Capitalism is Threatening Women’s Right to Choose and Destroying the American Family
Meet Alex. She’s not very well drawn, but don’t blame her for that. That one’s on me.
Alex is thinking about having children.
Maybe she’s discussed the idea with her partner. Or maybe she learned she was pregnant two weeks ago and is deciding whether or not to have an abortion (hopefully she lives in a state which recognizes her bodily autonomy). Perhaps she’s single and is going to go the insemination route*.
Whoever Alex is**, she’s thinking about what it would look like to have — and raise — a child in America. She reads a story in the news talking about the high cost of college and starts thinking “can I afford a child?”
So she starts making a list — a timeline — of all of the costs she might face. She wants to make sure her kid has the best shot at a good life, and that starts with making sure she is healthy during her pregnancy. So she sets up an appointment with her doctor. Does she have insurance? If she’s single, an individual healthcare plan is going to cost her around $450 a month. If she’s doing this with a partner, a family plan is going to be closer to $1150 a month.
If she doesn’t have insurance, some of the upcoming costs are going to get much, much more expensive. Luckily, Alex has insurance through her employer, so she goes straight to her doctor (I’m not an artist).
Her doctor gives Alex a clean bill of health, and only recommends basic checkups (monthly for months 2–7, every other week for weeks 28–36, and weekly for weeks 36–40, coming to around 14 checkups). Those visits cost around $100–200 each (assuming no indicators which require further testing), so the prenatal care bill comes to around $2100. She has good insurance, so she’s only going to $400 out of pocket.
If Alex had other negative health indicators (family history of pregnancy complications, chronic illness, etc), it might have been more complicated. And if she had no insurance, she’d have had to foot the whole bill.
Eight months into her term, Alex is very pregnant.
She’s been working throughout her pregnancy, but at this point it’s hard for her to be on her feet for long periods of time, let alone go into the office daily.
Her office doesn’t offer paid maternal leave, but they do have a 12 week unpaid leave plan (better than average for the US). Alex wants to spend time with her newborn, and even though 3 months isn’t that long, she plans to think about it more then.
Her last month is pretty rough, and she ends up taking many days off, unpaid. Her boss is unhappy but understanding, and tells her they’ll talk about it when she returns from maternity leave.
Time for delivery! A few days before her expected delivery, she starts having contractions, and rushes to the hospital. She’s worried, but a nurse puts her at ease: an unexpected, slightly early delivery is common. Her delivery goes off without a hitch, and she holds her child for the first time, naming them Jessie.
After staying overnight, she leaves the next day. There’s just the simple matter of the bill. If she’s in Alabama (the cheapest state for deliveries), the median is $5,000; in Alaska (the most expensive), the median is $10,000. But it also varies wildly from hospital to hospital. In California, for example, the cost of an uncomplicated vaginal birth varies widely — from $3,296 to $37,227. Insurance tends to cover around a third the cost of delivery, leaving Alex with a bill that could be anywhere from $1,650 to $12,500.
Side note: Alex actually has a disturbingly high chance of dying during delivery. America has a notoriously high rate of maternal mortality, with 20.7 out of every 100,000 women dying during child birth. That number may seem low, but America ranks 59th in the world, behind almost every Western nation, and sandwiched between Thailand/Chile and Ukraine. So the cost of her delivery doesn’t necessarily mean better outcomes (especially if Alex is black, in which case her maternal mortality rate is twice as high: 47.2 out of every 100,000).
So far, her pregnancy has kept her out of work for the better part of a month, probably increased her rent (kids require more space), and left her with a medical bill of several thousand (if she has insurance) and tens of thousands (if she doesn’t have insurance).
But the costs don’t begin to stop there.
Once her 12 weeks are up, it’s time to go back to work. Jessie is only three months old, and can’t exactly be left alone, so that means daycare. Daycare costs an average of around $800/month (again, varying by neighborhood and region).
Of course, she could stay home to take care of Jessie, but that would mean reducing her hours or leaving her job. Either way, whether she pays for daycare or works less, it’s a hit to her finances. If she’s a single mother, reducing her hours or leaving her job probably aren’t options. If she has a partner, it depends how well-paying their job is.
It might not even be a relevant decision. After a few weeks back on the job, she finds out that her manager is considering letting her go after her pre-delivery absence. He tells her she can’t miss any more work for awhile. A few emergencies — surely it’s reasonable for a parent to leave their job for an emergency with their child — could cost her job.
Whether or not she loses her job, she’s about to be hit with another huge expense. As Jessie approaches the age of 2 or 3, she starts thinking about what school her kid should go to. She knows how much she’s struggled with rent, student debt, and basic expenses (particularly since having her child), and she wants to make sure that her child never faces the same problems.
That means getting Jessie into a good best school. The local public school isn’t great, but she also doesn’t feel like she can afford to move to the better school district nearby, nor can she afford the local private schools (which are almost as expensive as colleges!)
And that’s not just high school, it’s the full K-12, and of course after that, college. At this point, she can’t afford to pay for her kid’s college, so Jessie’s going to end up with some student loan debt, but we can’t really blame Alex for that. She did everything she could and then some.
Notably absent from this story is day-to-day expenses. Having a child is like having an extra person in the household. Mostly because it is having an extra person in the household. They need baby formula and diapers when they’re younger, books and school supplies, and through it all, their rapidly growing bodies mean new clothes constantly.
But the institutional expenses — medical care for every stage of development and education for every stage of development — have ballooned out of control, particularly as millennials have aged into child-rearing.
That’s bad for society, and it’s bad for the next generations. More and more kids are growing up growing up hungry, undereducated, or even homeless. We’re failing to provide parents with the tools they need to provide for their children, and failing to give children the tools they’ll need to thrive as adults.
The result? We’re having fewer kids — particularly millennials. Yet another industry millennials are killing: having babies.
Are we really protecting those women’s choices if we’re making one option financial untenable?
We need to take some of the profit out of these industries, and make sure that all prospective parents have the basic resources they need to parent: pre-natal care, delivery costs, healthcare for their children, parental leave, daycare, and quality education.
It’s not just an economic issue either, but one of a women’s fundamental right to choose. Some of the primary reasons women seek abortions are financial (not being able to afford a child). Let me be clear, I believe that we should support that right fully (and I mean fully, 100%, no qualifications). But we should also make sure that they are able to make that choice without a primary concern being whether or not their child will be healthy and educated if their parents’ finances waver.
Being pro-choice means supporting a woman’s right to choose when to have (or not have) a child, but it also should mean supporting a woman’s ability to afford to raise a child.
Our support for women’s reproductive rights should extend beyond the legality (and affordability) of abortion, and tackle the robustness of the institutions required to facilitate child-rearing.
(By the way, Elizabeth Warren has plans for many of these):
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*Alex could also adopt, which would obviously remove certain of the medical costs (although has its own associated costs and barriers)
**Alex could very well be a trans man. I initially chose a gender neutral name for a reason, but swiftly learned that I wasn’t well educated enough about the medical concerns facing the trans community — nor is there enough easily obtainable information — to possibly do justice to trans Alex’s struggles. He would face medical discrimination at many of these steps, and may face unforeseen medical complications thanks to negligence.