The Fertility Industry and the Myth of a Birth Rate Crisis: Why Pronatalism Won't Reverse Population Decline

Nandita Bajaj and Pamela Tsigdinos

The Trump administration has failed to move the needle on its goal of boosting US declining birth rates and reversing the "fertility crisis," which Health and Human Services Secretary Kennedy recently called "a threat not only to our economy, to our national security," and Dr. Oz said has left a third of Americans "under-babied."

Falling birth rates are not a crisis, but rather a positive result of greater reproductive choice. Far from being "under-babied," women worldwide have more children than they desire due to lack of reproductive choice. As a result, world population is still growing, projected to reach 10.4 billion by the 2080s, and consumption is growing with it, unleashing vast ecological and social consequences. 

Slower growth—and ultimately zero growth—is good for people and the planet, but maybe not for those in power, who for millennia relied on women's reproductive labor to produce more workers, consumers, religious followers, taxpayers, and soldiers.

Trump's pronatalism is informed by a racist "great replacement" conspiracy theory, while some progressives flirt with their own misguided version of pronatalism. But well-intentioned or not, pronatalist policies don’t work. In the US and globally, they have failed to reverse the trend of declining birth rates. That’s because lower birth rates primarily reflect greater reproductive autonomy, education, and employment opportunities for women, not economic barriers to having babies.

Failing to boost birth rates by other means, Trump pivoted to fighting infertility. Posturing as "the father of IVF", he recently tried incentivizing IVF treatment. But that won’t boost birth rates, either. 

There is no conclusive evidence that primary infertility, a biological inability to reproduce, is a cause of declining birth rates in the US. Most of the decline occurs in younger Americans, including a dramatic drop in teenage pregnancies—a trend the Trump administration perversely decries. These trends are driven by choice, not infertility.

We must address environmental and health-related drivers of infertility, but conflating it with low birth rates is inaccurate and has serious consequences. It further stigmatizes people dealing with biological infertility and treats a trend due largely to greater choice as a problem requiring medical intervention.

While Americans overwhelmingly consider access to IVF as a good thing, Trump's pro-IVF agenda is anything but feminist. Together with its expansion of the global gag rule and funding cuts to Planned Parenthood, the administration's IVF-expansion plan is part of a pro-conception doctrine influenced by tech-right elites with large investments in the 'fertility' industry.

That industry, which includes IVF and assisted reproductive technologies (ART) like egg freezing, is now big business with estimated revenue of $10.9 billion. 

It has a dark side—making misleading claims to obscure very high failure rates, hiding cases of abuse and preying on the vulnerable, and leveraging scientific research for mercenary commercialization. When painful realities eclipse the hype and the interventions don’t work, it’s the patients who shoulder the blame, while the industry co-opts feminist empowerment rhetoric to keep marketing the services.

Rather than acknowledging these harms, IVF and egg freezing are generally promoted as public goods. WHO guidelines acknowledge biological infertility causes immense shame and anxiety. But instead of tackling the toxic stigmas and norms behind this, they put the onus on patients to 'fix' their infertility through ART, reinforcing the notion that motherhood is a mandatory aspect of a woman’s life.  

This expectation is one of the greatest impediments to reproductive justice, as we both know firsthand. One of us, a product of a traditional Indian culture, didn’t even know that not having children was a choice until almost age 30. The other had a decade-long traumatic battle with primary infertility and multiple failed assisted reproductive procedures. We’ve each experienced the stigma aimed at people without children. 

ART has undeniably allowed people to realize their family dreams. But when trusted institutions like WHO promote it uncritically, it encourages exploitation by an increasingly predatory industry. 

Since 2014 Silicon Valley has been cashing in on its investments in "femtech," including unregulated ‘full stack’ clinics. Tech billionaires and white nationalists are investing billions in the fertility industry to create more babies of a certain kind. ART proponents are increasingly likely to have close ties to the Trump administration, and be motivated by eugenicist fears of "race suicide" and "erasure of Western civilization." 

Paternalistic fertility management has a long, well-studied history of coercion, but its modern-day equivalents tend to fly under the radar. There is a large body of research into how paternalism has impacted contraceptives, abortion, and sterilization. But there is a glaring gap in research on how paternalism impacts ART. 

That needs to change. The American College of Obstetricians and Gynecologists stresses the need for informed consent. That should include being fully and objectively informed about ART. Unless caregivers and patients are aware of ART’s harms and exploitations, women will remain at the mercy of the pronatalist ideologies and business interests boosting the multi-billion-dollar fertility industry.

####

Nandita Bajaj is executive director of the nonprofit Population Balance, senior lecturer at Antioch University, and producer and host of the podcasts OVERSHOOT and Beyond Pronatalism. Her work focuses on the combined impacts of pronatalism and human expansionism on reproductive and ecological justice.

Pamela Mahoney Tsigdinos is an independent scholar, journalist, and author of Silent Sorority and An IVF survivor unravels 'fertility' industry narratives. Her pioneering work focuses on the marketing narratives of the commercial fertility industry, the lived experience of IVF survivorship, and the socio-environmental impacts of regional tourism governance.