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Desiree walked into Gateway Women’s Care in September 2022 excited to learn how far along she was in her pregnancy. Then 24, the self-described “Google freak” had spent days studying images from ultrasounds to get ready for what she might see. She was happy about the pregnancy and eager to share the news with her close-knit family, especially her mom.
She’d tried to schedule an appointment with several obstetricians, only to be told they weren’t taking new patients or wouldn’t see her until she was at least 10 weeks along.
But a free pregnancy center in Durham could get Desiree in right away. Both a sister and a cousin had been to Gateway, which put her at ease. The technician, a registered nurse dressed in scrubs and a lab coat, looked so young that she remembers kindly asking where she had gone to school. A technician-in-training stood beside her.
Desiree’s partner held her hand as she laid on the narrow, gray exam table. The room was clean, and she could see the sonogram screen beside her.
The technician couldn’t see the embryo from an abdominal scan, so she tried a transvaginal ultrasound, which can give a clearer image in early-term pregnancies.
A large gray speck on the sonogram screen caught Desiree’s eye. She asked if it was her baby.
“She said it was fluid or something, but definitely not a fetus,” Desiree recalled. But then the technician told her she needed to go to the ER immediately.
“You’re having an ectopic pregnancy,” Desiree said the technician told her. “You need to go to the hospital now because it’s going to rupture.”
Once outside of Gateway, Desiree called her mom, who met them at the WakeMed ER. In a private room, a nurse performed another ultrasound, the screen out of Desiree’s sight. A doctor came to her bedside to interpret the image, and he had good news: what Desiree had pointed out at Gateway was in fact a healthy embryo measuring four weeks and five days.
For Desiree, the good news was overshadowed by hours of emotional turmoil and a $6,250 ER bill. “It was traumatizing, and I would never recommend them to anybody,” she said.
(The Assembly is using the women’s first names throughout this article for privacy; two North Carolinian women who previously spoke with other news outlets about their experiences at crisis pregnancy centers told us their participation made them subjects of online harassment.)
Gateway’s executive director, Wendy Bonano, declined a request for an interview. Responding to a negative Google review Desiree left, the center wrote, “Each client who uses our free services reads and signs an acknowledgement that Gateway Women’s Care provides limited care in our facility and not emergency care,” adding that the sonogram technician followed Gateway’s policy.
In 2022, Desiree’s ultrasound was one of 833 performed at one of Gateway Women’s Care’s three Triangle locations, and one of at least 6,000 performed at North Carolina crisis pregnancy centers, according to an annual report submitted to the state health department. These explicitly anti-abortion, Christian centers often offer “pre-abortion services” like pregnancy tests, ultrasounds, and counseling for unplanned pregnancies, but they don’t offer prenatal care during the course of a pregnancy.
“Crisis pregnancy centers offer a variety of services,” said Dr. Jonas Swartz, a Duke professor and OBGYN who has studied the centers. “They sometimes offer maternity clothes for people who have just given birth or who are going to give birth. And they sometimes offer resources for infants. But their express goal is to intercept people who are going to seek abortion and talk them out of having an abortion.”
And over the last decade, taxpayer money to support these centers’ work increased from $300,000 a year to more than $12 million.
There are at least 100 crisis pregnancy centers operating in North Carolina, most of which have received state funding through the Carolina Pregnancy Care Fellowship, a little-known statewide nonprofit that also goes by the name “Lifelink Carolina.” But an investigation by The Assembly found that these unlicensed facilities are not subject to the same privacy regulations or governmental oversight as medical clinics, and in cases like Desiree’s, have shared inaccurate information. Less than a quarter of the state funds they received went to support pregnant people.
Swartz co-wrote an article detailing how the centers may be legal, but unethical, finding that they violate patients’ autonomy and have shared inaccurate information on contraception, sexually transmitted infections, and abortion. The American College of Obstetricians and Gynecologists said that crisis pregnancy center staff’s use of “deception, delay tactics, and disinformation” undermines “the tenets of informed consent and patient autonomy and impede[s] access to comprehensive, ethical care.”
Despite ongoing concerns about oversight of these centers, the state legislature nearly doubled its taxpayer funding to crisis pregnancy centers in 2022, growing from $5.7 million to $9.7, and in the 2023 fiscal year, North Carolina gave these centers $12.4 million, the third-highest funding in the country. Funding totaled $7.5 million in 2024, a decline likely due to the state legislature not passing a comprehensive budget in the “short session.”
Historic Spending
Less than a month after the U.S. Supreme Court’s decision in Roe v. Wade in 1973, Greensboro became home to one of North Carolina’s first crisis pregnancy centers, Birthright. The number and locations of centers quickly grew, expanding to Asheville, Chapel Hill, Fayetteville, High Point, and Charlotte within a decade.
“The pregnancy center movement in the country was very fledgling back in the late ‘80s,” Roberta “Bobbie” Meyer, who then was the director of the Salem Pregnancy Center, told The Assembly. “There were less than a dozen pregnancy centers, and it was the sense of, we need to be sharing ideas, learn from each other.”
“Their express goal is to intercept people who are going to seek abortion and talk them out of having an abortion.”
Dr. Jonas Swartz, Duke professor and OBGYN
Meyer helped form a steering committee of the heads of other pro-life crisis pregnancy centers, maternity homes, and adoption agencies, which met for annual conferences. The group became the Carolina Pregnancy Care Fellowship in 1998.
Meyer, now 81, had been the executive director of the Pregnancy Care Center of Rocky Mount from 1994 to ’97, and the Pregnancy Resource Center of Charlotte from 1997 to 2010. She was a part of the fellowship for decades as a board member and became its state director in 2010.
Every center is independently run, but often provides lay counseling and educational classes where women earn points to cash in for items at a baby boutique. “We kind of become like a surrogate family to them after a while, once they get in with their client advocate,” said Victoria Miglin, chair of Lifelink’s board and director of a large center in Statesville.
For most of its history, the organization had a five-figure budget that mainly came from donations, retreats, and dues. Then in 2013, the state awarded it $250,000 from a federal block grant intended to help mothers and children. The fellowship continued getting state support from the block grant until 2017, when the organization secured $1 million from the state’s general fund largely to purchase medical equipment, like ultrasound machines, and training. The state’s funding to the fellowship paused for two years, after a 2018 Rewire News investigation revealed it had spent federal funds on religious materials.
Instead, the legislature increased funding to another large crisis pregnancy network, the Texas-based Human Coalition, increasing its award from $300,000 to $1.2 million per year.
Since 2020, more than $36 million in taxpayer funding has gone to at least 70 centers statewide. HELP Pregnancy Center, a Monroe, N.C., center whose vision is “to represent the voice of the UNBORN child … the Lord commands us to sound the alarm,” received at least $3.25 million over the last four years, more than any other center. This includes $2.5 million from the State Capital and Infrastructure Fund, which was created “to invest in public infrastructure.”
HELP has spent $1.9 million of those funds on expanding their office, including more than $117,000 on furniture and storage, more than $5,000 on decorations, and $3,400 on exercise equipment for employees, The Assembly’s review of expenses found.
HELP declined an interview with The Assembly. In a statement, director Tara Quinn said the decorations “include necessary furnishings that create an optimal environment for those we serve” and that the fitness equipment supports “the physical and mental health of our team.”
The Monroe center is one of two dozen primarily rural centers which received direct grants placed in the budget by the legislature, mostly from the state’s newly created reserve funds. One of these reserves, the “regional economic development” fund, bypasses governmental and private economic development organizations where recipients are vetted and generally must meet employment targets or return state funds. The conservative John Locke Foundation has said the fund, which paid $4.6 million to the centers, was created to “finance corporate welfare schemes.”
The recent increase in funding now ranks North Carolina as the third-highest state when it comes to currently directing public dollars to crisis pregnancy centers.
‘They Absolutely Lied to Me’
Jess, then 26, took a pregnancy test in October 2023. It was positive. The Holly Springs resident had just begun to get on her feet financially and wasn’t in a healthy relationship. She knew this was not the right time for a child.
Distressed, she called a pregnancy support hotline she found online, which recommended she visit the Your Choice Pregnancy Center in Raleigh. When she arrived, she felt like she was in good hands. The staff members were friendly and welcoming; one handed her a lollipop for morning sickness when she noticed Jess looked nauseated.
While Jess was raised in a Hindu-Buddhist family, the cross on the wall of the waiting room didn’t initially strike her as odd. She’d lived in the South most of her life. But as soon as she was perched on an exam chair, the tone shifted.
“They talked to me first about what religion I am, they wanted to know my beliefs, they wanted to know what I think about life,” Jess said. When she told them she is Hindu, they asked her what makes her religion special.
“I’m not here to talk about my religion, but to see how many weeks along I am,” she told them.
She had been at Your Choice for over an hour before they did an ultrasound.
“When they finally found the fetus, they’re like, ‘That’s your baby, you’re a mother,’” Jess recalled. She said they made her listen to the heartbeat against her objection. “That’s not what I wanted to hear.”
They told her she was seven weeks along and put a tiny rubber model of a fetus in her hand. “That’s how big your baby is right now,” they said.
Jess told them she was going to get an abortion. “They told me I couldn’t; they told me it was illegal,” Jess said. “I called them out on it. I said, ‘That’s not correct.’ And they were fighting me about it.”
While North Carolina lowered the legal limit for abortions in July 2023, she knew it was still legal up to 12 weeks.
“They absolutely lied to me,” she said.
Jess, who later got an abortion, said her younger sisters encouraged her to speak out about her experience. “It’s more than just me that’s going through this,” she said. “It’s many, many women who have been treated unfairly, and I think there needs to be a voice for us.”
Tonya Baker Nelson, the founder of Your Choice (which also operates under the name “A Hand of Hope”), denied that “anyone has ever been told by staff from Hand of Hope that abortions up to 12 weeks are illegal in North Carolina.” Nelson, who also previously served on the board of the Carolina Pregnancy Care Fellowship, declined further comment for this story.
Jess’ experience aligns with what Tara Romano, the executive director of Pro-Choice North Carolina, has heard from other women who went to crisis pregnancy centers.
Romano said the nonprofits use free ultrasounds to get pregnant people into their doors. “Then they proceed to proselytize, they do not present evidence-based pregnancy options,” she said. “There’s a lot of psychological manipulation.”
State law requires anyone seeking an abortion to get an ultrasound at least three days before the procedure, and suggests that they be required to view the image.
Your Choice has received at least $194,000 in state funds since 2020. The organization’s budget for that year included $513 to purchase more than 1,000 tiny fetus figurines like the one pressed in Jess’ hand, and nearly $2,500 for furniture.
‘Where Is the Oversight There?’
In April, top-ranking Democratic members of the Joint Legislative Commission on Governmental Operations mailed questions to 69 crisis pregnancy centers that have received state funds. The inquiries included how the nonprofits spent state funds, whether they had medical professionals on staff, and what services the centers provided, among other questions.
In return, the lawmakers received letters from two attorneys representing the majority of centers that argued they did not need to respond.
“It’s more than just me that’s going through this. It’s many, many women who have been treated unfairly, and I think there needs to be a voice for us.”
Jess, former client at a crisis pregnancy center
“I have advised Life Link Carolina not to respond to your letter,” wrote Paul “Skip” Stam, a former state House member who is the attorney for Meyer’s organization. He added that “no individual member of the Commission has the right to demand anything from anyone.”
State Sen. Gladys Robinson, who was one of the Democrats who sent the letters, challenged Stam’s assertion.
“We have precedent in the way the statute is being carried out,” Robinson said, noting that while the entire committee previously needed to make requests, the statute has changed. She said that a state senator who isn’t on the committee requested an investigation into Alamance-Burlington School System, and a staffer initiated a request into diversity, equity, and inclusion training at UNC System schools.
“These are taxpayer dollars. These are public dollars that come out of your pocket, mine, and everybody else in the state of North Carolina,” Robinson said. “I don’t understand why they are hesitant, or why they refuse to provide the information. It ought to be on record here. It ought to be provided to a legislator, ought to provide it to the entire public.”
Union County Republican state Rep. Dean Arp, a top budget writer and one of the legislature’s most vocal supporters for pregnancy centers, did not comment on whether the centers should report how they spend taxpayer money. But he defended state expenditures.
“I support state grants to these community-based non-profits, which work to improve the lives of young families in need,” Arp said in a statement.
Other state legislators who are known to support the centers, like eight-term Republican Sen. Ralph Hise, did not respond to requests for comment. Former Republican state Sen. Joyce Krawiec, who Meyer mentioned as one of the organization’s champions, also did not return requests for comment. After the Democratic lawmakers held a press conference, state Senate leader Phil Berger told reporters that the Democrats looking for oversight were “in a search for relevance.”
Among the questions the Democrats asked were who performs and certifies ultrasounds at the centers, their qualifications, and the metrics used to determine gestational age. “Care for women and women’s bodies is a very crucial kind of service, and we should not have non-medical people doing that,” Robinson said.
In professional healthcare settings, sonogram technicians must be overseen by a licensed physician, who then interprets the images. But that’s not the case in places like Gateway, where Desiree said the technician who saw her didn’t consult with a licensed obstetrician in the office after doing the transvaginal ultrasound.
Meyer, the executive director of the statewide pregnancy center coalition, stressed that the ultrasound technicians in her organization’s centers “are licensed professionals”—at minimum they are “a registered nurse who has been specifically trained to do limited ultrasounds.”
And she said that centers providing “medical services” are associated with an off-site physician.
“Every one of the pregnancy centers that offers medical services has a medical director,” she said. “They’re not in the building, but it’s under that physician’s license that all of the medical services [are provided].”
The lack of information about how the centers operate infuriates Robinson, who was previously executive director of a community healthcare agency.
“I’m accountable to the women of the state to make sure that if we’re funding someone to provide them services, that they are getting services from someone who’s a medical provider, who’s certified,” Robinson said.
The Assembly submitted public records requests to the state department of Health and Human Services for the Carolina Pregnancy Care Fellowship and Human Coalition’s expenses, contracts, and emails, which revealed how the primary organizations spent money, but not their subgrantees—the individual centers. The Fellowship’s quarterly and annual reports lacked reporting outcomes like the number of women connected to social services.
DHHS spokesperson Summer Tonnizzo said they do not have records on how individual anti-abortion centers spend taxpayer money, and pointed to state statute which requires the fellowship “to be responsible for managing and monitoring … each subgrantee project, program, or activity supported by grant funds.”
However, the same statute specifies that policies and procedures for state agencies overseeing, monitoring, and evaluating shall hold “grantees and subgrantees accountable for the legal and appropriate expenditure of grant funds” to “prevent the misuse of grant funds.”
“NCDHHS has no regulatory or oversight authority on the activities or outcomes of the centers,” Tonnizzo said in an email. “The General Assembly exercises full discretion as to the entities that continue to receive funding.”
Tonnizzo stressed that the department excluded funding the centers in its recommendations for maternal and infant health programs during the budget process.
The centers, which almost always provide pregnancy tests, explicitly do not provide prenatal and postnatal healthcare.
In 2020, the most recent year where individual centers’ spending data is available, less than a quarter of taxpayer money went to material support for pregnant people. Nearly 1 in 5 dollars were budgeted for advertising and promotional materials like branded plastic cups and custom koozies. Taxpayer money paid for the organizations’ overhead expenses, like utilities, and accounting performed by a family member of a longtime board member.
“If the purpose of the program was to distribute material goods to pregnant people in need, there are more efficient ways to do that,” said Emily Johnston, a researcher at Urban Institute who studies the effects of state and federal policies on the health and well-being of women and families.
Meyer told The Assembly that what pregnancy centers aim to do is more than just supply the material goods that they collect and distribute. She said that the organization’s goal is “a baby that’s born full term and is healthy,” and a mom who is given a “model” on how to parent.
The amount the state has given these centers baffles Swartz, the OBGYN.
“There seems to be no apparent regulation of these crisis pregnancy centers, yet the state is funding $23 million in the budget to go towards supporting these organizations,” Swartz said, referencing a recent biennial appropriation. “Where is the oversight there?”
Free Speech Fights
On an October afternoon in 2018, Essi left her family’s home in Cary and walked a half-mile down the road to Your Choice, the same center Jess visited. The then-16-year-old high school student had taken a dollar store pregnancy test, and it was positive. She wanted to be sure, and if so, she wanted an abortion.
She looked up Planned Parenthood, but their closest location was nine miles away in downtown Raleigh. Essi had neither a car nor the desire to explain to her guardian why she would be gone hours on the bus.
At the time, Your Choice’s website gave detailed information on abortion, including Plan B, Mifepristone, and surgical methods, the Internet Archive shows. “Our Services are FREE and Confidential,” it said.
She walked into an empty lobby, relieved that there was no one else that would see her there. They told her to take a pregnancy test that looked identical to the one she’d already taken, and—like Jess experienced—was asked about her religion. The test was positive and they told her she had two choices: to keep the baby or give it up for adoption.
“I know abortion is an option too, is there a natural way?” Essi recalled asking. She was unfamiliar with the abortion pill and didn’t “want to do anything too invasive.”
The repeated questions about faith, and lack of information about abortion despite the word “choice” in the center’s name made her feel like the staff were manipulating her. “I just left feeling like it was unprofessional.”
Later that week, Essi unlocked her phone at the end of her training shift at Panera Bread and saw a missed call and voicemail from the center. The caller on the voicemail said that if she didn’t call back in 10 minutes, they would call the police. She’d missed the window.
According to Cary police records, an unknown caller requested a welfare check on Essi at her home at 9:04 p.m. on October 20. The department sent three officers, who told Essi’s guardian she was pregnant. (The audio of the call has been deleted, as it’s past the department’s retention period, and Cary PD declined to release the officers’ notes, stating they require a court order. They did not provide an answer on why the caller’s name is missing.)
Nelson, the director of Your Choice, did not respond to questions about Essi’s case and whether she thinks it was a breach of confidentiality. Essi left a Google review, and the center never responded.
A medical center that bills insurance would be barred from sharing such information with law enforcement unless under specific situations, like thinking a patient was a threat to themselves, due to the federal Health Insurance Portability and Accountability Act, or HIPAA. But crisis pregnancy centers skirt many laws that regulate private information.
HIPAA applies to “health care providers who exchange health information electronically in connection with health insurance,” Jill Moore, a UNC professor who specializes in public health law said. Most of these centers advertise their services as free and do not bill insurance.
Responding to a complaint against a Louisiana crisis pregnancy center that disclosed the full names, last period, and due date of 13 women online, the federal agency that enforces HIPAA’s privacy, security, and breach notification’s rules, said “the requirements of the HIPAA Rules do not apply” to the center or its parent affiliate.
There are other state statutes and court cases that require patient information to be kept confidential by healthcare workers, but there’s no external enforcement agency, Moore said. “However, there’s also the possibility that a patient could report the provider to their licensing board.”
Sara Griffith, the chief nursing officer with the North Carolina Board of Nursing, said she was not aware of any complaints against nurses working in crisis pregnancy centers. Licensed, registered nurses working in pregnancy centers could be subject to disciplinary action if a client finds their actions incompetent, negligent, or unsafe, or for not wearing a badge with their full name and level of licensure “when providing care to a patient.”
“I would encourage these individuals to submit a complaint to the board,” Griffith said after being briefed of The Assembly’s findings, and said not having a nurse’s last name or license number is not a precluding factor. “Whatever information they can provide us: location, name, description, we will do our absolute best to identify that nurse.”
The centers have also been the subject of civil litigation. In 2023, a Massachusetts woman sued a crisis pregnancy center for failing to diagnose an ectopic pregnancy. In 2024, state attorneys general in New York and California filed lawsuits against a specific group of centers and their parent organization for promoting an unproven “abortion reversal” method. There are no known suits currently active in North Carolina.
It’s also an issue that hasn’t come before the medical board, Jean Fisher Brinkley, the board’s communications director, said in an email. Nor have individuals filed complaints to the state department of justice’s consumer protection branch, spokesperson Nazneen Ahmed said.
As the people’s attorney, the state attorney general can enforce medical regulations, like investigating whether Desiree’s diagnostic ultrasound constitutes a fraudulent impersonation of a medical clinic. The office can also investigate consumer protection complaints, and enter settlement agreements for unfair or deceptive acts or practices, like whether centers that falsely claim they are subject to HIPAA in exchange for personal health information is a violation of state law.
Other powers, like filing amicus curiae briefs that go against the General Assembly’s policies, were struck in a recent state law, which is likely to be challenged in court.
“The state should be about keeping people safe, including child and maternal health, rural health, and child care,” Governor Josh Stein said in a statement. “Instead, the General Assembly is funding facilities that do not provide medically sound information, and the legislature is failing to provide oversight or require accountability. It’s wasteful and wrong.”
State Attorney General Jeff Jackson previously voted against a federal resolution recognizing “the important role pro-life facilities, groups, and churches play” in 2023. He did not respond to requests for comment when presented with The Assembly’s findings on crisis pregnancy centers.
Essi worries other women looking for healthcare will find themselves in a similar situation. She said she went because she was looking for information and didn’t want her parents to find out she was pregnant. After the cops told her guardian, she helped Essi get the abortion that she wanted.
Essi said she didn’t know that she could have pursued legal action against the center. While she left the center feeling disappointed to not get the information she needed, she also felt empowered knowing that the staff couldn’t manipulate her into thinking that becoming a mother at 16 was her “path.” She left a Google review warning other women not to go to the center.
“The majority of people who are going to go are young because they don’t want to go to their parents to get health insurance,” she said. ”I was looking for privacy—which is so ironic—privacy, that the office is somewhere close, and free. That’s the kicker. That’s what gets everybody.”
Charlotte Kramon contributed reporting.
Correction: This story has been updated to clarify that the level at which a nurse is licensed, not her license number, should be displayed on badges.
Ren Larson is a staff reporter at The Assembly. She previously worked for The Texas Tribune and ProPublica’s investigative team, and as a data reporter with The Arizona Republic. She holds a master’s of public policy and an M.A. in international and area studies from the University of California, Berkeley.
Whitney Clegg is an investigative reporter and producer. She has previously worked for WBTV, Reveal, ProPublica, and CNN’s investigative unit, as well as worked on books on Jeffrey Epstein, Donald Trump, and Turning Point USA. She holds a master’s degree in journalism from the City University of New York.