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Donald Trump’s IVF plan doesn’t go far enough

Make America Breed Again. Credit: Getty

September 2, 2024 - 7:00pm

Donald Trump may be wrong about many things, but he is spot on in sounding the alarm over declining birth rates. In an interview last week, the Republican presidential nominee promised funded access to IVF for all US citizens, saying: “we want more babies, to put it nicely.”

Sceptics may be tempted to think that Trump’s offer has more to do with winning back liberal female voters than addressing America’s baby bust. But whether or not his commitment to free IVF is merely a political ploy, Trump is correct that the US — and indeed nearly all Western nations — needs more babies.

Across the world, birth rates are falling. Most rich countries — and increasing numbers of poor ones — have total fertility rates (TFRs) well below the replacement rate of 2.1 children per woman. In the US, the TFR has fallen from 2.5 in 1970 to just 1.67 today, meaning each generation will be 20% smaller than the last. America is still in a considerably healthier position than many industrialised nations: South Korea has a TFR of just 0.7. This means too few young people coming into the workplace to replace those who retire, and too few taxpayers to fund pensions and healthcare. Unless we reverse the decline, the West is facing a future of poverty, stagnation and labour shortages. For conservatives, the lack of children is more than just an economic tragedy: the collapse in family formation weakens the very foundations of civilisation, eroding the capacity to pass on history, culture and faith to future generations.

With such a bleak outlook, efforts by governments to help people have children should be applauded. Importantly, most young women do still want to become mothers, so fertility-boosting policies should be seen as an attempt to remove barriers to conception rather than a sinister plot to pressure people to breed. The Hungarian government has taken a notoriously intensive approach to family policy, but many other Western nations are waking up to the problem. Earlier this year, for example, French President Emmanuel Macron announced a programme of “demographic re-armament”.

Trump is no outlier in seeking — genuinely or not — to increase America’s birth rate. But although his IVF offer will be a relief to couples struggling with infertility, and may be welcomed by some conservatives as a “pro-family” policy, it will make little difference to overall fertility rates. There are many social and economic reasons why such a large proportion of women now never become mothers. But a significant factor is that many women are simply leaving it too late, waiting until after the age of 35 when the chances of conceiving are on the decline.

Crucially, IVF has low success rates for women in this age group; even if treatments were more widely available, the impact on birth rates would be marginal. In pronatalist Israel, the only Western nation with an above-replacement TFR and where fertility treatment is free for all, just 5% of babies are born through IVF. Even in the highly unlikely event that the US — where 2% of births are currently through IVF — were to attain Israeli levels of assisted conceptions, the effect on the American birth rate would be negligible.

It is even possible that promoting IVF could decrease birth rates. The public has a poor understanding of fertility and fertility treatments, and far too many assume that reproductive technologies are effective insurance policies against childlessness. Egg freezing has soared as cynical advertising preys on the fears of young women, but sadly these treatments are highly unlikely to result in babies. The greater the availability of fertility treatments, the stronger the false sense of security, the later women leave it to have children and the less likely they are to conceive, whether naturally or through IVF.

Conservatives should welcome efforts to encourage family formation. But IVF will not save the US — or anywhere else — from collapsing birth rates. The solution is far more complicated but at the very least will involve better fertility education, much more financial support for families, and higher status for parents. There is certainly a compassionate case for more widely available IVF, but reversing demographic decline is going to take a lot more ambition.


Miriam Cates was MP for Penistone and Stockbridge between 2019-24.

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Brett H
Brett H
13 days ago

I’d be interested to know exactly who’s having children and who isn’t. Then i’d be interested to hear the reasons. The Baby Boomers was a natural response, presumably of optimism, to changes in the world. Maybe falling birth rates is also a natural response to something felt. The government is the last to really understand or really care about something like this. What they’ll probably do is throw a lot of money at it, then later on down the line another government will say “Wait a minute …! “

Rob N
Rob N
13 days ago
Reply to  Brett H

What do you mean a bit like China and its 1 child policy?

Also the effects on the child of IVF are still mostly unresearched.

I think it is time for some radical policies. How about no right to vote or receive benefits unless you have given birth to at least 1 child and/or spent 5 years in the military and stay in the reserves till 40? Limited, of course, to native born citizens.

Brett H
Brett H
13 days ago
Reply to  Rob N

I’m not sure what you’re saying in relation to my comment.

David Morley
David Morley
12 days ago
Reply to  Rob N

How about no right to vote or receive benefits unless you have given birth to at least 1 child 

LOL – how about men getting a vote for every child they have fathered – legitimately or not.

Actually I think you are overestimating the desire to vote.

Delta Chai
Delta Chai
13 days ago

With a current TFR of 2.9 in Israel, ~5% of births via IVF means 0.145 births per woman. In the US it’s 2% of 1.67, or 0.0334. That’s a difference of 0.1116 births per woman via IVF.

Considering the gap between the current TFR in the US and the typical replacement rate of 2.1 is 0.43, thats not a negligible difference at all, that’s a quarter of the gap.

David Morley
David Morley
12 days ago

a significant factor is that many women are simply leaving it too late, waiting until after the age of 35 when the chances of conceiving are low and rapidly declining.

OK, but why? It can’t just be ignorance or stupidity, so why are women leaving it so late, and what, if anything, can be done about that. Until we understand the causes – and take action to change them – little is likely to change.

David Morley
David Morley
12 days ago

What’s notable — but predictable — about the reaction to Macron’s remarks is that he was instantly labelled “Right-wing” and lambasted by French feminists.

Quoted from the Macron article.

But why? And does this reveal at least part of the problem: that values which link to having children are now seen as right wing (cultural and historical continuity, sense of identity, sense of obligation to ancestors); and that the feminism we have values jobs (even the most banal, mundane and ultimately pointless) over having and raising children.

How about a new style of feminism, focussed on making women’s lives as fulfilling as possible, consistent with having children?

j watson
j watson
12 days ago
Reply to  David Morley

Putting the emphasis on women there DM. What do we men need to do? What does public policy need to do? Big questions on both too.

Simon Blanchard
Simon Blanchard
12 days ago

I think one cause is that we have such an infantilising culture. Childhood now lasts way into the late twenties and beyond, with all kinds of distractions on tap – far more attractive than starting a family. Inevitably by the time some women find the biological imperative irresistible it’s starting to become too late. That’s not to blame women; the infantilisation of young men has been even more profound and we’ve never needed much encouragement to be selfish and irresponsible.

Philip Stott
Philip Stott
12 days ago

In the UK it is the astronomical cost of housing that is putting the breaks on family formation.
Who would want to start a family in a house share, which is all most people can afford when they’re in their early twenties.
My wife and I are hardly ancient, and we bought our first place when we were both 25, 25 years ago.

j watson
j watson
12 days ago

Cates states the ‘…solution is far more complicated but at the very least will involve better fertility education, much more financial support for families, and higher status for parents’. Certainly concur with that. However whilst she’s been a strong campaigner flagging the impact of our diminishing fertility rate she’s avoided putting much ‘meat on the bones’ of her proposed policy response. Remarkably she’s been fairly silent on home ownership and the devastating trend on this if we are to encourage family formation. This is the problem – lacks some honesty about what policy responses might be needed thus can come across as a bit ‘performative’. Now she’s not defending a seat she could say more.
One point to bear in mind – the US fertility problem is less because of migration and the higher fertility rate they generate.

Miriam Cates
Miriam Cates
12 days ago
Reply to  j watson

I’ve written extensively elsewhere putting ‘meat on the bones’ but it is not possible to say everything in 700 words! On housing (a topic on which I have also written), I agree, but it is not the whole answer. For example, in Norway, over 90% of young people get their own place in their 20s. Yet Norway has one of the lowest birthrates in Europe. Cultural factors are far more important than economics.

Tony Price
Tony Price
12 days ago
Reply to  Miriam Cates

Thank you for reading the comments and replying – it would be good if more Unheard contributors did that! Meanwhile, discussion of this topic is all about money and economic effects of declining population; how about the other side which may well argue that a declining population is necessary to ensure the continuation of humanity, as we simply can’t keep on using up the earth’s finite resources at the rate we are doing now.

Alan Tonkyn
Alan Tonkyn
12 days ago
Reply to  Miriam Cates

I agree that housing is not the whole answer to the problem, and, as you say in your article, the solution is ‘complicated’ and, as you say here, faces important ‘cultural’ factors. In the past, running a home and bringing up children was seen as a vital job worth doing and deserving of esteem, though it didn’t give those who did it – nearly all women – high status in society. In their understandable quest for the sort of status and power enjoyed by men, and boosted by equal educational opportunities, women no longer want to do that vital work of bringing up and socialising the next generation, and so either avoid or delay having children. In addition, children are hard work (as well as rewarding!), and our hedonistic society shies away from what will limit certain freedoms and pleasures. So, we do indeed need a culture change to make having babies more attractive, alongside necessary financial and practical support.

Tyler Durden
Tyler Durden
12 days ago

I suppose the GOP thinks this is a viable response to the Democrats’ importing of low-income Roman Catholic babymaking units who will also vote for them.