Savannah Marten is a pro-life activist who thinks like a missionary. When she became the director of the Pregnancy Center of Greater Toledo in 2016, she was frustrated by a suspicion that the community had no idea it existed. So she set up her office with trendy furniture and prints of hand-scripted Bible verses, then promptly left it.

“We can only show up and serve to the level that we understand the people that are walking through our doors,” Marten said. She took a roll of quarters to the local laundromat, started conversations with patrons, learned about the families in the neighborhood, and spread the word about the center.

She started church-hopping nearby. She networked with local organizations, connecting over shared concerns for Lucas County and offering to partner with them or serve on their boards. She worked with hospital systems to get the center direct scheduling access with more than a dozen ob-gyns, so pregnant clients could see obstetricians earlier in their pregnancies—a proven factor in combating infant mortality.

It’s been a few years, but Marten estimates she still spends about half of her working hours outside the center. Though she wasn’t new to pro-life advocacy or the pregnancy center movement when she took the director job, she was willing to listen to her community and try new strategies. That approach has been a crucial part of the center’s success—leading to a 22 percent jump in clients last year alone—and could be the key to making pregnancy centers more effective for a new generation.

The Pregnancy Center of Greater Toledo opened in 1984 as part of a wave of centers popping up all over the country in the decade or so following the Roe v. Wade Supreme Court decision. After the landmark abortion ruling, “We started getting attacked by the pro-choice side saying, ‘You don’t care about women,’ ” said Roland Warren, current CEO of CareNet, one of the largest pregnancy center networks in the US. In response to the pushback, pro-life Christians shifted from protests and reaction to ministries and action.

Pregnancy centers—sometimes referred to as “crisis pregnancy centers” or “pregnancy resource centers”—became a big part of that response. Their original mission was profound but uncomplicated: to save babies. Philosophies differed back in the ’80s, and they still do. Some centers front evangelism, while some keep their faith affiliations in the background. Some offer certain medical services, but most rely on a volunteer-led counseling model.

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Over the decades, these pregnancy centers—now numbering over 2,000 in the US, far more than abortion clinics—have served hundreds of thousands of women and babies despite outside scrutiny and legal challenges. Critics have accused them of being misleading (because they do not provide abortion referrals), coercive, or proselytizing. They’ve also borne the brunt of the criticism lobbied at the pro-life movement as a whole of having a singular focus on saving life in the womb rather than addressing the factors that lead to unplanned pregnancy in the first place.

The narrow focus was something that frustrated Angie Weszely and Denise Stein when they led a center in Chicago. The expectations resulted in too much baggage between the counselors and their clients. They saw well-meaning Christian volunteers stuck in the fog of their pro-life checklists: Is she going to keep the baby? Did we share the Four Spiritual Laws?

A wave of new leaders is realizing that some of the tried-and-true strategies for pregnancy centers—opening a gospel tract or printing a sonogram—might not be as effective as they or their predecessors assumed. As many directors in the founding generation retire, younger Christians have begun to test new methods to care for women and reduce the demand for abortion.

This shift could be partly out of necessity. Last year, a New Yorker investigation into rural pregnancy centers reported that as few as 4 percent of women who visited came for direction on whether to have their baby or abort. A majority, the magazine found, wanted social services and pregnancy testing, which are required to sign up for Medicaid.

Some centers are adapting their offerings, providing pregnancy testing, screenings for sexually transmitted diseases, and even contraceptives. Others are sticking to pregnancy counseling but are adjusting their language and setup to cater to a different clientele.

The landscape has challenged the pregnancy center movement to take a closer look at its mission, at whether to prioritize spiritual salvation or abortion prevention, and at the lengths to which it should go to achieve either. On the abortion end, many Christians are looking upstream at factors that can throw a pregnancy into crisis: poverty, social isolation, insufficient medical care, and the lack of a committed partner.

Weszely and Stein cofounded a ministry, ProGrace, to separate abortion from politics—particularly the pro-life and pro-choice labels—and equip churches to support women in crisis pregnancies before they make their way to a clinic. Other Christian organizations, inspired by their convictions around life and family, are stepping in with resources beyond what a pregnancy center could offer.

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Overall, the church’s response is becoming more strategic, holistic, and comprehensive—a community endeavor that extends far beyond a center itself.

Neighborhood Culture

In Toledo, it started with paint color.

When “a bunch of white, middle-aged women who don’t live in the neighborhoods” were making all the decisions, “it looked like Joanna Gaines had set up the center,” said Marten. “But what we were hearing from our clients was that it felt like a hospital.”

A stylish, fast-talking 30-something with a pixie cut and a wide smile, Marten wasn’t going to let culture clash keep the center from reaching women in need. She enlisted leaders from Toledo’s African American and Latina communities to serve on a cultural competency advisory committee.

Savannah Marten at the Pregnancy Center of Greater Toledo
Image: Eli Lindauer

Savannah Marten at the Pregnancy Center of Greater Toledo

Members agreed to a two-year term, during which they’d advise the center on everything from the decor to the paperwork. The advisers didn’t have to be Christian or even pro-life; they just had to understand that the center was both of those and be willing to help.

At their recommendation, the center now takes its design cues from the colorful murals in the neighborhood, and hardly two walls are the same color. The lobby is a peaceful forest green. One of the client rooms contains a giant, multicolored floral mural painted by students at Toledo School for the Arts. Others have neon modular furniture and inspirational prints on the walls (“You are an awesome woman!”).

The committee also advised the center to space out the chairs in its cozy lobby—women coming in who have lived in poverty often need to protect their personal space and could feel uneasy sitting so close to someone else. The center transitioned intake paperwork to mobile-friendly online forms and shifted the questions based on adviser feedback.

“We realized we were asking about the father of the baby before we were asking about rape and sexual abuse,” Marten said. The center’s intake paperwork now asks about abuse first. Marten said it helps counselors discern whether bringing up partner support or marriage is even appropriate or whether a counselor might instead encourage a woman to speak to police.

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The small changes are making a big difference. In 2019, the center saw a 22 percent jump in appointments, performed 200 additional ultrasounds, and increased attendance at parenting classes by 8 percent. A greater portion of its clientele came back for multiple visits, allowing the staff to foster deeper relationships—and providing more chances to show them the love of the gospel.

Over 500 women who came through the doors had a baby last year, and staff know of only 8 who went ahead with an abortion.

Marten is bringing what she has learned in Ohio to a national CareNet conference for the second time this year, urging fellow directors to consider adding their own cultural competency advisers.

Racial Biases in Health Care

Down in Dallas, Cessilye R. Smith began Abide Women’s Health Services with fellow women of color in mind. In an area south of downtown that some call South Dallas, some call Fair Park, and some, like Smith, call “the hood,” she has set out to extend the work of the pro-life pregnancy center movement by addressing infant and maternal mortality among women of color.

According to the Centers for Disease Control and Prevention, black babies in the US are nearly twice as likely to die before their first birthday as white babies, and African American and Native American women are nearly three times more likely to die than white mothers during pregnancy or after giving birth.

Combating racial biases in health care is Abide’s first priority, and Smith believes it needs to be a bigger part of the pregnancy center movement as a whole. She said when black women turn up at hospitals to deliver after not being able to see an obstetrician regularly throughout their pregnancies, doctors may make assumptions that affect their standard of care. For example, they may think that black moms aren’t as interested in nursing and not offer robust breastfeeding support, or that they suffer from addiction and reduce their pain meds.

Cessilye R. Smith at Abide Women’s Health Services in Dallas
Image: Brianna Davila / Courtesy of Cessilye R. Smith

Cessilye R. Smith at Abide Women’s Health Services in Dallas

Since Abide opened its doors in 2017, providing free childbirth classes, support groups for new moms, and breastfeeding education, 90 percent of its clients have been black or Hispanic. Most of the staff members are also women of color, and the 25 women who volunteered last year began with training in implicit bias and cultural humility and diversity.

Smith has shifted her own approach to pro-life activism. No longer does she repeat the statistics about black abortion rates. Instead, she points to the factors behind them and the racial disparities in care, advocating for maternal justice through Christian outlets like the And Campaign.

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“When the public eye sees the pro-life movement fighting to end abortion without looking at the root, then you will always get the side-eye from the black community,” she explained to Catholic theologian and ethicist Charles Camosy.

Abide’s goal is to open a free maternal health clinic next year, then eventually a birthing center designed for women of color. In the meantime, Smith—whose home birth inspired her to become a doula—offers scholarships covering books, classes, and even bills to black students who want to become licensed midwives. The involvement of midwives and doulas (non-medical labor assistants) correlates with better birth outcomes, but women of color are far less likely to access such support. Black and Hispanic women currently make up less than 5 percent of licensed midwives in the United States.

Care Past Nine Months

Tammy Abernathy also has a personal connection to the women she sets out to serve at Hope Women’s Center in Phoenix. After raising her own children as a single mom, she got involved in the ministry to offer better support to women in similar situations.

In 2013, she took the helm of a network of four regional centers as they moved away from the medical offerings emphasized by others in the movement (think ultrasound techs and doctor referrals) to provide a broader range of counseling support instead.

“Women were coming with so many other coexisting things they were dealing with,” Abernathy said.

Her team is trained in trauma-informed care and works with women and teen girls who are dealing with poverty, domestic abuse, and unintended pregnancy—often all at once. Hope’s broader scope means Abernathy sees a higher percentage of clients return for ongoing support than she did in her previous work at a more traditional pregnancy center, she said.

Tammy Abernathy at Hope Women’s Center in Phoenix
Image: Steve Craft

Tammy Abernathy at Hope Women’s Center in Phoenix

Hope is part of the ProGrace network, which focuses on long-term outreach, so that women have a place to go both during and after a pregnancy.

ProGrace founders Weszely and Stein partner eager churches with pregnancy centers. They are clear about their convictions: While the organization does not advocate for abortion, stating that “God’s design for pregnancy was to intertwine a woman and a child,” they believe that “for the church to be a safe place, Christians need a way to respond that is outside of the debate,” Weszely said.

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For churches, that means pastors must acknowledge that women within their congregations are intimately familiar with abortion—it’s not just something that happens “outside” the church—and that Christians who oppose abortion not look to politics as the only fix. For centers affiliated with ProGrace, that means no “pro-life” or “pro-choice” talk, no marches, no endorsing candidates. For Abernathy, the ProGrace paradigm allows her to focus on the women in her centers rather than on the surrounding politics, she said.

The Evangelism Question

Evangelicalism has historically dominated the pregnancy center landscape, and the vast majority of today’s centers are affiliated with Protestant networks and churches. But even among Christian centers that share core beliefs, networks can have different approaches to when and how to incorporate the gospel.

CareNet, with its network of more than 1,130 Christian pregnancy centers, uses the mantra of being not just pro-life but “pro-abundant life.” Its leaders want to see families transformed through their relationship with God and the church. Yet affiliates are not required to share the gospel with each client. The hope is that it would come up organically.

There are no Christian symbols or Bible verses in the public spaces of Marten’s center in Toledo. But her office is full of them (“Be Still and Know That I Am God,” a print above her desk proclaims). Her conversations are peppered with Scripture in a way that sounds less like a script and more like wisdom she received from a friend.

“The gospel is so ingrained into everything we do,” she said. “But for us, the form is just as important as the message.” Marten shares CareNet’s philosophy: Don’t start by opening a tract. Start by meeting the women.

The same goes for another network, Heartbeat International. Its 2,500 affiliates list relationship building as a prerequisite for sharing the gospel, training volunteers to first “listen and learn.”

On the other side of the debate is Hope National, an association started by National Institute of Family and Life Advocates (NIFLA) cofounders Jim and Pat Dundas. The Hope National manual reads: “It has been the instruction in some pregnancy center volunteer training programs to make the gospel of secondary importance and/or practice in counseling the client. This is in direct opposition to the teaching of Christ.”

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In certain circumstances, focusing on evangelism can cost pregnancy centers federal funding through the Title X Family Planning Program at a time when more are looking to partner with state programs for maternal health. Some Title X centers violate the Dundases’ approach in order to comply with federal guidelines: They wait until after a client’s intake visit to ask permission to share the gospel.

Faith in the Background

Whether centers prioritize evangelism informs other aspects of their operation, including offering contraception. Christian pregnancy center networks have traditionally avoided doing so, worrying that it implicitly endorses sex outside of marriage. But some, stepping in as alternatives to Planned Parenthood, believe it allows them to reach more women.

The Source, a network of eight Christian pregnancy centers in Texas, made headlines late last year when it announced it would offer hormonal and other birth controls at its centers.

The Source CEO Andy Schoonover said the strategy is meant to reduce unplanned pregnancies (and thereby reduce the demand for abortion). “Women who are sexually active and not using contraceptives are approximately eight times more likely to have an abortion than those who are using contraceptives,” he said, citing CDC data.

The network also sees offering contraceptives as a way to establish relationships with women in their local communities.

“If they don’t get it from us, they will go somewhere else to get it,” Schoonover said. “Do we want to develop and maintain that relationship with the patient or would we prefer a different organization, which is more than likely not ideologically aligned, develop that relationship?”

In New York City, where the abortion is rate is double the average of the rest of the country, a pregnancy center called Avail strategically distances itself from evangelical pressures and expectations. Avail calls itself a nonprofit “with a Christian orientation” but says its goal is to offer a supportive place for women to take a breath and make a decision—not be swayed toward or away from a certain outcome.

“If you are facing an unexpected pregnancy, you may fear being judged or pressured,” Avail’s website reads. “At Avail, you will find the opposite. Our staff and volunteers strive to treat others the way they would want to be treated and are non-judgmental, respectful, and supportive.” The strategy is meant to make women in what could be the most progressive, pro-choice city in the country feel welcome walking in. (The ProGrace team gave an in-person training session at Avail last year.)

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At its Times Square office space, Avail also invites men to participate in the decision-making process around unintended pregnancies, with male counselors to meet with one on one as well as options for support after an abortion. It’s an approach also being used nationwide through CareNet, which now offers outreach for men at 65 percent of its centers. After its research found that the biggest influence on a woman’s decision about abortion is often the man who got her pregnant, CareNet’s Joseph Project partnered with the National Fatherhood Initiative to engage more men in parenting classes and mentoring.

Abortions Next Door

The Pregnancy Center of Greater Toledo also runs an after-abortion counseling center called the Haven House. Like the center, the Haven is eager to work with its neighbors—even though it’s next door to Toledo’s only remaining abortion clinic, with just a narrow parking strip between them.

Others may not have the same situation with location, but it’s easy for Christians in pro-life ministries to feel surrounded by the abortion-rights movement. Abortion clinics are closing at record rates, but Americans are becoming more vocal in their support of abortion itself.

Some pro-life activists have concentrated their efforts on the legal space or on protesting around the remaining clinics. But like those who launched their movement in the aftermath of Roe v. Wade, pregnancy center leaders today feel a deep calling to make a difference in the lives of women who could find themselves facing unintended pregnancies and desperate for assistance.

They want to do more than bring a woman in and show her an ultrasound or offer a gospel tract. (Most clients, Marten points out, are moms already and know the reality of the beating heart inside them.) Ministries are asking these women bigger questions like “What do you need?” and are stepping in to help.

The pregnancy center movement increasingly isn’t only about the baby, or even the baby and the mom, but about the whole family, neighborhood, and community.

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Every once in a while in Toledo, an unwitting woman comes into the Haven to check in for her abortion appointment next door. In the interest of honesty and maintaining a positive relationship with the abortion clinic, Haven staff reluctantly redirect these women to the building across the parking lot.

“But we also tell them we don’t believe they walked through our doors by accident,” said Marten, who has made some inroads in pro-choice circles and was given a woman of the month award last year by a feminist group in Toledo.

Before the mistaken woman leaves the Haven for her appointment, she is asked if she wants to talk about anything and is invited back.

Marten and her team pray earnestly to meet her again. They pray they’ve done enough to earn her trust. And, like pregnancy center workers past and present, they grieve over every lost baby and every forever-changed woman.

Maria Baer is a contributing writer for CT and is based in Columbus, Ohio.

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