It's 'almost free' to have a baby in Finland—and feels like 'the whole country is providing for a child'
When Maria Ainamo-McDonald, a 30-year-old marketing specialist who lives in Helsinki, Finland, gave birth to her son, it was "almost free." She stayed in a private hospital room for three days with her husband and new baby, where they received meals and support from hospital staff, she tells CNBC Make It.
The bill was around $327.
"It's basically like living in a hotel," Ainamo-McDonald says.
In the United States, the average out of pocket cost for maternity care is $4,500, according to a recent University of Michigan study. And the quality of care and facilities can vary drastically depending upon the hospital.
But Finland looks at giving birth differently than the U.S. — there healthcare is a right and giving birth is a family affair that emphasizes the mother and baby's well being. From the generous maternity packages granted to new parents, to the lengthy parental leave that Finnish people are guaranteed, many see Finland as the ideal place to give birth and raise kids.
Midwives and water births are standard
Finns are reimbursed almost in full other than the hospital stay (in Helsinki, the capital of Finland, a day fee for a hospital stay costs about $42 and the average stay is two or three days, according to the city's social services and healthcare division). It's also considered one of the safest countries to give birth, according to Seppo Heinonen, head of the department of obstetrics and gynecology at Helsinki University Hospital.
In part that's because hospitals treat the birth experience differently in Finland than in the US. For instance, midwives usually lead the birthing process In Finland, unless there's a complication or a pre-determined risk, Anu von Lode Valkeajärvi, a spokesperson for Kela, tells CNBC Make It.
At Helsinki University Hospital, people giving birth are guaranteed a midwife, and only see an obstetrician-gynecologist if there are birth complications. Mothers are also offered water births, according to Aydin Tekay, a physician in the department of obstetrics and gynecology there, told CBS in 2019.
In other countries with lower maternal and infant mortality rates, such as Canada and New Zealand, midwives are also the norm. Midwives tend to be less expensive, and are equipped to safely perform low-risk hospital births.
The midwifery "model of care" also emphasizes education, psychological well-being and reducing technological interventions during childbirth, according to the Midwives Alliance of North America. Studies suggest that the benefits of using a midwife include a decreased risk of needing a C-section and higher levels of satisfaction with the quality of care.
"We also try to as much as we can, listen to mother's hopes, wishes, what she wants to do," Heidi Kytoeaho, a midwife at Helsinki University Hospital, tells CNBC Make It.
One factor that makes the care so great is that the whole family gets to be present throughout the birthing process, Kytoeaho says. "I think that is the best part."
In the U.S., midwives only account for 8.3% of births, according to the latest statistics from the American College of Nurse-Midwives.
Free baby products for new parents
Social security programs for parents, like the maternity grant that gives new parents a box filled with 63 items for a new baby, are another big part of Finnish culture.
The free baby box includes clothes like: a snowsuit, booties and mittens, a sleeping bag and blanket, a light-weight overall, a wool coverall, a wool cap, a face mask for cold weather, a cap, multiple bodysuits, leggings and socks. The box also contains personal care items like a toothbrush and thermometer, plus bibs, blankets, towels, a book and a cuddly toy. Each year, the government agency Kela provides different products and designs, and companies can apply to have their items included.
The box itself is also part of the deal, because it can serve as a baby's first bed. Ainamo-McDonald said that her son slept in the box for the first month.
The items are also very nice, "not some low-quality charity thing," Anu Partanen, a Finnish journalist and author of "The Nordic Theory of Everything" tells CNBC Make It.
More than just its utility, the box is a "cherished tradition" that makes parents feel like "the whole country is providing for a child," Partanen says.
All parents who give birth in Finland have the option to take the birth box or a $185 stipend, but 95% of first-time mothers choose the box, according to Kela.
When women are discharged from the hospital after giving birth in the U.S., they're given a few supplies like diapers or wipes, and maybe instructions from their care team about what to expect, Michelle Moniz, Ob/Gyn and health services researcher at the University of Michigan, tells CNBC Make It.
But the benefits of the baby box are broader than just having the right tools to care for a newborn. "[The box] 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," Emily Oster, professor of economics at Brown University, and author of "Expecting Better" and "Cribsheet" tells CNBC Make It.
Substantial parental leave
Nordic countries famously have "very extensive and very generous" family, parental and sick leave, Jeff Sachs, a professor of economics at Columbia University, and co-creator of the World Happiness Report, tells CNBC Make It. (This is one reason why Finland is consistently ranked number one on the World Happiness Report.)
In fact Finland announced earlier in February a policy change allowing Fins to receive the same parental leave regardless of gender identity. The government attributed the changed to its "investment in the future of children and the well-being of families," according to a statement from the Ministry of Social Affairs and Health.
The policy allots an equal quota of 164 days to each parent and allows people to transfer 69 days to one another if need be. (Single parents get double the parental quota.) Pregnant parents also get an extra month before they go on parental leave. It could go into effect in the fall of 2021, according to the ministry.
The U.S., on the other hand, is the only developed nation that doesn't have a federally mandated paid parental leave policy, according to the Organization for Economic Cooperation and Development (OECD). Under the 1993 Family Medical Leave Act, companies with more than 50 employees have to provide 12 weeks of unpaid leave for new parents. And starting in October 2020, federal employees will receive 12 weeks of paid parental leave after the birth, adoption or foster care placement of a child.
There's strong evidence that suggests that paid parental leave, and maternity leave in particular, leads to numerous benefits including improved health for the baby and birthing person, better worker morale and retention and increased income, according to the American College of Obstetrics and Gynecologists.
"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," Moniz says.
The best of both worlds
Of course, there are some things that U.S. does very well, says Oster.
"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," she says.
However, "where we are experiencing a lot of inefficiencies without a lot of benefits are in the kind of low-risk space."
The U.S. is the only country among its peers where the maternal mortality rate is rising, according to Moniz. In Finland, the maternal mortality ratio is three deaths per 100,000 live births, while in the U.S. it was 17.4 deaths per 100,000 live births, according to a 2020 estimate from the Centers for Disease Control. The rate is 2.5 to three times higher for black women in the U.S.
And Finland's healthcare system is certainly not perfect.
Healthcare is mostly funded by municipal and state tax revenues, von Lode Valkeajarvi says. But as the Finnish population ages, and people have fewer children, the country has fewer tax payers. (In fact some Finnish municipalities pay residents as much as 10,000 euros or $10,838 over the course of 10 years to have a child.) In March, the Finnish government resigned because they were unable to pass healthcare reform aimed at cutting public social and healthcare expenses from an estimated $21.3 billion to $18.3 billion.
—Additional reporting by Emma Fierberg and Jessica Leibowitz
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