Today, however, Mississippi falls far short of that goal. Infant and maternal mortality rates are among the worst in the country. State leaders have rejected the Affordable Care Act’s Medicaid expansion, leaving about 43,000 women of childbearing age without health insurance. They chose not to extend Medicaid to women for a full year after giving birth. And they have a welfare program that provides some of the country’s least generous cash assistance — a maximum of $260 a month for a poor mother raising two children. Mississippi embodies a national pattern: States that have banned abortion or are expected to have some of the nation’s weakest social services for women and children and have higher infant and maternal death rates. According to a New York Times analysis, the 24 states that have banned abortion (or likely will) do worse on a wide range of outcomes than states where abortion is likely to remain legal, including infant and maternal mortality , teenage birth rates and the percentage of women and children who are uninsured. States that might ban abortion either have pre-Roe laws that ban abortion. have recently passed severe restrictions; or have legislatures actively considering new bans. The majority of these states have rejected the annual Medicaid extension after childbirth. Nine have denied the Affordable Care Act’s Medicaid expansion, which provides health care to the poor. None offer new parents paid time off from work to care for their newborns. “The safety net is woefully inadequate,” said Carol Burnett, who works with poor and single mothers as executive director of the Mississippi Low-Income Child Care Initiative, a nonprofit organization. “All of these proven barriers at the state level prevent mothers from getting the help they need, the health care they need, the child care they need.” Many anti-abortion activists have recognized that improving the health and livelihoods of mothers and young children is an important goal for their movement: “This has been my lecture in the pro-life movement for the last year,” said President Kristan Hawkins. of Students for Life. “No Woman Stands Alone in Post-Roe America.” Social spending is not the only answer to poverty and poor public health, and some in the anti-abortion movement stress that they want to help women and children — just not with more government spending. But there is a strong connection between state policy choices and outcomes for mothers and children, the researchers found. Perhaps the clearest example is health insurance. Many studies have linked it to improved health and financial security for poor Americans. Since 2014, states have had the option to expand Medicaid programs to cover nearly all poor adults, with the federal government paying 90 percent or more of the cost. But nine of the states that plan to ban abortions have not expanded it, citing opposition to Obamacare, which Republicans have long vowed to repeal. an unwillingness to provide health benefits to poor, non-working Americans; or concerns about the 10 percent of the bill being left to state governments to fund. “Closing the gap in Medicaid is the first and best option for women’s health care,” said Allison Orris, a senior fellow focused on health policy at the left-leaning Center on Budget and Policy Priorities. Starting in 2021, states also had the option to expand Medicaid to cover women for a full year after giving birth instead of two months. Just 16 states refused to do so or chose a shorter time frame — all but three also ban or seek to ban abortion. Women who are poor and pregnant are eligible for Medicaid nationwide, and the program pays for four out of 10 births nationwide. But health experts say it also matters that women are covered long after birth and in the years leading up to pregnancy. Conditions such as diabetes, cardiovascular disease, and substance abuse can lead to pregnancy complications and poor infant health. Research shows that expanding Medicaid can reduce maternal mortality. Medicaid also pays for contraception. Paid family leave and subsidized childcare are another example. None of the states that have banned abortion (or are likely to guarantee) parents paid time off from work to care for and bond with their newborns. Just 11 states and the District of Columbia do. Paid leave has been shown to benefit babies’ health and mothers’ physical and mental health as well as their economic prospects. In most states, there is no guaranteed child care for children until they enter kindergarten at age 5. Subsidies available to low-income families cover a small fraction of eligible children, ranging from less than 4 percent in Arkansas (which now bans abortion) to more than 17 percent in Vermont (which passed abortion rights legislation of abortions). In many states, the subsidies also present a conundrum: Parents have to work to get them, yet they can’t find or start a job without child care. Some states add other barriers. Mississippi requires single mothers to file for child support from fathers before they can receive subsidies. Also, a job that pays minimum wage — which is no higher than the federal minimum of $7.25 in 20 states — doesn’t necessarily pay enough to cover even subsidized care. Support for families is different in some states when children are 3 or 4 years old. Thirteen states and the District of Columbia offer or have committed to offering universal preschool. Unlike other family benefits, anti-abortion states are about as likely as other states to offer public preschool. Six of those 13 states ban abortion or are likely to. “This is consistent with the view that education is a public responsibility,” said Steven Barnett, senior co-director of the National Institute for Early Education Research at Rutgers, while other safety net programs “fall outside the accepted realm of public responsibility in the conservative states”. Poorer states may have fewer resources to fund benefits such as parental leave or state levies on the federal earned income tax credit. But what they choose to do with federal grants can be revealing, said Zachary Parolin, a professor of social policy at Bocconi University in Milan who has studied how states use the broad discretion given to them by the Welfare Program. Temporary Assistance for Families in Need. “You can’t say Alabama is providing too little cash assistance for low-income families with children because it can’t afford the program,” Mr. Parolin said. “It has a TANF program and it’s primarily funded by the federal government.” But in 2020, Alabama spent only 8 percent of welfare funds on direct cash assistance to families. Mississippi spent 5 percent. Instead, states often spend these grants on a wide range of other programs, such as pro-marriage advertising campaigns and abstinence-only sex education (in 2020, a state auditor in Mississippi found that the state spent millions of federal welfare dollars, including of speeches never delivered by former quarterback Brett Favre). Mr. Parolin’s research showed that states with larger shares of black populations tend to spend the least on cash aid, widening America’s poverty gap between black and white children. The Times analysis similarly found that states likely to ban abortion devote a smaller share of welfare funds to essential aid. States with less generous safety net programs also often use complex rules and bureaucracy to further limit access to benefits, said Sarah Bruch, a professor of social policy and sociology at the University of Delaware. States could help women and families, she said, not only by investing more in the safety net, but also by making it easier to find and use. Angela Rachidi, a senior fellow who studies poverty and safety net programs at the right-leaning American Enterprise Institute, said government has a role to play, but not alone: “We have a broader responsibility as a society — employers, churches, community organizations — to make sure mothers feel they can bring these children into the world.” Evidence so far suggests that these organizations will struggle to meet the growing need. After the Supreme Court’s decision, other governors who banned abortion trumpeted their commitment to pregnant women and children. “Being pro-life involves more than being ‘pro-birth,’” Oklahoma Gov. J. Kevin Stitt wrote in an executive order signed July 11. Oklahoma ranks in the bottom 10 states on measures of child poverty, infant mortality and the share of women of reproductive age without health insurance. In Texas on the day of the decision, Gov. Greg Abbott said in a statement that the state “has prioritized supporting the health care of women and expectant mothers in need.” On Wednesday, the governor’s press secretary, Renae Eze, said, “We look forward to continuing to work with the Legislature to ensure the health of all Texas women and their families.” Mr. Abbott pointed to Texas’ decision to offer Medicaid coverage to mothers six months after giving birth. The state rejected the full year of coverage offered by the federal government. Texas has also used techniques to purge children from Medicaid coverage for document failures. It has a higher rate of uninsured children and women of reproductive age than any other state. In its abortion-restricting legislation, Texas earmarked $100 million over two years for a program that connects women with counseling, education and supplies, called Alternatives to Abortion. That funding pales in comparison to another benefit that Texas has cut — an estimated $6 billion in federal funds each year…
