit states. “That is what the Defund Provision does.”

According to the lawsuit, if the provision is allowed to stand, it would threaten the healthcare of more than 1 million Americans who use Medicaid as their insurance at Planned Parenthood centers for care ranging from birth control to cancer screenings.

“The Defund Provision is a naked attempt to leverage the government’s spending power to attack and penalize Planned Parenthood and impermissibly single it out for unfavorable treatment,” the lawsuit states.

“It does so not only because of Planned Parenthood members’ long history of providing legal abortions to patients across the country, but also because of Planned Parenthood’s unique role in advocating for policies to protect and expand access to sexual and reproductive healthcare, including abortion.”

In a statement following the ruling, Planned Parenthood said it was “grateful” for the swift action.

“In states across the country, providers have been forced to turn away patients who use Medicaid to get basic sexual and reproductive healthcare because President Trump and his backers in Congress passed a law to block them from going to Planned Parenthood,” it said on Threads.

“The fight is just beginning, and we look forward to our day in court!”

June 26 (UPI) — The U.S. Supreme Court ruled Thursday that Planned Parenthood South Atlantic, the nonprofit’s arm that covers South Carolina, can’t sue the state over its closing off of the nonprofit’s Medicaid funding because it provides abortions.

“The U.S. Supreme Court has affirmed our right to exclude abortion providers from receiving taxpayer dollars,” wrote Gov. Henry McMaster, R-S.C., in an X post Thursday.

“Seven years ago, we took a stand to protect the sanctity of life and defend South Carolina’s authority and values,” he added, “and today, we are finally victorious.”

The 6-3 decision followed the court’s ideological makeup, with the three liberal judges in dissent while the six conservative judges ruled in support.

The court’s syllabus noted 42 U.S. Code Section 1983, which allows private parties to file suit against state officials who violate their Constitutional rights. However, in the opinion of the Court, which was delivered by Justice Neil Gorsuch, he wrote that “federal statutes do not automatically confer [Section 1983]-enforceable ‘rights.'”

“This is especially true of spending-power statutes like Medicaid, where ‘the typical remedy’ for violations is federal funding termination, not private suits,” he continued.

“No court has addressed whether that Medicare provision creates [Section 1983] rights,” he later wrote.

Justice Ketanji Brown Jackson wrote the dissent, and she also referred to Section 1983.

“South Carolina asks us to hollow out that provision so that the State can evade liability for violating the rights of its Medicaid recipients to choose their own doctors,” Jackson stated. “The Court abides South Carolina’s request. I would not.”

South Carolina had announced in July of 2018 that Planned Parenthood could no longer participate in the state’s Medicaid program, under a state law that prohibits the use of its own public funding for abortions.

The order further affected patients in that it had the effect of also blocking Planned Parenthood patients from receiving services such as breast exams, sexually transmitted diseases and contraception.

Planned Parenthood South Atlantic announced on its social media platform Thursday that, “Today, the U.S. Supreme Court decided that people using Medicaid in South Carolina no longer have the freedom to choose Planned Parenthood South Atlantic as their sexual and reproductive health care provider.”

“If you are a patient using Medicaid, keep your appointment,” the post continued. “We’re still here to provide you with the low or no cost care you deserve.”

The post concluded with “We’re in this with you, and we aren’t going anywhere.”

Republican-led states have sought to deprive abortion providers of public funds by restricting access to Medicaid.

The United States Supreme Court has cleared the way for South Carolina to strip the nonprofit healthcare provider Planned Parenthood of funding under Medicaid, a government insurance programme.

Thursday’s ruling was split along ideological lines, with the three liberal justices on the nine-member court dissenting.

The ruling overturned a lower court’s decision barring Republican-governed South Carolina from preventing Planned Parenthood South Atlantic, a regional branch, from participating in the state’s Medicaid programme.

Republican leaders in South Carolina have objected to Planned Parenthood because it provides abortions.

The Supreme Court’s decision bolsters efforts by Republican-led states to deprive the reproductive healthcare provider of public money.

The case centred on whether recipients of Medicaid may sue to enforce a requirement under US law that they may obtain medical assistance from any qualified and willing provider. Medicaid is administered jointly by the federal and state governments, and it is designed to provide healthcare coverage for low-income people.

Since the Supreme Court in 2022 overturned its landmark Roe v Wade ruling that legalised abortion nationwide, a number of Republican-led states have implemented near-total bans on the procedure. Some, like South Carolina, prohibit abortions after six weeks of pregnancy.

Planned Parenthood South Atlantic operates clinics in the South Carolina cities of Charleston and Columbia, where it serves hundreds of Medicaid patients each year, providing physical examinations, screenings for cancer and diabetes, pregnancy testing, contraception and other services.

The Planned Parenthood affiliate and a Medicaid patient named Julie Edwards sued the state in 2018. A year earlier, in 2017, Republican Governor Henry McMaster had ordered officials to end Planned Parenthood’s participation in the state Medicaid programme by deeming any abortion provider unqualified to provide family planning services.

The plaintiffs sued South Carolina under an 1871 law that helps people challenge illegal acts by state officials. They said the Medicaid law protects what they called a “deeply personal right” to choose one’s doctor.

The South Carolina Department of Health and Human Services, represented by the Alliance Defending Freedom conservative legal group and backed by President Donald Trump’s administration, said the disputed Medicaid provision in this case does not meet the “high bar for recognising private rights”.

A federal judge previously ruled in Planned Parenthood’s favour, finding that Medicaid recipients may sue under the 1871 law and that the state’s move to defund the organisation violated Edwards’s right to freely choose a qualified medical provider.

In 2024, the 4th US Circuit Court of Appeals, based in Richmond, Virginia, also sided with the plaintiffs.

The Supreme Court heard arguments in the case on April 2.

The dispute has reached the Supreme Court three times. The court in 2020 rejected South Carolina’s appeal at an earlier stage of the case. In 2023, it ordered a lower court to reconsider South Carolina’s arguments in light of a ruling the justices issued involving the rights of nursing home residents.

That decision explained that laws like Medicaid must unambiguously give individuals the right to sue.

WASHINGTON — The Supreme Court ruled Thursday that states may exclude Planned Parenthood clinics from providing medical screenings and other healthcare for women on Medicaid.

The court’s conservative majority reversed the longstanding rule that said Medicaid patients may obtain medical care from any qualified provider.

In a 6-3 vote, the justices ruled the Medicaid Act does not give patients an “individual right” to the provider of their choice.

The dispute has turned on abortion. Medicaid is funded by the federal government and the states. For decades, conservative states have argued their funds should not be used in Planned Parenthood clinics because some of those clinics perform abortions.

But until now, the federal government and the courts had said that Medicaid patients can go to any qualified provider for healthcare.

In dissent, Justice Ketanji Brown Jackson said the decision “will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them. And, more concretely, it will strip those South Carolinians — and countless other Medicaid recipients around the country — of a deeply personal freedom: the ability to decide who treats us at our most vulnerable.” Justices Sonia Sotomayor and Elena Kagan agreed.

Planned Parenthood clinics provide cancer screenings, birth control medical screenings, pregnancy testing, contraception and other healthcare services.

Congress pays most of the state’s costs for Medicaid, and it says “any individual eligible for medical assistance” may receive care from any provider who is “qualified to perform the service.”

Lupe Rodríguez, executive director of National Latina Institute for Reproductive Justice, called the decision “an attack on our healthcare and our freedom to make our own decisions about our bodies and lives. By allowing states to block Medicaid patients from getting care at Planned Parenthood health centers, the Court has chosen politics over people and cruelty over compassion.”

Three years ago, the Supreme Court overturned Roe vs. Wade and ruled states may prohibit nearly all abortions.

Nonetheless, South Carolina continued its legal fight to prevent Medicaid patients from receiving care at Planned Parenthood’s clinics in Charleston and Columbia.

Former Gov. Henry McMaster, who issued the ban on Planned Parenthood in 2018, said he did so to protect “his state’s sovereign interests.”

Critics of the move said the state has a severe shortage of doctors and medical personnel who treat low-income patients on Medicaid.

Four of the six Planned Parenthood clinics in Iowa and four in Minnesota will shut down in a year, the Midwestern affiliate operating them has announced, blaming a freeze in federal funds, budget cuts proposed in Congress and state restrictions on abortion.

The clinics closing in Iowa include the only Planned Parenthood facility in the state that provides abortion procedures, in Ames, home to Iowa State University. Services will be shifted, and the organization will still offer medication abortions in Des Moines and medication and medical abortion services in Iowa City.

Two of the clinics being shut down by Planned Parenthood North Central States are in the Minneapolis area, in Apple Valley and Richfield. The others are in central Minnesota, in Alexandria and Bemidji. Of the four, the Richfield clinic provides abortion procedures.

The Planned Parenthood affiliate said it would lay off 66 employees and ask 37 additional employees to move to different clinics. The organization also said it plans to keep investing in telemedicine services; it sees 20,000 patients virtually each year. The affiliate serves Iowa, Minnesota, Nebraska, North Dakota and South Dakota.

“We have been fighting to hold together an unsustainable infrastructure as the landscape shifts around us and an onslaught of attacks continues,” Ruth Richardson, the affiliate’s president and chief executive, said in a statement Friday.

Of the remaining 15 clinics operated by Planned Parenthood North Central States, six will provide abortion procedures — five of them in Minnesota, including three in the Minneapolis area. The other clinic is in Omaha.

The affiliate said that in April the Trump administration froze $2.8 million in federal funds for Minnesota to provide birth control and other services, such as cervical cancer screenings and testing for sexually transmitted diseases.

While federal funds can’t be used for most abortions, abortion opponents have long argued that Planned Parenthood affiliates should not receive any taxpayer dollars, saying the money still indirectly underwrites abortion services.

Planned Parenthood North Central States also cited proposed cuts in Medicaid, which provides health coverage for low-income Americans, as well as a Trump administration proposal to eliminate funding for teenage pregnancy prevention programs.

In addition, Republican-led Iowa last year banned most abortions after about six weeks of pregnancy, before many women know they are pregnant, causing the number of abortions performed there to drop 60% in the first six months the law was in effect and dramatically increasing the number of patients traveling to Minnesota and Nebraska.

After the closings, Planned Parenthood North Central States will operate 10 brick-and-mortar clinics in Minnesota, two in Iowa, two in Nebraska and one in South Dakota. It operates none in North Dakota, though its Moorhead, Minn., clinic is across the Red River from Fargo, N.D.

Hanna writes for the Associated Press.