Prior Government-Sanctioned Pronatalist Policies

In the last century, pronatalism has risen and fallen and re-risen in countries around the world. While there were likely complex, multi-factorial reasons for each period of pronatalist or anti-natalist policy specific to each country, the three most common motivations behind many pronatalist policies have included nationalism, economic concern, and promotion of conservative values. These drivers prioritize state goals over individual goals, framing reproduction as essential to societal and national well-being. Romania, Turkey, and Iran illustrate how some or all of these motivating factors have played a role in shaping policy designed to influence reproductive outcomes.

Romania, from the period of 1966 to 1989, serves as a classic example of government-sanctioned pronatalism within the guise of supporting the economy and building nationalism while promoting traditional family values.Reference Anton¹⁹ At the start of this period, with the election of Nicolae Ceaușescu as state leader, the Romanian Communist Party began to promote reproduction “for the good of the socialist nation,” wanting to expand its nationalist power in numbers and sustain its socialist system with the prerequisite large workforce, reflecting both nationalist and economic motivations. Chiefly, the new government focused on increasing fertility rates through the means of prohibiting pregnancy terminations. Overnight, abortion on request became illegal, with few exceptions except for life endangerment or for women above age 45 or who already had four children.Reference Anton²⁰ The immediate effect was profound; the monthly birth rate jumped from 14.5 to 36.1 per 1,000 persons in the first year.Reference Berelson²¹ However, this effect stabilized within just a few years as clandestine methods of abortion became prevalent. In turn, the government intensified its campaign by further implementing policies to strengthen traditional family structures. Divorce was made more difficult, families with three or more children received tax reductions, and indivduals over the age of 26 and without children were penalized with a celibacy tax.Reference Anton, Zordo, Mishtal and Anton²² Moreover, women who underwent illegal abortion (and those who aided them) were heavily criminalized, condemned to prison for six months to two years.²³ Collectively, Romania’s policies illustrate how economic concerns, nationalism, and conservative values intersected to drive pronatalist efforts.

Turkey provides another example of restrictive pronatalist ideology, driven primarily by nationalism. Notably, it illustrates a case wherin political rhetoric alone has influenced reproductive behaviors, even without overt criminalization of abortion. While abortion is technically legal in Turkey, political rhetoric against the procedure has dissuaded people from obtaining it and healthcare professionals from feeling safe providing it.Reference Telli, Cesuroğlu and Aksu Tanık²⁴ In 2012, strong pronatalist and antiabortion rhetoric emerged under the banner of nationalism from key Turkish politicians stating that abortion assists “to wipe this nation off the world stage.”Reference Dayi and Karakaya²⁵ This notion promoted reproduction as a patriotic duty, closely linking it to national pride and power. Further government messages encouraged couples to have at least three children.²⁶ Subsequently, the Ministry of Health announced a “Draft Law on Reproductive Rights” that proposed limiting induced abortion to 4 weeks gestational age, well before a person even knows they are pregnant, or banning it altogether.Reference Mihciokur²⁷ However, due to the effort of women’s rights groups, it was never passed. Nonetheless, it soon became clear that the ongoing rhetoric by governmental leaders was enough to prevent medical institutions from offering abortion services. One report stated that just 3 out of 37 state hospitals provided non-emergency pregnancy terminations, of which only one provided procedural abortion until 10 weeks gestational age.Reference Letsch²⁸ This was exacerbated by lawmakers removing induced abortion from public health insurance coverage.²⁹ Turkey officials then established the Health Transformation Program (HTP), which abolished family planning centers and excluded family planning and safe abortion access from the governmental health budget. As expected, abortion through the public sectors dried up, leaving these services available only to individuals of higher socioeconomic status (SES) affording private care. The experience in Turkey, not unlike the US experience under Roe v Wade, exemplifies legal availability but governmental rhetoric and policy that significantly affects availability of reproductive healthcare, especially for certain marginalized populations.Reference MacFarlane³⁰

Iran’s shifting family policies over the past century illustrates how all three motivators — economic concern, nationalist ideology, and promotion of traditional values — continually influence reproductive policies. Upon establishing its first national family planning program in 1967, Iran achieved the most effective family planning program in the world: public clinics distributed free contraceptives, the government legalized abortion and sterilization, schools and universities organized family planning education and programs, and the media launched a widespread campaign encouraging women to space out their pregnancies by 3–4 years and avoid pregnancy under the age of 18.Reference Asadisarvestani and Sobotka³¹ These progressive policies occurred under the Pahlavi Dynasty (1925 to 1979) which broadcasted its agenda with the goal of modernization and westernization, including the elevation of the status of women. Therefore, they deemed the fertility growth rate of 3.1% per annum as incompatible with their developmental goals of a modernized Iran where women’s participation in education and the labor force were encouraged and thus sought to reduce it. After the Islamic Revolution of 1979, however, the newly established theocratic Islamic regime overturned these policies to prescribe a profoundly restrictive gender model proclaimed to be “Islamic” and hence based on nonnegotiable conservative traditions sold as “divine rules.”Reference Hoodfar³² They enforced compulsory veiling and nearly eliminated women’s participation in the labor market and their judicial rights in court, lowered the age of marriage, and, predictably, restricted access to contraception and abortion. A decade later, the resulting high birth rate of 5.5 births per woman coupled with the depressed economy following the Iran-Iraq war prompted the theocratic regime to modify its family planning restrictions.Reference Abbasi-Shavazi³³ Therefore, a new government message emerged; they told the public the Prophet allowed Muslims to practice contraception in times of economic hardship, and they re-instilled a comprehensive family planning program into their larger national health program.³⁴ This changed family planning policy in 1989 resulted in a rapid decreased fertility rate and improved the status of women with increased female literacy and participation in higher education,Reference Lutz, Cuaresma and Abbasi‐Shavazi³⁵ a concurrent delayed lawful age of marriage, decline in infant mortality, and increased healthcare access in rural areas.Reference Hosseini-Chavoshi, Abbasi-Shavazi and McDonald³⁶ As of 2021, with a resulting new low fertility rate of 1.7 births per woman, however, the Islamic regime has once again adopted pronatalist, regressive policies with the stated motivation sold as the big three — Iranian national pride, economic growth, and traditional Islamic culture as an important means of rejecting westernization.³⁷ This propaganda was baked into the aptly named “Youthful Population and Protection of the Family” law passed in 2021, introducing a drastic change from Iran’s previous family planning policy. The government abolished its family planning budget, ended the distribution of free contraceptives and family planning educational programs in schools and universities, and banned permanent sterilization.Reference Karamouzian, Sharifi and Haghdoost³⁸ While the 2021 Family Law includes “positive” incentives, such as loans to buy or build housing, tax incentives, women’s priority in employment, and extension of paid maternity leave, it is also stringent on restrictive policies with limited access to reproductive health services as outlined above, as well as the banning of some prenatal services such as fetal screening in the absence of a high-risk pregnancy.³⁹

A Few of the Medical Harms of Pronatalism

Pronatalist ideology and policies, while often presented as benefiting a nation or society, pose significant health risks to those whom they most directly affect. Pregnancy-capable individuals bear the greatest burden, especially in settings with restricted reproductive choices, as seen in historical examples like 1960s Romania and contemporary policies in the United States outlined below. Additionally, those experiencing infertility and individuals whose reproductive choices or relationships diverge from societal norms face greater risk of stigma, discrimination, and mental health challenges in highly pronatalist environments. These harms highlight the fundamental conflict between pronatalism, which is inherently coercive and disproportionately impacts marginalized populations, and the principles of reproductive justice, which prioritize individuals’ health, safety, and autonomy.

One of the clearest examples of the harm these policies inflict is seen in restrictive abortion laws that are explicity rooted in pronatalist goals set by national leaders. For instance, during Romania’s 23-year pronatalist era, the number of women who died due to illegal abortion was approximately 25,000, and the infant mortality rate was 26.9 per 1,000 in 1989, with both figures the highest in all of Europe at the time. These outcomes were experienced the most in marginalized communities because, as is often the case, people with financial privilege had reproductive options through travel and other resources unavailable to the working class. Similarly, Iran’s 2021 Family Law is projected to worsen maternal, fetal, and reproductive health outcomes.Reference Aloosh and Saghai⁴⁰ Given fetal screening and abortion have become increasingly restricted in Iran, the number of newborns with mental and physical disabilities is likely to increase, especially among families who cannot afford to otherwise acquire fetal screening tests. Moreover, the abolishment of free contraceptives widens disparities between those who can afford to protect against pregnancy and those who cannot, forcing the latter to go through the physical, emotional, and financial tolls of unwanted birth.Reference Sarvestani⁴¹ The number of unsafe abortions is estimated to be between 129,000 and 219,000 annually in Iran. These figures, likely an underestimate, are projected to continue to increase, endangering lives of women and leading to outcomes commensurate with that of 1960s Romania.Reference Rastegari⁴²

Well-established data exposes that in country after country and regime change after regime change, when controlling for gross domestic product and female education, mean maternal mortality is significantly reduced in countries with more flexible abortion laws compared to countries with more restrictive abortion laws.Reference Latt, Milner and Kavanagh⁴³ This is due to several foreseeable reasons. Firstly, people who need abortion for health and life-saving means face significant limitations in their options for medical care. Although some abortion-restricted states have exemptions for life-saving abortions, the language remains vague such that it creates uncertainty and fear in providers in ultimately recommending abortion as the treatment plan.Reference Sabbath⁴⁴ Moreover, when restrictive abortion laws are motivated by pronatalism, they are often accompanied by a concomitant decrease in other family planning services such as contraception.⁴⁵ As a result, defunded and restricted methods of birth control lead to more pregnancies at baseline, and the resulting higher danger from more miscarriage, ectopics, and the normal risks of gestation and childbirth, as well as increased incidence of unsafe, clandestine abortion. Ultimately, as seen in Romania’s pronatalist era and many other countries, abortion bans do not effectively cause abortion rates to decrease; rather, the dangerous means by which they are performed increases.Reference Ganatra⁴⁶ This direct relationship between increased abortion restrictions resulting in increased abortion rates continues to be upheld: in the year following the Dobbs decision, there were cumulatively 2,200 more abortions in the United States compared to the year prior.⁴⁷ Pronatalism as a policy motivator — the concomitant decreased restriction to both birth control and abortion — is largely the force behind this phenomenon.

As US pronatalist policies are implemented at the state level, reproductive and family health outcomes have predictively worsened in abortion-restrictive states. While average maternal mortalities ratios were similar across US states in 1999, as of 2017, the mean maternal mortality ratio (MMR) was 28.5% (95% CI 20.7–35.1) in abortion-restricted states compared to 15.7% (95% CI 10.7–19.9) in protected states.Reference Addante⁴⁸ There were 1,193 abortion restrictions that states enacted between 1973 and 2017 after the US Supreme Court decision legalized abortion in Roe v. Wade. Reference Nash⁴⁹ The most striking difference in the US state-level data is in the analysis by race: Black, Hispanic, Asian, Native American, and White women all faced significantly increased risk of maternal mortality between 1999 and 2017 in abortion-restricted states; however, this association was especially strong for Black and Native American women compared to White women.⁵⁰ On the other hand, in abortion-protected states, MMR either decreased or remained stable for all racial groups between the two periods with less of a difference in MMR in Black and Native American people compared to White people. From a family health perspective, new data shows that Texas’s 2021 ban on abortion in early pregnancy was associated with a 12.9% increase in infant death and 10.4% increase in neonatal death in Texas, compared to decreased rates in other states.Reference Gemmill⁵¹ Congenital anomalies, the leading cause of infant death, also increased by 23% in Texas but decreased by 3% in the rest of the United States. Recent data from the Commonwealth Fund shows that the highest maternal mortality rates in the United States were seen in Arkansas, Louisiana, Mississippi, and Tennessee — states with total bans on abortion post-Dobbs — where most counties within these states don’t have a single maternal health center or hospital, known as a maternity care desert.Reference Collins⁵² States with abortion restrictions also have the fewest number of maternity care providers, which is likely to be exacerbated by the downtrending number of Ob/Gyn residency applications to these states.Reference Orgera and Grover⁵³

The adverse health consequences of pronatalism extend beyond pregnant people or people at risk for pregnancy. People living in pronatalist cultures who experience difficulty getting pregnant or complete infertility have higher rates of depression and anxiety,Reference Saleem⁵⁴ decreased self-esteem, intimate partner violence,Reference Bondade⁵⁵ social stigma,Reference Manikkam and Bhargavi⁵⁶ and sexual dysfunction, among others, compared to those living in more supportive communities. Insensitive remarks and questions about their failed procreation or unsolicited advice about how to “solve their issue” are common shared experiences of women with infertility in cultures that elevate and emphasize the importance of childbearing.Reference Parry⁵⁷ Interviews with 32 women with infertility in pronatalist Mumbai revealed that this societal pressure and treatment made them feel that their body has betrayed them and their inability to conceive made them less of a woman and person, all resulting in a negative effects on their identities.⁵⁸ This is especially relevant in populations where government funding, public health sector availability, and insurance coverage for infertility testing and treatments are inaccessible in most low-middle-income couples.⁵⁹ In a patriarchal society with pronatalist values, therefore, a woman’s status and identity become attached to her reproductive abilities, with resulting mental health and relationship consequences when those abilities are less than perfect.Reference Roberts⁶⁰

Pronatalist policies rarely advocate for childbearing or childraising through “nontraditional” families, such as same-sex couples, single parents, and unmarried couples. In fact, when motivated by conservative family values or nationalism, childbearing and raising within these families are discriminated against and overtly discouraged. It is no coincidence that in the United States, there is nearly identical overlap between the states that have outlawed abortion and those that have outlawed gender-affirming care.⁶¹ The adoption of pronatalism as an ideology that values women solely through a heteronormative and patriarchal lens lends itself to devaluing and undermining those who have non-conforming identities, worsening the criminalization and discrimination these communities already face. Within the year following Dobbs, a record number of 520 anti-LGBTQIA+ bills were introduced in state legislatures with almost half of them targeting transgender and non-binary people.⁶² Likewise, transgender, non-binary, and gender expansive people (TGE) are likely to face unique barriers when receiving reproductive health services, like limited healthcare provider knowledge, denial of care, discrimination, and misgendering as a result of transphobia and cis-sexism.Reference Harb⁶³ Similar to what previous studies have shown, as restrictions increase, so do unsafe methods of termination specifically within the LGBTQIA+ population. One study showed that 36% of TGE individuals disclosed considering self-terminating their pregnancy without the supervision of a provider, and 19% of those reported going through with it.Reference Moseson⁶⁴ In most cases, this was because clinical care was not deemed a safe or accessible option due to legal restrictions, health insurance, or healthcare denials or mistreatment. Further, a prospective study revealed that discriminatory laws and policies increase the prevalence of mental health disorders in LGBTQIA+ adults.Reference Hatzenbuehler⁶⁵ Similarly, LGBTQIA+ youth who lack supportive social environments like protection against bullying and discrimination have increased suicide attempts.Reference Hatzenbuehler⁶⁶ Pronatalism, in its promotion of traditional gender roles and lack of support for LGBTQIA+ individuals, only worsens mental and physical health concerns for this group of people who already experience disparities in health outcomes.

As Gender Parity Improves, People’s Reproductive Goals for Themselves are Shifting Away from the Goals of Pronatalist Policies

In effect, pronatalism threatens the advancement towards gender parity that people have fought for around the world for centuries. Most of today’s pregnancy-capable people matured to early adulthood with the reassurances afforded by Roe coupled with the the significant sociocultural and sociopolitical changes of the Women’s Liberation movement of the 1960–80s that suggested women, unshackled from the risk of pregnancy, could contribute to the educational, economic, and governance sectors of modern society. Delay in and even denial of traditional family building is becoming increasingly common in people across all US socioeconomic sectors, driven largely by desires to go to college and to contribute to society beyond parenthood.Reference Mills⁶⁷

Country-level fertility rate variability is directly correlated with women’s empowerment within society rather than by governmental population policies.Reference Pritchett⁶⁸ Policies that improve objective conditions for women, including education, integration into the workforce, safety, and a leveling in familial and societal power dynamics, likely have the most profound effects on fertility. This pattern is clearly seen over the last five decades in the United States, where women have made strides lessening the gender gap by outpacing men in college graduationReference Parker⁶⁹ and making up almost half of the labor workforceReference Fry and Stepler⁷⁰ while simultaneously increasing the average age of first birth, most recently at 27.3 years old in 2021 compared to 25.6 one decade prior, 24.9 in 2000, and 21.4 in 1970.Reference Schaeffer and Aragao⁷¹ Surveys of women of reproductive age have found that those who decide to have children later in life often stress the importance of establishing their independence through education, secured employment, and financial stability and achieving their personal goals prior to having children.Reference Benzies⁷² A survey of young Australian men found similar results, with participants highlighting “preconditions” for having children, including financial security and a permanent job.Reference Thompson and Lee⁷³ Delayed parenthood enables individuals to prepare through establishing a securer place in their career, accumulating sufficient resources, and fostering more stable parenting partnerships.Reference Beaujouan, Sobotka and Stoop⁷⁴ Despite the small delay in parenthood in university-educated women, the bulk of the fertility decline in the United States has actually been driven by younger, more economically disadvantaged women ages 15-19.⁷⁵ This is partly because more are entering college, but even those who are not are choosing to delay parenthood.⁷⁶ However, by encouraging — and at times coercing — people to have babies earlier and more frequently, pronatalism manipulates their desires to contribute to their society under the guise of supporting the national economy.

Women’s fertility intentions have been well studied in China through the lens of several seismic changes in national population policy over the past few decades. Most notably, in 2021 China shifted from a one-child to a three-child per family limit due to government economic fears when fertility rates dipped lower than anticipated under the one-child policy. Surveys of women living in China reveal those with higher education, longer working hours, or an unhealthy partner had a lower intention to have a second or third child.Reference Chen⁷⁷ This is a typical pattern; women’s fertility desires tend to decline with obtainment of higher education, thought to be related to personal and financial fulfillment in tasks other than child-rearing.⁷⁸ The time, stress, and financial costs of raising children are the most common stated reasons for lower fertility intentions. In a 2020 study of Chinese urban women conducted by the Women’s Studies Institute of China, almost half of the respondents reported negative effects of their pregnancy or childbearing on their careers, such as income loss and losing opportunities for training or promotions. Thirteen percent were fired or forced to resign, and 8% experienced demotion.Reference Wang⁷⁹

In Practice, Pronatalism Does Not Affect TFR in the Long-Term, and Is Therefore Ineffective

Due largely to the health harms and the incongruence with reproductive goals as mentioned above, policies to promote family growth just don’t work well to sustainably increase fertility rates. Pronatalist policies at best may increase TFR by 0.2 births per woman, but most often it is observed that pro-fertility policies result in no long-term change in TFR.Reference Gauthier⁸⁰ Policy instability at time of implementation and difficulty in funding sustainability contribute to failed outcomes.⁸¹ Hungary serves as one example of a country with failed results, spending 6.2% of its GDP on population promotion policies from the 1990s to the early 2010s without seeing increased fertility rates.Reference Lutz, Sobotka and Zeman⁸² Similarly, today, South Korea is considering giving couples as much as $70,000 per new baby born as a means of improving the size of a dwindling workforce, a sum almost twice its annual per-capita income.⁸³ When young men and women live in countries with economic uncertainty, they are unlikely to want to start or expand families beyond national averages despite whatever population policy their government is promoting at the time.⁸⁴ Policies may also be incongruent with what occurs in practice: for example, while a policy may state that parents may be granted more time off, the labor market can then be found inflexible or limited in childcare access or parental leave. The period of 2009–2013 in the Czech Republic demonstrated this paradox when it granted parents increased parental leave as a means of encouraging family growth but still had a low availability of childcare, thereby promoting the “male-only breadwinner” model of the family as women were required to take several years off of work or completely withdraw from the labor force.Reference Frejka and Gietel-Basten⁸⁵ The United States also fails to provide adequate support for its policies targeted on family-building, especially in states with greater abortion restrictions. In an analysis that measured states’ abortion policies as compared to policies directed at supporting maternal and child health and well-being, states with greater abortion restriction more often lacked evidence-based supportive family policies, such as expanded family/medical leave, temporary disability insurance, and requirement of accommodations for pregnant workers, as compared to abortion-permissive states.Reference Burns, Dennis and Doughlas-Durham⁸⁶ This inverse relationship between number of abortion restrictions and maternal-, child-, and family-friendly policies demonstrates that such policies are not only ineffective at encouraging people to expand their family size, but they are also incredibly problematic for individuals with unwanted pregnancies.

Societal and Economic Prosperity Can Be Achieved Without Pronatalist Policies

While we will not analyze the connection between fertility rates and traditional capitalistic markets, we advocate for approaches to achieve societal prosperity that avoid compromising people’s bodily sovereignty and reproductive justice. These approaches include optimizing societal factors hindering individuals who desire children but face barriers, such as economic instability or gendered domestic responsibilities. We also suggest adopting liberal immigration policies to address labor shortages and investing in the economic and political empowerment of women to expand their contributions to the workforce. In contrast to pronatalist policies that often infringe on reproductive autonomy and justice, these strategies help to create a more inclusive and supportive environment without attempting to influence individuals’ reproductive choices.

Historic gender norms that prevent shared childcare responsibilities may deter childbearing in individuals who would otherwise consider it. Changing domestic gender norms is a widescale undertaking in congruence with changes in societal culture. This can be addressed through a multipronged approach, beginning with gender-equitable education, promoting women’s economic rights and independence, and expanding opportunities for women’s political power. Expansion of parental leave policies, protections for both men and women who wish to take it, and availability and affordability of childcare and housing would address many of the factors that studies have identified as barriers to childbearing.Reference Haan and Wrohlich⁸⁷ Countries with the best family support programs typically have comprehensive policies that include paid parental leave, affordable childcare, flexible work arrangements, and financial support for families. For instance, Sweden, the first country in the world to replace gender-specific maternity leave with parental leave, offers 480 days of paid parental leave to be shared between two parents, each of whom is entitled to 90 days exclusively.⁸⁸ The non-transferable 90-day leave for each parent serves to counteract the tendency for unequal distribution of parental leave, i.e., fathers taking less leave than mothers. They also provide an extensive and affordable public childcare system whose fees depend on household income. Norway has a similar approach of distributing the parental benefit period by having a paternal quota of 15 weeks, nontransferable to the mother. The total period in which parental benefit is 100% paid is 49 weeks; alternatively, parents may choose to receive 80% pay for 59 weeks.⁸⁹

Reliance on immigrants and improved immigration policies may present an alternative approach to sustaining economic growth in low-fertility countries, thereby decreasing the need for pronatalist policies.⁹⁰ Of course, this necessitates a shift in current public and political attitudes towards immigration as well as improved conditions for migrants. Importantly, this must be equally balanced with an ethical awareness of the negative consequences on the economies immigrants leave behind, decreasing numbers in their own country of origin’s workforce.Reference Dodani and LaPorte⁹¹ Canada presents an example by which liberal immigration policies have led to national economic prosperity. According to Immigration, Refugees and Citizenship Canada (IRCC), Canada takes in about four times as many immigrants per capita compared to the United States,Reference North⁹² and their laws and attitudes toward detention are much more hesitant compared to the United States.Reference Sanders⁹³ Their resulting increase in labor supply from newcomers has significantly boosted the non-inflationary growth potential of the Canadian economy since 2019.Reference Champagne⁹⁴ Despite the more restricted immigration policy in the United States, immigrants make up 14% of the population and 17% of the workforce.Reference Passel and Cohn⁹⁵ Without future incoming immigrants in the United States, the workforce population would decrease from 173 million to 166 million between 2015 and 2035. By contrast, with continued new immigrant arrivals at the current rate it is projected the workforce population will increase to 183 million by 2035, according to the Pew Research Center.⁹⁶

The economic and political empowerment of women correlate reliably and positively to subsequent economic growth after accounting for potential confounders.Reference Dahlum, Knutsen and Mechkova⁹⁷ Studies have shown that these positive economic contributions have largely been due to an increase in their reproductive choices — the ability to choose if and when to have children. The introduction of the oral contraceptive pill in 1960, for example, gave women greater certainty in the pregnancy consequences of sex and thus greater flexibility in their long-term career investments.Reference Goldin and Katz⁹⁸ Initially, it was not legal for a physician to prescribe an oral contraceptive to an unmarried minor without the consent of her parents. Through the early 1970s, however, states began to decrease the age of majority for oral contraceptives to 18 and increase the rights of unmarried people, and thus the pill became equally accessible to young, single women. It was during this period that there were substantial increases in utilization of the pill before age 21 and of family planning services by young women born in the mid-1950s as compared to the 1940s.⁹⁹ Simultaneously, the age at first marriage and the number of female students in professional programs, such as law, medicine, dentistry, and business administration, all increased throughout the 1970s, which analyses have shown was profoundly due to an increase in family planning services.¹⁰⁰ One study showed that increased access to contraceptive pills increased the number of women in the paid labor force and the number of hours worked secondary to a reduction in likelihood of first birth before the age of 22. The mere ability to access birth control before age 21 accounted for 370 of the 450-hour increase in annual work hours per woman between 1970 and 1990.Reference Bailey¹⁰¹ In essence, women’s ability to control their reproduction has been associated with decades of economic advancement for women, children, and families and with improvement of the economy for all of society. Policies that promote reproductive freedom allow a woman to stay in the workforce today, as compared to pronatalist policies that would rather bet on a male offspring potentially being added into the workforce sometime in the future.