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Walk the room with me

That's how blind we are, even to our own self-interest.

DR. YAMICIA CONNOR, MD, PHD, MPH

This is week 6 of the Economic Body.

This week we're going to be talking about the one policy we should all agree on, and why we keep failing women.

We have spent the last five weeks talking about how economic decisions manifest as consequences on the pregnant body: hemorrhage, preterm delivery, a preventable death. These economic decisions include expired subsidies, eviction filings, a childcare desert, accounts where he controls all the finances. Things we usually think about separately from medicine. That has been the consistent argument of The Economic Body. But for our final series of sends, we're going to make a different one.

It involves what I think is the most perplexing thing about obstetrical care in this country. In a country that cannot agree on a single other subject, the care of pregnant women and their infants is a place where you would expect to see alignment. Not because of shared values. I'll be the first one to say that many of these parties don't share them. But because each party's interests point in the same direction. Very few questions in public health behave this way. That's why it is so perplexing, almost mind-boggling, that we are botching it anyway. That's going to be the subject of these next several sends. I want to put this puzzle in front of you.

Walk the room with me.

Take the parents. I think about it as an OB, but also as a mother, because I understand both perspectives. One is the immediate fear for the child in front of you: for their life, for their safety, for their well-being. The next is, what is going to be the rest of their life? In a second, your life has fundamentally changed forever. I don't think people recognize it. That, to me, is the scariest thing. The stakes are so much bigger, and people just have no idea.

For a child that has significant needs, somebody in that household has to dedicate their life to that kid. Full stop. Otherwise it doesn't work. Otherwise that child is going to be neglected. And that often is the mother. Mothers do this out of love, out of social expectations, for a lot of reasons. That is two lives fundamentally shifting. There's another layer of tragedy in the mother's loss: her hopes, her dreams, her career, anything she might have wanted for herself. In addition to the fear for the baby's safety and the baby's health. Not to mention the financial strain it puts on the family itself, and the strain it puts on the other children, who will, by definition, get less attention. And all of that happens so quickly.

What is so egregious is that this is a country that forces births on people and provides no resources for it. And the decisions aren't neutral. If you can prevent a preterm birth, especially a very, very early preterm birth, the ripple effects on that specific family and on society are hard to even fully articulate in words.

Now take the person who says he cares about none of that: the fiscal conservative who doesn't want to spend one dollar he doesn't have to. He is supposed to be my hardest audience. He is my easiest, because the numbers he lives by are the ones making my case. Prevention up front is cheap; the catastrophe downstream is not. Carry one delivery that would have come before twenty-six weeks all the way to term, and you have saved more than two hundred thousand dollars, in that one case alone. A few thousand dollars of prenatal care and stable rent, against a six-figure hospitalization and the lifetime behind it — that is not a close call, it is arithmetic. That's why I didn't say just prenatal care: stable rent, and the things that that enables. The man who refuses to fund the cheap thing is choosing the expensive bill on purpose and calling it thrift.

Prevention up front is cheap. The catastrophe downstream is not.

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It's undeniable that the fiscal conservative would be better off if we had better prenatal care for women. They would actually save money, and yet we choose not to do it. That's how blind we are, even to our own self-interest.

Community Tour · Signal $133B

I want to come back to the fiscal conservative, because it's important to understand this at the scale of a country, instead of one delivery. We need to think of these refusals not just by the effect they have on individuals and families, but by the effect they have on all of us. That refusal to fund the cheap thing has now become a drag on the whole economy that they themselves lament. Their indifference, or even worse, their cruelty, shows up as a bill we all have to pay, not just as a bill in one family's mailbox.

Restrictions across 16 states impose a $133 billion drag on the U.S. economy and hold 556,042 women out of the workforce. Eight of the ten lowest-GDP-per-capita states have bans.

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Prevention saves taxpayers money

This video states the fiscal conservative's own logic in ninety seconds: we already pay for the injury. The only choice we really have left is whether we pay for it before it happens or after.

We pay for the injury instead of preventing it.

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WHAT YOU ARE A PART OF · 14

When I chose OB/GYN as an MD/PhD, the response was almost uniform: I was wasting the credentials. Go to oncology. Go to cardiology. Pick something serious. Women's health was the soft specialty. Too narrow, too underfunded, too thinly studied to deserve the training I had.

That response is the diagnosis. Narrow? Women's health is the foundation of public health, family health, and global stability. It looks small because it has been kept small, by a century of exclusion, underfunding, and clinical incuriosity. The reason it looks soft is that the people most often harmed by it have been taught to absorb the harm quietly.

I went into it because that's where the work was. What I found was worse than I expected.

NEXT

Next, we'll be showing the twin study that proves this isn't just poverty talking, and the cost we all pay for waiting.

Thank you for being here. Forward this to one person who needs the spine.

— YC
Dr. Yamicia Connor, MD, PhD, MPH · Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective

A Labora Collective Publication — part of the Diosa Ara ecosystem