Why is motherhood so expensive in the United States? | | Infographic News

For millions of women in the United States, motherhood comes with an incredible cost.

From the earliest stages of pregnancy through the childbearing and child care years, the costs of medical care, childbirth and childrearing are higher in the US than in other wealthy countries. Even basic needs such as medical care and childcare can place a heavy burden on families.

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At the same time, the US has one of the highest maternal mortality rates among high-income countries at 18.6 deaths per 100,000 live births, compared to less than three in countries such as Norway, Ireland, Switzerland and Italy.

Black women are close three times more likely to die from reproductive complications. In 2023, the maternal mortality rate was 50.3 per 100,000 births for black women, compared to 14.5 for white women and 12.4 for Hispanic women, according to the US Centers for Disease Control and Prevention (CDC).

As people celebrate Mother’s Day in the US, Al Jazeera breaks down childbearing costs, maternity leave policies and child support costs in the country compared to the rest of the world.

High cost of delivery

In the US, the cost of delivery can vary widely depending on insurance coverage and whether the hospital and doctors are “in-network” or “out-of-network”.

Online providers have contracts with women’s insurance companies, which often means lower, negotiated rates for patients. Out-of-network providers don’t, so even insured patients face high bills or unexpected fees.

According to the US Census Bureau, about 92 percent of Americans in 2023 had health insurance through government programs, such as Medicaid and Medicare, or private insurance, meaning that about 8 percent were uninsured.

Even women with insurance can face thousands of dollars in bills for routine births, emergency care and postpartum care.

According to data from FAIR Healthan independent nonprofit organization that analyzes health insurance data, the national average cost of cesarean deliveries is $15,178, rising to $19,292 for cesarean births.

The map below shows the online price for each unit. The most expensive are:

• Alaska – $29,152 (female birth) $39,532 (C-section birth)
• New York – $21,810 (female birth), $26,264 (C-section birth)
• New Jersey – $21,757 (female birth), $26,896 (C-section birth)
• Connecticut – $20,658 (female birth), $25,636 (C-section birth)
• California – $20,390 (female birth), $25,169 (C-section birth)

Maria Haris, 40, was born and raised in the US and now lives outside of Denver, Colorado.

He asked that his name be changed because he is worried that revealing himself could cause controversy in his community.

Maria has a three-year-old daughter and is now a single-income earner after losing her job just weeks before her birthday.

Now that her daughter is in elementary school, she is trying to return to her corporate job but is struggling even though she has held well-paying positions throughout her career.

Haris said that despite the high level of insurance coverage, delivery and postnatal care has become a huge financial burden.

“It was about $40,000 for the three days I was in the hospital and about $6,000 per night in the room,” Haris said, explaining that her out-of-pocket expenses for the birth were about $3,000 in total.

He said he was charged about $600 a pill for painkillers that were less than $5 a bottle at the time in supermarkets.

“My daughter had jaundice, and as soon as we got out of the hospital, she had to go to the NICU (intensive care unit) the next day, and we got a ridiculous amount for the three days she was in the hospital.” He told Al Jazeera.

“I still have payment plans from his NICU visit three years ago.”

In-network vs out-of-network care

Medicaid is the largest provider of maternity care in the US, providing financial support 40.2 percent of all births in 2024.

Medicaid is a US government insurance program for low-income pregnant women who qualify if their household income falls at or below 200 percent of the federal poverty level. On average, this comes to about $50,000 a year for a family of three.

Compared to countries where public health systems pay more for births, most Americans navigate pregnancy through private insurance, deductibles and hospital co-payments that can leave families with long-term debt.

According to data from FAIR Health, the median cost of childbirth for women is $31,117, rising to $44,432 for C-section births.

The map below shows the out-of-network cost for each region. The most expensive are:

• Nevada – $49,699 (feminine birth), $72,604 (C-section birth)
• New Jersey – $42,712 (feminine birth), $55,730 (C-section birth)
• California – $42,078 (female birth), $66,662 (C-section birth)
• Florida – $39,256 (female birth), $57,072 (C-section birth)
• Alaska – $38,800 (female birth), $55,997 (C-section birth)

“People should know that there is a payment for nurses in the NICU, and if there is a doctor, each doctor has their own online policies. If a doctor comes to see you and the doctor is not in (your) network, then you are responsible for paying the money outside the network to that doctor,” Haris told Al Jazeera.

He said Colorado passed a law several years ago that if doctors are out of a patient’s network, they must notify the patient and the patient must sign a waiver to control the costs.

The difference between online and offline care can mean the difference between treatment costs and financial problems.

In some parts of the United States, the cost of out-of-network births can be as high as several times their monthly income, especially in the case of emergencies where patients may not have access to care.

‘I wish I had more time with my new baby’

The US is still one of the wealthiest countries that does not have paid public holidays.

While many European countries offer months, and sometimes more than a year, of paid vacation provided by national systems, American workers often rely on unpaid leave, employer benefits or savings.

The federal Family and Medical Leave Act of 1993 guarantees some workers up to 12 weeks of unpaid leave, but millions of workers are not eligible or cannot afford unpaid leave.

Jade, 43, is an African American mother of two from Chicago, Illinois, who asked that her last name not be used.

She said her period of pregnancy disappeared when she last gave birth eight years ago. Although he received 12 weeks of paid leave at 60 percent of his salary, followed by an additional four weeks without pay, it was still not enough to meet his needs.

I wish I had more time at home with my new baby. But I was worried that if I asked for more time they wouldn’t give me or my job would be lost, not to mention that losing money would be difficult for my family. So I went back to work when my son was four months old, and in the US, that is considered a good time off, but in my heart, Jade knew it wasn’t.

Her total bill for her last baby shower in 2018 was just over $46,000, of which she had to pay $18,000 herself.

Maternity leave policies vary greatly around the world, but most wealthy countries offer more protection than the US.

The Balkans region has always produced the highest number of programs in the world, often surpassing Western Europe in terms of time.

Bulgaria leads the world, offering about 59 weeks of leave at 90 percent of the mother’s salary, while countries like Germany, Austria and Luxembourg guarantee full payment of 14 to 20 weeks. In the Nordic countries, parental leave systems, which are usually shared between both parents, can last a year or more.

The cost of childcare in the US is among the highest in the world

After the birth of a child, child care costs continue to consume US household income. In 2023, couples in the US spent nearly 40 percent of their household income on childcare, the highest share among developed nations.

This was almost double Ireland’s rate of 22 per cent and well above countries such as Germany, Italy and Portugal, where child care costs are close to zero thanks to government subsidies and welfare measures.

New York Mayor Zohran Mamdani, a Democrat, has launched New York City’s first free child care system for street workers after winning the election on an affordability platform.

The table below shows the cost of raising children as a share of household income in selected countries around the world in 2023.

Jade was able to reduce childcare costs by relying on her mother-in-law to take care of her after she returned to work and hired a freelancer.

Haris says child care costs are high in her home state of Colorado, which has a higher cost of living than many other US states. They pay at least $25 to $30 an hour, which, for a 40-hour week, is about $4,000 a month.

The 40-year-old says that her husband, who is from Eastern Europe where women’s and children’s work is hard, says he “doesn’t like it here anymore”.

“I have a child, and I don’t have a job, my whole view of the US has changed,” she told Al Jazeera.