New Reproductive Health and Freedom Watch analysis finds 2026 state legislative sessions divided between efforts to protect unregulated pregnancy clinic patients and taxpayers and a coordinated push to expand the industry’s funding, privileges, and legal protections
WASHINGTON, D.C. — State legislatures are increasingly confronting a fundamental question about unregulated pregnancy clinics (UPCs): Should organizations providing medical services and receiving taxpayer dollars face greater accountability—or should they receive even greater public support while remaining largely outside the safeguards applied to other providers?
An estimated 2,600 unregulated pregnancy clinics (UPCs) operate nationwide, with projected 2026 revenue of $2.6 billion. Also known as “crisis pregnancy centers” or “pregnancy resource centers,” UPCs promote services ranging from pregnancy tests, obstetric ultrasounds, and STI care to parenting programs and material support for pregnant women and families.
RHFW tracked 114 UPC-related bills across 32 states in 2026: 58 bills in 19 states sought greater protections for UPC patients and taxpayers, while 56 bills sought to expand or protect the UPC industry through increased public funding, tax benefits, and special legal protections.
The divide is particularly striking because the two agendas are moving simultaneously. As one group of lawmakers sought basic standards governing medical care, patient privacy, and the use of taxpayer dollars, UPC allies worked to further institutionalize the industry through record public funding and new legal and tax advantages—often while opposing the very oversight that ordinarily accompanies those privileges.
“What emerged in 2026 was a battle over whether pregnancy centers should continue to operate under a different set of rules,” said Mika Matsuno, Director of Research and Strategy at Reproductive Health and Freedom Watch. “As lawmakers ask who is performing ultrasounds, what happens to patients’ health information, and where taxpayer dollars are going, the industry is simultaneously asking states for more money, more legal protection, and more legitimacy. The contradiction is becoming increasingly difficult to ignore: UPCs want to be treated like health care and social-service providers when it brings public resources and credibility, but not when it brings the accountability expected of those providers.”
The analysis finds that lawmakers seeking greater accountability increasingly focused on three areas:
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Medical standards: Nearly 30% of patient-protection bills addressed medical standards, including oversight of obstetric ultrasounds, health and safety requirements, and professional responsibilities for licensed medical providers.
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Patient privacy: Legislators pursued measures to close a significant privacy gap created because most UPCs do not bill for services and therefore are not covered entities under HIPAA. In Louisiana, a bill establishing privacy requirements for UPCs receiving state funding passed the House unanimously.
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Financial transparency: As public investment in UPCs grows, lawmakers in states including Arkansas and Oklahoma sought greater disclosure about how taxpayer dollars are spent.
At the same time, UPC allies advanced legislation designed to strengthen the industry’s institutional position. Combined, state legislatures directed over $200 million to UPCs in 2026—the highest annual total RHFW has recorded. Ohio became the seventh state to enact a special tax credit for donations to UPCs, while lawmakers in several states considered measures granting UPCs special legal protections.
The report argues these measures are best understood collectively rather than as isolated tax, budget, or regulatory proposals. Together, they represent an effort to make UPCs a permanent, publicly supported component of the post-Dobbs reproductive health landscape while shielding them from standards and safeguards that apply to other health care providers.
The analysis also documents a recurring contradiction in legislative testimony: UPC representatives and allies characterize the organizations differently depending on the policy under consideration. They are presented as social-service providers when seeking taxpayer funding, medical clinics when promoting ultrasounds and pregnancy testing, and private religious charities when opposing government oversight.
That tension became particularly visible in Louisiana and Oklahoma, where UPC allies argued existing regulation and industry self-regulation were sufficient while opposing proposals addressing patient privacy, medical licensing, or financial transparency.
Looking ahead to 2027, RHFW will monitor whether UPCs gain a larger role in federal maternal-health policy following the launch of Moms.gov; whether state funding programs spread into new states; whether model legislation designed to preempt UPC regulation gains traction; and whether patient privacy, ultrasound standards, licensing, financial transparency, and outcomes reporting emerge as national legislative models.
The analysis was prepared by Reproductive Health and Freedom Watch with partnership from the Public Leadership Institute.
Read the full memo here: https://