The Choosing Childbirth Act, passed in 2017, pays crisis pregnancy centers for providing services for expectant mothers. The centers can’t provide any information about abortion services, now a moot point after the state outlawed abortion in the wake of the 2022 U.S. Supreme Court’s Dobbs decision striking down Roe v. Wade.
This year, under Senate Bill 1135, Republican lawmakers put $18 million into the Choosing Childbirth Revolving Fund, a six-fold increase in funding from previous years. The boost represents about one-fourth of the appropriations for the state’s public health agency, the Oklahoma State Department of Health.
Crisis pregnancy centers can provide ultrasounds, prenatal care, sexually transmitted disease testing, infant supplies and may counsel pregnant women away from abortion. Almost 975,000 people received services from 2,750 centers across the country in 2022, according to the latest report by the Lozier Institute. Most are run by affiliates of churches but few are licensed medical clinics.
Oklahoma Democrats voting against SB 1135 said the state’s focus on crisis pregnancy centers was misguided.
“My concern with the Choosing Childbirth Act is that times have changed since that was initially passed, and there is no longer a choice,” Sen. Carri Hicks, D-Oklahoma City, said before the Senate passed the bill on May 28. “I think it is very important that any program that is funded through this $18 million, ongoing, recurring appropriation is evidence-based and accredited, and that doesn’t exist.”
States that have banned abortions or put restrictions on them since the Dobbs decision have boosted funding to crisis pregnancy centers. A report from Reproductive Health and Freedom Watch found at least 21 states, including Oklahoma, have funded crisis pregnancy centers using taxpayer money since 2021. Its national analysis of nonprofit tax filings found a 30% boost in overall revenue for the centers, from $1 billion in 2019 to $1.4 billion in 2022.
In the two years since the Dobbs decision, state legislatures appropriated $327 million in direct funding to crisis pregnancy centers, a 78% increase from the $184 million they appropriated in the two years before Dobbs, the report found.
Oklahoma’s funding boost came with some changes to the Choosing Childbirth program under the recently passed SB 538, including coverage of ultrasounds, mental health and substance abuse services and transportation. Notably, SB 538 allows the Oklahoma State Department of Health to reimburse crisis pregnancy center nonprofits directly.
Those legislative changes remove a bottleneck criticized by some GOP lawmakers when the reimbursements to crisis pregnancy centers had to go through a sole-source vendor, the Oklahoma Pregnancy Care Network.
The state Health Department questioned the network, which has been the only vendor since the program started in 2020, in an internal audit in 2022. It said the vendor took too long to reimburse nonprofit crisis pregnancy centers and fell short of its goals in providing pregnancy-related services. Despite those concerns, the Health Department kept renewing a contract with the network.
Health Department officials said performance and invoicing have improved since the 2022 audit. The network and Texas-based Human Coalition were the only bidders last fall when the contract came up for renewal.
New Contract Signed
The Oklahoma Pregnancy Care Network signed a new $3 million contract with the Health Department in February. The contract is for one year, with an option to renew for an additional year. Budget documents show the network plans to spend $2.4 million on reimbursements for crisis pregnancy centers. The other $600,000 will go toward the network’s salaries, benefits and administrative expenses.
In contract documents obtained under the Oklahoma Open Records Act, the network said it has five full-time employees, including an executive director with a salary of $96,250. Its entire operating budget comes from state funds.
Representatives of the Oklahoma Pregnancy Care Network did not respond to requests for comment.
As SB 1135 made its way through the Legislature in the late stages of this year’s session, some House Democrats took issue with the vendor, questioning the amount it spent on salaries and overhead. They also questioned the wisdom of putting taxpayer-funded, pregnancy-support services under myriad private nonprofits and not under a state agency.
“It’s curious to me that as soon as abortion was no longer accessible in Oklahoma, we felt OK offering additional funding to these organizations,” Rep. Forrest Bennett, D-Oklahoma City, said in a floor debate on May 30.
House Majority Floor Leader Jon Echols, R-Oklahoma City, who authored the Choosing Childbirth Act in 2017, said critics were more concerned about the religious affiliations of the crisis pregnancy centers than the results. Echols said with the funding boost, the state was confronting critics who said lawmakers only cared about the unborn and didn’t support children after birth.
Records show the Oklahoma Pregnancy Care Network reimbursed 16 crisis pregnancy centers across the state for almost $203,000 in services in April. The centers had more than 900 visits that month.
“By funding these entities, we are actively investing in the well-being and choices of women facing pregnancy, ensuring that they receive the care, resources and guidance needed to make informed decisions and choose life for their babies,” the network said in its bid submission to the state. “This allocation serves as a vital lifeline for the pro-life cause, promoting a culture of compassion, assistance and positive alternatives for women and families in our community.”
The Health Department last week released a notice of funding opportunity for nonprofits to apply for new Choosing Childbirth grants. Spokeswoman Erica Rankin said at least $5 million will be allocated for pregnancy centers, per the Legislature’s request.
“Once the proposals are reviewed, objectively scored, awarded and contracts are in place, contractors will submit monthly invoicing and be reimbursed for allowable expenses, per the submitted work plan and budget narrative,” Rankin said in an email.
Outlawed, But Still In Demand
Although state lawmakers banned abortion, Oklahomans are still getting them by going out of state for abortion services or obtaining abortion pills by mail or other means for self-managed abortions. The latest estimates from the Guttmacher Institute found about 4,000 pregnant Oklahomans traveled to New Mexico, Colorado, Kansas and Illinois for abortion services at clinics in 2023.
Those abortion numbers are similar to the pre-Dobbs ruling. From 2017 to 2021, the number of abortions in Oklahoma averaged about 4,100 per year, according to an abortion surveillance report from the state Health Department.
Among the services some crisis pregnancy centers offer are advice on reversing medication abortions, which typically involve taking a dose of mifepristone and a follow-up dose of misoprostol. The U.S. Supreme Court unanimously ruled in June that mifepristone, approved for use more than two decades ago, could remain on the market. More than 60% of U.S. abortions were medication abortions in 2023, according to the Guttmacher Institute.
A testimonial on the Oklahoma Pregnancy Care Network website describes one client, Addi, a high school student who became pregnant and took the first dose of mifepristone. The next day, she decided to call an abortion-pill reversal hotline and got a referral from a doctor in Oklahoma for progesterone, taken as a mifepristone antidote.
“The normal, healthy blue-eyed, blond-haired baby boy was born on December 25th, the best Christmas present of all time,” the testimonial from Willow Pregnancy Support reads. “Addi continues to stop by and see us and we continue to help support her with material goods of diapers, clothing and formula.”
The American College of Obstetricians and Gynecologists does not support prescribing progesterone to stop a medication abortion. It said abortion-reversal treatments are not based on science and do not meet clinical standards.
The Abortion Pill Reversal Network, operated by Heartbeat International, said it helps about 100 women per month access abortion-reversal pills.
Some crisis pregnancy centers, which are trying to rebrand as pregnancy resource centers, have reported harassment and intimidation since the U.S. Supreme Court struck down Roe v. Wade.
In June, three Florida residents pleaded guilty to federal charges they threatened and vandalized pregnancy resource centers in 2022. Meanwhile, the U.S. Justice Department said it prosecuted 25 cases since 2021 under the Freedom of Access to Clinic Entrances Act, which prohibits threats or violence at clinics providing abortions.
Medicaid Maternal Care
Bipartisan efforts since the Dobbs decision have targeted postpartum medical and mental-health coverage under Medicaid. Nationally, about 40% of births are covered under the low-income Medicaid program. In Oklahoma, more than half of all births qualify for Medicaid.
Oklahoma is among 47 states that have expanded Medicaid coverage for postpartum care for up to 12 months, up from 60 days. Postpartum care was first expanded for five years under the American Rescue Plan Act in 2021. The Biden administration and Congress approved a permanent expansion under the Consolidated Appropriations Act of 2023.
States must apply for a Medicaid waiver to gain extended postpartum coverage. That waiver was a key recommendation of Republican Gov. Kevin Stitt’s Helping Every Life and Parent task force formed in the wake of the U.S. Supreme Court’s Dobbs decision delegating abortion laws to the states. The report also recommended boosting state funding for crisis pregnancy centers and establishing a network for distribution of abortion-pill reversal drugs.
Since Oklahoma received approval for the Medicaid postpartum care expansion, the services have helped about 23,000 mothers each month, according to data from the Oklahoma Health Care Authority. The joint federal-state Medicaid program paid an average of $19 million in reimbursement to health-care providers for postpartum care per month.
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Oklahoma Watch, at oklahomawatch.org, is a nonprofit, nonpartisan news organization that covers public-policy issues facing the state.
