President Donald Trump has announced that he will support a $5,000 baby bonus to help persuade people to have more children.
Anu Sharma, founder and CEO of Millie, a California-based tech-enabled maternity clinic, sat down with MobiHealthNews to discuss the practicality of such a proposal and what needs to be done before the government attempts to incentivize childbirth.
MobiHealthNews: In your experience, what has been the reaction to the Trump administration’s proposal to give a $5,000 baby bonus to promote another baby boom?
Anu Sharma: The reaction was you honestly don’t get it. When you look at the state of parenting and birth rates, I think the basic issue is that it is really hard to be a parent. You do not really have access to affordable child care and paid family leave.
From a clinical standpoint, the maternal health model is pretty broken. From a practice standpoint, the reimbursement rates for OB practices are ridiculously low. There is physician burnout. Many practices have actually shifted away from providing obstetric care.
A $5,000 baby bonus does not anywhere come close to the reality of what parents need to be able to afford babies and pay for child care. If, by any miracle, we saw some level of success with this bonus actually having more babies in America, I don’t think we have the practice infrastructure from a health system standpoint to be able to support it.
MHN: Is there a realistic dollar figure that would make sense to encourage women to have more children?
Sharma: I don’t know if that is a legitimate question. There is a very large population of people who would like to have children but, for whatever reason, are not doing that.
One part of it is that women are finding partners later in life where their own fertility is not quite where it needs to be when they are ready to have children. It is expensive, and it is not universally covered. There is a certain group of people when they desire to have children they are at a point where they can, but it is not always achievable.
That is one side, the other side is, even if it is achievable it is not necessarily affordable. What families are struggling with is, how do we make parenting in America easier and how do we make it more possible for practices and care providers to also thrive?
I don’t know if a $5,000 baby bonus is necessarily going to solve the problem of people not being able to afford fertility care at the point where they are ready to have families. I don’t know if it resolves the affordability issue for people.
MHN: You’ve mentioned that women are less likely to start a family due to a rise in U.S. mortality rates. How severe are maternal mortality rates?
Sharma: Maternal mortality rates in the U.S. are pretty high compared to our peer nations. Within peer countries, U.S. maternal mortality rates are the highest. It is not just maternal mortality rates; it is also morbidity rates. That speaks to the near misses.
They could happen for a variety of reasons. Postpartum preeclampsia is a big one.
The healthcare system basically stops. You deliver the baby. You go home, and they say come back in six weeks.
There is a fair number of near misses that happen – that number has hovered around 50,000 a year. It is not quite a mortality number but is a near mortality number.
When you look at preterm birth rates, NICU stay rates, C-section rates, anxiety and depression, postpartum depression, none of it is good.
MHH: Why do you think the country’s maternal care system is outdated?
Sharma: If you look at France, Germany, UK, the Nordic countries, Canada, frontline care for low- to moderate-risk pregnancies is typically provided by midwives.
Here in the U.S., we don’t have [as many] midwives. It is an emerging concept.
Everyone gets OB-led care. OB’s are in short supply. They cost twice as much as midwives do, but also they are trained differently. They are really the people you want if you are having some need for interventional care or a high-risk pregnancy.
You end up seeing much higher rates of intervention, which shows up in our C-section members, when low- to moderate-risk pregnancies are cared for by a different kind of provider.
We also have a fairly incomplete model. When you look at the data, the way we do prenatal care is a handful of visits. They are broken up into trimesters; they happen at pre-specified intervals along the way. When things happen in pregnancies, 50% of maternal deaths happen after the baby is born in the first year of life, with a high concentration in that first six-week window.
A third of [maternal deaths] happen during pregnancy between visits, which makes labor and delivery the safest part of the episode, which is shocking at some level. The episodic, discontinuous one-size-fits-all approach that [the U.S.] has just doesn’t cut it when you superimpose that with what people actually need.
There are entire chunks that are missing altogether, things like nutritional support, mental health support, lactation support, basic education on breastfeeding, basic education on childhood education; none of these things are part of the model at all.
It is pretty broken, supported by a dwindling supply of OB practices that are under severe financial stress and are closing, so the care that we do have is also disappearing.
That is the larger context and backdrop in which we are talking about creating a baby boom and expanding baby bonuses.
That is a terrible idea, and it does not compute with the reality of why people do not have children.
MHN: What should the government do to incentivize childbirth?
Sharma: When you look at the big picture, our birth rates have been declining for a long time; it is not a new phenomenon.
Some of that has to do with higher education rates for women, higher rates of women in the workforce, people living longer and prioritizing different things.
A declining birthrate is not something we should be alarmed by.
It is not the birthrate itself; it is what that means for the economy.
If we did want to increase the birthrate and expand the base of the pyramid, how do we unlock that population which wants to have children but is unable to have children because of the inability to afford fertility care or afford life as a parent?
That comes down to things like the child care infrastructure and paid family leave.
It is those things that need just as much attention, and a one-time baby bonus isn’t necessarily going to induce the people who are sitting on the sidelines to jump into the market for babies.
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