Miss Marsharne Sullivan is standing in the lobby of the Pregnancy Care Center in downtown Jonesboro, Georgia, during a recent October afternoon, when a young woman in trendy overalls walks through the door. She announces that she’s here for a pregnancy test, and she doesn’t look thrilled to be needing one.

Sullivan hands her a clipboard and gestures toward a floral-print upholstered armchair. As the woman fills out the paperwork, Sullivan, the center’s 29-year-old assistant director, sits down next to her. “Did you come from work?” she asks, her voice calm and honey-dipped. “Have you been stressed out?”

The woman fiddles with the pen and bounces her foot on the gray Berber carpet. She has little ones at home. “I always wanted more,” she says. “I just wanted them… later.”

It’s not clear how the woman wound up at the center. Maybe she Googled “unexpected pregnancy Jonesboro” and went to the first place that came up. Maybe she found the clinic’s Facebook page or watched its dramatized video of young women like her, who are worried and unsure whether they’re capable of caring for a baby. Or maybe she got the center’s phone number off the billboard that looms over the Waffle House on the boulevard just beyond the bail bonds shop. The sign reads “Free Pregnancy Testing” in massive type next to a black-and-white photo of an anxious young woman, her eyebrows knit in a grimace.

Sullivan collects the clipboard and ushers the woman down the hall toward a bathroom in the back, where the pregnancy tests are kept. While she’s in the bathroom, her eyes might wander to the huge poster hanging across from the toilet, titled “The Amazing Journey from Fertilization to Birth,” filled with detailed descriptions of what’s happening in the womb at each stage of development. Sullivan waits outside in a cramped anteroom, and when the woman comes out, they stand together while the pee stick turns colors. Most of the wall above the sink is occupied by another poster, this one written in the first-person voice of a newborn baby: at one month, “I can smile — even when I’m asleep,” and at two months, “I let you know I’m happy by cooing, squealing, and gurgling.”

Sometimes clients want to keep the pregnancy test when they find out it’s positive, Sullivan tells me, and sometimes they want to throw it away. “It depends on their emotions,” she says.

She ushers the woman into the center’s counseling room, which she calls “a sacred space.” Sullivan has “seen the hand of God move” in that room, and she says her clients have too.

“It’s our job to just guide them, to be a beacon of light in the darkness.”

“Some are young, in high school, and they realize they’ve made poor decisions, and they try to figure out, ‘Where do I start? Where do I go from here?’” she says. “I’ve had clients who may feel a certain way, but when they went into the room, they’ve had a change of heart.” Maybe it’s the cute little knit baby hat Sullivan hands them when they walk in or the tiny plastic fetuses she encourages them to touch and hold to connect with the life she knows is already growing in their womb.

“It’s our job to just guide them, to be a beacon of light in the darkness,” Sullivan says.

Ostensibly, women facing unexpected pregnancies come to this center to learn about their options — abortion, adoption, carrying the pregnancy to term — but if Sullivan is doing her job, the young woman in the overalls will leave the counseling room with abortion firmly crossed off the list. That’s because the Pregnancy Care Center of Jonesboro is not, in fact, a health clinic. It’s a Christian ministry run by staff and volunteers affiliated with the nearby Baptist church. Aside from its mission of spreading the gospel to the majority-black city of 5,000 people, where more than one-third of households receive food stamps, the center exists to talk women out of having an abortion.

The Pregnancy Care Center is one of more than 2,500 throughout the United States, all part of a sophisticated long game by anti-abortion and mostly faith-based groups to severely limit abortion access in the country. Dubbed “crisis pregnancy centers” (CPCs) or “pregnancy resource centers” (PRCs), they outnumber actual abortion clinics three to one nationwide. In Georgia, a state with as few as nine abortion providers, according to the National Abortion Federation, there are more than 90 CPCs. Critics say these often unlicensed and unregulated centers are dangerous, feeding women false and misleading information that keeps them from making informed decisions about their pregnancies.

Though CPCs are not a new phenomenon — they’ve been around since before Roe v. Wade — they’re stronger, more marketing savvy, and better funded than before, even collecting more than $40 million in taxpayer dollars from governments in at least 14 states in 2018 — an unprecedented amount of public financial support. These changes are allowing a new generation of CPCs to enter the digital age and attract more women with well-designed websites, savvy search strategies, and social media campaigns. An annual conference of CPC leaders held in September included sessions like “Facebook Advertising Demystified” and “Reaching Millennials: Leveraging the Power of Social Media.” Marketing agencies, like Choose Life Marketing, which was founded in 2016, work specifically with CPCs to hone their branding and social media tactics as a way to help the clinics “further their mission of helping abortion-vulnerable women choose life.”

The movement also notched an important win this summer, when the Supreme Court struck down a California law that would’ve required CPCs to inform patients about free and low-cost abortion providers in their area. With Brett Kavanaugh on the bench, paving the way for a potential overturn of Roe, CPCs and their defenders could be one step closer to winning the abortion war.

Miss Kaitlyn, as she’s called by staff, hates the billboard — and not just because it’s expensive. Kaitlyn Crussel, the Pregnancy Care Center director, doesn’t like that the woman in the photo looks so despondent, because her center is trying to bring hope and light.

As Sullivan sweeps her client into the counseling room and closes the door, I sit down for a chat with Crussel, whose messy topknot and baby face make her look even younger than her 24 years. She got the job when she was just 22, fresh out of a bible college in Knoxville, Tennessee. She originally applied for the assistant position, afraid of taking on so much responsibility so young. But when the retiring director, Miss Sheila, called to offer her the top spot, she figured it was God’s will.

Crussel’s had the job for just a year and a half, but the center’s been around longer than she’s been alive. With its overt religious agenda and relatively limited services, the center represents an older model for CPCs. That billboard she dislikes so much? That’s considered a dated CPC marketing strategy. Many new-school centers rely on subtlety and have become nearly indistinguishable from traditional women’s health clinics, complete with ultrasound machines and sonographers in scrubs. This center isn’t licensed for ultrasounds (though it does have a machine), but more than 70 percent of CPCs now offer them, according to a recent survey by the anti-abortion Charlotte Lozier Institute.

Crussel guesses she was the youngest director in attendance at this year’s annual Care Net conference in Atlanta, which spotlighted strategies for updating CPCs for the 21st century. (Most centers are affiliated with one of three nationwide networks: Care Net, Heartbeat International, and the National Institute of Family and Life Advocates (NIFLA).) Held in September, the conference attracted some 1,300 CPC staffers from across the country with sessions like “Creating an Effective Google Adwords Campaign” and workshops on how to engage millennials with social media or how to use ads on Facebook to reach target audiences. Attendees learned that people facing unintended pregnancies search for answers online, and Google Adwords is the best way to “maximize your exposure and connect with individuals as they seek answers.” There were how-to sessions on creating landing pages for clinic websites and using blog posts to improve the performance of Adwords campaigns.

“We have come a long way from depending on ‘free pregnancy tests’ signage to medical services and beyond,” reads the description for a talk titled “Simple Steps to Reach the Abortion Determined.” There was a session devoted to counseling clients on something called “secondary virginity,” and another on the purported link between breast cancer and abortion, a claim endlessly repeated in anti-abortion circles and one that the American Cancer Society says is not supported by evidence. There were also workshops that promised to teach attendees to spot possible miscarriages and ectopic pregnancies on a sonogram, including how to “interpret the normal and abnormal appearance and location of the gestational sac, yolk, and heartbeat.” (When asked if someone could learn this process in a single 90-minute workshop, one sonographer I consulted called the idea “insane.”)

“Over time, we’ve seen more crisis pregnancy centers describing themselves as medical facilities or sexual health clinics,” says Andrea Swartzendruber, an epidemiologist at the University of Georgia who has studied CPCs. “They’re becoming more medicalized, and they are pretty savvy in terms of their marketing.”

The website for Crussel and Sullivan’s center makes no secret of its “Christ-centered ministry,” but many others have begun to scrub all religious content from their online presence. Some are so indistinguishable from clinics that do provide abortion that even Crussel can’t tell the difference. When I ask her to pull up the website of one Atlanta-area CPC — whose homepage reads, “Want an Abortion? Schedule an Appointment Today!” — she looks perplexed.

“You’re sure they don’t do abortions?” she asks, mousing through page after page of medical-looking content on STI tests, abortion, and emergency contraception. When I tell her the clinic is actually operated by a religious group, she looks relieved, though the name of its Christian parent organization — A Beacon of Hope — isn’t mentioned anywhere. A Beacon of Hope’s homepage, however, maintains a “Babies Saved!” log. Current tally: 7,366.

More than half of all CPC websites in Georgia do not make it clear that they don’t provide or refer for abortion, according to Swartzendruber’s 2018 research, and 53 percent include false or misleading statements about links between abortion and mental health problems or breast cancer. In September, Swartzendruber published a map identifying 2,537 crisis pregnancy centers across the United States to help women tell the difference between CPCs and traditional health clinics. “Crisis pregnancy centers do not provide prenatal care, abortion, or contraception, although they sometimes give the appearance that they provide those services,” she says.

Many CPCs set up shop near college campuses and medical clinics, including those that provide abortions. “These centers open literally across the street from our centers in an effort to delay women’s access to care,” says Staci Fox, president of Planned Parenthood Southeast. “Patients are getting inaccurate information about whether or not they’re pregnant, where they are gestationally in their pregnancy, and what their options are based on that information.”

“Women deserve access to accurate, unbiased health care, and these fake health centers don’t provide that.”

Crussel says it doesn’t sit well with her, either. “I don’t want somebody to come in here and say, ‘I saw on your website that you’re a women’s center, so do you [do abortions]?” she says. “We are a Christian-based organization. We talk about the Bible. We do share scripture. If that offends you, like, let us know.”

She says her center supports women even after they give birth and leads me to a smaller building out back, which they call the clothes closet. Inside, there are racks upon racks of onesies, shelves lined with baby bathtubs and wipes, plastic storage bins bursting with clothes for newborns, infants, and toddlers — all available to new parents who participate in the center’s Earn While You Learn program. Clients can accrue “baby bucks” — some centers call them “mommy money” or “daddy dollars” — by watching religious parenting DVDs and filling out accompanying worksheets to redeem credits for the closet. Formula costs $4 in baby bucks; wipes are 50 cents. After two or three visits, parents might have enough bucks to “buy” a car seat.

“We tell all our clients on the intake forms, ‘All this stuff has God in it,’” Crussel warns. “A lot of the time, they don’t care. They’re like, ‘It’s fine.’”

Sullivan knows firsthand the magic the clothes closet can work on a woman who is, in industry-speak, “abortion-minded.” She tells me about a client who came in adamant about needing an abortion because of her financial situation. Sullivan told the woman she respected her decision but asked her to visit the clothes closet before she left. When she saw the baby supplies the center was offering, “she was a completely different person,” Sullivan says. “Her face of sorrow turned into a face of sunshine.”

The Earn While You Learn DVDs cover topics ranging from “Bonding with Your Unborn Baby” to shopping for a car and are often paired with Bible study. Because the materials have not, to Swartzendruber’s knowledge, been evaluated for effectiveness, the researcher worries that these programs are suspect at best and manipulative at worst. “If you earn points in order to get resources related to childbearing, I think some would view that as coercive,” she says.

The DVDs come from Heritage House, a company that supplies CPCs with everything from pregnancy tests to the kinds of plastic uteri that Sullivan uses to convince her clients not to “kill their babies.” That’s the language used to describe abortion procedures in the pamphlets on display in the Pregnancy Care Center’s lobby, also supplied by Heritage House, whose website claims the content is “Physician Approved.” A brochure titled “What Does a Baby Feel During an Abortion?” ($220 per box of 1,000) strongly implies that a fetus can feel pain as early as six weeks, though the Journal of the American Medical Association found little evidence to support such a claim. Other flyers address the symptoms of “post-abortion trauma,” a condition academics have concluded “does not exist.”

If a center wishes to purchase the entire 44-module Earn While You Learn program, they can do so for $7,499. Firms like Heritage House appear to be making a tidy sum supplying CPCs with anti-abortion propaganda, but the funds that power this growing industry are increasingly coming from an unexpected source: public coffers.

Four days after I visit Crussel’s pregnancy care center, the Senate would confirm Brett Kavanaugh’s nomination to the Supreme Court, prompting worries from abortion-rights activists that Roe v. Wade may once again be in the crosshairs.

If Roe is overturned, abortion regulation will revert to the states, 14 of which have laws on the books that could ban most abortions overnight. Many more have conservative-leaning legislatures that would be unlikely to protect abortion in the absence of a federal law. In Georgia, where upwards of 96 percent of counties already have no abortion providers, Republican gubernatorial candidate Brian Kemp has vowed, if elected, to pass the tightest abortion restrictions in the nation.

Kavanaugh’s confirmation could signal a big win for the anti-abortion crowd, but things didn’t always look so rosy for CPCs. The industry suffered a blow in 2015, when California passed the FACT Act, which required both licensed health care facilities and nonmedical reproductive counseling centers to post a notice informing clients of the availability of free or low-cost abortions, contraception, and prenatal care. NIFLA, a CPC network, sued the state, arguing that the law infringed on centers’ free speech, but lost its appeal at the Ninth Circuit. In June of this year, the Supreme Court struck down the lower court’s ruling in an opinion authored by Clarence Thomas, who sided with the pregnancy centers in finding that the California law violated their First Amendment rights.

Crussel and Sullivan haven’t had time to keep up with politics. They’ve been busy preparing for their big fundraising banquet in October. The center relies on donations to fund their part-time salaries and that of another part-time marketing employee. Additional money comes from the sale of “Choose Life” license plates, which drivers in 32 states and the District of Columbia can purchase through their local DMV.

Just over a dozen Georgia CPCs — including the one that fooled Crussel — also get support from state taxpayers, thanks to a 2016 bill that allocated $2 million in public funding to what lawmakers call “positive alternative” pregnancy centers. Several states have made similar moves, including Texas, which just upped its original $5 million commitment to CPCs to nearly $40 million over the next two years. Many centers also receive federal grant money for providing abstinence-only sex education.

Critics worry about the lack of government oversight to ensure that these centers don’t misuse funds or distribute bad information. The nonprofit publication Rewire.News found that some CPCs use federal money to buy those pricey Earn While You Learn DVDs, while Georgia’s Department of Public Health hired an anti-abortion Christian organization to oversee its new CPC fund.

“The fox is guarding the henhouse,” says Megan Gordon, public affairs coordinator and lobbyist for Atlanta’s Feminist Women’s Health Center.

It’s unclear what might happen to CPCs if Roe v. Wade is overturned or weakened. One center director wondered privately if she and others in her position would be out of a job. Others think CPCs would flourish, whether that means redoubling their efforts in abortion-friendly states or continuing their work in places like Georgia, where women could lose the right to choose entirely. Crussel, for her part, says she fears a potential backlash from the dominant pro-choice culture but welcomes a world in which abortion is no longer an option for most women: “What a perfect opportunity for Christians to have the hands and feet of Jesus.”

The fate of CPCs in a post-Roe landscape is not something Planned Parenthood’s Staci Fox wants to spend time pondering. “Women deserve access to accurate, unbiased health care, and these fake health centers don’t provide that,” she says flatly. “Women deserve better.”

Nearly an hour after arriving at the center, the woman in the overalls is still in the counseling room with Sullivan. I ask Crussel whether clients like the woman are also counseled on, say, the risks of carrying a pregnancy to term — especially in Georgia, which has one of the highest maternal mortality rates in the country. Overall, the United States leads the developed world in maternal deaths. The numbers are considerably worse for black women. There are no pamphlets about this in the lobby.

Crussel says she doesn’t feel qualified to talk to women about things like that. They should probably discuss it with a doctor, she says. On that point, if nothing else, Crussel and Planned Parenthood agree.