Though prominent anti-choice groups in Virginia use terms like “pro-life” and “pro-family” to describe their views, the organizations don’t devote much time or many resources to advocating for policies that promote the healthy lives of children and families living in the state. The Family Foundation of Virginia, Virginia First Foundation, and Virginia Society for Human Life, for example, either oppose or have no opinion on policies, such as Medicaid expansion, that would help Virginia families. They have also taken no action on some hazardous environmental policies that could endanger fetal health.

The Richmond-based Family Foundation of Virginia, for example, doesn’t just oppose marriage equality and push for limiting access to abortion—it has also spoken out against Medicaid expansion. A 2014 blog post posted on its website criticizes Democratic Gov. Terry McAuliffe for “seeking to expand government by committing Virginia to the long-term costs of Medicaid expansion.” The 2015 edition of Family Foundation Action’s (the Family Foundation’s 501(c)(4) arm) legislative scorecard, which rates lawmakers on supposedly “pro-family” votes, also gave lawmakers points for voting to prevent Medicaid expansion.

Contrary to the claim made in the Family Foundation’s blog post, a 2017 issue brief from the Kaiser Family Foundation summarizing research on expansion found that “National, multi-state, and single state studies show that states expanding Medicaid under the [Affordable Care Act] have realized budget savings, revenue gains, and overall economic growth.”

Medicaid expansion in Virginia could allow an estimated 400,000 uninsured people to receive health insurance that they cannot currently afford.

Just over 12 percent of all uninsured Virginians are under the age of 18, according to the Virginia Health Care Foundation’s “2017 Profile of Virginia’s Uninsured” report. Digging a bit deeper, 61,000 uninsured children live in Virginia households with income at or below 200 percent of the federal poverty line, and 27,000 uninsured children are in families at or below 100 percent of the federal poverty line. Medicaid expansion would expand coverage for people in families that earn up to 138 percent of the federal poverty line, $28,180 annually for a family of three, allowing more of these children to have improved access to health care. According to a 2016 study by the Georgetown University Health Policy Institute’s Center for Children and Families, 29 percent of the Virginians who would potentially be eligible for Medicaid under the expansion are uninsured parents with children.

In addition to improved access to care, having health insurance during childhood can have a positive ripple effect for kids. Some studies have found that increasing eligibility to Medicaid and the Children’s Health Insurance Program (CHIP) improves academic outcomes.

Not surprisingly, pregnant women and their infants also benefit from broader access to health insurance. “For every 10,000 pregnant women who enrolled in Medicaid, there was an estimated annual reduction of 60 hospital visits for endocrine, nutritional, and metabolic diseases and immunity disorders for their children,” another report from the Georgetown University Health Policy Institute explained, citing a study released in 2015 analyzing the long-term effect of those who gained access to care through prenatal and child Medicaid expansion between 1979 and 1993.

Despite how many families in Virginia could gain access to care, anti-choice groups in the state haven’t taken up support of expansion. Olivia Gans Turner, president of the Virginia Society for Human Life (VSHL), told Rewire that her organization doesn’t take positions on issues outside of abortion, euthanasia, and protecting the rights of the disabled. “We are independent and nonsectarian,” she added, and endorse candidates with anti-abortion views regardless of party—although Turner acknowledges that this year they only endorsed Republicans (presumably through its political action committee).

As for Medicaid expansion, Turner said the issue is beyond her group’s scope, but that VSHL members are often active in local causes, which could include opposing pipelines in the state or expanding access to health care in poor communities. “We do encourage people to participate in the legislature,” she said, noting that her organization connects people to pregnancy resource centers—fake clinics that often lie to patients about abortion—for one-on-one help.

James Atticus Bowden, chairman of the anti-choice Virginia First Foundation’s board of directors, told Rewire that his organization is focused on keeping gender-separated restrooms in public facilities and repealing Virginia’s Certificate of Public Need program, which requires owners and sponsors of some prospective medical care facility projects to demonstrate a public need for the project in order to gain approval from the state health commissioner.

The Virginia First Foundation’s website identifies the group as an “education and advocacy nonprofit” and calls for Virginia to be “the safest place to be a baby in the womb, [or] a severely handicapped, ill, or aged person.” The site also notes a number of policies it opposes, including things “from Sanctuary cities to transgender nonsense to homosexual marriage to federal Medicaid expansion to Common Core in schools, and on and on.”

As for improving health care for pregnant women and children, Bowden said, “We don’t have a stated position on that anywhere. That’s not an issue that’s come up in the General Assembly.”

Instead of seeking to help women and families, many of Virginia’s anti-choice groups remain focused on policies to restrict access to reproductive health care. The Family Foundation and VSHL supported a bill in 2017 that would have prohibited the state’s health department from entering into contracts with or giving grants to organizations that provide abortion, an apparent attempt to defund Planned Parenthood. The bill passed the House and Senate, but McAuliffe vetoed the measure, citing concern that it would harm “tens of thousands of Virginians” that depend on Planned Parenthood for care.

Though it may not be surprising that anti-choice groups want to defund Planned Parenthood as they are seemingly against many forms of reproductive health care, doing so does call into question their supposed commitment to protecting healthy lives. Thanks to the refusal of Republican state legislators to expand Medicaid, the health-care provider’s five clinics in Virginia are among the few affordable options available to many uninsured people. These clinics, located in Charlottesville, Hampton, Richmond, Roanoke, and Virginia Beach, provide patients with services such as pregnancy tests, adoption information, STI testing, and general care.

Turner, of VSHL, says that her organization would be willing to support state funding of Planned Parenthood’s clinics if they “were to stay out of the abortion business. It’s dubious whether they would be willing to do that.”

But some organizations and advocates are stepping up to push for policies to improve the health and well-being of Virginians—particularly people of color and LGBTQ people.

Nakita Mayfield is a statewide community advocate for the Virginia Anti-Violence Project (VAVP), an organization that focuses on addressing domestic violence and hate crimes against LGBTQ people. The organization also focuses on fighting other forms of oppression, including racism. It helps connect LGBTQ people with housing, health care and other services. Mayfield is also a volunteer at the Richmond Reproductive Freedom Project (RRFP), a reproductive justice organization that provides funds for people seeking abortions they couldn’t otherwise afford.

During an interview with Rewire, Mayfield noted that access to services differs widely between larger cities like Richmond and rural swaths of the state. “I grew up in a very small, rural town in Virginia, and I know what a different level of access looks like,” Mayfield said. Many places don’t have reliable bus service or places for people to seek help if they’re experiencing abuse or need care. The same underserved communities often lack grocery stores and healthy food, good jobs and other necessary services, she said.

In communities just like these—rural, isolated, and poor—Virginia’s proposed underground pipelines could have a serious impact on pregnant women and infants. However, none of the three anti-choice organizations have weighed in on the issue publicly, despite their supposed interest in protecting fetuses. As Rewire has reported, pipeline opponents warn that fracking chemicals and other pollutants could cause birth defects and delayed neurological development in fetuses and infants. Studies show that fertility and pregnancy also can be affected, and because some chemicals are kept secret under company policies, researchers cannot determine all potential consequences of fracking on public health.

Many impoverished communities already have high-risk factors like poor air quality from industrial pollution and vehicle traffic, toxins from factories, and exposure to harmful plastics sold at dollar stores, the only retail options in some neighborhoods, another RRFP volunteer, who requested their name be kept confidential out of privacy concerns, told Rewire.

This, paired with a lack of primary care providers and scant opportunities for regular prenatal care, often cause children and families to suffer.

Mayfield, who joined VAVP in February, says she hopes to bring her organization’s services to smaller, more isolated Virginia regions like those where the pipelines may run, and open these communities to better health care, food access, education, and other necessities. “VAVP is on the right track when it comes to lifting up the people who are most affected by policies and laws, that they’re respected for who they are,” she said. “I can support agencies that support the population. There are some places that have absolutely nothing.”

Meanwhile, the anti-choice organizations’ silence—and opposition—on these issues speaks volumes. Clearly, it’s up to others to pick up the slack.

“We’ll always have more demand than supply,” the RRFP volunteer said, despite hopes that they’ll work themselves out of a job. “Our organization is always going to exist.”