Can social services handle abortion-ban baby bump?
Anti-poverty advocates say Indiana’s funding doesn’t match need
The American Congress of Obstetricians and Gynecologists recommends women start prenatal appointments within the first eight to 10 weeks of pregnancy. But 18% of Hoosier women don’t receive such care during their first trimester – the second-highest rate in the country. (Roberto Westbrook/Getty Images)
INDIANAPOLIS – From diapers and formula to childcare access, advocates say Indiana lags when it comes to providing services and supports that will see an increase in demand if abortion is banned.
With the legislature calling for a special session to curtail access to abortion following the U.S. Supreme Court decision, thousands more Hoosier children may be thrust into an inadequate system.
House Speaker Todd Huston declined an interview but pushed back against criticism in a statement, saying any bill limiting abortion would be coupled with actions to expand support.
“While it’s too early to speculate on what form legislation may take, I strongly believe we’ll couple any action with expanding resources and services to support pregnant mothers, and care for their babies before and after birth,” he said. “It’s my expectation for state lawmakers to take action to further protect life when we return to the Statehouse for a special session. We recognize the passion from all sides on this issue, and that’s why I expect the General Assembly to thoughtfully vet any legislation through the full legislative process, including committee hearings and public testimony.”
The Indiana General Assembly in recent years has declined to act on issues impacting mothers, such as waiving the tax on diapers or protecting accommodations for pregnant workers.
Healthcare providers terminated 7,756 pregnancies in 2020, with 384 abortions for women who lived outside of the Hoosier State. Over two-thirds of those abortions (5,258) occurred during the first eight weeks.
For decades, politicians crafted the state’s social systems with access to abortion in mind. If lawmakers vote to overturn the 50-year precedent without increasing services and aid, many impoverished Hoosier families could be left without any options.
Lack of supports for women
Even before the birth of a child, Hoosier women face challenges accessing healthcare and getting support. Indiana twice failed to pass a law granting pregnancy accommodations to employees, despite support from the governor’s office and medical community.
When it comes to prenatal care, the American Congress of Obstetricians and Gynecologists recommends women start their appointments within the first eight to 10 weeks of pregnancy. But 18% of Hoosier women don’t receive prenatal care during their first trimester – the second-highest rate in the country.
We need to stop talking about coat hangers and start talking in an honest way about how these laws will actually impact women’s lives and mortality.
– Amanda Stevenson, associate professor at the Unversity of Colorado Boulder
“Prenatal care is crucial to ensure that women have a healthy and safe pregnancy and childbirth experience,” the 2021 annual report from the Indiana Maternal Mortality Committee said. “Early prenatal care can identify high-risk pregnancies that may require a higher level of care.”
But when the committee analyzed the 60 pregnancy-associated deaths in 2019, the committee found that a quarter of women received no care at all during their pregnancy. Another 46.7% didn’t visit during their first trimester.
“In comparison, early prenatal care was noted for 68.9% of all Indiana births in 2019,” the report said. “This disparity suggests inadequate prenatal care is a contributing factor to maternal mortality in Indiana.”
Impoverished women may struggle to access healthcare if simultaneously juggling issues with housing, transportation and childcare but the report said it couldn’t conclude what specific barriers existed for the 60 women who died. Over half of women, 31, had incomes low enough to qualify for Medicaid and another quarter, 16, had no known insurance.
With a mortality ratio of 74.2 pregnancy-associated deaths per 100,000 live births, Indiana has one of the highest rates of maternal mortality in the country and developed world. With the overturn of abortion, some researchers fear that number could increase.
A study from the University of Colorado Boulder projected that maternal mortality could increase by 21% in the absence of abortion, with Black women seeing a 33% increase.
The paper did not include an analysis of deaths related to self-managed abortions but noted that, in the United States, carrying a pregnancy to term is 33 times riskier than having an abortion. According to the Centers for Disease Control and Prevention, there are 0.6 maternal deaths per 100,000 abortions compared to 20.1 maternal deaths per 100,000 live births.
Data from the CDC and Indiana Department of Health for maternal mortality cannot be compared because each agency uses different factors and equations to calculate their rates.
“We need to stop talking about coat hangers and start talking in an honest way about how these laws will actually impact women’s lives and mortality,” study author Amanda Stevenson, an associate professor of sociology, said. “This study provides one piece of the evidence we need to begin that hard conversation.”
Shortage of childcare
In August 2021, Early Learning Indiana released an index ranking each ZIP code’s access to quality childcare, giving Indiana an overall score of 60.6 – just over the ‘failing’ grade of 60 or less.
“Only 14% of counties were found to have moderate access and the remaining 86% were classified as having inadequate access. No counties in the state were classified as having adequate access,” the report summarized.
Even parents prepared to have children struggle to get childcare or keep the providers they use.
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The index used four different measures to rank ZIP codes, including capacity, quality, affordability and choice. On capacity alone, the state’s childcare providers could only serve an estimated 55.8% of the state’s children between birth and age 5.
Affordability increases with quality but even for low-quality care, the report found that families in some of the state’s poorest counties – Lake County and Marion County – may be spending a quarter or more of their income to obtain care for one child.
Though legislative leaders have acknowledged this crisis, which Gov. Eric Holcomb mentioned in his State of the State address last year, lawmakers haven’t proposed systemic solutions. In 2022, the legislature waived requirements for public schools operating after-school programs or childcare centers. No other childcare bill passed during that session.
The lack of childcare availability ripples out into other parts of Indiana’s economy, including its workforce.
Over one-third of Hoosiers surveyed by the Indiana Community Action Poverty Institute said they didn’t attend college or finish their degree because of childcare responsibilities.
Children living in poverty
Poverty nationwide increased for the first time in five decades in 2020, increasing from 10.5% the year before to 11.4%. For children, the poverty rate increased from 14.4% to 16.1%. In Indiana, 11.2% of people and 15.2% of children lived in poverty in 2019 – before the reported poverty increase.
Research from the Turnaway Study, which analyzed the outcomes of women denied an abortion compared to those who received one, found that people denied an abortion were more likely to be impoverished and unable to cover basic living expenses such as food, housing and transportation.
The Guttmacher Institute, an organization advocating for abortion access, estimates that 49% of women seeking abortions live at or below the federal poverty level of $23,030 for a family of three.
Ashley Burns, the president and CEO of the Indiana Diaper Bank, knows firsthand about families going without necessities and works to provide needy Hoosiers a basic, yet prohibitively expensive, necessity for young children.
Burns emphasized her focus on procuring and providing diapers to various agencies across central Indiana but acknowledged that limiting abortions would increase the demand for her organization.
“Nationally, 1 in 3 families are not able to provide enough diapers,” Burns said. “We’re a lifeline for a lot of families.”
Families pinching pennies may reuse diapers or keep the same ones on for too long, leading to rashes or urinary tract infections for babies and delaying their development. Burns reported distributing over 44,000 diapers in June, yet neither of the most popular social assistance programs for families cover diapers.
“You can’t buy diapers on WIC or SNAP (both supplemental nutrition programs); only TANF. But TANF is very hard to get, and the state hasn’t raised the amount given in so many years,” Burns said.
The state hasn’t adjusted TANF, or Temporary Aid to Needy Families, award amounts since 1988. A family of three can expect to receive up to $288 per month. In 2020, the Center on Budget and Policy Priorities found that Indiana had one of the nation’s lowest TANF-to-poverty ratios, with less than 10 families receiving benefits for every 100 families in poverty.
Prior to the pandemic, 10,599 Hoosiers living in single-parent households and child-only families received an average of $92.88 per recipient, according to a February of 2020 report. By April of 2022, the 7,598 recipients received an average of $97.22 in benefits each.
“That money doesn’t stretch far enough,” Burns said. “I believe that if people had more government help with diapers and wipes it would change everything.”
Burns noted that the state also taxes diapers, a necessity, but waives taxes for lottery tickets and candy bars.
“Even without overturning abortion, the need is already more than our capacity,” Burns said.
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