Out-of-Pocket Medical Bills from First Childbirth and Subsequent Childbearing

Yubraj Acharya, Marianne M. Hillemeier, Kristin K. Sznajder, Kristen H. Kjerulff

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Introduction: Many families in the United States struggle to pay medical debt. This study aims to investigate the association between having out-of-pocket medical bills from first childbirth sent to debt collection agencies and subsequent childbearing. Methods: As part of a large-scale birth cohort study (N = 2,169), women in Pennsylvania who delivered their first child in 2009 through 2011 were asked if any of the out-of-pocket medical expenditures resulting from the delivery were sent to debt collection agencies. Logistic regression models were used to assess the association between childbirth medical bills going to debt collections in the first year after delivery and subsequent childbearing over the following 2 years, controlling for relevant confounders, including maternal age, education, race/ethnicity, marital status, poverty level, insurance coverage, pregnancy intendedness, difficulty paying for basic needs, plans to have another child, pregnancy complications, and childbirth maternal and neonatal complications. Results: Women received out-of-pocket medical bills for as much as $32,000. Overall, 8.3% reported having medical bills from the childbirth sent to debt collections. These women were substantially less likely to have a subsequent child during the follow-up period (22.4%) compared with their counterparts, whose medical bills did not go to collections (44.4%; adjusted odds ratio, 0.60; 95% confidence interval, 0.39–0.93). Conclusions: When out-of-pocket medical bills from first childbirth are more than American families can afford to pay, they may postpone having a second child. This finding may be particularly true when childbirth medical bills are sent to debt collection agencies.

Original languageEnglish (US)
Pages (from-to)17-23
Number of pages7
JournalWomen's Health Issues
Issue number1
StatePublished - Jan 1 2021

All Science Journal Classification (ASJC) codes

  • Health(social science)
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health
  • Maternity and Midwifery


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