States with some of the nation’s strictest abortion laws are also some of the hardest places to have and raise a healthy child, especially for the poor, according to an analysis of federal data by The Associated Press.

The findings raise questions about the strength of the social safety net as those states are poised to further restrict or even ban abortion access following an expected U.S. Supreme Court decision later this year. The burden is likely to fall heaviest on those with low incomes, who also are the least able to seek an abortion in another state where the procedure remains widely available.

Mississippi has the nation’s largest share of children living in poverty and babies with low birth weights, according to 2019 data from the U.S. Census Bureau and the Centers for Disease Control, the latest available. Texas has the highest rate of women receiving no prenatal care during their first trimester and ranks second worst for the proportion of children in poverty who are uninsured, the data show.

Laws from both states are at the center of the nationwide fight over abortion access. The Supreme Court’s conservative majority signaled willingness in a Mississippi case to gut or strike down Roe v. Wade.

Anti-abortion lawmakers there say they will further promote adoption and foster-care programs if abortion is banned, as well as funding alternatives to abortion programs.

If Roe is overturned, 26 states are certain or likely to quickly ban abortion, according to the Guttmacher Institute, a think tank that supports abortion rights. Many of those states ranked poorly in measurements that nonpartisan advocacy groups consider key to ensuring children get a healthy start.

Data analyzed by the AP illustrates the hurdles pregnant women and their children face in states with the most stringent abortion restrictions and how access to resources can lag behind that of states that also have more permissive abortion laws.

Jazmin Arroyo, a 25-year-old old single mom in Kokomo, Indiana, had to stop working as a receptionist after her first child was born because she couldn’t afford daycare.

Arroyo found a job as a restaurant host, but it didn’t offer insurance and her second child has a heart defect. She now has thousands in unpaid medical bills.

“I never could have imagined how hard it would end up being,” she said.

Indiana has the second-highest rate of women — 18% — who don’t receive prenatal care during their first trimester and has a high percentage of children in poverty without insurance, more than 9%.

The AP analyzed figures from several federal government agencies in seven categories — metrics identified by several nonprofits and experts as essential to determining whether children get a healthy start.

Generally, states that had passed preemptive abortion bans or laws that greatly restrict access to abortion had the worst rankings. Alabama and Louisiana joined Mississippi as the top three states with the highest percentage of babies born with low birth weights. Texas, Indiana and Mississippi had the highest percentage of women receiving no prenatal care during their first trimester.

In response to AP’s findings, many conservative state lawmakers said women can give their newborns up for adoption and said they would support funding increases for foster-care programs. In Oklahoma, GOP Senate President Pro Tem Greg Treat said he would work to increase salaries for child-welfare workers and state money for adopting foster parents.

“There’s going to be a commitment there, but it won’t be a new commitment. It will be a continuing effort on our part,” he said.

Some Democratically controlled states with more permissive abortion laws also measured poorly in some categories.

New Mexico ranks third highest for the share of its children living in poverty, Delaware ranks fifth highest for the percentage of women who receive no early prenatal care and California is among the top five states — between Oklahoma and Arkansas — for the share of women and children on food stamps.

Those states are generally outliers. Overwhelmingly, the data show far more challenges for newborns, children and their parents in states that restrict abortion.

Abortion restrictions and troubling economic data aren’t directly linked, but finances are a major reason why women seek abortions, according to research by Diana Greene Foster, a professor of reproductive science at the University of California, San Francisco.

Children born to women who were denied an abortion are more likely to live in a household where there isn’t enough money for basic living expenses, her work has found.

Texas last year passed an unusual law that leaves enforcement of an abortion ban after six weeks to civilians — a law the Supreme Court largely left in place.

Maleeha Aziz, an organizer for the Texas Equal Access Fund, had an abortion when she was a 20-year-old college student, after birth control failed. She’s also experienced a condition called hyperemesis gravidarum, which causes persistent, extreme nausea and vomiting.

“I was a vegetable. I could not move,” said Aziz, who later had a daughter. “Pregnancy is not a joke. It is the hardest thing that a person’s body will ever go through.”

In Texas, 20% of women don’t get prenatal care in their first trimester, according to pregnancy-risk assessment data collected by the CDC in 2016, the most recent data available from that state. The lack of prenatal care increases the risk of the mother dying or delivering a baby with low birth weight.

Texas abortion foes also point to a program called Alternatives to Abortion. As with similar groups in other states, it funds pregnancy counseling, adoption services and classes about life skills, budgeting and parenting.

“This social service network is really critical in our mind to right now supporting pregnant women and expecting families,” said John Seago, the legislative director for Texas Right to Life.

Most such groups, known generally as crisis pregnancy centers, are not licensed to provide medical care.

Lo is a former Associated Press data journalist. Also contributing were AP writers Sean Murphy in Oklahoma City; Casey Smith in Indianapolis; and Jamie Stengle in Dallas; and data journalist Linda Gorman in Boston. Former AP writers Iris Samuels in Helena, Montana, and Melinda Deslatte in Baton Rouge. Louisiana, also contributed.

Fassett is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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