ÌÒ×ÓÊÓƵ

I have been studying policies that affect families since the late 1990s when I was a graduate student. One of the things that struck me over this time is how little attention we pay to demography in policy debates.

Contrast that with the economy or the environment where we have large discussions about the policy effects. For instance, when we consider immigration policy, policymakers debate the pros and cons of it on the economy: Will it drive wages up or down? How will it affect our growth?

It is rare for policymakers to discuss the demographic implications of a policy, which are often quite large. Ironically, our demography has a huge impact on our economy and the quality of our environment. I wanted to write a book that provides some guidance on population policy design.

If you are a low-income woman in the United States and need family planning assistance, there are a number of federal programs, such as Title X and Medicaid, that can provide contraception supplies and services at no cost to you.

The justification for these policies has always been health equity. By health equity, policymakers mean that low-income women should have the same access to contraception that middle-class women have. This access allows them to benefit from the expanding education and employment opportunities that middle-class women have gained over the past 50 years. I think that is terrific and makes a lot of sense.

At the same time, if you are a low-income woman in the United States and need help because you are infertile, government will not assist you at all. This is true even in states that mandate private health insurance cover infertility treatments for middle-class women. In other words, government will support low-income women if they don’t want to have children but won’t support them if they want to have children and need help. Given that asymmetry, I argue that we really aren’t that health equitable when it comes to government-sponsored family planning.

Government’s role should be to help people have the families they desire—not the families that government wants them to have. While that seems obvious, it is not at all what we see in government policy today.

Social science research very clearly shows that children who are wanted by their parents—children who are planned for, have prenatal care and where the parents are emotionally and financially prepared—do much better than children who were not planned for.

If you are a pregnant woman and do not want to have a child, in many states, abortion is not an option for you. If you are suffering from infertility issues and are not among the very wealthy, there is very little assistance available for you to become a parent. Socially, we should be promoting policies that increase wanted children and reduce unwanted ones.

The evidence suggests that wanted children have more education, are less reliant on government programs, less likely to be poor, less likely to live with a single parent, less likely to die in infancy, more likely to be employed and have better mental health on average. In the research, wanted children fare better on nearly every outcome. Given this evidence, again, I think it is important to help men and women make the fertility choices they want.

First, it is important to note that while birth rates are declining, the U.S. population is still growing and will continue to grow for several more decades. When people mention the decline, they are mostly concerned that today total fertility rates in the U.S. are well below replacement, typically about 2.1 births per woman. We have been below replacement for some time, but historically, the United States has had a lot of immigration which kept our population growing. This past year, our policies have slowed immigration considerably. Demographers now predict the U.S. population will eventually contract in the next 30-40 years.

We worry about declines in population because it can harm economic growth without considerable technology advances, although with AI and other technologies that may not be an issue. Our Social Security system depends on more workers than retirees, so this is an immediate problem with the decline in the number of births. Before our population starts to shrink, the composition of the population—relatively few young people and more older people—will affect the solvency of our Social Security system.

The decline in young people will also mean that the institutions that focus on our youth, such as the number of schools and universities, will likely contract, changing our economy. At the same time, environmentalists believe that population growth has led to a lot of degradation of our environment, which could become less of an issue with a shrinking population.