The United States
Ostara
Maternal Health Matters
The Ostara design means a lot to me. It’s inspired by the hare that is a symbol of new beginnings, rebirth, and the cycle of life, and I designed it to speak to the issue of maternal health, which is close to my heart.
When I had my children, I was living in Germany, and my experience of pregnancy and postpartum care couldn’t have been more different from what so many women in the U.S. face. I think (hope) that if more Americans knew just how differently most wealthy countries treat pregnancy, birth, and the months that follow they would fight for the standard of care they deserve from the medical establishment and the government.
So, let’s compare the statistics in the U.S. with other countries, and my own experiences in Germany:
The U.S. has the highest maternal mortality rate among developed nations. In 2021, the maternal mortality rate was 32.9 deaths per 100,000 live births, a significant increase compared to previous years.
For Black women, the maternal mortality rate is 2.6 times higher than for white women, a shocking statistic that illustrates pernicious systemic racism and racist medical misinformation about Black women’s bodies and pain.
Over 50% of maternal deaths in the U.S. are preventable with proper medical care and timely intervention, but 7 million women of reproductive age in the U.S. live in counties without access to maternity care (hospitals, birthing centers, or obstetric providers).
The average total cost of childbirth – encompassing pregnancy, delivery, and postpartum care – is approximately $18,865. This ranges from around $14,000 for a vaginal delivery, to over $25,000 for a C-Section.
Even with insurance, pregnant women in the U.S. have to pay an average of $4,500 per pregnancy out of pocket.
Medicaid covers nearly 50% of all U.S. births, but many states end Medicaid postpartum coverage just 60 days after childbirth, leaving mothers vulnerable to complications like postpartum depression, hemorrhage, and infections.
Many women in the U.S. only receive a single postpartum check-up 6 weeks after delivery, despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) for ongoing care during the “fourth trimester” (the first 12 weeks postpartum).
About 1 in 7 women experience PPD, but less than half receive treatment. Untreated PPD can significantly impact both maternal and infant health.
The U.S. is one of the only developed nations without guaranteed paid maternity leave. While the Family and Medical Leave Act (FMLA) offers up to 12 weeks of unpaid leave, it only applies to certain employees, leaving many without any job protection.
Over 23% of employed mothers return to work within 2 weeks of giving birth due to financial pressures.
Other Wealthy Countries
Countries with robust maternal healthcare systems have drastically lower maternal mortality rates. Finland is among the best globally, with 3 deaths per 100,000 live births, but Germany, France, the United Kingdom, Australia, and Canada all have maternal mortality rates X to Y times lower than the U.S.
In countries like Norway, where universal healthcare ensures equitable access to care, maternal mortality rates do not differ significantly by race, thanks to proactive measures addressing systemic inequality and culturally competent care.
Germany mandates every pregnant woman be assigned a personal midwife, even in rural areas. Prenatal visits are frequent and fully covered, ensuring all women have access to comprehensive care.
In Sweden, Canada, Germany, the UK, and many other countries, childbirth is free as part of universal healthcare, with minimal costs for additional private options. Even without health insurance the total cost that anyone would have to pay for a vaginal birth is around 3,000 Euros.
France, Germany, and other European countries provide free postpartum care for six months or more, including pelvic floor therapy and mental health support, ensuring women have sufficient recovery time and resources.
Globally, over 80% of countries guarantee paid maternity leave. For example, Sweden offers 16 months of paid parental leave. In Norway, parents can choose between 49 weeks at full pay or 59 weeks at 80% pay. Even countries with less generous systems, like the United Kingdom, guarantee 39 weeks of paid leave.
Countries like Finland, Germany, Scotland, and others not only provide comprehensive prenatal care and free health services for pregnant women, they also provide essential supplies for both mother and baby.
For example, Scotland’s Baby Box initiative aims to provide every new baby with a box that acts as a safe sleeping environment, filled with clothes, diapers, nursing pads, a thermometer, and more.
My own experiences as a mother have given me an understanding of what this means in practice. As a pregnant woman in Germany I had regular OBGYN visits—monthly at first, then weekly, then every other day, then daily as my due date got closer. I had my own midwife who made house calls before and after the birth, checking on me and my baby as often as I wanted. And it was that midwife who realized that what I had thought was normal post-birth cramping and exhaustion was actually a severe postpartum infection. Without her I wouldn’t have realized something was wrong until I was very sick indeed. When I struggled with PPD after my first daughter was born (she was a Schreibaby or a “scream baby” – German has a word for everything) I not only had access to mental health support, I was provided with a postpartum doula who came to my house, held the baby, cooked, whatever I needed. For all that I paid… nothing.
On top of all that, I had 14 months of paid maternity leave and access to affordable daycare – by affordable I mean around $200 per month for full time care, and if I had been living in neighboring Berlin it would have been free – plus time off to care for my kids if they got sick. I wasn’t just surviving; I was supported. And when I think about how many women in the U.S. go without even the most basic maternal healthcare, especially those in marginalized and underseved communities, it’s infuriating.
It doesn’t have to be this way. If those in power cared enough, we could make these supports a reality here, too. The image of the hare, a symbol of the goddess Ostara, is meant to remind us what’s possible; that we can demand better. Mothers and babies in the United States deserve more than what they’re getting now. They deserve real care, real support, and the chance to thrive.