Millions of dollars in state funds and tax credits have been doled out in recent years to assist mostly faith-based nonprofits in their efforts to reduce the number of abortions performed in Missouri.
Critics complain, however, that much of the money ends up benefiting what are called pregnancy resource centers, which they contend often pose as medical clinics while providing inaccurate information designed to scare women away from having an abortion.
Now lawmakers are wrestling with the sensitive issue once again as Republicans push for legislation banning local governments from limiting a pregnancy resource center's activities. Another bill would extend a tax credit for center donors. That tax credit is set to expire this year.
"We always want to be a society that strongly affirms life and the importance of life. Pregnancy resource centers across our state really do what is important to protect life," said House Speaker Pro Tem Shane Schoeller, a Willard Republican who is sponsoring a bill extending the tax credit and has made it one of his biggest legislative priorities.
Pregnancy resource centers -- also known as crisis pregnancy centers -- are faith-based, anti-abortion organizations that provide free services to women who want to carry their pregnancies to term. There are 56 centers registered with the Missouri Department of Social Services, including around a dozen in the Kansas City area.
Centers in Missouri are eligible to be reimbursed for some expenses from a state fund called the Alternative to Abortion program. Private donors to the centers can receive a state tax credit of up to $50,000 a year.
But a report prepared six years ago by U.S. Rep. Henry Waxman, a California Democrat, concluded that a vast majority of pregnancy resource centers across the country offer false or misleading information about the health risks of an abortion, which Waxman concluded was "an inappropriate public health practice."
Pamela Sumners, executive director of NARAL Pro Choice Missouri, said the national findings reflect what's happening in Missouri. She alleged many pregnancy resource centers spread false information, most notably a claim rejected by the National Cancer Institute that abortions cause higher rates of breast cancer.
"While there may be some reputable pregnancy resource centers out there, our experience teaches that most are deceptive, lack real evidence-based materials and aggressively proselytize," Sumners said. "Religious proselytism should not occur with taxpayer subsidies."
Deborah Neel, executive director of the Women's Clinic of Kansas City -- a pregnancy resource center with locations in Grandview and Independence -- dismisses such concerns as a smear tactic aimed at discrediting "unashamedly pro-life" organizations.
"I'm not saying every center is perfect, but the pregnancy centers I know don't operate in an unethical or deceptive way," Neel said.
In 2011, records show that nearly $1.8 million in pregnancy resource center tax credits were redeemed at centers across Missouri. Since 2007, more than $6.7 million in credits have been issued by the state.
During those years, the state's Alternative to Abortion program has given out an additional $8.5 million. Last year, more than $520,000 went to the Missouri Alliance for Life, a coalition of pregnancy resource centers, maternity homes and adoption agencies that seeks to promote the work of "Christ-centered, pro-life efforts in Missouri and the Midwest."
"Pregnancy resource centers take state dollars and multiply them many times over, because we have dedicated volunteers willing to invest their time in the work we do," said Cindi Boston, CEO of Springfield Pregnancy Care Center.
Kansas does not offer a tax credit program to pregnancy resource centers, but it does have a funding stream called the pregnancy maintenance initiative. That fund awards grants to nonprofit organizations for programs that provide services for women that enable them to carry their pregnancies to term.
Both Neel and Boston refer to their pregnancy resource centers as "limited medical clinics."
Yet Boston acknowledged that the centers typically aren't even allowed to draw blood. The only procedures most resource centers perform are pregnancy tests and abdominal ultrasounds. They also offer programs ranging from parenting classes to smoking cessation courses, and help expectant mothers find the resources they may need, from counseling to diapers.
"The majority of women who come through our doors say they don't believe in abortion but don't know if they have any other choice," Neel said. "We try to show them all of their options."
Those options, however, do not include abortion or contraception. To be eligible for the tax credit or state funding, pregnancy resource centers are statutorily prohibited from performing or referring for abortions, and funds cannot be used for "any family planning services."
"These centers are designed to provide resources or send women to other places to get resources if they wish to continue their pregnancy," said Elizabeth Nash, state issues manager for the reproductive health research organization The Guttmacher Institute. "They are not places to get medical care. To classify them as medical clinics is disingenuous."
But women walking into a pregnancy resource center may believe they are in a medical clinic, NARAL's Sumners said, because many hide their true intentions by locating near hospitals or Planned Parenthood clinics to give themselves the appearance of medical legitimacy.
The Women's Clinic in a Grandview shopping center, for example, is next door to a Planned Parenthood clinic.
Neel said that their locations are determined by where they are needed, not to conceal their mission.
When opponents accuse pregnancy resource centers of spreading medically inaccurate information, they usually focus on two claims: that abortion is linked to increased risk of breast cancer and that abortion can lead to mental-health disorders.
Neal and Boston defended both contentions. Boston said informing women of "all the consequences" that could arise because of an abortion -- no matter how infrequently they may occur -- is part of making an informed decision about their pregnancy.
For example, the New Beginnings Women's Center in Warrensburg states on its website that "carrying your first pregnancy to full term gives protection against breast cancer. Choosing abortion causes loss of that protection."
But medical experts contend that claim is false. Both the American College of Obstetricians and Gynecologists and the National Cancer Institute have concluded that there is no relationship between abortion and breast cancer. The American Cancer Society also maintains that both induced and spontaneous abortions are "not linked to an increase in breast cancer risk."
The American Psychological Association convened a task force in 2008 to review the mental health effects of abortion. The group concluded that, while women who chose to end an unwanted pregnancy may experience feelings of grief and loss, there is no evidence that a single abortion causes significant mental health problems.
"That doesn't mean that individual women haven't experienced mental health problems," said Nash of the Guttmacher Institute. "But abortion in and of itself does not create mental health problems."
The psychological association's report concluded that prior mental health is the strongest predictor of post-abortion mental health.
Ordinances requiring centers to post signs stating they do not offer abortion services were enacted in Baltimore and New York City but overturned by the courts. In San Francisco, a law banning centers from engaging in what the city labeled "false or misleading advertising practices" is being challenged in federal court.
In response to such efforts around the country, House and Senate committees in Missouri are considering legislation restricting local governments from passing ordinances aimed at regulating pregnancy resource centers.
Samuel Lee, a lobbyist for Campaign for Life Missouri, said these local ordinances are part of a coordinated effort to "restrict the free speech rights of pregnancy resource centers" all over the country. He said lawmakers must act now to protect centers in Missouri.
"The government should not be coming in and telling these organizations what to say to their clients, when to say it or how to say it," Lee argued.
But Michelle Trupiano, public affairs manager for Planned Parenthood of Kansas and Mid-Missouri, said that her organization faces massive state regulation about what it can do or tell its clients.
"The legislature has decided exactly what our doctors have to tell women," Trupiano noted. "We have to give them a booklet of information. We have to post signs on our walls. Women who go to pregnancy resource centers deserve accurate information, just like those who come to Planned Parenthood."