Universal Basic Income and Birth Outcomes: a reflection
by Charlene Hamilton
Recently, I held a free online lecture on two subjects dear to my heart: childbirth; and unconditional, universal Basic Income. I’ve become a fierce advocate for Basic Income, seeing it as one of the key tools to creating lasting systemic change in our society, and by extension, having a profound impact on birth in our culture. You can view that video here.
What is Basic Income?
Basic Income is the based on the idea that one of the benefits of being a citizen of a wealthy, technologically advanced country is that everyone has a right to share in that wealth, regardless of their employment status. This sharing would happen through a monthly dividend distributed unconditionally and universally; that is without means-testing or income caps, to everyone.
On a more fundamental level, it is the belief that freedom from suffering is a human right, and we have a moral obligation to eliminate suffering. It sees participating in paid employment as something that should be voluntary, not compulsory for survival; and that we have the technology and resources to eliminate survival-level employment. It says that human value and dignity does not come from “jobs”, it comes from doing things that feed our souls- whether that’s chosen paid employment, volunteering, civil engagement, or any other human activity.
In essence, it creates a stable, guaranteed financial foundation with a monthly payment of $X (often cited as $1000-2000 USD) for people to build upwards on. This is insead of our existing system that starts everyone at $0 and then demands that people sell their labor to others to exist; all while hoping that a poorly designed “safety net” catches them if they fall below $0. Costs for the program are recouped through a number of different potential avenues (quite beyond the scope of this article!).
How can Basic Income help improve birth outcomes?
Let’s start with the obvious: financial stability improves health.
It’s a well-known fact that if you aren’t worried about meeting your basic needs, your physical and mental health improves. We’ve known it since Maslow first introduced his “Hierarchy of Needs”[1], and research time and again shows that stress and ill health go hand in hand. One of the simplest, most impactful ways we can increase people’s overall well being is by creating guaranteed financial stability[2] that isn’t based on participation in paid employment.
For families expecting a baby, the pressures of increased time, energy and resource needs can contribute to the overall progression and outcome of the pregnancy. Financial stability eases some of that burden, and decreases stress levels.
This access to financial stability is especially important in relationships where domestic abuse is present- financial control is one of the key weapons in an abuser’s arsenal[3]. Those of us who have worked with expectant domestic abuse victims, know how much of a chain that financial control can be, and how difficult abusive situations can make pregnancy and birth. A Basic Income attached to the individual, that moves with the individual, would allow more people to leave harmful relationships, and that would not only improve physical and mental health, it would literally save lives.
Then there’s the fact that a guaranteed financial foundation may allow for increased employment freedom.
Given how pregnancy is often seen as a liability in our modern capitalism-driven culture, pregnant employees often find themselves hiding their pregnancy as long as they can, or wrestling with how much leave they can “afford” to take. Even with legal protections in place, pregnant workers still face discrimination.[4] The Pregnant Worker’s Fairness Act[5], which would close many loopholes in the Pregnancy Discrimination Act of 1978, has been kicking around the Unites States congress since 2012, and passed the House in 2022, making pregnant worker rights a federal mandate.
An unconditional, universal Basic Income would give pregnant employees more flexibility and freedom to stand up for those rights. They could push back on exploitative workplaces or join unions, because they would know that even if they were fired they would have a safety net already in place. They could leave the workplace completely to be home after the birth and through the early years, knowing there was a financial floor under their feet. Or they could choose to leave a job that refused to support and accommodate their pregnancy to pursue employment with actual, meaningful benefits.
A Basic Income helps put power in the hands of the people seeking employment. Employers would have to start courting all levels of employees- they can’t treat them as disposable resources. This means better pay rates, and better benefits packages; and better benefits often includes better pre- and post-natal care.
But even with employer-offered benefits, financial stability increases consumer choice in birth.
Right now, most birthing families are restricted by their insurance in their choice of pregnancy care provider and birth location. They may do some research, but very often their research is bound by “How much can we afford, and what and who will my insurance cover?” Even if they desire midwifery care, or an out-of-hospital birth, it may not be a financially viable option
A Basic Income creates “wiggle room” in your monthly budget, which would increase financial access to services like choosing your birth place and provider, choosing an out-of-hospital birth with trained professional midwives, having continuous support from a doula at the birth, or a postpartum doula for help in those first 100 days. You have the ability to take classes that may not be covered by insurance, or to access allied care providers like lactation consultants or pregnancy-focused massage therapists. These services become normalized when more people have the resources to choose them, instead of being seen as “trendy” or a “luxury.”
Even more importantly, financial security increases access to services for at-risk populations. A wealth of data shows that comprehensive childbirth education & doula care increases positive birth outcomes, maternal health and maternal well-being. We clearly know the impact of choosing a birth place and provider based on individual needs and choice, be it going to a provider or with a lower cesarean rate, or choosing a midwife and out of hospital birth.
There are many organizations trying to bring these services to communities our system overlooks, but those are certainly not filling the entire need. The presence of a Basic Income in people’s lives would allow more families to have the option of a doula at their birth, or take a childbirth education class, or choose a different OBGYN, or an out-of-hospital birth with a midwife. It would also allow those agencies working with traditionally marginalized and oppressed communities more flexibility and focus in meeting needs, because there would be a layer of systemic poverty mitigation that didn’t previously exist.
It works on the provider side, too; financial baselines allow more people to choose service-oriented work.
The programs that train people to be doulas, childbirth educators or midwives are often time-consuming and expensive, without access to traditional education funding. Working in these professions almost always requires self-employment, meaning the people going into these fields are the ones who have disposable income. In many communities the independent birthworker demographic skews heavily white, because training opportunities have been out of reach for other populations.[6] While this is beginning to shift[7], there is still much to be done, and a Basic Income could be part of that work.
With a Basic Income, opportunities for people to seek out birth-related education and work in these service-focused fields increases. Seeking out avenues of non-traditional education would carry less financial risk, because there’s a guaranteed financial floor supporting you. It would make these professions much more accessible to everyone, and it would allow for the development of more community-based programs of education, training, or apprenticeship.
Basic Income would also have the added benefit of making these services more affordable to the consumer overall: if you’re not worried about having to “make ends meet,” you have more control over how many births you attend, how much you charge per birth, and what your time and energy commitment can be.
To sum up, here’s how Basic Income supports better birth:
Overall maternal health increases with financial stability & access to maternal care.
People have greater flexibility in choosing birth provider and location.
More people 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 people accessing quality, proven health care.
People with access to comprehensive pregnancy care, education, labor support & postpartum support will have better birth outcomes overall.
Obviously, there’s much more to the discussion about an unconditional, universal Basic Income than presented here. It is not a magic wand that will sprinkle fairy dust and reduce all poverty and suffering, or bring the USA’s maternal and infant mortality rates into line with the rest of the “developed” nations. Only focused and determined systemic change will do that. But a Basic Income is one step in moving forward into that systemic change. I encourage anyone who is interested in the subject to explore some of these resources:
It is important to note that there are many legitimate criticisms of Maslow’s work, not the least of which was his racism and ableism. But as a basic understanding of human needs, it inspired deeper work by others.
https://www.fcnl.org/updates/2022-02/your-job-or-your-pregnancy-pregnant-workers-need-protections
https://www.nationalpartnership.org/our-work/economic-justice/pregnant-workers-fairness-act.html
https://www.doulasurveywa.org/demographics-of-doula-workforce
The opinions expressed in this piece belong to the author, and do not necessarily reflect the opinions held by Birthing from Within as a company.