The reverse birth tourists: US women seek cheaper countries to have babies – The Guardian US

Americans are choosing to have babies abroad to avoid the crushing maternity and childcare costs in the US
Last year, more than 66,000 Americans had babies abroad. The government doesn’t ask parents why they’re overseas. But “expat” motivation surveys, migration experts and interviews with over a dozen Americans around the world reveal that many leave home, at least in part, to escape the crushing financial and personal costs of starting a family in the United States.
The US has some of the highest childcare costs in the world – even Americans with employer-provided insurance can expect to pay an average of $4,569 in out-of-pocket childbirth fees. It is the only high-income country that doesn’t mandate paid maternity leave, and has longer workweeks (and less paid time off) than most other developed countries. The price of infant care tops $15,000 a year in some parts of the country and is expected to rise as a result of the Covid-19 pandemic.
This is why American “birth migrants” are seeking refuge from unique US burdens in countries with either lower costs of living or more government support for parents and children.
We present four women’s stories – and how much they paid in total.
On giving birth abroad: In the US, I was living paycheck to paycheck. I was tired, and I felt cheated – I had put in all this hard work, I finished my education like I was told to, put the hours in, I’m getting all this praise from my supervisors, so why is nothing moving? So I applied for a masters program in marketing in France. That’s where I met my husband, a Frenchman from Normandy.
When it came time to deliver my twins, we ended up having to go to the emergency room because something just felt off. I still had this really American fear of costs and was mentally doing the tally. Even as I’m in labor, the entire time, I’m thinking, OK, they’ve given me this medicine, add it to the bill. I had an emergency C-section, add it to the bill. I needed a bag of blood, add it to the bill.
I also had a private room, with three square meals, a lactation consultant to teach me how to breastfeed, and someone who came in to teach us how to do the first bath…and in my head all of that was going onto the tally. When the nurses started giving diapers and formula, because my milk hadn’t come in, I told my husband, no no no. Go around the corner and buy diapers and formula, I’m not paying for this.
When it was time to leave the hospital, I told my husband, you go into the office and look at the bill. In my head, I was expecting to pay thousands of euros and was bracing for the impact. And then he walked in, and 30 seconds later he walked out, and I asked him, “OK, how much was it?” He said, “Darling, this is France. Get in the taxi.”
Total cost of childbirth: $0
On maternity leave: I had a real fear of telling the people at my job that I was pregnant, like am I still going to have an income? But with my company, I received 100% of my current pay for maternity leave – except times two, because I had twins.
On giving birth abroad: When I met my husband, we decided to try living abroad. We chose New Zealand because of its social safety net, decent public schools, and subsidized childcare.
I showed up to New Zealand pregnant with my first child, and I was able to get midwife care – she came to my house throughout my pregnancy, supported me in a home birth, and when there were complications, accompanied me while I was transferred to a hospital. At that time, I was on a tourist visa, so we were responsible for the costs. When I had my other two children, we were residents, and so all the costs were covered by the healthcare system.
Total cost for first child: $3,550 (out-of-pocket costs as mother on tourist visa).
Total cost for second and third children: $0
On maternity leave and childcare: We left San Francisco in 2005, and in the subsequent years when I’ve come back to visit, one by one, my girlfriends were getting married and struggling so much. I have two friends who are a highly educated couple – a scientist and a lawyer – and they work 12-hour days with a commute, so the kids have to be in “before daycare”– daycare, and “after daycare”– daycare.
In New Zealand, not only do you get 18 paid weeks of child leave, but childcare is subsidized and income tested, so when I had two little kids in daycare and I was an aspiring writer who still hadn’t published anything, my bill was less than $100 per week. And when your children are between the ages of three and five, you get 20 hours free, because research has shown that high quality childcare between the ages of 3-5 leads to one of the best outcomes. It just makes sense.
Total cost for 30 hours per week of childcare: $85 per week for children under three, and $24 per week for children over three
What’s your takeaway? The clear majority of Americans don’t see that the rest of the developed world does it differently. They don’t realize they have the right to something else. There’s this idea that if you are getting assistance from the government it’s a handout, and it’s shameful or smacks of communism. But in the countries with a social welfare state, they see this as an investment in their future.
On giving birth abroad: I’m Peruvian, and I came to Chile to study for a Masters in architecture. Now I’m doing a PhD. My husband, John, is an American musician in an orchestra. He wanted to travel internationally, and then after five years go back to the US.
For me, the balance between my work and family life is very important. When we got engaged and started talking about having kids, I was really concerned about what sacrifices I’d have to make if we had kids in the US. So we decided to stay where we were. In Chile, it’s mandatory to put at least 7% of your salary towards health insurance, and women in their childbearing years pay even more. Since I knew I wanted to be a mother someday, I paid for the premium insurance so delivery costs would be lower.
Out-of-pocket cost for delivery, including a C-section and four-day hospital stay: $350. Cost of premium health insurance: $195 per month
On maternity leave and childcare: In Chile, there’s a law that mandates six months of paid maternity leave, so I got 100% or my salary for those six months. This is great for women who are already working, but for women who are recently married in their childbearing years, it can make it really difficult to get a job. Maternity leave isn’t paid by the company – it’s paid by my own healthcare, which in Chile is more expensive for women than for men.
After maternity leave ends, the government pays for your daycare until the baby is two years old, so you can go back to work. Once they turn two, though, you have to pay out of pocket. The university where I have a part-time job while I’m doing my PhD has very good childcare, and it’s subsidized by the government.
Cost for 45 hours per week of childcare for child older than 2: $340
On giving birth abroad: Both Americans and Turks automatically assumed I would go back to America to give birth. There’s this idea that everything is better in America – that healthcare is better in America. I just don’t perceive it that way. I saw going back to the states to have a baby as expensive. (I’ve had two spine surgeries at Mt Sinai Hospital in New York. The first cost me more than $100,000 and the second $93,000.)
Women in America are also discharged almost immediately. It’s a systemic problem. And because I’m an older mom, I just didn’t see why I would go to a subpar medical system that doesn’t prioritize me and would kick me out of the hospital right away.
I don’t understand how people function in America.
Total cost for an emergency C-section at a private hospital, including five days in a private room: $4,000


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