Andorra – Maternity and Giving Birth

What maternity care options are available in Andorra?

Andorra’s public healthcare network is financed through social security contributions and administered by the Caixa Andorrana de Seguretat Social (CASS), which guarantees residents access to affordable, high-quality treatment at Hospital Nostra Senyora de Meritxell and other public facilities. This constitutes the main route for maternity care in the Principality, and the vast majority of deliveries take place within this hospital setting.

Distributed across the country’s parishes, a network of around ten community health centres provides preventive services, vaccinations, first aid, antenatal care, and childcare support. These centres act as the initial point of contact during pregnancy, offering routine check-ups, blood tests, and referrals to specialist obstetric services at the main hospital when clinically necessary. The system does not follow a strict GP-gatekeeper model — instead, Andorra uses what is known as a “referring doctor” principle.

Every resident is required to select a referring doctor who functions as their general practitioner, coordinates onward referrals to specialists, and oversees overall health monitoring. Pregnant women are strongly encouraged to register with a referring doctor at the earliest opportunity, as this professional will organise antenatal appointments and obstetric referrals throughout the duration of the pregnancy.

For treatments or specialities unavailable within Andorra, bilateral agreements with hospitals and medical facilities in Spain and France allow for cross-border referrals. The resident’s general practitioner arranges the referral, the visit is coordinated through CASS, and the appropriate proportion of expenses is subsequently reimbursed. This arrangement has direct implications for expectant mothers: if your pregnancy requires highly specialised neonatal intervention that cannot be provided locally, a transfer across the border may be necessary — something worth factoring into your birth planning from an early stage.

Home births and freestanding birthing centres are not a recognised feature of the Andorran healthcare model. Given the country’s compact geography and the accessibility of the main hospital, delivery in a hospital setting is the accepted standard. Public health coverage is open to legal residents who are employed in Andorra or who contribute to CASS through self-employment or other qualifying arrangements. If you have not yet registered with CASS after arriving in Andorra, doing so without delay is essential to ensure maternity services are covered.

One important point to bear in mind: because Andorra is not a member of the European Union, the European Health Insurance Card (EHIC) carries no validity within the Principality. Do not assume your EHIC will cover any element of maternity care in Andorra. Confirm your CASS enrolment status with your employer or directly with CASS well ahead of your due date.

How much does it cost to give birth in Andorra?

Within the CASS framework, patients are reimbursed between 75% and 90% of general healthcare expenditure, with maternity care attracting reimbursement of up to 100%. This considerably reduces out-of-pocket costs for enrolled residents and makes giving birth in Andorra comparatively affordable — particularly when measured against countries where maternity services are predominantly delivered through private providers.

Public health insurance in Andorra encompasses core services including hospitalisation, routine medical treatment, maternity care, and emergency assistance. In practice, patients typically pay for services at the point of use and then submit receipts along with stamped documentation to their local CASS office, which processes the reimbursement by bank transfer. The proportion reimbursed ranges from 75% to 90% depending on the specific service.

Where healthcare expenditure is incurred with providers not authorised by CASS and the Andorran authorities, the reimbursement rate drops sharply to just 33% of the amount spent. It is therefore critical to verify that your obstetrician, midwife, and any other specialist involved in your care are all operating within the CASS-approved network. Always check coverage with CASS before booking any antenatal appointment or procedure.

Precise costs for individual maternity procedures — including ultrasound scans, antenatal blood panels, epidural anaesthesia, caesarean sections, or neonatal care — are not published as fixed public figures and will vary according to the provider and the clinical circumstances. For current fee schedules and applicable reimbursement rates, contact the CASS website directly or speak with your referring doctor.

Private health insurance is a popular choice among Andorra’s expatriate community, offering access to private clinics and coverage beyond the limits of the public system. Most international health insurance plans include a maternity benefit, though the majority impose a waiting period of 10 to 12 months before maternity-related claims become eligible. If you are planning to conceive after relocating to Andorra, review your policy terms well in advance. One notable feature of the Andorran system is that private insurance holders typically access care at the same medical facilities as those covered by the public system — private insurers simply cover the patient’s share of the cost rather than directing patients to separate facilities.

What is the standard of maternity and neonatal care in Andorra?

In 2017, The Lancet’s Healthcare Access and Quality Index (HAQ) awarded Andorra a score of 95 out of 100, placing it first in the world. Although this ranking captures the overall healthcare system, it reflects the exceptional level of care that all residents — including pregnant women — can reasonably expect from Andorran medical professionals.

Hospital Nostra Senyora de Meritxell in Andorra la Vella is the country’s principal healthcare facility, providing a comprehensive range of services that encompasses emergency medicine, surgery, diagnostic imaging, and maternity care. This state-owned institution has approximately 200 beds and, as the only major hospital in the Principality, is where all planned and emergency hospital births take place. The concentration of obstetric and neonatal specialists within a single centre represents a practical benefit should complications arise during labour or delivery.

Healthcare professionals in Andorra frequently complete their medical training in Spain or France, ensuring that clinical standards are firmly rooted in European medical education. The approach to maternity care therefore closely mirrors what expectant mothers would encounter in hospitals in either neighbouring country, with evidence-based protocols for labour, delivery, and postnatal care applied as standard.

As a microstate, Andorra’s capacity for advanced neonatal intensive care is necessarily more limited than that of a large urban hospital across the border. For treatments or specialities that fall outside what the local system can provide, cross-border agreements with hospitals in Spain and France facilitate transfers when required. In cases of high-risk pregnancy or very premature birth necessitating specialist neonatal intensive care, your referring doctor and obstetrician will discuss the possibility of transfer in advance if your pregnancy is identified as high-risk.

The multilingual character of Andorra’s healthcare workforce — where Catalan, French, Spanish, and English are all widely spoken — means that communication about medical needs is generally straightforward for both residents and international visitors. Catalan is the country’s official language, but the breadth of languages used in clinical settings reduces the likelihood of significant language barriers during pregnancy and childbirth. If you communicate primarily in a language other than these four, it is worth enquiring ahead of time about the availability of interpreter services for labour and delivery.

What should expats know about maternity rights and leave in Andorra?

Andorra currently provides 16 weeks of paid maternity leave, extended to 18 weeks in cases involving medical complications or multiple births. Some legislative sources cite 20 weeks for employed mothers who give birth, with an additional two weeks per child in multiple birth situations. Given that entitlements are subject to ongoing legislative revision, it is advisable to verify the current position directly with the Andorran Government or CASS before your due date rather than relying solely on secondary sources.

Maternity leave benefits in Andorra are paid through the social security system (CASS). Fathers are presently entitled to up to 14 days of paid paternity leave, to be taken within the first six months following the child’s birth. However, paternity leave entitlements are undergoing substantial reform. The Social Affairs and Equality Commission of the Consell General has agreed to a phased expansion that will bring paternity leave to full parity with maternity leave at 20 weeks by 2030. The progressive increases are: 6 weeks in 2026, 10 weeks in 2027, 14 weeks in 2028, 17 weeks in 2029, and 20 weeks in 2030.

Beyond paid statutory leave, employees in Andorra may also take unpaid parental leave lasting between one and four months initially, with the possibility of extending this for equal periods up to a combined maximum of two years. This offers families additional flexibility when they wish to remain at home with a newborn beyond the paid leave entitlement, although it is unpaid and subject to the terms of individual employment contracts.

Maternity and paternity leave entitlements are available to all new parents, with benefits disbursed through CASS. These rights extend fully to foreign nationals who are legally employed and registered with CASS in Andorra — citizenship or nationality is irrelevant, provided you are working lawfully and making social security contributions.

The new equality legislation encompasses fathers, adoptive parents, and foster carers, though provisions for self-employed workers are still being finalised. If you are self-employed or engaged on a contractual basis, consult CASS or the Ministry of Social Affairs for the rules currently applicable to your situation, as your entitlements may differ from those of salaried employees. For the most current information, refer to the CASS official website or the Andorran Government’s portal.

How do you register a birth in Andorra?

Birth certificates, along with certificates for deaths and marriages, are issued by the Civil Registry (Registre Civil). Registering your newborn is a legal obligation that must be fulfilled promptly following the birth. The steps below set out the process for registering a birth in Andorra.

1. Obtain the hospital birth record. Following your baby’s delivery at Hospital Nostra Senyora de Meritxell, the hospital will issue official documentation confirming the birth — usually a medical birth certificate or delivery record. Retain this document carefully, as it is a mandatory requirement for the civil registration process.
2. Visit the Civil Registry (Registre Civil). The birth must be registered at the Civil Registry Office (Registre Civil) in Andorra la Vella within 30 days of delivery. Check the office’s opening hours before attending and consider telephoning ahead to establish whether an appointment is required.
3. Assemble the required documents. You will need to present the hospital birth record, valid passports or national identity cards for both parents, and any additional supporting documents requested by the registry. Where applicable, a marriage certificate should also be brought. Unmarried parents may be required to sign a declaration of parentage at the time of registration.
4. Complete the registration forms. Registry staff will provide the necessary forms, which call for information about the child, both parents, and the circumstances of the birth. Staff at the Registre Civil will assist you through each stage of the process.
5. Receive the birth certificate. The Civil Registry will issue an official birth certificate recording the child’s full name, date and place of birth, and the parents’ details. This document serves as the essential foundation for all subsequent administrative procedures involving your child.
6. Register the birth with your home country’s embassy or consulate. Most countries require parents to formally notify their nearest embassy or consulate of a birth abroad in order to establish the child’s nationality and secure a passport. As many countries maintain no permanent diplomatic mission in Andorra la Vella, you may need to deal with an accredited embassy in a neighbouring country — typically Spain or France. Initiate this step as soon as possible after completing civil registration in Andorra.
7. Apply for a passport for your newborn. Once consular registration and nationality documentation have been completed, submit a passport application for your child. Requirements and processing times vary by country — consult your embassy’s current guidance for details of the applicable procedure and fees.

Andorra ratified the Hague Convention of 5 October 1961, which establishes a simplified legalisation procedure for documents through an apostille, on 15 April 1996, with the Convention entering into force on 31 December 1996. As a result, an Andorran birth certificate can be apostilled for use in the majority of countries worldwide without the need for full diplomatic legalisation — a practical advantage for expat families who need to use the document in their country of origin.

What nationality will my child have if born in Andorra?

Andorra does not operate a broad birthright citizenship system based on place of birth (jus soli). Birth on Andorran soil alone is insufficient to confer Andorran nationality automatically. Instead, the country applies a combination of restricted jus soli and jus sanguinis — citizenship through parentage — subject to specific qualifying conditions.

Jus soli in Andorra is narrowly defined. A child born in Andorra acquires citizenship only if at least one parent is already an Andorran national or has accumulated 10 years of lawful residence in the country. This is a significant threshold: the majority of recently arrived expatriate parents will not have reached 10 years of residence by the time their child is born, meaning their child will not automatically qualify for Andorran citizenship.

Children born to at least one Andorran parent qualify for citizenship automatically. Those born abroad must be entered in the Civil Registry, ensuring that intergenerational documentation is properly maintained. Where one parent holds Andorran nationality at the time of birth, the pathway to citizenship for the child is clear — but civil registration in Andorra remains a prerequisite.

For the majority of expatriate families in which neither parent holds Andorran nationality and neither has accrued 10 years of Andorran residence, a child born in Andorra will have no entitlement to Andorran citizenship at birth. That child’s nationality will be governed exclusively by the citizenship laws of the parents’ countries of origin. You should contact your country’s embassy or consulate to understand the procedures for establishing and documenting your child’s citizenship from birth.

Andorra does not, as a general rule, permit dual citizenship, and Andorran law traditionally obliges those who naturalise as Andorran citizens to renounce their previous nationality or nationalities. Nationality law is a complex and fact-specific area. Always verify your child’s individual circumstances with your relevant embassy or consulate and, where necessary, seek guidance from a qualified legal adviser with expertise in both Andorran law and the law of your country of origin.

What are the laws and attitudes around abortion in Andorra?

This is among the most significant issues for anyone contemplating starting or expanding a family in Andorra, and it merits a candid and thorough explanation.

Abortion in Andorra is illegal without exception. Current law recognises no grounds on which termination is permitted — not rape, not foetal abnormality, not risk to the mother’s health, nor any other circumstance. This places Andorra in a very small group of jurisdictions worldwide that maintain an absolute prohibition, and it stands in stark contrast to the legal position in the vast majority of other European states, where termination is available on request up to a specified gestational limit or on broad health grounds.

The Co-Princes of Andorra are the President of France and the Bishop of Urgell, the latter being bound by Catholic social teaching on matters of pregnancy and life. This distinctive constitutional structure has historically represented a formidable barrier to legislative reform. In recent years, the Vatican has signalled that it would ask the Bishop of La Seu d’Urgell to relinquish his role as co-prince if the Andorran government were to decriminalise abortion — a step that would likely precipitate a constitutional crisis.

Women in Andorra who choose to end a pregnancy typically travel to Spain or France, both of which provide ready access to abortion services. Such women must finance these services entirely from their own resources, as no public or private abortion provision exists within Andorra and CASS does not reimburse the cost of services obtained abroad for this purpose. The entire financial and practical burden falls on the individual.

Among the concerns raised by international observers, the complete prohibition of abortion in Andorra is regularly highlighted. Domestic civil society organisations, including Stop Violències, have actively campaigned for decriminalisation, and the issue continues to generate sustained public and political debate within the Principality. Women’s rights advocates have drawn attention to repeated delays in fulfilling commitments to reform.

As of 2025, the legal position is unchanged. Anyone considering a move to Andorra who may at any point need access to reproductive healthcare should be thoroughly informed of this situation before doing so. For the latest developments, follow official communications through the Andorran Government website and the Ministry of Health.

Frequently asked questions about having a baby in Andorra

Can I give birth in Andorra as a foreign national?

Yes. Foreign nationals residing in Andorra who are employed or self-employed generally contribute to CASS and are entitled to the full range of healthcare benefits available under the public system, including maternity care. If you have not yet registered with CASS, arrange enrolment through your employer as promptly as possible after arriving in Andorra.

Where will I give birth in Andorra?

Hospital Nostra Senyora de Meritxell in Andorra la Vella is the country’s main hospital and the facility where all maternity services are concentrated. As the only hospital in the Principality, it is where every hospital-based birth — whether planned or emergency — takes place. Home birth is not a standard option within the Andorran healthcare system.

Will CASS cover the cost of my birth in Andorra?

CASS reimburses up to 100% of maternity care costs for enrolled residents. In practice, you will ordinarily pay costs at the point of use and then claim reimbursement from your local CASS office by submitting your receipts and the relevant stamped documentation. Always confirm the specific reimbursement rate applicable to each service you receive, as rates differ according to the procedure involved.

How long do I have to register my baby’s birth in Andorra?

You are legally required to register the birth with the Civil Registry Office (Registre Civil) within 30 days of delivery. Failing to meet this deadline may create complications for subsequent administrative steps, including obtaining a passport for your child. Contact the Registre Civil without delay following the birth.

Will my baby automatically be an Andorran citizen if born in Andorra?

Being born within Andorra’s borders does not automatically confer Andorran citizenship. A child acquires Andorran nationality at birth only if at least one parent is an Andorran citizen or has completed 10 years of lawful residence in Andorra. If neither condition is satisfied, the child will have no entitlement to Andorran citizenship at birth.

Do I need to register my baby’s birth with my home country’s embassy?

Yes. In addition to registering with Andorra’s Civil Registry, you must notify your home country’s embassy or consulate to establish your child’s citizenship and arrange a passport. As many countries have no permanent diplomatic mission in Andorra, you may need to contact an accredited embassy in a neighbouring country, typically Spain or France. Check your country’s consular website for the specific steps required.

What is the paternity leave entitlement in Andorra?

Fathers in Andorra are currently entitled to 14 days of fully paid paternity leave, which must be used within six months of the child’s birth. Under new legislation, this entitlement will increase progressively: 6 weeks in 2026, 10 weeks in 2027, 14 weeks in 2028, 17 weeks in 2029, and 20 weeks in 2030. Verify the entitlement in force at the time of your child’s birth with CASS or the Andorran Government.

Is abortion available in Andorra?

Abortion in Andorra is illegal in all circumstances as of 2025. No exceptions exist under current law, and no termination services are available anywhere within the Principality. Women who choose to end a pregnancy typically travel to neighbouring Spain or France, where abortion is widely accessible, and must cover all associated costs themselves without any reimbursement from CASS. The legal position has not changed as of 2025. Monitor the Andorran Government website for any future legislative developments.