On the door of a white R.V. that serves as the Wabash Valley Crisis Pregnancy Center’s mobile unit are the stencilled words “No Cash, No Narcotics.” The center, in Terre Haute, Indiana, is one of more than twenty-five hundred such C.P.C.s in the U.S.—Christian organizations that provide services including free pregnancy testing, low-cost S.T.D. testing, parenting classes, and ultrasounds. Sharon Carey, the executive director of the Wabash Valley center, acquired the van in January, 2018, for a hundred and fifty thousand dollars, after finding a company that retrofits secondhand vehicles with medical equipment. That May, Carey began to dispatch the van to rural towns whose residents often cannot afford the gas needed to drive to the C.P.C. or to a hospital. Carey has selected parking spots in areas with high foot traffic, so that prospective clients can drop in to learn about the C.P.C.’s services. In Montezuma, she chose the lot outside a Dollar General. In Rockville, she discovered an I.G.A. supermarket frequented by the local Amish community; the van parks next to the hitching post where Amish shoppers tether their buggy horses. Driving straight up to the Amish farms would have been the wrong approach, Carey felt. The community is insular, and was unlikely to welcome outsiders offering their teen-agers free pregnancy tests or screening for chlamydia and gonorrhea.

In Brazil, which is one of the poorest cities in Indiana, Carey chose the parking lot of the Church of the Nazarene, across from a Circle K convenience store and not far from House of Hope, a Christian drug-rehabilitation center whose residents rely on the van for S.T.D. testing. On a recent Wednesday morning, Libby Butts, the manager of client services for the mobile unit, who wears her hair in a long braid, and Mary Hargis, a sonographer, came aboard. Hargis, who is fifty-six, had on a pink lab coat over a T-shirt featuring an image of a sewing machine and the words “Quilting in My Veins, Jesus in My Heart.” She opened a silver wheelie bag containing a new ultrasound machine, and disappeared into the van’s makeshift examining room, which contained a sink, a table with stirrups, and a large TV screen on which the ultrasounds would be shown.

Hargis began volunteering at the C.P.C. in 2005. “I think, if women are fully informed, most would choose life for their child,” she told me as she assembled the machine. “Maybe I’m naïve, but from what I’ve read, and hopefully accurately, I’m not sure they’re always informed.” On the wall was a rack of pamphlets with titles such as “Before She Decides” and “Intentional Abstinence for Singles.” Like much of the literature dispensed by C.P.C.s, the brochures presented carefully selected facts in order to make a case against abortion (“A small number of women have died from infection”) and contraception (“You can be infected with any S.T.D. even when using condoms 100% of the time”).

The C.P.C. movement took off in the late sixties, as states considered repealing laws criminalizing abortion. Robert Pearson, a Catholic carpenter, founded one of the first centers, in Honolulu, and then set up a foundation for C.P.C. owners, providing them with training sessions, pamphlets, and slide shows, many of which featured gory images of fetal remains. C.P.C.s employed various deceptive techniques to attract women, often advertising themselves as abortion providers. Centers were sometimes established next to abortion clinics and were designed to resemble them. Until the seventies, abortion had mostly been a Catholic issue, but following Roe v. Wade, in 1973, evangelical Christians began to join the pro-life movement. In 1978, the Southern Baptist pastor Jerry Falwell partnered with the conservative activist Paul Weyrich in an effort to register and organize religious voters, and they seized on the issue of abortion as a mobilizing cause.

In the eighties, some pro-life activism became associated with violence, when groups such as Operation Rescue staged sit-ins at abortion clinics and incited attacks against abortion providers. Several doctors were assassinated. C.P.C.s, under increasing scrutiny, were hit with a wave of lawsuits. Following a congressional investigation in 1991 that condemned C.P.C.s for committing consumer fraud and for publishing misleading advertising, the national anti-abortion organizations Heartbeat International and Care Net standardized C.P.C.s’ training and materials, attempting to transform them into institutions that offered advice and support. In 1991, the Wabash Valley center was among the first C.P.C.s to hire part-time medical providers and to purchase ultrasound equipment. Like many other centers, Wabash Valley also began to run abstinence-only education programs in public schools. In 1996, President Bill Clinton’s welfare-reform act allocated fifty million dollars a year to abstinence-training programs, giving C.P.C.s an infusion of federal funding. In 2003, President George W. Bush increased that funding by thirty-three million dollars. In 2009 and 2010, the Wabash Valley C.P.C. received twenty-six thousand five hundred dollars to teach abstinence to public-school students in surrounding Vigo County.

These days, as few as four per cent of the women who visit C.P.C.s are pregnant and undecided about whether to have an abortion. Most come for social services, including the pregnancy verification required to sign up for maternal and infant Medicaid. In the past decade, C.P.C.s, which are at the forefront of the grassroots anti-abortion movement, have identified a new sense of mission and authority as rural health-care providers have struggled with a lack of funding. (In the U.S., more than a hundred rural hospitals have closed in the past decade.) This dynamic was particularly evident in Indiana under the governorship of Mike Pence, who grew up as a Catholic and became an evangelical Christian as an adult, and has praised C.P.C.s for “telling the truth about the cause of life.” In 2007, as a member of Congress, Pence sponsored the first federal bill to defund Planned Parenthood, which did not pass. In 2014, the year after Pence became governor, he signed a bill prohibiting private insurance plans from covering abortions in most cases. In 2015, he launched an investigation of Planned Parenthood’s fetal-tissue-disposal practices. (The investigation found no wrongdoing.)

That year, Pence gave $3.5 million to Real Alternatives, a Pennsylvania-based anti-abortion organization that supports C.P.C.s. The funding was diverted from Temporary Assistance for Needy Families, a state-run federal program intended to clothe and feed children and to create initiatives that help prevent “non-marital childbearing.” Indiana has some of the lowest payouts to TANF recipients in the country. The Real Alternatives contract stipulated that the organization and its subcontractors must “actively promote childbirth” and must not refer clients to abortion providers or promote contraceptives. To date, the state has allocated $11.25 million to Real Alternatives. In early 2016, Pence signed into law an array of bills that restrict abortion, including one measure, which was recently upheld by the Supreme Court, requiring that fetal remains be buried or cremated.

As Vice-President, Pence has attempted to reshape the country’s reproductive-health-care policies according to his religious ideology. He staffed the Department of Health and Human Services with several people he knew from his time in Indiana, including Alex Azar, a pharmaceutical executive and lobbyist in Indianapolis; Jerome Adams, a former Indiana health commissioner; and Seema Verma, who worked on the redesign of Indiana’s Medicaid program. In July, 2017, H.H.S. said that it would terminate the contracts of eighty-one organizations receiving pregnancy-prevention grants, and issued new rules that favored groups promoting abstinence-training programs. The National Campaign to Prevent Teen and Unplanned Pregnancy had found in 2002 that abstinence-only programs led to “no significant changes in participants’ initiation of intercourse, frequency of intercourse, or number of sexual partners.” The Trump Administration also announced that it would ban organizations that provide abortion referrals from receiving funds from the Title X Family Planning Program, a federal grant that offers services including contraception counselling. As a result, Planned Parenthood withdrew from Title X funding, which it had used to provide more than 1.5 million women with services such as pregnancy testing and birth control. In March, H.H.S. designated $5.1 million of Title X money for the Obria Group, a largely Catholic organization that subsidizes C.P.C.s in Southern California.

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In response to C.P.C.s’ growing influence, the national campaign #ExposeFakeClinics invited visitors to its Web site to review C.P.C.s online, to report false advertising, and to “take it to the streets.” Last year, the advocacy organization NARAL Pro-Choice America conducted an undercover investigation of forty-five crisis pregnancy centers in California, finding that C.P.C. employees very often presented misleading information, claiming that “having an abortion was linked to an increased risk of breast cancer, infertility, miscarriage, and/or the made-up ‘post-abortion depression’ that results in suicide.” Amy Bryant, a gynecologist at the University of North Carolina School of Medicine who has written about the medical ethics of C.P.C.s, told me that the centers, which are ideologically driven, violate the Hippocratic oath. “They do not have the well-being of the woman seeking care from them as their primary interest,” she said.