Say I found out I was pregnant — I didn't mean to be, and I'm not quite sure what I'm going to do about it.
I see an ad on the Internet, maybe, or in a newspaper for an organization called Real Alternatives. The ad promises "free pregnancy support services" and lists a hot-line number, 888-LIFE-AID, which I call.
Someone on the other end refers me to a social-service agency in Philadelphia — which is one of dozens across Pennsylvania, all of which are part of a network that receives state funding.
On a recent, asphalt-bubbling hot day, I go. I tell a receptionist at the agency that I'm expecting — even though, in truth, I'm not.
The receptionist says a "counselor" will speak with me over the phone, and leads me into a private room. I tell the woman on the other end that I'm considering an abortion, mostly because I'm young and not yet financially secure. She is tender but stern. She says that if I have an abortion, "Psychologically, you're never going to forget. You're taking a life."
She tells me that abortion often leads to depression — a claim that has been refuted by the American Psychological Association, which concluded in 2008 that a single abortion is "not a threat to women's mental health," and in fact, poses no greater a risk than delivering a baby.
She also informs me that "proven facts" show that abortion can "interfere with having other children," another theory rejected by medical science. The Guttmacher Institute reported in 2007 that the "overwhelming scientific consensus" is that an early abortion "poses virtually no long-term risk of infertility."
Before we part ways, she reminds me again, "Whatever decision you make is going to be with you for the rest of your life."
"Counseling" like this (some call it advocacy) is administered across Pennsylvania, all by one organization: Real Alternatives, a staunch and vocally anti-abortion nonprofit whose stated mission is to show women that "childbirth is a viable alternative to having to submit to an abortion that they really do not want in the first place."
Groups like Real Alternatives exist throughout the country, mostly funded by anti-abortion organizations like Heartbeat International and individual donations. Real Alternatives, though, is funded almost entirely by the state of Pennsylvania — financed, that is, by you, the taxpayer, and it has received tens of millions of dollars since 1997.
Just this summer, the Pennsylvania legislature doled out $5.8 million to Real Alternatives, which is not a penny less than last year, giving the organization a special distinction indeed. In a year that saw huge slashes to the state budget — including cuts in AIDS pharmaceutical services, an 18 percent loss in the operating budget of the Department of Environmental Protection, and $1 billion eliminated from schools, among many other cuts — Real Alternatives' budget was left untouched.
In fact, its state funding increased this year by 4 percent.
That money, City Paper has found, goes to pay for part of the $199,000 salary (including benefits) of the CEO of Real Alternatives, who has no medical experience. It also funds an army of hundreds of "counselors," non-medically-qualified personnel whose job it is to dispense the organization's (sometimes outright inaccurate) information — and who, despite lacking the credentials of nurse practitioners or psychologists, cost the state much more per hour for their services than either.
"These aren't counselors," says Democratic state Rep. Dan Frankel. "They are single-issue, anti-abortion activists. They are no different than those folks who carry placards outside of Magee hospital in my district to try to intimidate abortion clinics."
To be sure, in Pennsylvania, state funding goes to organizations on both sides of the debate over abortion. But those organizations that do advocate for abortion rights, like family-planning centers, receive no money for abortions and use state funds only for a slew of medical services, including breast cancer screenings, Pap smears and STD screenings.
Real Alternatives does none of those things. Rather it is, quite proudly, a massive, statewide anti-abortion information campaign. And you're paying for it.
Pennsylvania's generous relationship with Real Alternatives was born out of a compromise.
It was the 1990s, and then-Gov. Robert Casey — who's since been dubbed the "father of pro-life Democrats" — was running the show in Pennsylvania. During his tenure, Casey sparred with President Bill Clinton over abortion issues, was sued by Planned Parenthood, and ultimately tightened the state's abortion policies, even winning some ground before the U.S. Supreme Court. "This is a guy who had fiscal conservatives proudly putting his sign in their front yards," fondly recalls Edel Finnigan, executive director of the Pro-Life Union of Southeastern Pennsylvania.
Since the '60s, hundreds of centers throughout the U.S. have sought to persuade pregnant women not to have abortions, but their work hadn't ever previously been funded by the states. The idea was too controversial: The centers faced bold opposition by the abortion-rights movement and had been called deceptive by the North Dakota Supreme Court, the Texas Attorney General and the Federal Centers for Disease Control.
But Casey, by alternatively wooing anti-abortion Democrats and threatening to cut funding for family-planning services, managed to get a deal struck: For every dollar in the state budget that went to family-planning services, like contraceptives, breast exams and Pap smears, a dollar would go to anti-abortion programs — like Real Alternatives. It was a gentleman's agreement: never put on paper but nonetheless honored like a sacred decree for years.
That's not to say everyone was happy with the arrangement: Dayle Steinberg, president of Planned Parenthood Southeastern Pennsylvania, says it has "always been completely unfair because they're not providing medical services, and we are."
In the wake of this deal, one problem quickly became apparent: The network of anti-abortion programs the state wanted to fund didn't actually exist here. And so the state itself contracted to create it, essentially, from scratch.
In 1995, a 33-year-old man named Kevin Bagatta, who hailed from Long Island, N.Y., answered a newspaper ad seeking a director for a new, state-funded network of crisis pregnancy centers and other anti-abortion agencies. His qualifications: a law degree and a background in government contracting, as well as time in the Air Force, where he was "in charge of nuclear weapons," he said in an interview with City Paper. But Bagatta had no experience at all working in medical or social services.
Still, he landed the job. And in 1997, Real Alternatives opened its doors.
Bagatta, now 49, met with CP recently at the Harrisburg headquarters of Real Alternatives. He has salt-and-pepper hair and is built like a football player. The headquarters' walls are decorated with a Pennsylvania state flag and posters documenting various stages of fetal development. Throughout the meeting, Bagatta spoke passionately of the need for the program. Real Alternatives, he believes, "represents the best in America." It is also "the only program in the state that provides a positive approach to a controversial issue," he said. "You know what that's called? A solution!"
Via a PowerPoint presentation, Bagatta proudly explained that Real Alternatives is revolutionary. In the '90s, it became the first program of its kind in the country to be funded by state dollars, making Pennsylvania revolutionary, too.
Since then, Real Alternatives has grown exponentially. During its first year, the statewide organization received about $2 million in annual public funds, and about 7,440 women visited it. Now it has a $5.8 million state budget and locations in nearly every part of the state, from Erie to Pittsburgh to Oil City to here in Philadelphia, where there are nine sites. In the past year, more than 18,000 women in Pennsylvania utilized its services. In 2005, Real Alternatives even consulted Texas on its fledgling anti-abortion program, on which it now spends about $4 million (a Texan flag now hangs in Real Alternatives' headquarters).
But the heart of the organization, Bagatta cheerily explained, is its counseling. Indeed, the vast majority of the program's state funds go to counseling services, according to invoices obtained by CP. "We're paying for speech," explains Bagatta. "An alternative to abortion is not a pamphlet. It's another person."
Who are these people, exactly?
More than 500 Real Alternatives counselors work throughout Pennsylvania in 97 anti-abortion sites, which include crisis pregnancy centers, maternity homes, adoption agencies and social-service agencies. (Comparatively, there are 20 abortion clinics in the state.) The vast majority of these Real Alternatives locations are Christian-affiliated agencies. The state contracts with Real Alternatives, and then Real Alternatives subcontracts the counseling work to these sites.
These counselors, of course, meet with women privately. But what happens behind those closed doors is not, thanks to documents obtained by CP, a mystery. According to the 2010-12 agreement between Real Alternatives and the state's Public Welfare department, the counselors are contractually required to "maintain a pro-life mission" and "agree not to promote, refer or counsel abortion nor abortifacients as an option" — not even, apparently, to women whose lives are at risk because of their pregnancy. Counselors also must "understand" that their centers are paid not "for the provision, referral or advocacy of contraceptive services, drugs or devices." And they must teach women that abstinence is the "best and only" way of avoiding unplanned pregnancy and sexually transmitted diseases.
Unlike counselors recognized by the National Board for Certified Counselors, who must have a master's degree, the Real Alternatives "counselors" are not required to have any degree at all. He defends this choice, arguing that, "We don't provide medical services. We provide human services."
In addition to their state-mandated requirements of never mentioning abortion as an option and teaching that abstinence in the "best and only" means of preventing pregnancy or STDs, Real Alternatives counselors often tell pregnant women about the "risks" of abortion. These include claims that it causes depression, infertility and breast cancer — information Bagatta calls "facts" that "women need to know" — but which have been deemed untrue by the American Psychological Association, and the Guttmacher and National Cancer institutes, respectively.
"This is a group out to discourage abortion even if they have to lie to people," remarks Democratic state Rep. Babette Josephs, an abortion-rights advocate. "And a panicked, pregnant teenager is likely to readily believe them."
This counseling, it turns out, is not cheap to taxpayers: In the past year, CP has found, the state paid out $4.5 million for counseling services provided by Real Alternatives — including a whopping $63 for every hour of anti-abortion counseling. Comparatively, through Medicaid, it costs the state $20 an hour for a woman to undergo a health screening at a family-planning center, which includes STD testing, a Pap smear and a breast exam, and which is usually performed by a nurse practitioner with an advanced degree. Also through Medicaid, the state reimburses psychologists with doctorates $39 for almost an hour of psychotherapy.
Other CP findings include how much it has cost the state for Real Alternatives to run its hot line 888-LIFE-AID, which receives an average of fewer than two calls a day (at least $28,000 to $40,000 annually, depending on the year); Bagatta's annual salary, including benefits, according to recent tax records ($199,000, though that includes private donations and consulting fees from other anti-abortion, government-funded programs throughout the U.S.); and how much it has cost the state, since July 2008, for Real Alternatives to print "information and training materials," including the pictured brochure "Milestones of Early Life" ($12,000).
Despite its peculiar costs, the program has gone relatively unquestioned by lawmakers and state officials. During the Auditor General's recent damning investigations into the Public Welfare department, it was never audited.
Anti-abortion advocates, like Republican state Rep. Matt Baker, argue that the funds for Real Alternatives are warranted, noting, "The program has served over 189,431 women the last 16 and half years — and that number does not count the babies!"
Others, like Josephs, call the funding levels "shocking" and "wasteful."
However much opponents dislike funding Real Alternatives with taxpayer dollars, there has always been a silver lining: The gentleman's agreement ensured that as long as anti-abortion programs got state dollars, family-planning services would enjoy the same.
Only it's not clear, even as Real Alternatives enjoys almost unheard-of protection in the budget, whether the deal is still being honored on the other side.
For years, as Real Alternatives grew in size, so, too, did family-planning services in Pennsylvania. When Real Alternatives got $4.3 million in state funds in 1999, family-planning services received the same amount; when Real Alternatives got $5.5 million in state funds in 2005, family planning got that, too; and so on.
But that changed in 2008, when, according to lawmakers on both sides of the abortion debate, the state government revised the way it channeled federal dollars to family-planning services. Suddenly, it wasn't so easy to determine if the deal was being honored — and this year, according to Frankel, the Corbett administration made matters even worse. "One of the techniques this administration utilized was, in my view, hiding some of the cuts by collapsing different line items" in budget documents, Frankel says.
In fact, no one — from the state's Public Welfare department to lawmakers to budget analysts to abortion-rights groups — could tell CP exactly how much state funding will go to family-planning services this year, which has led some to speculate that the deal "is dead," as Sue Frietsche, senior staff attorney of the Women's Law Project, put it recently.
Indeed, family-planning providers are closing their doors across the state. In the past year-and-a-half, six Planned Parenthood sites in Pennsylvania have shut down, according to Planned Parenthood's Steinberg. "It's a tragedy," she says of women's decreased access to services like Pap smears and STD screenings in those areas. "It's like taking a two-by-four to poor women."
In the meantime, Bagatta is hustling to bring in even more state funds to Real Alternatives. In the meeting with CP, Bagatta suggested that Real Alternatives deserves not just $5.8 million this year, but $6.7 million.
Turning to right-hand man Thomas Lang, Bagatta allowed himself a momentary fantasy: "Can you imagine what we would look like with $20 million a year?" he asked.
"There would be no abortions!"