Women and their access to health care has been in the news these past few weeks, as the plan to replace the Affordable Care Act (ACA) made headlines for what it potentially leaves out of women’s health care coverage – maternity/prenatal care; postnatal and newborn care; preventative reproductive and sexual health care (birth control, pap smears, mammograms); and coverage for pre-existing conditions such as surviving sexual assault and/or domestic violence, or a past C-section. And of course it will defund Planned Parenthood, where many low-income women, young women, immigrant women, queer women and rural women access their basic health care.
North Carolina has hardly been a leader in women’s health. The NCGA completely defunded Planned Parenthood of state funding back in 2015. They are one of 19 states that refused to expand Medicaid, which could cover up to 250,000 more low-income women for a more substantial period than pregnancy-plus three months (note: maternal mortality is considered a possibility for any mother who dies within one year of delivery). And despite some lawmakers’ claims that the numerous abortion restrictions put in place since 2011 are about “women’s health”, data shows NC women actually doing more poorly on numerous health determinants.
One women’s health “initiative” the NCGA has managed to find money for is the anti-abortion ministry of crisis pregnancy centers (CPCs). In 2011, the state created a “choose life” license plate, with proceeds going to CPCs (in case you are wondering, there is no corresponding plate that shows support for reproductive rights). In 2013, when sales of license plates didn’t seem to be enough, they budgeted $250,000 to fund these mostly religious centers that lure in patients who think they are going into a reproductive health care clinic. In 2015, despite making cuts to social safety net programs many NC women and children depend on, they managed to increase this funding to $300,000. And in this year’s House budget, they are proposing $1.3 million for CPCs.
What does this money do for the women of North Carolina? The main goal of these “life-affirming ministries” (as they refer to themselves) is to stop women from obtaining abortions. And if they can spend enough time with the clients, convince them – generally through lies and deception – that all non-procreative sex is sinful and wrong; basically, push a certain conservative religious view of sexuality. And the state continues to give them our tax dollars to do it.
The CPC services – pregnancy tests, ultrasounds, “incentive” programs, occasional STI testing – are all free of charge to the client, allowing the CPCs to target low-income patients with few resources to safely navigate an unplanned pregnancy. Many of the CPCs don’t say up front they are opposed to abortion, nor do they mention they aren’t necessarily staffed by medical professionals or paid staff. They do like to use the incentive of a “free ultrasound” to lure in patients, though, and that is in part what this $1.3 million is supposed to do – “purchase durable medical equipment”. And because these are not medical facilities, there seems to be little oversight for how they use equipment, what medical information they provide to clients, and what they do with any private health information they collect.
It’s been difficult to tell what the results for NC women’s and infants’ health are due to the NCGA’s investment in CPCS. Their reports to the state seem to focus on how many patients they saw, without any study or discussion of things like: number of women newly signed up for Medicaid; number of high-risk pregnant women referred to specialty OB/GYNs; number of women who found regular pre-natal care, and followed up with at least a year of post-partum care, etc. And while it’s difficult to determine the impact of programs like this on health indicators like pre-term and low-weight births, there doesn’t seem to be any moves to measure these critical maternal/infant health indicators, either.
If religious ministries want to operate centers to convince women to continue their pregnancies, that’s their right to do so. There will be plenty of women who feel comfortable using such services. They should be upfront, however, about their mission, rather than luring in patients with deception and then spreading lies about birth control and abortion. It’s a public health hazard, and disrespectful to the clients. And if they are to continue getting tax dollars, there needs to be better accountability for the medical information they provide, and any results they are getting. They also need to be upfront about their biases against things like premarital sex and LGBTQ rights. Our tax dollars should be spent on programs that are proven to be effective and are also accessible to all who seek them out. Rather than invest in CPCs, the state should use that money to better fund public health departments, rural health centers, maternal health programs, contraception access and comprehensive sex education programs that provide medically accurate information on all reproductive health options. And the state should also increase their funding for supports for low-income mothers and families, but that is for another article.