What can be done to reverse the nation’s declining birthrate?

Financial incentive initiatives for aspiring parents have proven ineffective in reversing declining birth rates, Harvard health experts stated on Tuesday regarding a policy suggestion that has received attention in recent weeks.

They suggested that a more impactful strategy would involve addressing the factors that complicate parenting: elevated living costs, insufficient affordable childcare, and improved support for older parents who desire to grow their families.

The discussion, convened at The Studio at Harvard T.H. Chan School of Public Health, followed a July report from the Centers for Disease Control and Prevention indicating that the U.S. fertility rate has decreased by 22 percent since its last peak in 2007.

Ana Langer, professor of public health practice, emerita, noted that the reasons for the decline in fertility are varied, complicated, and challenging to reverse.

Surveys probing why individuals might refrain from having children highlight issues such as the cost of living, negative medical experiences from prior pregnancies, and concerns regarding major global challenges such as climate change. She emphasized that many respondents are surprised to learn that declining fertility is perceived as a concern, often expressing greater worry about overpopulation and its effects on the planet.

The situation is further complicated by the significant societal changes in the U.S. since the 1960s, when there was an expectation that nearly everyone aspired to raise a family. Today, she explained, individuals feel empowered to prioritize careers over family life, and there is much greater acceptance of those who opt out of parenthood entirely.

Margaret Anne McConnell, the Chan School’s Bruce A. Beal, Robert L. Beal and Alexander S. Beal Professor of Global Health Economics, remarked that some factors contributing to the declining birthrate reflect positive cultural transformations.

Fertility rates are decreasing most rapidly among the youngest demographic, specifically girls aged 15 to 20. Teenage pregnancy has long been viewed as a societal challenge and is associated with problematic pregnancies, poor infant health, interrupted education, and limited job opportunities.

Additional elements include the widespread access to birth control, which affords women greater reproductive autonomy, alongside the increasing representation of women in higher education and the workforce.

McConnell mentioned that some individuals stop short of achieving their desired family size due to fertility, medical, and various other issues. One solution to tackle declining fertility, she posited, would be to discover ways to enable those parents to achieve the number of children they wish.

“Whenever we see people able to make reproductive choices that align with their family’s goals, I believe that’s a success,” McConnell stated. “I also think that individuals choosing to have children later in life is a positive outcome. … To the degree that we can facilitate people reaching their desired family size, I believe that should be a societal objective.”

The event, “America’s Declining Birth Rate: A Public Health Perspective,” included Langer, McConnell, and Henning Tiemeier, the Chan School’s Sumner and Esther Feldberg Professor of Maternal and Child Health.

Addressing the declining birth rate has become a priority for the current administration — President Trump has proposed a $5,000 “baby bonus” and $1,000 “Trump Accounts” as part of the “One Big Beautiful Bill” passed this summer.

Panelists at the online event highlighted that declining birth rates are not exclusive to the U.S. This trend is observable in numerous countries globally, for many of the same reasons. As individuals — especially women — gain more education and wealth, they typically opt for smaller families compared to previous generations.

Tiemeier pointed out that evolving societies and cultures have transformed the dynamics between men and women. He also added sex education to the list of significant changes that have contributed to the decline in birth rates, particularly among teenagers. He stated that questioning whether declining fertility constitutes a problem is overly simplistic given the complexity of the issue.

In a nation with a growing population, where women average three children, the birth rate dropping to 2½, just above replacement level, could be economically advantageous, ensuring a sufficient workforce to support an aging populace.

Countries with birth rates below 1, where the population is already shrinking, face dangers of insufficient workers to sustain their economy, alongside social and societal consequences stemming from a lack of young individuals.

Tiemeier and McConnell remarked that other nations have attempted to simply incentivize childbearing through monetary compensation, yet this has not proven effective. Even if declining birth rates were viewed as disastrous, McConnell asserted that governments still haven’t discovered effective levers to increase it.

Nonetheless, this does not imply that there aren’t measures governments can implement to assist parents as they navigate a challenging and costly phase of life. Initiatives aimed at reducing childcare costs have been launched in various cities and states, with further possibilities remaining.

Tiemeier noted that both Republicans and Democrats express interest in supporting families, although their methods may differ. Thus, this could be a rare issue where they might find common ground.

Other areas that warrant attention include maternal health, as a considerable portion of the population resides in healthcare “deserts” far removed from medical services. Programs designed to reach these regions, as well as establishing a national parental leave policy, would aid young families in managing this stage.

“Any actions we take are likely to yield modest effects due to the sheer number of factors involved,” Tiemeier observed. “Claiming that we are awaiting a solution with a dramatic impact is misleading. There are no transformative outcomes in this discourse.”