Text ‘A’ for Abortion: How a Texas Group Targets Pregnant Women Online

The moment Stephanie Moore saw the positive line appear on her home pregnancy test in 2019, she fell to her knees and sobbed. She had recently graduated from college and knew she wasn’t ready for a baby.

“I felt like the world was closing in around me,” Ms. Moore, 31, recently said. “I don’t think I’ve ever cried like that before.”

Then, she picked herself up, opened Google on her phone and typed: “Abortion near me.”

Ms. Moore quickly found a site for the Grapevine Women’s Clinic, just a short drive from her suburban Dallas home. “Take Control. Start with a Free Abortion Consultation,” the site read. She had recently been diagnosed with a blood disorder, and wanted to know how an abortion would physically affect her.

“I didn’t really need someone to go over my options,” she said. “I just needed more information as far as my health.”

While Texas recently enacted a strict law prohibiting abortion after about six weeks of pregnancy, the procedure was still largely available there at the time. When Ms. Moore called the number on the website, the person who picked up could not answer her questions. Instead, she said, the agent encouraged her to schedule an appointment to see if the pregnancy was “viable,” trying to steer her toward an ultrasound.

The woman on the phone did not work for an abortion clinic, or even a licensed medical facility. She was a counselor for Human Coalition, a Christian nonprofit that is quietly orchestrating a national effort to end abortion. Using local numbers that route to anti-abortion call centers and the promise of free ultrasounds, the organization seeks to intercept newly pregnant women and persuade them to keep their babies.

“Studies show that the majority of abortion-minded women will choose LIFE after seeing a sonogram of their child,” a page on Human Coalition’s main website reads.

Anti-abortion organizations have existed for decades, setting up so-called crisis pregnancy centers near Planned Parenthood clinics, and advertising on billboards and in the Yellow Pages. Human Coalition helped shift the battle to people’s phones and computers, where it relies on search engine optimization, targeted digital ads and an arsenal of websites that look like local health clinics to find women searching for abortions across the country — including in places where it will remain legal if the Supreme Court reverses Roe v. Wade.

“The abortion-determined woman will not walk into a pregnancy center voluntarily,” Brian Fisher, the organization’s co-founder, said in 2017. “They must be outreached to and found.”

As its reach has widened, Human Coalition has earned lucrative government contracts to provide alternatives to abortion. Nearly half of Human Coalition’s funding now comes from Republican-led states. At the same time, its lobbying arm shapes policy in states that are quickly moving to restrict or outlaw the procedure, and helped push through S.B. 8, the strict new law in Texas.

With a decision on Roe looming, the abortion landscape across the United States is set to be fundamentally altered — and organizations like Human Coalition are planning to seize the moment to expand.

“In a post-Roe world, our work really begins in a lot of ways.” Chelsey Youman, the director of public policy at Human Coalition, said in an interview. “We have all of these women who are out there and they need help. We know them, we care for them, we love them.”

“Children rescued”

Inside the glossy high-rise that houses Human Coalition’s headquarters in Plano, Texas, large TV monitors count the number of “children rescued” nationwide. Floor-to-ceiling photographs of mothers and babies, brightly colored graphics and religious quotes fill walls throughout the office.

In an adjacent suite, dozens of call center staff talk to women around the country facing unexpected pregnancies.

Much of Human Coalition’s work happens in that suite. The nonprofit said that in 2021, it served 18,000 clients via telecare and saw 2,500 people at its seven brick-and-mortar facilities across the United States. About two-thirds of its clients are considering abortion, it said.

For two days in February, The Times visited Human Coalition headquarters and conducted limited interviews with executives. During that time, the number of “children rescued” ticked up on the TV monitors by 22, to reach 22,740.

When it was founded in 2009, the organization — first called Media Revolution Ministries and later Online for Life — operated as a data-driven online marketing and referral service for crisis pregnancy centers. It eventually grew to run its own C.P.C.s, forming a national network that includes partnerships with independent facilities — allowing it to reach women across the country through targeted online ads.

Crisis pregnancy centers are core to the anti-abortion movement now, and outnumber actual abortion providers by more than 3:1, according to Andrea Swartzendruber and Danielle Lambert, researchers at the University of Georgia’s College of Public Health, whose team has mapped C.P.C.s across the country.

Earlier this year, Times reporters went to all of Human Coalition’s brick-and-mortar centers in five states. There was very little foot traffic, and the few women who agreed to speak with reporters said they had always planned to keep their pregnancies. They said they received free baby supplies and health care referrals, and were happy with their services so far.

But in interviews with nearly a dozen women who called or visited C.P.C.s linked to Human Coalition, many described feeling deceived into thinking that they would receive abortions, or at least unbiased advice about how to get one. Several of them later shared their experiences publicly in Google reviews online.

Ms. Youman denied that the organization intentionally misleads women seeking abortions, pointing to disclaimers on its websites that say it does not provide or refer for abortion.

A Times review of the 56 websites linked to Human Coalition, however, found that the disclaimers are tucked into the legal terms of service, or other places where they could easily be missed.

Not a doctor’s office

At first, Keri Boardman, 28, wasn’t sure if she had come to the right location in Charlotte, N.C.

“I had a hard time finding the place because it didn’t say the same name that it said on the website,” she said of her 2020 visit. “So I rode past it like three times before I got in there.”

She had no idea that she had stumbled into a crisis pregnancy center run by Human Coalition, in part because the center goes by three different names, each with its own website: Pregnancy Resource Center of Charlotte, Charlotte Women’s Clinic and Health for Her.

Using multiple names is common for crisis pregnancy centers, said Dr. Swartzendruber. “They’ll have one website that is directed toward potential clients that often hides their religious affiliation,” she said, “but their organizational website directed to volunteers or donors is much more transparent about their goals.”

Human Coalition employs registered nurses and social workers, but the centers themselves are not licensed or inspected by state health departments.

At the Charlotte center, Ms. Boardman was initially given a urine test, which showed that she was pregnant. Next, a counselor guided her to an ultrasound room, but the technician said that she couldn’t see Ms. Boardman’s pregnancy on the monitor, and asked her to come back two weeks later.

When Ms. Boardman returned, the technician printed an image showing a very early pregnancy. However, it was labeled 13 weeks and two days — indicating that she was too far along to take pills to terminate her pregnancy. Abortion pills currently have federal approval for use up to 10 weeks.

A counselor then asked her what she knew about surgical abortion.

“That’s when things went a little different,” Ms. Boardman said.

Ms. Boardman had just moved to Charlotte, and was starting a new job while enrolling her two children in school. She was uncertain about the pregnancy, but said that her experience at Health for Her was convincing. She decided she could not go through with an abortion.

Two weeks later, during a checkup with her obstetrician, a new ultrasound image showed that Human Coalition had gotten it wrong. Ms. Boardman was actually only nine weeks pregnant. That would have put her at the very beginning of her pregnancy and eligible for the abortion pill when she first visited Health for Her.

“That part was when I really noticed that, medically, they don’t know what they’re doing,” Ms. Boardman said of her ultrasound at Health for Her.

In an email to The Times, Human Coalition said its ultrasound technicians are all credentialed and overseen by a licensed doctor, and that it is confident in the accuracy of that work. But none of the women who spoke to The Times recalled seeing a doctor, and Human Coalition declined to elaborate on their role.

Several abortion providers who spoke to The Times said they do not accept ultrasounds from crisis pregnancy centers because they are often inaccurate.

“Invasive” messages

Stephanie Moore didn’t expect to hear anything more from the Grapevine Women’s Clinic after she called them in 2019. She hung up after the agent on the phone told her they do not provide abortions.

But for two weeks, the center continued to call and text her, asking her to follow up. The last text message shocked her:

“It was just very invasive,” said Ms. Moore, who shared voice mail and text messages with The Times. “I didn’t form a relationship. I wasn’t a patient. There was nothing of the sort, and they were just so persistent.”

Ms. Moore did not respond to the final text, which arrived the same day she took her first abortion pill at Planned Parenthood.

Had she responded, her answer would not have been protected by HIPAA, the federal patient privacy law. The law applies only to health care and other related providers who bill for their services. Most crisis pregnancy centers, including those run by Human Coalition, offer their services for free.

Human Coalition’s leaders say the organization takes client privacy seriously, and that staff members are trained to protect sensitive information. The personal data it collects is wide-ranging, from the date of a woman’s last period, to her abortion history and current pregnancy plans. Human Coalition records all phone calls that come into its call centers and says that its social services department sometimes works with clients over a period of years.

Reproductive rights advocates worry that anti-abortion centers could share private information with law enforcement agencies in order to help track or even prosecute women in states where abortion becomes illegal.

“We are expecting to see a huge increase in criminalization,” said Kim Clark, a senior attorney at Legal Voice, a legal advocacy group that supports abortion rights. “Crisis pregnancy centers are in a perfect position to facilitate those types of investigations and criminal prosecutions because they collect massive amounts of very personal data about individual pregnant people.”

Ending abortion with taxpayer funds

In its early years, Human Coalition was entirely dependent on private donors, including the Thirteen Foundation, a conservative organization funded by the fracking billionaire Farris Wilks and his wife, JoAnn.

But as it grew, it needed to find new sources of income. In 2017, tax records show, Human Coalition received $600,000 from North Carolina for a two-year pilot project to “assist women experiencing crisis pregnancies to continue their pregnancies to full term.”

Since then, Human Coalition has drawn more money from states seeking to curtail abortion — including Texas, Georgia and Tennessee — accounting for almost all of the organization’s growth.

According to Human Coalition’s 2021 annual report, government money made up 44 percent of the $18.7 million it generated in revenue. The organization recently applied to provide hotline services for the state of Arkansas, and hopes to win similar funding in Louisiana.

This increase fits a nationwide pattern. Public funding for crisis pregnancy centers across the United States has jumped from $17 million a decade ago to nearly $89 million this year, according to a tally of state budget figures by The Associated Press.

But as more state governments fund C.P.C.s through “Alternatives to Abortion” programs, critics argue that the money is being spent with little oversight. In a 2019 report, the North Carolina Department of Health said that it was “unable to determine the effectiveness or cost of expanding” Human Coalition’s work, after the organization failed to comply with reporting requirements. Despite that review, in 2021, the state’s legislature allocated $6.4 million to Human Coalition in its new budget, more than a tenfold increase from 2017.

“We haven’t even shown that the money that they’re spending already is doing anything,” said Julie von Haefen, a Democratic state representative from North Carolina who opposed the funding. “Now we want to increase the money? It’s just bad government.”

The nuclear family, at all costs

Four days after Kathleen Cooper’s partner was arrested for domestic violence in January 2020, a Google search for “free pregnancy test” led her to Cornerstone Pregnancy Services in Elyria, Ohio. Cornerstone is an independently run crisis pregnancy center that partners with Human Coalition.

Ms. Cooper was struggling. On top of the abuse, she was already an unemployed single mother of two. She was determined to end her pregnancy.

“If I brought this child into the world, that child would be at risk of being abused,” she said.

Cornerstone was close to Ms. Cooper’s home, and she’d been there before, when she was pregnant with her daughter years earlier. The center had persuaded her not to end her pregnancy then, and she knew it didn’t provide abortions. But she couldn’t afford the procedure, and thought Cornerstone might help her figure out how to qualify for public funding. The closest Planned Parenthood was 45 minutes away, and Ms. Cooper did not have a reliable car.

After confirming that she was pregnant, Ms. Cooper, 37, said that a counselor at the center interrogated her about her choice to terminate, and encouraged her to try couples counseling with her abusive partner.

Ms. Cooper’s partner was later convicted, and sentenced to 90 days in jail, court records show.

Cornerstone’s executive director, Cynthia Carter-Harris, did not respond to The Times’s request for comment about how the center typically handles domestic violence cases. Dr. Joseph P. Spirnak, who was not present, but whose signature appears at the bottom of Ms. Cooper’s pregnancy verification form, also declined an interview request.

In an email, Human Coalition said that it helps Cornerstone find and stay in touch with clients, but that it could not speak to its practices. Had she come to a Human Coalition facility, it would have offered her resources to ensure her safety, it wrote.

Ms. Cooper eventually made it to Planned Parenthood in Cleveland, where she had an abortion two weeks later with aid from an Ohio abortion fund. A counselor at Planned Parenthood also encouraged her to see a therapist.

She has since split from her partner, and said that her experience at Cornerstone inspired her to become an activist. She now volunteers with reproductive rights organizations and speaks publicly about her abortion.

Googling abortion

For years, abortion rights advocates have called on Google to stop allowing crisis pregnancy centers to run misleading abortion-related ads on the search giant’s platform. Because crisis pregnancy centers aren’t selling anything, they do not fall under the purview of the Federal Trade Commission Act, which prohibits unfair or deceptive advertising.

In response to the criticism, Google made a change in 2019, requiring advertisers in the United States, Britain and Ireland to be certified to use abortion-related keywords. A disclosure saying “Does not provide abortions” or “Provides abortions” appeared in gray under each paid ad.

“These are design choices that Google is making, and algorithmic choices that Google is making,” said Emily Peterson-Cassin, a lawyer with Public Citizen, a nonprofit consumer advocacy organization. “That’s really insufficient to depend on a small disclaimer that maybe folks are going to read. Maybe they’re not.”

In an email, a Google spokesperson said that protecting users from harmful and misleading ads was a top priority. The company in June made a subtle design change to its abortion-related disclosures, which now appear above each paid ad.

“We know that people come to Google looking for information they can trust during deeply personal moments,” the spokesperson wrote. “While we have heard this type of transparency has been enormously helpful since it was implemented in 2019, we recently updated these disclosures to make them even more visible.”

In 2020, the search giant also added a verification feature that allows users to click on any ad to see who is behind it.

But some lawmakers say the company needs to do much more.

In a letter sent June 17, a group of Democrats in Congress urged Google to better protect users from misleading abortion-related search results, including paid ads. The letter came after a recent study found that in some states, one in 10 Google searches for abortion led to centers that oppose the procedure.

David Sumara, the co-owner of an online marketing agency that places ads for abortion providers and other clients, said crisis pregnancy centers shouldn’t be allowed to advertise using the keyword “abortion” at all. He noted that the search giant already has a precedent for this kind of policy.

To prevent fraud, the company requires locksmiths and garage door repair businesses in the United States to become verified as providers of those services before they can run ads that use related keywords.

“If the goal of Google is to protect searchers,” said Mr. Sumara, “then we would like to see Google apply those same regulations to something that’s arguably more sensitive and more impactful to someone’s life.”

Google’s spokesperson said the company allows ads that promote different perspectives, and that its policies are tailored to specific issues facing each industry.

“The central question here is how come Google has this much power in the first place?” Ms. Peterson-Cassin asked.

A post-Roe future

The evening that Politico published a leaked draft opinion from the Supreme Court indicating that it planned to overturn Roe v. Wade, Human Coalition’s president, Jeff Bradford, sent an email to the organization’s donors and supporters.

“If the reversal becomes final, the pro-life movement is ready to care for these families,” he wrote.

It was that kind of care that Keri Boardman was seeking when she called Health for Her again in 2021. She had miscarried the year before, and she saw this new pregnancy as a sign.

“I was just like, OK, God’s telling me I’m ready now,” she said. “I told him I wasn’t ready before. I’m ready now.”

Ms. Boardman was nervous, having just lost a pregnancy. Because of the pandemic, she said, her doctor couldn’t see her until the end of the first trimester. Despite her prior experience with Health for Her, she figured a free ultrasound there could help soothe her nerves.

She called the same number as before, and was greeted by a friendly agent. But when she told her she planned to continue the pregnancy, she said the agent’s tone became curt.

“Right away I could hear the change as soon as I said ‘I’m keeping my baby,’” Ms. Boardman said. “She shut me down and was like, ‘Call your doctor.’”

Human Coalition told The Times that it provides “holistic care” to all of its clients, and did not respond to questions about whether it prioritizes certain services for women seeking abortions.

In Ms. Boardman’s case, she did not have time to understand why she wasn’t offered an ultrasound this time. The agent had already hung up the phone.