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How to reverse nation’s declining birth rate

Health experts urge policies that buoy families: lower living costs, affordable childcare, help for older parents who want more kids

Alvin Powell

Harvard Staff Writer

August 20, 2025 5 min read

Financial-incentive programs for prospective parents don’t work as a way to reverse falling birth rates, Harvard health experts said on Tuesday about a policy option that has been in the news in recent months.

Instead, they said, a more effective approach would be to target issues that make parenting difficult: the high cost of living, a lack of affordable childcare, and better options for older parents who still want to see their families grow.

The discussion, held at The Studio at Harvard T.H. Chan School of Public Health, came in the wake of a July report from the Centers of Disease Control and Prevention that showed that the U.S. fertility rate was down 22 percent since the last peak in 2007.

Ana Langer, professor of the practice of public health, emerita, said the causes of fertility decline are numerous, complex, and difficult to reverse.

Surveys investigating why people might not want children cite things such as the cost of living, negative medical experiences from previous pregnancies, and wariness about major global issues such as climate change. In fact, she said, many survey respondents are surprised that declining fertility is even a problem and say they’re more concerned about overpopulation and its impacts on the planet.

The landscape is complicated by the fact that U.S. society has changed significantly since the 1960s, when expectations were that virtually everyone wanted to raise a family. Today, she said, people feel free to focus on careers rather than families, and there is far greater acceptance of those who decide never to have children.

Margaret Anne McConnell, the Chan School’s Bruce A. Beal, Robert L. Beal and Alexander S. Beal Professor of Global Health Economics, said some of the factors that have contributed to the declining birth rate reflect positive cultural shifts.

Fertility rates are falling fastest, for example, in the youngest demographic, girls age 15 to 20. Teen pregnancy has been long considered a societal ill and is associated with difficult pregnancies, poor infant health, interrupted education, and poor job prospects.

Other factors include the widespread availability of birth control, which gives women more reproductive choice, as well as the increasing share of women in higher education and the workforce.

Today people feel free to focus on careers rather than families, and there is far greater acceptance of those who decide never to have children.

Margaret Anne McConnell

McConnell said some stop short of having the number of children they desire, due to fertility, medical, and other issues. One way to address declining fertility, she said, would be to find ways to enable those parents to have the number of children they wish.

“Any time we see people being able to make fertility choices that suit their family, I think that’s a success,” McConnell said. “I think people choosing to have children later in life is also a success. … To the extent that we can make it possible for people to reach whatever their desired family size is, I think that that would be a societal priority.”

The event, “America’s declining birth rate: A public health perspective,” brought together 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 focus of the current administration — President Trump has floated the idea of a $5,000 “baby bonus” and $1,000 “Trump Accounts” that were part of the “One Big Beautiful Bill” approved this summer.

Panelists at the virtual event pointed out that a declining birth rate is not just a problem in the U.S. It has been declining in many countries around the world, and for many of the same reasons. As people — particularly women — become better educated and wealthier, they tend to choose smaller families than their parents and grandparents.

Tiemeier said that changing societies and cultures have altered the very nature of relationships between men and women. He added sex education to the list of key changes that have fueled the birth-rate decline, particularly for teen pregnancies. The question of whether declining fertility is a problem is too simple for such a complex issue, he said.

In a country with a growing population, where women have, on average, three children, the birth rate falling to 2½, slightly over the replacement value, would be beneficial economically, ensuring more workers to support the population as it ages.

Countries with a birth rate below 1, whose population is already contracting, risk too few workers to fuel their economy, not to mention the social and societal impacts of a lack of young people.

Tiemeier and McConnell said that other countries have tried simply paying people to have more children, and it doesn’t work. Even if the declining birth rate was considered a catastrophe, McConnell said, governments haven’t yet found levers that can bring it back up.

That doesn’t mean there aren’t things government can do to help parents navigate a difficult and expensive time in life. Programs to lower the cost of childcare have been instituted in some cities and states, and more can be done.

Tiemeier said both Republicans and Democrats are interested in supporting families, though their approaches may be different. So this may be a rare issue on which they could find common ground.

Other areas of associatedneed include maternal health — a significant part of the population lives in healthcare “deserts” far from medical care. Programs designed to reach those areas, as well as a national parental-leave policy, would help young families navigate that time.

“Any measure that we take will have a modest effect, because there are so many things contributing to this,” Tiemeier said. “To say that we are waiting and looking for a measure that has a big effect is an illusion. There are no big effects in this discussion.”