Five Questions with Leonard M. Lopoo, author of “Wanting Children: Family-Planning Policies and the Engineering of America’s Population”
The US government spends hundreds of millions of dollars every year to promote and facilitate contraception. Whereas other wealthy countries support broader fertility interventions under the banner of “family planning,” the United States remains committed only to helping Americans—and especially poorer Americans—plan not to have a family.
In an unflinching treatise on one of the century’s defining social issues, Leonard M. Lopoo shows how the US’s asymmetric reproductive approach is a vestige of the country’s earlier sins: America’s first reproductive policies were authored by some of the twentieth century’s most prominent eugenicists, a group whose primary goal was birth prevention among lower economic classes and racial minorities. These origins have consequently created a contradictory position for the country today, in which contraception for the lowest-income Americans is subsidized, while many upper-class Americans employ technologies to have children with preferable traits.
Wanting Children posits a new and elevating criterion for how we think about fertility in the twenty-first century. Read on for a Q&A with Leonard M. Lopoo about his thought-provoking argument that if the United States is to legislate reproduction, the only defensible approach is equity: helping people who want children to have children.
Wanting Children is examining one of the thorniest, most intimate issues of US policy: how we administer fertility interventions and the origins of the resulting disparity we see in who can access which forms of treatments. What were the origins of the project?
I started studying public policies that affect families when I was a graduate student in the late 1990s. I have always been fascinated with our demography and have been surprised by how little attention we pay to it as a nation. In fact, many Americans do not know basic facts about our demography: how many people live in the United States? What is the age distribution or racial composition of our population? I also realized pretty quickly that there was a lot of inconsistency in our population policy goals.
Let me give you an example. In the late 1960s and early 1970s, there were several popular books that suggested the US population was growing too fast and that we should expect a lot of civil unrest because we did not have the food supply or retirement support to take care of so many people. As a result, policymakers created a number of measures to stop population growth. The US population in 1970 was around 200 million. Today, one hears many political actors concerned that we are not growing fast enough—emphasizing pronatalism and encouraging population growth. Ironically, the population in the United States today is nearly 350 million.
In Wanting Children, the answer I provide for this inconsistency is that we have no overarching population goals. This absence is quite different from other policy domains. For example, there is agreement across party lines that economic growth is good. Political actors may disagree about the means to generate economic growth, but no one thinks that economic stagnation or decline is good. That is not true for our population. The book started with the goal to generate an overarching population policy—one that political actors from different perspectives would agree on, which could generate a more consistent population policy. That overarching goal, by the way, is what I call “wantedness.”
What is wantedness, and why is it important?
There is strong social science literature that shows that children who are planned for and wanted by their parents have much greater success in nearly every measurable outcome than those who were unwanted. For instance, on average, they attain greater education levels, earn higher incomes, tend to be healthier, and experience stronger psychosocial outcomes—to name a few. My claim is that policymakers should ask, during any population policy debate, will this option increase the number of wanted children? If the answer is yes, then this policy will move us in a positive direction.
What do you hope readers will take away from the book about how we view equality within our fertility intervention programs?
As I have studied the population policies in the United States, I have also been struck by the asymmetry in our government-sponsored family planning policies. First, it is important to note that these family planning programs only provide resources for low-income people. Secondly—and worryingly—these same family planning programs only offer assistance for contraception and other reproductive health services aimed at preventing pregnancy. This is distinct from the policy attitudes of many of our peer nations, which consider family planning to include both the desire to prevent childbearing (contraception) and to support childbearing for those with infertility issues. So, we have this asymmetry: the government will help a poor American if they want to avoid childbearing, but will offer no assistance if they want to have children and are having trouble.
In Wanting Children, I detail some of the explanations others have offered for this inconsistency—the primary one being health equity. Health equity is the idea that anything available to middle-class women and men that helps them maintain their health should be available to the disadvantaged as well. Because family planning allows middle-class women to time their childbearing to take advantage of labor and educational opportunities, the government has the responsibility to make these options available to low-income women, too. This argument seems just to me. However, I ask, doesn’t health equity apply to infertility as well? In the book, I show that we do not really abide by the health equity argument with regard to infertility—only when we’re discussing birth prevention. And it’s that contradiction of who can access which treatments and when we facilitate that access, that speaks to a larger, systematic inequality that I hope strikes a chord with readers.
While you were working on this project, what did you learn that surprised you the most?
During the research for the book, the more I learned about fertility technologies, the more I realized how unprepared we are for these changes. Today, some wealthy Americans use genetic testing with IVF to design their children. As more people use these technologies and as these technologies advance—to reduce a child’s likelihood of having devastating illnesses, for example—the more important it will be for all Americans to have access to those interventions. The children of those citizens who cannot use these technologies will have a difficult time competing with the children of those who can—a situation akin to the storyline from the movie Gattaca coming to fruition. We are about to face a number of exceedingly difficult ethical issues, and the sheer scope of this potential quandary became evident to me as I delved further into work for this book.
Where will your research and writing take you next?
The population policy landscape is changing all the time. Clearly, one of the most important changes is the Dobbs decision. In 2022, the Supreme Court ruled in Dobbs v Jackson Women’s Health Organization that the U.S. Constitution does not grant the right to an abortion and gave each state the authority to decide its legality. At this point, 12 states have banned abortion completely, and several more have limited access. The role of medical abortions, which includes the use of mifepristone and misoprostol, has completely altered the landscape as well. Currently, the Fifth Circuit Court of Appeals has called into question the use of telemedicine to provide some of these medications for medical abortions, and access to abortion is changing based on one’s resources and geographic location. All of this to say, there is a lot of important work to be done in this space. There is so much with respect to policies and their impact on our population that we do not understand. For reasons both good and bad, I certainly won’t run out of topics to study.
Leonard M. Lopoo is the Paul Volcker Chair in Behavioral Economics and professor, chair, and associate dean of public administration and international affairs at Syracuse University’s Maxwell School, where he directs the Maxwell X Lab and serves as senior research associate in the Center for Policy Research. His popular writing has appeared in the Wall Street Journal.
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