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.

Conclusion

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.