A crisis of meaning

Americans are having fewer babies. The Trump Administration wants to fix that. Declining birth rates aren’t good news for any country, and the latest U.S. data shows a current total fertility rate of 1.6, well below replacement level of 2.1. President Trump, acting on campaign promises, sees increasing access to fertility treatments as one way to boost a baby boom.

The White House recently announced new policies aimed at addressing the high cost of assisted reproductive technologies such as IVF, and expanding fertility treatment coverage through insurers. But the relationship between fertility treatments and the hope for increasing birth rates on a national level is complicated, and reasons behind demographic decline are complex. It’s unclear if infertility is driving the drop in America’s total fertility rate, or whether the real culprits are delayed childbearing, fewer marriages, or a waning desire for parenthood—as some recent surveys suggest. Perhaps a growing contingent of Americans simply don’t find forming families a compelling way to spend their lives.

Fertility treatments can easily cost patients tens of thousands of dollars. The administration’s plan would reduce the cost of several fertility related drugs and increase U.S.-based manufacturing of such drugs through a deal with EMD Serano. It also offers guidance to employers interested in adding fertility coverage. The majority of U.S. employers still don’t offer fertility benefits to employees.

Families experiencing infertility have reason to celebrate these policy initiatives. But in the aggregate, data may not demonstrate that increased use of assisted reproductive technologies meaningfully increases national birth rates. Widespread use of assisted reproductive technology may simply redistribute births rather than increase total fertility rates. For example, the rates of IVF use in Denmark continue to rise, while the total fertility rate continues to fall. And in fact, expanded use of IVF can prompt women to further delay having children.

The United States certainly isn’t alone in employing a variety of policy solutions to move the needle on birth rates. Many Western countries subsidize fertility benefits, offer child allowances, and provide free healthcare or childcare. Yet all have birth rates that stubbornly remain below the replacement rate. If forming families was simply a matter of introducing the right incentives, a country would have already found the winning formula.

It may be that we’re witnessing the limits of policy to address the most fundamental questions of human existence. Making a political case for having kids is an ancient impulse. It’s an uncomfortable truth that governments can’t legislate meaning. Expanded access to assisted reproductive technologies can’t resolve the metaphysical questions that our polarized political parties are ill-equipped to address. Why am I here? Do I matter? Should there be more of me?

Raising children involves profound suffering and self-sacrifice. Most of us, when given the choice, would prefer to avoid both.

My experience of building a family has been nothing like the curated domesticity of social media. I have been pregnant eight times in the past nine years. I’ve given birth 6 times, and have five living children. One of my sons is profoundly disabled. I’ve known early miscarriages and a later-term loss that ended in a silent delivery room. You can’t package that experience for likes. Parenting has introduced me to the most profound suffering I’ve ever experienced. Raising a family is brutally painful work. Voicing that reality is a non-negotiable when we discuss forming families.

Parenting has paradoxically introduced both profound pain and essential meaning to my life. It may be that the deepest joys in life are experienced not because we’ve avoided pain but because we welcomed it. There is nothing I’d rather be doing than forming a family—watching five extraordinary lives unfold is a privilege.

Encouraging Americans to have more babies is less about inventive policy solutions and more about recovering a shared sense of meaning. I don’t parent because it’s useful—for my country or anyone else—but because I believe life itself is deeply good.