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A Texas program works to help some of the most vulnerable women and babies

JUANA SUMMERS, HOST:

There's a special program in San Antonio helping some of Texas' most vulnerable new moms and their babies. It's a critical service made all the more so in the last year since the Supreme Court ended the federal right to abortion. Women struggling with substance abuse or housing insecurity are more likely to have unplanned pregnancies - pregnancies many must now carry to term. Katia Riddle takes us to San Antonio. And a warning, this story contains mention of suicide.

KATIA RIDDLE, BYLINE: The pregnancy was an accident. She was in an abusive relationship.

L: He actually hit me when I was pregnant. And I was all like, well, that's not going to stop him, then nothing is going to stop him.

RIDDLE: NPR is not using this woman's name, just her initial - L. She doesn't want this man to find her. L considered abortion, but even if she wanted one, it was impossible. It's illegal in Texas. She didn't have the means to leave the state. She had another son, a 4-year-old. She had to care for him. And she had another complication.

L: I was struggling with opioids.

RIDDLE: L was taking methadone. That's a drug that helps with recovery from opioid addiction. She needed a place to live that would be supportive of her recovery. She got to a breaking point - homeless and pregnant, in danger of relapse. That's when she found Casa Mia.

UNIDENTIFIED CHILD: (Crying).

L: It's OK, baby. It's OK, baby. It's OK. It's OK.

RIDDLE: Today she's holding her 2-month-old baby boy. He was born healthy, despite L's struggles with addiction. Casa Mia is a place where pregnant women who are struggling with substance abuse can live. They can stay as long as they need to after having their babies. The program provides L with medical treatment for addiction and mental health care. Had she not found it, she says, her life would look much different.

L: Oh, both my kids would have been taken away permanently, I know. That's for sure. I probably would have been out in the streets, homeless, 'cause that's where I was.

DANA SUSSMAN: And there are certain states that will criminalize you for using substances and being pregnant.

RIDDLE: Dana Sussman is the executive director of Pregnancy Justice, a legal advocacy group for pregnant people. She says pregnant women struggling with substance use disorder are often scared their children will be taken from them if they seek help. They could even face criminal charges because Texas now grants a fetus equal rights to the mother.

SUSSMAN: But also provide you with no mechanism to seek help without the specter of criminal charges or the child welfare system.

RIDDLE: Nurse Lisa Cleveland saw this firsthand working in the neonatal intensive care unit at a Texas hospital. Often when babies are taken from their mom at birth, she says, they are never reunited.

LISA CLEVELAND: The majority of the time, these babies go into foster care.

RIDDLE: Babies who are exposed to opioids in the womb can have something called neonatal abstinence syndrome. A baby is given this diagnosis every 25 minutes in the United States, according to one study. Cleveland knew there had to be a better way to care for these babies.

CLEVELAND: So you may notice we have these special swings.

RIDDLE: She founded Casa Mia through the University of Texas Health Science Center at San Antonio. The program is run out of a converted old house. Nine women live here now. Babies and cribs are around every corner. There's a garden. She points to a row of battery-powered baby swings that line the wall in the living room.

CLEVELAND: So those work really, really great for babies who are experiencing withdrawal symptoms.

RIDDLE: The best medicine for a baby with this condition, says Cleveland, is their parents. The goal here is to keep them together.

CLEVELAND: Mamas and babies go together. They're kind of a - it's a two-pack, right? And so to sort of think that you're going to have healthy children raised by an unhealthy mother - the two - that doesn't equate. That just doesn't work out.

RIDDLE: That's why they prioritize helping mothers with recovery and destigmatizing substance abuse. The program is funded through Texas Health and Human Services. They have a long waiting list. Demand has grown significantly in recent years. These kinds of programs are rare.

STEPHEN PATRICK: So we're really struggling, as a nation, dealing with opioid use disorder, pregnancy...

RIDDLE: Stephen Patrick is the director of the Center for Child Health Policy at Vanderbilt University. He says caring for these babies is expensive. The U.S. spends nearly half a billion dollars on treating babies with neonatal abstinence syndrome a year. He says the majority of them still don't have adequate care.

PATRICK: What we've been doing so far really isn't working.

RIDDLE: Criminalizing substance use disorder instead of treating it in pregnancy, says Patrick, surfaces a larger issue.

PATRICK: I think time and time again, we see the needs of pregnant women and infants flying under the radar.

RIDDLE: In the wake of the Supreme Court decision that restricted abortion, says Patrick, there has been little conversation about the well-being of babies - especially the most fragile of them.

PATRICK: No one really owns the problem.

RIDDLE: After much pressure, the state of Texas recently expanded its Medicaid benefit to postpartum mothers. Low-income women can now receive health care for a year after they have a baby. But advocates say the state still has a long way to go toward supporting new parents. Casa Mia is one of the few places some of the most vulnerable moms can find support.

LORNA WEIS: And then this is our room.

RIDDLE: Lorna Weis is another mom who lives here. She gestures to a dorm-style room where she and other women sleep. Weiss was in a master's program and working a full-time job when she started using methamphetamine.

WEIS: It was the miracle drug for a while.

RIDDLE: Suddenly, she had enough energy to get through her busy schedule.

WEIS: For about six or seven months, and then it quickly consumed everything that I was and everything that I had.

RIDDLE: Then she became pregnant. She was in an abusive relationship. She started looking for a way out.

WEIS: And I just was getting slammed doors in my face.

RIDDLE: Weiss called as many social service agencies and shelters as she could find. There was nowhere to go.

WEIS: And I'm getting, you know, like, six and seven, eight months pregnant and really starting to be kind of at the end of my rope. And then I had the baby.

RIDDLE: After he was born, she hit bottom - a suicide attempt. Her son went into foster care. That's when she found Casa Mia. She tries not to imagine what would have happened if she hadn't landed here.

WEIS: I don't think about it. I try not to think about it because I'm really big on law of attraction and bringing good things into your life. And I just know that I was at the end of my rope.

RIDDLE: After receiving treatment at Casa Mia, she scheduled to be reunited with her baby in a few months. She points to a bulletin board covered in pictures of him.

WEIS: This is where he was little - long legs. He was born 4 pounds, 15 ounces, 19 inches long. He was all legs and feet.

RIDDLE: Isaiah Phoenix is her son's name - Phoenix, she says, because he was born of hope. For NPR News, I'm Katia Riddle in San Antonio.

SUMMERS: If you or someone you know may be considering suicide, call or text 988 to reach the Suicide & Crisis Lifeline.

(SOUNDBITE OF LEWIS CAPALDI SONG, "FORGET ME") Transcript provided by NPR, Copyright NPR.

Katia Riddle