Wanting Children: Family Planning Policies with Dr. Len Lopoo
Fertility is often talked about as a couple trying to conceive, a patient preparing for IVF, a woman tracking ovulation, or a doctor reviewing labs.
But there is a larger system around every family-building decision.
Policies shape whether people can access fertility care. Insurance rules shape how long they have to wait. Workplace support shapes when people feel ready to become parents. Public programs shape whether people can prevent, postpone, or pursue pregnancy.
In his book, Wanting Children: Family Planning Policies and the Engineering of America’s Population, Dr. Leonard M. Lopoo explores how family planning policy has shaped the way people build families in the United States.
His research boils down to one question:. Are we helping people have children when they want them?
What Is Pronatalism?
Pronatalism is the idea that policies can encourage people to have more children, and the idea has become more visible as birth rates decline in the United States and other countries. Europe and parts of Asia have faced this concern for years. In the United States, while immigration has helped keep population levels more stable, fertility rates have still been declining over time.
The question is not only whether a society wants more births. The better question is what kind of support helps people who want children.
Policies should both help people who want children as much as they support people who do not want children, each with the resources they need.
That is where the word “wanting” becomes important.
Why Wanted Children Matter
Wanted children are children born into circumstances where parents are ready to welcome them. That readiness encompasses emotional, financial, education, career, partnership, and health.
Children do better when parents are prepared and supported. They are more likely to have better educational outcomes and less likely to experience poverty or need long-term government support.
This is why family planning must not only mean contraception; it must also mean helping people who are struggling with infertility. As much as people need support to avoid pregnancy when they are not ready, they also need support when they are ready and need help.
Fertility Care Has Been Left Out
Many public family planning programs have focused on contraception and pregnancy prevention. That support is important. It has helped many people make decisions about their bodies and futures.
But infertility care has not been supported in the same way.
In many states, there is no mandate for private insurance to cover even lower-cost fertility support. IVF is often discussed as the major expense, but the gap can simply be medication to support ovulation, diagnostic testing or time with a specialist before beginning IVF.
For military families, this can feel especially unfair. Service members spend their most fertile years serving the country. When they are ready to build a family, fertility support could be unavailable in the way they need.
Waiting Can Make the Problem Worse
Some insurance rules require proof of infertility before care is covered. That could mean twelve months of unprotected intercourse without pregnancy. That delay can be painful. It can also be medically unhelpful.
Because age matters in fertility. Certain conditions worsen over time. Endometriosis, PMOS, inflammation, and other reproductive health concerns do not pause while a patient waits to qualify for care.
A delayed diagnosis increases physical suffering and may add future medical costs. What begins as a fertility issue can become a broader health concern. This is why earlier support is not only compassionate; it is practical.
Family Policy Is Fertility Policy
Many policies affect fertility even when they are not labeled that way.
Childcare support affects family size decisions. Paid leave affects when people feel ready to have children. Health insurance affects whether treatment is possible. Early childhood education can reduce the pressure families feel after a child is born.
Policymakers often do not consider the fertility impact of these decisions. But every one of these policies affects decisions on family planning.
A more thoughtful system would ask how policy supports the whole family-building process.
IVF Access Should Not Depend on Wealth
Advanced reproductive technologies are often available to people with more financial resources. That includes IVF, genetic testing, and other tools that could improve the chance of a healthy pregnancy.
The ability to afford the upfront costs of medical technologies can make IVF cost-prohibitive, creating a financial barrier that keeps many people from care.
Dr. Lopoo argues that broader access could help reduce costs over time. When technologies become more available at scale, innovation can grow and costs can lower.
Pronatalism in Other Countries
Also facing fertility decline, other countries have created more generous family support systems.
Policies vary by country. France has long offered stronger public support for family and fertility. Scandinavian countries also provide more structured support. Estonia was highlighted as a surprising example because of its generous IVF access and lack of a long waiting list.
These countries have treated fertility support as part of public policy and demonstrate that broader support is possible.
Genetic Testing Raises New Questions
The future of fertility care also includes questions about genetic testing.
Many patients choose genetic testing during IVF to reduce the risk of pregnancy loss or serious genetic conditions. For many families, this is a deeply practical and loving decision. They want to transfer an embryo that has the best chance of becoming a healthy child.
But if genetic testing is only available to people with wealth, the gap grows to those who can gain access to information that could shape health outcomes.
Genetic testing should be an available option, as is the right to decline it for personal, religious, or ethical reasons. However, the concern is access. It should not be available only to the families who can afford it.
Start Thinking Bigger About Fertility Care
Fertility care does not begin and end inside a clinic. It is shaped by public policy, insurance coverage, workplace support, childcare access, medical timelines, and the cost of technology.
If we want healthier families, we need to ask better questions. Are people able to prevent pregnancy when they are not ready? Are people able to pursue pregnancy when they deeply want a child? Are patients getting help early enough? Are fertility technologies available to everyone? Are policies protecting choice or limiting it?
At Health Youniversity, we believe family-building support should honor the whole person and the whole system around them. Fertility is personal, but it is also public. The policies we create today shape the families of tomorrow.
If this conversation opens your eyes, share it with someone who needs a wider view of fertility care. The more we understand the system, the better we can advocate for families who want children.
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Leonard M. Lopoo is the Paul Volcker Chair in Behavioral Economics and Associate Dean for Public and International Affairs Programs at Syracuse University’s Maxwell School.
Dr. Lopoo received his Ph.D. from the University of Chicago in 2001 and was a postdoctoral fellow at the School of Public and International Affairs at Princeton University from 2001-2003 before joining the Maxwell School.
He is a nationally recognized expert on family policies, particularly as they relate to fertility, marriage, and maternal employment.
He has written over fifty academic articles and reports on these topics and is the author of the recently published book Wanting Children: Family Planning Policies and the Engineering of America’s Population from the University of Chicago Press.
LinkedIn: https://www.linkedin.com/in/leonard-lopoo-8184582a5/
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