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BIRTH RATES ARE FALLING. HERE ARE REAL SOLUTIONS.  
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Katelyn Jetelina
April 25, 2025
Your Local Epidemiologist
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_ In the U.S.—and across much of the world—fertility rates are
falling, and populations are projected to shrink. People are having
fewer children because the system makes it too hard, too risky, and
too expensive. _

"Amor", by Ana Patrícia Almeida (CC BY 2.0)

 

I have two beautiful daughters. But the journey to bring them into the
world nearly broke me—physically, emotionally, and financially.

It took three years of infertility treatments to get pregnant the
first time and the cost drained our savings. One round of treatment
can run upwards of $50,000—just for a single ovulation cycle, paid
entirely out of pocket. And when we tried to fight our insurance
denials, we were told there was a “medical alternative”: don’t
have a baby.

After all that, our first child died in a stillbirth, which was
traumatic and heartbreaking. When I finally made it to my third
pregnancy, I hemorrhaged. I still remember the panic in the room, the
alarms, the fading voices. And afterward? I had no paid maternity
leave unless I used up my sick days. I was expected to bounce
back—physically, mentally, professionally—as if nothing had
happened.

Our childcare costs are now almost as high as our mortgage.

This is not a rare experience. And honestly, I’m one of the lucky
ones. I was able to get pregnant eventually, as I had access to
personal support, excellent doctors, and a hospital.

But all of this is why the current national conversation about
declining birth rates feels so disconnected from reality.

A national conversation is gaining momentum around declining birth
rates

In the U.S.—and across much of the world—fertility rates are
falling, and populations are projected to shrink.

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The reasons people are worried vary. Some fear a loss of global
influence or long-term human survival. Others approach the issue
through religious, political, or ideological lenses—or just out of
curiosity. Whatever the motivation, the question keeps coming
up: _What can we do?_

In response, the new administration—guided in part by Project
2025—is considering
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incentives to encourage people to have more children. Ideas include
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like on menstrual cycles, or a “National Medal of Motherhood” to
mothers with six or more children, as well as financial incentives
like a $5,000 cash baby bonus or Fulbright scholarships reserved for
mothers.

Globally, paying families to have children has yielded mixed results.
In Russia, for example, payments ($10,000) have increased fertility
rates by about 20%. However, in Canada during the 1970s, similar
efforts yielded only a short-term increase.

So no—we don’t need to blindly throw spaghetti at the wall. We
have the evidence
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want people to have more children, we need to create a society that
actually supports parents.

And right now, the U.S. is nowhere close.

1. ACCESS TO AFFORDABLE CARE IS NOT READILY AVAILABLE

Even with insurance, the cost of prenatal care, delivery, and
postpartum support can put families under serious financial strain.

Infertility treatments in particular are prohibitively expensive. But
when states mandated insurance coverage, birth rates increased by 32%
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connection is clear: covering care works.

Access to care is another problem. More than 2 million women of
reproductive age live in “maternity care deserts”—areas with no
OB-GYNs, no midwives, no hospitals offering obstetric services.
That’s more than 1,000 counties where pregnancy care is out of
reach. The U.S. has one of the lowest supplies of midwives and OB-GYNs
compared to other high-income countries.

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Source: Commonwealth Fund

2. THERE’S LITTLE SUPPORT FOR NEW PARENTS

In some parts of the U.S., paid maternity leave simply doesn’t
exist. When I had my daughters in Texas, I had zero paid time off
unless I used my sick leave. A friend of mine went back to work just
two weeks after giving birth. Two weeks.

California, where I live now, offers six weeks of paid leave. But
compare that to countries where parents receive six months, nine
months, even a year of leave. The difference in recovery, bonding, and
mental health is massive.

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Source: Commonwealth Fund

And yes—paid leave increases birth rates. After the U.S. implemented
12 weeks of unpaid leave under the Family and Medical Leave Act in
1993, the probability of a first birth rose by 5% each year.
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3. RAISING A CHILD IS FINANCIALLY DAUNTING

Childcare is second to rent—or more. In some states, the cost of
infant care rivals the cost of a mortgage. In some states, it can
require up to 19% of a family’s income. The Department of Health and
Human Services sets the affordability benchmark for childcare
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no more than 7% of a family’s annual income, meaning the average
cost of childcare is unaffordable
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many families.

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Source: USA Facts

And that’s if you can even find a spot. Childcare deserts are
common, especially in rural and low-income communities. Many parents
are left patching together care, paying out of pocket, or leaving the
workforce entirely—usually moms—because the math just doesn’t
work.

But again, the data is clear: expanding access to childcare increases
fertility. In some studies, a 1% increase in childcare coverage led to
a 0.2–1% increase in fertility.

4. THERE’S A CLIMATE OF FEAR

We don’t talk enough about this: the U.S. has one of the highest
maternal mortality rates in the developed world. And for Black women,
the risk is even higher—nearly three times higher than for white
women.

This isn’t just a statistic. It’s a fear many of us carry when
considering pregnancy.

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Maternal deaths per 100,000 live births in countries. Source:
Commonwealth Fund

And in some states, that fear now includes criminalization. There are
cases where women have been investigated after a miscarriage or
pregnancy complication—sometimes by a nurse or a family member.

To make matters worse, some states are even proposing surveillance
tactics like monitoring wastewater to track birth control and abortion
pill use.

Even _thinking_ about pregnancy now comes with fear, judgment, and
potential punishment. This fear doesn’t exist in a vacuum. It
influences how people think about their health, autonomy, and safety
when considering pregnancy.

5. PROGRAMS THAT SUPPORT WOMEN ARE BEING DISMANTLED

While asking women to have more children, we’re dismantling the very
infrastructure that supports their health.

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Just this week, one of the long-running studies, called Women’s
Health Study, a critical source of data on women’s health, was shut
down.

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The Office of Women’s Health has now been eliminated at CDC.

BOTTOM LINE

People aren’t having fewer children because they don’t care about
family, faith, or their future, or the future of this country.
They’re having fewer because the system makes it too hard, too
risky, and too expensive. A $5,000 payment is a drop in the bucket
compared to what is required of families in this day and age.

If the government wants to be part of the solution, it shouldn’t
just throw out incentives. It should invest in the foundation:
affordable care, parental leave, safe childbirth, and supportive
systems.

Let’s focus on what matters: building a society where families can
thrive. If we do that, everything else—including birth rates—may
just follow.

Love, YLE

Your Local Epidemiologist
[[link removed]](YLE) is founded and operated
by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of
two little girls. Dr. Jetelina is also a senior scientific consultant
to a number of non-profit organizations. YLE reaches over 340,000
people in over 132 countries with one goal: “Translate” the
ever-evolving public health science so that people will be
well-equipped to make evidence-based decisions. This newsletter is
free to everyone, thanks to the generous support of fellow YLE
community members. To support the effort, subscribe or upgrade
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* population decline
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* maternity
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* Family policy
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