Should we make birth free?

In Ireland, public hospitals do not charge women for childbirth. In Finland, the cost is practically negligible. But in the United States, the average uninsured woman will pay over $18,000 for childbirth, while the insured will still pay over $3,000 out of pocket. To add insult to injury, maternal and infant mortality in the United States are worse than both Ireland and Finland (and most other developed nations), and a report has found that financial barriers are a significant contributing factor to maternal mortality around the world. That’s why some Republicans and Democrats are calling on Congress to make birth free. And why shouldn’t we?

Americans United for Life (AUL) and Democrats for Life of America have co-written a “Vision for Congress to Empower American Mothers, Families, and Communities,” which makes the case for the United States to make birth free. Undoubtedly, one of conservatives’ main objections will be the cost of such a policy. The costs raise significant issues, but a lower national birthrate is far more costly. Federal programs already cover many births in the United States, but many families have incomes too high to qualify for those programs, and yet not high enough to absorb crushing costs.

According to AUL, making birth free in America could reduce maternal and infant deaths, decrease the fertility gap, and reduce abortion rates in the United States, three things Republicans and Democrats alike profess to support. In addition to removing this financial barrier to care, AUL states that a “comprehensive program to Make Birth Free would also reduce pregnancy and childbirth costs overall, making the program more cost-effective over time.”

In the wake of the recent CDC report that maternal deaths had risen by 40 percent, lawmakers should be brainstorming ways to solve the maternal health problem endemic to the United States. Before this spike in maternal deaths, American mothers already faced 10 or more times the rate of pregnancy-related death than in Australia, Austria, Israel, Japan, and Spain. At least some of these deaths are attributed to skipped pre- or post-natal appointments due to cost, leading to death from otherwise preventable causes. Yet in the richest nation in the world, these “deaths from poverty” should be unthinkable. Making birth free could accomplish that.

There has also long been a fertility gap in the United States, a gap that’s risen to its highest level in 40 years. The “gap between the number of children that women say they want to have (2.7) and the number of children they will probably actually have (1.8),” exists at least in part because our economic and social structures in the United States are not conducive to family life. As AUL notes, “American women consistently say they want to have more children than they actually have.” Eliminating the cost of childbirth could reduce this gap, helping women achieve what they actually want: more children. A RAND health insurance experiment corroborated this theory: women with free medical care had 29 percent more births than those with high-deductible plans.

Making birth free could also save the lives of countless children who otherwise might have been aborted. Three-quarters of women seeking abortion list financial concerns as one of their top reasons for having an abortion, and “natural experiments in countries like Italy, Spain, and Russia have shown that removing financial barriers to childbirth can reduce abortion rates.” While Affordable Care Act insurance plans currently cover contraceptives and even abortions, they do not cover standard prenatal care, such as ultrasounds. Providing free prenatal care is one way that pregnancy care centers have tried to reduce the burden of childbearing on women. Why doesn’t our government do the same?

Money is not neutral, and spending requires prioritization. The government is spending money on things that it values. In 2023, as the Republican Party is fractured and re-forming around its new party leaders and platform, presidential hopefuls and the political elite would do well to consider the values of their youngest voters, who increasingly possess the political will to put their money where their mouths are regarding family-supportive policy.

In this Post-Roe America, Republican Millennials, many of whom are now parents, want their party to become known for supporting women and families in addition to valuing and protecting unborn life. This movement is gaining ground among conservatives. Perhaps it’s time for Republicans to lead by making birth free in America. At the very least, it is time to make this proposal part of our national conversation.