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The politicians and activists who decry abortion often brush past the cost of pregnancy. Someone with an unwanted pregnancy can just put the child up for adoption, they suggest, or perhaps a family member can care for it. As Republicans seek to end abortion rights and the Supreme Court prepares to potentially overturn Roe v. Wade, the suggestion seems to be to just have the baby and figure it out.
But a pregnancy isn’t that simple.
There’s the physical toll: the fatigue, sickness, possibility of long-term health issues and even, rarely, death. The emotional difficulty. The stress of needing to leave work for appointments (I had “only” 13, but those with added complications can have appointments multiple times per week) and taking sick days (I took at least four, and would have needed more if I had a job that required me to be on my feet). The struggle of finding a way to afford time off for the birth and postpartum recovery in a country with no national paid maternity leave (this one was not, luckily, an issue for me personally; my husband had to take unpaid leave).
Some of these things are hard to quantify. One thing isn’t: the hospital bill.
The cost of childbirth can vary a huge amount depending on type of birth, insurance, region and hospital. For patients on Medicaid, nearly all pregnancy and birth costs are covered. These patients make up a large share of births: Medicaid paid for 42% in the U.S. in 2019. But that leaves many births covered by private insurance, for which patients usually foot more of the bill.
How much? On average, about $2,000. And that’s just for the birth itself.
The Health Care Cost Institute, an independent nonprofit, analyzed data from more than a third of the population with employer-sponsored insurance to dig into the out-of-pocket costs of childbirth.
It found that those costs ranged from an average of $974 in Michigan to $2,685 in Nebraska, with a national average of $1,905 out of pocket. Costs can go much higher: The 90th percentile cost to patients for delivery was $4,327, according to HCCI’s analysis.
C-section births were typically more expensive, with an out-of-pocket cost of $1,962 on average nationally, whereas vaginal births cost patients an average of $1,875.
Within those payments, HCCI found that the average cost of anesthesia services, such as an epidural, for vaginal births was about $200 to patients, according to analysis provided to HuffPost.
My childbirth experience provides a more specific example. In many ways, it was a best-case scenario, with no major health concerns and employer-based insurance. It wound up on the low end of out-of-pocket costs, setting me back $1,527.93 — an amount that was still significant, especially combined with other pregnancy- and baby-related costs.
I showed up at the hospital in the evening and within a few agonizing hours, received an epidural (for which I paid $109.38). The birth itself was uncomplicated, from a medical sense: My obstetrical care cost $292.40 out of pocket. The biggest out-of-pocket cost was the hospital stay, at $1,126.15. Without insurance, of course, this total would have been far higher: The hospital charged $25,887.42 for my total time in the hospital and $6,479.63 for the baby’s, but insurance picked up her tab.
It’s tough to come up with average figures for prenatal care, but the doctor visits and tests add up. HCCI told HuffPost that, on average, patients whose costs it analyzed paid more than $1,300 out of pocket on medical costs in the nine months leading up to birth — costs that aren’t necessarily related to pregnancy, but serve as a potential proxy.
We can break that down a bit more.
Most patients, even relatively low-risk ones, go to many appointments. Most of my 13 prenatal appointments had low co-pays of $7.26; some, for reasons I can’t decipher, were more or less than that, bringing my all-in doctor visit cost to $162.24. I also paid $25 for the OB-GYN office to create a form for the birth.
The American College of Obstetricians and Gynecologists recommends having only one ultrasound in many cases, but it’s common to have more than that — often at least two, and I had four. On average, ultrasounds cost the patient between $60 to $70 out of pocket, HCCI found. My ultrasounds were cheaper out of pocket: Some were covered entirely, and the two that came with a bill were $23.06 and $17.91 each.
Pregnant people also undergo a huge number of tests and vaccinations. They’re not very expensive — on average, routine tests cost patients less than $10, HCCI told HuffPost — but they can add up. Early in pregnancy, patients are typically tested for whether they are in fact pregnant, and then a series of other factors, including their blood type and whether they have various diseases and infections. Throughout the pregnancy, there are many more blood tests, along with a glucose screening. My tests only cost me $27.46 total, plus $8.77 for vaccinations.
But that’s not counting genetic testing or other services, which can cost a patient hundreds of dollars. Those cost me $309.85.
These costs all assume a low-risk, uncomplicated pregnancy and childbirth, which many are not. Severe morning sickness can lead to hospitalization. Six to nine percent of women develop gestational diabetes, which means more frequent testing and appointments. Restricting activity and bedrest, which is controversial but still recommended to about 20% of patients, often means time off work.
At the hospital, some people are surprised with an out-of-network provider like an anesthesiologist, potentially increasing costs. Even variations on insurance and time of year can have a major effect on the out-of-pocket cost based on whether someone has already used up some of their deductible.
After childbirth, the health care costs continue. Postpartum care in the U.S. is fairly lacking — many people get only one appointment at around six weeks. But postpartum issues also have a price tag, although out-of-pocket estimates are difficult given the number of variables. Some people need treatment for postpartum anxiety or depression — one in eight women suffer symptoms of postpartum depression — including appointment copays and sometimes medication. Some need postpartum physical therapy, which isn’t always covered by insurance (I had a $20 copay per appointment).
To go beyond health, there are other costly factors for a pregnant or postpartum person. Most need maternity clothes. Some will need new post-baby clothes, too, given many people don’t go back to their pre-pregnancy size. There are lotions and salves for the discomfort; sitz baths for the postpartum pain; special underwear and, well, diapers for when the post-birth bleeding hasn’t stopped.
Whether someone has a wanted pregnancy or one they wished to end, most of these costs are unavoidable.
And then there’s the baby. Disposable diapers may run more than $900 in the first year. Child care costs have climbed to an average of over $14,000 per year during the pandemic. Breastfeeding isn’t free, as it requires various supplies and a huge amount of time; formula isn’t, either, typically running from $1,200 to $1,500 in the first year and taking up a new parent’s time and energy. Babies need clothes, a place to sleep, a stroller, a car seat and more.
Let’s again set the baby aside; pretend costs related to them don’t matter. Let’s set aside the less tangible difficulties of pregnancy. Let’s set aside that a pregnancy may be unwanted. Let’s set aside the potential of major medical issues.
Let’s pretend that all a pregnant person needs to worry about is finances. I’m one of the lucky ones — with employer-based insurance, relatively good health, a complication-free pregnancy and birth and a dual-income household with no other kids. And my all-in cost for medical bills alone was $2,202.22.
That’s two-thirds of many Americans’ take-home pay each month. It’s more than the median listed monthly rent in the U.S. It’s equal to about four months of car payments. It’s roughly five months of groceries for the average American family.
Pregnancy isn’t a health-neutral event. We shouldn’t pretend it’s a cost-neutral one, either.