Catholic Social Doctrine and Family Policy: Thinking Outside the Two-Chambered Box

Rethinking Abortion Language

On June 24, 2022, the United States Supreme Court handed down one of the most momentous decisions in its history in the case of Dobbs v. Jackson Women’s Health. In Dobbs the Court overruled two of its most notorious decisions, Roe v. Wade (1973) and Planned Parenthood of Southeastern Pennsylvania v. Casey (1993). While the implications are enormous, the Court’s holding is rather simple: the Constitution of the United States does not prohibit individual states from proscribing or otherwise restricting access to abortion. “The Constitution does not prohibit the citizens of each State from regulating or prohibiting abortion,” wrote Associate Justice Samuel Alito for the 6–3 majority.

In response to Dobbs, both pro-life and pro-abortion advocates have been hard at work pressing their representatives to pass abortion-related legislation, or introducing ballot referenda. Individual states have passed laws and regulations related to abortion access, ranging from near total bans on abortion on the one hand, to protecting abortion on demand for any or no reason through term. And as the laws have been passed, new waves of litigation have arisen across the country, testing the limits of various statutes and regulations against both state constitutions and federal civil laws that might be read as having implications for abortion access. Dobbs did not end the abortion wars, but rather dispersed the battles to multiple fronts.

Important as litigation and legislative initiatives are, we must think about abortion less as a legal or political issue than as a moral one. And in prioritizing the moral case against abortion, we must rethink the language we use. Catholics cannot make the moral case against abortion if we use a language that already surrenders to the moral philosophy of the other side. We cannot make a coherent case against abortion if we endorse and use a moral language that otherwise absolutizes the rights paradigm of abortion proponents. Put simply, we must learn how to remove the abortion debate from the language of individual rights claims. If we do not do this, we will lose the moral argument. And if we lose the moral argument, we will lose the legal, regulatory, and public policy arguments, as well.

In the United States, “rights” is the word we use to signify the inherent alienation of every person from every person. Rather than communicate and encourage the natural solidarity of all human persons, rights language is born from a theory in which we are all enemies of one another. And when we use that language, even in a purported defense of unborn life, we perpetuate that anthropological (and, thus, theological) falsehood.

Applied to abortion, this has two related implications. First, by casting abortion in terms of individual rights (including the purported right of the unborn child), we perpetuate the lie that the unborn child and mother are rivals against one another, with competing claims of rights. Rather than to see the child and mother as the most intimate form of human community, we see them as the most fundamental enemies.

The second problem with casting abortion as a clash of the rights of the mother against the rights of the child is that we have no rational way to adjudicate whose claims prevail in the event of a perceived or asserted conflict. Or worse, the weight of argument favors the “right” of the mother to rid herself of the intrusive assertions of the rights of the child. When there are no adjudicating principles between competing and incompatible claims of rights, the resolution of those conflicts will fall to something else, such as individual power or mere democratic whim. Thus, even legislative victories protecting the lives of unborn children are built upon a fragile foundation, subject to collapse at the change of the political wind.

I realize that even Church documents utilize a kind of rights language. That language does not express assertions of competing rights, however, but rather the protections and immunities that are a necessary corollary of the natural dignity of the human person. But that is not what the average American means by rights, nor is it how most American Catholics understand assertions of rights. We have been raised in a moral and political story that tells us we are bearers of claims against one another as autonomous individual rights bearers.

The tension is illustrated in the most important abortion-related encyclical of Pope St. John Paul II, Evangelium Vitae. While John Paul articulates a defense of unborn life in terms of the “right” to life (understood, again, as rooted in human dignity and community, not individualist autonomy), he implicitly accounts for the danger of using the language of rights because of the way it is almost universally understood in modern liberal societies. He turns his attention to various attacks on human life in its earliest stage. Once considered crimes, these attacks now “assume the nature of ‘rights,’ to the point that the State is called upon to give them legal recognition and to make them available through the free services of health-care personnel,” John Paul laments. (Pope St. John Paul II, Evangelium Vitae, §11.) Even worse, he continues, “those attacks are carried out in the very heart of and with the complicity of the family—the family which by its nature is called to be the ‘sanctuary of life.’” (EV § 11.)

Again, when Pope John Paul uses the language of rights (in this and other encyclicals), he obviously uses that language as an expression of the necessary implications of human dignity and solidarity. And if this was the universally recognized meaning of rights, the language could be used without concern. But, as the pope himself illustrates, this is not how most people understand rights. Instead, at least in the U.S., rights are understood as competing claims of power by autonomous, isolated, and “naturally” atomistic individuals. This is why he puts “rights” in scare quotes in the passage cited above, to account for what once were considered crimes.

While I understand that it is a major undertaking, requiring a good deal of reorienting our moral language, we would do better to jettison rights language altogether, and replace it with the language of Catholic social doctrine, built upon the four-fold foundation of dignity, solidarity, subsidiarity, and common good. We can only offer a coherent and intelligible account for the protection of unborn life if we recover a moral language that begins with the dignity of all human beings as created in the image and likeness of God. Moreover, we must reiterate the natural solidarity and subsidiary nature of the human person. This implies both that we are united as participants in the same shared nature and that we are dependent upon one another as an essential aspect of our being. The moral case against abortion cannot be won using the language of individual rights. On the contrary, using that language is the guarantee that it will be lost—indeed, that it is already lost.

And our use of this language distorts our perception and support of other policy options, including those related to the care and nurture of expectant mothers and newborn infants.

Free or Subsidized Birth

It hardly needs to be noted that the foundation of the Catholic theology of the family is openness to new life. “The transmission of human life is a most serious role in which married people collaborate freely and responsibly with God the Creator,” explained Pope St. Paul VI in Humanae Vitae. (Pope St. Paul VI, Humanae Vitae, § 1.) “By their very nature,” adds Gaudium et Spes, “the institution of matrimony itself and conjugal love are ordained for the procreation and education of children, and find in them their ultimate crown.” (Vatican II, Gaudium et Spes, §48.) This moral mandate to be open to children necessarily suggests the need for strong public policies that favor and support begetting and raising children. This includes sharing the economic costs and easing the economic burdens of having children.

In July 2022, shortly after the overruling of Roe, Elizabeth Breunig published an essay in The Atlantic entitled, “Make Birth Free: It’s time the pro-life movement chose life.”[1] In January 2023, Catherine Glenn Foster, President of Americans United for Life, and Kristen Day, Executive Director of Democrats for Life of America, posted a white paper entitled, “Make Birth Free: A Vision for Congress to Empower American Mothers, Families, and Communities.”[2] Both documents lay out a compelling case for universal, federally funded pregnancy, childbirth, and postpartum care. In addition to the specifics of the proposals, they are also examples of how some social issues simply do not fit the traditional partisan divide in America’s two-party system. The proposal for universal health care for pregnancy, childbirth, and postpartum care falls squarely within the four pillars of Catholic social doctrine, which ought to be our starting point for policy considerations. Yet many, if not most, “anti-abortion” activists disfavor these policies in the spirit of the individual rights theory of a particular political party.

At the outset, I want to deflect an obvious objection: None of the authors of these proposals (or the many commentators supporting and tweaking their suggestions) believe that such a large-scale government program would be “free.” Indeed, they acknowledge the considerable cost of such a program, and discuss various methods of collecting and administering tax funds that would finance free birth. “Make birth free” is a rhetorical device to communicate a policy proposal that would spread the cost of carrying and delivering a child across an entire taxpaying population, as an expression of common good. “Free birth” is a proxy for “shared cost of birth.”

Among peer high-income countries, the United States ranks poorly for infant and birth-related maternal mortality.[3] In 2020, the infant mortality rate in the U.S. was 5.4 deaths per one thousand live births.[4] Norway, by contrast, has the lowest rate at 1.6 deaths per thousand live births. The maternal mortality rates are just as disturbing. In 2020, the maternal mortality rate in the U.S. was almost twenty-four per one hundred thousand live births, more than triple the rate in most other developed peer countries—even though the U.S. spends two to four times as much on health care as the same peer countries. For the U.S., the question is not the amount that we spend on health care, but how we spend it. Encouraging and supplementing healthy births and perinatal care—and redirecting health care dollars toward that care—would almost certainly be a more efficient way of spending health care dollars. Certainly, it would be more in accord with the principles of Catholic social doctrine.

Solely from the standpoint of Catholic moral theology, any policies that encourage life should be presumptively favorable, even if the details of specific programs are open to prudential judgment and discussion. A Catholic conversation for such a program should default to favoring policies and programs that encourage healthy pregnancy and childbirth, and that remove financial burdens. Care must be taken in both the way revenue is raised and how assets are disbursed. Basic principles of efficiency, fairness, and equity must be taken into consideration. And, like all considerations of subsidiary structures, the moral agency of parents and family must be supported, not subsumed. But even so, the discussion should be in the context of the four-fold doctrines of dignity, solidarity, subsidiarity, and common good, not the two-fold ideologies of American partisan politics.

Moreover, if we are sincerely committed to encouraging procreation as a social good, we should recognize that economic considerations are not the primary concern. Of course, economic impacts are important, especially as the cost of a free birth program will have ripple effects across the economy. It would be irresponsible not to take other costs into consideration. But we must not reduce suggestions like free birth to mere economic calculations. We should not begin the discussion with economic considerations and mold the policy accordingly. Rather, we must begin with our commitment to human life as a social good, and work to make the economics fit that commitment. And even if, in good faith, we might determine that the costs of such-and-such programs outweigh their benefits, we begin with Catholic principles of social doctrine, not libertarian economic considerations.

Catherine Foster and Kristen Day point out that even with high-quality, employer-based health insurance, the out-of-pocket cost for a family to bear a child averages from $3,000 to $5,000.[5] And that is assuming no medical complications for mother or developing child. Many well-meaning couples who desire to have children simply do not have the means to bear this cost. If the newborn baby requires neonatal intensive care, out-of-pocket expenses for families often exceed $10,000.[6] Elizabeth Breunig reports specific examples of such costs, reaching as much as $24,000 for a high-risk delivery in Indiana. As Foster and Day put it, “Maternity care in the United States is uniquely expensive.” In other developed countries, the out-of-pocket cost of comprehensive maternity and birth is either free or practically free. Citing Ireland and Finland as examples, Foster and Day point out that infant mortality rates are also lower where comprehensive maternity care is provided through public funds.

Day and Foster calculate that, given the average cost of childbirth in the United States, “the approximately 3.6 million annual births . . . would cost about $68 billion.” They point out that 42 percent of live births are already covered for low-income families through Medicaid, leaving about $39.5 billion that would be covered by new spending, either on the state or federal level.[7] This is less than the $54 billion of aid sent to Ukraine in 2022 alone, just to cite one comparative example.[8] Day and Foster go into further details about perverse economic incentives and disincentives that could be alleviated by free birth.[9] While important, these are secondary to the moral case for free birth.[10] Moreover, as noted above, for the U.S. the problem in health care spending is inefficiency, not amount. Preventive health care and health care maintenance are more efficient than emergent care and treatment of preventable disease and injury.

Perhaps nothing indicates the inherent dignity of the human person (including the unborn and their parents) more than a social program that is welcoming and encouraging of the proliferation of humans. Potential parents should not be dissuaded from having children because of the perceived cost or stigma of childbearing. Rather, Catholic-informed social policy advocacy should send every available signal that children are welcome and families who have children are valued. We cannot simultaneously affirm the dignity of the human person while advocating for social policies that discourage their birth or hinder the health of newborns or their mothers. Human dignity does not imply mere tolerance of new life, but rather proactive encouragement and support. Yes, we must count the cost. But we should make the cost fit the policy, not vice versa.

If we take seriously the essential social nature of the human person, along with its implication that we are born to care for one another, then we must share the cost of the most basic part of human development—conception and birth. Having children, whether the cost is borne solely by the family or spread over the entire population, is not a “private” event. On the contrary, hardly anything is more “social” than adding another person to society. The doctrine of solidarity suggests a very strong presumption that the cost of adding that person should be shared by all as a sign of welcoming hospitality, the essence of solidarity.

This is not to suggest that we encourage irresponsible choices by couples who may not be able to bear the non-financial burdens of childbirth. Indeed, the central document of Catholic teaching on childbirth, Dignitatis Humanae, contemplates the natural regulation of childbirth for serious reasons. Plus, “With regard to physical, economic, psychological and social conditions, responsible parenthood is exercised by those who prudently and generously decide to have more children, and by those who, for serious reasons and with due respect to moral precepts, decide not to have additional children for either a certain or an indefinite period of time.” (Humanae Vitae §10.) To advocate for free childbirth is not to advocate for irresponsible parenting. The same considerations that apply to responsible planning for families should pertain across the spectrum of society. But within those considerations, the doctrine of solidarity suggests that we share the joy and burden of new life when it is otherwise appropriate for families to grow.

Of course, the commitment to solidarity must be consistent with principles of subsidiarity. But subsidiarity is not simply a libertarian term for smaller government; it comes from the Latin word for “help,” “assist,” or “aid.” Subsidiarity structures are helping structures, not necessarily small or local. The presumption is that people, including people in families, are dependent upon others for their well-being. Subsidiarity already assumes solidarity, or else it makes no sense. To be sure, Catholic teaching emphasizes that the “helping” structure should be as small, local, and immediate as is consistent with its effectiveness. If smaller is better, smaller is mandatory. But help—not size or proximity—is the primary consideration. Subsidiarity is not a prohibition of social programs, but rather a means of ordering them, according to which social help is administered on the proper level, consistent with dignity and moral agency.

A comprehensive program for free birth might be better administered under programs in individual states through existing Medicaid and other social welfare programs. Or it may be that the most efficient administration of a free birth program would be through something like the federal Medicare program. In both cases, the regulatory structure is already in place. Another possibility is to offset the out-of-pocket expense of childbirth through tax credits, or even direct cash transfers. Yet another option might be for state and federal policy to incentivize private insurers and employers to provide comprehensive free birth, or to disincentivize out-of-pocket expenses such as deductibles and copays.

People of good will might disagree about the most efficient means of implementing programs, and good cases may be made for these or other proposals. In any event, the doctrine of subsidiarity does not suggest whether free birth is good social policy, but rather how that social policy should be implemented. Help is required. The policy question is where and how that help is most appropriately administered while preserving the moral agency of the family. These are not “conservative” or “liberal” proposals. They are not “Republican” or “Democrat.” Rather, they are proposals rooted in four-fold Catholic social doctrine. This doctrine resists identification with any brand of liberal politics because it is rooted in the moral anthropology of Catholic Christianity, not liberal political theory.

Paid Parental Leave?

Closely related to the social good of free childbirth is a generous policy of paid parental leave. The moral arguments supporting prenatal care and subsidized birth apply to sharing the cost of very early childhood development and parental transition. The question is not whether parents with newborns need help, but rather what kind of help they need and how it is best administered. And, again, the solution is not founded in libertarian economics or individualist moral philosophy, but rather in dignity, solidarity, subsidiarity, and common good.

As with the cost of childbirth, the United States is an outlier in providing for federally assisted paid parental leave. Some individual states have moderate paid leave programs. And many private companies have paid leave benefits, often tiered by partial pay through a certain number of weeks, followed by an option for unpaid leave for an additional number of weeks. Sadly, Catholic institutions, including some Catholic dioceses and archdioceses, provide less generous paid leave than similarly sized or situated secular businesses or organizations. And, while the federal Family and Medical Leave Act requires some employers to provide twelve weeks of unpaid leave, the United States is one of very few developed countries with no national paid maternity or other paid family leave programs or mandates.

Again, the principles of dignity, solidarity, subsidiarity, and common good (rather than the ideologies of partisan politics) ought to form our thinking about the propriety, in principle, of state or federally mandated paid maternal or family leave, especially related to newborns and infants. These policies must take into consideration various incentives, disincentives, and means tests. For example, the principle of subsidiarity suggests that families who have the independent financial means to care for young children without public assistance should be incentivized to do so. And while social policy should not discourage two-income families, neither should it penalize families who make the choice to forego an income from one parent for the sake of staying at home with young children. We should stigmatize neither families for whom two incomes are necessary, nor those who subordinate financial considerations to nurturing children. Finding the proper balance in these considerations is not an easy task. But our discussion of them should begin with the presumption that we all have a stake in, and thus responsibility for, policies and programs that attempt to address various legitimate options. And we must be willing to direct policy toward the solutions most in accord with the principles of Catholic social doctrine.

In the case of paid or subsidized family leave, the principles of solidarity and subsidiarity are our primary guides. Solidarity applies to families no less than to individuals. Families are not insular. The relative health and well-being of any family impacts others. While charity rather than “family-interest” should be our primary motivation for the care of other families, we cannot ignore the social impacts that dysfunctional families have on the larger social fabric. Solidarity is not an aspiration; it is a reality. The question for social policy is how solidarity challenges us to make public choices consistent with the inseparable web of social relationships. Similarly, the doctrine of subsidiarity requires us to ask what level of help for families is consistent with moral agency. The measure of subsidiarity is not size or proximity, but the level of help that is consistent with the integrity of the moral agent. This applies to the subjective agency of the family no less than to agency of the individual person.

Various proposals can be considered. Perhaps the most obvious is to modify the federal Family and Medical Leave Act (or similar state programs) to require large companies to provide paid parental leave. Any such laws or regulations should continue to take into account the relative size of the company and other considerations that make such a mandate more or less feasible. Requiring employers to provide paid leave (rather than wealth-shifting programs) is probably most consistent with the principle of subsidiarity. When paid family leave can be borne by a direct employer, it can be administered more efficiently than larger wealth transfer programs administered by state or federal treasuries. Of course, laws and regulations that encourage (or require) such programs might be necessary. But the closer to the employer and employee that such programs are, the more efficiently they may be administered. Companies would be given the flexibility to design programs that are most consistent with the good of the family balanced with fairness to other employees and the sustainability of the company, so long as they comport with minimum standards of paid leave.

As another option, expanded child tax credits for young children would make it easier for one parent to stay home with infants and young children. Such credits should be indexed to average family wages and other calculations that take into consideration the opportunity costs of staying home versus going back to work outside the home. Such a calculation may consider the equivalent wage-value of homemaking, including the whole suite of services that are provided by stay-at-home parents. For example, we could conceive of a more generous tax credit program for parents who choose to stay at home versus those who choose paid childcare. We can respect both choices while favoring one over the other.

If direct aid rather than tax credits is a more efficient means of accomplishing the same social goals, that also should be considered. We must not shy away from discussion of things like guaranteed minimum income programs simply because they are generally associated with the “wrong” political party or ideology. By no means am I suggesting that such direct transfers should immediately be implemented, if implemented at all. I am suggesting, however, that the four pillars of Catholic social doctrine set out the perimeters for the legitimacy of discussing such programs, especially for families with young children in the most formative years. If we take the moral theology of the Church seriously, we cannot reject such a discussion simply because it does (or does not) comport with the fiscal or economic policy of one or the other political parties.

Put another way, the standard we should use to measure the propriety of such programs should be the four-fold principles of Catholic social doctrine, rather than the two-fold constrictions of American partisan politics. If we cannot divorce ourselves from the default mentality of American partisanship and wholly embrace Catholic moral principles, we cannot have an authentic discussion of these and other political, economic, social, and civic matters. Nor can we present a coherent witness against the moral anthropology that informs the social maladies that devalue children, parenthood, and traditional families.

Prudence Must Guide Policy Choices

A broad range of legitimate options are available in a discussion about practical laws, regulations, and institutions for the social support of the family. Within the basic framework of the four pillars of Catholic social doctrine, there may be many feasible, good-faith alternative arguments. I am not suggesting that any particular way of expressing the proper subsidiary structures is the correct one.

Rather, I am calling for us Catholics to reorient ourselves so that the discussion is sustained in a coherent Catholic understanding of the nature of the human person. The regnant structure of liberal individualism that characterizes both major political parties in the United States cannot offer solutions consistent with the entire range of social doctrine because it begins with a moral anthropology that expressly rejects that doctrine. One cannot simultaneously affirm the solidarity of all human persons and the individualism of modern liberalism. If one affirms the latter, one cannot frame a coherent argument for the natural structure of the family. Nor, if we embrace that individualist morality, can we articulate an intelligible argument for subsidiary structures to support the family. If we accede to the ideology of liberalism, we underwrite the very moral anthropology that undermines Catholic morality.

EDITORIAL NOTE: “This article is adapted from Dr. Craycraft’s forthcoming book, Citizens Yet Strangers: Living Authentically Catholic in a Divided America (OSV Press, March 11, 2024).