Last month, former President Donald Trump announced he would not pursue a federal abortion ban, as many of his supporters hoped, and he criticized states with bans that make no exception for rape or incest.

Gov. Kristi Noem of South Dakota, who at the time was on a short list of candidates to become Trump’s pick for vice president, responded immediately. Even though her state’s ban has neither exception and is considered one of the strictest in the country, Noem highlighted the parts of Trump’s message that she agreed with and sidestepped the rest.

“.@realDonaldTrump is exactly right… this is about ‘precious babies.’ It should be easier for moms, dads, and families to have babies — not harder,” she wrote on X following Trump’s announcement. “South Dakota is proud to stand for LIFE and support babies, moms, and families.”

But some state lawmakers, health care advocates and political observers in South Dakota say that Noem does not always follow through on that rhetorical promise. Since she became the first female governor of South Dakota in 2019, she has rejected programs and millions of dollars in federal funds that would have benefited pregnant people, parents and children — policies that might be at odds with her vision of limited government.

That Noem doesn’t always follow through on her talk is an oft-repeated criticism, said Jon Schaff, a political science professor at Northern State University in Aberdeen, South Dakota, who put it another way: Noem, he said, is “all hat and no cattle.”

“You look like a cowboy, but you’re not one,” Schaff said of the well-worn phrase. “I think there’s been a sense that she’s maybe overly concerned about sort of the imagery of politics rather than the substance.”

Much of that criticism has been eclipsed by the fallout from Noem’s memoir, “No Going Back,” in which she provides an account of shooting and killing a pet hunting dog called Cricket two decades ago. Still, Noem has pitched herself as a governor, rancher and mom passionate about family values and a second Trump presidency. For his part, Trump has not yet publicly eliminated her as a potential running mate, so her record on taking “care of moms and their babies both before birth and after” bears examination.

Noem’s Record

Noem’s office declined to comment, saying responses from state agencies were sufficient. But her record does, in fact, include measures that support families. In 2020, she helped create the first paid family leave policy for state employees, and she expanded it last year from eight to 12 weeks. She extended the length of time that people in prison can spend with their newborns in a “mother-infant program” from 1 month to 30 months. And she expanded a program called Bright Start, which pairs nurses with first-time parents, to cover the entire state with a $2.5 million budget increase.

In a statement, a spokesperson for the South Dakota Department of Health wrote that Noem is “committed to freedom for life” and pointed to a recently launched mobile health clinic called Wellness on Wheels, which provides services to rural communities such as connections with federal Women, Infants and Children benefits and pregnancy risk assessments. Over half the state counties are defined as a maternal care desert.

“DOH programs like Bright Start, Wellness on Wheels, WIC, pregnancy care and many more support this initiative in ensuring our future generations are healthy and strong,” the statement said.

Abortion

At times, Noem has tried to put distance between herself and the state’s abortion ban, which was put in place by a trigger law that was passed before she took office. The ban only allows the procedure to “preserve the life of the pregnant female.” But she has not embraced opportunities to add exceptions to the ban’s language, even after calls to do so from within her own party.

Three female Republican lawmakers attempted to enact legislation to add “risk of death or of a substantial and irreversible physical impairment of … major bodily functions” to the permissible circumstances for an abortion. Rep. Taylor Rehfeldt, Sen. Sydney Davis and Sen. Erin Tobin — all registered nurses who identify as pro-life — met several times with Noem staffers as they tried to build support for the measure, and they believed they had Noem’s support. But as opposition emerged from anti-abortion advocates, principally South Dakota Right to Life, Noem did not help. Rehfeldt withdrew the bill.

“I never got an official statement from her office,” Rehfeldt said. “But I will tell you that there was consensus, and then all of a sudden there wasn’t.”

In the next legislative session, Rehfeldt brought a new bill that mandated that the Department of Health and the state attorney general create an educational video intended to clarify — but not change — the ban’s language; Noem signed that one in March. Susan B. Anthony Pro-Life America released a statement thanking Noem “for making South Dakota the first state to protect women’s lives with a Med Ed law.”

Medicaid Expansion

Maternal and infant health outcomes are particularly alarming in the state’s Native American population. About 44% of all pregnancy-associated deaths from 2012 to 2021 were Native Americans and Alaska Natives. In 2023, more than 3% of all Native American babies born in South Dakota had syphilis, part of an unprecedented modern outbreak.

One component of the problem is the chronically underfunded Indian Health Service hospitals and clinics, which are overseen by the federal government. If South Dakota expanded eligibility for its Medicaid program, as 39 other states and the District of Columbia have done, it would infuse IHS facilities with badly needed additional money from newly covered patients.

“That may be like a job position for a new doctor or salary for a dentist,” said Janelle Cantrell, head of the Medicaid and health care exchange enrollment program at Great Plains Tribal Leaders’ Health Board in Rapid City, South Dakota.

But Noem has opposed and delayed expansion. In 2022, South Dakota voters took the decision out of her hands by approving a ballot initiative for Medicaid expansion. According to state Rep. Linda Duba, a Democrat, Noem has dragged her feet on the expansion, which has resulted in far fewer residents enrolling than expected. At the same time, Noem supports adding a work requirement to Medicaid eligibility, which is popular among GOP governors.

“There’s nothing proactive going on,” Duba said. “That comes from the administration. They didn’t want Medicaid expansion. They’re doing everything they can to slow-walk it and keep the enrollments down.”

Department of Social Services Cabinet Secretary Matt Althoff said in a statement that Medicaid expansion enrollment is going “efficiently and smoothly,” and that he expects a monthly average of 40,000 enrollees a month in the next fiscal year. He pointed to the state’s low unemployment rate and rising per capita personal income as an explanation for below-expected enrollment.

Early Childhood

South Dakota has no state-funded preschool program. Noem’s administration declined to apply for $7.5 million in federal money to pay for a free summer meal program for low-income children, something several GOP governors have also done. She also helped defeat proposals to pay for school lunches for eligible students and once called subsidized child care a “line in the sand” she wouldn’t cross.

“I just don’t think it’s the government’s job to pay or to raise people’s children for them,” she said in a radio interview in December 2023.

Some of Noem’s own initiatives have fallen flat. A pledge to eliminate the state’s 4.5% grocery tax, a full sales tax on all food items that only South Dakota and Mississippi charge, was a cornerstone of her 2022 reelection campaign. Repealing the tax, she said, would help “single moms who may rent an apartment and have a tough time feeding their kids with the rising food costs that we have.”

But the bill to repeal the tax failed to pass one of its first committee hearings, despite the Legislature’s Republican supermajority.

“It is amazing to me how much of a national profile that Kristi Noem has, in some ways not being all that successful in terms of achieving legislative agendas,” said state Sen. Reynold F. Nesiba, a Democrat and the chamber’s minority leader.

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