The Toll of Giving Birth

Bringing new life into the world should be a moment of hope – not hardship. Yet for millions of parents, the experience of giving birth comes with a heavy financial, medical, and emotional toll.

New research from health insurance comparison site iSelect reveals the U.S. states where the toll of childbirth – measured through childcare affordability, maternity leave policies, and maternal health outcomes – is highest. From limited paid leave to soaring childcare costs and worrying maternal mortality rates, the findings expose a stark reality: some states carry a burden on parents, and it isn’t just limited to financial costs.

Lower scores indicate a higher overall burden on parents.

The US States with the Highest Toll of Giving Birth

Rank	State	Average cost of birth (vaginal & C-section) USD	Employer obligation to provide paid maternity leave	Maternal mortality rate (per 100,000 births)	Score
1	Alaska	$32,473	Voluntary	25	7.08
2	Nevada	$25,121	Voluntary	20	32.29
3	Wisconsin	$24,917	Voluntary	13	32.54
4	Florida	$25,333	Voluntary	24	32.6
5	Arizona	$23,245	Voluntary	30	36.77
6	New Jersey	$33,122	Mandatory	26	36.84
7	Nebraska	$22,875	Voluntary	25	37.8
8	Pennsylvania	$23,279	Voluntary	17	38
9	Minnesota	$21,437	Voluntary	12	38.09
10	Kansas	$23,136	Voluntary	23	38.24
11	Texas	$22,148	Voluntary	28	39.51
12	Mississippi	$21,600	Voluntary	39	39.53
13	New Hampshire	$22,435	Voluntary	18	39.68
14	New York	$31,345	Mandatory	22	39.71
15	Utah	$22,149	Voluntary	16	39.95
16	Arkansas	$22,110	Voluntary	38	40.83
17	Hawaii	$20,420	Voluntary	16	41.12
18	Vermont	$21,533	Voluntary	4	41.31
19	Wyoming	$21,276	Voluntary	22	41.32
20	South Dakota	$22,071	Voluntary	28	42.16
21	Virginia	$21,217	Voluntary	33	43.33
22	Indiana	$20,333	Voluntary	31	44.32
23	California	$30,496	Mandatory	11	44.52
24	Idaho	$21,039	Voluntary	20	44.76
25	New Mexico	$19,943	Voluntary	28	44.95

1. Alaska

Alaska ranks worst overall, with an average birth cost of $32,473, a voluntary employer maternity leave policy, and a maternal mortality rate of 25 per 100,000 births. Its overall score of 7.08 out of 100 reflects high financial costs combined with limited structural support.

2. Nevada

Nevada follows, with average birth costs of $25,121 and a maternal mortality rate of 20, resulting in a score of 32.29.

3. Wisconsin

Wisconsin ranks third, with birth costs averaging $24,917 and a maternal mortality rate of 13.

4. Florida

Florida places fourth, with birth costs of $25,333 and a maternal mortality rate of 24.

5. Arizona

Arizona reports average birth costs of $23,245, but a maternal mortality rate of 30 deaths per 100,000 births, among the highest in the bottom five states.

The US States with the Lowest Toll of Giving Birth

At the other end of the ranking, Maryland scores highest overall (85.13), supported by mandatory paid leave requirements and comparatively lower birth costs.

Rank	State	Average cost of birth  (vaginal & C-section) USD	Employer obligation to provide paid maternity leave	Maternal mortality rate (per 100,000 births)	Score
1	Maryland	$16,190	Mandatory	21	85.13
2	Delaware	$19,425	Mandatory	17	79.55
3	Rhode Island	$20,073	Mandatory	17	76.25
4	Maine	$22,453	Mandatory	12	71.55
5	Alabama	$14,343	Voluntary	39	71.01
6	Oregon	$23,442	Mandatory	17	70.93
7	Massachusetts	$23,259	Mandatory	16	69.69
8	Illinois	$21,687	Mandatory	18	69.51
9	Washington	$24,082	Mandatory	18	66.75
10	Iowa	$18,823	Mandatory for government employees	19	63.09
11	Colorado	$25,133	Mandatory	16	61.7
12	Louisiana	$14,419	Voluntary	37	60.43
13	Connecticut	$26,477	Mandatory	16	57.86
14	North Dakota	$17,817	Voluntary	22	55.59
15	West Virginia	$17,208	Voluntary	24	53.1
16	Montana	$17,667	Voluntary	30	51.73
17	Oklahoma	$17,750	Voluntary	30	50.86
18	Michigan	$19,288	Voluntary	19	50.65
19	Kentucky	$18,712	Voluntary	35	50.64
20	North Carolina	$18,815	Voluntary	27	50.35
21	Missouri	$17,386	Voluntary	24	50.28
22	Ohio	$18,665	Voluntary	25	49.71
23	Georgia	$18,930	Voluntary	32	49.21
24	Tennessee	$19,559	Voluntary	41	46.42
25	South Carolina	$20,457	Voluntary	32	46.36

These states generally combine stronger maternity leave protections with more moderate healthcare costs and comparatively lower maternal mortality rates.

The takeaway is clear: despite regional differences, none of the highest-cost states guarantee substantial paid leave at the employer level, and maternal health risks remain high in many areas. For expecting families in these states, the financial and medical realities of giving birth are especially difficult.

More information on methodology and the global ranking can be found onsite: https://www.iselect.com.au/health-insurance/insights/global-toll-of-giving-birth/

Methodology

This dataset ranks US states based on affordability, parental support, and maternal safety when having a child. Two distinct rankings were produced due to differences in available data sources and healthcare systems: A global ranking of countries A USA-specific ranking of states Each ranking uses three key factors.

All data was collected from publicly available sources and normalised to a score between 0 and 1. These scores were then combined to give each location a total score out of 100, and locations were ranked from best to worst overall. The aim of the index is to assess how affordable, supported, and safe it is to give birth in each location using comparable, high-level indicators.

About iSelect      

At iSelect, we’re passionate about making Aussies’ lives easier by saving them time, effort and money. We are Australia’s go-to destination for comparison across insurance, utilities and personal finance products made available from our range of providers. Our service is provided at no cost to the customer. www.iselect.com.au