The medical, financial and social realities of post-Roe America

Let’s be honest: It’s been a pretty trying year for women’s health. Even before the Supreme Court overturned 50 years of judicial precedent to strike down Roe v. Wade, affecting reproductive health options for women, things were grim: COVID, baby formula shortages, tampon shortages, narrowing access to contraception and more. 

Now, the future is bleak indeed. 

Pregnancy, while a completely natural process for most women, can also be dangerous. Even healthy women can experience serious, life-threatening complications during pregnancy. And sometimes the only way to treat those conditions, such as miscarriages or ectopic pregnancies, are abortion procedures, such as dilation and curettage (D&C). So, when SCOTUS overturned Roe, pregnancy suddenly became a whole lot more dangerous for women in a country that already has the worst maternal mortality statistics in the industrialized world, because these lifesaving procedures won’t be performed in many states. 

But beyond the heightened medical risks, there are further consequences of the Supreme Court’s decision that will increase out-of-pocket expenses for pregnant women and the children they bring to term. Those are the costs of doctors’ visits during an unwanted pregnancy, medical bills before and after pregnancy that insurance may or may not cover, unpaid time off from work to handle pregnancy medical needs and then those of the child, unpaid maternity leave, the high cost of childcare, very little paid leave throughout that child’s life to allow parents to provide proper care, and more. 

You see, overturning Roe brings with it severe medical, financial and social consequences for women of childbearing age and their families. Taking away women’s reproductive and basic healthcare rights without simultaneously setting those same women up to raise their children successfully is, frankly, a disaster for our nation.

Let’s start just by looking at the financial costs of pregnancy. Prenatal care, delivery and postpartum care costs can range widely. The price depends on whether a woman experiences a relatively straightforward pregnancy, the type of delivery she has and any complications that may occur during the pregnancy or delivery. 

A recent report from the Kaiser Family Foundation (KFF) found that even the most seamless pregnancy, birth and postpartum period cost more than many families with insurance can afford. 

On average, the price of pregnancy, childbirth and postpartum care comes to nearly $19,000. Hospital childbirth costs have increased nearly fourfold since 2000. The average out-of-pocket payments reach almost $3,000 for women enrolled in large group plans. Yet another KFF study from just a few months earlier found that 45 percent of single-person, non-elderly households could not afford more than $2,000 in out-of-pocket medical expenses. Among multiperson homes, almost a third did not have enough money to pay for the out-of-pocket costs of pregnancy and childbirth.

If pregnancy is too expensive for so many who do have insurance, what of the women and families without pregnancy coverage or any insurance at all? In a country where the spending on healthcare is rising faster than anywhere else in the world, pregnancy can quickly become a financially catastrophic event.

These data points only capture some of the economic consequences of pregnancy and childbirth. There are other severe burdens to consider. Some argue that the strain on a woman’s body that pregnancy entails would, in any other circumstance, be classified as a serious chronic illness. Because beyond the weight gain, swollen limbs and nausea, pregnancy can lead to serious, sometimes long-term, health issues for women and their babies. These include gestational diabetes, preeclampsia, postpartum depression and health problems for children. Treating these conditions can be costly and lengthy. In fact, according to a 2021 report from Mathematica and the Commonwealth Fund, the societal cost of maternal morbidity, from conception to age 5, is $32.3 billion. 

That number, which the report notes is likely an underestimate, includes medical and nonmedical costs such as lost economic productivity and increased use of social services, assuming they even exist as they do not in many states. Seventy-four percent of these costs are the result of outcomes for children such as premature birth, developmental disorders and respiratory distress, which increase as income levels decrease. 

Once women recover from their pregnancy and childbirth, they must manage the ongoing, and increasing, expenses of childcare. According to a 2021 report from the Center for American Progress, the average monthly cost for infant care in a licensed childcare center was just over $1,300. That’s nearly $16,000 per year. Depending on where you live, however, some Americans pay more than twice that annually for high-quality center-based infant care. According to data from the U.S. Department of Agriculture (USDA), a child born in 2015 to a middle-income family costs approximately $12,980 to $13,900 annually (depending on the age of the child). Inflation adjustments boost those costs by 23 percent in 2022, ranging from $16,007 to $17,141 — increasing the average cost to raise a child to 18 years of age from 233,610 to between $288,126 and $308,538 

And yet, in America, there is no law requiring paid leave for parents, let alone paid maternity leave. As an industrialized nation, the U.S. is an outlier in this regard. In fact,  it is just one of six countries in the world, and the only wealthy one, with no national paid leave. There is very limited federal support (tax-related and not available to all) for childcare, despite costs becoming harder and harder for families to cover. And 28 million people still go without any form of health insurance at all. In this country, pregnant women and their families are basically left to fend for themselves, even though with the reversal of Roe, many are now also forced to carry a pregnancy to term whether they are prepared to care for the resulting child or not. 

Without significant societal support that families need to raise healthy children, overturning Roe will have severe ramifications for our nation, including increased morbidity and mortality for women and babies and skyrocketing costs for everyone. Congress therefore must act immediately to require paid family and paid maternity leave, affordable and accessible childcare and full coverage for prenatal and postpartum care for every American woman of childbearing age. It is the only way forward into our dangerous post-Roe future.

Martha Nolan is senior policy advisor at HealthyWomen, a nonprofit that educates women to make decisions about their health care.