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With the impending ban on abortion in Texas, advocates and experts say government support systems for low-income mothers and children are already inadequate – and will not withstand the growing need.
“When you say‘ social safety net ’in Texas, it sounds like a joke,” said D’Andra Willis of the Center Afia, a reproductive justice group in North Texas. “Anything they could create or increase to protect people, if they really didn’t care, they don’t.”
Pregnant women in Texas are more likely to be uninsured and are less likely to seek early prenatal care than the rest of the country. They will give birth in one of the worst for maternal mortality and disease conditions. And newlywed low-income parents will be weaned off Medicaid sooner than in many other states.
This would make many Texans want to avoid pregnancy altogether. But study, not to mention access to contraception, could become a problem in a state that does not require sex education and narrows family planning opportunities in recent years.
Republican lawmakers, many of whom have focused on restricting access to abortion in recent years, said strengthening the state’s social security system will now be a top priority. But defenders who have worked on these issues for years say any help is likely to be too little, too late.
“People don’t realize it’s more than access to abortion,” Willis said. “We’re going to set people up for poverty.”
Maternal mortality in Texas
Texas consistently ranks in the top 10 states for maternal mortality, in a country that already ranks worse than its peers in that category.
Maternal mortality and disease – death or serious illness or injury – disproportionately affect black women. The State Committee for the Analysis of Maternal Mortality and Disease found that black women accounted for 31% of pregnancy-related deaths, but only 11% of live births.
The incidence of serious maternal morbidity among black women in Texas is almost twice as high as among whites, according to a University of Texas study.
“This is the worst and most dangerous place to have a baby,” Willis said. “It’s safer to have an abortion in Texas than to have a baby in Texas.”
Willis is also concerned about the potential increase in deaths and injuries related to pregnancy as desperate women turn to self-directed abortion care.
One of the causes of maternal mortality in Texas, according to experts and advocates, is the staggering level of uninsured residents of the state. Texas is one of 12 states that has not expanded Medicaid and has one of the lowest eligibility standards in the country: a parent with three children would have to earn less than $ 400 a month to qualify for Medicaid.
As a result, in 2019, almost one in five Texans did not have health insurance, which is twice the national average. And even worse statistics for women of childbearing age – in 2017, more than a quarter did not have health insurance, the highest in the country.
Texas also has the lowest level of women’s access to prenatal care in the first trimester, according to a study by ProPublica and Vox. According to the U.S. Department of Health, infants are five times more likely to die if their mothers do not have access to prenatal care.
Pregnant Texans can qualify for Medicaid with a much higher income – up to $ 4,579 a month for one parent of three children. As a result, half of all births in the state are funded by Medicaid, which is one of the highest rates in the country.
For many years, this program covered women during pregnancy and two months after delivery. But last year as part of the U.S. Rescue Plan, the federal government allowed states to easily expand coverage for the first 12 months after childbirth.
On the recommendation of the Texas Maternal Mortality Task Force, lawmakers have approved a bill that extends coverage to 12 months after birth.
“This was the first time there had been such strong bipartisan support for the issue,” said Diana Forrester, director of health policy at Texans Care for Children. “It was amazing. We were very excited.”
But then the State Senate rolled it back to six months after the birth. While the Federals have automatically approved applications to extend coverage to 12 months, the new six-month plan will require Texas to go through a long and cumbersome waiver process.
Texas has not yet filed a waiver, Texas Texas Medicaid director Stephanie Stevens said at a hearing last Thursday. While the state hopes to start offering six months of postpartum Medicaid coverage in October, it will depend on when their waiver is approved.
She said the federal government has at least 120 days to consider the waiver, “but we have seen waivers on which they have not acted much longer than that.”
Right now, due to the federal health emergency, no one is expelled from Medicaid after their entitlement expires. This declaration should end in July, but it may be extended, as it has been several times.
The choice to approve just six months of Medicaid postpartum extensions has been a big disappointment for maternal health advocates.
“If you want healthy kids, you have to have healthy moms,” Farester said. “How are your healthy moms? You provide them with coverage. ”
Access to contraception, sex education
Uninsured and low-income Texans who prefer not to conceive also face problems in accessing contraceptives and reproductive health.
Beginning in 2011, Texas began a multi-year effort to “pay” planned parenting, in part by cutting budgets for women’s health and family planning.
By 2014, more than a quarter of family planning clinics in Texas were closed, most of which were not related to Planned Parenthood. Although some have reopened, access to contraception, cancer screening, STIs and other sexual health care remains much rarer than it was before.
The rest of the clinics, which receive family planning funding from the state, are struggling to keep up with the demand for services.
“This program has never left money on the table,” said Erica Ramirez, director of policy and advocacy for the Coalition for Women’s Health in Texas. “We really want to make sure lawmakers know that our women’s health programs … don’t meet that need right now, and that need will only increase.”
The state’s reproductive health programs are further stretched, Ramirez said, because Texas is one of two states that do not cover contraception in its child health insurance program. Adolescents participating in this program who wish to gain access to contraception must go through state-funded family planning clinics.
“It’s easy to fix,” Ramirez said. “In fact, there is evidence that this will lead to cost savings for the state, and it appears that if the CHIP covers comprehensive treatment, gaining access to something as important as contraception should be seen as comprehensive care.”
Texas has one of the highest rates of teenage pregnancy in the country and the highest rate of repeat teen births – teens who have multiple children before their 18th birthday. Texas does not require high school students to get a sex education.
“We can’t get birth control. We cannot get proper medical care. We are not given a complete sex education, so we are not trained in birth control or natural contraception, and now you can not have an abortion, “said Willis. “You’re taking it all away … and you have no plan.”
Lawmakers and opponents of abortion say the plan is based on the Alternative to Abortion program, in which the state has invested more than $ 100 million in recent years. The program funds a network of nonprofits designed to support people during pregnancy, often with little government oversight.
But even some of these programs say they are not ready to support the influx of needs.
Vincent DiCar, chief outreach officer at Care Net, told the Texas Tribune last week that 82 Texas pregnancy and pregnancy centers could not keep up with demand because the state banned abortions after about six weeks of pregnancy.
“We believe that crisis pregnancy centers are amazing, of course,” he said. “But if that’s the only solution, we don’t have enough manpower to help all the people who need help if Rowe vs. Wade is repealed.”
Other obstacles for new parents
These centers usually offer only material support, counseling or parenting classes during the first months of a child’s life. But an unplanned pregnancy can have lifelong consequences for both mother and baby.
And many of the most significant changes that supporters are pushing for should happen in future legislative action.
Texas does not require employers to offer any paid leave, although federal regulations require qualified employees to provide 12 weeks of unpaid occupational safety, which is offered under the federal Family and Medical Leave Act.
Unlike neighboring New Mexico, where a program has just debuted that offers a free year of childcare for most families, Texas offers a limited childcare scholarship program for children of low-income parents who work or study .
And when the state decides that due to an unplanned pregnancy the father cannot properly care for the child she gave birth to, the foster care system intervenes. The state is in the midst of a decade-long lawsuit over its inability to properly care for children in the admission system, often with alarming consequences.
Willis of the Aphia Center said children are often placed in foster care because of circumstances that are far beyond their control – or the control of their parents. And whether these children are in foster care or at home with their parents, many of these factors will only get worse.
“You have young women who don’t have control over their bodies to even gain access to birth control,” she said. “And then these same women live in areas that are food deserts that are heavily affected by air quality and environmental issues that deal with poor school systems.”
When she thinks of existing support systems for low-income Texans who will have to bring their pregnancies to term as a result of the upcoming abortion ban, she said she feels hopeless.
“Black women in Texas never had any hope that any of this would happen,” she said. “And now it feels like we’re almost back to square one.”
Disclosure: Planned Parenthood, Texans Care for Children, and Afiya Center were financial supporters of The Texas Tribune, a nonprofit, nonpartisan information organization funded in part by donations from members, foundations, and corporate sponsors. Financial supporters play no role in Tribune journalism. Find their full list here.