US Could Make Childbirth Free, To Tackle Falling Birth Rates

Miami Herald

11 hours ago

America could make childbirth free for privately-insured families, in an effort to tackle declining birth rates.
The bipartisan Supporting Healthy Moms and Babies Act, which would designate maternity care as an essential health benefit under the Affordable Care Act, was introduced in the Senate in May.
If passed, insurance companies would be required to cover all childbirth-related expenses, including prenatal care, ultrasounds, delivery and postpartum care, without any co-pays or deductibles.
Medicaid, America's government‐funded health insurance program, already covers these costs.
Democratic New York Senator Kirsten Gillibrand, who has cosponsored the bill, told Newsweek: "Even with insurance, the costs associated with having a baby can be astronomical, and expenses are even greater for women who have health complications during pregnancy, a high-deductible insurance plan, or gaps in their coverage. By requiring insurance companies to fully cover care throughout pregnancy and a year postpartum, this bill will make childbirth more affordable for families."
It comes amid growing concerns about America's population. Fertility rates are projected to average 1.6 births per woman over the next three decades, according to the Congressional Budget Office's latest forecast released this year.
This number is well below the replacement level of 2.1 births per woman required to maintain a stable population without immigration.
The Donald Trump administration has made this issue one of its priorities, the White House exploring giving women a "baby bonus" of $5,000, according to an April New York Times report.
Many trying to tackle this global issue have called for public health policies and financial plans to help make it easier for couples to have children in society.
The financial crisis and its effect on housing, inflation and pay is generally named as a major contributor to people's decisions to delay having children, to have fewer children or not to have them at all.
Republican Mississippi Senator Cindy Hyde-Smith, who introduced the bill along with Gillibrand, Democratic Virginia Senator Time Kaine and Republican Missouri Senator Josh Hawley, said she hopes her bill will help change this.
"Bringing a child into the world is costly enough without piling on cost-share fees that saddle many mothers and families with debt. This legislation would take away some of the burden for childbearing generations," she said in May. "By relieving financial stresses associated with pregnancy and childbirth, hopefully more families will be encouraged to embrace the beautiful gift and responsibility of parenthood."
Pregnancy, childbirth and postpartum care average a total of $18,865 with average out-of-pocket payments totaling $2,854, according to KFF, a nonpartisan health policy research organization, based on data from claims between 2018 and 2022.
Financial concerns are repeatedly cited as a reason for not having children. Indeed, just a few days ago, the United Nations Population Fund warned of a global birth rate crisis, after finding that one in five had not had or did not expect to have the number of children they wanted. Some 39 percent said this was because of financial limitations.
But Suzanne Bell, who studies fertility and related behaviors with the Johns Hopkins Bloomberg School of Public Health, said that while "making childbirth cheaper or free is incredibly important," she does not think it will effect the birth rate.
"The cost of raising a child, in particular the cost of child care, is very high and far outweighs the cost of childbirth," she told Newsweek. "We desperately need policies that support families with the cost of child care, especially families with low incomes."
Beth Jarosz, a senior program director U.S. programs at the Population Reference Bureau, agreed that "reducing health care costs is important, but may not be enough to move the needle on births."
"The cost of childbirth is just one of the many costs of having a child, and people are also reeling from the much bigger costs of child care, housing, and other necessities," she told Newsweek.
Theodore D Cosco, a research fellow at the University of Oxford's Institute of Population Aging, called the bill "a step in the right direction" but said the same as Bell and Jarosz.
"Parents generally aren't deciding whether to have children based on a $3,000 delivery bill, they're looking at the hundreds of thousands of dollars spent actually raising the child," he told Newsweek.
But he added: "The policy certainly carries some symbolic weight, signaling bipartisan support for families and could potentially help build momentum for broader reforms, such as child care subsidies or paid parental leave."
The other concern is that, while financial concerns are generally accepted as a major contributor to declining birth rates, they are not the lone cause.
Bell said that even the policies she calls for "are also unlikely to increase the birth rate, as evidence from other countries with much more supportive policies suggest."
Norway is considered a global leader in parental leave and child care policies, and the United Nations International Children's Fund (UNICEF) ranks it among the top countries for family-friendly policies. But it too is facing a birth rate crisis.
Norway offers parents 12 months of shared paid leave for birth and an additional year each afterward.
It also made kindergarten (similar to a U.S. day care) a statutory right for all children aged one or older in 2008. The government subsidizes the policy to make it possible for "women and men to combine work and family life," as Norway's former Minister of Children, Equality, and Social Inclusion Solveig Horne said at a parental leave event in 2016.
And yet, Norway's fertility rate has dropped dramatically from 1.98 children per woman in 2009 to 1.44 children per woman in 2024, according to official figures. The rate for 2023 (1.40) was the lowest ever recorded fertility rate in the country.
Financial barriers "are only part of the picture," Cosco said, "psychological, cultural, and structural factors matter too."
Newsweek spoke to several experts about Norway specifically, who all cited recent culture changes.
For example, "young adults are more likely to live alone" and "young couples split up more frequently than before," Rannveig Kaldager Hart, a senior researcher at the Norwegian Institute of Public Health's Centre for Fertility and Health said.
He went on to speak about "intensive parenting," which refers to the modern parenting style in which parents invest time, money and energy into creating successful adults.
The expectations of this parenting style "may cause some to postpone or have fewer children than they otherwise would," Hart said.
Nevertheless, backers of the American bill seem to believe that it may be part of the solution.
"Being pro-family means fostering an economy that makes it feasible to raise a child. But too often, parents find themselves dealing with sky-high medical bills following the birth of a child. This legislation would eliminate out-of-pocket maternity costs for families with private health insurance and prohibit private carriers from imposing cost-sharing on beneficiaries, empowering parents to focus on what matters most," said Hawley.
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