Make Birth Free

It’s time the pro-life movement chose life.

Illustration of a baby swaddled in money.
Katie Martin / The Atlantic; Getty

About the author: Elizabeth Bruenig is a staff writer at The Atlantic.

Immediately after the Supreme Court’s decision in Dobbs came down, anti-abortion groups began distributing press releases celebrating their victory and vowing to get around to something the movement has politically neglected for the past several decades: helping mothers afford children. For so many millions already distraught by the ruling, the ready promises of help on the way came not so much as a comfort but as an insult. The fact that American mothers and infants have access to relatively few resources compared with the women and children of our peer nations notwithstanding, better welfare policy wasn’t exactly what the majority of abortion-rights activists were demanding at the moment.

There was perhaps a time when America’s pro-life movement, in its incipient stages, could have mobilized for broad political reforms along these very lines. The largely progressive politics of life dreamed up by Catholic theologians and mainline Protestants in the first half of the 20th century hoped to unite all sorts of distinct issues—living wages for workers, nuclear disarmament, destroying the draft, eradicating capital punishment—under the principle that human life is good and worth advancing, both in quantity and in quality. Abortion was a concern within that framework, but not a totalizing one, and not predictive of an entire politics or even a specific policy commitment. Well into the 1970s, pro-lifers maintained a variety of positions on what ought to be done about abortion, including but not limited to the distribution of birth control and funds for mothers, designating a legal right to life, and simply banning abortion and nothing more.

But the modern American anti-abortion movement that emerged by the late 1980s was an ecumenical joint with an evangelical id and a much narrower sense of what it meant to be “pro-life.” In place of a broad societal vision, it had a highly specific legal goal: regulating the practice of abortion. Because Roe and later Casey prevented states that would’ve banned abortion outright from doing so, overturning those decisions became a key element of the movement’s long-term strategy to regulate abortion out of existence. Organizing, funding, and political activity all centered on this singular effort. Everything else was noise.

Thus, though American pro-life activists have had decades and plenty of encouragement to tackle the privations—poverty, poor housing options, and limited access to child care—that seem to precipitate many abortions, their attention has instead remained obdurately trained on regulating the practice of abortion itself, through legislation codifying (inter alia) term limits, specific clinic conditions, and burial requirements for fetal remains. Anything done in service of overturning the rulings, even something as facially perplexing as devout Catholics voting for Donald Trump, was ipso facto a higher political priority for the vanguard of “life” than anything having to do with the living conditions of American mothers and infants.

Nevertheless, the triumphant post-Dobbs press releases had to say something, and most of them gestured at precisely the kind of legislation that the anti-abortion movement has adamantly ignored for the past 50 years. Alliance Defending Freedom, the conservative legal organization that helped draft Mississippi’s Gestational Age Act and helped the state defend it before the Supreme Court, lauded its own win in Dobbs with a statement applauding the fact that states could now “ensure women have greater access to the support and resources they need and deserve … and that they receive the care and resources they need to flourish.” Susan B. Anthony List, a major pro-life advocacy organization, declared in its post-Dobbs press release that the group was prepared to “redouble our commitment to women and families—building on a pro-life safety net that includes 2,700 pregnancy centers nationwide and initiatives like SBA Pro-Life America’s Her PLAN,” by which they meant charity, not policy. Meanwhile, the Republican strategists who mocked up a “Marshall Plan” for American women and children recently in National Review were sober enough to admit up front that anti-abortion leaders “feel restrained from supporting a ‘safety net’ for women, out of ideological concerns” and “perceived mission creep.” If you know you’re going to underdeliver, you might as well underpromise too.

A better tack: Rather than tee up an exhausting, decades-long legal battle over whether crisis pregnancy centers (the modern anti-abortion movement’s preferred delivery method for services, money, and goods for women in need) ought to receive state funds and under what conditions, agree that pregnancy, childbirth, and postpartum care should all be free, and demand that the federal government make it so.

To address the predictable objections: Yes, the costs of pregnancy, childbirth, and postpartum care really do spell the difference between life and death for scores of American mothers and infants. Preventing preterm births and safeguarding babies’ health in the first few months of life would likely reduce relatively high American infant mortality rates to levels closer to those of our peer nations, many of which spend much more than we do on mothers and babies. Likewise, a 2020 report issued by the Commonwealth Fund on maternal mortality in the U.S. observed that barriers to prenatal and postpartum care—namely non-insurance and poorly crafted Medicaid policies that drop new mothers from expanded postpartum coverage only 60 days after birth—contribute a great deal to maternal death. In a country where health care can be cost-prohibitive, deaths arising from inadequate or inaccessible care might as well be tallied as deaths from poverty.

This is especially the case with respect to pregnancy, birth, and postnatal care, all of which range from manageably costly to exorbitantly expensive. For many, private insurance is hardly a comfort. Young mothers enrolled as adult dependents on their parents’ private health-insurance plans may not discover that their benefits don’t extend to maternity care until their multithousand-dollar bills for routine obstetrician visits arrive. The costs associated with childbirth itself are even more harrowing. A recent study published by the American Academy of Pediatrics found that the average out-of-pocket expense for giving birth while privately insured exceeds $3,000. More than one in six privately insured births result in more than $5,000 of out-of-pocket expenses. Over the course of reporting this story, I encountered mothers across the country who shared extraordinary medical bills from having given birth: A hospital in Texas charged one couple north of $10,000 for labor and delivery, with some $3,000 paid out of pocket in the run-up to the due date, and another $1,500 charged after the birth; in Indiana, a high-risk delivery this year totaled more than $24,000; in Colorado last year, a hospital sent a mother a $14,000 bill for her uncomplicated hospital delivery without so much as an epidural, $5,000 of which she was forced to pay out of pocket.

The federal government could—without much structural innovation—eliminate these costs altogether, and with them lethal barriers to maternal and infant care. Medicare already covers the costs of pregnancy and childbirth for people who are eligible for the program due to disability. This coverage could be extended to everyone, regardless of disability status, age, income, or work history—and such an expansion should be feasible, at least administratively.

In July 1973, the very first Medicare expansion to extend coverage to people of all ages experiencing a particular condition went into effect under the Nixon administration. Known as the Medicare End-Stage Renal Disease (ESRD) program, the policy covers the cost of dialysis and kidney transplants for any individual in need, including children and others who wouldn’t ordinarily qualify for Medicare benefits. Covering prenatal care, childbirth, and postpartum care would need only follow along the same lines, with a slightly broader purview: The benefits would cover 100 percent of pregnancy costs for all Americans without any other eligibility requirements.

And yet: Where’s the constituency for effecting this kind of change? Pro-lifers are a powerful bloc within the Republican Party—but still only a bloc, and they would need a fresh insurgence of allies to replace the business conservatives they would lose were they to sincerely demand concrete policy relief for mothers and babies. (Said fiscal conservatives have been openly hostile to generous programs for mothers and infants for years now, and I’ve seen nothing that makes me suspect they’ll undergo a change of heart now.) They would be wise to court politically estranged American independents, many of whom were sympathetic to Senator Bernie Sanders’s presidential runs, complete with his centerpiece proposal, Medicare for All. Creating a Medicare program for pregnancy and birth wouldn’t remotely accomplish what Sanders envisioned, but it would save lives, promote healthier moms and babies, and rescue millions of parents from stressful financial burdens and the threat of medical debt.

This would require veteran pro-lifers to take on a trifecta of onerous tasks: moving on from a narrow fixation on regulating the practice of abortion itself; taking up welfare as a cause just as worthy of political agitation as abortion; and overcoming a veritable addiction to liberal tears, indisputably the highest goal of American politics at this point in time, and which militates against human flourishing in every case. It’s time the pro-life movement chose life.