The landmark Dobbs decision was nearly two years ago, and the politics of abortion has been in upheaval ever since. One overdue change has been a renewed emphasis on supporting the health of pregnant and new moms across the political spectrum.
For states seeking to better protect both pregnant women as well as the babies they carry, there are a range of options that could increase the odds of healthier outcomes and more stable childhoods. And state governments are starting to step up to the challenge.
Conservative states that have taken aggressive action to restrict abortion, like Texas, Florida and Indiana, have spent some new money to help mothers during pregnancy, such as funding pregnancy resource centers and child care vouchers. North Carolina, a politically divided state, coupled its 12-week abortion ban with an expansion of social spending, including paid leave for state employees, more money for foster care, and funding for prenatal health care for low-income moms.
Mississippi, after some coaxing, became another in a string of states choosing to extend postpartum Medicaid coverage for new moms. And one of the more high-profile recent efforts was the “Momnibus” in Kentucky, a bipartisan effort to tackle maternal mortality in the state.
Kentucky lawmakers felt like they were facing a crisis — from 2018 to 2021, their state had the sixth-highest maternal mortality rate in the U.S. The “Momnibus” bill, as the name implies, was an all-of-the-above approach, allowing pregnant women to enroll in health care coverage outside of the normal open-enrollment period, a new mental health hotline for moms, expansion of the existing home visiting program for new mothers, and telehealth services around lactation consulting and safe sleep practices.
Thankfully, new numbers from the Centers for Disease Control and Prevention show our nationwide maternal mortality rates are trending down from COVID-era highs, reflecting underlying disparities in health care access among Black women and higher risks of complications for older moms. (The often-touted statistic that the U.S. has higher maternal mortality than other developed nations is misleading, as different data collection methods means that we are effectively comparing apples and oranges.)
But different states face different problems. Utah, for example, has a maternal mortality rate much lower than the national average, with only 30 such deaths over a four-year period. Thirty deaths of new moms is, obviously, 30 deaths too many, and lawmakers could explore steps like the ones taken in Kentucky to help reduce that number as close to zero as possible.
In March, Utah joined Mississippi and 43 other states in offering Medicaid coverage to postpartum moms up to one year after delivery. The Biden administration, egregiously, would not let Utah enact coverage that did not include pregnancies that end in abortion. The White House was wrong to make supporting new moms a condition of supporting women who chose to end their pregnancy voluntarily, but both sides can now celebrate that more new moms will be able to receive health coverage in that precious first year of their child’s life.
But the pressures facing pregnant moms and new parents go beyond just physical health; they include economic challenges as well. From 2008 to 2015, the national average for out-of-pocket spending on maternity care rose by nearly 50%. For working-class parents, these costs can be thousands of dollars they don’t have, right at the time of life they can least afford it. One fix could be state legislation directing health insurers to cap the amount of out-of-pocket costs new parents are expected to bear.
Some parents already receive free childbirth in Utah. In 2021, Medicaid covered 1 in 5 births in Utah, which means those parents paid nothing for maternity care, and labor and delivery. But the program has some flaws.
In 2023, an unmarried pregnant woman expecting her first child would pay nothing for her obstetrics care and delivery so long as her income was under $21,000. If she married her partner, they would be eligible for free care only if their combined household income was under roughly $28,400. If both the mom and her potential spouse are working service-sector jobs, this could be a profound disincentive to tie the knot. A pro-family, pro-marriage state like Utah could explore creative ways to diminish that marriage penalty, whether through a federal waiver or a state program aimed at covering the gap for lower-income couples, so that fewer couples would be incentivized to stay single so that the mom could receive health care coverage.
Another proposal was offered by Rep. Rosemary Lesser — a doctor herself — during the 2023 legislative session: expanding the number of pregnant women eligible for having the costs of their labor and delivery covered by Medicaid. This would mean, for example, a household of three with an income under $35,800 — be it a single mom with two kids at home or a married couple expecting their first child — could rest assured knowing the costs associated with labor and delivery would be free.
Of course, the costs associated with raising a child go well beyond childbirth, and Utah lawmakers are working on policies recognizing those costs. They passed a bill easing some restrictions on child care providers, which could help make the service more affordable. The legislature’s move to expand eligibility for the state’s child tax credit from children under 4 to those under 5 is also a modest and welcome step. But because of the strict eligibility thresholds for the credit, only a small portion of Utah parents will benefit. On the agenda for future discussion should be expanding the credit to working-class families who don’t owe enough in taxes to earn the full value of the credit.
Many lawmakers point to the importance of strong families when it comes to goals such as lowering abortion rates and ensuring children’s well-being. This is true — abortion rates among married women are much lower than among singles, and reams of social science data provide strong evidence that kids raised in a two-parent, married household do better academically, socially and physically than kids raised in a less stable environment.
But changing the culture in a pro-marriage direction takes time. And the impact of a half-century of legalized abortion on our nation’s culture can’t be erased overnight. Working to remove barriers to marriage, or increase its cultural salience in a time of alienation, will take hard work from government, churches and other institutions of civil society. But in the meantime, scared and vulnerable women who find themselves pregnant when they weren’t necessarily planning to be can find meaningful support from charitable organizations, neighbors and friends, backed up by strategic public resources.
Mothers facing an unplanned pregnancy also can benefit from the experiences of peers who have been there. Community-run programs, like those envisioned in the Community Mentors for Moms Act of Sen. Marco Rubio, R-Fla., could benefit from seed funding or public service campaigns. And once the baby is born, the Utah Home Visiting Program is an example of evidence-backed programs that can improve outcomes for children and parents, and could merit new funding.
The politics of life are in limbo in Utah, where the state Supreme Court is currently deliberating over the state’s ban on abortion except in cases of rape, incest, untreatable fetal abnormality or risk to the life of the mother. Whichever way that case is handed down, the Beehive State has the opportunity to lead in walking the walk on behalf of moms and their babies. Solid, sustainable steps to support families and invest in programs that can aid new moms can and should be a priority.
Patrick T. Brown (@PTBwrites) is a fellow at the Ethics and Public Policy Center and a Deseret News contributing writer.