The first nonmedical service advertised on the website of Informed Choices, an Iowa City crisis pregnancy center, or CPC, is  a pre-abortion screening.

“Get a pre-termination evaluation and discuss your options in a supportive environment with registered nurses,” the page reads.

Once clicking on the link, visitors are greeted with information about abortion risks and ultrasounds. At the very bottom of the page, however, in a drop-down Frequently Asked Questions menu labeled “Do You Make Referrals Or Offer Abortions” reveals a significant detail: “Informed Choices does not offer or refer for pregnancy terminations or birth control. Information and services are provided only as an educational service.”

Matthew Fanning, Informed Choices’ executive director, said this reality is often a surprise to women visiting the clinic.

“We’ve had gals that come in, and they thought that it was an abortion clinic, and then they’re like, ‘Wait, you don’t do abortions,’ but we do still want that opportunity to talk with her, help her make that right decision,” Fanning said.

Informed Choices is a CPC. CPCs are generally known to help encourage mothers to carry pregnancies to term.

CPCs, however, long predate the state’s financial endorsement.

Thirty years ago, Iowa City resident Kymberly Koester sought to terminate an unwanted pregnancy in Eastern Illinois. In her search for an abortion clinic, she unknowingly stumbled upon a CPC, which was not Informed Choices, that tried to convince her to keep her baby.

“I knew right away that I did not want to be trying to have a baby as a young person,” Koester said.

CPCs are nonprofit organizations established by anti-abortion groups designed to dissuade individuals from terminating pregnancies, and they are on the rise in Iowa using tax dollars.

The centers have existed since the 1970s all over the country. Koester, as a 23-year-old, walked into one believing she could receive abortion care.

Although she was initially welcomed in — even after telling the front desk she was there for an abortion appointment — Koester quickly realized she was mistaken after seeing brochures on an adjacent table about adoption. A receptionist later called her name, taking her farther into the building.

Sitting in a room with more brochures and images, which Koester described as fully developed babies that died lining the walls, the reality of her situation dawned on her. She knew she wanted to leave.

She got up to leave the clinic but was stopped by the front desk, where staff members tried to convince her to stay.

Although Koester’s experience happened decades ago, CPCs remain widespread today. Some CPCs present as health care clinics but use medically misleading claims to discourage people from seeking abortions. And several are being funded by Iowa tax dollars.

Creating crisis for generations

Mazie Stilwell, director of public affairs for Planned Parenthood North Central States, said CPCs often attempt to look like a Planned Parenthood building or other recognized abortion care facilities.

In Iowa, there are two abortion providers: Planned Parenthood and the Emma Goldman Clinic. Combined, they have four brick-and-mortar locations. According to the Crisis Pregnancy Center Map website, there are 53 CPC locations across the state, up by more than 10 since reports in 2023. And some are being funded by tax dollars amounting to $1,101,225 over two years starting in 2024, according to the Iowa Department of Health and Human Services, or HHS.

In Iowa, the state-funded public program More Options for Maternal Support, or MOMs, has allocated more than $680,000 to four CPCs across Iowa in 2024, including Informed Choices.

The Iowa legislature allocated $204,638 to Informed Choices to be administered through HHS. According to the 2024 report by Iowa HHS, these funds are used for a variety of purposes, including:

• Targeted digital marketing to improve website visibility
• Localized search engine optimization to ensure clients find services in their county
• Printed brochures and flyers distributed throughout high-trafficked public areas
• Streaming, radio, and other online broadcast advertisements
• Social media
• Attending or hosting public events
• Presentations at public meetings

The MOMs bill was met with significant pushback from Democrats, including Iowa House Minority Leader Jennifer Konfrst, D-Windsor Heights, who said there is a fundamental issue with funding CPCs, as they are typically underregulated and often lack the necessary staff and accreditation to provide medical care.

“They act like medical clinics for pregnant women, but in reality, they have very few providers on staff,” Konfrst said. “They don’t necessarily know how to handle an ectopic pregnancy or other legitimate health issues. There was one [in Massachusetts] that missed a woman who was having an ectopic pregnancy, and she needed emergency surgery after they missed it.”

Konfrst referred to a 2023 lawsuit filed against the CPC Clearway Clinic in Worcester, Massachusetts. The complaint stated the women received an ultrasound from the clinic, but they failed to identify she had an ectopic pregnancy, which required emergency surgery a month later.

Despite Democrats’ opposition, the bill passed along party lines, with Republicans controlling the governor’s office and holding agenda-setting majorities in the Iowa House and Senate.

Over the past few years, funding CPCs has become a key piece in Republican efforts in the legislature, as Iowa remains one of the strictest states on abortion access in the country with women unable to get an abortion after fetal heart activity is detected, which often occurs before women know they are pregnant.

During discussions of funding for CPCs in 2024, Iowa Sen. Mark Costello, R-Mills, said putting funding into CPCs helps them expand their services but acknowledged their services and obligations are not synonymous with those of medical clinics.

“The purpose of the MOMs program is to provide support for non-medical services to promote childbirth,” Costello said. “The bill clearly states it is for non-medical services.”

Costello did not respond to multiple requests from The Daily Iowan for an updated comment.

Funded by Iowans

CPC oppositionists, however, point toward Iowa’s broader barriers to health care access and question the legitimacy of using tax-payer dollars to fund nonmedical organizations.

According to a 2023 report from PeriStats, an online source developed by March of Dimes, a national nonprofit that provides free access to perinatal, maternal, and infant health-related data, 33.3 percent of Iowa counties are classified as maternal care deserts. These areas lack any hospitals or birth centers providing obstetric care.

A 2023 study published in the Journal of the American Medical Association reported that Iowa’s maternal mortality rate has doubled in the past two decades.

Maternal health care deserts are growing across Iowa, and Konfrst said Republicans tout CPCs as a method of combatting these deserts, but she said there is an issue presenting nonmedical providers as the solution for Iowa’s systemic barriers to maternal health access.

“When we fund them at the state level, we are sending the message that we support and endorse what they’re doing, and we just can’t do that,” Konfrst said.

She also said funding CPCs sets a dangerous precedent because many are not bound by HIPAA laws, which ensure patient privacy.

Stilwell also had concerns surrounding patient confidentiality and said CPCs are not required to keep information private, which can lead bad actors to prey on women in vulnerable positions.

Additionally, many CPCs will advertise they are compliant with HIPAA, but there is currently no legislation nor board in charge of regulating these claims, meaning CPCs can choose to no longer follow HIPAA requirements at any point.

Konfrst said being voluntarily compliant with HIPAA means there are no laws that restrict CPCs from deciding not to follow the laws.

“There’s no protection there. There are no teeth to it,” Konfrst said.

This regulatory blind spot is exacerbated by a U.S. Supreme Court precedent designating CPCs as protected organizations under the First Amendment’s protection for freedom of religion and speech.

The case, National Institute of Family and Life Advocates v. Becerra, dealt with a California law requiring CPCs to disclose if they were an accredited clinic and provide abortion information on their website. The court ruled in 2018 that CPCs are not obligated to do this because of their First Amendment right to religion and free speech.

The decision explicitly affirmed CPCs’ right to omit any information on how to get an abortion.

Inside IC’s Informed Choices

According to Fanning, the executive director of Informed Choices, the CPC is accredited by the Accreditation Association for Ambulatory Health Care, or AAAHC. Of the 53 CPCs in Iowa, only two say they are certified for health care on its website: Informed Choices in Iowa City and Burlington.

AAAHC is based in Deerfield, Illinois, and it accredits clinics that specialize in outpatient care. According to its website, the AAAHC has accredited more than 6,800 organizations from a wide range of services, including:

• Ambulatory surgery centers
• Office-based surgery centers
• Endoscopy centers
• Student health centers
• Medical and dental group practices
• Community health centers
• Employer-based health clinics
• Retail clinics
• Indian and Tribal health centers

The AAAHC website makes no mention of accrediting CPCs.

Due to Informed Choices’ accreditation status, they are covered by HIPAA.

However, according to the National Association of Free and Charitable Clinics, even licensed health care providers are only subject to HIPAA if they electronically transmit protected health information through transactions such as billing health care providers or electronically billing individuals’ private bank accounts.

CPCs frequently provide free services, such as pregnancy tests, meaning they are not required to send billing information, potentially exempting them from certain HIPAA obligations.

In charge of these services at Informed Choices is Fanning, who spent 22 years in the military and was a devout pastor before becoming the executive director of the nonprofit. His desire to contribute quickly landed him a role in the organization, he said.

RELATED: OB-GYN students opt for residency programs in states without abortion bans

Despite having no past experience running a CPC, Fanning was tapped for the position.

“God’s got his way of working all these things out,” he said.

Informed Choices has two registered nurses at the location as well as radiology staff trained to perform ultrasounds, Fanning said. The location also provides counseling services for pregnant women and has donation services for things like diapers and car seats.

Fanning said most of the funding from the MOMs grant goes toward counseling services at Informed Choices, particularly pre-abortion consultation and counseling.

“They sit down with them. They go through all those choices with them and help them to make the choice that’s best for them,” Fanning said.

Most of Informed Choices’ funding comes from donations, which in some cases doubles funding from the state. According to the clinic’s filed 990 forms, Informed Choices brought in more than $440,000 in donations in 2023.

One of Informed Choices’ registered nurses, who declined to give their name but spoke with the DI, said they will walk women through a decision-making sheet to determine the pros and cons of carrying a pregnancy to term.

The nurse said education is vital for what they do because of the abundance of misinformation surrounding abortion. When asked what type of information they see the most, the nurse said much comes from misconceptions about when life starts.

“When they can see that heart beating, it’s more than cells,” she said. “The same baby that you see on the ultrasound with that heart beating at six weeks old is the same baby nine months later that you’re holding in your arms.”

The nurse said religious beliefs do not impact the care they administer.

“We are a faith-based organization, yeah, but we meet them where they’re at,” she said. “We see Buddhists, Muslims, atheists, and all the above. And we just meet them where they’re at, and we love them where they’re at.”

Racing to the right

Lina-Maria Murillo, author of “Fighting for Control: Power, Reproductive Care, and Race in the US-Mexico Borderlands,” and gender studies researcher at the University of Iowa, said one of her ongoing concerns is the people who are running CPCs.

“We’ve seen them grow very much so, and yes, we’ve seen other kinds of reproductive care shrink in Iowa in a very, very short time,” Murillo said.

Murillo said in some cases abortion abolitionists, or people who do not believe in abortion under any circumstance, including from rape or incest, are seeking and achieving leadership at CPCs.

“They are really extreme people. They will say things like, ‘A mother should give her life up for the infant or for her fetus,’” Murillo said.

Murillo cited Iowa House Rep. Brad Sherman, R-Williamsburg, as an example of someone in Iowa involved in CPCs who is against abortion. Sherman was one of the co-founders of Informed Choices in Iowa City and has introduced legislation that would criminalize women seeking abortions. He is also running for governor of Iowa in 2026.

House File 2256, proposed by Sherman and other Republican lawmakers in 2024, would have made a person who completes an abortion liable for murder. The bill was killed in committee, but it contributes to concerns Murillo said she has regarding the leadership of CPCs.

Sherman did not respond to multiple requests from the DI for comment.

Murillo said the growth of CPCs creates more chances for vulnerable women to be manipulated, just like Koester said she experienced 30 years ago.

Koester fears what CPCs could mean to Iowans looking for abortions, but she has found a community of activists since she came to Iowa City and encourages others to speak out against societal injustice.

“I know there’s a lot of fear, like fear out there that we would be targeted then because of standing up for each other, but if we all need to stand up for each other and for ourselves, [we have to],” Koester said. “Because if we are going to go out, we got to go out by making noise and standing up for each other.”