Care occupations are strongly gendered and remain relatively poorly paid, particularly in the United States. Prior research points to individual, relational, and market- valuation factors in explaining the relative earnings of care workers. In contrast, this study applies a comparative institutional perspective to investigate cross-national differences in the relative earnings of care workers. Using merged data from the U.S. Current Population Survey and EU-SILC, we find that national variance in labour market and welfare state institutions explains nearly all of the difference in the relative earnings of reproductive care workers between the U.S. and EU. Higher rates of collective bargaining coverage and welfare state spending contribute to higher relative earnings for reproductive care occupations, and lower relative earnings for high-status nurturant care occupations. Differences in the relative earnings of care workers appear to be primarily a construct of social and labour market policies.