Don't Let ‘Pronatalists' Define What's Family-Friendly

New York Times

21-05-2025

When I was eight months pregnant with my younger daughter in 2016, I got a $1,000 bill. The hospital wanted some cold, hard cash up front, even though the administrators knew we had health insurance through my husband's job. 'What if I gave birth in the car on the way there? Would we even get a refund?' I fumed. But we wrote the check anyway.
A few months after my daughter was born in that hospital, we got an $8,000 bill for a blood test panel my obstetrician swore would be covered by insurance. (I was able to haggle it down a bit after many phone calls — what a fun way to spend my brief maternity leave.)
I thought about this moment last week with a rueful chuckle when I read that some Republicans, like Senator Josh Hawley of Missouri, support a child tax credit with the explicit intention of both raising the birthrate and encouraging more parents to stay home with their children. 'It gives them that opportunity to say, 'Oh my gosh, we can actually raise our kids,'' Hawley said.
My family would have welcomed the extra cash, for sure, but $5,000 — the amount floated for both the baby bonus and the tax credit — barely covered the cost of birthing a second healthy kid nine years ago, much less would provide enough of a cushion for either of us to leave paid employment, or have a third kid. I agree with Senator Hawley that expanding the child tax credit is a good idea, and it's one that has had bipartisan backing. But while we should do anything we can to bump up the meager support we give to new parents, the idea that $5,000 is a replacement for any kind of job is pretty silly.
This kind of policy push comes at a time when the Trump administration has asked a gaggle of self-proclaimed 'pronatalists' for their advice on how to raise the birthrate. Their suggestions include a 'National Medal of Motherhood' for women who have six or more children and educating people about natural fertility charting. Sean Duffy, the secretary of transportation and a father of nine, signed a memo earlier this year directing his department to prioritize 'communities with marriage and birthrates higher than the national average' — even though there's not evidence that doing so would do much to support the majority of American families or encourage them to have more children.
The hard truth is that birthrates have fallen all over the world, and we don't know that there's any single public policy lever that entices people to have children. As the demographer Jennifer Sciubba put it in The Hill, 'governments are not the driving force behind individual decisions over whether or how many children to have. They've always played at most a supporting role, even when fertility rates were high, and their ability to raise the rates in a low-fertility world is limited.'
Inviting a set of mostly conservative pronatalists to set the agenda for family policies is a mistake, because they're framing the issue all wrong. We shouldn't be asking: How do we get Americans to have more babies? We should be asking: How do we make life better for parents and children in a way that benefits society?
I called Sciubba, who is also the president and chief executive of the Population Reference Bureau, to ask her how, if we could somehow start from scratch, we could improve the lives of families in the United States. She told me that she would focus on local policy above all, because it would allow for more flexibility and acknowledge the huge diversity of Americans' backgrounds and desires. 'The way that we've talked about this pronatalism these days has been a one-size-fits-all approach,' Sciubba said, and that's not productive.
Parents want wildly different things, and even the same parents want different things at different points in their children's lives. Though some conservatives are implying that Americans are clamoring to permanently leave the paid work force to manage the domestic sphere, only 22 percent of women and 14 percent of men want to stay at home to manage family and household responsibilities, according to Gallup polling from earlier this year.
A pro-family policy would allow families to make decisions around work that best suit them, for instance. Parents, and especially mothers, may go in and out of the work force, or switch between full and part-time employment based on their caregiving needs and the age of their children.
There was a lot of discussion last year about how, because you can't fit three car seats in a sedan, car seat laws discourage Americans from having a third child. But we rarely talk about how family-unfriendly city architecture and transportation are, even though 80 percent of Americans live in cities.
Ideally, having policy be more local would also allow it to be less partisan. Maybe in a state like South Dakota a family-friendly policy would include tweaking the car seat law or improving the quality of rural roads, but in New York City, Los Angeles or Chicago, local government could incentivize building apartments with courtyards, which Bloomberg's Alexandra Lange argues provide both affordable middle-class housing and safe areas for kids to play.
Of course, car seats and courtyards alone won't make the United States an ideal place to raise a family. But we should still start thinking about more bespoke solutions rather than relying on federal fixes that are unlikely to be forthcoming any time soon. America is never going to solve our problems by being Finland — a place smaller than California that has fewer people in it than New York City.
What's definitely not family-friendly is the set of proposals in the 'big, beautiful bill' making its way through Congress, which include cuts to Medicaid and food stamps, and increased work requirements to qualify for health care. Making sure all children — and their parents, especially pregnant women — have access to high-quality, consistent health care and nutrition is probably the most vital set of family-friendly policies the United States could enact. The Trump administration is also working on suggestions to lower the expense of in vitro fertilization, but I'm not sure how it can possibly square that goal with its overall zeal to cut medical costs from the federal ledger.
I don't think most mothers want medals, no matter how many children they have. They want to be able to make ends meet with dignity, and our country is making that harder every day.
End Notes