Our Broken Fertility Culture
America's fertility rate has plummeted. In response, politicians are floating a plethora of policies designed to encourage Americans to have more babies. These "pro-natalist" efforts, however, are taking place within a larger broken culture of fertility in America, which includes inconsistent understandings of life, callous policy treatment of mothers, and preventable difficulties in birth. Addressing our crisis of fertility must go beyond policy and nourish a new culture of family and fertility from the bottom up.
The replacement-level fertility rate for a population is 2.1 children per woman over the course of her life; in 2023, America's was sitting at 1.6. The problem isn't limited to the United States, either: Fertility rates are falling all across the developed world. The United Nations recently announced that we will reach peak population on Earth in 60 years, at which point the population will begin to contract. Only a decade ago, we thought this reversal might be over a century away.
In the United States and abroad, politicians, entrepreneurs, and other leaders are speaking out, with many promoting all sorts of policies to boost fertility rates. As self-proclaimed pro-natalist Elon Musk said recently, we "should view the birthrate as the single biggest problem [we] need to solve. If you don't make new humans, there's no humanity, and all the policies in the world don't matter." President Donald Trump put forth a potential solution: "[W]e will support baby bonuses for a new baby boom. How does that sound? That sounds pretty good. I want a baby boom."
Yet while fertility is where politicians focus, it represents just the tip of the iceberg. Abortion ends over one in four pregnancies worldwide and remains an intensely divisive political issue here at home. In vitro fertilization (IVF) has brought children to many families who couldn't previously have them, but it has also created an ethical thicket, with millions of embryos sitting frozen for an indefinite time and the emergence of technology to choose a child's genetic makeup. Maternal health outcomes in America are worse than almost anywhere else in the developed world. The birth experience is over-medicalized and risky, especially for black women. Moreover, most mothers give birth to and raise children while working. Not only have labor-policy reforms been slow to support working mothers, but men's share of household labor hasn't rebalanced.
This is all taking place in a culture that has increasingly pushed against the historic human experience of vulnerability, mutual dependence, and the bonds of family. Nowhere are these humbling elements of the human condition made clearer than in the birth of a child.
No wonder our fertility culture lacks consensus. Fixing that is essential, and will require more than toggling with public policy or telling people to have more children. Before looking at solutions, though, we need to examine recent history to understand how we ended up where we are.
FALLING FERTILITY RATES
America's fertility rates have trended downward over the last seven decades. Prior to that, the last deep dip happened in the 1920s and 1930s — the era of world war and depression. The end of World War II and economic recovery ushered in the baby boom of the mid-1940s to the mid-1960s. What propelled the next dip shortly thereafter — the one we are still in today — is more complicated.
Between 1970 and 2021, nearly every industrialized country dropped from significantly above the replacement fertility rate to below it. This is true of countries that look radically different from one another, both demographically and socioeconomically.
Scholars' explanations for the phenomenon vary. Many point out that wealthy, industrialized nations tend to have better health care and more birth control than poorer ones. As infant mortality rates in these countries began declining at the turn of the 20th century, people needed fewer pregnancies to reach their desired number of surviving children. Then during the mid- to late-20th century, scientists introduced prescription birth control, while policymakers and judges legalized abortion. These developments granted couples more control over family size.
Women's educational and work opportunities in wealthier nations also changed radically during this period, reducing the economic necessity of marriage while increasing the relative costs of child rearing. Previously, only a few professions were open to women, and at various times and places in America, pregnant women or new mothers were prevented from working entirely. As changing norms opened up the workforce, women seized this new opportunity by storm. Stepping back from work to become a mother became a much costlier choice, and fewer women made it.
Women's economic success also outpaced gender norms and traditional divisions of labor within marriage, with the man at work and the woman at home. As Nobel Prize winner Claudia Goldin explained in a recent paper, if women are now working, having babies, and still doing all the housework and child care, they are going to have to cut back on something.
She meant that they have fewer babies, but marriage rates are declining, too. A larger percentage of Americans are unmarried than ever before. Marriage tends to be a reliable indicator of childbearing: For married women under 44, the birth rate is almost three times higher than that of unmarried women of the same age. However, married women make up a much smaller percentage of the population than they used to. Their decline is perhaps the largest factor at play in reducing the share of women who become mothers.
In America, there has also been a move away from religion and church attendance — both of which tend to be predictors of marriage and, in turn, children. Meanwhile, among young, progressive Americans, religious-like environmental and cultural movements are pressuring people to avoid having children, for fear of contributing to climate change or bringing children into a fallen world.
While some scholars say that declining fertility reflects people's preference to stay single, have smaller families, not marry, or not go to church, others point to studies suggesting that some people want more children than they can have. Institute for Family Studies scholar Lyman Stone points to decades of surveys suggesting that most American women want two or more children, yet those who end up having children at all average just one to two. Stone attributes this largely to the decline in marriage, but the cost of raising a child also appears to be a factor.
Indeed, financial concerns are often listed as a top obstacle keeping potential parents from having children and current parents from having as many as they would prefer. According to Bureau of Labor Statistics data updated for inflation, as of March 2024, the cost of having a child is $312,202. In addition to dollar costs, American parents spend more time with their children than ever before, usually while also working. The combination of time-intensive parenting and full-time work is another reason Americans aren't having more children.
The decline in childbearing resembles a snowball rolling down a hill — one composed of some combination of these factors. And as snowballs rolling downhill tend to do, it's collecting more mass along the way. At some point, the cultural norm becomes staying unmarried, prioritizing work over family, or having one or two children, or none at all. As cultural pressure to attempt parenthood decreases, the practice becomes more foreign, and the fear and anxiety surrounding it grow. The fertility decline becomes a self-perpetuating cultural nosedive.
Often, the potential consequences of the biggest threats we face are the hardest to explain in terms of scale. A major cyberattack or fiscal crisis would be devastating in a way that most people today would struggle to imagine. While none of us have experienced a baby bust below replacement level, within a decade, we'll likely see it firsthand: If current trends hold, the number of deaths in America will begin eclipsing the number of births by 2038.
The effects may be subtle at first, then less so. Overcrowded schools will start to empty out. Companies will struggle to find enough workers. Caretakers for our aging population will become scarce. The innovative and creative energy of the young will decline. Our current budget problems will compound. We'll experience lower wages, slower growth, smaller communities, and emptier houses. The dark, empty storefronts of the Rust Belt will become common nationwide.
INCENTIVIZING BIRTH
One look at the trends noted above suggests that few drivers of fertility decline are easily reversible through public policy. As Goldin said in a recent paper, "[t]he birth rate is...clearly determined by forces that are independent of the whims of governments," which "has been the case since the beginning of time."
That's not stopping governments from trying, of course. According to a United Nations report, 66% of European and almost 40% of Asian governments have enacted policies that seek to boost fertility rates, or at any rate, slow fertility decline. Under the Trump administration, the United States is looking to follow suit. Many countries are experimenting with massive cash handouts to encourage marriage and childbirth, including $10,000 payments per child in Russia and $14,000 wedding bonuses in one South Korean province, with an additional $770 per month for children under a year old across the nation.
How effective are these payouts? A 2020 paper reporting on a Russian policy beginning in 2007 found large increases in the fertility rate: more than 20% in the long run. Yet other studies, including a 2021 review of 35 studies across Europe and North America, found that cash bonuses produce positive yet temporary results at best, typically by encouraging families to have children earlier rather than by increasing the number of children people end up having.
The authors of the 2021 review did find that wrap-around public services for parents — such as child-care support and paid maternity leave — were more effective at boosting fertility rates. Access to child care slightly increased the number of children families tend to have — with the effects compounding with each subsequent child — as well as first-time births, especially among lower-class families. Perhaps counterintuitively, their study suggested that publicly funded child care may also increase fertility for stay-at-home mothers who are tending to an infant by allowing them to put their older toddlers in daycare — a classic example of how the fighting between stay-at-home and working parents can obfuscate policies that benefit everyone. They also found that perhaps the most significant policy lever for increasing fertility rates was paid parental leave, particularly for higher-earning parents. The opportunity cost of leaving the workforce is often higher for high earners; paid leave helps reduce that cost.
But child care and paid leave are not fertility elixirs. While more generous family support is generally associated with higher rates of fertility, the effects remain small: Most European countries have had some version of both in place for decades, while fertility rates continue to decline. Meanwhile, despite offering parents far fewer child-care or paid-leave options, the United States has a higher rate of fertility than nearly every other developed nation.
The Trump White House is considering ways to boost American fertility: $5,000 baby bonuses, Fulbright scholarships reserved for married parents, free IVF, the works. In reality, fertility is unlikely to respond to these kinds of policy changes. The proposed baby-bonus amounts tend to be lower than those offered in other countries, which have seen little lasting effect. Exclusive scholarships for married parents make for good political theater, but they would do little to influence life on the ground. The most generous policy would be making IVF — which runs upwards of $20,000 for a single round — free. Yet, as we will see in the sections to come, the evidence suggests that subsidized fertility treatments boost fertility rates less than intended.
All of which is to say, fertility is difficult to encourage through direct policy incentives. Although they confer other benefits that may merit policymakers' consideration, cash payouts and wrap-around services have a marginal impact on fertility rates. But what about more indirect measures, such as rolling back abortion access or addressing maternal mortality rates?
ABORTION ACCESS
Abortion casts a dark shadow over our fertility culture. It shows how confusedly and callously some of our policymakers deal with motherhood and life. In 2024, 3.6 million babies were born, while 1 million pregnancies were aborted. In theory, if abortion was made rarer — through law, economic support for families, or cultural revival — our fertility rate would soar.
By any standard, pro-life or pro-choice, America's abortion landscape is a mess. At one extreme, activists are "shouting" their abortions and refusing to limit the procedure, even though much of the developed world bans abortion after the first trimester. On the other extreme, activists are turning neighbors into abortion snitches and delaying women's medical treatment until they are dying.
People have long disagreed about the ethics of abortion, but the 2022 Dobbs Supreme Court turned opinion polarization into policy polarization by sending the issue back to the states. Red states sought to curb abortion access with limited exceptions, while blue states sought to expand it without limit. There's a strong case, in a country as divided as ours, for determining more issues at the state level. But people live where they do for a wide variety of reasons. Something as fundamental as a mother's health or a child's life shouldn't hang on the luck of the geographic draw. Instead of being prudent and pragmatic, the current abortion landscape feels designed for political expediency.
One indirect result of the Dobbs decision was exposing how little conservative states do to support women and children. The red states most likely to roll back abortion access are also the ones that have failed to developed robust programs to support families, particularly vulnerable ones. Whereas a generation ago, abortion was spread out across socioeconomic demographics, today abortion is increasingly concentrated among low-income, unmarried women. This suggests that concrete economic and community supports for women could reduce abortion. Yet most conservative policymakers seem uninterested in these approaches.
The reverse is also true. Blue states tend to provide the most generous benefits to mothers, fathers, and their newborn children. At the same time, they also tend to allow abortions at any point in a woman's pregnancy. Third-trimester abortions require horrific procedures affecting both the mother and the baby. Out of over a million abortions that occurred in 2024, 1% were late term, meaning 10,000 babies died this heinous death — far from a blip or one-off.
Neither political party promotes a holistic culture that values life, children, and parenthood. Indeed, though the Dobbs decision was a welcome step for the pro-life movement, in some ways, it was also a defeat. Instead of reducing abortion rates and increasing fertility, the pro-life victory in the courts resulted in abortions reaching a decade high in 2023, according to the Guttmacher Institute. The president largely responsible for the Dobbs court has washed his hands of the issue, both sides have hardened, and there's little humility or nuance left in what should be the most tender of conversations. Until Americans can come to some consensus on abortion, efforts to address the fertility crisis will be seriously hindered.
FERTILITY TREATMENTS
For all our sad talk about falling birth rates and ending unwanted pregnancies, fertility treatment is a space that's full of joy and hope. Over 40% of Americans either have undergone fertility treatment or know someone who has. The vast majority of Americans support access to fertility treatments, and policymakers — including President Trump — increasingly look to IVF as a way out of our fertility crisis.
But IVF's effect on the overall fertility rate is limited, due to its high failure rate and concentrated use among older mothers. While births do increase through IVF among that population, it's unlikely that a new baby boom will be driven by middle-aged women.
The popularity of fertility treatments also comes with a cost: There are upwards of 1.5 million embryos frozen indefinitely in the United States today. This is because the IVF process usually creates far more embryos than are used. Patients can choose between implanting them all, donating them, freezing them indefinitely, or throwing them away. Freezing is a popular option.
In 2024, after a clinic worker accidentally dropped frozen embryos, resulting in their deaths, the Alabama Supreme Court ruled 8-1 that embryos are protected under the state's wrongful-death statute. The ruling prompted IVF facilities in the state to pause treatment. Who would want to work in a place where you could be liable for murdering children? What parent would want to choose between being impregnated with quintuplets and being sued?
Moreover, in seeking to support those with severe infertility and help cancer patients form families, we've gained greater ability to design our children. According to a lesson plan from New York University: "Although current technology allows only for the selection of embryos that have such traits, parents may soon be able to engineer their child's genome so that he or she has certain desirable traits, like better immunity to disease or higher intelligence." The plan then lists the possible traits that parents might be able to choose: eye color, hair color, height, sexual orientation, intelligence, and cancer risk.
The first photo in the bestselling book Homo Deus by Yuval Noah Harari shows the moment of fertilization in vitro. Harari suggests that "the main products of the twenty-first-century economy will not be textiles, vehicles, and weapons but bodies, brains, and minds." These are weighty matters. Different people approach the same technology with very different intentions that can change over time. Already, new technology from Orchid allows doctors to screen for thousands of genetic conditions. What is a miracle for parents predisposed to disease may lessen the tolerance for children left to the genetic lottery, especially if they're born with certain vulnerabilities.
IVF's relationship with fertility is complicated. While it affords new opportunities for those otherwise unable to have children, it creates complex ethical and social problems, the consequences of which could be dire. When our ability to create life outpaces our comprehension of the political and ethical questions at stake, it behooves us to slow down and take stock of where we may be headed.
ADDRESSING BIRTH ANXIETY
There's a compelling argument that as long as birth is a life-risking proposition, American mothers will be hesitant to undertake it, regardless of what cash benefits or fertility treatments policymakers throw their way. After all, giving birth in America is riskier than in any other country in the developed world. In 2024, there were 19 maternal deaths for every 100,000 live births in the United States — more than double, and sometimes triple, the rate for most other high-income countries. Studies suggest over 50% of women in the United States fear giving birth, including both first-time mothers and more experienced mothers who know the trial and danger of labor.
While tragic maternal outcomes need to be addressed, they also need to be contextualized — otherwise, the numbers can unnecessarily contribute to a culture of fear regarding pregnancy and childbirth. Data-collection methods in the United States appear to have magnified maternal mortality rates. That's because most complications for maternal health outcomes are related to underlying health conditions, not something particular to the process of childbearing in America, yet they are categorized as the latter. Tighter definitions of maternal mortality rates show the United States' rates to be lower — more on par with those of Canada and Britain — but still elevated. As economist Emily Oster explained:
Conceptually, most people think of this as a death related to childbirth. What is complicated is the phrase "related to." A narrow definition would be a death in childbirth, from bleeding or other complications. A wider definition would be a death around childbirth from a condition that was exacerbated by childbirth.
The biggest drivers of maternal mortality are cardiovascular issues and obesity, with the United States being an international outlier for both. The latter can lead to preeclampsia — the most frequent cause of maternal mortality. However, preeclampsia, once identified, is treatable, and increasingly viewed as preventable, with new research suggesting that interventions as simple as a daily baby aspirin might help. This is why, according to the Centers for Disease Control (CDC), 84% of pregnancy-related deaths are avoidable.
But there are other reasons for high anxiety surrounding pregnancy in America. The United States tends to have a much more medicalized birth experience than other countries. For most of human history — and still in most other countries — birth largely took place outside of a medical setting. In America, approximately 91% of hospital births are attended by a physician. Nearly one-third are performed through cesarean-section surgery, or C-section. The procedure is often associated with maternal morbidity and mortality, longer recovery periods, adverse outcomes in subsequent births, and negative impacts on infant health.
On the flip side, as many as 35% of U.S. counties are considered "maternity deserts," with no providers nearby. This disproportionately harms rural communities and people of color: A 2022 March of Dimes study reported that one-sixth of black infants and a quarter of Native American infants were born in such counties. The wrong kind of treatment and the lack of treatment are both serious detriments to mothers' health.
Moreover, there's no question that black women suffer maternal mortality at a disproportionate rate. According to the CDC, black women are more than twice as likely to die in childbirth as white women (49 versus 19 deaths, respectively, for every 100,000 live births). This disparity remains even for wealthy black women, suggesting the need for targeted intervention that goes beyond economic support.
Giving birth in America is not a suicide mission. There were 669 maternal deaths in 2023 out of 3.6 million births, meaning there is a 0.02% chance of death in pregnancy and childbirth. Yet there remain serious gaps in maternal care that policymakers and others need to address. If politicians are serious about improving fertility rates, they must look beyond handouts and consider the conditions under which women labor — particularly those women who are most vulnerable.
RESTORING A CULTURE OF FERTILITY
As a nation, we've lost our grasp on the most basic aspects of fertility when we talk about birth in the callous terms of a "baby boom" and "baby bonuses"; when governments treat fertility as a dial to turn up and down; when there's no national agreement about when life should be protected in the womb and no plan for the fate of the embryos we keep frozen; and when we turn birth into something overly invasive, medicalized, and anxiety inducing, with limited improvement for the groups most at risk — black mothers and infants.
We've lost it when dog owners receive child-care subsidies from workplaces; when childless women protest benefits for mothers; when men ridicule other men for taking paternity leave; when the whole act of childbearing becomes more foreign and distant, occurring in secret behind hospital walls. We've lost it when a mother doesn't have job protection, or is called back to work soon after giving birth. We've lost it when we normalize single parenthood, when internet porn turns sex into a disembodied pursuit of one-sided pleasure divorced from fertility, and when we reduce words rich with meaning like "mother" and "father" to their functionality through terms like "birthing parent" and "non-birthing parent."
Before any baby boom can occur, we need to restore our cultural reverence for fertility. This starts not from the top down, but from the bottom up. As professor James Davison Hunter writes in his book, To Change The World:
What the state cannot do is provide fully satisfying solutions to the problem of values in our society. There are no comprehensive political solutions to the deterioration of "family values"....[B]ecause the state is a clumsy instrument and finally rooted in coercion, it will always fail to adequately or directly address the human elements of these problems; the elements that make them poignant in the first place.
Cultural change surrounding fertility starts in the home, with both partners exercising more responsibility while caring for each other and for their children. Couples who marry and commit to a lifelong partnership instead of merely living together tend to have more kids. According to Goldin's research, fathers' involvement plays a major role in how many children a family has, especially if the mother is working. When fertility is treated in isolation, outside of a relationship or without further responsibilities, it tends to wither, while outcomes for children worsen.
Groups with elevated fertility rates tend to profess a shared set of transcendent values. This isn't surprising: While Christian subculture may be accused (in many cases rightly) of chauvinist undertones, Christians also believe that life starts at conception, that sex is intended for marriage only (and powerful men are not exempt from such restraint), that marriage is something sacred and worthy of being desired, and that children are a gift from God. These beliefs correlate with higher rates of marriage and childbearing relative to agnostics or atheists. The overwhelming evidence also indicates that children raised in religious homes tend to have better outcomes. Religious commitment to marriage and children isn't just about numbers; it's about improving the lives those children go on to have.
Norms, beliefs, and structures at the household level influence, and are in turn influenced by, community structures such as neighborhood playgroups for kids, church-run lactation classes, and informal child care from neighbors. All help normalize fertility and child rearing while providing support for parents. If there is going to be an increase in fertility, it will likely happen in local communities that support parents through homegrown cultural norms and informal structures.
To do so is to push back on the modern trend of atomization and self-actualization and toward something richer, more mysterious, more true to the human condition. It is, in the words of Notre Dame ethicist O. Carter Snead in his seminal book What It Means To Be Human, to "remember that our embodiment renders us vulnerable and dependent upon the beneficence of others for our very lives and self-understanding, [and to] more clearly grasp our obligations of just generosity and reciprocal indebtedness to those others who are likewise vulnerable." This carries obligations not just for persons and communities, but for politics.
PRACTICAL MEASURES
Pro-natal policymakers would do well to focus not on coaxing childless individuals to have children, but on helping families that already have children flourish. If family thriving and optimism improve, people will be more likely have children. If we aim instead to produce more children regardless of family welfare, we may well get neither.
As I've written in these pages, we have plenty of options to choose from when it comes to improving the lives of new parents and infants. Baby bonuses may not incentivize new births, but they might reduce the financial squeeze on new parents if conferred when the baby is born instead of during the next tax cycle. Paid parental leave and better early-education options might not boost fertility rates, but they can improve outcomes for existing families and demonstrate support for bringing new life into the world.
We also have plenty of opportunities to make giving birth safer for mothers and their children. Improved access to telehealth and mobile "baby units" can make health care more available for women in maternity deserts. We can create more robust career paths for women to become doulas and midwives, and push for in-home care to be a more widely accepted birth alternative. We would also benefit from local, state, or national programming focused on improving outcomes for black mothers in particular, given their outsized risks in childbirth.
The American College of Obstetricians and Gynecologists recommends that women receive at least one ultrasound during pregnancy; other interventions could become similarly ubiquitous. For example, mental-health conditions are the most frequently reported cause of preventable pregnancy-related death, including deaths by suicide and addiction-related overdoses. Doctors should screen for postpartum depression to help prevent such tragedies.
More indirectly, economic interventions could increase men's marriageability, improve housing affordability, and encourage parental optimism about bringing a baby into the world. We should reduce the marriage penalties riddled throughout tax and benefit programs, which harm low-income families and are associated with reduced marriage rates. Given religion's influence on family formation, we should also protect people's right to practice their religion wherever possible and promote the vibrancy and diversity of religious institutions.
While we have plenty of opportunities to support family flourishing, fertility is a different beast. The lack of national consensus on what constitutes life — in utero or on ice — combined with broken families, a secularizing culture, and minimal public support for new parents, will not produce more babies on demand. One cannot order a tree to bear more fruit while failing to nourish the soil. If we want more children, we must first create a culture that supports the family.
