Weighing the Cost of Reproductive Choices as a Person with a Uterus

At the risk of TMI, we're going to look at the cost of reproductive choices. Strap in, kids. It's about to get real.

Back in March, after fighting with insurance companies and healthcare providers for three years over whether I was an adult who knew enough to make my own reproductive choices, I finally had an ablation and got my tubes tied.

One of the things we don't talk about as much as we should is how we weigh the cost of reproductive choices.

I can tell you how I weighed mine. That procedure led to a bill of more than $5,000. But to me, it was worth every penny.

First of All — Insurance

I'm old enough to remember when insurance didn't have to cover birth control. I remember paying almost $100 per month for birth control after my son was born. For a young couple thinking about grad school, that $100 a month was tough to swallow. But my then-husband and I knew it was the right choice for us.

Today, the Affordable Care Act mandates insurance coverage for contraception, with a few exceptions. As a result, women with access to insurance also have access to contraception.

Not everyone has access to insurance, though, and healthcare costs only go up. I had an insurance gap of one month last year. Today, the same birth control that cost about $100 per month 16 years ago costs $286 per month.

Luckily, the way I used to manage my birth control, I could wait a week (and for my new coverage to kick in). Even if I didn't have that option, though, I can now afford $286 per month. It wouldn't be fun, but it would be doable.

In a world where wages in the last 16 years sure as hell haven't kept up with the cost of contraception for most people, it's easy to see why it can be tough for some women to afford birth control — especially if they don't have health insurance.

Do You Trust These Clowns to Protect Your Reproductive Rights?

While the cost of insurance — and the cost of contraception without it — are definitely things to consider, that's not all we have to worry about.

There are other things to consider when looking at the cost of reproductive choices, and some of those are mental and emotional as well as financial.

Since 2017, our “leaders” have been chipping away at the ACA. The penalty for not having health insurance has gone away. And there has been talk of getting rid of the requirement to cover contraception among certain policymakers.

When you look at state-level efforts to restrict reproductive rights, and when you listen to lawmakers (like those from my own state of Idaho) talk about the reproductive system, you can't do anything other than cringe.

My own ongoing battle for more permanent pregnancy prevention became fiercer in light of these attacks. I can't trust these asshats to actually protect my reproductive freedom — many of them don't even recognize my bodily autonomy.

Besides, I'm already paying $394 each month for insurance. Let's say our “representatives” decide that insurance companies no longer have to cover contraception. Are they really going to drop my insurance premium by $286 now that they're no longer covering my birth control?

Yeah, no.

I'd be stuck paying $680 each month for insurance plus birth control. Not to mention living in fear of what would happen if the contraception failed and I found myself, in my late 30s, pregnant. Where would I even go to deal with that?

I don't have to worry about it anymore and I still get stressed just doing a “What if I end up pregnant?” thought experiment.

The emotional cost of reproductive choices (or lack thereof) takes its toll.

Why My Bill was Worth the Cost

When you look at the financials, this was a definite win, especially since I can't trust the jerks in charge to respect my rights. Yeah, I paid a little more than $5,000 out of pocket (I have a high-deductible plan and an HSA), but if I were paying $680 a month for insurance plus birth control, I'd hit that amount in slightly more than seven months. Even just accounting for the extra price of birth control, at $286 per month, I'd break even in a little less than 18 months.

Is that a long time? Sure. But the peace of mind that comes with not worrying about it is priceless.

As long as these jerks are in charge, the threat of losing access to affordable reproductive healthcare is very real. In many areas, especially in certain rural areas, access to affordable reproductive healthcare is already a pipe dream.

On top of knowing that I've dodged a financial bullet, I also feel a great deal when it comes to peace of mind.

I don't have to worry about becoming pregnant at age 39. I love my son and don't regret having him. But I also know I don't want any more children. Full stop.

When I had a scare at age 37, I was a wreck for weeks afterward. I researched everything about what my options would have been. And in Idaho, they were pretty damn scarce — and expensive.

Insurance wouldn't have covered any of it. There are requirements for a certain number of visits and procedures here. While I would have been able to afford to do anything related to my reproductive health, including giving birth, many women can't.

Even knowing that I could have financially afforded any option didn't allay my fears. So, even if I never break even on this procedure, it was worth every penny just for the peace of mind that came with it.

What Society is Willing to Pay For (Hint: It's NOT Birth Control)

There was a time when I couldn't afford reproductive health. However, society was willing to bear the cost. After my son was conceived, I had no problem getting on Medicaid in Utah. However, at the time, Medicaid wouldn't have covered the cost of contraception — even though it would have been less expensive.

Our society doesn't see those traditionally identified as women as fully autonomous humans. We expect them to make babies endlessly until they can't. And politicians and policymakers are open to the idea of paying for it (well, as long as those women are, ahem, certain types of women).

But heaven forbid someone with a uterus expresses a desire to avoid incubating tiny humans in their body.

My own journey to having an ablation and tubal ligation was fraught with frustration. Originally, my healthcare provider in this area didn't even want to discuss it with me, insisting I was still healthy and fertile.

Despite being in my late 30s, parenting a teenager, being divorced, and expressing zero desire to ever marry again, she insisted that I shouldn't take such a drastic step. “What if you meet a new man and love him enough that you want to give him a baby? You'll regret having this done.”

Lady, there isn't enough love in the world for me to want to start all over again with an infant.

Not only that, but several healthcare providers that I talked to told me how difficult it would be to convince an insurance company to cover the cost of some parts of the procedure. They would need a “valid” reason for me to make this lifestyle choice.

That's right. The belief that people with uteruses are baby-makers before anything else is so strongly ingrained in our society that it's the default — even if it costs more money than contraception and comprehensive sex education.

Bottom Line

There's nothing wrong with wanting and having children. I admire people who enjoy making parenthood their primary role. That's their choice.

But why is it so difficult for those who want to make a different choice to do so — and do so affordably?

The cost of reproductive choices is something we don't talk much about. When we do, we barely talk about the fact that someone choosing not to have children is saving themselves a lot of money.

Choosing a permanent form of contraception is more cost-efficient for our for-profit insurance companies, yet it's so difficult to get healthcare providers and insurers to approve it.

We're told we're supposed to keep having babies, but if our current crop of “leaders” continues dismantling the ACA, we could go back to a time when maternity coverage costs more than other coverage.

That's right. No matter how this goes, people with uteruses are expected to bear the brunt of just about any cost associated with reproduction — and we're given fewer choices about how to manage our reproductive health.

There's something very, very wrong with that.