After an abnormal Pap smear recently, I found myself in need of a colposcopy ― a fairly routine procedure in which doctors use binoculars to search for abnormal cells in the cervix.
After visually inspecting my goods, my OBGYN quelled my fears. Everything looked great, they said. Just in case, they took a small specimen to examine as an added precaution.
That one trip to the gyno? It cost me $193 out of pocket, excluding the biopsy lab test (which cost an added $115).
As a Harvard graduate student in the public health field, I’ve studied the benefits of preventive care and the social determinants that shape our health landscape. So I knew the colposcopy appointment was important, but I still couldn’t get over the price tag.
It got me thinking (somewhat facetiously, but not entirely) about the costs of women’s reproductive health care ― specifically, all of the things I could have bought (and that men can buy) if it weren’t for those expenses. For the price of my colposcopy and biopsy, for example, I could’ve purchased an Xbox.
Sometimes, it takes a medical scare to do the math.
For some Americans (myself included), health insurance and financial privilege render these expenses a nonissue. But for the millions of Americans with uteruses, vaginas and cervixes who are living on $8 an hour or less, these medical bills and upfront costs quickly add up ― my colposcopy appointment alone would’ve taken three eight-hour workdays to pay off.
(Note: Not all women have uteruses, and uterus-owners may not identify as women.)
But though this protective procedure was costly, it was a drop in the bucket compared to the aggregate of uterus-related spending that accrues over a woman’s lifetime.
“For the price of my colposcopy and biopsy, for example, I could’ve purchased an Xbox.”
Year after year, we pay to have our uteruses examined, tested, re-tested, poked, prodded, padded and password-protected from pregnancy. And we’re penalized for it. The cost of regular Pap smears (10 recommended exams between ages 21 and 65, at about $150 each without insurance), HPV tests (seven recommended tests between ages 30 and 65, at $30 each), monthly out-of-pocket birth control (about $11,400 over a woman’s lifetime) and feminine hygiene products (about $1,775 over a woman’s lifetime) can leave a woman owing around $15,000 over the course of her life. (Of course, these are just estimates, and costs vary.)
This is roughly equivalent to a ticket to the 100 Level Sky Club during the 2018 Super Bowl, 58 pairs of Kanye’s sold-out Adidas Yeezy 500 Utility shoes,* or a polar expedition to Antarctica.
Uteruses have always been big-ticket items on their own, but this is especially true during pregnancy and after childbirth, for women who choose to go that route. A recent study by Henrik Kleven of Princeton University found that before a woman gives birth, gender pay gaps are detectable but often small. After childbearing, however, a woman’s earning potential is significantly reduced ― often referred to as the motherhood penalty.
Childbearing disproportionately affects the future earning trajectories of womb-owners, represented by wages foregone. Michael Madowitz from the Center for American Progress developed a wage-loss calculator to predict loss of income as a result of time off due to childcare.
I gave it a whirl.
When I was a teacher in Las Vegas, I made $42,000 a year. Even if I contributed 15 percent of my income to retirement savings, only took one year off of work to raise kids (which many women can’t afford to do, while others give up their careers for much longer due to staggering child care costs) and retired at age 65, I would still risk losing:
$49,180 in lost wages (defined by the Center for American Progress as the number of years a worker is out of the labor force multiplied by his or her pre-leave salary);
$40,678 in lost wage growth (defined as the cumulative effect of time off on future earnings);
$56,773 in lost retirement assets and benefits (defined as the combined losses from missed 401(k) plan contributions while on leave, the lost growth of those assets until retirement and reduced Social Security benefits).
Combined, that’s $146,631. With every additional year off, that amount doubles.
“Year after year, we pay to have our uteruses examined, tested, re-tested, poked, prodded, padded and password-protected from pregnancy.”
But even before a woman starts to lose out on earnings as a mother, the cost of pregnancy alone is enough to place her under financial duress. If I were to give birth in Boston today, my in-network costs for pre- and postpartum care and vaginal delivery, anesthesia and outpatient hospital fees would be $8,012 (using an estimation calculator provided by Fair Health).
This is the amount that my health care plan should ideally pay; however, if my deductible is not met, I could be faced with paying the full amount out-of-pocket. Without insurance, my bill would be $14,985.
Let’s do the math, now. My wages lost after one year + my out-of-pocket pregnancy-related expenditures (assuming my deductible wasn’t met) = $154,643.
That’s about the price of one 2018 Porsche Panamera Turbo Sport. Or four years of private college tuition (with plenty of cash to spare). Or 5,154 SoulCycle classes.**
Fathers? They don’t experience this dip. Women’s wages tend to decrease by 4 percent per child, but men experience the opposite; fathers are rewarded with a 6 percent salary bump per child, on average. Kleven also estimates that a woman with children earns approximately 20 percent less than a man with children over the duration of her career. Reduced hours of economic participation are only partially responsible for this gap, meaning bias against mothers could explain the remaining difference.
To compare, if a man without insurance had an annual physical from age 18 to 85 that included a prostate exam and testicular cancer screening ($5,025 at $75 per exam), used one 75-cent condom every single day ($18,341), chose to have a vasectomy (average price $500), and needed a prostate biopsy at some point in his life ($5,000), he would still only spend about $28,866. This spending pattern is not representative of all men, of course, nor is this an insignificant amount of money. But it’s still significantly less than what women pay.
Of course, I’m not suggesting that men everywhere are financially capable of buying luxury cars because they don’t have uteruses (or that material items are equivalent to solid medical care), but the numbers do give us a reason for reflection. American society is still trying to deplume the womb by perpetuating lifelong penalties for uterus ownership instead of promoting systems to offset uterus-related costs over a woman’s life course.
So what can be done?
- The CDC’s National Breast and Cervical Cancer Early Detection Program offers free or low-cost Pap smears for eligible individuals with annual incomes at or below 250 percent of the federal poverty level. Furthermore, check with your doctor to see whether lab fees (such as HPV test fees) are included in the visit, or if the lab will bill you separately. Call your doctor’s office and ask about the costs upfront.
- If passed, the FAMILY Act would provide 12 weeks of paid family leave and would cover health and caregiving costs. Call your representatives. Bug Ivanka Trump.
- Complimentary feminine hygiene products can save a woman nearly $1,800 over the course of her lifetime. See if your organization has extra funds in its toilet paper budget to add a stash of tampons and pads to the restrooms.
In the meantime, if anyone would like to send my uterus a generous donation for her troubles, you can find it on Venmo.
Leena Kulkarni is an MPH candidate at the Harvard T.H. Chan School of Public Health and has previously worked with the United Nations Development Program’s Gender Team.
*Average sale price at time of publication was $258, but is subject to change.
**At $30 per class. Prices vary depending on region.