High Childbirth Costs in the U.S. Demand Policy Overhaul

The United States is one of the most costly countries to give birth in. While individual pre-pregnancy preparations may help to lower hospital bills, policy changes are also needed.

After Japan, the U.S. is the second most expensive country in the world to deliver a baby, according to 2022 data.

Pregnancy, childbirth, and postpartum care cost an average of $18,865. As insurance covers most of it, women enrolled in large group plans pay $2,854 out-of-pocket on average, according to KFF analysis. When the delivery results in a cesarean section, the out-of-pocket spending increases to $3,214.

This is a stark contrast to other Western countries. For example, in Canada, childbirth may cost nothing for citizens and residents covered by the publicly funded healthcare system. The same is true in the United Kingdom and France.

Ge Bai, PhD, CPA, a Professor of Accounting at Johns Hopkins Carey Business School and Professor of Health Policy & Management at Johns Hopkins Bloomberg School of Public Health, says the complete transfer of market control to the government — as in many other countries — could reduce the price of giving birth in the U.S., but it is currently infeasible.

The other way of reducing costs is improving market competition, especially for elective services like childbirth.

Options for low-income families

Bai points out that most low-income patients in the U.S. are eligible for government insurance programs, such as Medicaid, which covers both pregnancy and childbirth without co-pay.

Families whose income is too high to qualify for Medicaid but cannot afford commercial insurance can apply for the Children's Health Insurance Program (CHIP), which offers pregnancy coverage in 18 states. People can enroll in both programs even after the pregnancy has already begun.

However, financial struggles may not end when bringing the newborn home. A recent study found that postpartum individuals — those seven to 12 months past childbirth —- are more likely to have medical debt than pregnant people. This is especially true in the lowest-income neighborhoods.

The heightened risk could be explained by pregnancy, delivery, and postpartum care costs, as well as caregiving expenses. Moreover, parental leave during this period may lead to reduced earnings.

Bai calls medical debt "a mental burden" and an issue that cannot be ignored, while research suggests that medical debt may exacerbate already poor health outcomes and worsen existing health disparities.

Dr. Robin Elise Weiss, a doula and a president-elect at DONA International, a doula training organization, says the birth-associated costs could be cut by extending private and Medicaid coverage to one year postpartum.

It should include coverage for birth and postpartum doulas and preconception health appointments. Weiss also advocates for a comprehensive parental leave for all parents.

"These policy changes would be really helpful in reducing medical debt. We first need to reduce excess medical care when people don't need it, but have it available and ready for those who do," Weiss adds.

What can an individual do?

Policy changes may not happen soon — or ever — and maternal care is becoming less accessible. Only 45% of rural hospitals are now delivering babies, while 2.2 million American women of childbearing age live in "maternal care deserts" with no or little maternal care.

Weiss says individuals can lower childbirth costs by making pre-pregnancy preparations, such as managing their health affairs and chronic conditions.

This will help them have a healthier pregnancy, which may mean fewer tests and treatments. They should also start working on healthy lifestyle habits like nutrition and exercise.

- Dr. Robin Elise Weiss

Bai recommends individuals on commercial insurance to do "a comparison shopping" to learn which provider would entail lower out-of-pocket costs.

Childbirth is more costly in some states than in others. Those in Alaska pay the most, with an average $21,525 cost for vaginal delivery, compared to the $7,840 in Alabama, the cheapest state to give birth to.

The price of childbirth may also depend on the hospital. Costs are found to be significantly higher in government-owned or non-profit hospitals, as well as those located in rural areas and having relatively few deliveries.

People with a low-risk pregnancy can and should seek out care from providers who specialize in low-risk pregnancy and birth, Weiss says. This includes Certified Professional Midwives, Certified Nurse Midwives, and some physicians.

"It may also include home births and birth centers for their places of birth. Many people simply continue to see the person who has provided them with gynecologic care that may not be the best person for your care," Weiss adds.

Although childbirth in the U.S. costs more than in most other countries, low-income patients can apply for government insurance programs, giving them a financial alternative that won't start their baby's new life in debt.