A woman breastfeeds her newborn son in Fort Worth, Texas, in April 2020.
CNN  — 

Almost all of the states that produce the most unfavorable economic and health care outcomes for children are among those poised to ban or severely restrict access to abortion if the Supreme Court overturns the nearly 50-year-old Roe v. Wade decision.

That pattern underscores the paradox that the states most committed to requiring women to carry pregnancies to term tend to invest the least in the health and economic security of expectant mothers and children after they are born.

Most of the 21 states with laws on the books that would “snap back” abortion restrictions if the court overturns Roe fall into the bottom half of state rankings on a wide array of measures tracking the well-being of children and families, including childhood poverty, low birth weight and premature births, access to health insurance for low-income mothers, availability of prenatal care and the share of kids enrolled in early childhood education, an analysis of public data sources shows.

Fully 15 of the 21 states prepared to ban or severely restrict abortion rank in the bottom half of states in the overall assessment of children’s well-being calculated each year by the non-partisan Annie E. Casey Foundation, with nearly all of those 15 states falling near the very bottom of the rankings. Mississippi and Texas, the states whose restrictive new abortion laws have triggered Supreme Court reconsideration of the issue, rank dead last and fifth from the bottom, respectively, in the Annie E. Casey measure of childhood welfare.

The consistently poor results for children in most of these states have prompted charges of hypocrisy against abortion opponents who claim to be promoting a “culture of life.”

“The charade is up,” says Kristin Ford, vice president of communications and research at NARAL Pro-Choice America. “This is not about families. This is not about supporting women. This is about controlling people. Period. End of story.”

Two leading social conservative organizations, Concerned Women for America and National Right to Life, did not provide comments to CNN on these trends when requested.

The concentration of anti-abortion statutes in states that produce poor outcomes for kids reflects the changing alignment of politics over the issue since the Supreme Court established the nationwide right to abortion in the 1973 Roe decision, says Mary Ziegler, a professor at the Florida State University law school and author of the recent book “Abortion and the Law in America.” The correlation results from “the political realignment about abortion, which took a while after Roe,” she says.

Before the Roe decision, Ziegler notes, conservative Catholics provided the core of opposition to abortion; conservative White evangelical Christians came to the cause only later, in part because strategists in the social conservative movement saw it as a way to overcome the historic evangelical enmity toward Catholics. That meant the states with the strictest abortion restrictions pre-Roe included many Northern states with large Catholic populations that otherwise supported a substantial social safety net. Heavily evangelical Southern states that traditionally have spent less on families and social services, including South Carolina, Georgia and Arkansas, were among the minority of states that had somewhat loosened abortion restrictions before Roe.

“The connection between evangelical Protestantism, or the South, or even Republican politics, and opposition to abortion was not a thing,” Ziegler says.

But in the decades since, opposition to abortion has indeed gravitated more toward all those poles – White evangelicals, the South, the Republican Party. And that has meant the small-government ideology of those groups has suppressed the talk of supporting families and children that was once more common among abortion opponents, Ziegler says. “The anti-abortion movement hitched its star to the GOP, which means that all of the … policy that some in the movement had been interested in – whether it’s helping moms or helping kids – that was just not on the table,” she notes.

The 21 states

According to the Guttmacher Institute, 21 states have laws severely restricting or banning abortion that will go into effect immediately if the Supreme Court overturns the Roe decision. Those states are primarily concentrated across the Sun Belt and outer South, including Alabama, Arizona, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas. The roster of states with anti-abortion laws in place also includes two in the West (Idaho and Utah), two in the Great Plains (North Dakota and South Dakota) and six broadly in the Midwest (Iowa, Michigan, Missouri, Ohio, West Virginia and Wisconsin).

A few of these states perform well on the Annie E. Casey rankings for children’s outcomes. Utah, Iowa and Wisconsin finish in the top 10; North Dakota, Idaho and South Dakota finish between rungs 11 and 20. But these higher-performing states tend to be older, smaller, predominantly White states with relatively few children: All six combined have only about half as many children as Texas alone.

Most of the anti-abortion states, particularly those across the Sun Belt with both more kids in general and more kids of color in particular, produce weaker outcomes. Many of these are states whose economies revolve around large numbers of low-wage jobs, and the vast majority of them suffer from elevated rates of poverty, particularly among children.

Of the anti-abortion states, 15 ranked among the 25 states with the largest share of children living in poverty as of 2019, according to analysis by the nonprofit Children’s Defense Fund. In 13 of the anti-abortion states, at least 18.4% of children live in poverty – a list that includes such large states as Arizona, Georgia, Ohio and Texas. That’s true in just two states without the anti-abortion laws on the books (North Carolina and New Mexico). That high childhood poverty rate in 13 anti-abortion states is far above the national average of 14.4% that year. Texas alone has 1.4 million kids living in poverty, more than any other state (though California has about 20% more children overall).

Among the anti-abortion states, 16 also rank in the top half of states for the largest share of children living in “extreme” poverty (with incomes half or less of the national poverty level, or roughly $13,000 for a family of four). Fourteen of them fall in the top half of states for the biggest share of children reporting that they have experienced hunger.

The anti-abortion states are also disproportionately represented on the list of those with the most children who are born prematurely or with low birth weights, or who die as infants, according to data collected by the Center for Health and Social Policy at the University of Texas’ Lyndon B. Johnson School of Public Affairs. Fourteen rank among the 25 states with the highest share of kids born prematurely; 13 rank in the top half for children born with low birth weights.

Perhaps most strikingly, 15 of the 21 states that would restrict or bar women from terminating pregnancies rank in the top half of states for the highest share of infant deaths in the first year of life. The list includes all but one of the 11 states with the absolute worst records on that critical metric – about seven deaths or more per 1,000 live births. (By contrast, states without anti-abortion statutes comprise 12 of the 15 states with the lowest rate of infant mortality.) Maternal mortality rates are not published in every state, but the limited data available show that they are also elevated in many of the states poised to ban abortion, including Alabama, Arkansas, Georgia, Kentucky, Louisiana, Oklahoma and Tennessee.

‘This inverse relationship’

The challenge in the anti-abortion states is compounded because most of them have instituted few, if any, of the policies that childhood development experts consider the most effective in improving outcomes for low-income children and parents.

“There is this inverse relationship between the proportion of children who are born at risk at birth, based on low birth weight or preterm births, and the level of investment in children through our programs in the earliest years that can support healthier development,” says Cynthia Osborne, the director of the Center for Health and Social Policy at the LBJ school.

Thirteen of the 21 anti-abortion states, for instance, are among the half of states where the highest share of low-income women of childbearing age lack health insurance, according to the center’s tabulations. Thirteen rank among the half of states with the largest share of births to women who did not receive adequate prenatal care. Twelve rank in the bottom half of states in the share of young children who receive developmental screening. Though some have adopted aggressive early childhood programs, 18 of the 21 states trail the national average for the share of 3- or 4-year-olds who are participating in preschool, according to the Annie E. Casey Foundation’s data.

Osborne’s center has identified five key policies that it considers the most essential in producing positive outcomes for young children. That list includes instituting a state minimum wage higher than the national floor, creating a state Earned Income Tax Credit for low-wage families, requiring paid family leave and expanding Medicaid eligibility as allowed under the Affordable Care Act. Of these 21 anti-abortion states, five have adopted none of these policies (Georgia, Mississippi, South Carolina, Tennessee and Texas). Eight others have adopted just one of them and five have adopted only two. Just three of the 21 states have adopted as many as three of these policies; none have adopted more.

“The states in which children are performing the worst,” says Osborne, “are typically the states that have not implemented the policies that provide resources to households in order to reduce the stressors that many families face and to allow them to engage in the parenting behaviors and the type of nurturing that we know is important for early childhood development.”

By comparison, roughly half of the 29 states without anti-abortion laws have adopted at least three of these policies to bolster outcomes for children. To take just one comparison: Only six of the 21 anti-abortion states have adopted a state minimum wage higher than the federal minimum of $7.25. Twenty-four of the 29 states without anti-abortion laws have done so.

Mississippi presents perhaps the starkest contrast between the level of concern about children before and after birth. The Mississippi law banning abortion after 15 weeks triggered the case that the Supreme Court’s Republican-appointed majority may use to weaken or overturn Roe. But the state ranks at or near the bottom on virtually every critical measure of well-being for children and mothers.

A woman looks at a picture of her ultrasound at Houston Women's Reproductive Services, on October 1, 2021.

“It’s so frustrating, because the governor wants to force birth but doesn’t want to support the families that are already here,” says Dr. Aisha Nyandoro, CEO of Springboard To Opportunities, an organization that provides services for low-income families in Jackson, Mississippi.

Fully 28% of Mississippi children under 18 live in poverty, a higher share than in any other state. (The poverty rate is over 40% for Black and Hispanic children there, triple the rate for White kids.) Mississippi also has a higher share of children living in extreme poverty than any other state. More than 1 in 7 babies there are born prematurely and about 1 in 8 are born with low birth weights – in each case also the highest rate for any state. (For Black children, that rises to more than 1 in 6 on each measure.) Mississippi mothers suffer nine infant deaths for every 1,000 live births – also the highest number for any state. One reason for those results: The state ranks fourth from the bottom for the share of low-income women of childbearing age who lack health insurance. The poor birth outcomes are “a situation that is so preventable, but since we are not doing the work to prevent it, it has devastating outcomes for so many,” says Nyandoro.

Only on preschool is Mississippi’s record more defensible, with a slightly higher share of 3- and 4-year-olds enrolled in early education than the national average. The Annie E. Casey Foundation ranks the state dead last in both economic and health care outcomes for kids, 39th in education and last on the overall measure of child well-being.

‘We are underperforming’

When Mississippi Republican Gov. Tate Reeves recently appeared on CNN’s “State of the Union,” host Jake Tapper pressed him on how such trends squared with his claim to be supporting a “culture of life.”

“I perfectly acknowledge that many of those statistics in terms of health outcomes in our state, we are underperforming relative to other states across the nation, and it’s incumbent upon all of us to work to pass policies to change that,” Reeves said. “When you look at health outcomes in terms of prenatal care or other areas, we have a ways to go, and that hasn’t become effective in the last year and a half but it has happened over 200 years of our state’s existence, and we are going to do everything we can to improve upon that.”

Nyandoro is one of many analysts and advocates who say the state’s record sharply belies that claim, however. “We have to get very earnest about what it is that policy makers are allowing to happen, and we have to call them out on the inconsistencies of the reality on the ground vs. what they say as talking points,” she says.

Despite Reeves’ pledge, for instance, Mississippi has no minimum wage law, making it one of just seven states with either no statutes or wages lower than the federal hourly level (which applies in the state). It is also one of just 12 states that have still refused to expand Medicaid eligibility to working-poor families, as allowed by the Affordable Care Act. The state limits Medicaid eligibility to parents with income equal to just one-fourth of the federal poverty line.

That’s the lowest eligibility threshold in the country except for Alabama (at 18%) and Texas, the other state whose abortion restrictions are currently before the Supreme Court. Texas has also refused to expand Medicaid under the ACA and limits eligibility to parents earning just 17% of the federal poverty level. A higher share of low-income women of childbearing age lack health insurance in Texas (nearly 1 in 2) than in any other state, and in only two other states do a higher percentage of pregnant women fail to receive adequate prenatal care, according to the Center for Health and Social Policy. Looking specifically at health outcomes for children, the Annie E. Casey Foundation ranks Texas lower than any other state except Mississippi.

It is such results in the anti-abortion states that NARAL’s Ford points to when she says, “How cruel is it to force someone to carry a pregnancy to term and then to provide completely inadequate support for what they might need?”

The safety net for mothers and children is especially porous in Mississippi and Texas because they have not expanded Medicaid under the ACA. (In all, eight of the 21 anti-abortion states have refused to expand Medicaid, compared with only four of the 29 states without such bans on the books.) But even in the anti-abortion states that have widened eligibility for Medicaid, the rest of the safety net typically remains limited.

West Virginia captures that dynamic. It has expanded Medicaid eligibility and invested resources in early childhood education (though the share of kids not in pre-K remains very high). But beyond those measures, it offers little support to low-income parents, says Sean O’Leary, a senior policy analyst at the non-partisan West Virginia Center on Budget and Policy.

“We don’t have a big social safety net out there,” he says. “We don’t have a lot of labor supports for parents who are trying to work. We have a child care subsidy, but it has a real sharp cutoff. There is not much else going on there. We have a few bright spots and the return on those have been great, but there’s a lot of room for improvement when it comes to children in what we have been doing.”

The same can be said of most of the states ready to roll back or eliminate access to abortion if the Republican-appointed majority on the Supreme Court allows. The inescapable truth is that in many of the states that bill themselves as “pro-life,” life is often very tough for many of the children already there.