In office buildings in neighborhoods across the state, they bear names as nondescript as their locales: Carolina Pregnancy Center, A Woman's Choices, the Center for Women.
They are anti-abortion programs, and there are eight times as many of them in North Carolina as there are abortion clinics. The pro-life centers have operated quietly for decades, but they are about to be thrust into the spotlight because of two new state laws that will drive funding and clients to them.
Money from sales of the new "Choose Life" license plates, expected to become available later this year, will go to the anti-abortion centers. On Wednesday, under the new law that places restrictions on abortions, a state-run website will launch listing the places that provide free ultrasounds, a service provided by the private centers.
The financial benefit to the centers isn't expected to amount to much initially. More substantial will be their increased influence as more people use them.
Abortion-rights supporters have long accused these centers of providing incorrect or misleading medical information, and of coercing vulnerable young women and teenagers to give birth. A new report, to be released Monday by an abortion-rights group, contends a yearlong undercover investigation found the same problems in North Carolina.
The state's network of anti-abortion clinics disputes the accusations, and contends it works hard to guide women and teenagers through their options without influencing them. They say they rely on the best current medical information, and regularly train their staffs to adhere to the highest standards of care.
Over the past decade, what came to be known as "crisis pregnancy centers" expanded around the country, spurred in part by federal funding for ultrasound equipment. The centers offer counseling and often ultrasounds, testing for sexually transmitted diseases, and sometimes baby supplies and other resources for child-rearing. An ultrasound can help pinpoint how far along an embryo is, but it also can serve as a powerful tool to discourage women from aborting.
In 2006, a congressional investigation found the "vast majority" of federally funded centers provided false or misleading information. The investigation identified three main areas of concern: statements that there are links between abortion and breast cancer, infertility and mental illness.
In recent years, NARAL Pro-Choice state chapters have conducted investigations into the pregnancy clinics in New York, California, Maryland, Texas and Virginia, reaching the same general conclusions.
Over the past year, the North Carolina office of the organization embarked on an identical investigation, studying the centers' websites and other material, and sending staff and volunteers posing as pregnant women or couples into the clinics.
Carey Pope, executive director of NARAL Pro-Choice North Carolina, said the organization decided to investigate in the state after discovering the number of centers had nearly doubled since 2006, to 122. And, she said, it seemed abortion opponents were gaining momentum in the state.
Pope said the group's investigators found numerous instances where crisis pregnancy centers were misinforming and misleading women. "Staff and volunteers often use propaganda to dissuade women from abortions," she said.
NARAL says it found the vast majority of the centers it investigated in North Carolina had no medical professionals on staff, and only a quarter of them disclosed they were not medical facilities. More than two-thirds provided distorted or outright false information about abortion risks and consequences.
The report says one Jewish investigator who posed as a pregnant woman was told at five centers she wouldn't go to heaven unless she converted to Christianity, and that one volunteer challenged her to become a "born-again virgin."
"We have no objection to a center that offers women who have decided to carry a pregnancy to term any help they like," Pope said. "But lines are crossed when the center is not up-front about its limited services or uses misinformation or intimidation or coercion."
Hoping to educate
But just where that line falls is a matter of dispute.
Representatives of Carolina Pregnancy Care Fellowship, the umbrella organization for 67 anti-abortion centers in North Carolina, say they work hard to provide factual, impartial information to teenagers and women who are conflicted about their pregnancies.
"I hope that didn't happen," said Bobbie Meyer, state director of the organization, when told of the Jewish woman's experience. "We can't guarantee every word that comes out of a volunteer's mouth will be what we hope."
Meyer, who used to run Pregnancy Resource Center in Charlotte, said clients are listened to, treated with respect and told clearly that ultimately the decision is up to them.
"Our goal is to educate her but also help her know there's a support system available to her under the very difficult situation she might be in," she said. "It's not about helping her change her mind, but about helping her get her life together and make good decisions."
Mimi Every, executive director of Pregnancy Support Services in Chapel Hill and Durham, said her centers have never had a complaint.
Every has run the two centers since 1992 and also works as a consultant with the national pro-life group Care Net to train staff and volunteers in centers across the state. Most of the clients in her two centers are between 20 and 24 years old, followed by women in the 17- to 19-year-old range.
Every said workers are screened, trained and re-trained regularly, adding that her goal is to avoid practices that could be considered manipulative or coercive. "We're very careful not to fall into that trap," she said. "I think that would be a horrible thing to do."
Meyer said there are conflicting studies on such issues as whether there is a link between breast cancer and abortion. "What those in our pregnancy centers are trying to say is there is not a definite link but there is enough evidence to give cause for concern," she said.
The National Institutes of Health have discredited the claim that there is such a link.
Meyer said she's visited at least three-quarters of the centers in her network in the past year and a half, and that all are using printed materials taken from standard medical journals. She said 23 of the centers offer some type of medical service, such as a limited ultrasound for the purpose of determining fetal development.
At those clinics, she said, there is always a medical director who works as a volunteer, and at least one nurse on the staff.
"We're not twisting women's arms," she said. "We're not manipulating them."
NARAL Pro-Choice North Carolina says it didn't find a significant difference between the centers it investigated that are part of the Carolina Pregnancy Care Fellowship and those that are not.
Conflict in the law?
NARAL is calling for state regulation of the centers, especially because they will now receive state funding.
Elsewhere, legislation has been introduced in Congress to give the Federal Trade Commission authority to regulate the centers. Efforts are under way in New York City, Baltimore and Austin, Texas, to require pregnancy centers to prominently disclose if there is no medical professional on staff and if they don't refer clients for abortions. Some of those efforts are being challenged in court. San Francisco is about to crack down on false or misleading advertising at the centers.
State Rep. Jennifer Weiss, a Democrat representing Wake County, said regulating the clinics might be worth considering, but for now it makes sense to see how a pair of lawsuits play out.
Both the license plate law and the Woman's Right to Know Act, which requires women be given the opportunity to view an ultrasound of their womb and hear a description of it between four and 72 hours prior to an abortion, have been challenged in court.
Weiss is concerned the new abortion law has an internal conflict: It requires that women obtain an ultrasound from a doctor or qualified medical technician, but it doesn't require that the pregnancy centers have staff with those qualifications. She also worries a center won't certify an ultrasound if the staff knows the woman intends to use that certification to get an abortion.
"The law is steering them someplace to comply with the law, but the place may not allow them to comply with the law," Weiss said.
The state has not yet approved the design for the "Choose Life" license plates, but is expected to do so later this year if the law is upheld. It would join about 150 other specialty plates.
Conservatives have tried to get the "Choose Life" plate on North Carolina roads for nine years. This year the Republican-dominated General Assembly succeeded and also blocked Democrats from balancing viewpoints with a pro-choice license plate.
There are no estimates on how much money the "Choose Life" license plates might bring to the pregnancy centers, but a national pro-life group reports $13.6 million has been raised in 24 states over the past decade.
The Carolina Pregnancy Care Fellowship will distribute the money to centers based on the number of plates sold in each county and how many clients they serve.
At least 300 people have already signed up for the plates in North Carolina, which will cost $25 a year, with $15 of that going to the pro-life centers. Meyer said the hope is that after several years the funding will be enough to expand the centers' reach.
"There is nothing quite as vulnerable as a woman without a good support system who is pregnant and doesn't know what way to turn," she said.