Insane Cost of Giving Birth in America IS an Economic Issue

My 1-year-old has a hand-me-down T-shirt that reads: The Future Is Female! It’s a few years old, a relic of the Girlboss era of feminism, when cute slogans that sassed the patriarchy read like borderline sore-winner taunts. It’s stained with beet puree now, and looks like my baby wore it during a fight, which feels appropriate given everything that’s happened during the life of that shirt.

We were so confident that whatever was holding women back was over that pop feminism shrunk itself down to the size of a screen print. I used to find that kind of celebratory sloganeering cloying; now it just makes me sad.

Post-Dobbs, our futures have never been more closely tied to our femaleness, and our femaleness has never been less within our control. Our femaleness is now the determinant of our physical health, our financial health, our access to education, professional opportunity, and happiness. Being a reproductively capable person in America feels more and more like walking around with an anatomical time bomb that could, given the wrong circumstances, force me down a path of physical and financial ruin. The future has never been more female, or frightening.

Georgia gubernatorial candidate Stacey Abrams has recently taken some heat for a bad faith read on comments she made about abortion and the economy along these lines.

During an MSNBC appearance this week, she was asked about former President Obama’s recent comments that Democrats need to formulate a plan to address kitchen table issues—like the high cost of rent. Abrams countered that abortion is, in fact, an economic issue. Here’s what she said in part:

“Let's be clear. Having children is why you’re worried about your price for gas. It’s why you’re concerned about how much food costs. For women, this is not a reductive issue. You can’t divorce being forced to carry an unwanted pregnancy from the economic realities of having a child. It’s important for us to have both and conversations. We don’t have the luxury of reducing it or separating them out.”

This has caused a conniption among right-wing media, and the mainstream dupes who fall for their histrionics. But Abrams is not wrong. Children are expensive, and the choice whether or not to have them is an economic one as much as it is a personal one.

As profiteers move to extract more and more money from parents at every point in their children’s lives, as the government does nothing but force all pregnant people to give birth, the question of whether to have children becomes even more of an economic issue. The government is doing nothing to ease the massive cost of carrying, birthing, and raising children.

One party has spent the last 40 years working toward a future where every pregnancy ends in a compulsory birth.

The most recent Brookings Institution estimate for how much a child costs to raise from 0-18 is $300,000, or about $18,000 a year. That doesn’t include the cost of a college education, and that figure is likely higher in high cost of living areas. I have a 1-year-old child and live in Los Angeles, and can anecdotally attest that her first year of life has been much more expensive than that, even though she consumed primarily breastmilk (which is free) and only has child care two days per week.

It should not be controversial to point out that a country that would force anybody who becomes pregnant to carry that pregnancy to term and endure childbirth is essentially condemning them to physical injury (ask your mother how many stitches she needed after you were born), but it also condemns them to economic hardship. This applies even if a mother opts out of the cost of parenthood by surrendering their child for adoption, because the U.S. medical industry, driven by profit first and patient care second, is constantly innovating new ways to extract money from patients at their most vulnerable moments.

Let’s set aside the absurdity of the suggestion of the Amy Coney Barretts of the world that adoption is a simple alternative to abortion. Adoption is an alternative to parenting, but it is not an alternative to pregnancy and childbirth, and it is a choice that carries with it so much trauma and heartache that very few healthy mothers who give birth to healthy children choose it without being coerced in one way or another. About 4 million babies are born each year. About 18,000 of those are put up for adoption.

Lindsey Graham’s Abortion Ban Bill Is Bad Policy and Dumb Politics

Florida Senator Rick Scott came up with the extraordinarily cruel suggestion that the state fund the cost of an impoverished woman’s childbirth… if and only if she gives her child up to adoptive parents. It’s the same sort of economic coercion that the largely unregulated billion-dollar adoption industry utilizes now, but it’s still shocking coming from an elected official. Scott made it clear that a faction of American conservatives believe that people who are poor do not deserve to raise their own children.

But just because Scott’s “saying the quiet part loud” plan may not ever become law, we’re on a path to a place where it may as well be. The cost of childbirth is exorbitant, and getting worse. There will be a time in the not-so-distant future where mothers who were forced to carry an unplanned pregnancy to term by Republican policies will be forced to choose between surrendering their child at birth and suffering medical-related bankruptcy.

According to a piece in Fortune earlier this month, hospitals are slapping new parents with surprise bills from so-called obstetrics emergencies departments. Many of those OEDs are staffed by private equity-backed companies, and women who believe they’re going into labor have no idea that they’re accessing “emergency” services when they utilize them. They’re money-making machines for hospitals and can cost patients thousands out-of-pocket, even if they’re insured. Proponents of the departments say that OEDs exist to provide patients with the best care possible, but one source quoted in the article remarked that “[Health care facilities] will always have a rationale for why income maximization is a reasonable and moral strategy.”

This isn’t the first time that parents have had to worry about surprise bills related to their own child’s birth. It’s almost impossible to know in advance of a birth how much it’s going to cost, because that amount is dependent on so many variables that attempting to ballpark it is useless. The location of the birth matters, as does usage of anesthesia (and whether the anesthesiologist even takes insurance—and they often do not), the length of labor, whether or not the birth requires surgical intervention, whether the baby needs the NICU, whether the NICU accepts insurance, maternal recovery time, and the overall health of the baby post-birth all factor in. Even a routine uncomplicated vaginal birth can cost five figures. An emergency C-section with a NICU stay can cost $250,000.

Recent polling has found that, in the waning weeks before the midterm elections, Americans’ jitters about the economy now give Republicans a slight edge.

Problems with using national polls to predict local results aside, it’s always been puzzling to me that voters associate Republicans with sound economic decisions. What do poll respondents who associate conservatives with good fiscal policy believe “the economy” means? Do they think it means how much they pay for gas and how well the stock market is doing? Congress has very little to do with either of these things. Do they think “the economy” means inflation? That’s a global problem, and Republicans have no concrete plan to tackle it.

I suspect that when most Americans respond to polling about “the economy,” they’re reacting to what messaging they’re receiving from mass media about “the economy” combined with how they personally feel that they are doing.

But the ability to control when and how often they give birth is perhaps the biggest economic issue in most American women’s lives. It doesn’t need to be this way. The government could subsidize and mandate paid parental leave on the federal level. They could extend the child tax credit, subsidize wages of child-care workers to stop the bleeding from the profession, subsidize the cost of child care so that people aren’t forced to choose between parenthood and their profession. Universal health care would mean that obstetrics would no longer be treated like a cash cow by private equity, and that the cost of childbirth wouldn’t be financially ruinous to all but the wealthiest sliver of society.

Of course Stacey Abrams was right. Abortion is an economic issue. Birth is an economic issue. Parenting is an economic issue. Before Dobbs, one of the more grotesque truths of living in America was that the size of your family was not determined by what you wanted, it was determined by how much family you could afford. In the post-Dobbs future, it doesn’t even matter what you want, or what you can afford.

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