Despite all the contraceptive products you see when you walk down the aisles at CVS, “family planning” means more than avoiding pregnancy. It also includes having the power to have children when you want them. Sadly, the way we run our healthcare system puts way too much emphasis on not getting pregnant and leaves women in the dust when it comes to helping them conceive a family.
In vitro fertilization, one of the most common ways to deal with infertility, costs an average of $12,400 — per cycle. Carrying that through to live birth can cost over $100,000. This is the primary option for couples who seek children of their own, though the costs for adoption are by no means cheap: domestic adoption costs average about $30,000.
There is very little state assistance for those who wish to explore these options. Fifteen states have passed laws that require insurers to either cover or offer coverage for “infertility diagnosis and treatment.” Three — California, Louisiana and New York — explicitly exclude coverage for IVF. Many of the maximum costs cover one round of IVF at most, and a plethora of regulations and conditions apply in each case.
And those are just the commonly legal options. In Michigan, where I call home, surrogacy contracts are illegal; those who enter willingly into a surrogacy contract are subject to a fine of up to $50,000. This obviously does nothing to attract the LGBT community to Michigan, as gay men have exactly zero options to start a family.
In contrast, birth control is widely supported under the Affordable Care Act. It mandates that insurance pay for all FDA-approved methods of birth control, which includes an exhaustive laundry list of options, ranging from male and female condoms to sterilization surgeries to “family planning education and counseling.” And there is still that $9 per month option at Walmart.
That one can get extensive state and federal aid to avoid childbirth yet no assistance and sometimes deterrence to bearing children smacks of hypocrisy. It demonstrates our misplaced values and ignored incentives.
Wouldn’t it be better if the government stayed neutral in family planning?
While government currently encourages women to be focused on their career and crush that alleged pay gap in their youth, they are stony-faced to the consequences of putting off childbirth. The government’s priorities no doubt incentivize women to choose family while they are young because they won’t be able to afford it later on — something that contributes to that pesky glass ceiling we’re always talking about.
This system of perverted incentives takes an even worse toll on less educated women and bars their social mobility. As Megan McArdle wrote in her “marry young” piece for The Daily Beast,
… [l]ess educated women who will never have the money for five rounds of IVF aren’t running that risk; instead, they’re choosing an even bigger risk: having a child before they’re in a stable relationship. Fifty-eight percent of first births to those women now take place outside of marriage. And while the father is usually around at the birth, within five years, a substantial fraction of those relationships will have broken up.
I do not advocate for special-favor subsidies and individual mandates for women’s health care. Those policy solutions keep family planning — all of it — more expensive. I advocate for government neutrality. Stop messing around with incentives that laws cannot possibly predict or control. That way, more people can get what they want and do some real family planning.