Cross-posted from Cold Button Issues.

On average, American women have approximately one-half a child fewer than desired. With approximately 2 million American women turning 45 each year, the conventional end of the childbearing years, there are 1 million “missing” desired children every year. With a life expectancy of approximately 77 years in the United States, this equates to 77 million years of human life lost annually due to lower than desired fertility. In comparison, the Global Burden of Disease claims that malaria and neglected tropical diseases cost 63 million DALYs annually.

Helping to support American women achieve the number of children they desire could be transformative in terms of producing more years of human life, and it would also help millions of American women fulfill what is, for many, an important life goal.

Similar fertility gaps between actual children and desired children exist in many other countries throughout the world. Some causes of lost years of healthy life (starvation, lack of clean water, many infectious diseases) will naturally be ameliorated by economic growth.  However, missing children due to non-realization of desired fertility remains a major problem in even the richest countries.

How Many Desired American Children Are Missing?

Many diseases plague humanity, taking away years of life and reducing the quality of life even for survivors. Yet the failure of American women to have as many children as they want ranks high in terms of lost years of life- even set against global disease burden.

There are different ways to estimate fertility. One way is to look at completed fertility- how many children women have when they reach the end of what is the (assumed) end of their reproductive years. This is called completed fertility. Another way is to look at how many children are being born to women at different ages and to assume that a woman will have the average number of children each year until the end of her reproductive years. This is called the total fertility rate. No matter how you measure fertility, American women are having fewer children than they say they want.

The most detailed work on American women failing to achieve their desired fertility comes from Lyman Stone, an economist who writes for the Institute for Family Studies. Comparing survey  data to actual fertility rates, he shows that American women now have roughly one-half of a child fewer than desired. Chart from  Stone (2018).


With approximately 2 million American women turning 45 each year, the conventional end of the childbearing years, there are 1 million “missing” desired children every year. If we multiply that by the US life expectancy of about 77 years, we get 77 million lost years of life. We could also discount that by some factor to make years of lost life more comparable to DALYs. Say you think one-fifth of those years are effectively “lost” due to compromised health. Then the approximate DALYs lost to American women not having as many children as they want would be 62 million- basically equal to DALYs lost globally from malaria and neglected tropical diseases, and more than those lost to HIV/AIDS and STIs.

Valuing Non-Existent People

Some say we shouldn’t be counting the well-being of future people in our moral calculus. But in practice, I think that claim is largely ignored by effective altruists. Such a claim is rejected by those who are concerned about the future of humanity and are interested in protecting future generations against major disasters, pandemics, and hostile artificial intelligence.

The value of future beings is also taken for granted by people who care about animal welfare. Broiler chickens, for instance, are normally slaughtered at six or seven weeks old. Most farm animals just don’t live very long. If you’re working on improving animal welfare laws or pushing corporations to treat farmed animals more ethically, in practice you’re working to help animals who haven’t even been born yet.

I think the lives of kids born ten years from now count, morally. And the kids born the year after that and so on. And if we could do something to extend their life from 70 to 80 by curing cancer, that would be nice. And if we could extend their life from 0 to 80 by supporting women and families in achieving the number of children they want, I think that would be even nicer.

Recommended Interventions

The primary interventions I think a funder could make to support women achieving their fertility goals are through political advocacy and research. I don’t think any philanthropic funder, no matter how rich, is capable of directly moving this issue by, for example, offering financial support to families. As such, I lay out the case for supporting natalism in the United States, but I avoid offering a specific ROI calculation such as $5 billion in advocacy funding will get you another million wanted babies.

More speculatively, I suggest addressing public misinformation and ignorance about fertility could play a useful role, as could more work on estimating the value of potential lives foregone.

Missing Advocacy Groups

If you want to read somebody complaining about birth rates, you’re probably glad you found this piece, and if you look you can find other laments online. But it’s not clear if there’s anyone you could throw money at to do something about it.

The most obvious current choice would be the most pro-natal think tank in the United States, the Institute for Family Studies, which recently had an annual budget of $671,000. Interested funders could just give IFS more money in support of their past work and to build up the field. A funder could also just approach major left-wing and right-wing think tanks and give them earmarked donations for pro-natal policy work as a way to elevate the importance of this issue on both the left and right. Subjectively, I think there is much more interest in pro-natalism on the American right and would be easier to elevate this issue on the right. However, I also think it is probably true that natalism (very neglected overall) is even more neglected on the American left.

Another approach would be to incubate a pro-natal advocacy group directly. The existence of pro-natal advocacy groups seems strangely neglected. There are many groups or cultures that are strongly in favor of having children and supporting families, of course. But there’s not an important “Americans United for More Babies” coalition. That said there are prominent individuals, including in politics, who have expressed support and encouraged Americans to have more children, such as Senator Mitt Romney and Senator Sherrod Brown

Funding scholars to research the most effective pro-natal policies and activists and back pro-natal politicians and laws is a neglected philanthropic opportunity. While further research could perhaps lead to the development of new policy ideas to help women and families achieve their fertility goals, there is already evidence that some pro-natal policies can increase birth rates. A review of the literature on pro-natal  child incentives show they work, although they are expensive and could not be funded by private philanthropists (Stone, 2020).

Non-monetary cultural interventions can work as well. In the country of Georgia, Patriarch Ilia offered to personally baptize children born to couples that already had two children, an offer that appeared to cause a spike in Georgian births.

Education About Fertility Decline

Prior et al (2019) showed that Australian college students were shockingly  ignorant of age-related fertility decline, with most women students dramatically underestimating the decline in fertility after the age of 35. It would be useful to assess American knowledge of the biology of fertility through public opinion surveys. If Americans are similarly ignorant about fertility, one possible response would be a public awareness campaign.

Another response would be to lobby for state sex educations standards to require educating students about fertility and the risk of failing to achieve one’s desired fertility. Many US states claim to require public schools to offer comprehensive sexual health education. California, for instance, requires “education regarding human development and sexuality, including education on pregnancy, contraception, and sexually transmitted infections,” as well as information about methods of HIV transmission. However, California does not require students to learn about how best to get pregnant and how fertility declines with age. And many states don’t require any form of sex education to be taught. SIECUS, which tracks differences in sex ed curriculum across states, doesn’t mention any state having requirements to teach about age-related declines in fertility. 

Estimating the Value of a Statistical Life (Foregone)

While I believe that the value of potential human lives  is probably the same as current lives, perhaps discounted for uncertainty, there is no consensus on this question. But I think any person who wants to optimize for any altruistic action, whether an effective altruist or not, whether a formal consequentialist or not, should have an answer to this question. How bad is environmental contamination when its effects on fertility are taken into account? Diseases that cause sterility are how much worse than similar diseases that don’t? 

This question is important. Another reason why we should care about potential human lives not coming into existence when they are desired by their potential parents, is that the parents themselves are failing to realize an important human preference or goal. There should also be some accounting of the loss that potential parents frequently experience when they have fewer children than desired.

The value of a statistical life is calculated by how much people are willing to pay to reduce the risks of death by some increment. For those who think valuing potential lives the same as current lives is unreasonable, perhaps a similar method of estimation could be used. I recommend that funders who are trying to optimize for human welfare devise a method to calculate the value of a statistical life foregone. Perhaps there is a way to measure how much compensation women require to take jobs that reduce expected fertility or perhaps public opinion surveys could be used to estimate how harmful to potential parents it is to have one fewer child than desired.

Hire a Program Officer

This issue is hugely important but not that many people write about it. While writing about this, I kept running into articles written by Lyman Stone and a few other people who work at the Institute for Family Studies.

If I were a billionaire, I’d try to hire one of them, or perhaps a professor of demography, to address one of the greatest sources of lost human life on earth.


If more people are born, there will be more years of human life, including healthy human life. So it might seem obvious that having more people born is better. I think that’s true in general.

There are many arguments brought up against promoting natalism and childbearing in general. One popular argument against is the so-called Repugnant Conclusion, the argument that if we are able to increase total happiness by increasing the size of the population at the cost of the happiness of those already living, we could reach a world with a very large population full of people whose lives are barely worth living.  Raising the US total fertility rate to slightly above replacement doesn’t put us in that speculative, dystopian scenario. Another argument is that people, especially women, should never feel social pressure or coercion to have unwanted children. Therefore, this analysis focuses only on the lost years of human life due to women having fewer children than desired

Finally, this problem’s magnitude is much greater when all countries not just the United States are examined. However, for reasons of cultural humility and political sensitivities about population policy, I would not encourage the Western-dominated effective altruism movement to involve itself in such questions in developing countries. 


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I think there's a big difference between caring about the welfare of future people and caring about bringing future people into existence in the first place. I.e. I think this post is conflating the "totalist" view of population ethics where the morally relevant goal is maximizing the sum of all welfare (number of entities times the average welfare of entities) with the averagist view of population ethics where the morally relevant goal is maximizing average welfare for the entities that exist.

I can't speak for anyone but myself, but I really don't like the idea of creating humans because other people want them for something. Hearing arguments framed that way fills me with visceral horror and makes it relatively harder for me to pay attention to anything else. 

Is this very different from people wanting to become parents or have more children themselves?

FWIW, I don't think it's good for a person's own sake to be born, so the only reasons to have children are for the benefit of others. Still, most parents probably do it because it's something they want for themselves and don't think is wrong or bad, and may think is good for the children. The point of this article is that it would be very good for the children if we could help more of them be born.

I know  a lot of people feel this way, but I disagree.

If it's not good for people to come into existence, then human extinction is no big deal. All the people who die during the asteroid strike or whatever,  were going to die already, so the downside is just the lost years of life and whatever fear and suffering the looming asteroid causes. I think human extinction is very bad because it would prevent many generations of people from coming into existence.

And FWIW, I do think it's also bad for potential parents to not have the family they want and I think that's a problem too. But I don't have a good sense of how to quantify that loss to the parents.

This post relies heavily on the claim that on average, US women want more children than they have.

I was skeptical of this claim because it's not in line with my personal experience or common sense (it seems like most people could have more children if they really wanted)

Stone 2018 seems to be the only reference for this. It's a non-peer reviewed blog post on the Institute for Family Studies website. IFS seems to be a conservative think-tank with a strong agenda.

You can look up the survey data and check yourself. I relied on IFS for doing the work of graphing it and explaining it clearly. 

So for instance here is information from Gallup up to 2013.

Here is data from GSS.

I don't take these polls very seriously because it's ambiguous if the "ideal number of children" includes the financial/work/time costs.

Lots of people have a different idea of what the "ideal" is vs. what they want in practice.

Good point on the bias of IFS, but I'll push back on this claim not being in line with common sense. Why do you think most people could have more children if they really wanted? It seems like financial constraints, infeasibility of finding childcare, and increasingly tight marriage markets (as represented by older age at marriage) are all factors holding people back.

If you surveyed people on whether they "want to speak another language" I think most people would say yes. But do they go and do it in practice? No, because of the enormous amount of time/money/work. That doesn't seem like a tragically unmet "want".

I think that analogy proves too much. You could also survey people on whether they "want to go to the doctor more often than they do", and if they said yes, you could shrug and say "well they don't do it because it costs a lot of money, that doesn't seem like a tragically unmet want". What's the limiting principle behind "if people don't do something because they are responding optimally to their financial/effort costs, then public policy doesn't really need to help them do it"?

This is an excellent post, in tune with the One Billion Americans argument. My main worry is that we should not lean too heavily on preferences people state on surveys about the number of children they would like to have. Survey responses do not really match the real decisions people take about irreversible, long-term decisions like having a child. There are many plausible ways in which these could differ, e.g. if people describe how many children they would like to have, but their partner wants to have fewer children. Or they would like to have children, but they find it hard to find a partner who meets their standards. Or they would like to have children if their parents could help with childcare, but their parents actually cannot because they live far away or are still working. All of these would lead me to apply some discount factor to the number of children that

Of course, these are social constraints that we should ideally lift. Women being forced to have fewer children than they would like because of economic worries shouldn't happen. But there's only so much that philanthropists can do, so in this view we have to accept that the "optimal" number of children that can be promoted by advocacy/education is not the same as the "ideal" number of children that these people would like to have.


Thanks for writing this. For anyone with good ideas in the area, it's worth noting that addressing demographic decline is listed as an area the FTX Foundation is interested in funding.

Thank you for framing this in terms of wanting to support women have children that they desire - often when people talk about wanting to 'increase the birth rate' they don't disentangle 'helping people have kids that they want to have' from more coercive measures, which makes me nervous. 

'The primary interventions I think a funder could make to support women achieving their fertility goals are through political advocacy and research. I don’t think any philanthropic funder, no matter how rich, is capable of directly moving this issue by, for example, offering financial support to families.'
-why wouldn't offering financial support be effective?

Does the research on 'missing children' ask why  the respondents didn't have as many children as they wanted? Because this would be useful to know, and would help determine what interventions might be most effective. For example, if most people say that they didn't have as many children as they wanted because they couldn't afford it, then financial support would be the best intervention; if they say that they didn't find the right partner in time, maybe the best intervention is ?trying to make dating sites better?; if they say they waited too long and were then unable to conceive, then the fertility education you suggested might be very effective. Other reasons I can think of might be: lack of maternity leave, lack of social support, or their partner didn't want more kids. 

I imagine the financial claim isn't that offering financial support doesn't work, but a claim more like - there aren't enough resources to offer enough financial support to enough people to meaningfully alter the US fertility rate on the basis of this alone.

Like - how much does it take to raise a child? I've heard 250k, so let's go with that. You don't need to offer the entire amount as financial support, but something like 5k/year seems reasonable. Across 18 years, that's still $90,000. That means that if you give a billion dollars away as financial support, with zero overheads, you've supported the birth of ~11,000 children. This is a rounding error compared to the size of the issue, so I wouldn't see it as "directly moving the ". To directly move the needle at a cost of 90k/child, you'd need to invest hundreds of billions of dollars. It would probably work effectively, but the resources just aren't there in private philanthropy.

By contrast, political advocacy actually could work on the scales that we're talking about.

Yeah, this is what I meant. Thanks, Jay!

One possibly scalable intervention here would be a dating site (or other matchmaking service) that didn't have the fundamental conflict of interest where its income stream depends on its users failing to form successful long-term relationships.

The probability of success would be low, and even if you did gain a large market share it would only solve a fraction of the problem, but the cost of trying might be low enough that despite those factors it would still be a worthwhile philanthropic investment.

Yeah, I think this would worth be trying.

Even more speculatively, I was thinking of whether trying to reduce wedding costs would be effective. Married couples have much higher birth rates than unmarried couples, and it looks like it might be partly causal. For instance, I know couples who waited to have children till they married and waited to marry until they could pay for a wedding.