Study maps how nonprofit religious groups set up facilities near abortion clinics

When patients who have appointments at the Planned Parenthood in Carbondale, Illinois, are late, staff members often know where to find them — at the crisis pregnancy center right next door.

"We have stories all of the time of patients who are misled. They actually think they're at a Planned Parenthood Health Center and then, not until after they're on the table getting an ultrasound, they realize it's not," said Christina Villarreal, chief external affairs officer for Planned Parenthood of Illinois.

At the Planned Parenthood in Flossmoor, Illinois, the potential confusion is built into the clinic's scheduling.

"This happens so often that they have a standing policy that if someone comes in late because they were taken next door to the crisis pregnancy center that they will fit them in, regardless of what the schedule is," said Mary Jane Maharry, director of communications for Planned Parenthood of Illinois. "The doctors are committed to staying late, because this happens so frequently."

Crisis pregnancy centers are faith-based nonprofit organizations that operate with the goal of persuading pregnant women to continue their pregnancies. They often open close to abortion clinics to intercept women who may be seeking to terminate pregnancies — whether by diverting patients through "sidewalk counseling" outside abortion clinics or positioning themselves close enough to clinics that would-be patients accidentally book appointments with them instead of their intended destinations.

When Planned Parenthood of the St. Louis Region and Southwest Missouri opened its Fairview Heights, Illinois, clinic across the state line after Missouri's near-total abortion ban in 2022, a Missouri-based prayer- and pregnancy resource center called Coalition LIFE followed it across the border.

Coalition Life workers moved into an office right across the parking lot from the Planned Parenthood clinic and set up a van there offering ultrasounds and anti-abortion counseling. The center's website says it is "committed to providing women with options, information and loving support that allows them to choose life."

Brian Westbrook, CEO of Coalition Life, said, "They do pregnancy testing, ultrasounds, STD testing and then, of course, options coaching in that unit, as well," meaning women are counseled about not terminating their pregnancies. "We're saving lives out there as a result of that."

A new study previewed exclusively by NBC News tracked the strategy of crisis pregnancy centers, mapping the distance between abortion facilities and the centers in the U.S.

While crisis pregnancy centers' pattern of locating near abortion facilities is well documented, the new research, published in the peer-reviewed Journal of Medical Internet Research, maps women's geographic access to both crisis pregnancy centers and abortion facilities.

The new study found that in 2021, crisis pregnancy centers outnumbered abortion clinics 3-to-1 in the U.S., but acknowledged that the figure is probably greater now post-Dobbs.

"Estimates have likely changed drastically since the Dobbs decision as some states banned or severely restricted abortion and increased funding for CPCs and other states have passed protections and expanded abortion access," the study said.

The study found that nationally:

59.7% of women ages 15 to 49 lived within 15 miles of a "dual presence" zone; that is, within 15 miles of both a crisis pregnancy center and an abortion facility.

More than one-quarter lived within 15 miles of only a crisis pregnancy center; 14.3% lived within 15 miles of neither kind of facility.

Only 0.8% lived in an "abortion facility only" zone.

On average, the distance between crisis pregnancy centers and abortion facilities in the U.S. was 5.5 miles. In some areas, the centers and abortion clinics may be only doors away.

Crisis pregnancy centers, or CPCs, "have been telling us their strategy," said Andrea Swartzendruber, a reproductive health epidemiologist at the University of Georgia College of Public Health, who is one of the co-authors of the study, along with Danielle Lambert, an assistant professor of epidemiology and biostatistics. "Part of their strategy is to compete with abortion facilities. This is the first study to actually look in a systematic way how near they are to abortion facilities and look at women and where they are located."

Swartzendruber and Lambert are also co-founders of the Crisis Pregnancy Center Map , an online tool that tracks locations of the centers. They used geolocation from the map alongside an abortion facility database to track the locations of the different facilities, as well as census data, for the study.

"Despite their risks to individual, family, and public health, this study's findings suggest that, before the Dobbs decision, CPCs' tactic of locating near abortion facilities was largely realized, and the centers were 'positioned' to attempt to intercept people considering and seeking abortion, given their relative numbers and locations, and close proximity to abortion facilities," Swartzendruber and Lambert wrote in the study.

According to the American College of Obstetricians and Gynecologists , "many CPC staffs use false and misleading information, emotional manipulation, and delays to divert pregnant people from accessing comprehensive and timely care from patient-centered, appropriately trained, and licensed medical professionals."

Lambert said: "They are providing misinformation about abortion, both surgical and medication abortion. Often they have misinformation around the laws, like what the gestational limits are and where you can go."

Lambert said the misinformation is just as pervasive in states where abortion is legal — explaining that the proximity of crisis pregnancy centers to abortion clinics is about targeting women not just on the ground but also online, as women are searching for care on the internet.

"They're co-located in a way where their advertising likely overlaps," Lambert said. "So if you think about Googling 'abortion services near me,' we know that a lot of times CPCs may show up in those searches. So those are areas where you may accidentally end up at a CPC thinking you're at a place that offers legitimate abortion services," she said.

Supporters of crisis pregnancy centers say they provide women facing a difficult decision with information to possibly make the choice to keep their pregnancy, along with resources such as pregnancy tests and parental coaching.

"Ultimately, pregnancy help organizations exist to provide women with the support and resources they need during some of the most vulnerable moments of their lives. They offer their services freely and without judgment, empowering women with care, compassion, and comprehensive options," said Andrea Trudden, Vice President of Communications at Heartbeat International, one of the largest crisis pregnancy center networks in the United States.

Taxpayers support crisis pregnancy centers In states where abortion care is almost totally banned or severely restricted, crisis pregnancy centers are sometimes the only resources available for women who are pregnant. The private, religiously affiliated nonprofit organizations typically provide free pregnancy tests and dissuade women navigating unintended pregnancies from getting abortions. They may also offer parenting classes and baby supplies, such as diapers. While some do have medical personnel on staff and offer ultrasounds and limited STD testing, they're usually staffed by volunteers and aren't bound by federal health privacy laws .

They don't offer prenatal care or gynecological care, abortion procedures, abortion medications or help for women having miscarriages. They aren't subject to the same standards as health facilities, and they are often unregulated by state health departments .

In states where abortion has been severely restricted or almost totally banned, crisis pregnancy centers often receive financial support from the government. Some states, such as Missouri and Louisiana, offer tax credits for corporations and people who donate to crisis pregnancy centers. Other states allocate taxpayer dollars directly to the centers.

An analysis from the abortion-rights watchdog organization Equity Forward found that 22 states have devoted some of their budgets to funding the centers, accounting for $489 million in total.

Florida, Missouri, North Carolina, Tennessee and Texas have given the most money to crisis pregnancy centers since Roe was overturned, according to the analysis.

Ashley Underwood, executive director of Equity Forward, said that there is little oversight of how taxpayer dollars are being spent and that the organization analyzed crisis pregnancy center spending through public records and grant reports.

"We're able to see that they are using specifically the public funding towards procuring [search engine optimization] professionals to help them with their online presence. We see that they are using this money for overhead costs, for replacing physical ads, billboards and things of that nature," she said "We see very, very little of that money going towards actually providing material support and services for pregnant people and families."

Some of the states distribute federal dollars meant for helping families in need, known as Temporary Assistance for Needy Families (TANF) funds, to crisis pregnancy centers. NBC News couldn't independently verify what the funds are spent on.

"The TANF program is one of, if not the only, federal program that provides direct cash assistance to families," Underwood said.

Funding challenges for reproductive health care Meanwhile, advocates for abortion access say the combination of abortion bans, rising health care costs and donor fatigue is causing funding challenges for reproductive health care.

The National Abortion Federation, which runs a national hotline for patient support and helps cover procedure costs, announced it would be able to subsidize only up to 30% of abortion costs , down from 50%. Planned Parenthood's fund announced similar cuts.

The struggles also extend to independent abortion clinics across the country. Abortion Care Network, a national association for independent abortion clinics that started a campaign called Keep Our Clinics to raise money for such facilities, said donations are down sharply since the fall of Roe v. Wade.

"In 2022 we were able to raise $5 million and distribute $5 million to our clinics," said Nikki Madsen, executive director of the Abortion Care Network. "In 2023 we were able to raise a little over $3 million and distribute that to our clinics. So far this year, we've only raised $750,000."

Madsen said clinics also face increased costs for supplies and equipment to accommodate patients from other states, as well as increased legal costs and higher security costs for anti-abortion-rights protesters outside clinics.

"They can't be sustainable, and they've already started to close their doors," Madsen said.

Abortion clinics offer other health care Abortion-rights advocates say that when communities lose abortion clinics, they also lose access to other health care services for women.

"They provide miscarriage management. They often provide reproductive and gender-affirming care in their communities, and they are often in areas of the country where we have large health care disparities and maternal mortality," Madsen said. "So when we lose these clinics, we don't only use abortion lose abortion care. We're losing these other critical reproductive health and gender-affirming and maternal care services."

An investigation of federal public health data found that from 2019 to 2022, the rate of maternal mortality cases in Texas rose by 56%, compared with just 11% nationwide, after the state banned abortion in nearly all cases.

Crisis pregnancy centers outnumber abortion clinics 9 to 1 in Texas, according to the crisis pregnancy center study.

"There's no evidence to suggest they are a possible solution" to a maternal mortality crisis, said Swartzendruber, one of the co-authors. "In fact, the weight of the evidence shows that they are more likely to cause risk," she said, adding that the centers often divert women from getting the medical care they seek and provide misinformation about health care that they don't ideologically agree with, such as contraception.

"So the possibilities of what could happen in the future, particularly given a shift in political climate and based on the elections, how they could potentially be used or increased in funding, I think is a serious issue."

Crisis pregnancy centers did receive additional federal funding during President-elect Donald Trump's first term in office. His administration made significant changes to the Title X family planning program , a federal program that gives grants to agencies offering family planning services and related health care, prohibiting participating clinics from providing abortion referrals. The change led more than 400 Planned Parenthood clinics to leave the Title X Network and Obria Group, a Christian nonprofit pregnancy center, to join it.

The Biden administration has issued regulations to reverse Trump's Title X policies.