A proposal to make birth free in the United States has sparked discussion among Catholics and other pro-lifers in recent months. 

Written by President and CEO of Americans United for Life Catherine Glenn Foster and Democrats for Life of America Executive Director Kristen Day, the white paper was published in January and outlines a proposal to “empower American mothers, families, and communities” by federally funding costs associated with childbirth.

Proponents of making birth free enthusiastically support the proposal as the future of pro-life and pro-family policy in the United States. But the plan outlined by Foster and Day has also been met with skepticism from some pro-life voices. 

Foster and Day propose a paradigm for childbirth that would alleviate the financial burdens of childbirth, which costs approximately $19,000 per birth without medical intervention. Even women with insurance often pay at least $3,000 out of pocket for delivery alone.

Currently, 42% of births in the United States are already financed through Medicaid, which means that the nation spends $28.5 billion on childbirth, Foster and Day write. Making every birth free would cost an additional $39.5 billion. Foster and Day explain that making birth free would cost about 6.25% of what the government currently spends on health care.

Making birth free would not only eliminate direct costs to families, but it would also reduce the cost of delivery itself by correcting the “misaligned financial incentives for healthcare providers” that make birth so expensive, Foster and Day write. For example, they explain, by eliminating financial incentives to doctors associated with C-sections and facilitating wider access to doulas and midwives, making birth free would remove artificial price controls and lower the overall cost of birth. 

Foster and Day also argue that making birth free would enable women to choose life over abortion, citing research in other countries that has indicated that abortion rates fall when financial barriers to childbirth are removed. 

 

Starting a Conversation

Proponents of making birth free don’t only see it as an expedient policy for achieving pro-life ends; they see it as an act of justice consistent with living in a political community. 

“From our perspective, making birth free as a national policy is really about saying … that we want to set a new direction for American social policy that looks at what our common goods are,” said Tom Shakely, chief engagement officer for Americans United for Life. In addition to the fiscal benefits for families, he sees the proposal as “an important social signal in support of families as they welcome new life.”

Shakely acknowledges that the strongest opposition to the proposal stems from concern about its financing. The most generous version of the proposal, covering expenses related to all births, entails a $40-billion addition to the federal budget, which Shakely points out is about a 1% increase in total federal spending. 

He noted, “That increase [in the federal budget] happens more or less every year anyways. There are so many ways to pay for [the proposal], and there are so many reasons to pay for it, when you compare it to a lot of other programs that really should be cut.”

“We’re trying to start a conversation and say, ‘What would it look like, in this post-Roe era, to move beyond a purely philanthropic, a purely charitable response for the pro-life movement? What would it look like to actually make it state policy?” Shakely told the Register. 

 

Skepticism Remains

Shortly after Foster and Day published their white paper, Wesley J. Smith offered a critique of the proposal in National Review. Smith, chair and senior fellow at the Discovery Institute’s Center on Human Exceptionalism, wrote that he “like[s] the goal but [is] dubious about the means,” fearing that government involvement could reduce access to quality health care. 

“I applaud Americans United for Life for sparking an important conversation,” Smith told the Register. “I am wary of the government being the sole funder because with that appropriation of public money would come binding regulations that would, I fear, often be antithetical to the pro-life cause.” Smith suggested that nonprofit philanthropic means would more adequately further the goals of the white paper. 

“There is a lot to like in the proposal,” wrote author Leah Libresco Sargeant and Ethics and Public Policy Center fellow Patrick T. Brown. “But ‘Make Birth Free’ undersells some of the powerful programs that already exist to blunt the cost of birth.” 

Sergeant and Brown argue that the ends of the white paper could be achieved with existing programs by expanding Medicaid for pregnant and postpartum women, expanding the quality of care given by federally funded patient advocates, capping birth-related insurance payments, and building a pro-family policy agenda that addresses costs incurred after birth. 

Though supportive of the proposal to make birth free, Carmel Richardson, a contributing editor at The American Conservative, wants to see a broader shift in how Americans view birth. “Birth used to be free, or close to it,” she wrote. But the medicalization of childbirth and the accompanying cascade of interventions have driven up the price of birth, and insurance companies seldom cover care from midwives or doulas. Those who opt for a homebirth run the risk of paying twice, as Richardson did.

After laboring at home under the care of a midwife, Richardson gave birth to her daughter within 20 minutes of arriving at the hospital. The total cost of her stay — which included no anesthesia, surgery, or medical intervention for mother or baby — came to $25,700. Much of the hospital bill was covered by insurance, but the midwife’s costs were not. 

Broadening insurance coverage for midwife care could be done with or without making birth free, and it would make safe alternatives to hospital deliveries cheaper and more widely accessible, she told the Register. 

Shakely addressed the same point, arguing that the proposal could positively change the cultural perception of childbirth. “Making birth free, if implemented in the right way, can actually help people realize that childbirth is not necessarily a health-care event, and it’s certainly not inherently an emergency event,” he said.

 

Forging Bipartisan Pro-Life Policy

Professor Charles Camosy of Creighton University School of Medicine thinks that making birth free could be a bipartisan victory for the pro-life movement. “Significantly, the Republican Party of the last 40 or 50 years is reconstituting itself in ways that make Republicans far more likely to support programs like this,” he told the Register. 

In fact, Sen. J.D. Vance, a Republican from Ohio, has already voiced support for the proposal. 

“I really worry that Republicans, if we’re not willing to accept that something has gone terribly wrong in healthcare — especially for young mothers — that we’ve made a big mistake,” he said last month on American Moment’s Moment of Truth podcast. 

Vance shared that, in the chaos of delivery, he and his wife chose an anesthesiologist who was outside of their insurance network, which resulted in a $20,000 bill. Surprise costs like this can be “catastrophic” for many Americans, Vance said.

He sees the proposal to make birth free as a recognition that “we could either be on the side of the insurance company or of young mothers.” Vance said that he is trying to determine how to structure a policy to make birth free and how to pay for it, and he’s eager to make the proposal a reality. 

That’s encouraging news to Elizabeth Bruenig, a staff writer for The Atlantic who sparked the current discussion with her July 2022 article “Make Birth Free.” She told the Register that she has been surprised by the positive response that many of her fellow Catholics have had to the proposal. “I think these kinds of expenditures are worthwhile,” she said. “I’m glad Sen. Vance is interested in it.” 

Sen. Chris Murphy, a Democrat from Bruenig’s home state of Connecticut, tweeted his own support for the proposal in response to an article by Bradley Devlin published in The American Conservative. Murphy acknowledged that his “interest in this issue comes from a different place” than Devlin’s, but called making birth free a “really worthwhile idea.”

And while he sees making birth free as a matter of justice, Shakely also contends that there may be political advantages for pro-life candidates who incorporate the proposal into their platforms. 

“In terms of electability, [making birth free] gives something substantive for candidates to run on,” Shakely told the Register. “It’s one thing to be anti-abortion … but it’s far more compelling to voters across the spectrum [for a politician] to be for something affirmative in the form of the American family.”