Pregnancy Help Organizations (PHOs) are nonprofit organizations that hold a pro-life viewpoint and seek to provide a range of services to women and men facing unintended pregnancies. Support services range from pregnancy testing, to material assistance, to parental education, to sexual risk avoidance (SRA) education, to housing assistance and more. PHOs include subset organizations. The subset organizations primarily include pregnancy help centers (PHCs), maternity homes, adoption agencies, and non-profit life-affirming social services agencies providing material support and other assistance to individuals facing an unintended pregnancy. Most are faith-based and provide services at no cost to their clients.
Pregnancy Help Centers (PHCs) have traditionally been known as “crisis pregnancy centers.” Today PHCs may be referred to as “pregnancy resource centers,” “pregnancy care centers,” “pregnancy medical clinics,” or simply “pregnancy centers.” They are typically faith-based, non-profit entities, offering pregnancy options counseling, community referrals, obstetrical ultrasound, STI testing, pregnancy tests, sexual risk avoidance education, parenting education, material assistance and/or community referrals. These services are generally provided at no cost to clients. These constitute the largest sub-category of PHOs. They are typically, but not necessarily affiliated with one or more umbrella organizations such as Heartbeat International, Care Net, NIFLA and/or Birthright.
Adoption Agencies are another subcategory of PHOs. Adoption Agencies are organization licensed and formed for the purpose of placing children into the homes of non-biological parents willing to serve as their permanent legal parents. Non-biological parents assume all legal responsibilities, with their adopted child(ren) gaining the same status and privileges as a biological child, including inheritance rights.
Pro-life Social Service Organizations are organizations, typically not-for-profit, that provide services at low or no cost to qualifying individuals. Services may be material (e.g., baby clothes, furniture, diapers), educational (e.g. parenting classes, sexual risk avoidance education), or supportive (spiritual counseling, referrals). Examples of such organizations include but are not necessarily limited to Catholic Charities and Lutheran Social Services.
Maternity Homes constitute housing programs of different varieties that provide housing services to pregnant women. Many offer additional supportive services, such as parental education or childcare.
Maternity housing can take several forms. The National Maternity and Housing Coalition classifies maternity homes into four general classifications:
- Live-In House Parents: “A couple or family lives in a home with a high degree of authority and folds mothers into family life.”
- Live-In Staff: “Staff members live with moms, sharing a common life.”
- Rotating/Shift Staff: “Various levels of staff work in shifts within a 24-hour period without living in the home.”
- Shepherding/Host Homes: “An entity serves as a bridge between pregnant women and host home.”
The modern model of maternity housing is moving away from host homes and the shepherding home model and into group housing with trained staff, including social workers and counselors.
PHOs IN DETAIL
PHOs, which include four sub-categories—pregnancy centers, maternity homes, adoption agencies, and life-affirming social service organizations—have held a continual presence in the United States for over a century. According to the Worldwide Directory of Pregnancy Help, which is published and maintained by Heartbeat International, there are 4,103 PHOs within the United States. While services and models may vary, PHOs are generally nonprofit organizations (some through church associations, others as 501(c)(3) entities); typically faith-based, although not necessarily Christian. For example, “In Shifra’s Arms” is a life-affirming Jewish organization that provides options counseling and other services for pregnant women of all faiths. Their mission is “to nurture women and help them create a positive future for themselves and their children.” In Shifra’s Arms does not make direct referrals for abortion. Typically PHOs operate under an independent board of directors. Many are primarily volunteer-manned.
- Pregnancy Help Centers (PHCs)
Pregnancy Help Centers constitute the largest subset of PHOs. PHCs began in 1968, with the opening of Birthright in Toronto, Canada. Between 1969-1970 Birthright centers were opening in the United States, with locations in Atlanta and Chicago. In May 1971, “Lifeline,” a pregnancy counseling hotline was opened in Los Angeles and received 759 calls for the remainder of that year. In 1971, the Alternatives to Abortion International (now “Heartbeat International”), an affiliation organization for PHOs, was established in Ohio, consolidating the then 60-70 pregnancy testing centers and hotlines. Others soon followed. In 1980, the Evangelical Christian Action Council (now “Care Net”) opened its first pregnancy center in Baltimore, Maryland. As the need for quality and unbiased medical services grew, the National Institute of Family and Life Advocates (NIFLA) was founded in 1993 to pioneer medical conversion of pregnancy help centers. To date, there are numerous pregnancy center affiliation organizations within the United States offering varying models to suit community needs.
As of 2019, an estimated 2,700 pregnancy centers are located in all 50 of the U.S. States and Washington D.C. These pregnancy centers provided numerous services to over 1,848,376 clients, at little or no cost, totaling an estimated $266 million. These services included, but were not limited to:
- Consulting with 967,251 new clients
- Providing 731,884 free pregnancy tests
- Performing 486,213 free ultrasounds
- Providing 160,201 tests for sexually transmitted infections
- Distributing over 4 million free baby items
- Maternity Homes
Maternity homes constitute the longest-standing subset of PHOs in the United States. The Salvation Army opened the first maternity home, then called a “home for unwed mothers” in 1886. During the early 1900s, the Jewish Maternity Hospital was opened in New York City’s Lower East Side. For most of their history, maternity homes were typically institutionalized and hidden, caring for women who intended to place their child(ren) for adoption. The modern model of maternity housing is significantly different, offering a family-style environment with supplemental support for women who choose to parent or place for adoption. As maternity housing evolved with the legalization of abortion, married couples often took in homeless pregnant women in a housing model typically referred to as “Shepherding Homes.”
In the 1970s, Jim and Anne Pierson helped develop a more modern model for maternity homes. Following an encounter with a young college-aged woman—who was the victim of rape and in need of housing—the Piersons became acutely aware of the need to locate housing for homeless pregnant women as part of the overall need to serve women within the pro-life movement. In response to this crisis, the Piersons housed the young woman who ultimately placed her child for adoption. Motivated by this experience, the Piersons opened their first maternity home in Lancaster, Pennsylvania shortly thereafter.
In 1984, the Piersons expanded their outreach and started Loving and Caring, Inc., a life-affirming non-profit that provides “materials and services to agencies and Christian ministries which serve teen moms, single parents, and families affected by crisis pregnancy” to over 5,000 ministries, organizations, and individuals. During this time, President Ronald Reagan praised the efforts of Loving and Caring, Inc. in a speech, bringing more recognition to the evolving maternity home movement. 
It is currently estimated that there are some 400 maternity housing locations throughout the United States, serving approximately 1,800 adult women. Some homes are small with one to two women. Others are large with twenty women or more. Most allow women to stay after giving birth. The average length of time a woman is allowed to stay is estimated to be eight (8) months post-birth.
The modern model also seeks to care for women beyond just their temporary housing needs. Today, most maternity homes offer educational services, counseling services, job assistance and other resources to help women, whether they place their child for adoption or choose to parent. Moving forward leaders of the modern maternity home movement would like to see increased maternity home options for women, including post-birth transitional housing for both mothers who parent and those who place for adoption. Maternity homes may be recipients of various forms of government funding.
- Adoption Agencies
Adoption Agencies are another category of PHOs. Heartbeat International has a number of affiliates that are licensed adoption agencies, such as Bethany Christian Services. There are an estimated 3,000 adoption agencies within the United States, including both public and private agencies.
Before 1851, there were no laws in the United States regulating the adoption of children. While many adoptive parents loved and cared for their children, others used adopted children for profit or labor. The tide began to turn in 1851 when Massachusetts enacted the “Adoption of Children Act,” which directed judges to ensure that adoption decrees were “fit and proper.”
Adoptions have evolved significantly since the 1800s. Not only are laws more protective of children, but today adoption agencies also offer a wide range of adoption options and care for birth mothers as well as adoptive families, including infant adoption, foster care adoption, international adoption, pregnancy counseling services, post-adoption support, family counseling, refugee services, housing services, and even embryo adoption.
In 2014, there were 110,373 domestic adoptions within the United States and 5,987 international adoptions (children born outside the United States and adopted by families within the United States). Some sources report that as many as 2 million American couples are waiting to adopt, equating to 36 couples per each child placed for adoption. While many adoption agencies are Christian, popular adoption agencies may also be Jewish (Jewish Children’s Adoption Network), Muslim (New Star Kafala), or Secular (Adoption Options).
Today, many Adoption Agencies are including advocacy and education on becoming a foster parent in addition to their traditional services of placing children with adoptive families. This service is particularly important given the current foster care crisis in the United States. In FY19, 423,997 children in the United States were in foster care. Of these, 122,216 were eligible for adoption, while only 66,035 were placed for adoption. Tragically, when children “age-out” of the foster system, they often face immensely difficult challenges. More than 23,000 children age-out of foster care annually. While 70% hope to attend college, only 3% will actually earn a degree. 25% will fail to earn a high school diploma or equivalent. 60% of boys will be convicted of a crime. 70% of girls will become pregnant by age 21. Tragically, 50% will develop a substance abuse problem. According to Sherry Lachman, “one-third of homeless young adults were previously in foster care.” Horrifically, an estimated 60% of child sex trafficking victims in the U.S. have a history with the child welfare system.
- Pro-life Social Service Organizations
Pro-life Social Service Organizations, such as Catholic Charities and Lutheran Family Services, offer pregnant women material support, parenting education, options counseling, and emotional/spiritual support. Such groups typically have a long history within their communities of offering such support. For example, Catholic Charities has been a consistent provider of practical help to families facing a pregnancy decision since it was founded in 1910. Today it continues provides assistance through 165 local agencies nationwide.
 For a more comprehensive overview of PHOs, see “A Legacy of Life and Love: Pregnancy Centers Stand the Test of Time.” Charlotte Lozier Institute. 2020. Available at: https://lozierinstitute.org/wp-content/uploads/2020/10/Pregnancy-Center-Report-2020_FINAL.pdf (Accessed 21 Oct. 2020.).
 Additional affiliation organizations can be found at Gaul, M. and Bean, M. “1968-2018 A Half Century of Hope: A Legacy of Life and Love.” Page 6. Charlotte Lozier Institute. 2018. Available at: https://s27589.pcdn.co/wp-content/uploads/2018/09/A-Half-Century-of-Hope-A-Legacy-of-Life-and-Love-FULL.pdf (Accessed 4 Dec. 2018).
 “Staffing Approaches for Maternity Homes.” National Maternity Housing Coalition. Available at: https://natlhousingcoalition.org/images/Staffing-Models-for-Maternity-Homes-Oct-2017.pdf. (Accessed 21 Jan. 2019).
 Peterson, Mary, Facilitator and Housing Specialist, National Maternity Housing Coalition. Email to Jeanneane Maxon. 17 Jan. 2019.
 As of June 3, 2020. Available at: https://www.heartbeatinternational.org/index.php?option=com_civicrm&task=civicrm/profile&Itemid=1502&_qf_Search_display=true&qfKey=68b52efb1adb82385d95cec55418be87_4787
 Gaul, M. and Bean, M. “1968-2018 A Half Century of Hope: A Legacy of Life and Love.” Page 11. Charlotte Lozier Institute. 2018. Available at: https://s27589.pcdn.co/wp-content/uploads/2018/09/A-Half-Century-of-Hope-A-Legacy-of-Life-and-Love-FULL.pdf (Accessed 4 Dec. 2018).
 Gaul, M. and Bean, M. “1968-2018 A Half Century of Hope: A Legacy of Life and Love.” Page 4. Charlotte Lozier Institute. 2018. Available at: https://s7589.pcdn.co/wp-content/uploads/2018/09/A-Half-Century-of-Hope-A-Legacy-of-Life-and-Love-FULL.pdf (Accessed 24 Oct. 2018).
 Gaul & Bean, pgs 5-6.
 Gaul & Bean, pg. 6.
 A list of these groups can be found at Gaul & Bean, pg. 6.
 “A Legacy of Life and Love: Pregnancy Centers Stand the Test of Time.” The Charlotte Lozier Institute. 2020. pg. 16. Available at: https://lozierinstitute.org/wp-content/uploads/2020/10/Pregnancy-Center-Report-2020_FINAL.pdf (Accessed 21 Oct. 2020).
 Ibid. pgs. 16, 24.
 Ibid. pg. 16.
 Mansnerus, Laura. “COMMUNITY; No Shame, but Plenty of Need, at Home for Unwed Mothers.” The New York Times. 15 Feb. 1998. Available at: https://www.nytimes.com/1998/02/15/nyregion/community-no-shame-but-plenty-of-need-at-home-for-unwed-mothers.html (Accessed 30 November 2018).
 “Jewish Maternity Hospital (New York, N.Y.) Patient Registers, 1921-1933.” Historical Note. Ichan School of Medicine at Mount Sinai. Available at: https://icahn.mssm.edu/about/ait/archives/collection/jewish-maternity. (Accessed 30 Nov. 2018).
 Peterson, Mary. Facilitator and Housing Specialist, National Maternity Housing Coalition. Personal Interview. 9 Jan. 2019.
 Pierson, Anne, Director of Ministry Service, Loving and Caring. Personal Interview. 1 Jan. 2019.
 Ministry Overview. Loving and Caring. 2019. Available at: https://lovingandcaring.org/about-us/ministry-overview (Accessed 14 Jan. 2019).
 Peterson, Mary, Facilitator and Housing Specialist, National Maternity Housing Coalition. Email to Jeanneane Maxon. 3 Jan. 2019.
 Peterson, Mary, Facilitator and Housing Specialist, National Maternity Housing Coalition. Personal Interview. 9 Jan. 2019.
 Peterson, Mary, Facilitator and Housing Specialist, National Maternity Housing Coalition. Personal Interview. 9 Jan. 2019. and Pierson, Anne, Director of Ministry Service, Loving and Caring. Personal Interview. 1 Jan. 2019.
 “Agency Adoptions.” Nolo. 2018. Available at: https://www.nolo.com/legal-encyclopedia/agency-adoptions-29896.html (Accessed 4 Dec. 2018).
 “What you need to know about the history of adoption.” American Adoptions. 2019. Available at: https://www.americanadoptions.com/adoption/history-of-adoption (Accessed 17 Jan. 2019).
 “Adoption: By the Numbers: A Comprehensive Report of U.S. Adoption Statistics.” National Council for Adoption. 2017. Available at: https://indd.adobe.com/view/4ae7a823-4140-4f27-961a-cd9f16a5f362 (Accessed 17 January 2019).
 “How Many Couples Are Waiting to Adopt?” American Adoptions. Available at: https://www.americanadoptions.com/pregnant/waiting_adoptive_families (Accessed: 17 January 2019).
 See “The urgent need for foster families in the U.S.” Bethany Christian Services. Available at: https://bethany.org/help-a-child/foster-care/us-foster-care (Accessed 4 Feb 2020).
 “The AFCARS Report: Preliminary FY 2019 estimates as of June 23, 2020 – No. 27.” U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Available at: https://www.acf.hhs.gov/sites/default/files/documents/cb/afcarsreport27.pdf (Accessed 1 May 2021).
 “Infographic: What Happens When Kids Age Out of Foster Care?” Staff Contributor. Children’s Home Society of Minnesota. Lutheran Social Service of Minnesota. 23 Jan. 2019. Available at: https://chlss.org/blog/infographic-what-happens-when-kids-age-out-of-foster-care/
(Accessed 4 Feb. 2020).
 Founder and Executive Director of Foster America and a former domestic policy adviser to Vice President Joe Biden.
 Lachman, S. “The Opioid Plague’s Youngest Victims: Children in Foster Care.” The New York Times. 28 Dec. 2017. Available at: https://www.nytimes.com/2017/12/28/opinion/opioid-crisis-children-foster-care.html (Accessed 4 Feb. 2020).
 “SEX TRAFFICKING: Sex and human trafficking in the U.S. disproportionately affects foster youth.” National Foster Youth Institute. Available at: https://www.nfyi.org/issues/sex-trafficking/. (Accessed: 4 Feb. 2020).
 See e.g., Catholic Charities Dallas. https://ccdallas.org/need-help/children-family-senior-services/pregnancy-adoption/pregnancy-services (Accessed 4 December 2018).
 “Our History.” Catholic Charities USA. 2018. Available at: https://www.catholiccharitiesusa.org/about-us/history (Accessed 30 Nov. 2018).