The cost of having children in the U.S. has climbed exponentially since the 1960s. So it’s no wonder the growing crop of Democratic presidential candidates have been proposing ways to address or bring down the costs tied to raising a family.

Most recently, Massachusetts Sen. Elizabeth Warren said she wants to provide universal access to child care. According to her proposal, the U.S. would partner with local governments and other organizations to provide various child care options, paying for it with revenue from her wealth tax.

Whether or not Warren’s proposal becomes law, the data show a worsening problem. In 2015, American parents spent, on average, US$233,610 on child costs from birth until the age of 17, not including college. This number covers everything from housing and food to child care and transportation costs. This is up 8 percent from 1990.

As a mother myself, as well as a sociologist who studies families, I have experienced firsthand the unexpected costs associated with having a child. And this spike in costs has broad implications, including leading fewer families to have children.

Labor and delivery

The overall costs of labor and delivery vary from state to state.

Expenses for a delivery can range from $3,000 to upwards of $37,000 per child for a normal vaginal delivery and from $8,000 to $70,000 if a C-section or special care is needed.

These costs are often a result of separate fees charged for each individual treatment. Other factors include hospital ownership, market competitiveness and geographical location.

It’s worth noting that these costs often include additional fees for ultrasounds, blood work or high-risk pregnancies.

As a result, for women who are concerned about the costs related to giving birth, it’s important to explore the average costs at their local hospitals and review their insurance plans before they decide to become pregnant.

Child care and activities

The U.S. Department of Health and Human Services deems child care affordable if no more than 10 percent of a family’s income is used for that purpose. However, parents currently spend 9 to 22 percent of their total annual income on child care, per child.

Child care has become one of the most expensive costs that a family bears. In fact, in many cities, child care can cost more than the average rent. This is particularly challenging for low-income families who often do not make more than minimum wage.

What’s more, Americans now view childhood differently. Whereas, in the past, children often engaged in family labor, now children are protected and nurtured.

Yet children’s activities can be costly. For example, Americans families will spend on average $500 to $1,000 per season on extracurricular or sports activities for each of their children.

In fact, due to the rising costs of sports, the number of children who aren’t physically active has increased to 17.6 percent. Low-income children are three times less likely to be physically active than children who reside in higher-income households.

Another hidden cost of having kids is time. In my experience, many parents do not realize how much time they will invest in their children, often at the expense of personal freedom and work expectations.

In fact, the American Time Use Survey shows that, on average, parents with children under the age of 18 spend about 1.5 hours per day on domestic and child care responsibilities. Women spend 2.5 hours a day, while men spend roughly only one hour on these tasks.

Weighing the causes

Researchers at Pew argue that the recent decrease in birthrate has as much to do with the Great Recession in 2008 as it does with the increase of women who are not willing to sacrifice their careers for family.

This speaks to yet another cost of having children: Mothers are often pushed out of careers or “opt out,” based on high demands of balancing family and work-life balance.

Researchers have also found a growing trend of men and women who become single parents by choice. This group of parents prioritize children over marriage and often are on single incomes. That also contributes to the reduction in overall childbirth, from a financial and practical perspective.

Ultimately, the decision to have a child is a personal one. The data show that the burden of costs and the stress of family life are real. Yet, despite the costs associated with having a child, many parents report overall satisfaction with their marriage and family life.

Considering the high costs of having of a child, coupled with the tension of balancing family and work, states and companies are starting to invest in family support policies, parental benefits and competitive education. And individuals are creating more innovative approaches to managing family-work balance, such as a reduction in working schedules, family support and a push for more shared responsibilities within the home.

This is an updated version of an article originally published on March 28, 2018.

Heidi Steinour does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.