For Republican candidates, talking about mothers and babies is a thorny issue

A month before Election Day, as Republicans in Congress dodged questions about a proposal to ban abortions after 15 weeks of pregnancy, Sen. Chuck Grassley (R-Iowa) Tweet That he wanted to talk about mothers and children.

Grassley, in what could be his closest race since becoming a senator in 1980, said he has heard a lot about the lack of prenatal care in rural Iowa. He introduced his answer, called the Healthy Mothers and Babies Act. “This bill will help fill those gaps in rural America so we can provide health care for high-risk pregnancies,” he said.

Republicans are favored to win the House of Representatives in the midterm elections, and only need to pick up one seat to take the Senate. Polls show that abortion is a motivating issue for many voters, with Republicans cleaning up their websites, softening hard lines or going quiet on women’s health as Election Day approaches. Some have confused abortion questions by suggesting Democrats hold extreme views, an attack President Donald Trump helped popularize.

Before the Supreme Court struck down the constitutional right to abortion in June, the women were cracking down on the health care system. But the state response to that decision further divided reproductive health care into sanctuaries and deserts, ensuring that access varied widely across state lines. And new government reports paint a worrying picture of maternal health, showing that the Covid-19 pandemic has contributed to an increase in deaths from pregnancy and childbirth complications – and that the vast majority of recent deaths are preventable.

Democrats have made protecting abortion access a central theme of their campaign to keep congressional control, hoping for a surge in political engagement after the court’s decision. But polls show the economy remains voters’ biggest concern.

Some Republicans, like Grassley, are conducting pre-election talks on proposals of their own. But policy experts and women’s rights advocates say they are not going far enough to change the situation for women.

“To address the maternal health crisis, we need more than just guidance,” said Alison Orris, a senior fellow at the Center on Budget and Policy Priorities, a progressive think tank.

In September, when Sen. When Lindsey Graham (R.S.C.) introduced a bill that would have fixed the federal ban on abortions after 15 weeks, the proposal appeared to split her party. Most congressional Republicans have advocated for states to make their own decisions about reproductive health, which conservatives argued before the Supreme Court acted. Others wanted to see federal action but said Graham’s proposal did not go far enough. House Republicans who think this way have introduced their own proposal.

Senate Minority Leader Mitch McConnell said Graham’s measure would not get enough support to pass.

However, Graham, who is not up for re-election, has proposed the ban several times over the past decade — and previous versions of the legislation were co-sponsored by nearly every sitting Republican senator.

“If we take back the House and the Senate, I can assure you that we will vote on our bill,” Graham said.

The maternal mortality rate in the United States — which is higher than in any other industrialized nation — has risen over the past two years, spurred in large part by the Covid-19 pandemic, according to a new Government Accountability Office report commissioned by Congress. Antenatal care is a major factor in preventing maternal and infant mortality, and the report notes that the pandemic has made it harder for women to care, from closing public transit and childcare facilities to job losses, which have hit women harder than men. .

Access to reproductive care has declined in many states, largely due to Republican efforts, such as funding restrictions and other state laws that make it harder for health centers to stay open. Many of these centers provide reproductive care, including contraceptive counseling. Republicans control legislatures in 30 states, most of which ban nearly all abortions before pregnancy when a fetus can survive outside the womb.

Vicki Shabo, a senior fellow at the think tank New America, said the Supreme Court’s decision “took away a constitutional right and created chaos for people around the country who are trying to figure out how to govern.”

“They are doing this in the context of a country that does not offer paid leave; 50% of families live in a childcare desert; Even women and children are not guaranteed access to health in all states; And the wages are too low and the work is not predictable enough to be able to support a family,” he said.

Congressional Democrats last year passed an economic recovery package that included several policies aimed at improving families’ financial security, including a five-year program that gives states the option to extend women’s Medicaid benefits for a year after childbirth.

Under an ongoing public health emergency, no one can be excluded from Medicaid. Once the deadline expires, women living in 34 states — including the District of Columbia — who opted in will be eligible for Medicaid the year after giving birth, when more than half of pregnancy-related deaths occur.

Insured women are more likely to receive routine care, including important interventions for health conditions that can make pregnancy risky, such as diabetes.

More than two dozen states, including some with the nation’s strictest abortion restrictions, have not adopted the postpartum coverage extension, meaning women lose pregnancy-related coverage 60 days after giving birth.

These women may be eligible for full Medicaid if their state expands its adult Medicaid programs under the Affordable Care Act. In other states, they can purchase marketplace coverage through the ACA and experience a small gap in coverage when switching plans. Low-income women will be eligible for subsidies to cover their premiums.

In some states, many women will lose coverage entirely after the first two months.

Orris said Grassley’s maternal health bill offers “helpful and important steps” — specifically, mandatory reporting of maternal quality measures, funding for more integrated prenatal care and guidance to states on coverage of doulas and community health workers. But the bill, which offers no major policy proposals, likely won’t match the benefits offered through the postpartum coverage extension, she warned.

“Extending postpartum coverage to one year after birth would help, and I think it’s notable that Iowa is not among the states that have adopted this option,” Orris said.

On the day the Supreme Court announced its abortion decision, Sen. Marco Rubio (R-Fla.), one of the most imperiled Republican incumbents, released his own announcement: a promise of a comprehensive legislative package to support mothers.

Over the next three months, Rubio introduced three bills: the Standing with Moms Act, which would have established a government website for pregnancy resources that would include information on abortion options and other information from anti-abortion groups; the Community Mentors for Moms Act, which would create mother-to-mom mentorship programs; and the Providing for Life Act, which includes an enhanced child tax credit and a paid leave program.

Paid family medical leave, available in 11 states and the District of Columbia, allows people to take paid time off work for disruptive health events, including having a baby, becoming seriously ill, or caring for a sick relative.

Paid leave has many benefits for the health of a new mother and baby, said Shabo, who has advocated before Congress for a federal program. This is associated with higher rates of breastfeeding, lower rates of postpartum morbidity, better infant outcomes, fewer cases of shaken baby syndrome and overall maternal health, she said. It is also associated with higher rates of labor force participation and earnings over time, which increases financial stability.

Supporters of a federal paid family medical leave program scored a bittersweet victory this congressional session: For the first time, the House has approved one. But opposition from Republicans and concerns from Sen. Joe Manchin (DW.Va.) about the cost and business community have ruined its chances of becoming law.

Rubio’s proposal would allow new parents to borrow from their future Social Security benefits for their earnings while taking leave. But Shabo noted that the proposal would hurt women and families of color, who are more likely to rely on Social Security in retirement.

“Asking you to sacrifice the ‘future you’ when you know that is needed at all stages of life is not a smart way to make policy,” Shabo said.

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