The Global Toll of Giving Birth

The toll of starting a family is rising almost everywhere in the world. From medical bills and childcare to lost income during parental leave, the cost of giving birth worldwide has become a growing financial pressure for parents. At the same time, global awareness of maternal health has sharpened, with policymakers, employers and families paying closer attention to gaps in care, support and safety reflected in the maternal mortality rate across countries. Against this backdrop, a new study by health insurance comparison service iSelect has resulted in the Global Toll of Giving Birth Index.

This new data-driven ranking of countries and US states evaluates how affordable, supported and safe it is to give birth today. The index brings together key indicators spanning medical expenses, income replacement, maternity leave by country, childcare affordability and maternal health outcomes. Together, these factors offer a clearer picture of the real-world pressures facing new parents.

The findings also reveal stark contrasts. In Australia, childcare costs equate to around 10% of the average wage, while in the United States it rises to approximately 40%, highlighting the scale of childbirth costs USA families face even after delivery. By comparison, Germany’s figure sits at just 1%, underlining how policy choices and social support can dramatically reduce financial strain. These disparities help to explain why some nations are consistently ranked among the best countries for maternity, while others continue to leave families absorbing the bulk of the cost themselves.

The Global Toll of Giving Birth Index ranks countries globally and US states separately based on three core pillars: affordability, parental support and maternal safety. Using publicly available data, each location was scored across cost, maternity leave provision and maternal health indicators. These figures were normalised and combined into an overall score out of 100 to allow fair comparison across different healthcare systems.

By comparing affordability, policy support and safety side by side, the rankings shine a light on where parents are most protected, as well as where the financial and health risks of childbirth remain highest.

The best countries for maternity

Based on affordability, parental support and safety, the Global Toll of Giving Birth Index highlights clear leaders in managing the cost of giving birth worldwide while delivering strong health outcomes for mothers.

1. Norway – Score: 92.13

Norway ranks first overall, with childcare costs averaging just 7% of wages, along with 49 weeks of paid maternity leave and a maternal mortality rate of 1 per 100,000 births. These strong figures place Norway among the world’s leading countries for affordability, support and maternal safety.

2. Greece – Score: 84.75

Greece places second, combining low childcare costs of 6% of wages with 43 weeks of paid maternity leave and a maternal mortality rate of 5 per 100,000 births. This reflects the impact of strong statutory support for new mothers.

3. United Kingdom – Score: 69.90

The UK ranks third, with childcare costs equivalent to 14% of wages, 39 weeks of paid maternity leave, and a maternal mortality rate of 8 per 100,000 births. This positions the United Kingdom among the best countries for maternity despite higher childcare expenses.

4. Iceland – Score: 69.19

Iceland comes in at number four, supported by low childcare costs of 5% of wages, 26 weeks of paid maternity leave, and a maternal mortality rate of 3 per 100,000 births, underlining its strong maternal healthcare standards.

5. Italy – Score: 67.92

Italy completes the top five, with childcare costs effectively at 0% of wages, 21 weeks of paid maternity leave, and a maternal mortality rate of 6 per 100,000 births. Though mothers receive less time off work, they benefit from lower ongoing childcare expenses.

The worst country for maternity

By contrast, the United States ranks last worldwide, with a score of just 7.39, which is due to exceptionally high childcare costs of around 40% of wages, an average of 12 weeks of paid maternity leave, and a maternal mortality rate of 17 per 100,000 births. This reinforces the scale of childbirth costs in the USA compared with other developed nations.

How Australia compares

With a score of 49.47, Australia places 25^th overall (out of 33 countries), with childcare costs accounting for around 10% of wages, 12 weeks of paid maternity leave, and a maternal mortality rate of 2 per 100,000 births, highlighting how affordability pressures persist despite strong safety outcomes.

How the cost of giving birth differs in US states

While the United States ranks poorly overall, several states stand out for offering comparatively lower birth costs, stronger maternity leave policies and safer outcomes for mothers.

Here are the highest-ranking regions.

1. Maryland – Score: 85.13

Maryland ranks first nationally, with an average birth cost of US$16,190, mandatory paid maternity leave, and a maternal mortality rate of 21 per 100,000 births. This places it at the top of the US index despite higher mortality figures than global leaders.

2. Delaware – Score: 79.55

Delaware is second in the USA, combining an average birth cost of US$19,425 with mandatory paid maternity leave and a maternal mortality rate of 17 per 100,000 births. This reflects relatively strong policy support by US standards.

3. Rhode Island – Score: 76.25

Rhode Island has average birth costs of US$20,073, mandatory paid maternity leave, and a maternal mortality rate of 17 per 100,000 births. Though costs are on the higher end of the scale, the combination of these factors makes it one of the more balanced states for affordability and support.

4. Maine – Score: 71.55

Maine places fourth despite higher average birth costs of US$22,453, supported by mandatory paid maternity leave. The maternal mortality rate here is 12 per 100,000 births, which is one of the lower figures among US states.

5. Alabama – Score: 71.01

Despite paid maternity leave being voluntary, Alabama completes the top five, with relatively low average birth costs of US$14,343. However, a high maternal mortality rate of 39 per 100,000 births highlights ongoing safety challenges despite its overall ranking.

The states with the highest childbirth costs in the USA

Looking at the financial cost of childbirth alone, not including maternity leave expectations, several states illustrate a heavier strain that most within the United States.

New Jersey (index score of 36.84) records the highest average cost of birth at US$33,122, alongside mandatory paid maternity leave and a maternal mortality rate of 26 per 100,000 births.

Alaska (7.08) follows closely in terms of financial pressures, with average birth costs of US$32,473, voluntary paid maternity leave and a maternal mortality rate of 25 per 100,000 births, ranking last overall in the index.

New York (39.71) also features among the most expensive, with average birth costs of US$31,345, mandatory paid maternity leave and a maternal mortality rate of 22 per 100,000 births.

California (44.52) rounds out the group, where average birth costs reach US$30,496 despite mandatory paid maternity leave and a comparatively lower maternal mortality rate of 11 per 100,000 births.

Planning for birth with confidence

Across both global and US rankings, the data highlights a clear pattern. Where public policy and healthcare systems fall short, families are more exposed to the overall toll of giving birth worldwide and the financial risks that follow. In countries and regions with limited paid leave or high medical fees, health insurance often becomes a critical safety net. The right cover can help to manage childbirth costs, reduce out-of-pocket expenses and provide access to private maternity care.

As disparities in affordability, maternity leave by country and the maternal mortality rate persist, understanding what coverage is available is an increasingly important step for parents planning for a family.