Iowa looks to imitate Texas's fraud-ridden 'Alternatives to Abortion' program

An anti-abortion Iowa state senator is proposing that his state follow Texas lead in creating an “Alternatives to Abortion” system. However, the Texas program has been riddled with fraud and other issues. 

Iowa Republican Sen. Mark Costello, who oversaw pushing a 20-week ban through the state senate in 2017, is proposing the state copy a Texas program with the stated goal of providing “alternatives to abortion.”

To sell fellow legislators on the idea, Costello brought in John McNamara, executive director of the Texas Pregnancy Care Network, who boasted that, without the program, Texas would not have been able to pass its devastating six-week abortion ban: “I think it probably would not have come into effect if it was not for the fact that Texas for 16 years has been providing such ample support and help to pregnant women through this program.”

But McNamara’s assertion isn’t accurate — and that’s a problem for Costello’s proposed program in Iowa. 

The early years of the Texas program were hardly wide ranging or cost effective. The Texas Tribune reported that in 2005 the program received “a few million” dollars in federal funding that was earmarked for anti-poverty initiatives; but in that first year, it served fewer than a dozen individuals. 

In the first five years of the program, Texas funded it by diverting money from family planning and women’s health services. During that time, the Texas Pregnancy Care Network, one of the original providers under the program, fell far short of its projected number of people served while also overspending. For this, NARAL Pro-Choice Texas noted in 2010, it was rewarded with a 60% increase in its 2009 budget. 

To fund the program, Texas has continued to shift money from other health-related initiatives, including moving $20 million out of air-quality funding in 2017. 

As time went on, the Texas program became ripe for fraud. For example, another Texas anti-abortion organization, the Heidi Group, received millions of dollars from the state, but rather than using it all to provide services, it spent money on things like cruises and employee perks. As with the Texas Pregnancy Care Network it also wildly overestimated how many people it would be able to serve. The group told the state it expected to serve 70,000 people but by 2017 had instead served just a few thousand. 

In December of last year, one of the group’s subcontractors was suspended by the state. The subcontractor, called A New Life for a New Generation, had received over $2.5 million from the state. A Texas TV station reported that A New Life spent money as the Heidi Group did, on trips and perks for members, including spending state money to cover building costs at a vape lounge owned by New Life’s president. 

Despite all of this, Texas is set to spend $100 million this biennium on the Alternatives to Abortion program. The Texas Legislature has never seemed particularly interested in what the participants in the program do with all that money. Until 2017, there wasn’t even a requirement for a public report on how contractors spent the millions they were given.

Many of the Texas “alternatives” are nothing but so-called “crisis pregnancy centers” run by anti-abortion groups, which often engage in misinformation meant to persuade or even trick people into continuing their pregnancies. Texas crisis pregnancy centers, for example, push the discredited notion that there is a link between abortion and breast cancer and focus on “post-abortion stress syndrome,” an invented ailment not backed by any evidence that no medical organization recognizes. 

Nevertheless, Costello is proposing to use state tax dollars to pursue the same failed strategy that Texas has. Iowa anti-abortion legislators tried something similar during the 2021 legislative session, when they proposed using state money for “pregnancy resource centers” and to “utilize proactive targeted digital marketing using proven search engine marketing techniques to reach pregnant women in real time who are in crisis and actively seeking an abortion.” In other words, the state wanted to use taxpayer money to leverage technology to actively interfere with people seeking an abortion, still a constitutionally protected right. 

Further, Costello and McNamara are simply wrong that most people seeking abortions are doing so because of a lack of support or information. A 2014 study showed that even when people are required to view an ultrasound of their uterus — currently mandated by eight states — more than 98% chose to still have an abortion. The Turnaway Study, which looks at the effects of unintended pregnancies, found that over 95% of people feel abortion was the right decision for them. That same study found that most people who were seeking an abortion were aware of the option of adoption but were not interested in it. 

In short, the research shows that most people have abortions because they want an abortion, not because they are unaware of other options or feel unsupported. 

However, the anti-abortion movement has remained savvy about pushing the most outlandish ideas, shifting them from hyperconservative states like Texas to slightly less conservative states like Iowa. The eagerness to replicate the “alternatives” program shows that states aren’t adopting the anti-abortion playbook just by trying to pass laws similar to that of Texas; they’re also attempting to use the same playbook to pass laws that divert state health care money to anti-abortion initiatives with a history of being both ineffective and riddled with fraud. It’s a comprehensive strategy, and it appears to be succeeding for now.

Published with permission of The American Independent Foundation.