Opinion: America is worrying about fertility again. But it’s not really about families

OpinionFirst Opinion America is worrying about fertility again. But it’s not really about families There’s a fine line between a pro-family agenda and a coercive one Manage alerts for this article Email this article Share this article By Sonya Borrero, Christine Dehlendorf, and Rachel LoganMay 1, 2026 Borrero, Dehlendorf, and Logan are authors of the forthcoming book “Reproducing Control: The Family Planning Framework’s Conflict with Reproductive Autonomy.” America is worried about fertility rates — again. Coverage of the country’s declining birth rate reflects widespread unease: Families are struggling, young adults are delaying or forgoing parenthood, and the future labor force feels uncertain. These concerns are rooted in real social and economic challenges. Childcare is unaffordable, housing is out of reach for many, health care access is precarious, and paid parental leave is still not guaranteed. Only now, as these pressures have produced sustained fertility declines, have calls for expanded material supports gained real political traction.Advertisement But America’s anxiety about fertility has never been only, or even primarily, about supporting families. It is about who is having children, under what conditions, and in whose interest. In other words, it is about power and control. Throughout U.S. history, reproduction has been treated less as a deeply personal decision than as a tool for securing national strength, economic growth, and demographic dominance. Political attention to fertility rises not because people’s lives have become easier or harder, but because births are not occurring in the “right” way, at the “right” pace, or among the “right” groups. The language and targets have shifted over time, but the underlying logic of reproductive governance has remained strikingly consistent.Advertisement At the turn of the 20th century, fears of “race suicide” reflected panic that white, native-born women were having too few children, while others were having too many. The eugenics movement translated those anxieties into policy, resulting in the forced sterilization of tens of thousands of people deemed “unfit” to reproduce, including poor people, women of color, and people with disabilities. These eugenic sterilizations were framed as protecting the genetic quality of the nation. By the mid-20th century, overt eugenic rhetoric fell out of favor, but the impulse to manage people’s reproduction did not. It was repackaged as “family planning.” Emerging in the 1940s, this framework reframed fertility not as something to be coerced outright, but as something that could — and should — be rationally managed through planning, education, and access to contraception. U.S. reproductive policy, public health programming, and clinical practice remain largely centered on preventing “unintended pregnancy.” This language sounds neutral. It’s not. Planning presumes a set of ideal conditions for childbearing — conditions most accessible to white, economically secure Americans — while stigmatizing and discouraging the reproduction of others. During President Johnson’s “War on Poverty,” family planning was fully incorporated into anti-poverty policy. Poor women’s childbearing, particularly among Black and immigrant populations, was increasingly portrayed as a driver of intergenerational poverty and social disorder. Rather than confronting structural inequities in education, employment, and housing, policymakers turned to fertility as a point of intervention, shifting blame for poverty away from social conditions and onto people’s reproductive behaviors. Once family planning normalized the idea that fertility should be responsibly managed in the public interest, new technologies — notably intrauterine devices and contraceptive implants — were easily folded into that project. For many, these new long-acting contraceptives were liberatory, offering unprecedented reproductive control. At the same time, they were aggressively promoted — and sometimes coerced — among socially and economically disadvantaged people, often in the name of preventing poverty. Technologies that expanded reproductive autonomy were simultaneously weaponized as instruments of control.Advertisement This history reminds us that today’s pronatalist agenda does not emerge from a vacuum. Where the state once worried about too many births, it now worries about too few. The premise, however, is the same: Reproduction is something to be steered and evaluated in service of national interests rather than respected as a domain of individual autonomy. Moreover, influential strands of today’s pronatalist movement invoke “replacement” narratives, linking calls for increased fertility — particularly among white populations — to racist and xenophobic anxieties about demographic change. This is why fertility panic deserves careful scrutiny, even when it motivates good ideas. Expanded childcare, paid leave, affordable health care, and housing stability would materially improve millions of lives. These supports are long overdue, but the proposals currently under consideration fall far short of matching the scale of economic insecurity shaping family decisions, especially for those at the margins. Moreover, economic support alone does not guarantee autonomy in a post-Dobbs landscape where abortion access is increasingly restricted. The difference between a genuinely pro-family agenda and a coercive one lies in the underlying assumptions and motivations. Do policies expand people’s ability to decide whether, when, and how to have children? Or do they presume that parenthood is the expected outcome? Do they respect those who cannot or do not want to have children as full participants in society? Do they support families in all their forms, or only those that align with a particular vision of national strength? When fertility becomes a patriotic duty or an economic imperative, the line between support and pressure blurs quickly — especially for women and for those who are socially or economically marginalized. Instead of asking how to increase birth rates, a more durable and ethical response would ask whether people have the conditions to make reproductive decisions freely at all. That means advancing economic opportunity, gender equality, health care (including abortion) access, and socio-cultural narratives that value all families, not just those that align with the ruling party’s demographic or political goals.Advertisement Supporting people’s reproductive decisions, whatever they may be, is not anti-family. Reproductive autonomy is, in fact, the foundation of any ethical family policy. A society that truly values children is one that trusts all people to decide whether and when to bring them into the world — and then commits to supporting those decisions. America does not need to be made fertile again. It needs reproductive freedom to be made a reality. Sonya Borrero, M.D., M.S.; Christine Dehlendorf, M.D.; and Rachel Logan, Ph.D., M.P.H., are authors of the forthcoming book “Reproducing Control: The Family Planning Framework’s Conflict with Reproductive Autonomy.” Letter to the editor Have an opinion on this essay? Submit a letter to the editor. 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