How the US became the most expensive place in the world to be a mother

For millions of American women, motherhood comes with a staggering price tag — far higher than in most other wealthy countries. From the earliest stages of pregnancy through delivery and child care, medical and parenting expenses place a heavy burden on families.

The United States also has one of the highest maternal mortality rates among high-income nations, at 18.6 deaths per 100,000 live births, compared with fewer than 3 in countries such as Norway, Ireland, Switzerland and Italy. Black women face a risk of dying from childbirth complications three times higher, with a rate of 50.3 per 100,000 live births in 2023, according to the US Centers for Disease Control and Prevention (CDC).

The high cost of childbirth

Childbirth costs in the US vary widely depending on insurance coverage and whether the hospital and doctors are in-network. According to FAIR Health, a nonprofit that analyzes insurance claims data, the national average for an in-network vaginal delivery is $15,178, rising to $19,292 for a cesarean section.

The most expensive states include Alaska ($29,152 for vaginal delivery, $39,532 for C-section), New York ($21,810 and $26,264), New Jersey ($21,757 and $26,896), Connecticut ($20,658 and $25,636) and California ($20,390 and $25,169).

Maria Haris, 40, who lives near Denver, Colorado, said that despite having the highest-tier insurance, she still paid about $3,000 out-of-pocket for a three-day hospital stay for a natural birth, on a total bill of roughly $40,000. She was also charged nearly $600 for a single over-the-counter painkiller that costs about $5 in a pharmacy. Her daughter had jaundice and spent nearly three days in the neonatal intensive care unit (NICU), adding a similar bill. “I am still paying off the NICU bill from three years ago,” she said.

Medicaid, the health insurance program for low-income people, covered 40.2% of all births in 2024. But families still face high bills if an out-of-network doctor is involved. The average cost for an out-of-network vaginal delivery is $31,117, climbing to $44,432 for a C-section.

No federal paid maternity leave

The US is one of the few wealthy nations without a federally guaranteed paid maternity leave policy. The 1993 Family and Medical Leave Act provides up to 12 weeks of unpaid leave for some workers, but millions of Americans are ineligible or cannot afford to take time off without pay.

Jade, 43, a mother of two in Chicago, Illinois, said she received 12 weeks of paid leave at 60% of her salary plus four weeks unpaid. Her total childbirth bill in 2018 was over $46,000, of which she paid $18,000 out-of-pocket. She wished she could have spent more time at home with her baby but feared losing her job. “I went back to work when my baby was four months old, and in the US, that is considered a great leave, but in my heart I knew it wasn’t enough,” she said.

By contrast, Bulgaria leads the world with nearly 59 weeks of leave at 90% pay, while Germany, Austria and Luxembourg guarantee full pay for 14 to 20 weeks.

World's highest child care costs

In 2023, American couples spent roughly 40% of their disposable income on child care — the highest among developed economies, nearly double Ireland's 22% and far above Germany, Italy and Portugal, where costs are near zero thanks to state subsidies.

Haris said child care costs in Colorado, a high-cost-of-living state, run $25 to $30 an hour, or about $4,000 a month for 40 hours per week. Her husband, who is European and accustomed to better maternal and child care services, says “he doesn’t love this place anymore.” “I have a child, no job, my whole outlook on America has changed,” she told Al Jazeera.