In 2024, the United States, along with the rest of the world, is facing a population time bomb that will have devastating economic and social consequences in the coming decades. But it is not the kind of calamity that anti-natalist doomsayers like Paul Ehrlich, author of The Population Bomb (1968), have been wrongly predicting for decades. The coming social upheaval will be a result of declining birth rates and shrinking populations. The solution to the coming catastrophe will not be fewer but more births—and to create a culture that welcomes life rather than destroys it. Perhaps no public policy concern is more urgent than increasing birth rates. And no concrete proposal will do more to facilitate that than to make birth free.
“Free birth” is a policy proposal that would spread the cost of birth—from prenatal care, through birth, and well-baby care for infants—across the entire tax-paying population. The discussion to make birth free was energized by Elizabeth Bruenig’s Atlantic article “Make Birth Free: It’s time the pro-life movement chose life,” published right after the Dobbs decision. Bruenig summoned pro-lifers to shift their advocacy to concerns about the cost of carrying a child to term and delivery. A white paper coauthored by Catherine Glenn Foster (president of Americans United for Life) and Kristen Day (executive director of Democrats for Life of America) followed soon after: “Make Birth Free: A Vision for Congress to Empower American Mothers, Families, and Communities.” (A popular version of the white paper was published in Compact.)
The proposal has gained further momentum over the past couple years, and thus has the potential to make a real difference. According to the Washington Post, Ohio Sen. JD Vance, before he was tapped as VP, was engaged in bi-partisan discussion to introduce legislation implementing some of Bruenig and the white paper’s propositions. Most recently, Patrick Brown argued in Compact that free birth should be subsidized rather than IVF, as proposed by Donald Trump.
To defuse an obvious objection, no one who advocates free birth is under any delusion that such a policy will not be costly. But the initial economic cost of such a program will be far outweighed by the long-term social and economic benefit of increasing live births and growing the U.S. population.
According to the National Center for Health Statistics at the U.S. Centers for Disease Control (CDC), the 3.6 million babies born in the U.S. in 2023 represent the lowest birth rate (1.6 children per woman) in the history of keeping such data. This is less than the 2.1 births per woman required merely to keep pace with deaths. According to the CDC, the rate has been generally below replacement since 1971, and consistently below since 2007.
Additionally, infant and maternal mortality rates in the U.S. are alarmingly high in comparison to peer countries. In 2020, the infant mortality rate in the U.S. was 5.4 deaths per 1,000 live births, compared, for example, to 1.6 in Norway. In the same year, the maternal mortality rate of 23.8 deaths per 100,000 live births was more than three times the rate in most other wealthy countries.
The devastating social and economic impacts of these statistics can hardly be exaggerated. As the population ages, fewer and fewer people will be contributing to the economy to meet the high costs of Medicare, Medicaid, and other healthcare programs designed to meet the needs of the elderly. While we should not measure this population catastrophe merely by a utilitarian calculus, the future economic impacts alone are sufficient to tell us that drastic and immediate measures are required to reverse these declines and fend off economic calamity.
And while a variety of public policy measures and programs may be required to meet future needs, free birth is a necessary element in any basket of social and economic policies to meet the alarm of declining population.
According to Foster and Day, the average cost of childbirth in the U.S. is $19,000. Citing a study by the American Academy of Pediatrics, they detail how 17 percent of mothers with good health insurance still incurred more than $5,000 in out-of-pocket expenses. Adding the cost of any potential pre- or neo-natal complication quickly multiplies both expenses. About 10 percent of such families paid more than $10,000 out of pocket from 2016 to 2019. Many families pay much more, depending on the state and severity of complications.
Free birth is also pro-life. Women and young married couples cite a variety of reasons for having no or fewer children than past generations; the cost associated with pregnancy, delivery, and prenatal care is the rationale for a significant number. This is also the justification for a substantial number of abortions for unintended pregnancies. For example, according to a 2013 study analyzing why women seek abortions, 40 percent of the respondents cited financial concerns. While it would not eliminate the felt need for all abortions, a federally funded free birth program would almost certainly lower the number of abortions in the U.S.
Free birth is also a positive pro-life policy and not merely an anti-abortion stance, allowing Republicans to offer something more than just strictures. Such a policy would also call the bluff of pro-abortion advocates, who like to disguise their positions in terms of “reproductive justice” or “reproductive rights.” A free birth program would contribute to a culture of welcoming life, preventing abortion, and caring for the well-being of mothers and children.
While the cost of free birth would not be unsubstantial, it would be a mere fraction of what the U.S. now pays for other programs and policies. For example, according to Foster and Day, a national free birth policy would cost about $39.5 billion above what is already spent through Medicare and Medicaid. Adding $60 billion or so for perinatal care, the U.S. would spend approximately what it gave to Ukraine in 2022 to support its war with Russia. And it is about one-sixteenth of what the U.S. spends on healthcare overall.
Children are a public good, and having children contributes to the overall well-being of society. Not only do they contribute to the happiness of their immediate families, they also grow to make economic and social contributions to the broader culture. Put another way, the decision whether or not to have children is not a private matter. Indeed, what is more public than adding to the population? As children contribute to the overall good of society, it only makes sense that the cost of producing children should be borne by all who benefit.
By itself, making birth free will not reverse the birth dearth in the U.S. But it would be a very significant step toward forestalling and reversing an imminent economic and social disaster—and even saving unborn lives, as struggling mothers would no longer be pressured by the prospect of astronomical hospital bills. More and healthier babies and mothers will make for a healthier and more prosperous society.
Kenneth Craycraft is author of Citizens Yet Strangers: Living Authentically Catholic in a Divided America. He and his wife are the parents of nine children and grandparents of ten.
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