The Expansion of Medical Services in Pregnancy Centers and Planned Parenthood Post-Roe

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 — ranging from testing and treatment for sexually transmitted infections to even providing primary medical care — has been unfolding for years. It gained steam after the Supreme Court overturned Roe v. Wade three years ago, clearing the way for states to ban abortion.

New Clinical Infrastructure in Anti-Abortion Centers

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 v. Jackson Women's Health Organization ruling. As abortion bans kicked in, the centers expanded medical, educational and other programs. 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. In some cases, Alternatives is some patients' only health provider.

“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 anti-abortion center are there for reasons unrelated to pregnancy, including some who use the nurse practitioner as a primary caregiver. For example, some patients receive all medical care at these centers, including hormone therapy from specialized OB-GYNs.

Planned Parenthood’s Strategic Response and Mobile Units

The push could get more momentum with Planned Parenthood closing some clinics and considering shuttering others following changes to Medicaid. Planned Parenthood is not just the nation's largest abortion provider, but also offers cancer screenings, STI testing and treatment, and other reproductive health services. To address the need for access points, a new mobile clinic is expected to begin providing abortion pills in Illinois by the end of the year.

The mobile facility – set up inside of an RV – will include a small waiting area, laboratory, and two exam rooms. "Our goal is to reduce the hundreds of miles that people are having to travel now in order to access care...and meet them where they are," said Yamelsie Rodriguez, President of Planned Parenthood of the St. Louis Region and Southwest Missouri. This mobile unit will initially provide medication abortion up to 11 weeks gestation and eventually offer surgical abortions.

Accountability and Clinical Concerns

The changes have frustrated abortion-rights groups, who, in addition to opposing the centers' anti-abortion messaging, say they lack accountability. There are “really bedrock questions” about whether this industry has the clinical infrastructure to provide the medical services it’s currently advertising. Specifically, critics highlight several areas of concern:

• The centers refuse to provide birth control.
• Most 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.

Overview of Expanding Medical Facilities

• Alternatives Pregnancy Center: Features family practice doctors, radiologists, and specialists in high-risk pregnancies.
• Reliance Center: Utilizes nurse practitioners as primary caregivers for nearly 40% of patients.
• Planned Parenthood Mobile Unit: Equipped with a laboratory and two exam rooms to provide medication abortions and STI screenings.

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. This evolving landscape has set up likely battles between states with a patchwork of different abortion laws.