259 babies are born every minute worldwide.
One of the best places to have a baby might surprise you.
With lengthy parental leave, hundreds of dollars worth of free baby
products and low-to-no childbirth costs, here's why it's better to have a
baby in Finland than in the U.S.
Kela is the Finnish government agency that provides social security
benefits. Meet Kela communications specialist Anniina Kuokka.
Kela is a Finnish social security institution, so basically most of the
Finnish social security benefits are granted from Kela and we have all
kinds of benefits. We have benefits for children, benefits for illnesses
and pensions.
In 2019, Finland gave out €9.3
million worth of maternity grants.
Thanks to Kela, and higher taxes, childbirth costs are totally covered for
Finnish residents.
New parents may expect to pay for the hospital room out of pocket, but
that's usually it. When you go give birth, it's almost free.
We stayed in the hospital for three days, three full days as a family.
We had our own family room and we got like meals and support and help and
everything. And the bill was about €300 in the end, you know, for the
whole thing. It's basically like living in a hotel.
In the US, it's a different story.
Both born at NYU. The cost out of pocket for both my children was around
about $2,000 per child.
So I got pretty lucky because I had really good insurance and I only paid
$250.
Why such a range?
Dr. Michelle Moniz co-authored a 2020 study about the out-of-pocket costs
for childbirth in the U.S.
In this study, we found that women's out-of-pocket costs for maternity
care are rising over time from approximately $3,000 at the beginning of
the study period to about $4,500.
It can be very difficult for patients to predict beforehand what they
might be on the hook for in terms of costs.
One really important finding in this study was that it's the deductibles.
Deductibles are getting higher, meaning people are required to pay more
out of pocket before insurance kicks in.
So even though the cost of birth has plateaued, the out-of-pocket costs
are on the rise. I called the insurance company to get like a quote or an
estimate and i t was really hard to get a number.
They told me to call the hospital and just kind of went down a rabbit
hole. So I didn't really have an idea and I expected a lot more.
Emily Oster is a professor of economics at Brown University and a mother
of two. She's written two books about the convergence of her professional
and personal life as a mother.
In terms of like how much any individual person pays, that's also very
hard to predict because it depends both on the copays associated with your
insurance. Also how far you've gotten in terms of your deductible.
Do you have a health savings account?
So there's like a thousand layers of things that we deal with in the U.S.
insurance system that would be different than a place with more of a sort
of standard single -payer model where it wouldn't matter what kind of
insurance you have, there's only one kind of insurance.
Why are rising out-of-pocket costs such a crucial issue?
When I see that kind of a cost, I worry that patients may choose to delay
or defer some of the healthcare services that we recommend for them during
pregnancy. Things that we hope will improve outcomes for both mom and for
baby. From an insurance perspective, there are a few ways to go about
cutting costs. I think it is important to retain choice and some people
would like to have a doctor and there are many excellent obstetricians.
But I do think that more midwife births with low -risk women is a way to
save money. Midwives do tend to be less expensive, and in this sort of
context of a hospital birth and so on, there's absolutely no reason to
think that they couldn't do a fairly large share of low -risk births.
At the Helsinki University Hospital in Finland, m idwives are the norm.
I have been a midwife for 10 years, a little bit over 10 years now.
Within 10 years, it has been a little bit less than a thousand births.
We don't have doctors in the births.
Only if there's any complications, then the mother will see a doctor.
But if everything goes normally, it's just a midwife.
It is a lot of responsibility.
Finland is one of the most safest countries to give birth and we also try
to, as much as we can, listen to the mother's hopes and wishes, what she
wants to do and the whole family can be together most of the time.
So also the spouses can be with the mother most of the time.
So I think that is the best part.
Things weren't always so efficient in Finland.
The infant mortality rate in the 1930s was so high, the Finnish government
devised a plan to improve it.
Enter the baby box.
Back in the days when the box was designed, the box was meant to be a safe
and clean place for the baby to sleep in as some families were so poor
they didn't have a safe and clean place for the baby to sleep in.
The free box was incentive for new parents to sign up for the public
healthcare system. They couldn't get the box without visiting a doctor.
Today's baby box has 63 items for both the baby and parents.
New parents can take the box or a €170 stipend.
About 95% of first -time mothers choose the box.
But the contents of the box are worth much more than €170.
Companies vie for a spot in the baby box and it gets competitive.
So the contents are usually pretty high-quality.
If you go to a store and buy all the products that are in the maternity
package, you would probably have to pay a lot more than €170.
Anu Partanen is a Finnish journalist, mother and author of "The Nordic
Theory of Everything."
Before she gave birth in the U.S.,
her friends managed to send her a Finnish baby box for her newborn.
It's a cherished tradition, but all the stuff in this is really nice.
It's not some low -quality charity thing.
It's just a really helpful, wonderful thing that makes you feel like I'm
being cared for and the whole country is providing for a child.
There are even some copycat boxes online that go for over $400.
So what do parents in the U.S.
get postpartum? A hat and a blanket.
That was it.
A hat and a blanket.
You get advice, you get phone numbers you can call as far as lactation
consultants and nurses, that can help.
They gave me some like baby products and maternity care products.
And the nurses are pretty liberal with like giving me as much as I want to
take home. I think I didn't get anything the second time because I was not
at the hospital very long.
The first time I recall distinctly getting the squeeze bottle and the
extra mesh underwear. What do American parents want or need?
The information is as important as the stuff.
I'm a first-time mom, so I didn't really know what I needed.
I was like calling all my mom friends like, "What do I need?"
And trying to gather everything.
As a patient, I would've love to have more practical advice.
So, even with my medical fund of knowledge, there are so many things that
you learn when you're home by yourself with a newborn.
One thing is the box which everybody sort of focuses on like, OK.
There's this great box, it has all this stuff in it.
But I think it is really emblematic of a much larger difference, which is
that in many other places, you get a lot of social supports after you have
a baby, there's a home visiting program.
There's, you know, different kinds of help and in the U.S.
we don't have the box, but we also don't have those things.
Another great Finnish mainstay is generous parental leave.
In Finland, you get 10 months of paid parental leave, out of which about
four months is set aside for the mother.
And you start it before the baby is born and then father can keep nine
weeks. Typically, parents stay home for the first three weeks.
They share the rest of the time until the baby is nine months old.
A parent can even stay home until the child is three years old and keep
his or her job. However, the stipend is much smaller.
In February 2020, Finland proposed increasing parental leave, so the
father's time off matches the mother's.
There's no federally mandated paid parental leave policy in the U.S.
The Family Medical Leave Act provides eligible workers with 12 weeks of
unpaid leave to care for a child.
My sister -in -law, she didn't get any paid leave and just had to use
disability and then was unpaid.
Policies that allow moms and dads to be at home during the first few weeks
of their child's life, including paid parental leave policies, could have
a profound positive impact on outcomes in this country.
And I would love to see more employers adopting those kinds of policies.
As the issue gains more traction, more U.S.
employers are increasing paid parental leave.
The evidence is quite strongly in favor of the idea that some kind of
parental leave, maternity leave in particular, benefits mom, but also
benefits the baby.
So I think there's pretty clear reasons to introduce some parental leave.
Increased paid parental leave may intrigue American parents, but there is
one issue that's overlooked.
Maternal mortality rates are on the rise in the U.S.
and it's the only developed nation where this is happening.
As a clinician, I can tell you there are many, many causes to the rise in
the maternal mortality rate.
Things like difficulty accessing health care services both in pregnancy
but also before a pregnancy.
So somebody who's having trouble accessing stable housing is going to have
trouble accessing medical care and doing all of the things that help keep
you healthy during pregnancy.
Taking a prenatal vitamin, staying hydrated, eating a healthy diet,
exercising. So, I think there are many, many contributors to the outcomes
that we see and we need interventions at multiple levels to try to improve
those outcomes.
Finland, on the other hand, has one of the lowest infant mortality rates
in the world. It was also rated the sixth best place in the world to raise
children in 2020.
The U.S. was ranked number 18.
And at the top of the list, Denmark, followed by Sweden and Norway.
That said, it's not all bad.
There are some things the U.S.
does very well, and I think it's important not to lose sight of that.
In particular, if you have a very complicated pregnancy or a very
complicated infant health situation, the healthcare setup in the U.S.
is actually really quite good.
I think where we are experiencing a lot of inefficiencies without a lot of
benefits are in the kind of low -risk space.
Other countries are taking note of Finland's success.
Scotland began offering a version of the Finnish baby box in 2017, and
Japan offers subsidized childcare to low -income households and free
preschool for all to increase the overall birthrate.
In the meantime, what can American parents do to prepare for parenthood in
the U.S.? Be really careful when you're selecting your health insurance
plan, calling your plan and asking about specific services is one way to
try to better understand what services you might be responsible for.
Dr. Moniz says it's important to know the out-of-pocket costs from your
insurance plan for services like prenatal office visits, lab work during
pregnancy, ultrasounds, fetal testing, childbirth and postpartum visits.
For now, the Finnish model may be a pipe dream for the U.S.,
but as 2019's happiest country in the world, perhaps Finland is onto
something.