The fertility conversation we're not having
and a new bipartisan bill to fully cover childbirth in America
Hi everyone,
Short-ish newsletter today, with two stories to share —
The first is about a new bipartisan bill that would require private health insurers to fully cover the cost of childbirth with no co-pays or deductibles. That includes prenatal, childbirth, and postpartum care up to a year after birth.
Right now, the average out-of-pocket cost for giving birth under private insurance in the U.S. is nearly $3,000, with some families having to pay tens of thousands of dollars more for unexpected out-of-network costs, NICU stays, birth complications, hidden hospital fees, and more. It’s a notoriously stressful burden and eliminating all those costs would be a very big deal. The legislation has a pretty unusual origin story, and is backed by an even more unusual alliance of organizations.
You can read my story here, and I talk about the reporting on the Apple News Today podcast.
In the second piece, I argue that our society could do a lot more to support early parenthood for those who want that, and if we're serious about reproductive choice, then we shouldn't ignore it.
As an excerpt…
Everyone should have the right to decide if and when they have children. Yet over the past 50 years, the United States has built an economy that increasingly works against fertility — demanding more years in school and longer hours at work for people, especially women, in the years when it is biologically easiest for them to have children, and concentrating wealth and income among those past their reproductive prime.
As a result, American schools and workplaces are particularly ill-suited for supporting those who hope to start families earlier than average.
“If I were to complain about how society ‘has wronged me as a woman,’ it would be that it has treated my limited ‘fertility time’ with extreme disregard,” wrote
, a genomics PhD student, recently on Substack. “At each step of the way I was encouraged to ‘be patient,’ do more training, told that ‘things will figure themselves out,’ even when I wanted and could have speedrun through things.”The average age of a new mom is now 27.5, up from age 21 in 1970. I had no interest in having kids in my early twenties, but there are certainly reasons others might want that: Fertility decreases with age, and some find it easier to keep up with young children when they themselves are younger and have more energy. Others hope for larger families so may need to start conceiving earlier, or may prioritize making sure their own parents have many years to spend with grandkids/
Of course, discussing reproductive timelines is fraught. Having others invoke the fact that women experience a decline in fertility with age feels intrusive and insensitive. And the conversation is even trickier today, when anti-abortion activists are pushing a conservative pro-baby agenda from the highest echelons of government and the Heritage Foundation is putting out literature blaming falling birth rates on too many people going to graduate school. (The evidence for that is very weak.)
Yet it’s precisely in such moments that progressive leaders should offer clear alternatives that both respect women’s autonomy and ensure people can make less constrained choices.
You can read the full piece here.
That’s all for now. I’m getting married this weekend! Very happy about this, and you’ll be hearing from me next time as Rachel Cohen Booth 🙂