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In The Grand Scheme: Six Sinister Tactics Employed By Anti-Abortion Centers

Jack Dobkin, Research Associate | Reports


Across all levels of government, access to abortion in the United States is under the most serious threat in over 50 years. As right-wing, Christian fundamentalist and white supremacist politicians and advocates have gained greater power in recent years, they have hardened and increased their already unrelenting attacks on access to abortion. One way in which they have been scheming toward the current state of affairs is through the coordinated proliferation of anti-abortion centers (AACs), which are sometimes called crisis pregnancy centers (CPCs) or pregnancy resource centers (PRCs). AACs are centers that pretend to provide comprehensive pregnancy care but are little more than anti-abortion counseling centers. Their growth has boomed in the last few decades, during which time abortion clinics have been systematically forced to shut down. AACs now outnumber abortion clinics by a factor of 3:1.

This expansive growth of AACs has occurred due to the highly coordinated efforts of anti-abortion organizations across the United States. Anti-abortion organizations regularly shop tactics around to each other or mimic the “successful” tactics of other groups toward the founding and expansion of AACs. In some cases, explicit partnerships are formed between these organizations to prop up AACs. This report will lay out six of the tactics on which these anti-abortion organizations have coordinated and spread specifically to set up and expand AACs across the United States: search engine optimization (SEO), model legislation, “Choose Life” license plates, medical licensing and the use of ultrasound technology, mobile AAC units, and “Earn While You Learn” programs. The research and analysis here build on the impressive and important work of activists, abortion advocacy organizations, medical professionals and public health experts who have for years been calling out the harm that AACs propagate.


Access to abortion in the United States is currently under the most dangerous threat in over 50 years. Texas has banned abortion at six weeks of pregnancy, enabling vigilantes to terrorize pregnant people while effectively banning abortion for almost 10% of the U.S. population. Other states are already following Texas’s lead, introducing legislation to do the same. And there is a serious chance that this year Roe v. Wade is overturned either in part or entirely. In this landscape, anti-abortion centers (AACs) — also called crisis pregnancy centers (CPCs) or pregnancy resource centers (PRCs) — are trying to position themselves as the appropriate organizations to cater to the needs of pregnant people and abortion seekers in a post-Roe U.S. Where abortion clinics may be forced to shutter operations in the near future, AACs are preparing to increase their targeting of pregnant people and expand their anti-abortion ideology and religious evangelization — and in many states, using taxpayer dollars to do so.

Even in a world under Roe, this is not a far-out or far-off reality. AACs already outnumber abortion clinics in the U.S. by a ratio of 3:1. And AACs have recently filed amicus briefs in Dobbs v. Jackson Women’s Health highlighting their supposed role in “replacing” abortion clinics that may be forced to close. We know that AACs are no replacement for health centers that provide the full range of reproductive care, including abortion care. Whereas reproductive health centers and abortion clinics provide appropriate and medically informed healthcare, AACs peddle ideological counseling, religious proselytization and dangerous misinformation. Unfortunately, in addition to a legal environment ripe for the support and expansion of AACs, they are buoyed by massive, well-funded and closely connected networks of anti-abortion organizations.

Equity Forward is committed to holding power accountable through research that is necessary, accurate, intersectional, strategic and user-friendly. We do this in several ways — one of which is by exposing the influential but often hidden network of connections among the many anti-abortion actors in our country. The proliferation of AACs nationwide (and globally) is one manifestation of the connected work of AAC networks — sometimes explicitly working in tandem, other times sharing the same playbook.

So, just how organized and intertwined are these efforts of anti-abortion organizations, individuals and networks toward the proliferation of AACs? In exploring the tactics that AAC networks have employed, shared and conspired in together, this report will expose the links between many of these actors and actions and how they fit together as part of a coordinated anti-rights attack. This report will look at six sinister tactics that have spread throughout the anti-abortion world in service of expanding AACs, frequently through the work of one or a few organizations that champion its use and then recruit other organizations and individuals to spread it far and wide. The six tactics that make up part of this AAC playbook and are analyzed here include:

  1. Search engine optimization (SEO)
  2. Model legislation
  3. “Choose Life” license plates
  4. Medical licensing and the use of ultrasound technology
  5. Mobile AAC units
  6. “Earn While You Learn” programs

This graphic was made using the LittleSis Oligrapher tool. 

Search Engine Optimization (SEO)


Search engine optimization (SEO) is a catch-all term referring to several data-based marketing techniques used to improve the visibility of a website in search engine results. Because search engines use bots and algorithms to assess and assign search match levels to all websites, it is important for websites to use the right keywords and phrases to improve their appearance in search results, thus driving more traffic to their websites. SEO is an incredibly important and effective tool in digital marketing, and many organizations — whether companies trying to sell a product or nonprofits trying to reach their supporters — now prioritize SEO-minded approaches in their digital marketing.

How Did AACs Begin Using SEO?

Applying SEO to AACs was Brian Fisher’s brainchild. After years of working in corporate jobs, Fisher felt “called” to limit abortion access using marketing techniques he learned in the private sphere. Along with friend and colleague Tim Kachuriak, Fisher applied corporate digital marketing techniques — namely, SEO — to manipulate pregnant peoples’ online search results, driving those researching abortion away from comprehensive pregnancy care or abortion clinics and, instead, toward AACs. The two founded Online for Life in 2009, a company that set out to promote and consult on the use of SEO and other digital marketing techniques for anti-abortion advocacy groups.

After a few years, Online for Life became a newly-formed organization, Human Coalition, the Texas-based anti-abortion organization that Fisher led until 2020. Human Coalition continued promoting and implementing SEO techniques among AACs, while also expanding into the business of brick-and-mortar AACs themselves. Human Coalition now owns seven brick-and-mortar AACs and works directly with at least 35 others to “intercept” pregnant people who are searching for abortion care or clinics online. To illustrate this, here are search results for “abortion [city name]” in four major markets, which each result in a Human Coalition-affiliated anti-abortion center populating as the first link:

[Google Search for "Abortion Pittsburgh," Accessed 6/11/21]

[Google Search for "Abortion Raleigh," Accessed 6/11/21]

[Google Search for "Abortion Cleveland," Accessed 6/11/21]

[Google Search for "Abortion Dallas," Accessed 6/11/21]

How Has SEO Spread Across the Anti-Abortion Movement?

As such, Online for Life/Human Coalition and Fisher have been foundational in pioneering, spreading and teaching AACs how to incorporate SEO into their practice — effectively weaponizing pregnant people’s internet use against them.

Fisher himself has boasted that “Human Coalition is one of the larger pro-life groups in the country that no one has ever heard of.” And yet, Human Coalition has become a relatively well-connected player in the anti-abortion world in just a few years of existence. In 2017, Fisher was invited to speak in front of a crowd gathered by the prominent anti-abortion group Family Research Council (FRC). The topic of that speech? “Rescuing Mothers and Children from Abortion Using Cutting-Edge Technology and Data,” aka, SEO.

Organized by FRC, the speech was attended by folks from across the anti-abortion world. Most notably, Care Net staff seemed particularly engaged and interested in incorporating Human Coalition’s SEO tactics, specifically asking how to access the organization’s knowledge and training on the subject. Heartbeat International — which, along with Care Net and National Institute of Family and Life Advocates (NIFLA), operates the vast majority of AACs worldwide — has bragged that the organization has so clearly manipulated SEO to the point that someone “who makes a Google search such as ‘pregnant and scared’ finds a local Heartbeat International affiliate or Option Line in [their] search.”

"[Removing ads from Google] would have been a serious blow indeed to marketing for pro-life pregnancy centers who work hard to reach women through internet advertising. A woman who makes a Google search such as 'pregnant and scared' finds a local Heartbeat International affiliate or Option Line in her search." — Heartbeat International, 2014 Annual Report

And although Human Coalition still carries out the work that Online for Life once focused exclusively on, it seems others have also taken inspiration from Online for Life’s tunnel-vision business model. Choose Life Marketing is an entire company devoted to revamping websites and improving SEO techniques for anti-abortion organizations. Notably, NIFLA is listed among Choose Life Marketing’s partners.

This graphic was made using the LittleSis Oligrapher tool. 

Model Legislation


Anti-abortion organizations exert their policy goals by drafting “model” legislation that they shop around to lawmakers, and those with lobbying arms advocate for their passage and implementation, often across state lines and at multiple levels of government. Whether at the state or federal level, effective legislation can secure or limit funding, expand or restrict rights or set up a certain environment in which experiences take shape. Anti-abortion organizations have become skilled in their highly coordinated efforts to draft and pass harmful model legislation to codify their ideologies. In fact, 2021 was the worst year on record for anti-abortion legislation.

While “copycat” bills outright banning or restricting abortion access tend to get the most attention, it is less well known that public dollars for AACs are allocated similarly using this tactic. “Alternative to Abortion” (A2A) programs originated in Pennsylvania, but have now spread to 13 states (as well as a 14th that has since ended its program). In 2021 alone, three states introduced legislation to establish AAC-based A2A programs, modeling their programs on the existing predecessors. As states become even more hostile toward abortion, AACs are positioning themselves to take advantage of this legislative environment.

How Did Anti-Abortion Model Legislation Begin?

Legislation as a tactic is not unique to the anti-abortion world. What is noteworthy and relevant to this report, however, is how commonplace it is for anti-abortion organizations to draft and shop copycat or model legislation around the country, including toward the implementation and expansion of AACs. Two culprits heralded model legislation in the anti-abortion world as one of their most effective tactics.

Founded in 1968, National Right to Life Committee (NRLC) is a project of the anti-abortion National Conference of Catholic Bishops and is the nation’s oldest and largest anti-abortion group, with affiliates in all 50 states. Following Roe, NRLC shifted in the 1970s to a strategy of incremental erosion of abortion rights via state legislation. Similar to NRLC, Americans United for Life (AUL) was founded by a group of anti-abortion Catholics in 1971, also predating Roe. In the 1970s, it reorganized with a legal focus and as a legal defense fund before shifting in the 1980s and 1990s to an incremental and state-level legislative strategy to chip away at Roe (and, later, Planned Parenthood v. Casey). Having likely taken inspiration from NRLC, AUL has now eclipsed NRLC as the most prolific source of anti-abortion model legislation nationwide, while NRLC still boasts the largest fiscal presence and general footprint.

How Has Model Legislation on AACs Spread?

As the leaders in heralding model legislation into the world of anti-abortion advocacy, NRLC and AUL have drafted hundreds of anti-abortion model bills, all the while encouraging and inspiring other organizations and legislators to adopt the same approach. Since adopting and spreading these strategies, NRLC has drafted 35 model bills, while AUL’s widespread efforts are annually cataloged in its “Defending Life” publication, a playbook of its model legislation that is sent yearly to every state and federal legislator.

Unsurprisingly, AUL has drafted resolutions specific to the proliferation of AACs. One prioritized on AUL’s website is a “Joint Resolution Honoring Pregnancy Centers.” This model resolution is rife with misinformation and misleading framing about what AACs do, citing bad actors, such as FRC and Care Net, in its text. AUL has spread this model resolution nationwide, encouraging states to pass it by using it as a metric for its state anti-abortion rankings in “Defending Life.” Dangerously, in the past, AUL paired the resolution with further legislation supporting AACs on the ground. For example, in 2010, AUL successfully drafted, distributed and passed this model joint resolution in the Virginia legislature right after AUL was also effective in squashing a separate effort to regulate AACs in the state. AUL also drafted the “Women’s Ultrasound Right to Know Act,” model legislation introduced in at least three states that would require forced ultrasound viewings as part of a mandatory waiting period before an abortion. This model legislation aims to limit abortion by bolstering AACs, which perform these unnecessary ultrasounds and then convince pregnant people to carry their pregnancy to full term (another AAC tactic further discussed below).

A recent Equity Forward report highlighted the work AUL has done with the Center for Arizona Policy, an organization that pushes not only “its own [model] bills, [but] the group [also] pushes legislation developed by the national Americans United for Life” through its deep connections to powerful Arizona state legislators. Arizona was one of the three states that attempted to establish a state A2A program through legislation in 2021.

To advance their agenda, AUL and NRLC have long worked closely with their ally Susan B. Anthony List (SBA List), which takes these drafted bills and advocates for their passage. Explicitly describing this tactical coordination, SBA List President Marjorie Dannenfelser has discussed the “symmetry” of anti-abortion work, saying “where one group ends another one begins… We are happy for organizations like AUL [to draft model anti-abortion legislation] … and then our job as the political arm is to advance [their] measures.” In addition to their programmatic coordination, at least AUL and SBA List are also linked through a shared major donor—the Center to Protect Patient Rights, a project of the right-wing Koch family.

NRLC and AUL pioneered the use of model legislation to bolster AACs, and have certainly inspired more than just the individuals and organizations they directly interact(ed) with, as can be seen in the evolution of Human Coalition. When Human Coalition was Online for Life, it focused exclusively on SEO and other digital marketing techniques for the anti-abortion world. Once the transition to Human Coalition took shape, the organization started expanding. After opening their own brick-and-mortar centers, they established a political arm to advocate for model legislation to expand their dangerous work. Unfortunately, these efforts have been effective in some states thus far. Human Coalition Action — the organization’s political arm — drafted model text, shopped around and helped pass the “Every Mother Matters Act.” These model bills force pregnant people to consult with state-funded AACs before they can access abortion care, stripping pregnant people of their autonomy and intentionally delaying the process of abortion in hopes of pushing pregnant people past gestational limits.

These efforts are part of a larger, highly coordinated right-wing strategy to disseminate and pass model legislation across every state. While AUL and NRLC work on anti-abortion legislation, Project Blitz — a coalition including the Heritage Foundation, Focus on the Family and FRC — has similarly published its own playbook of other fundamentalist Christian model legislation restricting human rights. In a display of just how coordinated these efforts are, Project Blitz does not draft anti-abortion model legislation, explicitly ceding that agenda to AUL.

Other right-wing organizations have similarly followed suit in drafting model legislation. The National Association of Christian Lawmakers (NACL) is an anti-abortion organization that drafts and shops around model legislation, seeking to impose fundamentalist evangelical Christian beliefs on people nationwide. Founded in 2019 by State Representative Jason Rapert in Arkansas — the most virulently anti-abortion state in the country according to AUL’s “Defending Life 2021” — NACL’s explicitly stated goal is to be the Judeo-Christian version of the right-wing big business bill mill, American Legislative Exchange Committee (more commonly known by its acronym, ALEC). Thus, when Texas introduced and later passed its horrific abortion ban, NACL quickly developed a model version of the legislation to be readily introduced by anti-abortion legislators in several states across the country, with more likely to come. While NACL has only developed two model resolutions and two model bills, none of which deal directly with AACs, the organization’s explicit and targeted mission, and its connections within the anti-abortion world (including NACL Board Member Tony Perkins, President of FRC) raise concern as to NACL’s likelihood for spreading pro-AAC legislation in the near future. In addition to NRLC, AUL, SBA List and the others mentioned here, NACL should continue to be monitored and held accountable as anti-abortion and right-wing Christian evangelical forces gain greater legislative footholds and as they have become bolder in recent years.

This graphic was made using the LittleSis Oligrapher tool. 

"Choose Life" License Plates


It is common for states to offer drivers the ability to personalize their license plates. Plates can be personalized in their plate numbers, or they can be personalized through the choice of a specific theme/brand for the license plate. While the former is regularly just a process completed by the state’s Department of Motor Vehicles, the latter often involves an organization gathering enough signatures for the state to create its customized branded plate. Once this is secured, drivers can pay a fee to have their desired plate of choice, with a portion of plate sales going to that organization. A common customized plate available in at least 32 states is the “Choose Life” plate, backed by the anti-abortion organization Choose Life America. Anti-abortion advocates nationwide have taken up this approach to funding AACs, funneling the money raised by the sales of plates directly into the support or expansion of AAC networks.

[Choose Life, Accessed 4/6/22]

How Did Choose Life Begin its License Plate Program?

“Choose Life” license plates were first conceived in Florida in 1996. The anti-abortion fundraising organization was started by Randy Harris, who was then the commissioner of Marion County. Harris envisioned the funds raised from the sale of the plates explicitly going to support the operation and expansion of AACs across the state. After years of back and forth, including a gubernatorial veto, Florida’s “Choose Life” license plate was approved in 2000.

How Has the "Choose Life" License Plate Program Spread?

The lengthy approval process, particularly the veto, garnered some national controversy, and anti-abortion actors in other states took note of this approach to fund AACs. As such, “Choose Life” license plate campaigns started popping up in several other states nationwide. Although Choose Life is a national organization, it operates in a largely horizontal, non-hierarchical manner. The national umbrella organization provides “a uniform application, distribution, utilization and reporting process,” but for each state where a Choose Life plate exists, there is a state Choose Life chapter. These chapters operate largely independently of each other but are all connected as part of the Choose Life network. Following Florida, 31 other states now have the option to fund AACs through the purchase of a “Choose Life” license plate. Several other states have either “half plate” options or groups formed or working toward establishing a program. In a show of the group’s proliferation, only five states have no activity tied to Choose Life America, and the organization claims to have raised over $28 million toward funding AACs as of 2019.

“Choose Life” license plates and their impact on the spread of AACs are bolstered by AUL, which considers whether a state “provides direct funding to [AACs] and/or offers ‘Choose Life’ license plates (with proceeds going to PRCs or alternatives)” as a metric in their anti-abortion playbook on the evaluation of each state’s anti-abortion antagonism. Most recently, AUL cheered Idaho’s passing of SB 1249 during the 2020 legislative session, the latest state to establish a “Choose Life” license plate program. When officials separately in New York and Missouri would not support the establishment of a Choose Life license plate in the state, AUL filed amicus briefs in defense of Choose Life, cementing the relationship between the two organizations. Notably, the New York brief was filed on behalf of Care Net, Heartbeat International and NIFLA.

In at least Virginia, Heartbeat International serves as the state’s distributor of funds raised by the Choose Life state affiliate. In this way, Choose Life essentially acts as a direct fundraiser for Heartbeat International, which then distributes those funds to the AACs of their choosing — likely directly benefiting their own networks. In the run-up to the establishment of Virginia’s Choose Life license plate, the Knights of Columbus were “heavily involved in the campaign.” The state council of Knights of Columbus in at least Florida sells merchandise branded with Choose Life imagery, further cementing a relationship — potentially financial — between the organizations. Among many other AACs, Choose Life state affiliates in at least Florida and Rhode Island have been documented to distribute money to AACs associated with Care Net. Choose Life’s symbiotic relationships with these massive anti-abortion organizations and AAC networks certainly underwrote the proliferation of their license plate program nationwide.

This graphic was made using the LittleSis Oligrapher tool. 

Medical Licensing and the Use of Ultrasound Technology


AACs provide ideological and religious counseling, not medical care, and their “staff” are often volunteers who lack any background in medical care. In order to appear legitimate, AACs have often aesthetically “medicalized” their sites, having volunteers wear white coats, obtain minimal medical licensing and implement the unapproved non-diagnostic use of ultrasounds. AACs have convinced themselves that when a pregnant person views activity on an ultrasound, they will change their mind about abortion. No evidence exists to support these claims. AACs use ultrasounds against professional advice to explicitly deceive pregnant people and manipulate their feelings toward convincing them against abortion.

In order to appear legitimate, AACs have often aesthetically "medicalized" their sites, having volunteers wear white coats, obtaining minimal medical licensing, and implementing the unapproved non-diagnostic use of ulstrasounds.

How Did AACs' Medical Licensing/Use of Ultrasounds Begin?

In the early 1990s, lawyer Thomas Glessner left AAC network Christian Action Counsel — the organization which would later become the massive AAC network Care Net — to form NIFLA. Glessner envisioned NIFLA as a network for affiliate AACs, not unlike his previous employer, but with a heightened focus on providing legal guidance and representation to those affiliates. As NIFLA became more established, Glessner became fixated on how to craft legal guidance around a particular tactic for AACs — the conversion of centers into medical clinics to implement the use of ultrasounds.

Glessner was convinced that by using ultrasound, it would be easier to emotionally manipulate pregnant people to carry their pregnancies to full term and that it would lend an appearance of medical legitimacy to the misinformation that AACs push. Glessner and NIFLA set out to ensure that affiliate AACs converted to medically licensed facilities and that they used ultrasound machines, with NIFLA providing legal guidance on how to do this.

How Have AACs' Medical Licensing/Use of Ultrasounds Spread?

After developing the legal guidance for conversion to medically licensed facilities, NIFLA turned to the more operational approach of how to ensure this could be carried out — with an eye toward securing ultrasound equipment and instruction on its use for all affiliate AACs.

Toward this end, in 1998, NIFLA established the Institute of Limited Obstetric Ultrasound, a course to train affiliate AACs in their deceptive practices of “limited obstetric ultrasound.” With an already expansive network of affiliates, this meant that guidance toward medical conversion and ultrasound use was spreading rapidly. NIFLA took this a step further in 2001 when it established The Life Choice Project, a package that includes training from the Institute, as well as anti-abortion consultants and nurse mentors to build out these problematic programs.

Despite NIFLA’s already large network, the organization was bent on exporting this deceptive practice as far and wide as possible. Toward that end, in 2004, NIFLA entered an official partnership with the noted anti-abortion group Focus on the Family. This partnership, called Option Ultrasound Program (OUP), provides grants to cover the cost for AACs to convert to medical clinics and to install and train on ultrasound machines. Between its inception in 2004 and 2019, the program claims to have funded $18.6 million in grants to 1,037 AACs to install and train on ultrasound use, greatly expanding the reach of this tactic. Much of this money goes toward AACs purchasing NIFLA’s “The Life Choice Project” package, making OUP essentially a way to move money back and forth between the organizations while ensuring the proliferation of this harmful tactic through AACs nationwide.

Inspired by Focus on the Family, the anti-abortion group Knights of Columbus started their own version of OUP, called the Ultrasound Initiative, in 2009. The Ultrasound Initiative matches funds raised for both brick-and-mortar AACs and AAC mobile units to install ultrasound machines in their centers. In its first decade, the Ultrasound Initiative claims to have distributed over $56.3 million in grants to AACs, funding 1,173 ultrasound machines at more than 900 AACs. Owing to NIFLA’s training infrastructure, OUP’s/The Ultrasound Initiative’s grant giving, and the proliferation of ultrasound-outfitted AAC mobile units over the last decade (further discussed below), ultrasounds have become one of the clearest examples of AAC coordination.

Although these organizations are the pioneers and most interconnected players in the world of ultrasound use at AACs, nearly all anti-abortion groups have come to shepherd this tactic. The AAC organization Glessner originally came from, Care Net, declared in 2003 that “ultrasound may end abortion,” and Heartbeat International, similarly one of the largest AAC networks worldwide, said that as of 2008, 460 of its affiliates were equipped with ultrasound technology. Around this time, in the mid-to late-2000s, when ultrasound use among AACs was already widespread, evidence demonstrated that pregnant people who want an abortion are not dissuaded by viewing an ultrasound, and questions started being raised around the ethics and unknown potential medical risks of non-diagnostic ultrasounds. Despite these concerns, NIFLA, Care Net, Heartbeat International and AACs nationwide continue to champion this practice rooted in the ideological and emotional manipulation of pregnant people, not science or compassionate care.

Concerningly, the proliferation of ultrasound use at AACs created an environment in which legislators have felt able to mandate their use for abortion as a way of implementing more unnecessary obstacles to abortion access. Where these laws exist, the only place people can turn to for an ultrasound is often an AAC. Because ultrasound prior to most abortions is not medically necessary, and insurance plans will not cover medically unnecessary services, the only affordable option to meet this requirement is typically an AAC. Oftentimes, an AAC is the only option to meet this requirement at all, owing to the decades-long forced closures of abortion clinics, and the increase of AACs. Yet, on many occasions, such as those documented in Texas, the ultrasounds forced upon pregnant people do not even meet the unnecessarily mandated standards put in place by anti-abortion ultrasound laws. Anti-abortion legislators and AAC operators know this. They do not care about the health and safety of pregnant people. In reality, this is just a marketing scheme designed to drive people through the doors of AACs under the guise of medically sound information while wasting the time and resources of people seeking abortions.

A wave of so-called “informed consent laws” swept the U.S. during the mid-to late-2000s, shortly after ultrasound use spread through AACs. Laws were introduced at both the state and federal level and passed in several states — including the aforementioned model legislation which forced ultrasounds as part of the “informed consent” process. In the U.S. House of Representatives, the first federal proposal was introduced by none other than virulently anti-abortion then-Senator Sam Brownback. Brownback would later advocate against abortion access and other human rights as the U.S. ambassador-at-large for international religious freedom under former President Trump.

Importantly, in 2016 NIFLA brought the state of California to court over the state’s new requirement for AACs to display whether they were medically licensed facilities. The case eventually went to the Supreme Court, which ruled that the requirement was unconstitutional, making it incredibly hard for pregnant people to discern whether the person conducting their ultrasound is actually qualified to do so. Although the “promotion, selling, or leasing of ultrasound equipment for making ‘keepsake fetal videos’” is “an unapproved use of a medical device” per the U.S. Food and Drug Administration, the provision of non-diagnostic ultrasounds at AACs is largely unregulated and goes unchecked (and is even bolstered legislatively!). Future research and advocacy should certainly center on the lack of legal and medical standards and enforcement, especially regarding these “entertainment ultrasounds.”

This graphic was made using the LittleSis Oligrapher tool. 

AAC Mobile Units


Anti-abortion think tank Charlotte Lozier Institute (CLI) describes anti-abortion mobile units as “spaces for the provision of pregnancy testing and limited pregnancy confirmation ultrasounds (and more) on board a comfortably designed vehicle which travels to designated locations.” Although these activities do take place in these units, AAC mobile units are first and foremost a method to transport anti-abortion counseling and religious proselytization as far and wide as physically possible — just like their brick-and-mortar counterparts. These units are often large vans, buses or RVs that have been retrofitted with seating, an observation room and ultrasound equipment and that travel around, luring pregnant people in to subject them to the same deception and manipulation perpetrated by the brick-and-mortar AACs that mobile units are often affiliated with.

AAC mobile units regularly park on high school and college campuses, where they prey on young people who may have difficulty finding access to comprehensive care. And similar to how many brick-and-mortar clinics set up shop within eyesight of abortion clinics, AAC mobile units regularly park directly in front of abortion clinics, hoping to literally “intercept” pregnant people on their way in to receive proper healthcare. While CLI’s description does capture some of what AAC mobile units do, it misses important context — namely, that these units employ ultrasound technology in unregulated and unapproved ways and against the advice of professionals, and that AAC mobile units lean heavily on religious evangelizing and conversion.

How Did AACs Begin Using Mobile Units?

It is difficult to pinpoint an origin story for the use of mobile AAC units. Future research on the origins of this tactic would prove fruitful. The tactic seems to have really taken off in the 2000s, as part of a series of expanding “services” offered by AACs in an attempt to gain more legitimacy in the eyes of the public (and donors).

During that time, two anti-abortion organizations seem to have originated the tactic and continue to dominate the world of AAC mobile units: ICU Mobile and Save the Storks. ICU Mobile was first conceptualized by Sylvia Slifko in 2003 in Akron, Ohio, after claiming that God came to her and told her to take her anti-abortion work out to pregnant people where they are. This epiphany turned into the organization ICU Mobile in 2009, which became the first full-fledged organization to focus specifically on AAC mobile units. Shortly thereafter, Save the Storks followed suit. Joe and Ann Baker established Save the Storks in 2010, aiming to take deceptive ultrasounds to pregnant people in need from the very start.

How Have Mobile Units Spread Across the AAC Movement?

Much of the spread that has been able to be tracked stems from the above-mentioned organizations. To spread this tactic, both organizations take a similar approach, teaming up with a target brick-and-mortar AAC that wants to expand its anti-abortion advocacy. Once a partnership with a brick-and-mortar AAC has been secured, AAC mobile units turn to OUP and the Ultrasound Initiative to secure the equipment to outfit the units.

Following this formula, ICU Mobile has grown to a self-reported fleet of 40 AAC mobile units operating in 22 states since its founding.

Save the Storks has grown at an even faster pace and with a bit more transparency. As of 2021, Save the Storks claims to maintain a fleet of over 60 AAC mobile units operating in 27 states. To fund this, in 2020 alone, Save the Storks claims to have distributed nearly $2 million in grants for “Stork Buses.” For context, Save the Storks awarded less than $200,000 in grants for brick-and-mortar AACs that same year. Clearly, the organization views AAC mobile units as a priority in which to invest. Financial documents show that many of the AACs receiving grant money from Save the Storks are affiliates of the massive AAC networks Care Net, Heartbeat International and NIFLA. Save the Storks also helped sponsor Care Net’s and Heartbeat International’s annual conferences, suggesting that partnerships exist between these groups.

Between ICU Mobile and Save the Storks, at least 100 AAC mobile units were accounted for in 2021, but CLI claims that more than 120 were in operation nationwide. Since these metrics are self-reported and these organizations regularly subcontract with AACs, it is difficult to understand what level of regulatory accountability — if any — exists for these mobile units. Just like their brick-and-mortar counterparts, AAC mobile units continue to spread their harm unchecked.

This graphic was made using the LittleSis Oligrapher tool. 

"Earn While You Learn" Programs


While AACs love to inflate their mission as altruistic support for pregnant people, what they do not love to advertise is that this “support” is often conditional. Many AACs try to promote their “pro-life” bona fides by claiming to offer material goods such as diapers, baby clothes, baby food and other supplies that parents may need. However, pregnant people are typically only given access to these supplies upon completion of some version of “parenting classes” at AACs. Individual AACs or networks may decide which exact curricula packages to purchase, but the substance of the classes is frequently religious, sexist and paternalizing in nature. What is worse, these programs are often implemented by AACs using money from the federal Temporary Assistance for Needy Families (TANF) program. Money in this program is intended to distribute cash aid to families in need of financial assistance. So, instead of the money going directly to pregnant people or families — who are best suited to determine how to spend money for their own needs — they must take unnecessary and patronizing steps to receive the material goods offered as assistance through these programs. With the prerequisite of these often religious “classes” in pursuit of state-based aid, this also directly calls into question the separation of church and state.

How Did AACs Begin Using "Earn While You Learn" Programs?

It is a bit hard to pinpoint a single origin for these parenting programs. Future research may clarify the origins of this tactic. From what this research has been able to unearth, however, a group called Earn While You Learn (EWYL) seems to be a prominent and vocal propagator of this tactic. The organization stemmed from Dinah Monahan’s work in founding and running AACs in Arizona. Monahan claims that her AACs were handing out plenty of free supplies to parents in need but that their parenting classes were not well attended. So, to lure pregnant people to their deceptive classes, Monahan tied receipt of supplies to class attendance. After a year of doing so, Monahan’s AAC devised a complete curriculum for its classes. The program is set up so that once a pregnant person completes courses, they receive “Mommy Money,” which can be used to “purchase” necessary pregnancy and baby supplies at the “Mommy Store.”

The curriculum Monahan developed is full of concerning misinformation, biased assumptions and religious evangelizing. EWYL uses harmful language to lean into their and other AACs’ abuse of TANF dollars — claiming to shift “the paradigms for a generation that has grown up on handouts.” This language is rooted in racist and classist stereotypes that disparage parents for their use of government assistance. The director of North Carolina’s A2A program explicitly doubled down on these prejudices when discussing the ethos behind the state’s use of EWYL, referring to parents seeking help in moments of need as coming from “culture[s]…that are very effective at manipulating and being users.” This line of thought is a common narrative among AACs, which parade as “charitable altruists,” when, in reality, they often operate under a white savior complex while targeting communities of color and poor people with their problematic curriculum. These dynamics remain true despite the ironic reality that AACs themselves often rely on government funding to pay their staff and fund overhead costs — money that is truly meant to directly supply cash assistance to (expecting) parents in need.

Of course, their view of parents in need is limited to two heterosexual parents — in fact, EWYL allows parents to earn more money for dual attendance, depriving single parents of equal benefits. The curriculum is rife with religious proselytization, which EWYL hopes “creates openings for the counselor to share Christ” and “provid[es] the Truth that the Bible teaches.” In its “Authentic Manhood” program, EWYL preaches rigidly gendered and sexist ideas about manhood, based on “God’s design for men,” and advises that “Daddy Dollars” at AACs be put toward tools and sporting goods, rather than actual parenting supplies.

In its "Authentic Manhood" program, Earn While You Learn preaches rigidly gendered and sexist ideas about manhood, based on "God's design for men," and advises "Daddy Dollars" at AACs being put toward tools and sporting goods, rather than actual parenting supplies.

How Has "EWYL" Spread Across the AAC Movement?

What can be gleaned about EWYL’s spread is concerning. To start, the organization publishes its lengthy anti-abortion curriculum through Heritage House ’76, a company run by Mike Monahan, who happens to be married to Dinah. Essentially, the Monahans have created a “non-profit” business model that shifts money back and forth between their two entities, allowing the couple to mutually benefit from the harm they perpetrate. EWYL claims that its curriculum is currently in use at more than 700 AACs. If true, this would represent nearly one-third of all known AACs nationwide. And although it is difficult to track exactly which AACs are using the program, in 2019, Equity Forward’s partner Progress Florida obtained records showing that Florida Pregnancy Care Network (the administrator of Florida’s A2A program) used ‘several years [of] state funds’ to purchase Earn While You Learn curriculum.”

These public records were obtained by Progress Florida in 2018-19 and used here with permission. Read more about Florida's A2A program in this 2021 Floridians for Reproductive Freedom Report.

As mentioned above, North Carolina’s Carolina Pregnancy Care Fellowship also put funds toward purchasing the EWYL curriculum to offer it to AACs in the state. Additionally, some Heartbeat International and Care Net affiliates are known to have adopted the program, suggesting potential connections between these organizations. It is not just AACs that may be spreading this tactic, however. EWYL encourages anti-abortion doctors, businesses, churches and even individual staff at local Women, Infants, and Children (WIC) offices to distribute “Mommy Money” for attendance at approved classes, events or appointments. Much of EWYL’s curriculum has been translated to Spanish, vastly expanding the potential reach of its dangerous practices.

This graphic was made using the LittleSis Oligrapher tool. 


If you are having a hard time following all the connections, you are not the only one! It is by design. Anti-abortion organizations are so interconnected and coordinated in their work that it is sometimes hard to distinguish one from the other. To visually represent these entanglements, we used Little Sis’ interactive mapping tool, the Oligrapher. Click here to look at all the connections discussed in this analysis and make sure to click on each node to learn more about each organization and further connections it may have.


It is abundantly clear that AACs are not the compassionate centers supporting pregnant people that they market themselves as. Rather, they serve as a sinister tool for a highly coordinated anti-rights movement that both implements that movement’s harmful policies and markets messages of shame to pregnant people all over. These dangerous forces operate out of the same playbook when it comes to the propping up of AACs. While some groups are explicitly synced with one another, some are sharing and cherry-picking individual tactics and others are taking inspiration from what has been done and taking it as far as they can. This report has laid out some of these tactics and their interconnected nature as they specifically relate to the proliferation of AACs in recent years.

Because the anti-abortion movement is in every city of every state across this country, it is important to note that this report is not exhaustive. The siphoning of TANF funding for AAC use, for example — a tactic shepherded around the country by AAC network Real Alternatives — was not discussed here, as it was covered at length in Equity Forward’s recent report “Mapping Deception.” Other tactics likely exist, and many more connections among the anti-abortion networks and individuals running them surely do; only main players and illustrative examples were included in this report for the sake of brevity. A future, much longer report might build on those included here to show how many more people and organizations are coordinated in this attack on the human right to have control over one’s own body.

AACs knowingly prey on people at crucial times in their lives. When pregnant people seek the healthcare they need and are entitled to access, they need to know that they will receive comprehensive, accurate, safe and compassionate care. AACs provide none of this — and they know that. While right-wing interests like AACs have been especially buoyed in recent years, these organizations have seen massive growth with no accountability. And — like many right-wing attacks on human rights — these efforts are at the very least shopped around from person to person, from organization to organization, and are oftentimes explicitly proliferated through joint ventures, all at the expense of the health, wellbeing and safety of pregnant people. It is time to treat AAC networks and the organizations supporting them as what they truly are — highly coordinated, well-funded, targeted attacks on human rights.


Jack Dobkin (he/him) is a research associate at Equity Forward. He is a passionate advocate for reproductive justice and human rights, with a particular interest in LGBTQIA+ communities. Before joining Equity Forward, Jack worked in queer advocacy, with a focus on LGBTQIA+ communities across the Southern United States, and also worked as an organizer for both national and municipal progressive political campaigns. Jack holds a bachelor’s degree in international politics from Georgetown University.

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