Costa Rica – Maternity and Giving Birth

What maternity care options are available in Costa Rica?

Costa Rica provides a strong network of prenatal and maternity services through both public and private channels. Most families work within one of two main pathways — the Caja’s public system or private sector providers — and a combined approach is not uncommon, with some expectant parents attending public prenatal check-ups while choosing a private hospital when the time comes to deliver.

Those who use the public healthcare system will find that the Caja initiates prenatal care from around four to six weeks of pregnancy. Upon registration, patients are assigned to a local EBAIS (public primary care clinic) for their initial appointments. Beyond the first trimester, referrals to larger public hospitals for more specialised antenatal monitoring are standard practice. This tiered structure — from community EBAIS clinics through to regional and then specialist maternal-infant hospitals — ensures that pregnancies requiring more intensive oversight are directed to facilities equipped to manage them.

Communities in rural areas are served by the EBAIS (Basic Teams for Comprehensive Health Care) model, which extends prenatal services into remote locations. Delivery itself, however, almost universally takes place within a hospital environment: close to 99% of births are attended by skilled healthcare workers, predominantly in hospital settings. Home births exist in certain communities but are not promoted as a mainstream pathway within the healthcare system.

Using the public CCSS system requires legal residency and active monthly contributions. Eligible residents receive prenatal care, hospital delivery, and postnatal care entirely free of charge at the point of access. Foreigners who lack residency, or who prefer a different experience, typically turn to private hospitals instead. A cost-conscious hybrid approach — relying on public antenatal care while paying for a private delivery — is an option worth considering for those looking to balance quality and expenditure.

Private hospitals offer a distinctly different environment. Facilities such as CIMA Hospital and Clínica Bíblica provide private suites, obstetric teams who communicate in English, options including water births, and policies that welcome partners and doulas throughout the process. Three Costa Rican hospitals have earned international recognition for the calibre of their facilities and care standards: Clínica Bíblica and CIMA in San José, and Clínica La Católica in Guadalupe.

It is worth noting that Costa Rica’s maternity system differs considerably from those in countries such as the Netherlands or the UK, where midwife-led care and planned home births form an established part of the standard pathway. In Costa Rica, obstetricians and hospital settings dominate, and partners are not always permitted inside delivery rooms in the public system — a fact that often surprises those expecting the norms they experienced elsewhere.

How much does it cost to give birth in Costa Rica?

The financial cost of having a baby in Costa Rica is shaped almost entirely by whether you deliver through the public Caja system or choose private care, with the two routes representing very different levels of expenditure.

Within the public system, maternity services carry no direct cost for those who are enrolled and contributing. Monthly Caja contributions fund all routine antenatal consultations, ultrasound scans, hospital delivery, and postnatal appointments. Residents who have completed their CCSS registration and maintain their contributions face no out-of-pocket charges for these services.

The financial picture for private care is considerably different. A vaginal birth package at a private hospital — encompassing hospital charges and the primary medical team including the obstetrician, paediatrician, and anaesthesiologist — typically falls in the range of USD 3,000 to USD 6,000 (roughly CRC 1,530,000 to CRC 3,060,000), as of 2025. Caesarean sections, or any complications requiring additional intervention, will push costs above these estimates. Some private hospitals offer discounted bundled rates for patients paying directly rather than through insurance, so asking about package pricing during your initial consultations is worthwhile.

For those intending to use private health insurance to fund their maternity expenses, planning ahead is essential. Both local private policies and those from INS (Instituto Nacional de Seguros) commonly apply a waiting period of 10 to 12 months before maternity-related costs become eligible for reimbursement. If you are planning a pregnancy, your insurance arrangements should be made well in advance of your relocation. INS offers several policy options that incorporate maternity benefits — including INS Medical and Seguro Vital 360 — which can cover services such as prenatal and postnatal care, vaginal and caesarean deliveries, routine newborn care, and pregnancy-related complications.

International health insurance obtained through global providers may come with different terms regarding maternity coverage and waiting periods. Maternity is frequently classed as an optional rider or subject to its own exclusion window, so reading the fine print carefully is non-negotiable. Premium rates and policy conditions change regularly; always go directly to your insurer to confirm current terms before making assumptions about your coverage.

What is the standard of maternity and neonatal care in Costa Rica?

Costa Rica’s maternal and newborn health record is among the strongest in Latin America, a reflection of the country’s longstanding investment in its universal public healthcare system. With a maternal mortality ratio of approximately 22.0 deaths per 100,000 live births and a neonatal mortality rate of approximately 6.9 deaths per 1,000 live births, Costa Rica consistently performs well against other upper-middle-income nations globally.

The foundation of these outcomes is the CCSS, which provides comprehensive maternity services across the population regardless of economic background. A well-functioning three-tier referral structure channels complex cases towards specialist maternal-infant hospitals, ensuring that when complications develop during pregnancy, there is a clearly defined escalation pathway to access the appropriate level of care.

There are, however, notable distinctions between what is available publicly and privately. Private hospitals tend to have better-resourced neonatal intensive care units — CIMA’s NICU, in particular, is frequently cited as among the best available — while public hospitals are capable of managing complications but operate predominantly with shared postnatal ward arrangements rather than private rooms. The public system also tends toward a less interventionist philosophy than some expats from other healthcare cultures may expect: elective caesarean sections are uncommon, and as noted, partners are regularly excluded from the delivery room.

Geography also plays a meaningful role in what services are accessible. San José, Heredia, and Escazú have the widest range of public and private maternity options, including specialist referral centres. Coastal areas such as Nosara and Tamarindo have only limited private clinic facilities, and deliveries in these locations may require transfer to an urban centre. EBAIS clinics in rural communities handle routine antenatal care, but more complex pregnancies are referred to hospitals in larger towns. Expats living outside major urban areas should incorporate realistic travel times and healthcare access into their birth planning as early as possible.

Language is another practical factor, particularly within the public system. Spanish proficiency is assumed at public hospitals, and bringing a bilingual companion or professional interpreter is advisable if your command of the language is limited. Private facilities, including CIMA and Clínica Bíblica, employ many obstetricians and gynaecologists who are fluent in English and other languages. Medical consultations in a second language — particularly during the heightened stress of labour — benefit significantly from advance preparation.

What should expats know about maternity rights and leave in Costa Rica?

Maternity leave protections in Costa Rica are established under the Labour Code (Código de Trabajo) and extend to all legally employed workers in the country, including foreign nationals holding valid employment contracts. As of 2025, the key entitlements are outlined below.

Employees who are pregnant are entitled to a total of four months of maternity leave, structured as one month prior to the anticipated birth date and three months following delivery. During this period, the employee continues to receive their full salary, with the cost divided equally between the CCSS and the employer — each covering half. To trigger this entitlement, the employee must submit a medical certificate stating the projected due date to their employer no later than five weeks before the leave commences.

Employees who experience complicated pregnancies resulting in pregnancy loss or the death of the child are entitled to two months of leave; where the employee’s own health is materially affected, this period may extend to up to three months.

For fathers and co-parents, entitlements are more modest. Private sector employees who become new fathers are entitled to two paid days of paternity leave per week across the four weeks following the birth — eight days in total, as of 2025. Where the child’s mother dies during or after childbirth, any remaining maternity leave entitlement transfers to the biological father.

Adoptive parents are also covered by leave provisions. Both adoptive parents are entitled to three months of paid leave from the point at which the adoption takes effect.

Self-employed individuals and independent contractors are not entitled to maternity leave through the Labour Code in the same manner as employees. If you work on a freelance or self-employed basis, your access to financial support during and after pregnancy will depend on the history of your CCSS contributions and any private insurance cover you hold. For personalised guidance, contact the Ministerio de Trabajo y Seguridad Social (MTSS) or engage a qualified employment lawyer practising in Costa Rica, as individual circumstances vary considerably.

A reform to the Costa Rican Labour Code came into effect in June 2022, introducing a range of amendments to leave arrangements and protections connected to maternity and paternity, including the establishment of new categories of special leave. This area of law has continued to develop, and the most current rules should always be confirmed with the MTSS or a local legal professional.

How do you register a birth in Costa Rica?

Birth registration in Costa Rica falls under the authority of the Registro Civil, which operates within the Tribunal Supremo de Elecciones (TSE). For births occurring in hospital, much of the initial registration work is handled by hospital staff on the parents’ behalf. The typical process unfolds as follows:

1. Hospital notification: For births that take place in hospital, the facility ordinarily completes the initial registration with the Civil Registry directly. Parents will be given a temporary birth declaration form at the time of birth — a yellow document known as the Declaración de Nacimiento. It is important to note that this yellow carbon paper record serves only as an initial declaration and is not adequate as a formal birth certificate for purposes such as passport applications or embassy registration.
2. Obtain the official birth certificate: Following the birth, a temporary certificate (Certificado de Declaración de Nacimiento del Registro Civil) is issued initially, but parents will need to obtain the full long-form birth certificate (certificado de nacimiento literal) through the Registro Civil. This can be accessed online via the TSE portal by searching for your child’s name to retrieve their identification number. The certificación de nacimiento is delivered as a digital document by email; a printed copy will be needed for formal appointments and applications.
3. Home births: When delivery has taken place outside a hospital setting, the parents must present documentation confirming the birth and the child’s vaccinations directly at a Civil Registry office. It is advisable to contact the Civil Registry ahead of a planned home birth to establish precisely which documents will be required.
4. Child’s name and surnames: At registration, the child is assigned two surnames (apellidos) in accordance with Costa Rican naming conventions. The father’s first surname is recorded as the child’s first surname (primer apellido), while the mother’s first surname becomes the child’s second surname (segundo apellido). This convention applies to all births registered in Costa Rica, regardless of the parents’ nationalities.
5. Register with your home country’s embassy or consulate: Once the Costa Rican birth certificate has been obtained, contact your home country’s diplomatic representation in Costa Rica to register your child as a national. The procedures and fees involved differ from country to country. As one example, the US Embassy in San José operates an online application process for the Consular Report of Birth Abroad (CRBA), enabling parents to complete the application, upload required documents, and pay fees before attending an in-person appointment. Consult the relevant embassy website well in advance for up-to-date instructions and requirements.
6. Obtain a passport for your child: After the embassy or consulate registration is complete, apply for a passport in your child’s name, using the issued certificate of birth abroad along with any additional documents stipulated by your home country’s passport authority. Before leaving Costa Rica with a child, you must also obtain a permiso de salida (exit permission), which is mandatory for all Costa Rican minors — both citizens and legal residents — as a safeguard against children being taken out of the country without authorisation.

The Tribunal Supremo de Elecciones (TSE) oversees the Civil Registry and provides access to its online services. For official guidance on birth registration procedures, visit the TSE website or attend a Registro Civil office in person. For embassy registration and obtaining your newborn’s passport, refer to your home country’s embassy in Costa Rica for current requirements, applicable fees, and how to book appointments.

What nationality will my child have if born in Costa Rica?

Any child born on Costa Rican territory acquires Costa Rican citizenship automatically. The country applies a jus soli principle, conferring citizenship on the basis of place of birth rather than the nationality of the parents. This approach is similar to that of countries such as Brazil, Canada, and Mexico, and stands in contrast to jus sanguinis systems — common across much of Europe — where citizenship flows exclusively from the nationality of the parents.

What this means practically is that your child will be a Costa Rican citizen from the moment of birth, even if both parents hold foreign passports. This carries real-world implications: as a Costa Rican citizen, the child is subject to Costa Rican law concerning travel, including the requirement to secure a permiso de salida before any international journey as a minor.

A child born in Costa Rica may also qualify for citizenship in one or both parents’ countries of origin, depending on the relevant nationality laws. Most countries allow citizenship to be transmitted through parentage (jus sanguinis), enabling a child born abroad to be registered as a citizen provided at least one parent is a national. The procedure for claiming such citizenship must be pursued through your home country’s embassy or consulate in Costa Rica, and requirements typically include the Costa Rican birth certificate, evidence of the parent’s citizenship, and documentation of the parental relationship.

Nationality matters can become intricate where dual citizenship is involved, particularly if one country imposes renunciation conditions or residency requirements. Always seek confirmation of your child’s specific entitlements from the relevant embassy or consulate, and engage a qualified legal adviser if any aspect of the situation is unclear. General guidance should not be treated as a substitute for advice tailored to your child’s particular circumstances, given the long-term consequences involved.

What are the laws and attitudes around abortion in Costa Rica?

Costa Rica’s abortion legislation is substantially more restrictive than that which many internationally mobile people will have encountered in their countries of origin. As of 2025, abortion is legally permissible only where the pregnancy constitutes a serious threat to the life or health of the pregnant person — a procedure referred to as aborto terapéutico. This exception is set out in Article 121 of the Penal Code. Abortion on grounds such as foetal abnormality, sexual violence, or financial hardship is not permitted under law, and elective terminations are illegal.

For many years, even the legally permitted therapeutic abortion was extremely difficult to obtain in practice, hampered by institutional resistance and the absence of clear regulatory guidance. In 2019, the Inter-American Court of Human Rights issued a ruling against Costa Rica in the Artavia Murillo case, which related to in vitro fertilisation and brought broader regional scrutiny to reproductive rights policy in the country. In 2020, the Constitutional Chamber of the Supreme Court (Sala IV) ordered the Ministry of Health to publish a technical protocol governing access to therapeutic abortion, and the Ministry subsequently released guidelines designed to enable the procedure to be carried out within the public health system for cases satisfying the legal criteria.

Accessing a therapeutic abortion through the CCSS public system requires a medical determination that the pregnancy poses a genuine threat to the life or health of the pregnant person. This involves formal assessment and documentation by healthcare providers; legal guidance may be advisable in complex or contested cases. Private healthcare providers generally do not offer abortion services given the constraints of the legal framework.

Costa Rica is a predominantly Roman Catholic society, and both public opinion and political discourse on abortion remain largely conservative. Expats accustomed to broader access to termination services in their home countries should be aware that options here are severely limited, and that navigating the healthcare system in this area may involve overcoming both procedural and attitudinal obstacles.

For the most current information on legally accessing therapeutic abortion services, contact the Ministerio de Salud de Costa Rica directly, or seek guidance from a qualified medical and legal professional within the country. The law’s practical application in this area has undergone change in recent years and continues to evolve; always verify the current position through official sources rather than relying solely on secondary guidance.

Frequently asked questions: having a baby in Costa Rica

Can I give birth in Costa Rica as a foreigner without residency?

Yes. Anyone can give birth in Costa Rica and will receive emergency obstetric care regardless of their immigration status. That said, access to free routine prenatal care and publicly funded delivery through the Caja system requires legal residency and active CCSS registration. Those without residency will generally need to fund private care from their own resources or through an international health insurance policy.

How do I enrol in the Caja for maternity care as a new resident?

The Caja Costarricense de Seguro Social (Caja) is the public healthcare system available to Costa Rica’s legal residents. Pregnant women are accorded preferential patient status within the system. To enrol, you must hold legal residency and complete your registration with the CCSS, including commencement of monthly contribution payments. Once enrolled, present yourself at your nearest EBAIS clinic to begin your antenatal appointments.

What documents do I need to register my baby’s birth in Costa Rica?

For hospital births, the facility typically completes the initial registration with the Civil Registry on your behalf and provides a temporary birth declaration form. Parents must then obtain the full long-form birth certificate from the Registro Civil — available through the TSE’s online portal — which is required for embassy registration and passport applications. Contact the TSE for the current list of required documents.

Will my baby automatically be a Costa Rican citizen?

Yes. Any child born in Costa Rica acquires Costa Rican citizenship automatically by virtue of birth on its territory, irrespective of the parents’ nationalities. Your child may additionally be entitled to citizenship in your home country through descent, but this must be formally claimed through your embassy or consulate in Costa Rica. Dual nationality is possible in many cases, though you should verify the specific rules applicable to your country of origin.

How much does a private hospital birth cost in Costa Rica?

A standard vaginal birth package at a private hospital, covering the hospital’s fees along with the core medical team — typically the obstetrician, paediatrician, and anaesthesiologist — generally ranges from USD 3,000 to USD 6,000, as of 2025. Caesarean sections and any additional complications will increase the total. Contact private hospitals directly for their current pricing, as charges vary between facilities.

Does international health insurance cover maternity care in Costa Rica?

Many international health insurance policies are accepted at private hospitals in Costa Rica, but maternity benefits are frequently structured as optional add-ons or subject to waiting periods — often in the range of 10 to 12 months. Do not assume coverage is in place without first verifying the specific terms of your policy with your insurer directly, particularly regarding waiting periods and any exclusions that may apply.

Can my partner be present at the birth in Costa Rica?

Within the public system, partners are frequently excluded from the delivery room. Private hospitals such as CIMA and Clínica Bíblica, by contrast, actively accommodate partners and doulas throughout the birth process. If the presence of your partner during delivery is a priority, choosing a private hospital is the more dependable route.

Do I need a permiso de salida to travel internationally with my newborn?

Yes. Travelling out of Costa Rica with a minor requires a permiso de salida (exit permission), which applies to all Costa Rican minor children — whether citizens or legal residents. This document is obtained through the relevant immigration authority and ordinarily requires the consent of both parents. Build the time required to obtain this permission into your travel arrangements well before any planned international trip.