Why is being a mother so expensive in the United States? 

For millions of women in the United States, being a mother comes with an extraordinary price tag.

From the earliest stages of pregnancy through childbirth and into years of childcare, expenses for healthcare, delivery and raising a child are significantly higher in the US than in most other wealthy countries. Even basic needs like medical care and childcare can place a major burden on families.

At the same time, the US 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 three in countries such as Norway, Ireland, Switzerland and Italy.

Black women are about three times more likely to die from childbirth complications. In 2023, the maternal mortality rate was 50.3 per 100,000 live births for Black women, compared with 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 the cost of giving birth, maternity leave policies and childcare costs in the country compared with the rest of the world.

The high cost of giving birth

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

In-network providers have agreements with a mother’s insurance company, which usually means lower, negotiated prices for patients. Out-of-network providers do not, so even insured patients face much higher bills or unexpected charges.

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

Even insured mothers can face bills running into thousands of dollars for routine deliveries, emergency procedures and postnatal care.

According to data from FAIR Health, an independent nonprofit organisation that analyses health insurance claims data, the national median in-network charge for a vaginal delivery is $15,178, rising to $19,292 for caesarean section births.

The map below shows the in-network costs per state. The most expensive include:

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

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

She asked that her name be changed because she was worried that revealing her identity could lead to backlash in her community.

Maria has a three-year-old daughter and is now in a single-income household after being laid off just weeks before her due date.

Now that her daughter is in preschool, she is trying to return to her corporate career but is struggling despite having been in well-paying roles throughout her career.

Haris said that despite having top tier insurance coverage, her childbirth and post-birth care has been a big financial burden.

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

She said she was charged nearly $600 a tablet for over-the-counter pain medication that was barely $5 a bottle at the time in supermarkets.

“My daughter had jaundice, and right after we got back from the hospital, she had to go into the NICU [neonatal intensive care unit] the next day, and we got another ridiculous bill for the nearly three days she was in the hospital.” she told Al Jazeera.

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

In-network vs out-of-network care

Medicaid is the single largest payer for childbirth in the US, financing 40.2 percent of all deliveries in 2024.

Medicaid is a US government health insurance programme for low-income people with pregnant women typically qualifying if their household income falls around or below roughly 200 percent of the federal poverty level. On average, that works out to about $50,000 a year for a family of three.

Compared with countries where public healthcare systems cover most childbirth costs, many Americans navigate pregnancy through a patchwork of private insurance, deductibles and hospital charges that can leave families with long-term debt.

According to data from FAIR Health, the national median out-of-network charge for a vaginal delivery is $31,117, rising to $44,432 for C-section births.

The map below shows the out-of-network costs per state. The most expensive include:

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

“People should know there is a charge for the nurses in the NICU, and if there’s ever a doctor, each doctor has their own in-network plans. If a doctor comes in to see you and that doctor is not in [your] network, you are then responsible to pay out-of-network costs for that doctor,” Haris told Al Jazeera.

She said Colorado passed a law a few years ago that if doctors are out of a patient’s network, they have to let the patient know and the patient has to sign a document to essentially be responsible for the costs.

The difference between in-network and out-of-network care can mean the difference between manageable medical costs and a financial crisis.

In some US states, out-of-network childbirth costs can rise to several times the average monthly income, particularly in emergencies where patients have little control over where they receive care.

The US remains one of the few wealthy countries without federally guaranteed paid maternity leave.

While many European countries offer months, and in some cases more than a year, of paid leave funded through national systems, American workers often rely on unpaid leave, employer benefits or personal savings.

The federal Family and Medical Leave Act 1993 guarantees some workers up to 12 weeks of unpaid leave, but millions of employees do not qualify or cannot afford to take time off without pay.

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

She said her maternity leave fell short when she last gave birth eight years ago. Although she received 12 weeks of paid leave at 60 percent of her salary, followed by an additional four weeks unpaid, it still wasn’t enough to fully cover her needs.

“I wish I had more time at home with my new baby. But I was worried that if I requested more time that they would not grant it or my job would no longer be there, not to mention that the loss of income would be hard for my family. So I returned to work when my baby was four months old, and in the US, that is considered a good amount of time off, but in my heart, I knew it was not,” Jade told Al Jazeera.

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

Maternity leave policies vary dramatically around the world, but most wealthy nations offer far more generous protections than the US.

The Balkan region consistently offers some of the most extensive leave policies in the world, often surpassing Western Europe in their duration.

Bulgaria leads globally, offering nearly 59 weeks of leave at 90 percent of a woman’s salary, while countries like Germany, Austria and Luxembourg guarantee full pay for 14 to 20 weeks. In the Nordic countries, generous parental leave systems, often shared between both parents, can extend to a year or more.

Childcare costs in US among world’s highest

After childbirth, childcare costs continue to strain household finances across the US. In 2023, couples in the US spent about 40 percent of their disposable household income on childcare, the highest share among selected developed economies.

That was nearly double the rate in Ireland at 22 percent and far above countries such as Germany, Italy and Portugal, where net childcare costs are close to zero due to state subsidies and public support systems.

New York Mayor Zohran Mamdani, a democratic socialist, has launched New York City’s first free childcare for municipal workers after winning election on a platform of affordability.

The table below shows the net cost of childcare as a share of disposable household income for couples in selected countries worldwide in 2023.

Jade managed to keep her childcare costs down by relying on her mother-in-law as a caregiver when she first returned to work and has since hired an au pair.

Haris says childcare costs are extraordinarily high in her part of Colorado, which has a higher cost of living than most other US states. She pays at least $25 to $30 an hour, which, over a 40-hour week, amounts to roughly $4,000 a month.

The 40-year-old says her husband, who is from eastern Europe where maternity services and childcare are robust, says “he doesn’t love it here anymore”.

“I have a child, and no job, my entire perspective of the US has changed,” she tells Al Jazeera.