On May 10, many flowers and many boxes of chocolates will be gifted to mothers in the United States, Canada and elsewhere. Greetings will be filled with joy and gratitude for maternal presence. Mothers will wear their finest clothes to spend time with their children, receive gifts and enjoy a beautiful day.

It is no wonder most countries in the world have a Mother’s Day, even if it is on different dates. Motherhood is a wondrous thing, and it needs to be celebrated. But there is one place on Earth where it brings heartache to many.

In Gaza, where 22,000 women have been killed in two and a half years, many children dread this special day because it reminds them of intolerable pain. Too many mothers have died and many more are gravely ill.

My own mother, Najat, who is just 46 years old, is suffering from cancer, which was diagnosed quite late.

On March 21, when the Arab world celebrated their mothers, I did not say “Happy Mother’s Day” to mine. Instead, I silently prayed that she would remain with us a little longer. I did not think about celebrations; I thought about my own fears of losing her.

On Mother’s Day, my mother did not wear her finest clothes and did not join us for a special meal, smiling and looking happy. She was frail and worn down.

A week before Mother’s Day, she had undergone her third round of chemotherapy and had spent days bedridden, unable to move and barely able to speak. No words in the world would have been enough to tell her how much she meant to me that day. But I stayed silent. On the day when others celebrated their mothers, I held back my tears so I would not add to her pain.

My mother’s case is not unique. The genocide has brought immense suffering to Gaza’s mothers. And that pain, misery and death start from the moment women step into motherhood. Maternal death rates during childbirth increased threefold during the genocide. A recent report documented 220 Palestinian women dying while giving birth in Gaza between January and June 2025.

The famine disproportionately affected pregnant and breastfeeding women, putting them and their children at risk of death and various health complications. Mothers had to go through the pain of watching 70,000 children languish due to malnutrition. More than 150 mothers had to bury their children who succumbed to the famine.

More than 22,000 women have lost their husbands and are now forced to be the mothers and fathers of their children, carrying on their backs alone the excruciating task of survival amid a genocide. Many others may not have lost their husbands, but they still are the main caretakers of wounded and ill children or the elderly in their families.

Many have to live with the constant throbbing pain of losing their children in the Israeli attacks; more than 21,000 of the victims of the genocide were children.

All the while, the burden of running a household has grown immensely as there is no running water, electricity, or normal access to food. Life in tents that do not protect from the scorching heat or the freezing cold, from disease or pests, is intolerable. And so is the loss of loved ones. Even the most resilient mothers of Gaza are at the threshold of their strength.

It is no wonder that so many mothers are getting sick. But Israel has also made sure that they are not getting the treatment they need.

The Israeli army has bombed all hospitals in Gaza and destroyed the only specialised oncological hospital. That has meant that not only are cancer and chronic illness patients not receiving proper treatment, but also that, during the war, there was no way to carry out the necessary regular checkups that can catch diseases in early stages.

The doctors told my mother that her cancer had been growing in her probably for nearly two years. Early discovery could have made treatment much easier and improved her chances.

I am truly living the worst days of my life. I am torn between my fear for her and the need to muster the strength to replace her at home. I see her break every day, little by little, which breaks me.

I am the eldest daughter, and so the responsibility for the household has fallen on my shoulders. My mother used to do everything as if it required no effort at all, as if life simply moved on its own. Now I have stepped into her shoes and realised just how exhausting this work has been.

I look at my only sister, who is just three years old, and try hard to convince her that I am happy and that our mother is fine. I keep telling her that Mom’s hair will grow back long and beautiful again. On every chemotherapy day, my sister asks me, “Where did Mama go?” I take a deep breath before answering that she has gone to the doctor. It is not a simple question to answer while trying to keep in mind the pain of the reality it exposes.

I cook, clean, and take care of everyone at home. When I am done and it is time to take a break, my mind does not rest. It keeps asking incessantly: “Will she recover? Will she come back to us as she was? Will these heavy days pass?” Every possibility that crosses my mind exhausts me and weighs heavily on my heart. This is not a passing crisis. This is my mother, and this is cancer, and this is Gaza amid a genocide.

We are now waiting anxiously for her surgery – full mastectomy – to be scheduled.

Doctors have said my mother also needs radiation therapy, which is not available in Gaza now. She has been given a medical referral, which has not been approved yet. She is one of 20,000 Palestinians in Gaza in urgent need of evacuation, which has been purposefully made brutally slow.

Every now and then, my mother looks at the referral paper that confirms her urgent need to travel and sighs deeply with sorrow. I cannot tell what she is grieving most, her illness, the mastectomy, her changed appearance, or the restricted Rafah crossing.

I am almost certain that her heart cannot bear all of this and that her mind may one day collapse under the weight of all this pain. Her suffering – and that of so many other Gaza mothers – will not even be captured in a statistic. It will go unseen – just as the architects of the genocide intended.

For millions of women in the United States, being a mother comes with an extraordinary price tag.

From the earliest stages of pregnancy through childbirth and into years of childcare, expenses for healthcare, delivery and raising a child are significantly higher in the US than in most other wealthy countries. Even basic needs like medical care and childcare can place a major burden on families.

At the same time, the US has one of the highest maternal mortality rates among high-income nations at 18.6 deaths per 100,000 live births, compared with fewer than three in countries such as Norway, Ireland, Switzerland and Italy.

Black women are about three times more likely to die from childbirth complications. In 2023, the maternal mortality rate was 50.3 per 100,000 live births for Black women, compared with 14.5 for white women and 12.4 for Hispanic women, according to the US Centers for Disease Control and Prevention (CDC).

As people celebrate Mother’s Day in the US, Al Jazeera breaks down the cost of giving birth, maternity leave policies and childcare costs in the country compared with the rest of the world.

The high cost of giving birth

In the US, the cost of childbirth can vary widely depending on insurance coverage and whether the hospital and doctors are “in network” or “out of network”.

In-network providers have agreements with a mother’s insurance company, which usually means lower, negotiated prices for patients. Out-of-network providers do not, so even insured patients face much higher bills or unexpected charges.

According to the US Census Bureau, about 92 percent of Americans in 2023 had health insurance coverage through public programmes, such as Medicaid and Medicare, or private insurance, meaning roughly 8 percent were uninsured.

Even insured mothers can face bills running into thousands of dollars for routine deliveries, emergency procedures and postnatal care.

According to data from FAIR Health, an independent nonprofit organisation that analyses health insurance claims data, the national median in-network charge for a vaginal delivery is $15,178, rising to $19,292 for caesarean section births.

The map below shows the in-network costs per state. The most expensive include:

• Alaska – $29,152 (vaginal birth)  $39,532 (C-section birth)
• New York – $21,810 (vaginal birth), $26,264 (C-section birth)
• New Jersey – $21,757 (vaginal birth), $26,896 (C-section birth)
• Connecticut – $20,658 (vaginal birth), $25,636 (C-section birth)
• California – $20,390 (vaginal birth), $25,169 (C-section birth)

Maria Haris, 40, was born and raised in the US and now lives just outside Denver, Colorado.

She asked that her name be changed because she was worried that revealing her identity could lead to backlash in her community.

Maria has a three-year-old daughter and is now in a single-income household after being laid off just weeks before her due date.

Now that her daughter is in preschool, she is trying to return to her corporate career but is struggling despite having been in well-paying roles throughout her career.

Haris said that despite having top tier insurance coverage, her childbirth and post-birth care has been a big financial burden.

“It was about $40,000 for the three days that I was in the hospital and about $6,000 a night for the room,” Haris said, explaining her out-of-pocket costs for her natural birth were about $3,000 out of the total.

She said she was charged nearly $600 a tablet for over-the-counter pain medication that was barely $5 a bottle at the time in supermarkets.

“My daughter had jaundice, and right after we got back from the hospital, she had to go into the NICU [neonatal intensive care unit] the next day, and we got another ridiculous bill for the nearly three days she was in the hospital.” she told Al Jazeera.

“I still have payment plans from her NICU visit three years ago.”

In-network vs out-of-network care

Medicaid is the single largest payer for childbirth in the US, financing 40.2 percent of all deliveries in 2024.

Medicaid is a US government health insurance programme for low-income people with pregnant women typically qualifying if their household income falls around or below roughly 200 percent of the federal poverty level. On average, that works out to about $50,000 a year for a family of three.

Compared with countries where public healthcare systems cover most childbirth costs, many Americans navigate pregnancy through a patchwork of private insurance, deductibles and hospital charges that can leave families with long-term debt.

According to data from FAIR Health, the national median out-of-network charge for a vaginal delivery is $31,117, rising to $44,432 for C-section births.

The map below shows the out-of-network costs per state. The most expensive include:

• Nevada – $49,699 (vaginal birth), $72,604 (C-section birth)
• New Jersey – $42,712 (vaginal birth), $55,730 (C-section birth)
• California – $42,078 (vaginal birth), $66,662 (C-section birth)
• Florida – $39,256 (vaginal birth), $57,072 (C-section birth)
• Alaska – $38,800 (vaginal birth), $55,997 (C-section birth)

“People should know there is a charge for the nurses in the NICU, and if there’s ever a doctor, each doctor has their own in-network plans. If a doctor comes in to see you and that doctor is not in [your] network, you are then responsible to pay out-of-network costs for that doctor,” Haris told Al Jazeera.

She said Colorado passed a law a few years ago that if doctors are out of a patient’s network, they have to let the patient know and the patient has to sign a document to essentially be responsible for the costs.

The difference between in-network and out-of-network care can mean the difference between manageable medical costs and a financial crisis.

In some US states, out-of-network childbirth costs can rise to several times the average monthly income, particularly in emergencies where patients have little control over where they receive care.

‘I wish I had more time with my new baby’

The US remains one of the few wealthy countries without federally guaranteed paid maternity leave.

While many European countries offer months, and in some cases more than a year, of paid leave funded through national systems, American workers often rely on unpaid leave, employer benefits or personal savings.

The federal Family and Medical Leave Act 1993 guarantees some workers up to 12 weeks of unpaid leave, but millions of employees do not qualify or cannot afford to take time off without pay.

Jade, 43, is an African American mother of two from Chicago, Illinois, who requested her last name not be used.

She said her maternity leave fell short when she last gave birth eight years ago. Although she received 12 weeks of paid leave at 60 percent of her salary, followed by an additional four weeks unpaid, it still wasn’t enough to fully cover her needs.

“I wish I had more time at home with my new baby. But I was worried that if I requested more time that they would not grant it or my job would no longer be there, not to mention that the loss of income would be hard for my family. So I returned to work when my baby was four months old, and in the US, that is considered a good amount of time off, but in my heart, I knew it was not,” Jade told Al Jazeera.

Her total bill for her last childbirth in 2018 was just over $46,000, of which she had to pay $18,000 herself.

Maternity leave policies vary dramatically around the world, but most wealthy nations offer far more generous protections than the US.

The Balkan region consistently offers some of the most extensive leave policies in the world, often surpassing Western Europe in their duration.

Bulgaria leads globally, offering nearly 59 weeks of leave at 90 percent of a woman’s salary, while countries like Germany, Austria and Luxembourg guarantee full pay for 14 to 20 weeks. In the Nordic countries, generous parental leave systems, often shared between both parents, can extend to a year or more.

Childcare costs in US among world’s highest

After childbirth, childcare costs continue to strain household finances across the US. In 2023, couples in the US spent about 40 percent of their disposable household income on childcare, the highest share among selected developed economies.

That was nearly double the rate in Ireland at 22 percent and far above countries such as Germany, Italy and Portugal, where net childcare costs are close to zero due to state subsidies and public support systems.

New York Mayor Zohran Mamdani, a democratic socialist, has launched New York City’s first free childcare for municipal workers after winning election on a platform of affordability.

The table below shows the net cost of childcare as a share of disposable household income for couples in selected countries worldwide in 2023.

Jade managed to keep her childcare costs down by relying on her mother-in-law as a caregiver when she first returned to work and has since hired an au pair.

Haris says childcare costs are extraordinarily high in her part of Colorado, which has a higher cost of living than most other US states. She pays at least $25 to $30 an hour, which, over a 40-hour week, amounts to roughly $4,000 a month.

The 40-year-old says her husband, who is from eastern Europe where maternity services and childcare are robust, says “he doesn’t love it here anymore”.

“I have a child, and no job, my entire perspective of the US has changed,” she tells Al Jazeera.