MEMPHIS, Tenn. — Taylor Cagnacci moved from California to Tennessee hoping to start a new chapter in a state that offers a low cost of living and natural beauty.
But he’s outraged by poor social services in Tennessee, which leave she and many other mothers fighting in a state where abortion is prohibited with limited exceptions.
“I would have had my child no matter what, but for other women, it’s a crappy situation they put you in,” said Cagnacci, a 29-year-old mother from Kingsport who relies on Medicaid and federally funded nutrition. the program “You have to be your child. But where is the help then?”.
Tennessee has a porous safety net for mothers and young children, recent research and an analysis by The Associated Press have found. We don’t know how many women in the state have given birth because they haven’t had the opportunity to have an abortion, but it’s clear that from the moment a woman in Tennessee becomes pregnant, she faces greater barriers to a healthy pregnancy, a healthy baby, and financially. A more stable family than the average American mother.
Like other states with strict abortion bans, Tennesseans of childbearing age are more likely to experience maternal care deserts and a general shortage of doctors. Women, infants and children are less likely to sign up for a government nutrition program known as WIC. And Tennessee is one of 10 states that has not expanded Medicaid to a large portion of low-income families.
“Every day is survival,” said Janie Busbee, founder of Mother to Mother, a Nashville-based nonprofit that provides baby supplies to low-income mothers. “If we could take that stress away, maybe they’d have time to dream.”
In 2022, the US Supreme Court ruled in Roe v. GOP state leaders in Tennessee, which banned abortion after Wade was overturned, say they are strengthening services for families.
In 2022, Tennessee expanded Medicaid coverage for mothers from 60 days postpartum to one year, allowing 3,000 more mothers to use the program each year.
The state also raised the Medicaid income limit for parents to the poverty level – nearly $26,000 for a family of three — and provides recipients with 100 free diapers per month for children under two. According to the governor’s office, these changes have resulted in thousands of new parents accessing government services.
“Pro-life is about so much more than defending the lives of the unborn,” Republican Gov. Bill Lee said in his 2023 annual address to lawmakers and has recently resonated on social media. “This is not a matter of politics. This is about human dignity.’
Still, nonprofit leaders and moms told the AP there are still big gaps in the safety net.
Anika Chillis, a 39-year-old single mother from Memphis, has Medicaid, WIC, and the Supplemental Nutrition Assistance Program (formerly known as food stamps). While she’s very grateful for the help, she said even that can go away, like when she temporarily lost WIC.
“It’s hard,” she said, sitting on a park bench as her 2-year-old son and 9-year-old daughter played nearby. “Food is going up all the time.” And being a single mom “makes it doubly hard on you.”
Tennessee fared poorly on WIC enrollment, Medicaid, maternal care and adequate paid family and medical leave, an October study found.
Other states with equally restrictive abortion laws — such as Idaho, Alabama, Missouri, Georgia and Mississippi — also ranked poorly on many measures. The researchers said the restrictive states had a slightly higher average birth rate and a much lower average abortion rate than the least restrictive states.
“In general, the more fiscally conservative these abortion-restricting states are, the more socially conservative they are,” said Dr. Nigel Madden, the book’s lead author. to analyze Published in the American Journal of Public Health.
The Republican majority in Tennessee’s legislature has long rejected efforts to expand Medicaid to people earning up to 138 percent of the federal poverty level — about $35,600 for a family of three. And TennCare is already facing criticism after a federal judge earlier this year ruled that the state had outlawed coverage for thousands of families and had a “lethargic” response to nearly 250,000 children losing coverage because of state-caused paperwork problems.
DiJuana Davis, 44, was among the accusers. In 2019, the Nashville resident had to undergo surgery to prevent pregnancy and alleviate her chronic anemia. A few days before the procedure, he was informed that his Medicaid coverage had been suspended and the hospital had canceled.
She later learned that her renewal paperwork was going to the wrong address, a mistake that left her without insurance for two months, during which she became pregnant and developed preeclampsia. Doctors induced labor to save her life, and her son was born prematurely.
“The system is broken,” he said, “and it needs to be fixed.”
More than 3% of the 83,000 babies born in Tennessee in 2023 were born to mothers who did not receive prenatal care. Only seven states had a higher share, according to an AP analysis of data from the Centers for Disease Control and Prevention.
After birth, a shortage of doctors hampers ongoing care. About a third of Tennesseans live in a primary care shortage area — a higher share than in all 10 other states — according to an AP analysis of data from the Census Bureau and the Health Resources and Services Administration.
Mothers described navigating various support programs as frustrating. Chillis was on WIC for several months after her son’s birth, but then ran out because of errors in the renewal process; he eventually recovered with the help of the nonprofit Tennessee Justice Center.
Chillis credits a nonprofit preschool provider with connecting her with the support programs in the first place: “I don’t see a lot of advertising about, you know, how you can get into this program or you can leave,” she said. “People have no knowledge.”
Cagnacci, who is pregnant and has a 1-year-old child, said she was on SNAP for a while but missed an appointment and didn’t figure out the steps after that. The recertification process was “such a headache” that it goes without.
“I felt like he was deliberately making it difficult for me so I could give up,” he said.
Women with young children in states where abortion is banned or limited to the first few weeks of pregnancy said it can be difficult to get social services there, according to one. survey From the health policy research organization KFF. Nearly half said it’s difficult for women in their state to get food stamps, for example, 3 in 10 in states where abortion is generally available.
“Pro-lifers who support these abortion bans often suggest that these policies are designed to protect children, women and families,” said researcher Madden. But the weakness of the safety net shows “the hypocrisy of that argument.”
Tennessee’s new diaper program shows a deep political divide over aid programs. The Republican governor described it as an effort to strengthen families, while Democratic state Sen. London Lamar said GOP leaders are “trying to put a little reflection on the abortion ban.” The conservative Tennessee states that “it is not the responsibility of the state to have a diaper for every baby” and opened the possibility of cutting the program.
Of Tennessee’s 2.8 million households, 30 percent earn above the poverty level, but not enough to meet the cost of living in their counties, according to one. final report. Often, they are not eligible for government assistance.
“Some are working three jobs and still can’t make ends meet,” said Busbee, of Mother to Mother.
A fragmented charity patch can help, but they don’t cover the entire state. Nashville Diaper Connection, for example, serves 30 counties, working with partners to provide 50 diapers a month, mostly to working families who earn too much for Medicaid. Other nonprofits are prevented from helping by government agency revenue rules. And most charities are limited by the flow of donations.
Nonprofit leaders fear their jobs could become more difficult with a new administration in Washington and a GOP-controlled Congress. Republicans may demand significant changes to federal aid programs they have long criticized, such as Medicaid and food stamps.
“We’re four years into the Trump administration, and the goal of the Trump administration was to cut social services,” said Signe Anderson, senior director of food advocacy at the Justice Center. “I’m worried about … families in Tennessee and across the country.”
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Kruesi reported from Nashville, Tennessee. AP data reporters Kasturi Pananjady and Nicky Forster contributed to this report.
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The Associated Press Department of Health and Science is supported by the Science and Education Media Group of the Howard Hughes Medical Institute and the Robert Wood Johnson Foundation. AP is solely responsible for all content.
