MEMPHIS, Tenn. (AP) — Taylor Cagnacci moved to Tennessee from California with hopes of starting a fresh chapter in a state that touts a low cost of living and natural beauty.
But she’s irate about Tennessee’s impoverished social services, which are leaving her and many other mothers in trouble in a state where abortion is banned with few exceptions.
“I definitely wanted to have my child, but for other women, that’s a pretty crappy situation to put you in,” said Cagnacci, a 29-year-old mother from Kingsport who relies on Medicaid and a government-funded nutrition program . “You have to have your child.” But where is the support after that?”
Tennessee has a leaky safety net for mothers and teenage children, recent research and an analysis by The Associated Press found. 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 time a Tennessee woman becomes pregnant, she faces greater obstacles in her path to a robust pregnancy, a robust child and a financial situation facing a more stable family than the average American mother.
Like other states with strict abortion bans, Tennesseans of childbearing age are more likely to live in the desert of maternal care and face a general physician shortage. Women, infants and children are less likely to participate in a government nutrition program called WIC. And Tennessee is one of only 10 states that have not expanded Medicaid to a larger share of low-income families.
“It’s about survival every day,” said Janie Busbee, founder of Mother to Mother, a Nashville-based nonprofit that provides baby supplies to low-income mothers. “If we took some of that stress away, maybe they would have time to dream.”
GOP leaders in Tennessee and other states that have banned abortions after the U.S. Supreme Court’s 2022 Roe v. Wade repealed, arguing that they would strengthen services for families.
Tennessee increased its Medicaid coverage for mothers from 60 days postpartum to one year in 2022, allowing an additional 3,000 mothers to utilize 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 offered recipients 100 free diapers a month for babies under two. According to the governor’s office, these changes have resulted in thousands of fresh diapers for parents using state services.
“Pro-life is about much more than just defending the lives of the unborn,” Republican Gov. Bill Lee said in his annual address to lawmakers in 2023 and reiterated recently on social media. “This is not a question of politics. This is about human dignity.”
Still, nonprofit leaders and mothers told the AP that there are still significant 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 is deeply grateful for the support, 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. “Food prices are constantly rising.” And being a single mother “makes it doubly difficult.”
Challenges in Medicaid and Health Care
Tennessee performed poorly in WIC enrollment and Medicaid because it had adequate maternal care and access to paid family and medical leave, according to an October study.
Other states with similarly restrictive abortion laws – such as Idaho, Alabama, Missouri, Georgia and Mississippi – also performed poorly on numerous measures. Researchers said restrictive states have a slightly higher average birth rate and a much lower average abortion rate than the least restrictive states.
“In general, these states that restrict abortion are the more fiscally conservative and socially conservative states,” 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 illegally canceled coverage for thousands of families and responded “lethargically” when nearly 250,000 children lost coverage because of paperwork problems caused by the state have.
DiJuana Davis, 44, was among the plaintiffs. In 2019, the Nashville resident was scheduled to undergo surgery to prevent pregnancy and relieve her chronic anemia. Days before the procedure, she was told her Medicaid coverage had been canceled and the hospital would cancel treatment.
She later discovered that her renewal paperwork was going to the wrong address, which resulted in her being uninsured for two months – during which time she became pregnant and developed preeclampsia. Doctors induced labor to save her life, and her son was born prematurely.
“The system is broken,” she said, “and it needs to be fixed.”
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 proportion, according to an AP analysis of data from the Centers for Disease Control and Prevention.
After the birth, the shortage of doctors makes it tough to provide ongoing care. About a third of Tennesseans live in an area with a lack of basic services — a larger share than in all but 10 other states, according to an AP analysis of data from the Census Bureau and the Health Resources and Services Administration.
Meal and diaper programs
Mothers described several assistance programs as frustrating. Chillis participated in WIC for several months after her son was born, but then went without it due to a mistake during the renewal process – she was eventually restored with the support of the nonprofit Tennessee Justice Center.
Chillis credits a nonprofit preschool provider with connecting her with service programs in the first place: “I don’t see a lot of ads about how to get into this program or get this service,” she said. “People just don’t have the 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 wasn’t sure what the next steps were. The recertification process gave her “such a big headache” that she decided not to do it.
“I just felt like it was intentionally made so difficult for me that I would just give up,” she said.
Women with teenage children in states that ban abortions or limit them to the first weeks of pregnancy said it can be tough to receive social services there, according to a survey by health research organization KFF. Nearly half said it is tough for women in their state to get food stamps, for example, compared to three in 10 in states where abortion is widely available.
“People who claim to be pro-life and have advocated for these abortion bans often claim that these measures are aimed at protecting children, women and families,” said researcher Madden. But the weakness of the safety net shows “the hypocrisy of this argument.”
Tennessee’s fresh diaper program highlights the deep political divisions surrounding relief programs. The Republican governor described it as an attempt to strengthen families, while Democratic Senator London Lamar said GOP leaders were “trying to put a small berth on an abortion ban.” And Republican Senator Mark Pody recently told the right-wing News website Tennessee conservatives said that “it is not the state’s responsibility to have a diaper for every single baby” and suggested the possibility of cutting the program.
Charities are struggling to fill gaps
According to a recent report, 30% of Tennessee’s 2.8 million households earn above the poverty line, but not enough to afford the basic cost of living in their county. They are often not entitled to state aid.
“Some work three jobs and still can’t survive,” said Mother to Mother’s Busbee.
A fragmented patchwork of charities can support, but they don’t cover the entire state. The Nashville Diaper Connection, for example, serves 30 counties and works with partners to provide 50 diapers per month, primarily to working families who make slightly too much for Medicaid. Other nonprofits are prevented from helping by government agency income rules. And most charities are constrained by the ebb and flow of donations.
Nonprofit leaders fear their work could become more tough with a fresh administration in Washington and a GOP-controlled Congress. Republicans could seek significant changes to federal aid programs they have long criticized, such as Medicaid and food stamps.
“We went through four years of a Trump administration, and the goal of the Trump administration was to cut welfare,” said Signe Anderson, senior director of nutrition promotion 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 journalists Kasturi Pananjady and Nicky Forster contributed to this report.
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The Associated Press Health and Science Department receives support from the Science and Educational Media Group of the Howard Hughes Medical Institute and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
