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- How many hands shape reproduction today
- When data can’t explain why people don’t have kids
- What markets and philosophers are saying about “better” children
- Lessons from countries that subsidize fertility care
- AOC’s egg-freezing story and what it reveals
- Roe, choice and the shifting responsibilities of society
- Money dysmorphia and the media’s role
- Big barriers to starting a family
- Policy moves that could make parenting easier
- Stories that illuminate how people decide
- Why saying “having kids is good” is complicated
- Changing desires and identity over time
- Where social infrastructure still falls short
Anna Louie Sussman argues that building a family today rarely happens in isolation. Her reporting in Inconceivable: The Impossibility of Family in an Age of Uncertainty shows how doctors, insurers, employers, lawmakers and a booming fertility industry shape who becomes a parent and how. The book reframes falling birth rates as a deeply personal negotiation, not just a set of demographic numbers.
How many hands shape reproduction today
Reproduction is increasingly a system, not just a private decision. Clinics, insurers, employers and lawmakers all influence outcomes. The fertility industry markets not only babies, but “better” babies through genetic testing and enhancements.
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- Medical gatekeepers: fertility clinics and specialists set access and cost.
- Economic players: insurers and employers decide what treatments are covered.
- Policy makers: laws and benefits determine safety nets and supports.
- Market forces: tech’s promise of engineered children reshapes demand.
When data can’t explain why people don’t have kids
Demographers point to marriage, income or education to explain birth rate declines. Sussman finds these numbers miss the intimate trade-offs people make.
Individuals weigh risks, hopes and values. Some delay parenthood because they lack a partner. Others delay because they fear financial collapse. These are judgments that don’t reduce neatly to statistics.
What markets and philosophers are saying about “better” children
There is a renewed debate about selecting traits and using technology to shape offspring. Some thinkers openly argue for parents’ freedom to enhance children. At least one academic even defends the term “eugenics” in a modern guise.
Sussman warns that this rhetoric matters. It can normalize an approach that ranks human life by genetic potential. Technology makes those ideas practicable in new ways.
Lessons from countries that subsidize fertility care
When governments treat infertility as a medical condition, usage rises. Public programs reveal unmet demand.
- Tokyo and France: subsidized egg freezing programs were oversubscribed.
- Denmark: offers many publicly funded IVF rounds. There, about one in nine babies is conceived with medical help.
- United States: far fewer births use assisted reproduction—roughly one in 36—largely due to limited access and cost.
Accessible treatment equals more births via assisted technologies. That gap suggests policy can change outcomes.
AOC’s egg-freezing story and what it reveals
Representative Alexandria Ocasio-Cortez has publicized her egg-freezing process. That narrative drew strong reactions and opened a window onto broader trends.
Sussman points out that women who freeze eggs often share traits: urban professionals in their late 30s who cite a lack of a partner as the main reason. The choice is common among those who can pay for it, but insurance coverage remains limited.
Roe, choice and the shifting responsibilities of society
The overturning of Roe v. Wade changed the landscape. Legal access to abortion once reframed parenthood as a chosen path for many. Now, in many places, choice is restricted.
Sussman argues that the removal of reproductive choice has not reliably produced greater public investment in parents or children. Rather, responsibility often remains individualized.
Money dysmorphia and the media’s role
Sussman describes “money dysmorphia”—feeling financially unready despite being relatively secure. That subjective fear affects decisions about having children.
Journalists and commentators can help by clarifying real versus perceived financial barriers. But the larger problem is structural. In the U.S., having a child can be a trigger for deep economic vulnerability.
Big barriers to starting a family
- High and unpredictable medical costs for fertility care.
- Insufficient parental leave and childcare supports.
- Housing and job instability.
- Cultural expectations about what children “need.”
- Limited access to partners at later reproductive ages.
Policy moves that could make parenting easier
There are concrete reforms that change outcomes quickly. Sussman and others point to options that would lower hardship and expand choice.
- Paid parental leave and more generous unemployment safeguards.
- Public funding for IVF and broader insurance mandates for fertility care.
- Affordable childcare and expansions of pre-K and 3-K programs.
- Stronger safety nets to reduce the financial cliff families face after a baby.
Stories that illuminate how people decide
Sussman contrasts different mindsets. An ex-partner saw a second child as unaffordable. A pregnant woman in Venezuela recited a proverb: a baby arrives with a loaf of bread. The difference is not just money.
Optimism, faith, cultural norms and what people are willing to sacrifice shape decisions. Some lower expectations about extras, like private lessons. Others can’t imagine parenthood without those things.
Why saying “having kids is good” is complicated
Sussman resists a blanket moral claim that childbearing is inherently superior to other relationships. She recognizes parenthood can be an exceptional bond for those who desire it.
Making a public case for children also raises questions about gendered expectations and state obligations. Policy arguments often depend on whether society values children as a public good.
Changing desires and identity over time
Many people are unsure if they want kids. Desires shift with age, experience and information absorbed from media.
Sussman notes she once doubted wanting children. Later, she embraced parenthood. That uncertainty is common and complicates how policy and culture should respond.
Where social infrastructure still falls short
Across the U.S., supports vary by state. City residents may find more services than rural families. The result is unequal access to the basic conditions for raising children.
Without reliable supports, people worry they may fall too far. That fear can deter people from starting families, even when they might otherwise want children.
