The Population Bust – What Have Men Got to do with It?

July 15, 2026 | alexandersanger

By Alexander Sanger

July 15, 2026

The sky is falling! The sky is falling! There has been a hailstone of articles in the press about the falling birth rate of the United States (and worldwide) with accompanying predictions that it is the end for our country and way of life. Various experts of varying political persuasions try to sort out the reasons why and pontificate what, if anything, to do about it. Falling fertility rates are hardly new news nor are any of the explanations or remedies proffered. Nonetheless, major publications including The New York Times and The Wall Street Journal have leapt into the fray, as have other publications, including The Atlantic and The Economist. A slow hot summer in the newsroom?

The U.S. total fertility rate (TFR) now stands at 1.57. The world TFR average is approaching 2.1, which is equivalent to the replacement rate. Sub Saharan Africa is largely above this rate while the rest of the world is below it. It will take decades for world population to stabilize, so population will continue to grow assuming birth rates stay as they are, which they won’t. They never do. Some countries, Japan (TFR 1.1), Russia (TFR 1.4) and China (TFR 1.0) for example, are losing population now. A nation’s population size is due to several factor besides birth rates: death rates, emigration rates and immigration rates. There isn’t much immigration to these countries. Russia’s attempt to absorb Ukraine is one solution to its declining population. Is absorbing Taiwan to be China’s solution? In short, nations care about population size. Nations want to continue, not fade away. Their way of life, their culture, their language all matter to them. Nations believe they are a gift to the planet. Yet their people are falling short, aren’t doing their part in this national aspiration. So, why?

Anna Sussman’s article in The New York Times on May 10, 2026 (https://www.nytimes.com/2026/05/07/opinion/birthrate-kids-parents-demographics-future.html) argues that falling fertility rates, which remain stubbornly below the replacement rate, are the result of a world seen by potential parents as too uncertain and unpredictable in ways vastly different from the past. The economy, society and public health – all have been disrupted and now appear more volatile than ever. The Great Recession of 2007-2009 followed by the Covid pandemic are two examples. In sum, argues Sussman, potential parents live in an era of “polycrisis” and don’t see a world hospitable to having children. Other villains in the reproductive environment include nonstop digital information, and a decline in culture, family values and religion. And then there is an increase in the use of long acting contraception, which has reduced teen pregnancy in a spectacular fashion. However, it has probably also reduced everyone else’s fertility. All these factors combine, she argues, to delays in meeting suitable mates and marriage, which lead in the long-term to fewer children born because there is less of a fertility window for women in which to have children.

Women’s expanded access to education, as is pointed out in The Wall Street Journal article on June 6, 2026 by Heidi Mitchell (https://www.wsj.com/health/wellness/us-fertility-rate-impact-f8024b33), has led to women running out of the biological clock while still looking for a suitable mate. Finding an affordable home, getting job stability and later searches for a mate all lead to reduced baby-making window, as well as to increase in infertility (which affects at least one in six people) as women give birth, or try to, later in life.

The Mitchell article points out, rightly, that governmental intervention with subsidies and other inducements works only at the margins and may affect the timing of children, but not the ultimate number. Nonetheless, governments keep trying. The government of Turkey (TFR 1.5) recently extended parental leave for mothers and fathers (less for fathers), and also made cash payments for the birth of additional children. Experience in Western Europe shows these incentives are essentially a waste of money. (https://www.nytimes.com/2026/05/17/world/europe/erdogan-turkey-demography-babies-family-planning-economy.html)

In another recent Times article of July 11, 2026 on Emma Waters of the Heritage Foundation (https://www.nytimes.com/2026/07/08/us/politics/emma-waters-restorative-reproduction.html), which supports financial incentives for marriage before age 30 and bonuses for more than two children, revealed that she supports only low tech methods to treat infertility and not the more high tech methods. I examine early childbearing as sometimes a successful reproductive strategy for certain parents in my book, Beyond Choice: Reproductive Freedom in the 21^st Century. It is not a universal solution for all.

In a recent opinion piece in the Times, Lyman Stone, of the Institute for Family Studies, (https://www.nytimes.com/2026/07/11/opinion/population-forecast-birth-rate.html) after bemoaning that our nation’s population is not at one billion (seriously?), calls for, “serious money aimed at the people doing the work of raising the next generation of Americans, an end to the marriage penalties woven through our tax and welfare codes, a surge in building family-size houses on par with the one during the last baby boom, and a culture that treats children as a future worth having rather than a lifestyle expense.” Conservatives like big government when it funds a baby boom.

Perhaps a cultural change at far less expense is called for. Another Times article of July 12, 2026 entitled, “Did America Style ‘Gentle Parenting’ Spoil French Children”, (https://www.nytimes.com/2026/06/29/magazine/american-parenting-french-children.html) Madeline Schwartz compares receptivity to children in France and Sweden where greater gender equality and openness to children in public spaces mean that parents and children can more easily coexist. “Four percent of Swedish parents say their children limit their freedom… In France the figure was 38%.” That said, France’s fertility rate is higher than Sweden’s.

One possible explanation for falling fertility that is noticeably absent or minimized in all these recent articles is the role, or lack thereof, of men. There was mention of women delaying finding mates but little, if any, about the quality or quantity of the males in the eligibility pool or other matters relating to mating and reproductive strategy. Are men delaying finding suitable women as much as the reverse? Are men dropping out of the reproductive dance? Are men nothing to write home about?

In recent articles there are three mentions of certain male behaviors that women see as an anathema for men as potential mates and fathers of their children. First, machismo. Derek Thompson, in an article entitled “The Great Depopulation” in The Atlantic, (https://www.theatlantic.com/ideas/2026/05/global-birthrate-decline/687297/) interviews economist Fernández Villaverde, who makes the point that economies are now more service based, which means that people work in shops and offices rather than on the land or factories. These jobs are easier for women to take than men because they do not depend on physical strength. Villaverde says, “in Mexico, Brazil or Colombia if you are a woman 22 or 23 years old with a decent job in the service sector and a guy comes to you and tells you, ‘if we get married, I’m going to be the macho in the home ruling everything and you are going to work for me all the time and we’re going to have three kids,’ you tell the guy no.” Over half the births in Latin America are to single women. (https://webfs.oecd.org/Els-com/Family_Database/SF_2_4_Share_births_outside_marriage.pdf)

Second, more machismo. The Economist article on “India’s Baby Bust” (TFR 1.9) (https://www.economist.com/leaders/2026/06/04/indias-surprise-baby-bust-is-a-warning-to-the-world) points out that there is a waning tradition of living as an extended family. Now 70% live in nuclear families because of urbanization and changes in the labor market. The article continues, “this makes childcare a bigger burden and creates an incentive to limit family size, but most Indian men do not seem to have noticed, ‘my husband sometimes washes his own plate’, says Kavitha Kannon, a farmer and mother of two from Tamil Nadu.”

And third, still more machismo. Anna Sussman in her Times article talks about having a religious faith being indicative of having larger families. However, she notes that more Americans are identifying as ‘other’ or ‘none’ in surveys, and she also states: “of particular relevance is the rate of which women are fleeing the fold.” Sussman then adds parenthetically that one of her interviewees is “appalled by the manosphere.”

The conclusion of this cursory discussion of mating comes in the Journal article by Heidi Mitchell, where she notes the risk of women “running out of the biological clock while still looking for a suitable mate.” Note the word ‘suitable’ here. She does not elaborate except to quote Professor Claudia Goldin: “It takes two to make a baby and it takes two to raise a baby. If women are required to do most of the work racing children, we will have fewer children when women have greater autonomy. Men have to step up to care for the children they want.”

So, the discussion of males in these not-so-exhaustive articles on declining fertility comes down to cursory mentions of: macho males, the manosphere, men not sharing housework and child rearing and some males becoming more religious while women are not. These all seem to be correctable behaviors. So, men, shape up! Change your culture.

So, what is left out in these articles? One factor in declining human fertility might be increased infertility. Mitchell does state that infertility affects one in six people, but she does not discuss male infertility, only female. In fact, female and male infertility rates are close to equal (female slightly more). Causes included: lifestyle, environmental factors, health factors and delayed childbearing. There are multiple studies on whether or not male sperm counts are declining, but there is no mention here. Same with male testosterone counts. Diabetes, obesity, alcohol – there are villains galore in male behavior, aside from environmental toxins which are all too real. (https://www.fertstert.org/article/S0015-0282(25)01995-8/fulltext)

Beyond culture and infertility, are there are larger forces at work here?

As none of the authors bother to point out, fertility has been dropping in some countries for centuries, for instance France since the late 18^th Century and the U.S. since the early 19th. This “demographic transition” is well known, exhaustively studied and argued about. Economic and societal forces, the cost of children and their education, the decline of farming, rise of cities, changing culture, declining religion (but not everywhere) and the changing role of women, and the widespread use of birth control and safe, and unsafe, abortion, have led to a declining birthrate worldwide in every culture and religion. Fears of the collapse of the social security and pension systems and minoritization of majority races are paramount in the fertility panic in Western countries. In contrast, some of the more ecologically minded welcome a someday decreasing world population to ease the strain on natural resources and the environment.

Is this reduction in fertility deliberate or unplanned? Wanted or unwanted? A choice or unconscious? Is it an idea, an aspiration?

Men, women and couples do not always have the number of children they say they want. Studies have shown that 20% of women in developed countries are having fewer children than they had planned on. Reasons include financial reasons, little or no access to fertility drugs and a view that the world was inhospitable into which to bring and raise a child. On the contrary, some women in developing countries have more children than they want. About 40% or more of pregnancies in the U.S are unplanned; the same is true in low-income countries. Not all have access to reliable contraception. Hence the high abortion rate worldwide, whether it is legal or illegal. All this I examine in Beyond Choice: Reproductive Freedom in the 21^st Century. “Unintended pregnancy” has to do with mating, and mate selection and reproductive strategy. Over half of these unplanned pregnancies end in abortion, and the remainder, less miscarriages, are, over nine months, converted into wanted childbirth. For those who blame birth control and abortion for the low birthrate, the solution is criminalize them. The U.S. did that beginning in the 1840s, or earlier, as the white Protestant birthrate was falling. The overturn of Roe v. Wade was not coincidental to the falling white birthrate since the Great Recession. Russia and China too are gradually restricting access to abortion and birth control. While U.S. national abortion numbers have risen since the overturn of Roe, driven largely by telehealth and interstate access, research shows births have increased in states with bans, with an estimated 32,000 additional births annually, disproportionately among young women and women of color, not the births that the Trump Administration wants.

Is there an argument that fertility and population move in cycles depending on the environment? Do external factors, including natural disasters, and the economy affect human fertility? Didn’t Darwin say that it is the most adaptable species that survive. Is the reduced fertility an adaptation to a new environment?

So, speaking of environment, we have seen its effect before with various plagues and natural disasters that have resulted in reduced fertility and population. In the medieval world, there was the bubonic plague, aka the Black Death, which killed perhaps a third or half of the population of Europe. To say that the plague introduced uncertainty and anxiety, and an end to predictable progress is an understatement. It was a profound disruption of a way of life. A ‘polycrisis’ indeed.

Demographers and historians have studied the effect of the plague on fertility with the challenge that there are relatively few accurate birth records or, for that matter, death records. They have found that repeated plague-related shocks might have ultimately triggered fertility reduction by fostering female employment (because of fewer males to work) and by delaying marriage and childbirth, and that plague shocks may have favored investments in child quality rather than quantity.

More recently in the 20th century, demographers have examined fertility rates after the outbreak of the 1918 influenza epidemic and found a decline in fertility across nations. The more recent Zika outbreak in Brazil led to a similar finding, as did Covid. One could argue that modernity taken as a whole is a natural disaster or a plague and is having the same effect on fertility as the Black Death, with the exception that it is lasting longer than the flu epidemic or Covid.

But, back to the males. It has been argued that males are in a two-fold spiral down: women control contraception more than ever and men, relative to females, are earning less, though there remains the stubborn wage gap. Women are taking control of their lives, reproductive and otherwise, and are getting more education and delaying children until they are more settled. With men getting less education (there are more women in college then men), there are fewer peer mates out there for women. Do women settle for a lower status male? Some. Go younger or older? Some. Go without and use artificial means to have a baby. Some. Get pregnant by someone else’s husband? Is all fair in love and war? Yes. Fair has nothing to do with it. Successful reproduction does. It seems that the lower status males are the ones not having children. It has always been thus. Because of the stresses and dangers of childbearing and childrearing, women are seeking reliable, supportive males. Women do the choosing. In the current climate some males are decreasingly suitable to be eligible. The resulting manosphere of those not chosen feeds on itself with anger and resentment.

Some men have responded by taking on more responsibility for child rearing. I see it daily in the park. Other men live in their parent’s basement and play video games. See Nicholas Eberstadt’s landmark 2016 study, Men Without Work. One in three men are out of work in the U.S. – the highest figure recorded, and one in three men under age 35 live in their parents’ home. There is anecdotal evidence that, as was reported by Sussman, men are joining male centered churchesor the manosphere with an anti-woman ideology. Some men on the extreme Right want to repeal the 19^th Amendment and require women to stay home and have children. Not exactly the type of man most women want to father and raise her children. It can be argued that anti-DEI programs are aimed at increasing white male education and employment. While it’s true that some men are nothing to write home about, most are suitable husband/father material. Perhaps one investment is to compensate the child-care parent, be it the father or mother. Parenting is the most exhaustive, time consuming job on the planet. And it is uncompensated except emotionally. So, do we pay men to be fathers? You get more children and get men off the couch.

Whatever we do, we must keep reproductive freedom and invest in women having the children they what. Men and women each have reproductive interests, goals and strategies. Most want to have children and have them survive and be healthy. The choice of a partner and the timing of childbirth are crucial to each as well as the number of children to have. Reproductive freedom is vital to male and female reproductive success. Yes, biological differences means that there is a battle of the sexes for control of reproduction, but there can be cooperation.

Women, thankfully, are now largely in control of their sex lives and reproduction. That said, there are women in the Third World who are not, and we at Fos Feminista are endeavoring to reach them through health and education services, advocacy and outreach. There are women in the First World similarly who are not getting services, especially after the U.S. Government cut off Medicaid funding from Planned Parenthood. Is this U.S. cut of access to family planning a way to increase the birthrate? It is the poor who are affected, the minorities; these are not the population that the Trump Administration wants reproducing. But whoever said Trump’s policies made sense.

The Trump Administration’s reaction to the recent birthrate figures called for a New U.S. Baby Boom. The Administration is revamping (i.e. eliminating) the Title X program which has supported contraception for low income women since its inception in the Nixon Administration. Now the program, according to a CBS news report, will focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction. No contraception, which the program now describes as over prescribed and associated with damaging side effects. This is more of the typical Robert F. Kennedy, Jr. attack on medicine, but worse. Contraception isn’t overprescribed; women use it because they want to prevent pregnancy and time and limit their pregnancies. Over 80% of women of reproductive age use contraception annually. The only silver lining for males in this announcement is that male infertility is recognized as deserving of treatment. Men’s partners are now not going to get subsidized contraception as they have been able to for over 50 years. The Title X program is geared now to healthy pregnancies instead of preventing unintended pregnancies. Will it increase unintended and unhealthy pregnancies and abortion rates? Probably. Will men and women have more undiagnosed STDs and hence infertility? Yes. Will it increase birthrates? Yes. (https://www.cbsnews.com/news/us-birth-rate-pregnancy-contraception-title-x/)

Trump also wants to make IVF more affordable. That is good news for couples struggling with the cost of treatment and will probably lead to an increased birthrate. But infertility is only part of the birthrate decline. It is estimated that halving the cost of IVF will lead to about an additional 150,000 births annually in the U.S. or would offset one-fifth of the decline in births since 2007. It is not a panacea. (https://www.newsweek.com/trump-ivf-prices-study-good-news-birth-rate-12190423)

There is no panacea. Huge societal, economic and cultural forces need to work themselves out, and humanity needs to adapt to them if they can’t be changed. Men’s needs and issues need to be part of the discussion, not just dismissed as the irredeemable Manosphere. Culture can be changed by men, machismo discarded by men, the manosphere abandoned by men. Men have to do their part.

Public policies matter and not just those affecting access to legal birth control and abortion. Tariffs were meant to increase U.S. employment. They haven’t. Fiddling with the tax code to reduce the so-called marriage penalty hasn’t increased marriage. With birth rates falling worldwide, in some cases for 200 years or more, quick fixes might gain political points but not address the serious underlying economic and social issues.

I suspect humanity will right itself. Couples will decide, as Sussman says at the end of her article, that the world isn’t so bad, and they’ll give parenting a shot. I think, like Sussman’s couple, they will get accustomed to the various “Polycrises”, treat them as the new normal and plunge ahead to have children.

Sources:

https://webfs.oecd.org/Els-com/Family_Database/SF_2_4_Share_births_outside_marriage.pdf

https://www.cbsnews.com/news/us-birth-rate-pregnancy-contraception-title-x

https://www.newsweek.com/trump-ivf-prices-study-good-news-birth-rate-12190423

https://www.wsj.com/health/wellness/us-fertility-rate-impact-f8024b33

https://www.fertstert.org/article/S0015-0282(25)01995-8/fulltext

https://www.economist.com/leaders/2026/06/04/indias-surprise-baby-bust-is-a-warning-to-the-world

https://www.theatlantic.com/ideas/2026/05/global-birthrate-decline/687297

The Art of the Deal in Foreign Aid

April 3, 2026 | alexandersanger

April 3, 2026

By Alexander Sanger

The Trump Administration today issued its budget proposal for the next fiscal year. It eliminates funding for family planning and other vital programs. Some background first:

Just when I thought that the Trump administration hit bottom in cruelty, depravity and disregard of the humanity beyond our borders, the administration recently had USAID destroy millions of dollars of contraceptives that had previously been bought by USAID for African countries. The contraceptives have been sitting in limbo in Belgium since the Trump administration in 2025 had dismantled the American foreign aid program. They were literally left to rot rather than be distributed to health systems and providers in Africa for whom they had been purchased. There will be forthcoming, I am sure, a report of the health impact of this callous act on women who have been denied family planning through increased and unwanted pregnancies, children spaced too close together and thus infant mortality, and pregnant women resorting to unsafe abortions.

Fos Feminista has issued a report, When Aid Becomes Empire: The Silent Recolonization of Global Health, which analyzes the detrimental effects of the America First Global Health Strategy (AFGHS) that has been issued by the Trump administration. https://fosfeminista.org/wp-content/uploads/2026/01/Recolonising-Global-Health_V3.pdf

The new US foreign aid strategy is focused on 1) addressing and preventing future outbreaks and epidemics that affect American health and security; 2) developing bilateral agreements with nations rather than multilateral agreements with intermediary NGOs; and 3) exporting American technology to advance global health outcomes. In addition, the strategy envisions recipient countries giving favorable consideration to the US purchasing “key minerals and rare earth elements” within their countries. All the above in service of fighting “Islamic Extremism”. The AFGHS’s rationale prioritizes Africa, which it describes as “a continent of strategic importance to U.S. national interests,” citing amongst other advantages, its deposits of “key minerals and rare earth elements needed as inputs into advanced technologies that fuel critical military and commercial applications.” The competition with China for resources is clear.

The Fos report accurately uses the word “recolonization” to describe the new foreign aid program.

Foreign aid as practiced by many countries has been around a long time. Some historians even have discovered it employed in ancient Greece and Rome. Perhaps the most egregious example of foreign aid by colonial powers being used to pillage and pirate natural resources from colonies was Spain looting the New World of gold and silver – the 15^thcentury equivalent of “key minerals and rare earth elements”.

One of the beneficial examples of foreign aid in our history was when France, before Liberité, Égalité and Fraternité, gave arms and advisors to the fledgling American Revolution in 1776 in order to bloody the nose of the British Empire. This example could be called de-colonizing.

Geo-political interests have been omnipresent in modern foreign aid. When our turn came in the Marshall Plan, our main goal was to stop the incursion of communism in Europe. And when foreign aid in the 50s and 60s and beyond became a regular part of the US budget, the goal similarly was to fight the spread of communism abroad.

President Kennedy said in a message on foreign aid: “Is a foreign aid program really necessary? Why should we not lay down this burden which our nation has now carried for some fifteen years? The answer is that there is no escaping our obligations: our moral obligations as a wise leader and good neighbor in the interdependent community of free nations—our economic obligations as the wealthiest people in a world of largely poor people … and our political obligations as the single largest counter to the adversaries of freedom.

“To fail to meet those obligations now would be disastrous…. For widespread poverty and chaos lead to a collapse of existing political and social structures which would inevitably invite the advance of totalitarianism into every weak and unstable area. Thus our own security would be endangered and our prosperity imperiled….”

https://www.americanforeignrelations.com/E-N/Foreign-Aid-John-f-kennedy-s-special-message-to-the-congress-on-foreign-aid.html#google_vignette

The West is not alone in political uses of foreign aid. China props up North Korea to prevent the expansion of the West near their borders.

There are plenty of studies about the effectiveness, or not, of foreign aid, but the world has developed economically and healthwise since the advent of the Marshall Plan and US foreign aid, as well as foreign aid from other Western European powers. Multinational aid organizations with staff on the ground and effective accounting mechanisms have been developed over the decades to distribute aid effectively in cooperation with local authorities and institutions and to monitor effectiveness and prevent waste.

And one of the most effective aid programs has been in maternal and child health and family planning. Life expectancy has grown, birth rates have been reduced and child mortality drastically reduced. All this is due largely to family planning and maternal and child health funding for pregnancy prevention and for safe delivery services. Childhood vaccines have been an integral part of the success. The status of women has risen as a result.

All this is gone in the new US policy – no intermediate organizations (those hotbeds of Woke leftists!) and no family planning with maternal and child health and childhood vaccines not mentioned. What better way to attack Planned Parenthood and similar international organizations than eliminate them from funding. Also, no gender or DEI programs permitted. And the expanded Gag Rule is back. No discussion of abortion and more. No climate work. Faith-based organizations (i.e. Christian ones) are to be favored. There is, however, a focus on HIV/AIDS funding, from a prevention of epidemic viewpoint rather than humanitarian. Now we have US policies and products being a cornerstone of local health systems which will become markets for US innovation and product testing. Sounds like the Tuskegee experiments brought into the modern age. Products will have to comply with US standards, not those of the WHO – another multilateral organization tossed aside. This an excuse to ban mifepristone abroad which the Trump administration is maneuvering to get discredited by the FDA.

There are more questions than answers, especially about how this new system will work and whether governments can use their own funds for their own projects and priorities. But what is clear is that the Trump administration sees Africa as a takeover target, where the US comes in with much needed financing and structures the deal to give it voting control over the nation’s health and natural resource systems, no matter that it doesn’t have a clue how the country works. Some art of the deal.

The one thing we do know is that the new U.S. budget proposal has a vastly reduced amount for foreign aid from the United States. Unfortunately, other countries are following suit, including the UK.

The Administration’s new budget proposal unveiled today provides $18 Billion combined for targeted investments overseas and securing critical minerals. Humanitarian assistance is cut $2 Billion, Food for Peace is cut $1.2 Billion and Global Health is cut $4.3 Billion, leaving $5.1 Billion for Global Health. There are no disease specific accounts, leaving the administration the power to allocate “across HIV and other infectious diseases, such as malaria, tuberculosis and polio to strengthen global health, security and protect Americans from disease.”

There is “no funding that supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and Lesbian, Gay, Bisexual, Transgender, and Queer services to better focus funds on life-saving assistance. The United States should not pay for the world’s birth control and therapy.”

Examples of programs eliminated:

“Promoting reproductive health education and access to birth control and other harmful programs

couched under ‘family planning’ in Ghana;

…

Promoting health equity and providing condoms and contraception in Kenya.”

So, birth control is out. This and destroying contraceptives are deliberate slaps at women. The anti-family planning agenda of the Trump administration is clear. This is a fight over who controls reproduction – the administration wants men to.

The fight is now in Congress which in the past has supported family planning programs.

The need for international family planning assistance remains. See: https://www.guttmacher.org/adding-it-up?utm_source=Guttmacher+Email+Alerts&utm_campaign=922864ee96-EMAIL_CAMPAIGN_2026_03_26_12_19&utm_medium=email&utm_term=0_-922864ee96-260655221

The battle is on.

The New Eugenics – Heritage Foundation Project 2025 for Marriage and Increased Childbearing

February 19, 2026 | alexandersanger

Reading the opening lines of the Heritage Foundation Report – Saving America by Saving the Family: A Foundation for the Next 250 Years – I was struck by a deja vue. Not just because the Report warms over the usual right-wing attacks on the 20^th Century including reproductive rights, women’s rights and sexual rights, but some of the language about the rights of children were oddly reminiscent of statements made by my grandmother 100 years ago. I suspect the authors of this report were totally ignorant of this, so it’s worth a reminder.

The opening paragraph of the Report states: The first (truth) is that all children have a right to the affection and protection of the man and woman who created them. The second is that the ideal environment in which to exercise this right is in a loving and stable home with their married biological parents.

In 1926, my grandmother wrote an article for Holland’s Magazine entitled “Passports for Babies.” As reported by the Margaret Sanger Papers Project, “Sanger fantasizes about parents being subjected to an interview by a prospective baby. The demanding child inquires whether the parents have paid for their last baby, how many other children they have, and whether or not the parents can supply a happy home, proper food, a sunny nursery, and love and affection. Summarizing the prospective parents’ responses, the baby exclaims: ‘Five children already? Two dark rooms in the slums? No! Thank you! I don’t care to be born at all if I cannot be well born. Good-bye!’”

God forbid that the Heritage Foundation would ever quote Margaret Sanger in support of its thesis, but their arguments are oddly similar … as far as they go.

The Heritage Foundation chastizes much of modernity, global population trends, real world economic factors and the resulting changing social, cultural and mating environment where human reproductive strategies have been adapted for success. These adaptations include: more female education, fewer and later marriages, and fewer children.

Women are decried as selfish: the opening paragraph of the Report continues: In contrast, the default in American culture today is to put the desires of adults over the needs of children. Children are too often called to sacrifice what is due to them—the presence of their mom and dad under the same roof for the entirety of their childhood.

The body of the Report goes on to cite the Founding Fathers who signed the Declaration of Independence who were, quite literally, fathers: Fifty-four of the 56 signers of the Declaration of Independence married and had a total of 337 children among them—an average of six each.

Available figures indicate that the average American woman in 1800 had over 7 children (there are no figures for 1776), so the Signers were apparently on the low side of the average (perhaps they weren’t finished, or rather their wives weren’t, having children).

The Report somehow fails to cite what the Declaration of Independence actually said: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty and the Pursuit of happiness.”

Alas, we all know that the Founding Fathers didn’t “Remember the Ladies,” but not even the authors of the Heritage Report could bring themselves to assert that women have no right to Life, Liberty and Pursuit of happiness. Nor did the Framers talk of any children’s rights.

For me and my grandmother, Women’s Rights and Feminism are included in the right to Life, Liberty and the Pursuit of Happiness. My grandmother said, “No woman can call herself free who does not own and control her body. No woman can call herself free until she can choose consciously whether she will or will not be a mother.”

She added: “A woman’s body belongs to herself alone. It is her body. It does not belong to the Church. It does not belong to the United States of America or to any other government on the face of the Earth. The first step toward getting life, liberty, and the pursuit of happiness for any woman the serve decision whether or not she shall become a mother. Enforced motherhood is the most complete denial of a woman’s right to life and liberty.”

The Heritage Report fails to analyze why a declining birthrate is a worldwide phenomenon, including in so-called first world countries, and I would include Russia and China in them, in addition to Europe, Latin America and Asia. Much of the world now has a TFR less than 2.1, which is the replacement rate. The US is no outlier.

Contrary to the Heritage Report attacks on the lack of morality and the alleged disfavoring of religion in the US as drivers of reduced birthrates, smaller families also occurs in countries with a strong state religion and strict sexual morality and with no or little “Feminism”. For instance, Iran has 1.7, about the same as ours.

Fertility rates have been falling in some countries since the 18^th Century – long before modern birth control or abortion, before “Feminism” and “Gender”, before the sexual revolution (there are arguments that the sexual revolution began with the advent of the automobile, not the Pill), before welfare and before internet pornography and dating. Analysts have looked at such factors as: the Industrial Revolution, medical advances for child survival, costs of raising a child – all this before much female education and women’s entry into the modern workforce and feminism.

Single motherhood proliferates worldwide but varies from culture to culture. It is higher than the United States in many countries in Western Europe and Scandinavia and in Latin America; it is far lower in East Asian countries.

Wailing about smaller families is often a disguise about exactly who is having smaller families and who larger. In many countries there is concern with immigrants having a higher birth rate than those native born. This Great Replacement argument occurs not only in the United States, but in other western countries as well, hence Reports like the Heritage’s calling in coded language for greater native birthrates.

The Heritage Foundation’s call for a Manhattan Project for babies uses an unfortunate metaphor – the population bomb was an inept metaphor used in the early 1970s for what was thought to be unbridled population growth. It seems that the Heritage Foundation wants unbridled baby growth.

There are the expected attacks on Lyndon Johnson’s Great Society and its welfare programs and on the Pill and the sexual revolution and feminism and gender. The ideal country in the Heritage view for a Baby Boom is Israel, which is quite different from the US and the rest of the Western World with its religiosity, uniform language and culture, not to mention a history of real and immediate threats from its neighbors. The authors fail to mention that Israel has available sex ed, birth control and abortion. Nor did it mention that Israel allegedly once gave long-acting birth control to immigrant Ethiopian Jews without their consent.

Some of the Heritage solutions for the US: a large family tax credit, home childcare tax credit, reducing education levels and establishing church-societal marital boot camps, discouraging on-line dating, promoting family education in schools, making divorce harder (they do not realize that doing so is a disincentive to marriage), and mandating a day of rest, i.e. Blue laws (I am writing this on Super Bowl Sunday) and reducing welfare and head start programs. The list goes on and on.

In contrast to the research cited in the Heritage Report about the single parent homes destroying children, the Annie E Casey Foundation, which has decades of research on the family, states: “Compared to kids in married-parent households, children in single-parent families are more likely to experience poor outcomes. Research indicates that these differences in child well-being tend to be small, though, and can disappear when adjusting for key factors like poverty. While the research is complex, sometimes contradictory and evolving, mounting evidence indicates that underlying factors — such as strong and stable relationships, parental mental health, socioeconomic status and access to resources — have a greater impact on child success than does family structure itself.

Children thrive when they have safe, stable and nurturing environments and relationships, and these conditions and connections can exist in any type of family.”

There has been much discussion of our modern mating system, if it can be called that. In the modern economy, with modern contraception, women are getting the education they need to survive and thrive on their own without relying on a husband. They have their children when they are ready and when their children have the best chance of survival and thriving. The Report calling for women to get less education and to be stay at home moms flies in the face of that reality. That genie isn’t going back in the bottle.

What to do about men deserves more serious addressing than the Report does. The American male is not in great shape physically or educationally. My grandmother noted that during World War I 56% of American men were found unfit for military service. A recent study by the Defense Department found 77% of men unfit for service. Is it stricter guidelines or declining male health? Men attend college less then women. Antisocial behaviors are exhibited more by men than women. They are of declining marriageable material; hence women aren’t marrying them.

The Report’s proposals for family formation are targeted to benefit taxpayers, not those who don’t earn enough to pay taxes. The incentives are for the relatively well-to-do not the poor. Childbearing is to be encouraged for those who have, not those who have not.

Finally, one of the drivers of infertility is undiagnosed sexually transmitted infections. The more well-to-do get reproductive health care from private physicians or clinics. The less well-to-do from Planned Parenthood. And what has the current administration done? Defunded Planned Parenthood, thereby leading to more undiagnosed STDs and thus infertility among the less well off, as well as more unintended pregnancies and more abortion, legal or illegal (illegal abortions can increase infertility).

Eugenics by any other name.

Site Visit to Guatemala – Dec 8-10, 2025

December 14, 2025 | alexandersanger

On Dec 8-10, 2025, I went to Antigua, Guatemala to visit two Fos Feminista partner organizations and to attend a Fos board meeting. Antigua is surrounded by 4 volcanoes, one of which was smoking. The nation’s capital was once in Antigua but multiple earthquakes in the 1700s led the Spanish authorities to move the capital.

Guatemala is the most populous country in Central America with over 18 million people. The country struggles with persistent inequality. The population is primarily Mestizo, but Indigenous Maya communities make up about 35 percent—the highest proportion in the region. Guatemala is home to 22 Mayan languages, which makes delivering health care challenging. Poverty is widespread. In 2023, 56 percent of Guatemalans lived in poverty, with 16 percent in extreme poverty. Rural communities and Indigenous peoples are disproportionately affected, with poverty rates exceeding 80 percent in some areas. Malnutrition among children is alarmingly high: 46.5 percent of children under five suffer chronic malnutrition, one of the highest rates globally.

Guatemala faces a critical sexual and reproductive rights crisis. Adolescent pregnancy rates, particularly in rural and Indigenous communities, are among the highest in Latin America. Many of these pregnancies result from sexual violence, highlighting deep gaps in child protection and support systems. Early pregnancy often forces girls to leave school, limiting their opportunities and perpetuating cycles of poverty. 1 in 3 Indigenous women have no access to health and family planning services. 25% of teen girls are pregnant or parenting. The birthrate is 2.4.

Challenges in the country have been further exacerbated by the recent US funding cuts to USAID and UNFPA which brought $605.5M in support for global family planning and reproductive health programming and services to an abrupt end. Guatemala was among the largest losers of funds. Birth control pills are currently out of stock in government clinics.

The country has some of the most restrictive abortion laws in the world, permitting the procedure only when the life of the pregnant person is at risk. In practice, even these cases are difficult to access. Medical professionals often interpret the law narrowly, and social stigma further discourages care. As a result, many girls and women are forced to continue pregnancies, even in cases of rape or when their health is at risk. Illegal abortions proliferate.

The two Fos partners there are:

Founded in 1964, APROFAM (Asociación P r o B i e n e s t a r d e l a Fa m i l i a de Guatemala) is a long-standing partner of Fòs Feminista and one of the largest providers of sexual and reproductive health care in Guatemala and within the Fòs Feminista Alliance. In 2024, APROFAM provided more than 2.7M sexual and reproductive health services, including nearly 975,000 contraceptive services. APROFAM provides subsidized SRH services primarily through its clinics and occasionally through mobile clinics in collaboration with the Ministry of Health. It also offers general medical care including pediatrics.

And

WINGS (Women’s International Network for Guatemala Solutions) has been a Fòs Feminista partner since 2019. Founded in 2001, WINGS provides quality, free or subsidized reproductive health education and services to low-income, rural, and Indigenous populations, reaching around 25,000 individuals annually. Their model is complementary to APROFAM in that WINGS focuses predominantly on rural, Indigenous, and underserved provinces in Guatemala that are not reached either by APROFAM or the public sector. In 2025, WINGS reached an important milestone in expanding their mobile health outreach to every department in the country.

On Day 1 we visited an APROFAM clinic visit 2 hours away from Antigua. It was a public health clinic that APROFAM was borrowing for the day. It was spotless. They provided good quality compassionate care.

It was vasectomy day. I scrubbed up and observed one procedure. The patient was a man about age 35 or 40 with a few children (exact number undisclosed to me). Lively music was playing in the operating theater. A doctor, nurse and orderly did the procedure. It was very quick, 7 minutes, with lots of chatter with the patient who said he didn’t feel a thing. My high school Spanish being limited, I couldn’t understand what they were talking about – maybe football. All was very professional and relaxed. Patient was at ease and hopped off the table at the end. 10 more patients were done that morning. An 11th got a call from his office and left before his procedure.

The clinic also does tubal ligations for women but not today.

Below — ACS in scrubs

ACS with clinic and Fos staff and volunteers.

We next visited a health promoter’s house. She is part of the WINGS network. She is a nurse who does counseling and also inserts implants and IUDs in her home as well as providing injections and pills. Her 9-year-old daughter and family cat sat in, as well as an adult patient. There was also a teenaged male sex educator who spoke of his speaking to teens in schools. In the living room/consulting room was a chapel so that the patients can pray as they get care and feel absolved.

ACS with the WINGS nurse-educator.

These organizations are doing life saving work in very difficult circumstances.

Sharon Camp

November 17, 2025 | alexandersanger

Sharon Camp was determined. Determined to get out from behind the policy desk, from behind the research desk, from behind the lobbying desk and to do something concrete for women. She did.

We met numerous times in the mid and late 1990s to discuss financing for Plan B and its use at PPNYC clinics. The latter was easier than the former, as we were already offering the morning after pill to our clients, just not under the Plan B label. Alas we were in our usual financial straits and could not be an investor in Women’s Capital Corp. But we cheered her on and lobbied on Plan B’s behalf with medical, legal and regulatory authorities.

Plan B moved women’s health from relying on off label use to FDA sanctioned use of birth control pills for the morning after.

Well done, Sharon!

Visit to Mexico

November 19, 2024November 19, 2024 | alexandersanger

I spent the last week in Mexico City. The country of Mexico is now far ahead of the United States in terms of reproductive rights for women.

In addition to the fact that they now have a female president, Claudia Sheinbaum Pardo, who calls herself a feminist and has announced the creation of a Ministry of Women, the National Supreme Court beginning in 2021 has issued rulings that abortion can no longer be considered a crime and eliminated federal criminal penalties for abortion. Hence all federal health facilities in the country are obligated to provide abortion care. Like the United States, Mexico has states, 32 of them, and half have formally decriminalized abortion in their territory. We are working hard with our partner organizations in the remaining states.

The regulatory authority In Mexico, similar to the FDA, recently reduced restrictions for obtaining mifepristone in pharmacies and expanded the indications for misoprostol, two essential medications for self-managed abortions. They are available without prescription. On my visit, I went into three small neighborhood pharmacies in Mexico City asking for mifepristone, but none had it in stock but offered to order it. All had misoprostol in stock. I was assured by our partner organizations that Mifepristone is widely available in pharmacies throughout Mexico. Approximately 80% of abortions are done with medication. Our partners are working on access for the underserved and to de-stigmatize abortion in this deeply religious and patriarchal country.

Women from the US are coming to Mexico for abortion medication.

Health care in Mexico is fragmented, much like the US, and spotty. There is a proposal to move low-risk pregnancies out of hospitals to midwives. There is a very high rate of unnecessary Caesarians. Teen births are too high but declining.

The Mexican partners that we met with were: GIRE (Grupo de Información er Reproductión Elegida), Catholics for the Right to Decide (CDD) and the Association of Professional Midwives.

We had long discussions on the vote of Mexican immigrants to the US. The general feeling from our Mexican colleagues was that Mexican immigrants, while religious, voted on the economy and on personal security. They looked askance on recent illegal immigrants from their home country, fearing for their jobs and personal safety. The Mexican immigrants have achieved a piece of the American Dream and don’t want competition. The Democratic message didn’t hit on Mexican immigrant needs. Trump seemed a leader who related to their issues and beliefs. He represented America more than Harris.

L to R: Maria Consuelo Mejía, Rebeca Ramos (Executive Director of GIRE, the Grupo de Información en Reproducción Elegida), ACS, Marta Lamas (a leading feminist academic, activist, and thought leader in Mexico), and Giselle Carino, CEO of Fos Feminista. Marta and María Consuelo helped found GIRE more than 30 years ago, and María Consuelo also founded CDD, Catholics for the Right to Decide, in 1994.

ACS and Giselle Carino before a wall of green wave scarves.

The Race and Referenda

July 29, 2024 | alexandersanger

The stakes in the upcoming presidential race have never been higher for women and reproductive freedom and justice.

A report recently issued by 16 United States Senators, entitled Two Years Post-Dobbs: The Nationwide Impacts of Abortion Bans, sets forth the challenges and issues facing American women post-Dobbs. The report concluded that two years after Dobbs women are denied emergency care and life-saving treatments, hardship has been placed on women and families traveling long distances for care and the healthcare system is being strained. More than 23 million American women of childbearing age live in states with abortion bans. There is an unprecedented flow of pregnant patients across state borders risking at times their lives and financial security. It is stressing America’s reproductive healthcare system, like never before, including by impacting care in states that maintain access to abortion. It is driving healthcare providers out of states with abortion bans, creating a healthcare gap that would be difficult to fill since some medical residents are avoiding these states.

Women are being denied care in medical emergencies and doctors have to watch patients go into sepsis and watch their vital signs deteriorate because they are afraid the patient is not sick enough to qualify for a medical exemption, should there be one. For example, there were just 34 legal abortions recorded in Texas during a six-month period in 2023, but researchers estimate the number of women needing abortions in Texas is at least 400 a year for emergencies and 2,400 per year for physical health risks.

Miscarriage care and other emergency care for ectopic pregnancies for instance is the same procedure as an abortion, and this care is routinely being denied in states with abortion bans. Women with fetal anomalies are forced to seek care in states that permit abortion, as are rape and incest survivors.

Just some examples of the impact in states with legal abortion: there are three-week wait times at Kansas and Illinois clinics, wait time at clinics in Ohio forces patients to other states for care, and Wisconsin patients can get quicker care traveling to other states. The expense and difficulties of travel operate as a special hardship on low income patients.

When OB/GYN’s leave abortion ban states they lead to a lack of doctors trained to provide obstetric and gynecological care, including deliveries. A study has found that in Texas the infant death rate increased along the number of babies who died of birth defects. Between 2021 and 2022 there was a 12.9% increase in the deaths of children before their first birthday. Another study found that Texas had approximately 10,000 additional births between April and December 2022 which proportionally included pregnancies with increased risk of infant mortality.

In response to abortion bans, women are switching to long-acting methods of birth control, including IUDs and implants. Anecdotally, women are stocking up on the abortion pill just in case.

In the voting booth, women in at least six states, and probably more, will be able to vote on referenda to legalize abortion, including Florida and Colorado. No abortion rights referendum has lost since 2022.

Interestingly, when South Carolina ‘s legislature considered an abortion ban in 2023, three Republican female Senators bucked their party and voted against it. The party turned around and primaried them out of office.

In Poland last week, three members of the ruling coalition voted against a bill to slightly liberalize the strict Polish abortion ban. The bill lost by three votes. The Prime Minister retaliated and stripped two of the three members of their party coalition membership and stripped the third of his leadership position. Poland is hopefully moving towards decriminalizing abortion.

South Carolina doesn’t permit referenda. Poland does. Perhaps they should have a referendum.

Click to access 2024_dobbs_anniversary_national_report_final.pdf

Dr Ruth

July 16, 2024 | alexandersanger

Dr Ruth Westheimer once worked for PPNYC in our Harlem clinic researching our patients’ contraceptive and abortion histories. She used the material for her doctoral dissertation. Her job done, her position was eliminated. As she repeatedly said to me, “That Al Moran (my predecessor as President of PPNYC) he fired me!” The world is glad he did because she went on to become Dr Ruth. And she never held it against me and eloquently presented me an award at the Pill is 50 celebration. It seems to me that I should have been presenting her an award. Dr. Ruth brought sex into American homes with expertise, forthrightness and humor. Her life story as a Holocaust survivor and as a sniper in Israel seemed to inure her to the brickbracks of the Puritans who thought her some deviant corruptor of American women and youth. She stood firm, all 4’7″ of her, for truth and honesty and fun and pleasure. We are all in her debt.

teen pregnancy and premature death

April 15, 2024 | alexandersanger

A recent study out of Canada reports that women who were pregnant as a teenager were more likely to die before age 31 than their peers who did not get pregnant. The odds were similar for teens who had an ectopic pregnancy, miscarriage, stillbirth, or abortion. The risk increased the younger the teen was when pregnant and also if the teen was pregnant more than once.

The researchers say that the link between teen pregnancy and early death is likely not causal. The greatest cause of death was injury, both self-inflicted and accidental. How accidental death or suicide relates to early pregnancy is a murky area, but they could result from low educational attainment, adverse childhood experiences and increased risk taking.

Various experts opined that more needs to be done to prevent accidental pregnancy and unplanned pregnancy. I agree.

But I and others have felt that despite what teens may report about whether their pregnancy was “accidental”, many are in alignment with the shortened life expectancies that disadvantaged teens face whether or not they become a teen mother. This “weathering” hypothesis I have written about before. The many environmental, social, racial, familial, and pre-existing health factors that a disadvantaged teen faces all point to a life expectancy below that of her better off peers. The same applies to the teen’s mother who might be expected to help care for the baby. Weathering would seem to point a teen, consciously or not, to early childbearing while a) she is still relatively healthy and b) her mother is still with her to help. Researcher Arline Geronimus found that a disadvantaged teen is healthiest at age 16.

Risks of pregnancy are well known, and pregnancy is riskier the poorer the health of the mother. It is no surprise that it can lead to premature death, though as I said above, the researchers did not find a direct causal link.

But, and this is a big but, the teen has a baby. She has reproduced, and has done so when she is at her healthiest. Yes, there are risks to her and the baby, but perhaps less risks than if she had waited.

In an ideal world, women would not have to make this trade off. But even in countries with national health systems and with income supports for the most disadvantaged, the health discrepancies are still there. The messages of: wait until you are older, wait until you finish your education, wait until you have a good job, or wait until you are married, don’t resonate with all too many girls. The biological message of: reproduce while you can, does.

See:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816198

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816201