Expanding State and Federal Support for Decisions for Life

By: Charles A. Donovan

This is Issue 22 of the American Report Series. The most current version of this paper can be found at Expanding State and Federal Support for Decisions for Life.

The provision of alternatives to abortion has been the hallmark of the U.S. pro-life movement since the founding of the first pregnancy help centers more than a half century ago.  Ever since, and accelerating after the mid-1980s, PHCs, as the centers are known by shorthand, have rapidly expanded their personnel, volunteers, and services. PHCs have spread internationally as well, working in at least 114 countries, touching millions of the lives, and expending hundreds of millions of dollars in resources to assist women to carry unexpected pregnancies to term.

In addition to this form of private sector initiative, policymakers at the state and federal level have championed and adopted a wide range of policies to improve financial resources that go directly to women and families and to the agencies that support them. These measures include such landmark legislation as the federal Child Tax Credit, adoption tax credits, Medicaid expansion to cover postnatal care beyond the immediate postpartum period, the Children’s Health Insurance Program (CHIP) which recognizes unborn children as within its scope of application, the Title V Maternal and Child Health Block Grant, and many other provisions of law.

Now, in the wake of the landmark Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization, state and federal legislators are acting swiftly to refine and expand existing programs, all with the goal not only of supporting initial decisions for life but also establishing routes forward by which women and families can thrive and pursue the goals that care for children can affect on a daily basis.  This paper outlines and tracks these policies, utilizing seven categories of care that have been identified by Her PLAN, a project created by Susan B. Anthony Pro-Life America Education Fund. These categories of care address the circumstances that cause women to resort to abortion.  They honor and value the lives of both mother and baby and seek to encourage family formation and enduring relationships.

Cat. 1: Mentorship, Care Coordination and Cross-Cutting Support

Women point to many reasons they resort to abortion. Addressing a range of needs from job training to baby supplies to parenting classes may require access to one of the growing number of pregnancy centers that offer a variety of cross-cutting programs and possibly even a care coordinator.  A woman may also feel overwhelmed by the prospect of pregnancy, delivery, and parenting. This is especially the case when her partner, parents and/or friends have said they will abandon her unless she has an abortion. Life-affirming mentors can fill that gap with encouragement and support. Boyfriends can be encouraged and empowered to step up to their new role as parents. Support services like these can be facilitated through the following policies:

1. Fund Pregnancy Centers through direct state or federal funding. Follow the Alternatives to Abortion (A2A) model enacted by Texas or SBA Pro-Life America’s Support for Mothers and Babies bill. Through these grants, centers can provide support to women.  For more information about current state programs to fund pregnancy centers see: Fact Sheet: State Alternatives to Abortion Funding – Charlotte Lozier Institute.

Highlight: On February 6, 2023 Tennessee Gov. Bill Lee followed through on his proposal to add funding to the state budget in the form of grants to pregnancy care centers in the state. The $100 million in grants for the next fiscal year represent less than 0.2 percent of the proposed $55.6 billion budget and will provide the centers with additional funds to carry out their mission of providing an array of free services, including limited ultrasound, community referrals, material support, and counseling. Tennessee has supported placement of ultrasound machines in the past.  Tennessee abortions occur at a rate around 40 percent below the national average.

In West Virginia, new legislation designed to provide grants to the state’s pregnancy help centers was approved on March 9. The West Virginia budget separately sets aside $1 million in funding for this legislation, which should soon be signed by Gov. Jim Justice.  The same legislation will help with early intervention services for children with developmental delays.

Florida is also considering new legislation introduced in the Senate in March 2023 to appropriate $25 million in pregnancy support services.

2. Incentivize donations to pregnancy centers through tax credits. Both Mississippi and Missouri offer a tax credit to businesses that make donations to pregnancy centers. Missouri’s tax credit is available to individuals and certain corporations that pay income tax in the state. The donation can be in cash or stock or other forms of property. It must be a minimum gift of $100 up to a maximum of $50,000, and it may not exceed the amount of the giver’s income tax liability for the year the gift is made. Any unused portion of the credit may be carried forward to the next tax year.

Highlight: On February 23 the Mississippi House voted on a bipartisan basis, 104-8, to expand the state’s tax credit for donations to the state’s 37 pregnancy help centers and to create a new credit to assist with child care expenses for low-income individuals and married couples. The total cost to Mississippi of the PHC tax credit cannot exceed $3.5 million, with a per-PHC maximum of $1.75 million.

The related Children’s Promise Act is a tax credit available to businesses that make donations to entities under contract with the state’s Child Protective Services office and that provide services related to adoption or foster care. This tax credit has an annual cost-to-the state limit of $9 million with an individual contribution cap of $2.25 million.  Effective use of these credits would allow states to expand the caps in future years if child placements increase and other state costs are reduced.

3. Create a database of life-affirming services. Senator Marco Rubio (R-FL) has offered legislation to facilitate care coordination by creating a federal database of life-affirming services available to support pregnant women. Originally introduced in July 2022, the Standing with Moms Act was reintroduced in January 2023 with the goal, Rubio says, of giving women “easy access to the resources they need to look after their babies.” The site, to be called life.gov, will compile resources in seven areas: Education, Health care, childcare, mental health, legal support, financial assistance, and prenatal care.

Rep. Carol Miller (R-WV) and Senator Rubio have also collaborated to introduce legislation to fund integrated mentoring services.  First introduced in August 2022, this legislation, the Community Mentors for Moms Act, was reintroduced on January 24, 2023. The bill would amend Title V of the Social Security Act and appropriate $100,000,000 in each fiscal year from 2023 to 2025 to support mentoring programs for women who are pregnant or have a child or children under age six. Supported programs will assist mothers with such tasks as improving maternal health and parenting skills and increasing financial literacy. Agencies that provide, pay for, refer for or otherwise engage in abortion activity, or that provides financial support for such an agency, are ineligible for funding.

Highlight: States are also stepping up to create resources for women facing unexpected pregnancy. Governor Kristi Noem (R-SD), for example, created a life-affirming resource for the women of South Dakota at life.sd.gov.  The site has four major components, aggregating a large variety of programs under the rubrics of Pregnancy, Parenting, Financial Assistance, and Adoption.  The goal, Governor Noem says, is to “support moms and babies both before birth and after.”

Cat. 2: Health and Well-Being

While pregnancy is a natural condition and medical progress has resulted in improvements in standards of care, how pregnancy will impact a woman’s health can be a concern for women vulnerable to abortion. She may be concerned about access to health care and its cost. Her health and well-being can be better supported with a variety of policies and programs:

1. Allow moms to retain Medicaid coverage after delivery. Pregnancy can affect a woman’s health well past delivery, and traditionally Medicaid postpartum coverage ends after 60 days. Federal Medicaid policy guidance allows states to extend that coverage up to a year postpartum, allowing mothers to get care that can improve their outcomes and reduce maternal morbidity and mortality. (Note: this should not be confused with Medicaid expansion, which is a much more sweeping measure to expand Medicaid coverage to a larger portion of the population. The option discussed here only allows a woman eligible for Medicaid while pregnant to remain on Medicaid longer after delivery.)

A majority of the states have responded to new federal legislation, beginning with the Families First Coronavirus Response Act and continuing with the American Rescue Plan Act of 2021, the latter of which gave states the ability to expand postpartum Medicaid coverage to 12 months from the current 60 days, even if the state has not elected to expand eligibility for Medicaid coverage. Currently, more than 40 percent (41.0 percent) of U.S. births are financed by Medicaid. Forty-two states either have a 12-month postpartum coverage period or are seeking legislation or taking other action to obtain an 1115 Medicaid waiver to allow such coverage.

Highlights: Gov. Mark Gordon of Wyoming signed a bill on March 3 that expanded the state’s coverage of postpartum services for Medicaid-eligible women in the state from two months to a full year. A policy advisor to the governor testified during a hearing that the governor believes the measure “is an avenue to ensure that we take care of women and infants” and that providing physical and mental health care will allow those who qualify to be “a better parent and ultimately make the infant safer.”  The extension is supported with $3.8 million in state and federal appropriations.  In addition, on March 7 the Mississippi legislature sent Gov. Tate Reeves a bill extending Medicaid postpartum coverage to a full year after the birth of a child to Medicaid-eligible women.

2. Initiate or expand a nurse-family partnership to support pregnant and parenting women and families. Under this program, nurses are assigned to women when they are pregnant and serve them through the child’s second birthday. Nurses help women achieve a healthy pregnancy and a healthy start for their baby. The Nurse-Family Partnership has served moms and babies for 45 years and operates in many states. Federal funding for these services is available through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program administered by the Administration for Children and Families.

Cat. 3: Financial Assistance, Work, and Education

Not only do pregnancy and parenting come with significant expenses, but they can also create additional challenges to completing education or maintaining work. Initiatives like these can help women overcome these financial challenges and increase their earning capacity.

1. Ensure students at state colleges and universities are aware of their rights and the resources available to them. Representative Ashley Hinson (R-IA) and Senator Marco Rubio (R-FL) introduced the Pregnant Students’ Rights Act. The legislation, first introduced in May 2022, would ensure that colleges and universities covered by Title IX make pregnant and parenting students aware of the rights and resources available to them and of their right to file complaints under Title IX for failure to make these resources known. This measure has now been incorporated into Sen. Rubio’s comprehensive bill called the Providing for Life Act of 2023 (S. 74). The bill includes 14 distinct proposals on issues from child support enforcement, to adoption tax credit expansion, to grants to pregnancy help centers across the nation.

2. A pregnant woman deserves prompt child support for the unborn child she is carrying. Pregnancy requires additional nutritional and medical expenses as well as purchases to prepare to bring the child home from the hospital. U.S. Senator Kevin Cramer (R-ND) introduced the Unborn Child Support Act to provide for child support for unborn children. A related provision is included in Senator Rubio’s S. 74, requiring the father of an unborn child to provide at least 50 percent of the cost of pregnancy care or the insurance premiums providing such coverage. This provision may be exercised only with the authorization of the mother.

3. Expand child support enforcement during pregnancy at the state level. Under Georgia’s LIFE (Living Infants Fairness and Equality) Act, women in Georgia may seek child support during pregnancy.  HB 481 provides that “natural persons include an unborn child” and that “such unborn children shall be included in certain population-based determinations.” The act limits abortion after a fetal heartbeat is detected, and it “permits alimony and child support payments starting when an unborn child has a detectable human heartbeat. Parents have the right to recover the full value of a child’s life when a detectable human heartbeat exists.” Estimates are that the law will impact more than 20,055 abortions each year.

4. Defray the expense of supporting a child as costs begin in the womb. Senator Steve Daines (R-MT) and Representative Jason Smith (R-MO) acknowledged this fact with the introduction of the Child Tax Credit for Pregnant Moms Act to allow parents to take advantage of the child tax credit for their unborn child. Georgia included a similar provision with regard to state income taxes in the state’s LIFE Act. The Daines-Smith bill extends the application of the child credit first adopted in 1997 under the leadership of pro-family groups seeking the adoption of family-centered tax relief. The credit began at birth and ran through age 16. Daines-Smith would allow the credit to be claimed for an unborn child defined as “an individual of the species homo sapiens, from the beginning of the biological development of that individual, including fertilization, until the point of the earlier of being born alive or death.” The bill is a life-affirming measure recognizing the value of the unborn child and the onset of new costs to mothers and families securing prenatal care and preparing for birth.

5. Provide cash benefits to families starting in the womb. The Family Security Act 2.0 developed by Senator Mitt Romney (R-UT) offers monthly cash benefits to families with children starting in the womb.  The legislation, first introduced in 2022, would be financed by simplification and consolidation of several existing child benefits.  It would provide a monthly payment of $350 per month to families for children age six and under and $250 per month for children age six to 17. The money would be paid out over the course of the year, and not as a lump sum, and initial payments would occur halfway through pregnancy in light of the extra costs of prenatal care and childbirth. The proposal recognizes that both marriage and fertility rates are at historically low rates in the United States.

6. Explore paid parental leave policies to assist parental adjustment. It takes time to recover physically from childbirth, and infants need intense care and bonding in their first few weeks and months after delivery. Paid leave allows women that critical time. Lawmakers have offered several approaches to paid leave and it is incumbent upon legislators to find consensus for a particular approach. According to a Bureau of Labor Statistics survey published in September 2022, just 25 percent of private sector employees have access to paid parental leave.  On January 24, 2023 Sens. Marco Rubio and Mitt Romney introduced S. 35, the New Parents Act, which would allow parents to use a portion of their social security benefits to finance up to two months of paid leave for a newborn or adopted child. The Act recognizes that the birth and upbringing of children are pivotal to any system or policy of social security.

Cat. 4:  Material and Legal Support

Need for secure housing, utilities, food and transportation is heightened for women carrying an unborn child and bringing home an infant. Added to those needs are the unique concerns of the infant and urgency to resolving legal disputes such as those with a landlord. Programs like the following can help women navigate these challenges:

1. Prioritize care coordinators when offering financial support to pregnancy centers (see Cat. 1 on Mentorship, Care Coordination and Cross-Cutting Support). Care coordinators can help clients navigate existing programs like WIC (Women, Infants and Children, an infant and toddler feeding program), SNAP (Supplemental Nutrition Assistance Program, a state-administered U.S. Agriculture Department program that supplies resources to families with limited income), Medicaid, and LIHEAP (Low Income Home Energy Assistance Program, a program of grants administered by the U.S. Department of Health and Human Services to assist with home heating and cooling costs).

2. Identify regulatory burdens that may impede the creation of maternity housing. Housing is typically the largest component of a family’s budget. Residential facilities for pregnant women (and their children) can help women get on their feet during pregnancy and after. For example, Georgia has enacted “Betsy’s Law” to enable the creation of free housing and wraparound resources for pregnant and postpartum women. Signed by Gov. Kemp in May 2022, the law authorizes nonprofits to establish housing projects, requires them to meet standards in the area of building codes and insurance, and ensures that local authorities cannot constrain the housing by imposing conditions that they do not impose on single-family residences. Gov. Kemp stated at the time of signing the measure that his intent was to continue Georgia’s “reputation of being a state that protects life at all stages.”

3. Offer free car seats to low-income families through a program like this one in Texas. In addition, pregnancy help organizations throughout the United States routinely assist women and couples in acquiring basic needs for such items as car seats, strollers, diapers, formula, and other baby supplies.  The 2019 pregnancy help survey conducted by Charlotte Lozier Institute, Heartbeat International, Care Net, and the National Institute of Family and Life Advocates (NIFLA) documented the provision of an estimated 30,445 car seats in that calendar year. The centers provided, free of charge, more than 2 million baby outfits and nearly 1.3 million packs of diapers.

4. Establish and extend a network of maternity homes across the nation that provide robust services for up to two years after childbirth. The National Maternity Housing Coalition (NMHC) is organized under the auspices of Heartbeat International, the largest network of pregnancy help organizations in the world. The NMHC adheres to Heartbeat’s standards document, the Commitment of Care and Competence. The aim of the NMHC is “[t]o inspire excellence among maternity housing providers and articulate a collective voice” for community and public policy support. The NMHC operates a 24/7 toll-free number (800-712-HELP) and a center locator linking to websites for 115 homes around the nation (as of March 10, 2023).

Cat. 5:  Recovery and Mental Health

Pregnancy can be especially challenging for women who struggle with addiction, are recovering from trauma, or are victims of intimate partner violence or sexual assault. As recent studies have identified once again, the challenges of pressure to abort and the mental health consequences of abortion are widespread and significant. These are potential opportunities to reduce those challenges:

1. States may wish to promote Substance Abuse Prevention and Treatment Block Grants (SABG) for substance use disorder (SUD) treatment and recovery for pregnant women. Pregnant women and women with dependent children are a target population under the SABG program. The grant program requires that not less than 20 percent of awarded funds must be spent on education and prevention programs, including on alternatives that provide healthy outlets for people in the target populations covered by the program.  The program covers all 50 states, the District of Columbia, U.S. territories, Puerto Rico, and one tribal entity. The Substance Abuse and Mental Health Services Administration (SAMHSA) also offers a Tribal Portfolio Program that provides substance abuse and anti-suicide help to tribal entities.

2. Sexual assault victims who become pregnant as a result of rape can be further terrorized by an assailant who attempts to obtain custody rights. In 2015, Congress passed a federal law to increase STOP (Services, Training, Officers, Prosecutors) formula grant funding for states that have a law permitting mothers of children conceived through rape to seek termination of parental rights of their rapist. States have differing burdens of proof to block custody and may consider laws that empower victims to block the assertion of child custody rights by the rapist.All but one state has a law regarding the parental rights of perpetrators of sexual assaults.

Cat. 6: Prenatal Diagnosis

When parents receive news that their baby may have a disability such as Down syndrome, they are often counseled to seek an abortion. This has contributed to a tragic loss of human life – lives of equal worth, with potential to live joyously and to impart joy to their families and communities. According to a fact sheet compiled by Republican members of the Congressional Joint Economic Committee in March 2022, absent disability-selective abortion, “80 percent more babies with Down syndrome would be born each year and … the Down syndrome population would be 217,000 people greater in 50 years, an increase which is greater than the current Down syndrome population.”  Selective abortion contributes nothing to the amelioration of medical and social challenges attending disability, it merely destroys the affected individual – in other words, it is neither social nor medical progress.

1. Amend the Kennedy-Brownback Prenatally and Postnatally Diagnosed Conditions Awareness Act of 2008. This legislation had the beneficent purpose to provide patients with information about outcomes for people with the diagnosed condition and contact information regarding support services including peer support groups. Unfortunately, this legislation failed to exclude abortion referral and therefore has not been funded. With the addition of such an exclusion, this law could be federally funded and serve as a model to states. In addition, overall funding for amelioration of prenatally diagnosed conditions like Down syndrome is modest within the massive budget for the National Institutes of Health.

In December 2022, Congress passed a bill to fund the federal government through September 30, 2022 and added appropriations to increase research on Down syndrome through the Include project. The same legislation also included a measure supported by pro-life organizations and Down syndrome groups that will allow more disabled individuals to open tax-free savings accounts to assist them in paying for related services.  Previous law had required the individual to have experienced the onset of the disability before age 26 in order to qualify for the account – the new law raises the age of eligibility to 46. The law is called the Stephen Beck Jr. Achieving a Better Life Experience (ABLE) Act.

2. Enact state-level measures to furnish current and supportive information to parents who receive a prenatal diagnosis of a life-limiting condition. Idaho enacted a law regarding Down Syndrome diagnosis that requires distribution of a “support sheet” about Down Syndrome to patients at the time of diagnosis. Expanded to cover all diagnoses, this law could serve as a model to states seeking to make information about the growing array of resources available to families. The Idaho law is called the Down Syndrome Diagnosis Information Act. The information sheet is required to include information about the clinical course of Down syndrome, the most current information on life expectancy with the condition, and options available for treatment and therapy.  The sheet must also provide “information and support services for caregivers, including first-call programs and information hotlines specific to Down syndrome, resource centers, and other education and support programs[.]”

Cat. 7: Care for Children

For some women, having a child or adding a child to her family is not feasible. According to the most recent data from the U.S. Centers for Disease Control, covering some 43 jurisdictions that reported the data, approximately 60 percent of women who had an abortion in 2020 already had at least one previous live birth and 16 percent had three or more previous births. The following initiatives can either help to make adoption more available should she choose to make an adoption plan or help to improve the foster system:

1. Improve tax incentives for adoption. This can be done in Congress by making the federal adoption tax credit refundable, that is by allowing wage earners to claim the credit even if they had no income tax liability for the year in which the adoption expenses were incurred. States that impose an income tax of their own may consider implementing or expanding a state adoption tax credit. According to a report by the Charlotte Lozier Institute updated in August 2022, at least 20 states have such tax credits (predominantly) or a tax deduction to provide additional offsets for the cost of a private adoption, which can range as high as $30,000 to $60,000.

2. Defund agencies that promote abortion over adoption with public monies. Planned Parenthood performed 200 abortions for every adoption referral they made 2019-2020. More than 90 percent of women who enter Planned Parenthood and obtain a positive pregnancy test are subjected to abortion. The federal government and the states should focus efforts on educating about adoption, and how over 95% of adoptions are open, allowing the birth parents to remain connected with the child. Community health centers that provide a wide range of services using federal and state grants should receive public funding in lieu of the largest provider of U.S. abortions. Additional information about adoption policies can be found here.

3. Expand Safe Haven laws to provide “baby boxes” as a safe place to leave an infant. All 50 states have some type of Safe Haven law that allows infants to be safely relinquished at designated locations such as fire stations or hospitals. Some states have also aimed to extend the timeframe for when a baby can be relinquished, such as in Virginia which passed a law in 2022 to allow parents to surrender their infants up to one month old instead of 14 days. For more information about state laws, see “Save Haven Laws: An Invitation to Life.” Indiana has modeled installation of “newborn safety devices” (or baby boxes) in various locations, so the baby can be anonymously relinquished in a climate-controlled space. Safe Haven Baby Boxes offers more information about these devices.

Highlight: In the state of Indiana in the two-week period ending March 8, 2023, three babies were surrendered safely in baby boxes around the state. Eight babies were surrendered safely in the state in 2022, and Safe Haven leader Monica Kelsey reports that there has not been a single abandoned baby death in the state since the enactment of the Safe Haven law in 2016.  Kelsey herself was abandoned by her mother as an infant and did not meet her until she was in her thirties.  Safe Haven laws are consensus policies that can benefit, as the Indiana stories did, from wider publicity that reaches a parent or parents in need who may not trust the process.

4. Partner to improve outcomes for children in foster care. Governor Bill Lee of Tennessee has championed TN Fosters Hope, a public-private partnership to benefit children in the foster system. This includes building a faith-based network of churches to support the foster and adoptive needs in their communities and policy changes to help eligible children find forever homes.

5. Stop billing parents for the cost of foster care. Often children enter the foster care system due to financial instability at home. When parents reunify with their children, they can be billed by the state for their child’s time in foster care causing further financial instability and a cycle of dependency on the system. Additionally, attempting to recoup costs from low-income parents can cost states more than the funds they collect. Under new federal guidance, states are now permitted to stop this practice. Doing so will lead to greater stability and better long-term outcomes for children and parents.

Highlight. The increasing cost of private adoption warrants increases in the value of the federal and state adoption tax credits and deductions (most policy analysts prefer credits because they deliver more of their benefits to taxpayers who most need the relief). West Virginia has just adopted a measure that increases the value of the state credit from $4,000 to $5,000.  The bill also expands eligibility for the credit to kinship adoptions, which can be subject to the same costs as other adoptions already covered under the credit. The credit can be claimed in a single year or spread out over three tax years.  Legislative action on the bill was completed on March 9, 2023.

Highlight: The rapid spread of programs that provide an array of support and meet key needs of mothers and fathers facing an unexpected pregnancy is more than a response to changes in abortion policy. Many of these ideas have been developed over decades via state and federal initiatives, but there is no doubt that the reality of more children enjoying legal protection before birth has pricked the consciences of policy makers and encouraged them to take actions where fiscal or other concerns might previously have ruled.  This is especially true in the case of Medicaid expansion for postpartum services, though it should be noted that this low-income health insurance program already pays for more than 40 percent of U.S. births and 50 percent or more of births in states as diverse as Mississippi, Texas, Louisiana, New Mexico, and Alabama.

Perhaps the most comprehensive initiative in the area of pregnancy support, which dovetails with but finally transcends being an alternative to abortion, is the comprehensive set of proposals introduced by Sen. Marco Rubio of Florida.  Rubio’s Providing for Life Act (S. 74) offers a detailed framework, with 15 sections, for better meeting family needs via safety net programs, policy changes that foster participation by religious and charitable entities that eschew abortion, and tax policy changes that enhance benefits for raising and adopting children.  These changes are prompted by profound cultural values that integrate community supports in an integrated them that affirms and promotes life and family.  It remains the task of participating agencies, especially those drawing on taxpayer support, to demonstrate program integrity, focus on outcome measurements, and ensure that these investments inure to the benefit of healthy communities in a thriving nation.

Charles A. Donovan is the President of Charlotte Lozier Institute.