IMPACT

Here's What It’s Like To Live In A Country That Actually Cares About Mothers

American mothers get a raw deal post-birth, leaving many feeling exhausted, anxious and unsupported. These countries show it doesn't have to be that way.

When Rina Mae Acosta’s daughter was born last winter, she knew she could count on the help of her fairy godmother.  

Or to be more precise, her kraamverzorgster, the maternity nurse who visits every new mother in the Netherlands daily for the first eight days after giving birth. The nurses spend up to eight hours a day at the new mother’s home doing whatever it takes to help her rest and bond with the baby ― from taking care of laundry or grocery shopping to helping entertain older children ― as well as carrying out health checks. 

“The Dutch believe in the pragmatic approach of ‘mothering the mother,’” explains Acosta, who has two older sons ages 7 and 3 and co-authored “The Happiest Kids in the World: How Dutch Parents Help Their Kids by Doing Less.” “She basically held my hand and instilled in me the philosophy of tending to my own health and needs so that I, in turn, can take wonderful care of my babies. My connection with my maternity nurse was so special that she became a friend and has nursed me and all three of my babies.”

All this comes either heavily subsidized, or completely covered, by a universal health insurance scheme and followed by four months of paid maternity leave. Compare that with the U.S., where women wait four to six weeks for a postpartum checkup and 40% then miss it, according to the American College of Obstetricians and Gynecologists ― possibly because they’re already back at work by then.  

Rina Mae Acosta, who moved to the Netherlands from the U.S., benefited from the far more generous Dutch maternity policies.
Rina Mae Acosta, who moved to the Netherlands from the U.S., benefited from the far more generous Dutch maternity policies.

No wonder Acosta, who moved to the Netherlands from San Francisco after falling in love with her Dutch husband, feels American mothers are rather cruelly “thrown in at the deep end.”

But the Netherlands isn’t the only country offering the postpartum services of an exhausted new mom’s dreams. 

While the U.S. still famously has no universal right to paid parental leave, Sweden grants new parent couples up to 16 months off work between them. The Swedish equivalent of the fairy godmother is letting fathers take up to 30 impromptu days off in the first year, so they can drop everything to support their partners at home if needed. One recent study at the University of Stanford found anti-anxiety prescriptions to mothers fell by 26% after the policy was introduced in 2012. 

In France, new mothers get free physiotherapy for their battered pelvic floors; in Japan, women stay in the hospital for up to 10 days to recover from the birth. And Britain’s system of universal free health care means mothers never even have to see a hospital bill.

Meanwhile, American mothers are discharged earlier than many of their European counterparts, return to work sooner and face the highest maternal mortality rate in the developed world (a risk that’s especially high for black women). No wonder the early months leave so many exhausted, anxious and wondering if motherhood really has to be this hard.  

Lisa Ferland had her first child in her native U.S. and her second in Sweden, which UNICEF recently rated the best country in the developed world for raising kids. The difference, she says, is that the Swedish system is “like getting wrapped in a warm blanket. Someone’s taking care of you.”

When her son Calvin was born eight years ago, Ferland was living in Atlanta, Georgia, and working for a nonprofit public health organization. By hoarding vacation and sick time, she managed three months off, negotiating reduced hours for the first month back: “I felt very lucky. But I was back full time before my baby was sleeping through the night and I think it did lead to some post-partum anxiety, or blues. I was totally exhausted.” When her husband, a telecommunications consultant, was offered a job overseas, she saw the chance for a different kind of family life.

The first thing Ferland noticed when she had her daughter Lucy, now 5, was her midwives’ laidback approach. (Swedish antenatal services are largely midwife-led, with consultants involved only in more complex pregnancies.) “Sweden has a thing called lagom, where everything is not too much and not too little; just the right amount,” she says. “It’s very easygoing, very relaxed.” 

Lisa Ferland moved from Atlanta, Georgia, to Sweden. When she had her child, her husband was able to take 8 months of parenta
Lisa Ferland moved from Atlanta, Georgia, to Sweden. When she had her child, her husband was able to take 8 months of parental leave.

After an unexpected home birth, she and her husband checked into the hospital’s “baby hotel” ― a midwife-led unit where new mothers with uncomplicated deliveries usually stay for up to three days to recover in a private hotel-style room, while being helped to establish breastfeeding and bond with the baby. (Fathers pay a small charge to stay.) “It was so nice, it felt not medical,” recalls Ferland, author of “Knocked Up Abroad,” a collection of stories of expat motherhood from around the world. “We just cuddled in bed looking at our baby and it was the perfect type of bonding, whereas with my son he was whisked away and I could hear him screaming down the hall and he didn’t come back for hours.”

Once discharged, new mothers are handed over to the care of community nurses trained to monitor the welfare of both newborn and parent in the critical early days.

“You do build up a relationship with your nurse because you tend to see them weekly at the beginning,” says Jill Leckie, who was seven months pregnant when she moved to the Swedish capital of Stockholm from England and was still trying to adjust to the location change when she gave birth to daughter Stella. “It was my nurse that cottoned on to the fact that I had pretty serious postnatal anxiety.” 

Although she benefited from a swift referral to a psychologist, Leckie argues it’s not just Swedish postnatal services that boost mothers’ mental health; it’s the seamless interaction of a welfare state, health care and a work culture in which mothers aren’t made to feel guilty about taking time off.

“If you get a call from school saying, ‘Stella’s got a 40-degree temperature,’ you drop everything and your boss just goes, ‘Get out of here,’” explains Leckie, who now runs the website littlebearabroad.com, providing information for expat families and running an English-speaking play group in Stockholm. “That’s really the thing you find quite perplexing about other countries, that presenteeism, the, ‘Oh, my God, I can’t be seen to be having a family. I’ve got to keep working all the time.’ It’s crazy.”

Swedish mothers are also supported by an egalitarian culture expecting fathers to pull their weight. Ferland’s husband took eight months of parental leave, which she says was revolutionary: “It was a complete flip of our social structure as a family for him to say, ‘I could do this.’ It was really good for our marriage to have that role reversal.” The family also benefited from the heavy state subsidy for nursery care, which covers up to 90% of costs for some. “That has allowed me to work freelance and be an entrepreneur, to take those risks ― in a lot of ways it’s more friendly for women entrepreneurs,” says Ferland, who runs her own business as a self-publishing consultant for authors.

Jill Leckie was seven months pregnant when she moved to the Swedish capital of Stockholm from England. She was still try
Jill Leckie was seven months pregnant when she moved to the Swedish capital of Stockholm from England. She was still trying to adjust to the location change when she gave birth to daughter Stella.

Scandinavians do, of course, pay for their generous public services via higher taxes. But are there other, more hidden costs to parenting like this?

The downside of the famous Nordic sense of social solidarity can be pressure to conform to an expected norm. Ferland was taken aback to be told off by her children’s teacher for doing all the school drop-offs and pickups. (Swedish couples usually split it between them, with feminists arguing that women must demand their partner does half the parenting to achieve equality at work.) Stay-at-home motherhood is rare in Scandinavia, as is the use of nannies rather than group day care. 

“The thing you’ve got to understand is that the bedrock of Sweden is conformity,” explains Leckie, whose husband is Swedish. “It’s unusual for someone to stay at home with their child until they’re 3.”

The strongest argument made against importing European-style parenting to the U.S., however, has traditionally been that generous leave might harm women’s careers by cutting them out of the loop during the key promotion years. The Netherlands’ culture of part-time work for mothers has been blamed for hindering Dutch women’s progress into senior positions. The Czech Republic, where parents are entitled to up to four years of leave between them, recently began offering employers incentives for hiring mothers amid concerns that long absences were pushing women out of the labor market.

Yet the evidence now building up from states like California, which pioneered paid leave more than a decade ago, is arguably beginning to change the debate.

In June, Connecticut and Oregon became the seventh and eighth states, respectively, to legislate for paid parental leave, granting 12 weeks of paid time off to new mothers. Four years after Barack Obama raised the issue in his State of the Union address and three years after Donald Trump’s daughter Ivanka egged him into pledging six weeks of paid leave during his presidential campaign, it’s finally a hot topic on this year’s presidential primary trail.

“The political environment is definitely changing,” says Jessica Mason, senior policy analyst at National Partnership for Women and Families, a nonprofit advocating paid family leave and access to health care. “Thanks to those early adopter states, we have really built a case on the evidence about how to make that work.”

Research shows California’s originally groundbreaking policy of six weeks of paid leave not only boosted family life ― mothers reported finding it easier to look after their children and breastfeeding for longer ― but may actually have helped their careers. Mothers who took the leave ended up working more hours when they went back. In other words, taking a break may help some women hang onto a career when they would otherwise have felt forced to give up work entirely. 

When you do paid leave right, Mason says, it can help strengthen women’s attachment to work and also make child care arrangements more equitable. “But the details really matter. One of the lessons [American policymakers] have taken is to make sure that each individual worker is entitled to their own fair share of their leave, so that it doesn’t necessarily need to be split up between two parents,” she adds. 

Mason acknowledges, however, that paid leave should be backed up by better medical care and support postpartum so mothers aren’t left isolated. “There’s a lot of evidence that not only does the person who just gave birth need time to recover, but that mothers need to not be left alone in their apartment for 12 weeks,” she notes.

Paid leave done well can help make child care arrangements more equitable and, in heterosexual couples, can mean fathers take
Paid leave done well can help make child care arrangements more equitable and, in heterosexual couples, can mean fathers take on a more equal share of parenting.

Yet if change is coming, it’s moving glacially, leaving European mothers baffled that American families aren’t angrier with their lot. One explanation is that shifting to a European-style parenting culture would require more than just changing the law; it would mean a paradigm shift for Americans, from seeing happy family life as something parents figure out for themselves to seeing it as something governments fund and provide. 

“It would be a total culture revolution of everything: employers’ expectations, salary expectations,” says Ferland, who points out that while Scandinavians see their children’s services as something everyone invests in via taxes and deserves to enjoy, government handouts are more stigmatized in America.

Mason agrees these cultural differences run deep, but nonetheless, she thinks the gap is closing. “More and more people in the U.S. are not only aware but feeling more confident speaking up on the ways in which we really believe government can be a help to people, and should be playing that role in ensuring all people have access to basic rights and benefits like paid parental leave.” Perhaps one day, the idea of a kinder introduction to motherhood will no longer sound like a fairy tale.

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