For Republican candidates, talk about moms 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) tweeted that he wanted to talk about moms and babies.

Grassley, in the midst of what may be his closest race since becoming a senator in 1980, said he hears a lot about a lack of prenatal care in rural Iowa. He introduced his answer, called the Healthy Moms and Babies Act. "This bill will help fill those voids in rural America to make sure that we can deliver health care for high-risk pregnancies," he said.

Republicans are favored to win the House of Representatives in the midterm elections, and they would need to gain only one seat to take the Senate, too. With polls showing abortion is a motivating issue for many voters, Republicans have purged their websites, softened hard-line stances, or just gone quiet on women's health as Election Day approaches. Some deflect abortion questions by suggesting Democrats hold extreme views, an attack President Donald Trump helped popularize.

Women were falling through the cracks of the health care system well before the Supreme Court in June overturned a constitutional right to abortion. But state responses to that decision further splintered reproductive health care into sanctuaries and deserts, ensuring that access varies widely across state lines. And new government reports paint a troubling picture of maternal health, showing that the covid-19 pandemic contributed to a rise in deaths from pregnancy and childbirth complications — and that the overwhelming majority of recent deaths were preventable.

Democrats have made defending abortion access a central theme of their campaign to keep control of Congress, hoping to build on the surge of political engagement that followed the court's decision. But polls show the economy has become voters' biggest concern.

A few Republicans, like Grassley, are steering preelection conversations to their own proposals. But policy experts and women's rights advocates say they do not go far enough to change the situation for women.

"To make a dent in the maternal health crisis, we need more than just guidance," said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities, a progressive think tank.

In September, when Sen. Lindsey Graham (R-S.C.) introduced a bill that would set a federal ban on abortions after 15 weeks, the proposal appeared to divide his party. Most congressional Republicans have advocated for states to make their own decisions about reproductive health, which was what conservatives had 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 feel that way have introduced their own proposals.

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

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

"If we take back the House and the Senate, I can assure you we'll have a vote on our bill," Graham said.

The rate of maternal death in the U.S. — which is higher than in any other industrialized nation — increased during the past two years, spurred in large part by covid infections, according to a new Government Accountability Office report commissioned by Congress. Prenatal care is a major factor in preventing maternal and infant mortality, and the report noted the pandemic had made it harder for women to receive care, from the shutdown of public transit and child care facilities to job losses, which have hit women harder than men.

Access to reproductive care has dwindled in several states, largely because of Republican efforts, such as funding bans and other state laws that made it difficult for health centers to stay open. Many of those centers provided reproductive care, including contraceptive counseling. Republicans control the legislature in 30 states, including most that ban nearly all abortions before the point in pregnancy when a fetus can survive outside the womb.

The Supreme Court decision "has taken away a constitutional right and created chaos for people around the country who are trying to figure out how to manage," said Vicki Shabo, a senior fellow with the think tank New America.

"They are doing it in the context of a country that does not provide paid leave; 50% of families live in a child care desert; women and children are not even guaranteed health access in all states; and wages are too low and work is not predictable enough to be able to support a family," she said.

Last year congressional Democrats passed an economic recovery package that included several policies intended to improve household financial security, including a five-year program that gives states the option to extend Medicaid benefits to women for one year after childbirth.

Under the ongoing public health emergency, no one can be disenrolled from Medicaid. Once that expires, women living in the 34 states — along with the District of Columbia — that opted in will be eligible for Medicaid during the year after they give birth, when more than half of pregnancy-related deaths occur.

Insured women are more likely to receive regular care, including important interventions for those with health conditions that can make pregnancy riskier, like diabetes.

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

If their state has expanded its adult Medicaid programs under the Affordable Care Act, these women could be eligible for full Medicaid. In other states, they could purchase marketplace coverage through the ACA and experience only a short gap in coverage while changing plans. Low-income women would be eligible for subsidies to cover their premiums.

In a few states, many women would lose coverage entirely after that first two months.

Orris said Grassley's maternal health bill offered "helpful and important steps" — in particular, mandatory reporting of maternal quality measures, funding for more coordinated prenatal care, and guidance to states about coverage for doulas and community health workers. But the bill, which offers no major policy proposals, likely would not match the advantages offered through the postpartum coverage extension, she cautioned.

"Extending postpartum coverage for one year after birth would help, and I think it is noteworthy that Iowa isn't among the states that have adopted that option," Orris said.

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

Over the next three months, Rubio introduced three bills: the Standing With Moms Act, which would establish a government website for pregnancy resources that includes information about alternatives to abortion and other information from groups opposed to abortion; the Community Mentors for Moms Act, which would create mom-to-mom mentorship programs; and the Providing for Life Act, which included an expanded 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 from 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 mom and baby, said Shabo, who has advocated before Congress for a federal program. It is correlated with higher rates of breastfeeding, lower rates of postpartum disorders, more well-baby visits, fewer cases of shaken baby syndrome, and better overall maternal health, she said. It's also associated with higher rates of labor force participation and earnings over time, which increases financial stability.

Proponents of a federal paid family medical leave program notched a bittersweet victory this congressional session: For the first time, the House approved one. But opposition from Republicans and Sen. Joe Manchin (D-W.Va.) over its cost and concerns from the business community doomed its chances of becoming law.

Rubio's proposal would allow new parents to borrow from their future Social Security benefits to make up their income while taking leave. But Shabo noted the proposal would disadvantage women and families of color, who are more likely to rely on Social Security in retirement.

"Asking you to sacrifice 'future you when you know there are needs at all stages of life is not a smart way to make policy," Shabo said.