WACO, Texas With free pregnancy tests and ultrasounds, along with diapers, parenting classes and even temporary housing, pregnancy centers are playing an increasingly influential role in the anti-abortion movement.
While most attention has focused on scores of new state laws restricting abortion, the centers have been growing in numbers and gaining state financing and support.
Largely run by conservative Christians, the centers say they offer what Roland Warren, head of Care Net, one of the largest pregnancy center organizations, described as "a compassionate approach to this issue."
As they expand, they are adding on-call or on-site medical personnel and using sophisticated strategies to attract women, including Internet search optimization and mobile units near Planned Parenthood clinics.
"They're really the darlings of the pro-life movement," said Jeanneane Maxon, vice president for external affairs at Americans United for Life, an anti-abortion group.
"That ground level, one-on-one, reaching-the-woman-where-she's-at approach."
Pregnancy centers, while not new, number about 2,500, compared with about 1,800 abortion providers. Maxon estimated that the centers see about 1 million clients annually, with another million attending abstinence and other programs.
Abortion rights advocates have long called some of the pregnancy centers' approaches deceptive or manipulative. Medical and other experts say some dispense scientifically flawed information, exaggerating abortion's risks.
Jean Schroedel, a Claremont Graduate University politics professor, said that "there are some positive aspects" to centers but "things pregnant women are told at many of these centers, some of it is really factually suspect."
The centers defend their practices and information.
"Women who come in are constantly telling us, 'Abortion seems to be my only alternative, and I think that's the best thing to do,' " said Peggy Hartshorn, president of Heartbeat International, which she described as a "Christ-centered" organization with 1,100 affiliates. "Centers provide women with the whole choice."
One pregnant woman, Nasya Dotie, 21, single, worried about finishing college and disappointing her parents, said she was "almost positive I was going to have an abortion."
A friend at her Christian university suggested visiting Care Net of Central Texas. She met with a counselor, went home and considered her options. She returned for an ultrasound, and although planning not to look at the screen, when a clinician offered, she agreed. Then, "I was like, 'That's my baby. I can't not have him.' "
Thirteen states provide some direct financing; 27 offer "Choose Life" license plates, the proceeds from which aid centers.
In 2011, Texas increased financing for the centers while cutting family-planning money by two-thirds, and required abortion clinics to provide names of centers at least 24 hours before performing abortions.
In South Dakota, a 2011 law being challenged by Planned Parenthood requires pregnancy center visits before abortions.
Cities such as Austin, Baltimore and New York have tried regulating centers with ordinances requiring them to post signs stating that they do not provide abortions or contraceptives and disclosing whether medical professionals are on-site.
Except for San Francisco's, the laws were blocked by courts or softened after centers sued, claiming free-speech violations. Similar bills in five states floundered.
Most legal challenges to "Choose Life" license plates failed, although a North Carolina court said alternate views must be offered.
Some centers use controversial materials stating that abortion may increase the risk of breast cancer. A brochure issued by Care Net's national organization, for example, says: "A number of reliable studies have concluded that there is an association between abortion and later development of breast cancer."
Dr. Otis Brawley, the American Cancer Society's chief medical officer, who calls himself a "pro-life Catholic," said studies showing abortion-breast cancer links are "very weak," while strong studies find no correlation.
Other claims include long-term psychological effects.
The Care Net brochure says that "many women experience initial relief," but that "women should be informed that abortion significantly increases risk for" clinical depression, suicidal thoughts and behavior, post-traumatic stress disorder and other problems.
An American Psychological Association report found no increased risk from one abortion.
With largely volunteer staffs and donations from mostly Christian sources, centers usually offer free tests and ultrasounds, services that clinics such as Planned Parenthood charge for. They offer advice about baby-rearing or adoption, ask if women are being pressured to abort, and give technical descriptions of abortion and fetal development.
Many offer prayer and Bible study.
Warren, who described Care Net as a "Christian faith-based organization" with 1,100 affiliates, likened the centers' new strategies to his experience working at Pepsi.
"The end result was to put liquid into someone's stomach; we talked about it as 'share of stomach,' " he said. "The work that centers are doing, it really is a lot around 'share of mind.' "
Internet search optimization services are hired to float centers' names up when people search for abortion. Some no longer call themselves "crisis pregnancy centers," believing "crisis" makes women feel victimized. Many locate near abortion clinics.
"Watch CVS, where do they go? They go where Walgreens is," said Bridget Van Means, president of Thrive St. Louis, which parks a van across from Planned Parenthood.
Tova Tenenbaum, 24, entered Thrive's van for pregnancy and sexually transmitted disease tests, thinking it was Planned Parenthood until a form asked "what my relationship was with Jesus," she said.
She stayed for test results (negative) and to be polite, "but I had the feeling I'd been duped," she said, adding that a counselor promoted abstinence with misinformation like 'condoms have holes in them.' "
Thrive and other centers say they provide accurate information.
Waco's Care Net posts signs listing phone numbers but no name across from Planned Parenthood: "Pregnant? Considering abortion? Free services."
Another strategy, said Deborah McGregor, Waco Care Net's chief executive, is keeping distance from brasher anti-abortion groups, such as Pro-Life Waco, whose van outside Planned Parenthood reads: "Abortion. One heart stops. Another heart breaks."
She said that 94 percent of women receiving ultrasounds decide against abortion.
"It goes from a baby to my baby," she said. "If they are abortion-minded or abortion-vulnerable, we automatically offer ultrasound."
Her center's checklists consider a woman "abortion-minded" if she "has an abortion scheduled regardless of how tentative she seems" or asks questions like "'How much does an abortion cost?'" An "abortion-vulnerable" woman, "by continuing her pregnancy, faces obstacles that she may feel incapable of handling or unwilling to experience."
Pregnancy centers are not women's health clinics. Medical services at Waco's Care Net are pregnancy tests and ultrasounds, given to 2,500 women in 2011.
That year, Waco's Planned Parenthood performed 15,575 Pap smears, breast exams and other services, and in a wing required to be separate 445 surgical and 414 medication abortions.