Healthcare during pregnancy in Spain for expats

Updated October 13, 2026 · sources checked October 13, 2026

In short

Foreigners with legal, habitual residence in Spain and no obligation to prove cover elsewhere can use the public system, where a matrona and family doctor follow a normal pregnancy with two routine scans. EU citizens who move should register with the S1, not the EHIC. If your permit required private insurance, check its childbirth clause and waiting period in writing early.

Are you covered by the public system?

Spain's health law (Ley 16/2003, article 3) says that Spanish nationals and foreigners who have established their residence in Spain hold the right to health care. For that care to be paid by public funds, a foreign national must have legal and habitual residence in Spain and no obligation to prove health cover by another route. Health care is then delivered by your autonomous community, which issues your health card (tarjeta sanitaria).

Your situation	Your route to care	What to do now
Employee or autónomo paying Spanish Social Security	Public system, health card from your community	Register at your centro de salud with your Social Security number and padrón certificate
Spouse or child of someone covered	Usually as a family member (beneficiario)	Ask how to be added
EU citizen who moved to Spain, posted worker or pensioner	EU coordination: register with the S1 form from your home country	Ask your home institution for the S1
EU visitor with an EHIC	Medically necessary state care during a temporary stay	Not for travelling to give birth; not if you have moved
Residence permit that required health insurance (e.g. non-lucrative)	Your private insurer	Check childbirth cover and waiting period in writing
Resident for a year, on the padrón, no other public cover	Possibly the convenio especial	Ask your community's health service
In Spain without registered residence	Possibly public care under article 3 ter	Ask your centro de salud or social services early

The European Health Insurance Card is not a moving plan

The European Commission says the EHIC gives access to "medically necessary, state-provided healthcare while you are temporarily staying", that it "does not cover your costs if you are travelling for the express purpose of obtaining medical treatment", that it does not cover private care, and that if you move abroad you should register using the S1 form instead.

The convenio especial

Royal Decree 576/2013 lets people subscribe to a paid agreement with the public system if they can prove at least one year of continuous, effective residence in Spain, are on the padrón where they apply, and have no access to public cover by any other route. The consolidated decree sets a monthly contribution of 60 euros under 65 and 157 euros from 65, which communities may increase if they add services: ask your community for the amount that applies to you.

Without registered residence

Article 3 ter of the same law says foreigners who are not registered or authorised as residents have the right to health care in the same conditions as Spanish nationals, paid by public funds, if they are not obliged to prove cover by another route, cannot export cover from their country and no third party must pay. Each community sets the procedure and issues the document. If this is you, ask your centro de salud or town hall social services early in the pregnancy.

Private insurance: understand the waiting period

Spain's immigration regulation asks for a health insurance policy (seguro de enfermedad) for several kinds of residence, such as residence without working. Many expats also choose private care for an English-speaking obstetrician or a private room.

The clause that matters most is the waiting period (carencia): a period after you take out the policy during which certain services are not paid. Childbirth can be one of them. Its length is set by your contract, not by law, so there is no single figure to quote. Ask your insurer, in writing:

Are pregnancy follow-up, scans and childbirth included?
Is there a waiting period for childbirth, how long, and from which date?
Is it waived if I switch from another insurer, or if I was already pregnant?
Which hospitals and obstetricians are in my network? Is the epidural covered?
Is a caesarean covered like a vaginal birth?
Is my newborn covered from birth? Is there a deadline to add the baby?
Is neonatal intensive care covered?
Do I need prior authorisation for scans or admission?

Good to know

You can mix. If you have public cover and private insurance, you can often follow the pregnancy in one and give birth in the other. Bring all your results to every appointment and tell each team what the other is doing.

How a pregnancy is followed in the public system

Your matrona and your family doctor

The Ministry of Health's clinical practice guideline on pregnancy and the puerperium (2014) recommends that care in uncomplicated pregnancies be provided by midwives (matronas) and family doctors, with the primary care team and the support of the hospital's obstetric unit, and suggests that scheduled visits can be coordinated by midwives. The approach reflects international evidence such as the Cochrane review by Sandall and colleagues (2016) on midwife-led continuity models.

Your first step is usually your centro de salud: the family doctor confirms the pregnancy and refers you to the matrona, who becomes your main contact.

How many visits

The guideline suggests 6 to 9 visits for women at low risk. It relied on a Cochrane review (Dowswell and colleagues, 2010) comparing reduced-visit and standard programmes, which noted that women were less satisfied with fewer visits. Your matrona will set your calendar, and more visits are arranged when needed.

Your scans and key tests

What	When (national guideline)
First trimester scan	11 weeks to 13 weeks and 6 days
Second trimester scan	Around week 20
Routine third trimester scan	Not suggested if there are no risk factors
Group B streptococcus swab	Suggested between weeks 35 and 37

Communities organise these differently, and private clinics often offer more scans. Keep your pregnancy booklet (cartilla de embarazo, name varies by region) with you and take it to the hospital for the birth.

Time off work for appointments

Employees may be absent with pay, after notice and justification, for the time needed for prenatal examinations and childbirth preparation when they take place in working hours (Workers' Statute, article 37.3.f). Ask for an appointment slip (justificante).

Phrases for your first visit

English	Spanish
I am pregnant and new to Spain.	Estoy embarazada y acabo de llegar a España.
Which hospital will I give birth in?	¿En qué hospital voy a dar a luz?
When is my first scan?	¿Cuándo es mi primera ecografía?
Is there an interpreter?	¿Hay intérprete?
Can you write it down, please?	¿Me lo puede apuntar, por favor?

When to call

When to call. In an emergency in Spain, call 112. Contact your maternity unit or go to the emergency department (urgencias) straight away if you notice a change in your baby's movements, vaginal bleeding, fluid leaking from your vagina, a high temperature, a severe headache, sudden vision problems, sudden swelling of your face, hands, legs or feet, sudden breathlessness or chest pain, very severe vomiting, or any pain you are worried about. These are the symptoms the NHS lists as needing help, and they apply in Spain too.

Call your midwife, doctor or maternity unit straight away, day or night, if you notice any of the signs above. In an emergency:

United States 911
United Kingdom 999 (NHS 111 if it is not an emergency)
Canada 911
Australia 000
India 112 (108 for an ambulance)
European Union 112

Planning time off? Read maternity and paternity leave in Spain, and for general advice on check-ups, our page on prenatal appointments. The full overview is on having a baby in Spain as an expat.

Questions parents ask

Can expats use public healthcare in Spain during pregnancy?

Foreigners with legal and habitual residence in Spain who are not obliged to prove health cover by another route are entitled to public health care. Workers registered with Social Security get a health card from their community.

Does the EHIC cover giving birth in Spain?

The EHIC covers medically necessary, state-provided care during a temporary stay. It does not cover travelling for the express purpose of treatment, and the European Commission says people who move abroad should register with the S1 form.

Do private health insurers in Spain have a waiting period for childbirth?

Many policies set a waiting period (carencia) for some services, which can include childbirth. Its length depends on your contract, so ask your insurer for the clause in writing.

How many scans will I have in the Spanish public system?

The national guideline recommends two routine scans for women without risk factors, at 11 to 13+6 weeks and around week 20, and suggests no routine scan in the third trimester.

What is the convenio especial?

A paid agreement giving access to the public health system for people who have lived in Spain for at least a year, are on the padrón and have no other public cover.

Sources

BOE — Ley 16/2003 del Sistema Nacional de Salud, artículos 3 y 3 ter checked October 13, 2026
BOE — Real Decreto 576/2013, convenio especial de asistencia sanitaria checked October 13, 2026
European Commission — European Health Insurance Card checked October 13, 2026
Ministerio de Sanidad — Guía de práctica clínica de atención en el embarazo y puerperio (2014) checked October 13, 2026
BOE — Real Decreto 1155/2024, Reglamento de extranjería (seguro de enfermedad) checked October 13, 2026
Dowswell T et al. Alternative versus standard packages of antenatal care for low-risk pregnancy (Cochrane, 2010), PMID 20927721 checked October 13, 2026
Sandall J et al. Midwife-led continuity models versus other models of care (Cochrane, 2016), PMID 27121907 checked October 13, 2026
NHS — Pregnancy symptoms you need to get help for checked October 13, 2026

Mamavela explains; it does not replace your midwife, doctor or pediatrician, who know your situation. If something worries you, call them. In an emergency, call 911 (US), 999 (UK) or 112.