The Medical, Financial, and Social Realities of Post-Roe America

Let’s be honest: it’s been a pretty tough year for women’s health. Even before the Supreme Court overturned 50 years of legal precedent to overturn Roe v. Wade, affecting reproductive health options for women, things were grim: COVID, formula shortages, tampon shortages, restricted access to contraception and more.

Now the future is really bleak.

Pregnancy, although a completely natural process for most women, can also be dangerous. Even healthy women can experience serious and life-threatening complications during pregnancy. And sometimes the only way to treat these conditions, such as miscarriages or ectopic pregnancies, are abortion procedures, such as dilation and curettage (D&C). So when SCOTUS overthrew Roe, pregnancy suddenly became much more dangerous for women in a country that already has the worst maternal mortality statistics in the industrialized world, because these lifesaving procedures will not be performed in many states.

But beyond the increased medical risks, there are other consequences of the Supreme Court’s decision that will increase out-of-pocket expenses for pregnant women and the children they carry to term. These are the costs of visits to the doctor during an unwanted pregnancy, medical costs before and after the pregnancy that the insurance may or may not cover, unpaid work stoppages to meet the medical needs of the pregnancy and then to those of the child, unpaid maternity leave, childcare costs, very little paid leave throughout the life of that child to allow parents to properly care for them, and so on.

You see, knocking down Roe has serious medical, financial, and social consequences for women of childbearing age and their families. Taking away women’s reproductive rights and basic health care without simultaneously allowing those same women to successfully raise their children is, frankly, a disaster for our nation.

Let’s just start by looking at the financial costs of pregnancy. The costs of prenatal care, delivery, and postpartum care can vary widely. The price depends on whether a woman is having a relatively uncomplicated pregnancy, the type of childbirth she is having, and any complications that may arise during pregnancy or childbirth.

A recent report from the Kaiser Family Foundation (KFF) found that even the smoothest pregnancy, childbirth and postpartum period costs more than many insured families can afford.

On average, the cost of pregnancy, childbirth and postpartum care is almost $19,000. Hospital birth costs have nearly quadrupled since 2000. Average out-of-pocket payments reach nearly $3,000 for women enrolled in large group plans. Yet another KFF study from a few months earlier found that 45% of single-person, non-senior households could pay no more than $2,000 in out-of-pocket medical expenses. Among the group homes, almost a third did not have enough money to pay for pregnancy and childbirth costs.

If pregnancy is too expensive for so many people who have insurance, what about the women and families without pregnancy coverage or insurance at all? In a country where healthcare costs are rising faster than anywhere else in the world, pregnancy can quickly become a financially catastrophic event.

These data points capture only some of the economic consequences of pregnancy and childbirth. There are other heavy loads to consider. Some claim that the strain placed on a woman’s body by pregnancy would, under any other circumstances, be classified as a serious chronic illness. Because beyond weight gain, swollen limbs and nausea, pregnancy can lead to serious, sometimes long-term, health problems for women and their babies. These include gestational diabetes, preeclampsia, postpartum depression, and child health issues. Treating these conditions can be expensive and time-consuming. In fact, according to a 2021 report by Mathematica and the Commonwealth Fund, the societal cost of maternal morbidity from conception to age 5 is $32.3 billion.

This number, which the report says is likely underestimated, includes medical and non-medical costs such as lost economic productivity and increased use of social services, assuming they exist even as they do. not in many states. Seventy-four percent of these costs are the result of child outcomes such as preterm birth, developmental disabilities and respiratory distress, which increase as income levels decline.

Once women have recovered from pregnancy and childbirth, they must manage the continued and growing expenses of child care. According to a 2021 report from the Center for American Progress, the average monthly cost of infant care in a licensed child care facility was just over $1,300. It’s close to $16,000 a year. Depending on where you live, however, some Americans pay more than double that amount per year for high-quality center-based child care. According to data from the United States Department of Agriculture (USDA), a child born in 2015 in a middle-income family costs approximately $12,980 to $13,900 per year (depending on the age of the child). Inflation adjustments increase these costs by 23% in 2022, from $16,007 to $17,141, increasing the average cost to raise a child to age 18 from $233,610 to between $288,126 and $308,538.

And yet, in America, there is no law requiring paid leave for parents, let alone paid maternity leave. As an industrialized country, the United States is an exception in this respect. In fact, it is only one of six countries in the world, and the only rich one, without paid national leave. Federal support (tax related and not available to everyone) for child care is very limited, although the costs are becoming increasingly difficult for families to cover. And 28 million people still have no form of health insurance. In this country, expectant mothers and their families are essentially left to fend for themselves, although with the overthrow of Roe many are now also forced to carry a pregnancy to term, whether they are ready to take care of the resulting child or not.

Without the significant societal support that families need to raise healthy children, the overthrow of Roe will have serious consequences for our nation, including increased morbidity and mortality in women and babies and costs that are skyrocketing for everyone. Congress must therefore act immediately to demand paid maternity and family leave, affordable and accessible child care, and comprehensive prenatal and postpartum care coverage for every American woman of childbearing age. It’s the only path to our dangerous post-Roe future.

Martha Nolan is Senior Policy Advisor at HealthyWomen, a nonprofit that educates women to make decisions about their health care.

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