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On a Wednesday night in September 2022, a group of congregants gathered at Dream City Church in Phoenix while a young band, backlit by red and blue lights, sang of Jesus. The crowd stood, some clapping, others raising their arms to the worship music.

It was Freedom Night in America, a monthly event held by the religious arm of Turning Point USA, a controversial youth activist group that has grown into one of the most influential forces in the conservative movement.

This particular service announced a partnership between Turning Point and Choices Pregnancy Center, which operates three of Arizona’s 40-plus crisis pregnancy centers (CPCs). CPCs offer free pregnancy tests and ultrasounds, among other services, but most are not licensed medical facilities and don’t provide comprehensive reproductive health care.

When Turning Point founder and president Charlie Kirk walked onto the stage at Dream City that night, the young crowd welcomed the 30-year-old with bellowing applause.

“In a post-Roe America, it is on us as Christians and believers to make sure that every single woman who is pregnant in Arizona knows that there are options available that (are) not Planned Parenthood, that are not these abortion clinics,” said Kirk, who has made millions by merging his America-first political views with Christian ideology.

“Choices is doing such a wonderful job, and so we’re going to support them in any way we possibly can.”

Though CPCs have been around since the late 1960s, they’ve emerged as the latest frontier in the increasingly fraught battle over reproductive rights following the reversal of Roe v. Wade. Since the ruling, anti-abortion advocates have promoted the centers as an alternative for women who may have otherwise sought abortions.

Many elected officials, particularly those in conservative states, have embraced that perspective. A surge in taxpayer funding for CPCs has followed, even as other state and national leaders have raised concerns about what they describe as the centers’ deceptive practices.

In March, Arizona Attorney General Kris Mayes issued a consumer alert stating that CPCs can be “an obstacle hiding in plain sight” for those thinking about terminating their pregnancies. The nonprofit facilities often portray themselves as medical clinics, but instead “aim to discourage people from seeking abortion care and to persuade those seeking abortions not to access care,” the alert stated.

The warning echoed an open letter to consumers from California Attorney General Rob Bunta, which was signed by attorneys general from more than a dozen other states last fall.

Arizona’s 15-week abortion ban—reinstated after widespread public outcry prompted the repeal of a near-total, Civil War-era ban—is far more restrictive than abortion laws in any of those states.

“There’s a time clock running on when an abortion can be provided, especially with the 15-week bans currently in place in our state,” Richie Taylor, a spokesman for the Arizona Attorney General’s Office, told AZCIR. “And so anytime that is delayed or missed because of going to a clinic that doesn’t actually provide those services can be critical for a woman.”

Tessa Cox, a senior research associate at anti-abortion think tank the Charlotte Lozier Institute, touted the “incredible work” of crisis pregnancy centers, saying via email that they’d given tens of thousands of women access to “education, material resources, care and support that they might not be able to find anywhere else.”

In 2022 alone, she said, centers across the country “provided $367 million worth of goods and services at virtually no cost to clients.”

CPCs, which are typically nonprofit and faith-based, have been known to offer much of their material assistance in the form of “earn while you learn” programs, providing baby supplies in exchange for participation in counseling, abstinence education and other programming, including Bible studies. Most also provide select medical services, such as urine pregnancy tests and basic ultrasounds.

Those offerings are far more limited than the reproductive health care one could expect to receive from licensed medical providers like OBGYNs and sonographers, though. Such providers are qualified to perform more advanced screenings and tests, allowing them to identify and treat pregnancy-related complications and detect possible fetal abnormalities.

Comprehensive prenatal and postpartum care is especially important given the sprawling maternal mortality crisis unfolding across the United States, where maternal death rates more than doubled between 1999 and 2019. In Arizona, maternal death rates nearly tripled during the same time frame, with the most dramatic spikes among Black and Native American mothers.

CPCs, which often target under-resourced neighborhoods and communities of color, lend a “veneer of inclusivity to a fundamentally white (anti-abortion) movement” that could exacerbate those troubling trends, according to the Alliance, an organization that advocates for women’s rights and gender equality.

Arizona has at least 41 CPCs, which now eclipse the state’s nine licensed abortion providers. This mirrors trends in the U.S. at large, where crisis pregnancy centers outnumber abortion clinics 3-to-1, according to Equity Forward, which produces investigative research on human rights, gender equity and sexual and reproductive health.

Public funding for CPCs has also swelled since the Dobbs decision overturned Roe, with 22 states allocating nearly $500 million in taxpayer funds to the centers, an Equity Forward analysis shows. Arizona approved $3 million for CPCs through a Family Health Pilot Program backed by the influential lobbying group Center for Arizona Policy, which called the program a “practical way for the state to meet the needs of pregnant women and their preborn children.”

Federal funding for CPCs is robust as well: From 2017 to 2023, more than 650 centers received over $429 million, a June report by a national research firm found. The Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 provided most of the money, more than $289 million, but Temporary Assistance for Needy Families (TANF) also supplied a sizable $102 million.

The funding is often disbursed with little oversight, including in Arizona, according to the Equity Forward analysis.

“Money could be going towards diaper banks or towards doula programs or towards other sort of community-based organizations that are actually invested in the well-being of the people they are serving,” Equity Forward Director Ashley Underwood said. “The anti-abortion centers, because they are so closely tied to the anti-abortion movement, exist to progress the goals of the anti-abortion movement.”

In January, U.S. Rep. Ruben Gallego, D-Arizona, sent a letter to the U.S. Department of Health and Human Services contending CPCs should not receive TANF funding.

“It is past time that we stop the flow of taxpayer dollars to extreme, dangerous Crisis Pregnancy Centers that intentionally deceive vulnerable women seeking reproductive care,” Gallego said in an accompanying press release. “TANF funds are meant to support work programs, child care, early education, and other vital family programs—not shaming and endangering women.”

Cox, however, insisted that “women need the work that pregnancy centers do.”

“Helping women and families shouldn’t be a partisan issue, and it’s a shame some have chosen to demonize (CPCs) to push an agenda in which abortion is the first and only option,” she said.

Though crisis pregnancy centers don’t provide abortions, many dedicate portions of their websites to possible abortion risks and side effects, and work to connect clients with post-abortion support groups. Some, including Choices, also have pages providing information on abortion pill reversal—a procedure the American College of Obstetricians and Gynecologists has deemed unscientific and unethical.

Crisis pregnancy centers nonetheless come up in web searches for abortion providers often, Dr. Jonas Swartz, an OBGYN who has co-authored multiple reports warning of problems with CPCs, found in a 2021 study. Researchers provided screenshots of CPC and abortion clinic websites to more than 1,000 women, concluding that “women with limited knowledge about abortion and low health literacy may be particularly susceptible to misidentification of CPC websites.”

That’s by design, according to the Alliance. A 2021 analysis of crisis pregnancy centers in nine states found that nearly two-thirds of CPCs promoted false medical claims about abortion, contraception and reproductive health care providers.

“The idea of crisis pregnancy centers is that they want to intercept people who are seeking abortion and talk them out of that,” Swartz told AZCIR. “And so there is a deception inherent there in terms of how they’re approaching patients.”

Mayes’ consumer alert similarly warned of “deceptive and misleading tactics” employed by CPCs, including advertising free pregnancy tests and ultrasounds, locating close to clinics that provide abortion care and designing their facilities and websites to emulate full-service medical clinics. Some centers claim to have medically trained staff, but they are more often run by volunteers who sometimes don white coats to look like medical professionals, the alert said.

“It’s important that folks know the difference,” said state Sen. Anna Hernandez, D-Phoenix, who sponsored a bill to repeal Arizona’s abortion ban earlier this year. “If they’re going to an actual abortion provider, they’re going to get factual, scientific, medical information and not information that is made to sway them one way or another.”

Because most CPCs are not licensed health care providers, they may not need to comply with patient privacy laws or protect clients’ identities. The centers also could sell data to third parties, according to Mayes’ alert.

In April, Arizona Reps. Jacqueline Parker, R-Mesa, and Neal Carter, R-San Tan Valley, wrote a letter demanding the attorney general produce evidence to back up her “unfounded attacks on crisis pregnancy centers,” slamming Mayes’ alert as part of a “pattern of biased leadership and politicization of the Attorney General’s office.”

The letter followed a legislative committee hearing where CPC supporters had challenged Mayes’ claims.

“They don’t like…that I’m standing up for reproductive rights,” Mayes said of her critics in the Legislature. “But I am old enough to remember a day when we had policy disagreements between Republicans and Democrats and we didn’t stand up sham investigative committees to deal with them.”

Other elected officials have brought legal challenges against CPCs, “mainly in the form of local ordinances that require them to disclose that they are not medical centers and that they do not refer for abortion,” according to a commentary Swartz co-authored. They’ve had little success.

In 2015, for instance, Arizona Rep. Eric Meyer introduced legislation that would have required state-funded CPCs to provide scientifically accurate information and counseling related to  reproductive health care, including birth control. It also would have made it necessary for centers to prominently display entrance signs stating, in both English and Spanish, “This Center is Not a Licensed Medical Facility.”

The Phoenix Democrat’s bill died in committee, never making it to a vote.

This year, Arizona voters took on the broader issue of abortion access directly, seeking to amend the state constitution to establish a fundamental right to the procedure. The Arizona Abortion Access Act (AAA) will appear on the November ballot as the Right to Abortion Initiative, or Proposition 139.

If approved, the measure would generally allow abortions up to the point of fetal viability, or around 24 weeks gestation, giving pregnant Arizonans significantly more time to weigh their options. Given the state’s long history of anti-abortion advocacy, crisis pregnancy centers will continue to be one of them.

“We encourage any woman or individual who’s looking for this type of care to really do their research, review our alert,” said Attorney General Mayes’ spokesman, Taylor. “And if they do feel they were misled, to file a complaint with our office.”

This article first appeared on Arizona Center for Investigative Reporting and is republished here under a Creative Commons license.