A Vision for Congress to Empower American Women, Families, and Communities

Today, the American dream is out of reach for too many couples. Family incomes have not kept up with expenses, and many feel as though they cannot afford to have a child, particularly when the costs of pregnancy, birth, and post-natal care are exorbitantly expensive. 

The Cost of Childbirth

Childbirth is the number one reason for hospitalization in the United States, and that hospital visits can be extremely pricey. The average cost of childbirth is nearly $19,000, and even privately insured mothers will likely pay more than $3,000 out-of-pocket simply for delivery. Maternity care in the United States is uniquely expensive. Childbirth costs far less in other developed countries and comprehensive maternity care is free or cheap for all.

Stop Unnecessary C-Sections

Hospitals frequently charge higher rates for C-sections than for vaginal deliveries—usually around 30% more. However, these prices charged to families and insurers do not reflect the true cost to the healthcare provider. Indeed, the more physicians are paid for C-sections compared to vaginal delivery, the higher the C-section rate. By requiring hospitals to provide births free of charge to the consumer and reimbursing them equally for C-section and vaginal deliveries, Make Birth Free can eliminate unnecessary C-sections, which will reduce costs and improve outcomes. C-sections entail greater risks of infection, blood loss, and other complications. And because women who have C-sections are vastly more likely to have C-sections in subsequent pregnancies, the initial avoidance of unnecessary surgery reduces future childbirth costs as well, reducing costs in the long term.

Doulas and Midwives

Make Birth Free can incentivize the use of midwives and doulas for pregnancies where there are no complications or serious risk factors.  Midwives tend to be less expensive, decrease the risk of C-section and preterm birth and are well-equipped to safely perform most births with higher patient satisfaction. Indeed, many countries with low infant and maternal mortality rates center midwives at the core of their healthcare delivery to expectant mothers. By expanding reimbursement to providers like doulas and midwives and incentivizing home births and delivery at birthing centers, a federal program to Make Birth Free can lead to significant savings, better patient outcomes, and a more humane experience for mothers and families.

Remove Financial Barriers

Free pregnancy and childbirth would improve maternal and infant health outcomes. High costs deter women from seeking or obtaining prenatal and postpartum care, delaying the identification of a high-risk pregnancy or intervention to treat complications from birth. These financial barriers are a significant factor pushing maternal mortality higher in the U.S. than in peer countries. The U.S. maternal mortality rate in 2020 was 23.8 deaths per 100,000 live births, while Canada’s was only 8.3. By removing barriers to prenatal and postpartum treatment, physicians will be able to identify and prevent complications earlier, protecting the health and safety of both mother and child. But why free? Why not create a means-tested program? Although such policies might improve the existing model, they will not achieve the same benefits. The application process will still be a barrier preventing some women from obtaining care. The extra administration for determining eligibility will increase program costs.

A Real Choice

Whether pro-life or pro-choice, everyone should agree that no woman should feel coerced into choosing abortion as her only or most cost-effective option. According to several analyses, women rank concerns about financial preparedness as their top reason for choosing abortion. In other words, pregnant women in the United States often lack real and effective choice when making decisions about birth. Abortions compelled by external social and economic factors should be unacceptable in any society. Natural experiments in countries like Italy, Spain, and Russia have shown that removing financial barriers to childbirth can reduce abortion rates. By making birth free, Americans can transcend the politics of abortion partisanship and enable women to make their own choice without economic coercion.

A Roadmap to Congressional Legislation

There is precedent for Make Birth Free, and it has worked effectively for almost 50 years. Launched during the Nixon years, the Medicare End-Stage Renal Disease (ESRD) program covers the cost of dialysis and kidney transplants for patients of all ages. This expansion of Medicare was extremely successful: the costs associated with end-stage renal disease have been contained better than those of healthcare generally.

Private insurance compliant with the Affordable Care Act exempts preventative care from deductibles and co-pays. Make Birth Free will add to that prenatal and birth-related expenses.

A monthly maternal stipend equivalent to a social security monthly payment for the first two years of a child’s life. The stipend would come with no strings attached so that families can use the money however they wish to address their family’s needs. 

Making birth free to American women can and should be a national unifier in this divided time. Together, we can rise above the rancor of partisanship, leaving behind the disproportionate financial burdens imposed on mothers and families and forging a new path that transcends the existing paradigm.Together, we can empower American families and encourage a thriving future for the next generation. Let’s Make Birth Free.

Condensed from https://democratsforlife.org/images/Make-Birth-Free-White-Paper.pdf