How to not go broke when you have a child . . . (move from the US to Sweden)
I was born in Seattle, Washington and spent most of the first 40 years of my life in the Northwest US. After traveling led me to meet my Swedish husband, Mattias on the swing dance floor, we decided we wanted to be together and have a child. We knew that it would be much more affordable for us to live in Sweden, but it was eye-opening the contrast when I actually crunched the numbers for this article. Read on to hear the story behind the numbers.
The comments I hear constantly when discussion of healthcare reform comes up are,
“But, those other countries pay such high taxes! I don’t want to pay for someone else’s problems.” What if you look at it in a different way and think about how much money you have left after paying healthcare expenses and taxes?
For this comparison, I use my income as a music teacher in the US, compared to my income as a music teacher in Sweden, when making roughly the same income. ( I converted all the figures to US dollars.)
It is mentioned here, if the US would get rid of the insurance companies, a lot of bureaucratic mess and money would be freed up to actually put toward the cost of covering everyone, but my point here is to show what the actual costs and benefits are if you live with universal health care, parental leave, and higher taxes.
In 2013 in the US on an income of $34,800 per year, I paid 13% or $4,524 in taxes and spent $5,760 on healthcare (health insurance premium as a self-employed person and out of pocket expenses for care).
In Sweden on the same income, I paid 24% in taxes or $8,340 and spent around $900 on healthcare. (Chiropractic, acupuncture & doctor co-pays)
My husband’s salary was about the same as mine for the two years I am looking at here, so I estimate our combined household income for the year was around $70,000 (before I got pregnant).
Living in Sweden during the year of pregnancy and the first four months after birth; after subtracting my deduction in salary, healthcare costs and taxes for both of us, we still had $48,049 to spend. That meant that we had money to pay for rent and food and not go into debt.
By my estimation, if we had been in a similar income bracket in the US, we would have had $3,311 to spend for the whole year, after paying for healthcare and taxes. I’m ok with paying more in taxes.
Cost Per Year
The “normal year” taxes + healthcare expenses
Sweden 2015 =$9,240 compared with U.S. 2013=$10,284
The “birth year” with taxes + prenatal care, birth, NICU, health care for the first 4 months
Sweden 2016 = $7,341 Estimated expenses if in the US = $45,765
Loss of income compared to working full time:
Sweden = $6,270 Estimated if in the US = $17,400
(You can see my calculations at the end of this article for what it might have cost me to have the same pregnancy and birth in the US. I used averages from looking at different women’s real stories of how much their out-of-pocket expenses were for things, but it varies so widely, I’m sure it could have cost more than my calculations.) What follows is my healthcare and parental leave story behind the numbers.
After going through 4+ years of fertility challenges with a previous partner and working with a fertility clinic in Seattle, I was told at age 37, that my only option to get pregnant was to do IVF (to the tune of $15,000 just for one attempt). At that point, I was fed up with the fertility clinic after several months of IUIs and an ectopic miscarriage and already spending thousands of dollars out of pocket. Around the time that I quit the fertility clinic, I started seeing a spiritual coach to deal with all my depression. I had a dream one night that I needed to “get them out” and that led me to a holistic dentist that explained that the root canal treated teeth and titanium teeth implants I had were causing inflammation and infection in my body. They said on the first visit that it was likely the source of my infertility. So, I worked through 4 different surgeries to heal and repair and my health improved greatly, but at the same time, my marriage dissolved. It was 4 years later that I reconnected with Mattias — who is now my husband — and told him I was planning to become a single mom by choice. We started dating over a shared interest in being parents. And a year later, I found myself living in Stockholm, Sweden. By this point, I was 42 years old and I hoped I was fertile, but I wasn’t sure how everything was going to play out. After several months of going to acupuncture and not being pregnant, I decided we better check in with the fertility clinic here in Sweden. Just after my 43rd birthday, at the first visit with the doctor, the test confirmed I was pregnant.
At 16 weeks along, I was doubled over in pain and unable to get out of bed for nearly 2 days. I’m not sure why, but my instincts were that my baby was fine and that I needed to rest. But, after 2 days, when the pain went down a bit, I called the national healthcare nurses and they said I needed to go into emergency to be checked out. There was no fear of what the costs would be or if I was at a hospital that was “in-network” I simply went in to be seen. And they told me I had some really huge fibroids (non-cancerous tumors)- along with a strong healthy baby. The fertility doc had told me about this when he confirmed the pregnancy, but he only saw the very small one and didn’t catch the larger one that was sitting up above the uterus. It grew to about 12cm during pregnancy. Everyone kept asking if I was having twins.
Once I was seen by the emergency room doc, they asked how I was going to be able to handle work. They had me follow up with a doctor. I was prepared to have to make a huge case for why I needed time off work, but instead, this doctor looked at me and said, “What do you need?”
I was American. I was preparing to list all my symptoms and why it was difficult for me to work a full day. The doctor stopped me mid-sentence, “I know fibroids make things difficult, you don’t have to tell me every last symptom, just tell me what you need.” And he wrote me a note to go to half time work. With that note and some paperwork at my job, social insurance paid my salary at 80% for the part of my pay that I was missing.
My boss sat down with me and asked as a teacher “Which classes do you want to take off your schedule?” He didn’t pressure me to keep working full time or threaten me with job security issues. It was a matter-of-fact conversation about how best I could take care of myself because my employer wasn’t the one paying for my time off.
I knew if this had been happening in the US, then there would have been no sick leave or parental leave at all. I got paid if I worked and didn’t get paid if I didn’t work.
I cut my hours back to 4 days a week and when I went home each afternoon, I was mostly on bed rest for the hours I was home.
My back was in pain quite a bit of the time with all the fibroid issues and trying to cope with the stress of my job. I was able to go to the chiropractor and since I had paid out of pocket to a certain maximum for some visits before I got pregnant (It’s about equivalent to $120 per year before the rest is covered), I went multiple times during the pregnancy with no co-pay.
I struggled with wanting to go to swing dance evenings, but I had a lot of pain and dizziness if I was dancing for too long, so mostly I would hang out and watch others. Sometimes it was just nice to be social. I navigated my way with an increasingly bigger belly to the end of the school year in June and then felt quite good during July as I was free from work and it was the first time that I really realized — I’m going to have a baby. We hadn’t bought any baby things before that point. Having fertility challenges and friends with miscarriages in the past, meant I wasn’t sure that it was all real for a long portion of the pregnancy. But, when August rolled around and my due date was mid-September I debated about going back to school. I didn’t want to use up too much parental leave ahead of time, but I also felt my health was very important. So, I decided to try to go back part-time for the teacher days before school started.
I went and sat in a meeting for one morning and realized that was too much. I was able to go back to the doctor and ask for a full sick leave note. So, now I was able to get 80% of my full salary during the time until the baby came. (For those in Sweden who do not have pregnancy complications, but simply feel like the last part of the pregnancy is too much to keep working, you can opt to start your days of parental leave a few weeks before the baby’s due date.)
It was good that I got the doctor’s note because only a week after my attempt to return to work, my son was born three and a half weeks early. My husband had been off on a week of vacation where we were trying to get some projects done and get some basic things for the baby so we would be all set. The day before he was supposed to go back to work, I went in to get checked because things weren’t feeling right and my water broke right on the examining table, but I was not yet in labor. They allowed me time to go home and get ready and see if it got started, but by the next morning when we arrived at the hospital, labor had to be induced. Our son made his grand entrance in the wee hours of the night, with the help of some acupuncture and water for pain relief.
It felt so empowering to push him out and meet this little miracle that had been growing inside of me. He was born 11 years after I first tried to conceive and I never imagined that it would take learning to lindy hop, getting some teeth taken out, learning a new language and changing countries to finally get my wish.
The hardest part of the day was not the birth itself, it was afterward when they laid him very briefly on my chest and then poked him and said he wasn’t crying well enough. “We have to take him to get some breathing support.” And they took my husband away with him. He turned out to need more oxygen and NICU support that wasn’t available at the hospital where we gave birth. So, we would be transferred.
There is nothing glamorous about being in a taxi only an hour or so after birth without your baby and an empty car seat because the baby has been sent ahead in an ambulance. I remember clutching a teddy bear I had brought with me to the hospital — not knowing how much I would need it. It was the teddy bear that was given to me after my previous miscarriage. And the teddy bear that I left with my grandma when she had to stay in the hospital a couple of years later. And now, the teddy bear that would be in my arms as we traveled without my son.
When we got to the new hospital we had a room in the extra care ward and our son was in the NICU two floors below. We spent time sitting in a chair and being handed this little guy with all the tubes hooked up to him. And somewhere in between seeing him, I was supposed to get cozy with the breast pump every few hours to try to get my milk started. I was grateful when the NICU nurses said,
“He’s so big for our unit that this little monitor keeps falling off his foot. Don’t worry. He’ll be out of here quickly.”
But, the next morning as I tried to get sleep after pumping instead of visiting him in the middle of the night — I woke up at about 6 am and couldn’t stop sobbing. My husband finally heard me and also quite bleary-eyed — said:
All I could squeak out was
“I want my baby. . .” and I kept crying.
He held me and said we would go to eat breakfast and soon go down to see him. But, as we were sitting at breakfast, the NICU team came to say he had graduated from needing oxygen support and that he would be brought to us in an hour.
I was overjoyed to have him back with us.
It took a lot of extra time with the breast pump to get my milk started and Mattias did all the first feedings. He fed cups of formula and then little bits of my breastmilk until finally, Emanuel started to have the energy to also breastfeed. (If you have also struggled with getting breastfeeding going and end up with some or all formula feeding, read my article for more support here.)
We had 7 days total in the hospital and I remember thinking that my friends in the US were kicked out of the hospital when their babies were in NICU. I felt so blessed to be able to be with extra care and not have to travel back and forth to our apartment at the same time as dealing with a sick child. And, at some point, the doctor brought us paperwork to submit so that we could get paid for the care of a sick child (called VAB). It is the same money you get when your child is in preschool and you must be home to take care of them when they are sick. But, with the case of the hospital and NICU, they granted both of us VAB pay. This meant that our 2 weeks of double parental leave wouldn’t start until we were out of the hospital. So, I got 3 weeks with Mattias to help me get on track with breastfeeding and pumping and caring for a new little person in our household.
I remember in one of our moments of calculating how much breastmilk I had pumped and at what time we had collected this — I looked at Mattias and wondered —
“What if we were in the US? You wouldn’t be here able to help me and I would be looking at shortly going back to work.”
After my son got over the breathing issues in the hospital, he got jaundice and needed extra time under the sun lamps. And it returned again when he was 6 weeks old, and that required a trip back to the hospital for a check-up. We spent lots of time with doctors and nurses in those beginning weeks. And at home, there were many sleepless nights. But, I was never up at night trying to figure out how we were going to pay the bills.
What is the impact on the income of the mom’s who take time off to have a child or take unpaid leave? We tend to focus on the birth and health of the child, but what about the emotional and physical health of the mom?
Many Americans are forced to have a stay-at-home parent because the cost of childcare is so high. So, I also wanted to calculate what the cost was in the lost salary for me. And for the numbers, I only calculated for the 3 trimesters of pregnancy and the 4th trimester after birth. For 9 more months, I was off on leave — with a secured position from my job. I simply had to request 2 months in advance that I would be gone for 1 year of parental leave. (Parental leave and healthcare are paid by the government, not by employers, so there isn’t the same worry I felt from my American friends about how having a child would impact their job and income.)
We chose to stretch out the leave days so when I was home for the first year, instead of taking 7 paid days a week, I took out 4 and that made my parental leave last longer. I had several teacher friends where the mom took leave for the first year and the dad took leave for the second year. And then many others that trade-off days so they are each working fewer hours. (We have 480 days to share, with 90 days reserved for each parent — and you can use them anytime until the child turns 7 years old. These days are also available for adoption.)
My husband planned to take a year off for the second year, but his boss had such a small company that he requested that he work part-time instead. So, our son started in preschool at 1 year old, 2 days a week, alternating with 3 days a week, on the days that my husband was working. I reduced my working hours to 75% time (which is a guaranteed right you have as parents of young children) so that on the days that Mattias worked, it would be less stressful to pick up my son and prepare dinner and everything. I found it hard to go back to work when my son was a year old. I don’t think I could have handled going to work when he was 6 weeks old. I would have just quit a job that forced me to do that.
One thing I am grateful for here, beyond the money and time afforded by parental leave, is the fact that men are more involved in child care. When you go down the streets in Sweden, you see just as many men pushing strollers as women. One day, when I went into the breastfeeding room at the mall, there was a guy there with his 9-month-old, heating up some food and feeding. I remember having a conversation with him about how great it was that he was so involved with his child.
He said something like, “I’m no hero really. Just an average guy feeding my child.” But, there are so many men that would like to be more involved with their kids in the US, but they aren’t allowed time off and there is a work culture where they are expected to not change work schedules when a child comes.
Many men I have talked to, my husband included, have felt a shift in their bonding with their children when they are the stay at home parent for an extended period of time. You get to be the first one to see them do that new thing that they are learning and the first one to get spit up all over you. When both parents have a chance to experience this, it really does have an impact on the kids. (Our son was only able to be comforted by my husband at the very beginning because he was the one doing all the feedings.)
So the next time someone tells you to forget universal healthcare because the taxes will be too high. Can you please tell them that I’m happy to pay more taxes in trade for not paying my entire earnings to healthcare.
I want you to think about what legacy impact you want to have on our children. What kind of role models do you want them to look up to? What kind of boundaries between work and family do you want them to have? If we want women to truly be equal partners in the world of work, we have to support health care for everyone and paid parental leave. No one should have to go bankrupt because they had a child.
Here is the breakdown of my cost calculations:
Sweden: $22 / US Estimate: $2,440
$22 / $200 - fertility specialist/ultrasound
$0 / $350 -10 midwife visits
$0 / $105 3 doctor checks
$0 / $35 blood workup 7 ultrasounds
$0 / $350 -Chiropractor 10 visits
$0 / $1,400 -7 ultrasounds
Sweden: $25 / US Estimate: $40,600
Mom: $0 / $21,000 -Cytocin for labor induction, Acupuncture during labor, hospital Mid-Wife assisted birth, 7-day mom stay at the hospital, Recovery in extra care ward: nurses/midwives/doctors on call 24/7 a single room
Baby: $0 / $18,600 -5 days NICU for baby (just two floors away from our extra-care ward), 4.5 days with mom and dad in extra care ward, Transfer by ambulance from smaller hospital to one with NICU
Partner: $25 / $?-Extra fold-out bed for him to stay in and his only charge was for the meals
Transport: $0 / $1,000 -Ambulance for baby and taxi for mom and dad for change of hospitals to one with a NICU
First 4 months with my child:
Sweden: $0 / US Estimate: $985
$0/ $350 Well-child visits and an
$0/ $600 ER visit for jaundice at 6 weeks with doctor follow up at 8 weeks
$0 / $35 Check-up for mom
Loss of Salary compared to working full time the year before:
Sweden: $6,270 / US Estimate: $17,400
$870 -During pregnancy from going to half time work (I got social insurance money for 80% of half my salary, so it was like going to 90% pay.)
$5,800 — loss of income from spreading out parental leave days during the first 4 months (I was paid at around 50% my salary as opposed to 80% if I took out more days all in a row.)
(+$400 Child payment credit that is paid each month- split between the parents -instead of as a tax break once in the year like in the US.)
$5,800 -Income loss of $1,450 per month for April-July during pregnancy
$11,600 — complete loss of income to take off 4 months (no sick pay or parental leave being self-employed)
24% in Sweden vs. 12–13% in the US
Sweden 2015 — $8,340 / 2016 $7,294 (For the family calculations I estimated Mattias tax to be about what I paid in 2015.)
US taxes I paid in 2013 — $4,524 and an estimate for 2016 US $1,740 (based on the reduced income of $14,500 for that year and I added the taxes I paid in 2013 as an estimate of what Mattias would pay on around the same income.)