Wait, what? How could having a Universal Basic Income make for better births? The USA is a first world country, childbirth is no big deal here, right?
Sadly, no. In fact, the USA’s track record when it comes to maternal health is pretty atrocious when compared to other ‘first world countries’. Our Maternal Mortality rate is 26.4 women per 100,000 live births. That’s double what is was 25 years ago. Canada’s MMR is 12. The UK’s is 12. Australia’s is 7. Japan’s is 5. Slovakia, Lithuania and Czechia have better rates than we do. So does Iraq.
And the usual arguments of “Women are fatter, women are older, women are more unhealthy…” don’t always hold up statistically. Women of colour are four times more likely to die in childbirth- even if they aren’t poor. Despite spending more money than any other country in the world on maternal health, women die in childbirth here in alarming numbers. 1 in 3 women give birth via major abdominal surgery. Hospital protocols for recognizing critical complications, like hemorrhage, pre-eclampsia (severe high blood pressure) and infection, post-birth are inconsistent.
Maternity care itself is inaccessible and unavailable to many women, because we don’t have single-payer health care. That doesn’t even factor in that we’re one of only 4 industrialized countries that don’t mandate paid maternity leave. (The other three being Swaziland, Papua New Guinea, and Lesotho. I had to go look up Lesotho- it’s a country in southern Africa, population 2.4 million)
If you want to deep dive into these numbers, I highly recommend Birth By The Numbers, they do a wonderful job of examining all the issues, and what all these numbers are actually telling us. I also suggest NPR’s Lost Mothers series, which examines the rising Maternal Mortality Rate in the USA.
But back to Basic Income- how can that help improve birth outcomes?
Let’s start with the obvious- financial stability improves health. It’s a proven fact that if you aren’t worried about meeting your basic needs, your physical and mental health improves. And this is true for middle-income families, as well as the poor.
Then there’s that a guaranteed financial foundation allows for employment freedom. If you have a guaranteed financial baseline, and you aren’t working for survival, you have more flexibility and freedom to pursue employment with actual, meaningful benefits. Employers have to start courting all levels of employees- they can’t treat them as disposable resources. Better benefits often come with more comprehensive maternity care plans.
But even with benefits, financial stability increases consumer choice. Right now, most women are restricted in their choice of maternity care provider and birth location, by who and where their insurance company says they can. In rural areas, this is even more acute. You can “plan” a low-intervention, non surgical birth all you want- but if your insurance will pay for the Doctor with the 23% induction rate, and the hospital with a 27% cesarean rate, your odds of having a physiologically normal birth are lower, no matter what you do. Having “wiggle room” in your monthly budget increases your ability to access services like out-of-hospital birth with trained professional midwives, or having continuous support from a trained professional in labor (a doula), or taking a comprehensive childbirth education class.
Even more importantly, financial security increases access to services for at-risk populations. Despite a wealth of data showing that comprehensive childbirth education & doula care increases positive birth outcomes, maternal health & maternal well-being, these services are not usually covered by insurance plans. Which means that they fall into the category of ‘luxury’, and the women accessing these services are primarily affluent and white. There are many organizations trying to bring these services to at-risk women, women of colour and other populations who would benefit, but those are certainly not filling the need. A stable financial baseline would allow more women to have a doula at their birth, and take a childbirth education class.
It works on the provider side, too; financial baselines allow more women to choose service-oriented work. Because the programs that train women to be doulas, childbirth educators or midwives are often time-consuming and expensive programs, and working in these professions almost always requires self-employment, there are few women going into these fields; even if they want to. And, again, women of colour are vastly underrepresented- most women in the field are white women, with a spouse providing the primary income. If there was a basic income, it would open up opporotunities for women to seek out education, and go into these service-focused fields, without putting their family income at risk. It could have the added benefit of making these services more affordable overall, because providers aren’t trying to ‘make ends meet.’
To sum up, here’s how Basic Income supports better birth:
- Overall maternal health increases with financial stability & access to maternal care
- Women have greater flexibility in choosing birth provider and location
- More women are able to go into birth-service related work, increasing the number of doulas, midwives, childbirth educators, lactation consultants, etc.
- More providers + financial flexibility = more women accessing quality, proven health care.
- Women with access to comprehensive maternity care, education, labor support & postpartum support will have better birth outcomes overall.