Introduction
If the movement known as “pronatalism” took its own name seriously, one might expect it would push for law, policy, and culture change to ensure quality pregnancy care, access to help with infertility concerns, and assistance to families. After all, a new report from the United Nations shows that around the world, financial factors are what drive people to have fewer children than they actually desire. 1
Unfortunately, as Dr. Forati and Dr. Bartz make clear in their article,Reference Forati and Bartz 2 providing families and children with what they need to thrive is not what motivates “pronatalism.” Instead, as it currently exists in the United States, pronatalism tries to enforce traditional notions of gender roles in families and encourage women to bear and rear as many children as possible, regardless of their own hopes and plans for their lives. Vice President J.D. Vance, Elon Musk, and Peter Thiel, among others, have chimed in with enthusiasm.Reference Licon 3 Such views are beginning to emerge in actions of the Trump administration: Sean Duffy, Secretary of Transportation, recently issued an order directing the department’s grant and loan programs to prioritize projects in “communities with marriage and birthrates higher than the national average.”Reference Ngo and DePillis 4
Pronatalism and Abortion
The authors effectively describe links among pronatalism, traditional or conservative patriarchal values, (White) nationalism, and efforts to outlaw abortion and contraception. Pronatalism in the United States seems allied with antiabortion policy efforts, despite the fact that most medical experts agree abortion can be a necessary element of maternal health and pregnancy care. Indeed, the American Medical Association, among many other professional societies and scientific organizations, has issued multiple statements and policy guidances to this effect. 5 One wonders if public pronatalist voices are aware that abortion procedures can play a critical role in successful in vitro fertilization outcomes,Reference Macintosh 6 and the ability to provide pregnancy termination when a medical crisis strikes a pregnancy can be critical to protect future fertility.Reference Shachar, Baruch and King 7
Pronatalism’s origin story, however, is anxiety about declining fertility rates and the stress such demographic shifts may impose on health and care systems for older adults. 8 As the population ages, the concern is whether there will be shortages of younger people in the workforce: to sustain the labor market and economy overall, provide care for the elderly directly, and pay into systems like Social Security or Medicare that help people as they age. Although some countries have addressed demographic anxiety by allowing increased immigration, that seems unlikely in the current United States political climate.
Instead, recent “pronatalist” policy efforts seem to prioritize outlawing abortion in order to increase the number of babies born. But even a cursory look at the evolving landscape of restrictive state laws and their consequences since Dobbs v. Jackson Women’s Health Organization illustrates the failure of antiabortion policy to assist meaningfully with pronatalist goals. Despite new abortion restrictions and bans in many states, there has been a slight uptick in the number of abortions since the Dobbs decision, surprising some observers. According to the health policy research center KFF, “The combination of growth in telehealth availability for abortion care, lower telehealth costs, increased legal reproductive health care protections through state efforts, and higher rates of interstate travel, all likely contributed to the unexpected trajectory in abortion volume.”Reference Diep 9 Although that increase includes in its tally clinician-provided procedures and medication abortion pills provided through telehealth in the US, it does not include evidence of a parallel increase in self-managed abortions, with pills mailed to patients from outside the US.Reference Aiken 10 The actual increase may be higher.
In recent years, states with abortion restrictions have seen birth rates rise compared to unrestricted states; however, the uptick in birth rates has been driven by birth rates among the most marginalized communities. As one study noted, “fertility rates in states with abortion bans were higher than would have been expected in the absence of these policies, with the largest estimated differences among subpopulations experiencing the greatest structural disadvantages and in states with among the worst maternal and child health and well-being outcomes.”Reference Bell 11 In addition, these same states with abortion bans have seen increased rates of infant mortality.Reference Gemmill 12 To sum up, if the goal of abortion bans is to encourage certain women (married White women) to have more babies, there is no evidence of that result. Instead, there is evidence of harm to mothers and babies in marginalized subgroups.
Conclusion
It doesn’t have to be this way. Pronatalism could be a movement to provide the support and conditions people need to have and raise children. In addition to several global approaches offered by Dr. Forati and Dr. Bartz, it is worth studying the reproductive justice framework and movement. Founded and created by a group of Black women leaders in the 1990s, reproductive justice offers guidance for policymakers who want to take a more holistic, universal, and effective approach. Responding to a mainstream pro-choice movement seen as focused exclusively on “choice” and abortion rather than access and economic needs, reproductive justice is defined as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” 13 This broader and deeper approach is worth pursuing, to permit the US and other cultures to achieve justice and avoid harm, centering individuals’ experiences, rights, and needs.
