MEMPHIS, Tennessee – Taylor Cagnacci moved to Tennessee from California with hopes of starting a new chapter in a state that boasts a low cost of living and natural beauty.
But she is angry at Tennessee’s meager social services, causing her and many other mothers to struggle in a state where abortion is banned with limited exceptions.
“I was going to have my baby no matter what, but for other women, it’s kind of a crappy situation they’re in,” said Cagnacci, a 29-year-old Kingsport mom who relies on Medicaid and federally funded nutrition. “Put you in.” Program. “You have to have your baby. But where is the help after?”
Recent research and analysis from the Associated Press shows that Tennessee has a porous safety net for mothers and young children. It is unknown how many women in the state have given birth because they did not have access to abortion, but it is clear that from the moment a Tennessee woman gets pregnant, she deserves a healthy pregnancy, a healthy baby, and a financially Have to face big obstacles. Stable family compared to the average American mother.
Like other states with strict abortion restrictions, Tennesseans of childbearing age are more likely to live in maternal care deserts and face a shortage of doctors overall. Women, infants, and children are less likely to enroll in the government nutrition program called WIC. And Tennessee is one of 10 states that has not expanded Medicaid to a larger share of low-income families.
“It’s survival every day,” said Jenny Busby, founder of Mother to Mother, a Nashville-based nonprofit that provides baby supplies for low-income mothers. “If we took away some of their stress, maybe they would have time to dream.”
GOP state leaders in Tennessee and other states that have enacted abortion bans in 2022 after the U.S. Supreme Court overturns Roe v. Wade argue they are strengthening services for families.
Tennessee expanded its Medicaid coverage for mothers from 60 days postpartum to one year in 2022, allowing an additional 3,000 mothers to access the program each year.
The state has raised the Medicaid income limit for parents to the poverty level — about $26,000 for a family of three — and provides recipients 100 free diapers per month for children under age 2. According to the governor’s office, these changes have resulted in thousands of new diaper parents accessing government services.
“Pro-life is about more than protecting the lives of the unborn,” Republican Governor Bill Lee said in his 2023 annual address to lawmakers and was echoed recently on social media. “This is not a matter of politics. This is about human dignity.”
Still, nonprofit leaders and moms pointed out that the safety net still has significant gaps.
Anika Chiles, a 39-year-old single mother in Memphis, has Medicaid, WIC, and the Supplemental Nutrition Assistance Program. Although she’s very grateful for the help, she said it can also disappear — 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. “Groceries continue to rise.” And being a single mother “makes it twice as hard for you.”
An October study found that Tennessee performed poorly in WIC enrollment, Medicaid, adequate maternal care, and paid family and medical leave requirements.
Other states with similarly restrictive abortion laws – such as Idaho, Alabama, Missouri, Georgia and Mississippi – also ranked poorly on several 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.
“Generally, these states that restrict abortion are more fiscally conservative, more socially conservative states,” said Dr. Nigel Madden, lead author of the study published in the American Journal of Public Health.
The Republican supermajority in the Tennessee legislature has long rejected efforts to expand Medicaid to people earning up to 138% of the federal poverty level — about $35,600 for a family of three. And TennCare is already facing criticism, after a federal judge ruled earlier this year that the state unlawfully ended coverage for thousands of families because of the paperwork problems the state caused. The reason was a “sluggish” response to the approximately 250,000 children who lost coverage.
Dejuana Davis, 44, was among the plaintiffs. In 2019, the Nashville resident had to undergo surgery to prevent pregnancy and alleviate her chronic anemia. A few days before the procedure, she was informed that her Medicaid coverage had been cut and the hospital was canceling.
She later discovered that her renewal papers went to the wrong address, an error 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 and needs to be fixed,” he said.
More than 3% of the 83,000 babies born in Tennessee in 2023 had mothers who did not receive prenatal care. Only seven states had a higher share, according to an analysis of data from the Centers for Disease Control and Prevention.
After birth, lack of a doctor hinders ongoing care. Nearly a third of Tennessee residents live in an area with a primary care deficit — a higher rate than all but 10 other states, according to an analysis of data from the Census Bureau and the Health Resources and Services Administration.
Mothers described many support programs as frustrating to navigate. Chiles was at WIC for several months after the birth of her son, but then she left due to a mistake during the renovation process — eventually reinstated with the help of the nonprofit Tennessee Justice Center.
Chiles credits a nonprofit preschool provider for first connecting her to support programs: “I don’t see a lot of advertising about, you know, how you can get into this program or get this “Service,” he said. “People are just not aware.”
Cagnacci, who is pregnant and has a one-year-old child, said she was on SN for some time but missed appointments and was unclear about next steps. The process of getting recertified was “so much of a headache” that she’s doing without it.
“I just felt like it was being made deliberately difficult so that I would give up,” he said.
In states where abortion is banned or limited to the early weeks of pregnancy, women with young children said it may be harder to get social services there, according to a survey by the health policy research organization KFF. Nearly half said it is difficult for women in their state to get food stamps, for example, compared with 3 in 10 in states where abortion is generally available.
“People who claim to be pro-life, who advocate for these abortion restrictions, 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 reflects deep political divisions over aid programs. The Republican governor described it as an effort to strengthen families, while Democratic state Senator London Lamar said GOP leaders are “trying to bend a little on the abortion ban.” And GOP state Senator Mark Pody recently told the right-wing news website The Tennessee Conservative that “it’s not the state’s responsibility to have diapers for every single child” and raised the possibility of cutting the program.
According to a recent report, 30% of Tennessee’s 2.8 million households earn above the poverty level, but not enough to afford the basic costs of living in their county. Often, they are not eligible for government assistance.
“Some people are working three jobs and still can’t survive,” said Busby of Mom to Mom.
A fragmented patchwork of donations can help, but they don’t cover the entire state. For example, Nashville Diaper Connection serves 30 counties, working with partners to provide 50 diapers per month, mostly to working families who earn too much for Medicaid. Income regulations from government agencies hinder other nonprofits from helping. And most donations are hampered by the ups and downs of donations.
Nonprofit leaders fear their work could get tougher with the new administration in Washington and the GOP-controlled Congress. Republicans may demand significant changes to federal aid programs they have long criticized, such as Medicaid and food stamps.
“We’ve gone through four years of the Trump administration, and the goal under the Trump administration was to cut social services,” said Signe Anderson, senior director of nutrition advocacy for the Justice Center. “I’m concerned…for families in Tennessee and across the country.”
Crusi reported from Nashville, Tennessee. Data journalists Kasturi Pananjadi and Nicky Forster contributed to this report.
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