Why are birth rates declining in the US?

There have been a lot of headlines about birth recently. Media outlets at the local, state and national level are reporting on the declining birth rate in America after a new report from the CDC, and, at the same time, a new study published in the journal Health Affairs, shows the out-of-pocket cost of giving birth in America has gone up significantly in the past few decades.

The CDC report doesn’t explain why birth rates are declining, and there are clearly multiple factors influencing the trend, but we cannot ignore how much it costs to give birth. For most women, the co-pay is more than a month’s salary.

In America, 98% of mothers with an employer-sponsored health care plan can still expect to pay out-of-pocket for birth costs. The average cost is $4,500, while the average American woman’s monthly salary is $3,300, according to the Bureau of Labor Statistics.

The Affordable Care Act requires big employer-based health plans to cover maternity care, but a mother who has health insurance through work can still expect to pay more than a month’s worth of salary to have a baby.

“These are not small co-pays. The costs are staggering,” says Dr. Michelle Moniz, M.D.,M.Sc., an obstetrician-gynecologist at Michigan Medicine’s Von Voigtlander Women’s Hospital and researcher with the U-M Institute of Healthcare Policy and Innovation.

As the lead author of the study, Moniz was surprised to see that most women who have an employer-sponsored health care plan are still paying thousands of dollars to give birth. She wants to see policymakers consider alternatives to the current system. “Maternity and childbirth care are essential health services that promote the well-being of families across our country. Reducing patients’ costs for these high-value services makes sense. We all want babies to have the best possible start in life,” Moniz explained in a university release.

Moniz worries that rising costs for maternal health care are not only burdening families but also pushing mothers to limit or skip prenatal care.

What’s behind declining birth rates?

Health care costs for families are growing

Even for those who have uncomplicated births and health insurance at work, giving birth in America is expensive. And taking care of that baby’s health (as well as mama’s) doesn’t get cheaper. In 2018, the average American family spent $5,000 per person on health care. If you’re a two-parent family with two kids you’re looking at $20,000. Costs are reduced for those with employer-based health care, but parents are still paying $6,015 in out-of-pocket expenses, CNBC reports.

“There is growing evidence that cost protections have eroded for those who have employer-sponsored health coverage, putting the burden of health care costs on workers and their families,” David Blumenthal, president of the health care policy foundation The Commonwealth Fund, tells CNBC.

Having a baby is especially costly

To replace the population, American families need to have 2.10 kids, but the average is now at 1.73. The birth rate for women under 34 is falling, while rates for women over 35 are increasing.

Concerns over climate change are a factor for some who choose to have fewer or no children, but for many people, having a baby (especially before 35) just isn’t financially feasible. Millennials have more student debt than previous generations but make about the same as the young adults of Gen X were making in 2001. Salaries have not kept up with the cost of living, and millennials are more likely than older people to have a second job in the gig economy.

“Millennials are more risk averse than earlier generations at the same age. People 50 or even 25 years ago didn’t wait to be ‘financially well established’ before starting a family. Now it’s considered irresponsible not to,” Richard Jackson, the president of the Global Aging Institute, told Axios last year.

Diane Mulcahy is the author of The Gig Economy and an adjunct lecturer at Babson College. She tells Bankrate that, when she speaks with millennials, they point to two factors that make them feel insecure financially:

“One is that they’re very aware there’s no job security, so they’re the least likely generation to kind of settle into a full-time job and assume that everything’s going to be OK,” Mulcahy explains. “The other reason is clearly economic. Most millennials—at least on the professional end who have been to college—have significant debt and a lot of them are looking for ways to either build a financial cushion or reduce their debt faster.”

Josie Kalipeni, the policy director of the caregiving advocacy organization Caring Across Generations, tells The Atlantic a similar story, adding that soaring childcare costs are another factor pushing down on a generation of would-be parents. “Economic instability and unaffordable care could be factors for people deciding to have children later in life, or not at all,” Kalipeni explains.

Employer-based health care needs improvement, but so does employment in general

When millennials do find full-time employment, it often isn’t conducive to raising kids. According to Motherly research, birth rates are down because the current status for many working Americans—inflexible schedules, long work hours and a lack of legislated parental leave—is prompting people to reevaluate their family plans.

The United States is the only member country of the Organization for Economic Cooperation and Development (OECD) without a national paid leave program for parents, and that’s one of the reasons why America’s moms are among the most stressed in the world.

Put simply, today’s mothers do not feel society supports them, and that makes supporting a family so much harder.

We do love being mothers, regardless of how challenging it is

The truth is, it is hard and expensive to be a parent in America, but so many are still trying.

This generation is not having as many kids as previous generations did, but it is putting so much love into the ones it does have. While 88% of parents say it’s harder for us than it was for our parents, 99% of us really love being parents.

We want this, we want it so much. But if society wants to reverse declining birth rates, the costs have to go down.

We have to figure out how to reduce the costs to the planet, the time spent in cubicles and commutes and the cost of healthcare. When a co-pay for birth costs a mama a month of her salary (or worse, means going into debt), we can’t be surprised when fewer people are giving birth.

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