Three hundred fifty miles of cattle pasture and cornfields and single-stoplight towns separate Rapid City, near the western edge of South Dakota, from Sioux Falls, near its eastern border. That distance takes on new significance when a woman living in Rapid City needs an abortion.

The state's only abortion clinic is in Sioux Falls. In 2011, state lawmakers began requiring women to wait 72 hours between pre-abortion counseling and procedures. That means women who live in the state's western reaches must make four drives, totaling 24 hours, or be away from home for at least three days — weekends and holidays don't count toward the waiting period. Women pay for a hotel, miss school or work, find child care or bring kids. South Dakota doesn't have any doctors who do abortions; physicians fly in from surrounding states. With limited scheduling, the Sioux Falls Planned Parenthood is often booked weeks in advance.

In Rapid City one Thursday last summer, a 26-year-old bartender and student I'll call Nicole — her middle name — had a positive pregnancy test. Usually even-keeled, almost unflappable, Nicole says that afternoon, "I was just bawling." But as soon as she "got over the initial shock," she knew she wanted an abortion. She was committed to finishing school, and her boyfriend had recently moved to another state.

Nicole drove to a childhood friend's apartment, where they began making phone calls. She knew her best option was the Sioux Falls clinic — the next-closest option was 400 miles away, in Colorado. It didn't have an appointment for three weeks. Nicole wasn't sure she could wait that long; she wanted to use the abortion pill, which can't be taken after nine weeks of pregnancy. She knew an ultrasound would reveal exactly how far along she was, but she got conflicting information on whether her insurance would cover it. Later that night, her friend sent her an instant message with a link to the website for a nearby Care Net center that advertised free ultrasounds alongside information on "emergency contraception" and "abortion education."

"Just to let you know, they're probably going to be pro-life," her friend typed.

The next morning, Nicole called Care Net. "I didn't have anywhere else to go," she explains. On Tuesday, Nicole drove alone down Main Street, to a one-story office in a shopping center with a credit union and a KFC.

Inside, a receptionist behind a counter instructed Nicole to provide a urine sample in the bathroom. Then a nurse and a younger woman, about Nicole's age, brought her to a small room with a couch. For 45 minutes, they showed her Bible verses and pamphlets on adoption and an embryo's development. Nicole says, "The nurse really, really slowed down during the fetal pain part. She said, 'Here are the fingertips. The baby feels everything you're feeling.'" They told Nicole having an abortion might complicate future pregnancies and cause suicidal thoughts — both common myths. This is B.S., Nicole kept thinking, but you're trying to make me think it's true.

During the ultrasound, the nurse said the images weren't clear and she needed to do a transvaginal scan. "She didn't explain anything or say, 'We're going to stick this cone inside you,'" Nicole says, agitated. The nurse displayed the embryo on a scren, pointed to its features, and printed the images. The younger women prayed over Nicole and asked to be invited to her baby shower. The next week, ultrasound results in hand, Nicole drove more than six hours, following a two-lane highway across Wyoming and staying overnight in a hotel, to reach an abortion provider in Denver.

Stacey Wollman, CEO of the Care Net center in Rapid City, says all clients are informed that the center is a faith-based Christian ministry and can opt out of discussing faith, being prayed over, or receiving follow-up calls. She disputes that the staff would ever point out fingertips while explaining fetal development, discuss a baby feeling the sensations the mom feels, or ask to be invited to a shower.

Nicole says the nurse from Care Net called her every day for two weeks. Then once a month, she called from a restricted number and left messages saying, "I just want to chitchat." Annoyed, Nicole never answered or complained. The calls kept coming all the way until February — around when she would have delivered.

Every year, thousands of women like Nicole seek help at what appear to be secular medical clinics but are actually Christian anti-abortion centers. Throughout the United States, there are at least 3,000 crisis pregnancy centers, many of which belong to two religious anti-abortion organizations — Care Net and Heartbeat International. Some women arrive at those centers in search of Christian counseling or free diapers, but the vast majority are looking for professional advice to help them navigate unplanned pregnancies.

Increasingly, pregnancy centers are what's available. Around the country, access to abortion has eroded dramatically. As abortion regulations shutter medical clinics offering the full range of options, a woman facing an unplanned pregnancy finds herself in a very different landscape, one in which a pregnancy center is her most visible, most affordable — and sometimes the only — place to turn.

This isn't happening only in red states. Nationwide, anti-abortion centers now outnumber abortion clinics 3 to 1. They're in all kinds of towns, from Beverly Hills, California, to Shreveport, Louisiana. You've seen their ads on highway billboards and online: "Pregnant? Scared? We offer confidential counseling." Search Google Maps for abortion help in almost any town and you'll find local centers with pro-choice-seeming names and websites that say, "Need someone to talk to about your options? Contact us," or, "We inform. You decide."

Centers increasingly look just like doctor's offices with ultrasound rooms and staff in scrubs. Yet they do not provide or refer for contraception or abortion. Many pregnancy-center counselors, even those who provide medical information, are not licensed. And even some workers who are licensed, such as nurses and ultrasound technicians, repeat myths about abortion and contraception. Last year, I attended Heartbeat International's annual conference, where nurses told me that birth control "introduces too many chemicals into your body" and that women "never recover" emotionally from abortion.

The anti-abortion movement regularly presents pregnancy centers as a scattering of kindly women working with shoestring budgets. In the press or on websites, center directors use language about being small, humble grassroots organizations, without explaining national affiliations. Pro-life strategy documents reveal how, historically, the pregnancy-center movement "purposely remained underground, avoiding the limelight and the controversy of the pro-life political activism."

Many pregnancy centers are, in fact, run by religious women who want to help. But they also are an arm of a sophisticated political movement. A yearlong investigation of crisis pregnancy centers — including dozens of interviews with center staff and volunteers, anti-abortion and reproductive-rights advocates, lobbyists, elected officials, and women who have visited centers across the country — reveals that behind the scenes, an orchestrated network of donors, lawyers, lobbyists, and state representatives supports the individual centers. The national organizations Care Net and Heartbeat International train thousands of center staff to attract and dissuade "abortion-minded women." Online for Life, a deep-pocketed tech nonprofit funded by Texas billionaire Farris Wilks, helps pregnancy centers market themselves to "abortion-determined women" searching online for abortion-related terms, according to an Inside Philanthropy report.

At the Heartbeat conference, pregnancy-center staff referred to centers as "ministries" and discussed their underlying goal — shepherding spiritually "broken" women toward Christ. The majority of pregnancy-center staff I've met are Evangelical Christians who say they're dedicated to helping women escape a cycle of premarital sex and spiritual pain. Yet at the conference, Heartbeat speakers coached center staff to scrub their websites of Christian references. Speakers also recommended pregnancy-center staff to discourage women and girls from not only abortion but also contraception by emphasizing disproven "negative consequences" and encouraging "sexual integrity," meaning sex only within heterosexual marriage.

All of this is supported by tens of millions of federal and state dollars. At least 11 states now directly fund pregnancy centers, according to state contracts and contractor websites. Many states refer low-income pregnant women to anti-abortion centers on health department websites, as well as in "informed consent" materials that abortion providers distribute to patients.

Few states, however, have any laws regulating how pregnancy centers interact with women. Unlike other mental-health providers, center counselors are generally not bound by professional standards or malpractice laws. In many cases, the anti-abortion organizations that run the centers — not state employees — monitor their own work.

South Dakota has gone the farthest. As part of its 2011 legislation, the state required all women seeking an abortion to first visit one of two state-approved anti-abortion centers. One is the Care Net in Rapid City — the center that Nicole visited. The other is the Alpha Center in Sioux Falls, run by a longtime anti-contraception and anti-abortion activist. A district court has put the law on hold and is deciding whether the state has the right to force women to visit anti-abortion centers. As the judge evaluates the arguments, women across the state — and country — walk into pregnancy centers in search of free medical services. Some, like Nicole, are savvy about the centers' true goals. They also know they have no better option.

"Empowering women for life."

In Philadelphia, Cathedral Basilica of Saints Peter and Paul, a huge pillared brownstone with a green copper dome, was built without first-floor windows — its 19th-century architects feared Protestant passersby would break the glass. As the decades passed and Catholic immigrants flocked to Pennsylvania, however, the Church would grow to wield significant political power in the state.

Much of the public debate about abortion as we now recognize it began in Pennsylvania in the 1960s, when the Catholic Church lobbied hard to malign contraception and abortion. In her book, Before Roe, political historian Rosemary Nossiff describes how a lawyer for the Pennsylvania Catholic Conference, William Ball, pushed against the state's plan to counsel low-income couples on contraception by running full-page ads in 50 newspapers and testifying before legislators. On Sundays, priests sermonized against politicians who veered from the Church's positions. Former Representative Stephen Freind told me that Pennsylvania legislators and Church lawyers worked side-by-side to draft the nation's strictest abortion laws, with hopes of overturning Roe v. Wade.

In 1989, Planned Parenthood sued the state — represented by its governor, Bob Casey, an anti-abortion Democrat — arguing its restrictions violated women's constitutional right to abortion. It's well-known that the anti-abortion movement won its power when Planned Parenthood v. Casey reached the Supreme Court three years later. The court said states could write abortion laws as long as the restrictions don't put an "undue burden" on a woman seeking an abortion — a decision that opened the gates for laws now sweeping the country. Fewer people know that the same anti-abortion campaigners behind Casey also lobbied for tax dollars for crisis pregnancy centers, paving the way for their current spread.

In the early 1990s, Pennsylvania set aside $1 million for privately run anti-abortion centers. The state eventually tapped a nonprofit, Real Alternatives, and a lawyer, Kevin Bagatta, to run it. Before becoming president and CEO of Real Alternatives, Bagatta clerked for William Ball, the lawyer who in 1965 led the charge against the state's plan to counsel poor women on contraception, at Ball, Skelly, Murren and Connell. That's the same firm that represented the Pennsylvania Catholic Conference and sent lawyers to help legislators write abortion restrictions. Pennsylvania now pays Bagatta $223,075 per year.

Real Alternatives' slogan is "Empowering women for life." The organization holds itself out as a safety net for women so they don't "choose abortion out of a sense of helplessness, hopelessness, or being completely alone."

Between 2012 and 2017, Pennsylvania will give Real Alternatives more than $30 million in state and federal funding to support 98 sites, including pregnancy centers, social service agencies, maternity residences, and three adoption agencies. Real Alternatives reimburses centers for services they provide women (similar to how insurance companies reimburse doctors). Real Alternatives says its sites give pregnant women comprehensive support if they want to parent. And I spoke with women who arrived at centers happily pregnant and appreciated staff's parenting advice and gifts.

But a close look at Pennsylvania's pregnancy center program shows the government money is not going toward the things expectant women need: accurate health information, medical care, and long-term support in raising children. According to Real Alternatives' contract with the state, it reimburses a center just $2 each time a woman receives food, clothing, or furniture — a maximum of four times. That's a $24 cap for an individual pregnant woman's material needs. Centers may dispense more through donations. Still, the government program gives them the incentive to spend more time providing ideologically driven counseling, which is reimbursed at more than $1per minute, than they spend providing direct services.

In order for a woman to receive any material support, the program requires that she receive at least 20 minutes of counseling from staff, usually after taking a pregnancy test. Real Alternatives' contract with the state relies on debunked studies that imply abortion leads to breast cancer and clinical depression. Centers are not allowed to advocate for birth control, much less dispense it. The contract's directives advise pregnancy-center staff to make an "assessment of the client's spiritual needs" by asking questions like, "How does your faith impact the choices you make?" (One quarterly report from a center to Real Alternatives refers to clients with the aliases "Mary" and "Joseph.")

Some Real Alternatives centers market themselves as secular medical clinics, following the strategies Care Net and Heartbeat outline in their training. On its website, Morning Star Pregnancy Services, for example, offers "ultrasound before abortion" at its three locations in the Harrisburg area. Morning Star and about two dozen other Real Alternatives centers turned down my requests to visit. Kevin Bagatta and his staff declined multiple calls over several months. Real Alternatives is helping spread tax-funded anti-abortion centers throughout the country. The organization advised Florida, Minnesota, Nebraska, and North Dakota in establishing state-financed anti-abortion centers, and it helped establish Texas's multimillion-dollar program, which runs on the same model. In 2014, Real Alternatives won a no-bid contract to operate Michigan's burgeoning program.

"They know it's a baby."

Last spring, I drove across Arkansas and saw ads promising free pregnancy tests in empty downtowns and busy strip malls. Roadside crosses marked the miles, and I visited one center near a cluster of wooden shanties. Arkansas and Mississippi, two of the country's poorest states, each have more than 40 pregnancy centers and only one surgical abortion provider. Walmart's cheapest pregnancy test costs about $9 — the same amount as its cashiers' hourly wage — so it's not hard to imagine why a working woman might pull over for a free test.

In a corporate park in Little Rock, Arkansas, Pregnancy Resource Center shares a secluded cul-de-sac with the state's only surgical abortion provider. A few years ago, when a doctor who performs abortions moved across town to join the clinic's staff, the anti-abortion center followed. One Saturday, I watched about 30 protestors — mostly white men in T-shirts and shorts — stand on the lawn of the crisis pregnancy center screaming, "You're killing your baby!"

Every weekend, protestors block the clinic's driveway, and on some weekends, the police are called, clinic workers and escorts told me. The pregnancy center allows the protestors to stay, and protestors sometimes redirect women into the center. A physician at the clinic told me that patients periodically arrive for their abortion appointments late, after mistakenly first going to the pregnancy center across the cul-de-sac. That Saturday, women entering the clinic looked over their shoulders, then at the ground, some with tears in their eyes.

About 30 miles north of Little Rock, a billboard displayed between exits ("Pregnant? Need options?") advertised A Woman's Place, a pregnancy center in the small town of Cabot that has since been renamed Options Pregnancy Center. Cabot feels neither down-and-out nor especially fancy: Tidy homes and churches fade into a strip of chain stores like Kmart and Popeyes. Down the road, Options Pregnancy Center occupies a brick building beside a salon. Its website and ad in the high school paper offer "options counseling." It has an ultrasound machine. The needlepoint sampler in its bathroom says, "You will live with the guilt for the rest of your life knowing you made the choice to kill the precious life God placed in your womb for you to love."

I first met Options Pregnancy Center's director, Vikki Parker, at the 2014 Heartbeat conference. In Cabot, Parker and I sit in a meeting room in the center, describing how she started it after her daughter became pregnant at 15. "I did my very best as a Christian mom, trying to raise her right, but [unplanned pregnancy] came knocking at my door. When it did, I was devastated," she tells me. When her grandson was 8 months old, she went to her pastor and said she'd heard about crisis pregnancy centers and wanted to start one. "I didn't know she was sexually active ... I was thinking these kids have got to have a safe haven where they're not going to be judged."

I see why a girl who's afraid to talk to her mother about sex might confide in Parker, who exudes warmth and concern. Parker says she doesn't have to talk girls into continuing their pregnancy, explaining, "They know it's a baby. They know the part they played in it when they had sex." Options Pregnancy Center doesn't provide or refer for contraception because Parker believes the Bible forbids premarital sex and she doesn't think condoms are effective. She says she does not believe public schools should teach students how to access birth control. (Still, when I ask her whether the young women who arrive at the center generally use contraception, she tells me, "Honestly, I don't know why they don't. I mean, it's so readily available. It's not like they can't get it.")

In 2013, the U.S. Department of Health and Human Services awarded the center a federal grant of $352,125 to teach abstinence education in public schools. Over the years, government funding for abstinence programs has aided the mushrooming of pregnancy centers. Despite proposals by the Obama administration to reduce funding, Congress has continued and even increased it in recent years, explains Monica Rodriguez, president of the nonprofit Sexuality Information and Education Council of the United States. This spring, Congress has already set aside $75 million for the latest abstinence-only-until marriage program — an increase of 50 percent. The House budget proposed in June would double the program that funds Options Pregnancy Center, while eliminating all funding for health centers that provide birth control.

Options Pregnancy Center hired pastors to lead its public school lessons. I spoke with two of those pastors and read their curriculum, which only discusses contraceptives in terms of failure rates and emphasizes the "negative emotional consequences" of premarital sex. One of the pastors, Daniel Tyler, told me he teaches the idea that "if you start having sex, you can't grow emotionally." He adds, "The stuff we're saying is stereotypical, like guys thinking about sex all the time ... We teach that even the way a girl dresses can draw a guy to think about [sex]. There's a whole chapter on that."

The year Options Pregnancy Center won its federal grant, Arkansas had one of the nation's highest teen birth rates. And those pregnancies "disproportionately impact teen girls" because they "end up doing an overwhelming majority of the child rearing," according to a 2014 report by Kristen Jozkowski, Ph.D., assistant professor of community health at the University of Arkansas. Less than 2 percent of teen mothers will graduate college by the age of 30. Yet the federal government invests in programs that specifically forbid teaching teens how to use protection and contraception in the very communities with the highest rates of STIs and pregnancy.

"Don't you love your daughter?"

It was just before Christmas in 2009 when Arcadia Smith found herself at a Heartbeat and Care Net affiliate near her home in Mississippi. Smith was about a month pregnant. After years of struggling as a single parent, she had finally landed a managerial job at a doctor's office. She didn't want to end up homeless again or become too busy to help her 7-year-old daughter with homework.

Smith is not against all abortions but didn't want one for herself. She decided to place her baby for adoption, she says, to "give the baby to someone who wanted to cherish every moment — the first crawl, the first words."

At the center, Smith and her boyfriend met with a counselor from a third-party adoption agency that works with pregnancy centers. In the small house, Smith could hear other couples' conversations through the walls. "I poured my heart out," she said.

She remembers the counselor asking, "Don't you love your daughter? Don't you want to do for this one what you do for your first?"

"It's not that I don't like this baby — I'm just afraid for the baby," Smith recalls saying.

Smith says the counselor asked her boyfriend if he was willing coparent. When he said he was, the counselor insisted they had no reason to consider adoption. "It shocked me," Smith says. "I was thinking, But adoption is what you do."

Smith questioned her boyfriend, saying he might not stick around, regardless of whether they shared a child. But the counselor insisted. "It seems like he wants to be there," she said, and Smith could always raise the child without him. "I'm a single mother myself. I know how it is," Smith remembers the counselor saying.

At the Heartbeat conference I attended, a workshop leader instructed pregnancy-center staff to offer their personal stories of hardship to encourage clients to follow their advice. Many pregnancy-center workers have told me their goal is for every woman to mother.

"I don't know what 'single mother' means to her," Smith told me later. "Maybe to her it means divorced with alimony, with grandparents around, but to me, being a single parent means doing everything. My mother passed away when I was 8. I don't have a safety net. People don't understand that to really invest in a child and be there to provide stability, I have to sacrifice every single thing."

With the adoption counselor and her boyfriend in agreement, Smith was outnumbered. "The counselor looked at me like there was something wrong with me. I was already putting the blame on myself for getting pregnant. There's so much emphasis on being a good mom. I felt like less of awoman. Maybe I was selfish, a bad person who should be ashamed of myself."

When I called representatives for both the pregnancy center and the adoption agency to discuss Smith's story, they each said their organization is a strong advocate for adoption and would never discourage a couple from making that choice. Smith never made adoption plans. And she didn't tell anyone else about her ambivalence toward her pregnancy. "I thought, If that's how an adoption counselor reacted, imagine what someone else would say about me not wanting a baby." She gave birth to a girl in the spring of 2010. Six months later, she and her boyfriend broke up. She "became numb" and "overwhelmed" with postpartum depression. After missing work, she lost her job. "Everything snowballed," she says. She sometimes looked at her baby daughter and thought, It would be easier if she weren't here. "It wasn't that I didn't love my baby," she says. "I just hated the situation."

Months later, she called the center. "Look, where are you when I don't have a job, I don't have a car?" she recalls asking. The woman who answered the phone was apologetic. She gave her the number for a counselor at a church who helped her access other services.

Smith is now a single parent of two. "People judge single mothers every step of the way," she says. "But how would they judge me if I exercised my other options, my rights? I could've had an abortion, given my daughter up for adoption, left her at a hospital." Whatever decision she made, Smith figures, the reaction would be the same. "I'd wear a label for the rest of my life."

This article was reported in a partnership with The Investigative Fund at The Nation Institute, a nonprofit journalism center supported by the Ford Foundation and the MacArthur Foundation, among others.

This was originally published as "Pregnant? Scared? Need Options? Too Bad" in the August 2015 issue of Cosmopolitan. Pick up the issue on newsstands July 14 or click here to subscribe to the digital edition.

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