What Remains After Roe: The Crisis Pregnancy Center Empire in Appalachia 

For 53 years, the anniversary of Roe v. Wade has held a mirror to the sector. Too often, what it reflects back is the cost of our own silence, absence, and hesitation to invest in abortion access at a scale that the frontlines have long demanded beyond survival and beyond sustainability.

Since 2020, the National Committee for Responsive Philanthropy has worked to move research, resources, and guidance toward abortion access rooted in justice, centered at the state, and local levels, and shaped by those closest to the hurt and work. And still, nearly four years after the Dobbs decision, the limits of research alone have become undeniable. Philanthropy continues to underfund, delay, and constrain the movement’s vision, while anti-abortion forces do the opposite. Anti-abortion funders build patiently, plan across decades, and their funding does not excuse itself during legislative fads and ballot calendars.

Meanwhile, much of abortion access-centered philanthropy remains preoccupied with its own sunsets. Convening to discuss exits, legacy, and the vacuums their absence will create, rather than reckoning with the damage already done by years of underinvestment, silence and stigma. As of this anniversary, several major institutions have publicly announced plans to wind down or exit the field, including the Susan Thompson Buffett Foundation, the movement’s largest funder, the Compton Foundation, the Gates Foundation, the Grove Foundation, the Irving Harris Foundation, the Wellspring Philanthropic Fund, and the Tara Health Foundation.

Susan Thompson Buffett Foundation’s decision to sunset has surfaced a reckoning the sector postponed for far too long. Its scale and steadiness created tangible stability and in doing so, made it easier for the rest of philanthropy to avoid building shared responsibility, redundancy, and long-term infrastructure. The panic we are witnessing now isn’t about one foundation stepping back; it’s about a system that never prepared itself to hold the work collectively.

As others wait to make their plans public, philanthropy infrastructure organizations like Funders for Reproductive Equity and intermediaries like Groundswell Fund and Grantmakers for Girls of Color continue to fund grassroots work while also challenging the habits philanthropy has relied on for too long. Those reckonings matter. Because at this moment, abortion seekers, providers, and organizers are exhausted. Their grace is gone, and their patience is low.

And exhaustion on the frontlines is not just an emotional condition; it is the terrain on which opposition infrastructure is built. Appalachia shows us exactly how that transfer of power happens.

Maternal Health Deserts and Manufactured Scarcity

We are naming Appalachia not because it is marginal, but because it is revealing the impacts of a sector that has produced and sustained isolation in a region considered nonessential to national strategy. The expansion of crisis pregnancy centers (CPCs) in the region is not simply the result of opposition strategy; it is the predictable outcome of philanthropic absence. When long-term, values-aligned investment fails to materialize, anti-abortion infrastructure fills the vacuum with discipline and intent.

Appalachia matters in its own right and tells the truth; power is never neutral, and power doesn’t disappear; it reorganizes elsewhere.

Crisis pregnancy centers are not a deep south problem, not a midwest problem, and not a rural problem. They are a national infrastructure. They show up everywhere, but they grow fastest where care has been stripped away. CPCs thrive in the absence of full-spectrum reproductive healthcare. In places where entire zip codes, counties and even states have been abandoned, leaving CPCs with the space to redefine what care looks like. Their expansion is not accidental. It is the predictable result of policy failure and philanthropic neglect. Additionally, CPC density in Appalachia did not emerge in isolation.

It grew alongside a collapsing maternal health ecosystem as hospitals closed, midwives were criminalized, and OB/GYNs were pushed out by policy, cost, and political hostility. Leaving rural families forced to navigate pregnancy and birth under conditions that qualify as a humanitarian crisis.

This is what underinvestment produces, manufactured scarcity that leaves people desperate for any form of support, real or not. CPCs have stepped into that desperation with precision, embedding themselves in places philanthropy has too often labeled too complicated, too conservative, too small, or too politically risky.

Our data above reflects how care actually moves. Bordering states, many shaped by Appalachian care networks and migration, often serve people traveling for pregnancy-related care. We also include a small number of rural areas outside of the region facing similar disparities, to make visible how these systems operate across places.

Appalachia makes this truth impossible to ignore. The region stretches across more than a dozen states and holds deep diversity, people whose lives cannot be flattened into a single story. What binds most Appalachian communities is their shared history of extraction and divestment. That history shows up in today’s conditions, including the more than 160 crisis pregnancy centers embedded across the region.

To focus on West Virginia, the only state entirely Appalachian, is not to single out the state, but to see the pattern clearly. Nearly half of the state’s counties, 47.3%, are maternity care deserts, and another 12.7% offer only low or moderate access, not full-spectrum care. The imbalance is obvious, one abortion clinic serving 1.8 million people, in a state where there are roughly 6.8 CPCs per million residents. In a maternal health desert with little abortion access, pregnancy is no longer a choice or a journey; it is a gamble with people’s lives, shaped by policy, neglect and abandonment.

Fear, Faith, and Falsehood

The CPC model thrives on its ability to weaponize fear by exaggerating medical risks and exploiting uncertainty, leveraging faith through deep integration into church networks, and deploying falsehoods by presenting themselves as legitimate medical providers.

And in Appalachia, trust is currency. Anti-abortion networks understand this and have invested accordingly, building volunteer pipelines, leadership benches of medical professionals and political leaders, and long-term relationships over decades.

They have stayed where philanthropy that professes concern for the access and reproductive justice space cycles in and out, and they have built while many funders shift focus during crises and retreat once attention shifts. Unless philanthropy is willing to learn from that strategy, not to replicate its ideology, but to match its commitment, anti-abortion infrastructure will continue to outpace and overshadow our own.

A National Call to Build What Comes Next

We have to tell the truth about our own delay. Too often, those of us with access to platforms and decision-makers, including NCRP, softened language where it should have sharpened. We trusted proximity over pressure, and we allowed politeness to stand in for accountability. A restraint that by no means protected the movement, but protected funders from having to change.

We have used research to try to move resources to the frontlines, and we are listening as organizers tell us plainly: research is not what is missing, reports cannot substitute for action, and data cannot replace decisions. Additionally, its delivery must demand action and leave no room for delay between plenary sessions and abortion bans. In this moment, our responsibility is not to produce more proof, but to use proximity, platform, and relationships to interrupt harm as it is happening.

That means speaking less about the crisis and speaking bold intentions into the rooms where money is held, and decisions are delayed, naming risk aversion for what it is, challenging hoarding in real time, and refusing to let delay masquerade as strategy. What comes next is a grounding in southern-rooted frameworks and leadership for understanding reproductive access and gendered violence that helps funders and frontline partners move out of silos and toward integrated, survivor-centered strategies with real resources behind them. In 2026, NCRP will curate spaces grounded and curated by the people who built this analysis, inviting funders not just to learn, but to act.

Our commitment is to use research as a door, not a destination. To leverage proximity, platform, and relationships to surface the quiet parts in real time, disrupt harmful funding patterns as they are happening, and push resources toward frontline abortion access and care infrastructure with urgency, not permission.

Working from a place grounded in values aligned between what we name, what we build, and a refusal to separate analysis from responsibility. Not cautiously. Not eventually. But now, creatively, collaboratively, and with the courage to build the future we imagine.

Brandi Collins-Calhoun is the Movement Engagement Manager at the National Committee for Responsive Philanthropy (NCRP). A writer, educator and reproductive justice organizer, they lead the organization’s Reproductive Access and Gendered Violence portfolio of work. 

Over the past decade, we have seen the fruition of a well-financed 60-year campaign to roll back major movement-won advances made on racial, gender and economic justice. NCRP researchers took a deeper look at the investments from funders who advocated for policies and resourced organizations which undermine our democracy and basic human rights. Across our Regressive Philanthropy Initiative focus areas, NCRP researchers examined the year-over-year funding to grantees and compared it to funding contributions to movements focused on sustaining the democratic society we all want. According to the most recent data, progressive funders are still outspending regressive funders. However, the investment over time from regressive funders is far outpacing their counterparts. This is happening at an especially alarming rate, as regressive funders accelerate their efforts while other progressive funders cower in self-censorship.

Anti-LGBTQ+ organizations funding increases, while funding for LGBTQ+ communities decline

NCRP researchers compared our regressive funders dataset with the latest Tracking Report published by Funders for LGBTQ Issues. This annual report has noted a decline in U.S. foundation grantmaking to LGBTQ+ communities in recent years, falling 22% from 2022 to 2023.

Looking at the average total funding from the latest three years of our data, regressive funders on average funded $223 million annually to organizations focused on limiting rights to LGBTQ+ communities. According to the tracking report, in these same years, average funding to LGBTQ+ communities was $229 million per year. While our progressive allies remain slightly ahead of regressive funders, it is increasingly only marginal.

Even adjusted for inflation, funding for anti-LGBTQ organizations has increased significantly since 2010, escalating drastically in 2016. According to data from Funders for LGBTQ Issues, total funding for LGBTQ communities has continued to decline year-over-year since a peak in 2021.

Regressive funders work to change policy and public opinion in their anti-immigrant campaign

NCRP researchers have spent the last several years documenting the pro-immigrant and refugee movement, (PIRM) ecosystem. PIRM grants data, includes organizations across a spectrum, from core movement groups to multi-issue groups offering direct services to immigrant and refugee communities. This movement ecosystem reached an all-time funding high in 2018 with $428,964,490 in grants. NCRP’s dataset of anti-immigrant organizations is much smaller, with only 46 organizations. However, in this dataset there are only two organizations whose primary focus is to deliver direct services; the rest work to lobby, litigate, shift public opinion and influence state and federal anti-immigration policies. While pro-immigration and refugee funding has begun to revert to 2016 levels, opposition funding has risen, jumping 98% from 2019 to 2020.

It is important to note alongside these estimates of foundation support for anti-LGBTQ+ and anti-immigrant organizations that their work is complimented on a massive scale by Fox News’ anti-LGBTQ+ and anti-immigrant narrative work. Fox News is on track to sell over $1 billion in ads in 2025, and the network regularly out-rates all other news networks.

Progressive funders can’t let up the gas on multi-year support for democracy organizations

Doing deep engagement work in democracy has always been difficult in the United States, but the growing opposition to progress in our federal and state legislatures continues to threaten grassroots organizations engaged in this work. Legislative trackers suggest that thousands of pieces of democracy legislation from both parties get introduced every year. Only about 10% of these bills pass. Much of this largely goes unnoticed by the public, but American democracy is feeling those slow and subtle shifts of power now.

Using the most recent available data from the year following a presidential election, the Democracy Fund projects that pro-democracy support increased from $2.5 billion in 2017 to $3.2 billion in 2021.These projections are higher than regressive funding for anti-democracy organizations in those same years ($336 million for anti-democracy organizations in 2017 and $813 million in 2021). However, all funders that care about protecting a diverse civil society and basic human rights should notice that between 2017 and 2021 post-election years, anti-democracy regressive funding almost tripled. Based on all our annual data of anti-democracy funding, NCRP researchers predict this rise in funding will only continue once 2025 data is available.

If progressive funders do not stay ahead of coordinated anti-democracy funding, they risk ceding even more ground in the years ahead. Operating from a defensive position is a losing strategy to protect democracy organizations.

Research Manager for Special Projects and current Connecting Leaders Fellow at ABFE, Katherine Ponce engages in both qualitative and quantitative research projects to advance NCRP’s mission. 

Before NCRP, Katherine’s passion to strengthen the involvement of community in philanthropy grew during her time at the Sillerman Center for the Advancement of Philanthropy. Here she analyzed data trends for the center’s publications and outreach to uplift field partners focused on participatory grantmaking.

Katherine earned a dual degree, an MBA in Social Impact and MS in Global Health Policy and Management, in 2021 from the Heller School at Brandeis University, and a BA in 2015 from Towson University.

Combatting Self-Interest Cloaked in Philanthropy

The most effective way to combat self-interest cloaked in philanthropy is to shine a light on the individuals involved and their true intentions. At the Phoenix Project, we report on astroturf groups – billionaire-backed political pressure organizations in San Francisco and the greater Bay Area and their attempts to use wealth to unduly influence the political process and increase their wealth at the expense of working and vulnerable people.

The National Committee for Responsive Philanthropy (NCRP) has a similar goal with a project that explains the ways that grantmaking has been used both wittingly and unwittingly to attack representative government. NCRP’s regressive philanthropy research found that from 2020-2023 over $1.5 billion dollars were granted to attack representative democracy and to attempt to reverse progress on racial, gender, and economic justice in the United States. Today, philanthropy designed to maintain inequities and push anti-democratic ends is enjoying more support from foundations and giving vehicles like donor advised funds than giving intended to further justice and equality. In the case of California Forever, would-be residents of this so-called utopia will be forced to trade away rights, while the current agrarian and blue-collar population will be displaced, with long-standing environmental and social impacts. As a for-profit charter city, California Forever will not be subject to the rules of traditional governance. The billionaires, who have been secretly scooping up Solano farmland since 2017, are creating a city that will operate by its own rules. Michael Moritz has called it a chance to experiment with “alternative” forms of government. That form of government is authoritarian, or at the very least governed in a way that does not resemble representative democracy. Instead, this area and its government will operate according to the whims of the oligarchs bankrolling it and technocrats governing it. Although details are still sketchy, so-called Network State experiments like Próspera in Honduras, or Elon Musk’s Starbase in Texas, have established appointed governing board rather than elected bodies and have privatized public services like schools and police. Indeed, these largely crypto-backed ventures look more like the company towns of old than democratically run American cities.

Who’s Influencing These So-Called Parallel Establishments?

California Forever is part of the Network State, an idea born in Silicon Valley, and taken up among leading figures in the tech industry as well as the administration of President Donald Trump. The originator of the scheme is Balaji Srinivasan, a former partner at Andreessen Horowitz, the venture capital firm founded by storied entrepreneur and investor Marc Andreessen and Ben Horowitz.

As Srinivasan describes it, a Network State is a “parallel establishment,” a territory governed by technology elites. Anyone who opposes the plan — Srinivasan calls them “Blues,” a shorthand for liberals — would be made uncomfortable, and, as a result, leave. “Just like Blues ethnically cleansed me out of San Francisco, like, push out all the Blues.” Srinivasan has gone so far as to compare himself to Moses, leading fellow tech elites to the promised land.

The project, as far-fetched as it sounds, proved attractive to Silicon Valley leaders, who like to think of the tech industry as the ultimate meritocracy and have become increasingly uncomfortable with the messiness of democratic processes. A number of Network State-aligned cities have popped up over the last five years: Próspera, Honduras and Próspera, Africa; Starbase in Texas; Itana in Nigeria; and Balaji’s own Forest City in Malaysia to name a few. While there are variations to these Network State ventures –the Prósperas present themselves as techno-utopic colonies that allow for unregulated medical experimentation and run on cryptocurrency, while Starbase operates more similarly to a company town for employees of Elon Musk’s SpaceX facility – the overlap exists largely in their funding. Many Network State-aligned cities receive their funding from Andreesen Horowitz, Peter Thiel’s Founders Fund, and Promonos Capital, a joint venture between Marc Andreesen, Peter Thiel and Balaji Srinavasan. from Andreesen Horowitz, Peter Thiel’s Founders Fund, and Promonos Capital, a joint venture between Marc Andreesen, Peter Thiel and Balaji Srinavasan.

Politically, Andreessen, Horowitz, Thiel and Srinavasan have all become outspoken supporters of then-candidate Trump in 2024, with Srinavasan having been considered to run the Food and Drug Administration during Trump’s first term. Collectively, the billionaire posse spent millions to see him elected while a few, like fellow Silicon Valley tech elites Elon Musk and David Sacks, ultimately took prominent roles in his current administration.

In alignment with his tech billionaire backers, Trump has re-branded the Network State concept as Freedom Cities, Freedom Cities, proposing to develop the ten new for-profit charter cities as “Accelerating Zones” on federally-owned land across the countr. Among the dozen or so sites he proposes for this experiment is the Presidio National Park in San Francisco. Others have proposed that the Trump administration declare a national emergency to build a Freedom City on the site of a former Naval Air Base in the city of Alameda, California.

Going Global: Modern Day Colonialism Branded as Libertarian Experiment 

To understand the implications, look no further than Próspera, a Network State operating on Roatan, an island off the coast of Honduras. Próspera was founded by Venezuelan wealth fund manager Erick Brimen who began buying up land in 2017. Among its investors are Andreessen, Srinivasan and Thiel. Construction began in 2021.

Próspera has been called a “libertarian experiment.” A more apt description is that it’s a haven for businesses seeking to evade governmental oversight and regulation. Honduras Prospera Inc., the corporation established by Brimen, wields power over the city and ensures that companies operating there are not subject to the stringent labor, environmental, and other health and safety laws governing businesses that operate In the United States and other industrialized countries. Corporate taxes are a scant 1%. Plans to expand Próspera include taking the land of a long-established Black Caribbean community, leading to charges of “crypto colonialism” and legislation intended to shut down Próspera.

Success Stories from the Community 

Locally, the Bay Area’s own proposed Network State California Forever has been met with similar opposition. Solano Together, a coalition of community groups was successful in preventing an initiative on the November 2024 ballot that would have rezoned 17,000 acres of farmland to allow for a Network State of some 400,000 residents. After spending $9 million to see it passed, the measure, which was headed for defeat, was pulled. However, it is expected to be brought before voters in next year’s elections.

Since then, opposition, led by the Coalition of Artists Against Billionaires and Solano Together, and joined by a local chapter of the Sierra Club and Greenbelt Alliance, has continued. It has even united Solano County’s Democrat and Republican parties in opposition. Backers of California Forever recently used Vallejo’s monthly art walk as a vehicle to promote the project, drawing protests from the groups. Hundreds of residents were again warned of the threat to the community. The coalition is broad, drawing many first-time volunteers who pursue a grassroots strategy, educating residents on the more disturbing elements of Network State schemes like California Forever.

Residents’ fears are well founded. Balaji himself has alluded to California Forever as being an example of a Network State, while California Forever’s CEO Jan Sramek has increasingly described California Forever as being a tech-backed industrial manufacturing hub similar to Musk’s Starbase. After failing to convince Solano voters to support the initiative the first go-around, Sramek’s recent proposal is to build a deep sea shipping port that will be used in tandem with nearby Travis Airforce Base and the Military Ocean Terminal Concord to build military industrial technologies, which have become en vogue as of late with AI startup companies such as Thiel’s Andruil Industries and Palantir Technologies. This would be on top of massive luxury development geared towards employees of these industries, displacing the largely agrarian and blue-collar workers that currently call Solano County and the surrounding area home.

Phoenix Project and NCRP Model How to Fight Against Regressive Philanthropy in Network States and Beyond

Given the unprecedented wave of philanthropic funding used being leveraged to support increasingly anti-democratic ends, it is critical that those in the industry keep a critical eye towards supporting genuine community-supporting initiatives such as grassroots groups such as Solano Together and the Phoenix Project, as opposed to pro-Network State and other community-displacing initiatives. Calling out astroturfing efforts is an important first step in preventing corporate take-over and community displacement, and to do that means supporting genuine grassroot groups – those of marginalized economic and racialized identities and their efforts to protect their communities.

The Phoenix Project and NCRP believe that knowledge is power and will continue to shine a light on anti-democratic efforts masquerading as philanthropy and similar attempts happening both in the Bay Area, and across the country. To support the Phoenix Project, you can download their reports and sign up for their newsletter here. To continue to support NCRP, please continue to follow our blog highlighting the use of philanthropy towards anti-democratic ends, as well as support the ongoing work of our Regressive Philanthropy Initiative.

Julie Pitta is a former investigative journalist. She currently serves as president of the Phoenix Project, a nonprofit that exposes the dark money in local politics.