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The High Cost of Mother’s Day

May 18, 2018

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My youngest granddaughter, Sylvie, gave me a sneak preview last week of her gift to her mother for Mother’s Day. It was a charming booklet, hand-drawn in Sylvie’s first-grade classroom, declaring her love for her mom and featuring nearly a dozen “coupons” that Jessica could “cash in” over the coming months.

“I will do the dishes for one week,” read one coupon. “I will let you sleep in without waking you up,” promised another. “I will fix you breakfast in bed,” proclaimed yet another. Sylvie confided to me that her favorite coupon was for some special “You and Me” time with her mother.

Mothers treasure gifts like these for our entire lives. (One of my favorites was presented to me years ago by my son Sean, who is Sylvie’s father. On that Valentine’s Day, when he was about five years old, Sean served me breakfast in bed. The meal consisted of juice and toast, and he had cut the toast into heart shapes. “I wanted to make you pancakes,” he told me, “but I’m not allowed to use the stove.”)

Such magnificent memories make motherhood priceless for most of us. Still, I have an important question: Why does it cost so much to give birth in America?

The United States is the most expensive country in the world in which to have a baby. Medical experts say the cost of childbirth factors into thousands of bankruptcies in America each year.

Take the famous case of Stella Apo Osae-Cwum and her husband, as related by The Guardian newspaper in its recent series about motherhood in America. The couple went to the hospital “covered by insurance, saw an obstetrician in their plan, but when her three sons— triplets—were born prematurely, bills started rolling in.”

In the end, the hospital charged the family a total of $877,000. Why? Because the half-dozen neonatologists who attended the babies were not in-network.

The couple’s private insurance ended up covering most of the $877,00 bill, but her family was still responsible for $51,000. Eventually, a professional medical billing advocate in New Jersey agreed to take their case. The bill was finally lowered to $1,300.

In the U.S., costs of childbirth vary greatly by state and hospital. But according to Truven Health Analytics, a New York firm that collects health care data, the total price charged for a normal vaginal birth and newborn care in the United States is about $30,000. This rises to about $50,000 for a caesarean section.

Insurance usually covers the bulk of the charges, but American families are still responsible for thousands of dollars.

By contrast, if a woman gives birth in a state hospital in Western Europe (Britain, France, Germany, Spain, for example)— or in a variety of other countries (Australia, Brazil, India, and China, for example)—the cost is $0 (that’s zero dollars).

Despite the high cost of childbirth in America, though, we consistently rank poorly in health outcomes for mothers and infants. “The U.S. rate of infant mortality is 6.1 for every 1,000 live births, higher than Slovakia and Hungary, and nearly three times the rate of Japan and Finland. The U.S. also has the worst rate of maternal mortality in the developed world,” said The Guardian.

In fact, a mother giving birth in the U.S. is about three times as likely to die as a mother in Britain and Canada. (I had to read that twice before I could process it.) And for every American woman who dies from childbirth, 70 come close. That, according to National Public Radio and ProPublica, “adds up to more than 50,000 women who suffer ‘severe maternal morbidity’ from childbirth each year.”

These shocking statistics are the result of NPR and ProPublica investigating over the past year why American mothers die in childbirth at a far higher rate than in all other developed countries. The NPR story aired just last week.

Now there is obviously no higher emotional cost to a family than a mother dying in childbirth. But we can cite numerous factors to explain the high financial costs of giving birth in the U.S.: a fee-for-service payment system that encourages unnecessary tests and services; the vagaries of U.S. insurance companies; laws that discourage trained midwives from attending births, even though they are ubiquitous in most countries and their services are much less expensive than those provided by medical doctors; and lack of a single-payer system, which is the reality in every other developed nation.

It’s true that most American families—the lucky ones who have private insurance or Medicaid or Obamacare—don’t bear the full costs of childbirth on their own. But we still pay hugely more than any other advanced nation. And even if we do have health insurance, steep medical prices are eventually passed down to the consumer in the form of higher premiums and deductibles.

Finally, there is the fact that once these bundles of joy enters our lives, few American mothers are guaranteed any paid leave time to care for their infants. The majority of new moms in the U.S., in fact, are back at work within 10 days. But that’s another story.

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Jan Collins is a Columbia-based journalist, editor, and author. A former Nieman Fellow at Harvard and former Congressional Fellow in Washington, D. C., she is the coauthor of Next Steps: A Practical Guide to Planning for the Best Half of Your Life (Quill Driver Books, 2009).