The expectation that Supreme Court is about to scrap decades of federal protections of abortion rights is highlighting another issue: the lack of resources and support available for women to have and raise children. 

More women living in states without abortion access, should Roe v. Wade be overturned, will likely carry to term. Yet, not one of the two dozen states with laws on the books restricting abortion access offers paid family leave.

Eight of them have opted out of expanding Medicaid coverage under the health care law, which covers pregnancy through postpartum for low-income Americans.

And Mississippi, whose abortion restriction law is at the heart of an impending Supreme Court decision to overturn Roe v. Wade, ranks as the state with the highest rate of young child poverty and low birth weight and among the highest when it comes to infant mortality rates.

Twenty-six states are either certain or likely to ban abortion if Roe is overturned, according to the Guttmacher Institute.  And 13 states have “trigger laws” that would institute a ban quickly after the high court’s decision.

In the absence of constitutional protections, it will be up to individual states to decide the legality and access to abortion. And states with the most restrictive policies “are also the states that do the least for pregnant people and their children,” says Sara Rosenbaum, director of George Washington’s Center for Health Services Research and Policy. 

Data offered in an amicus brief for the Mississippi case filed on behalf of the Jackson Women’s Health Organization shows that 14 of the states with the most restrictive abortion laws “invest the least in policies and programs of proven importance and value to the health and well-being of women, children, and families.”

The brief, written by the  American Public Health Association, the Guttmacher Institute, the Center for U.S. Policy, and hundreds of public health scholars and professionals, including Rosenbaum, cites analysis of Medicaid coverage, WIC eligibility benefits, Temporary Assistance for Needy Families benefits, early entry into prenatal care, infant mortality rate, low birthweight, young child poverty, and adverse childhood experiences. It finds that a majority of the 14 states rank in the lower half of states in terms of early entry into prenatal care, infant mortality, low birth weight, and at-risk children. 

“You would be forced to have a child no matter your personal circumstances, you won’t have the right to be able to take time off to have that child, and you would not have the support you need to go to work to support your family,” Washington Democratic Sen. Patty Murray told CBS News. Murray has long pushed for federal paid leave and said she hopes this moment can galvanize support for a federal response as Americans “are going to start observing what this actually means to them and their families and their loved ones.” 

The U.S. is one of only a few countries that does not offer paid maternity leave. The Family Medical Leave Act gives up to 12 weeks off to have and take care of a baby, but without pay. Only 10 states, plus the District of Columbia, offer paid family leave, according to the National Conference of State Legislatures.

The pandemic-era expanded child tax credit that gave 35 million families up to $300 per month per child expired in December. Efforts to extend the credit as part of the Biden administration’s “Build Back Better” legislation failed to garner enough support within the president’s own party. Expiration of the tax credit led to an increase in the child-poverty rate. 

The U.S. falls well behind other wealthy developed countries when it comes to child-care spending. According to an analysis by the New York Times, the U.S. spends 0.2% of its GDP on childcare for children 2 years old and younger, amounting to roughly $200 a year for families in tax credits. 

Experts say that if abortion protections are terminated, low-income and minority women are likely to bear the brunt of the burden, since those with means will be more able to afford to travel to other states that provide access. Access to mental health support is also critical for postpartum women. 

“These are questions we are grappling with and nobody knows the answer yet,” says Adrienne Griffin, executive director of the Maternal Mental Health Leadership Alliance. She notes that mental health issues are the most common complications in pregnancy and child birth and that suicide and overdose are leading causes of death in women in their first year of post-partum. The maternal mortality rate is three times higher among Black women than among white women in the United States. 

With abortion protections threatened, as the draft Supreme Court opinion leaked this week suggests, there’s no consensus yet on Capitol Hill for federal legislation to address some of the fallout. 

“It’s not at all obvious to me that we have to expand the welfare state because of a decision on Roe. That’s a separate conversation,” Pennsylvania Republican Sen. Pat Toomey told CBS News. 

Missouri Republican Sen. Josh Hawley has proposed a refundable tax credit of $6,000 for single parents and $12,000 for married parents with qualifying children. “I think that we are going to need to have a very robust conversation about what we are going to do to help families and help women who are in tough circumstances,” Hawley told CBS News. “I hope I and others will have more to say on that soon.”

Nebraska Sen. Deb Fischer told CBS News she would urge the administration to implement her legislation that offers tax credits to businesses that offer paid leave. 

Republicans, though, are largely skeptical of a more robust federal response.

“There seems to be this theme that’s running of Republicans, do they care about children after they’re born? And the answer is yes we do, that child is valuable. But there’s lots of programs — the safety net is not just the federal government. It’s families, it’s churches and nonprofits, other entities out there, and government as well,” Oklahoma Republican Sen. James Lankford told CBS News. “A lot of it’s going to be states, obviously, because every state is going to be different on that. There’s this perception that the only way to help people is by mailing them a check. I don’t agree that’s the only way to do it.”

Other Republicans are inclined toward the state-based approach. “I don’t know if it would go on a federal basis. I think on a state-by-state basis, you might see a lot of people talking about modifications to benefits,” Republican South Dakota Sen. Mike Rounds told CBS News. “I really believe it’s more than simply saying we’re going to outlaw abortion. I’m pro-life, and pro-life means more than saying no abortion. It also means you try to help people make a good decision and know there are other alternatives for them who are struggling during a very challenging time in their life.” 

But a patchwork approach is concerning to Democrats. “I really worry you are going to have this increasing separation between quality of living for families based upon where you live,” Democratic Connecticut Sen. Chris Murphy told CBS News. “In Connecticut, you get paid family leave, paid sick leave, abortions are legal. And then you have states with very few if any rights or support programs for families. I don’t think that’s good for the country to have such fundamentally different sets of experiences for women and families on a state by state basis.”

Sarah Ewall-Wice contributed to this report.

Caitlin Huey-Burns

Caitlin Huey-Burns is a political reporter for CBS News.