Delayed Motherhood

Hello everyone, happy Friday!

I want to talk about something that’s been rattling around my brain all week. You’ve probably seen the headlines: U.S. fertility rates have dropped again to a record low of 53.1 births per 1000 women (insert horror movie violin sound track here). I am not surprised the birth rate is dropping. What surprises me, is every time there’s a national conversation about this, we focus on how women are too busy being selfish to procreate, or how it’s a mystery that the birth rate is dropping, or how it’s a political crisis. We focus on anything other than… the people struggling to get pregnant.

And I’m reading all of this, building a fertility company, surrounded by a team of brilliant women who are actively trying to make babies or raise their babies, and I keep thinking: this is not a mystery. Not even close. It’s just that nobody’s asking the right people.

There’s a through line that keeps coming up in the coverage, some version of: women today have more control over their fertility than ever before (I’ll ignore the not-so-subtle inference there that women are selfishly exercising this control and causing the declining birth rate).

We do have more control than ever before over the choice to not have children. And, that control vanishes the minute we decide we want children, only to be hit with infertility. Talk to anyone who is struggling to conceive – the word control never appears unless it’s after the words ‘out of’.

I know this because I see our Béa patients living this reality every day: researching, preparing, hedging, calculating and inevitably getting lost. We are not rejecting having children. We are trying to figure out how on earth to make it work. Kate Ryder wrote a brilliant piece in which her friend sums it up perfectly, “I just feel like at every turn I’m being punished.”

Building a family isn’t easy. Infertility makes it brutal.

Let’s start with the fertility care pathway, because it’s what I see up close and it’s the part that makes me want to throw a brick at something. If you go to your doctor and say you’ve been trying to conceive for six months and you’re worried, the most likely response is: try not to worry, and come back in another six months. This has a clinical name: Expectant Management. At Béa we call it “try harder”, and it’s a clinical excuse for patient neglect.

Something else that contributes to the brutality: the system is built to make women feel alone. Men are 50% of the problem in infertility. They also have complex, painful, emotional experiences through infertility and those experiences remain a footnote, leaving heterosexual women to go through the pain of trying to build a family whilst feeling increasingly isolated from a partner.

Then there’s clinical treatment. For most people that means IVF or nothing, and the average family can expect to spend close to $50,000 on IVF. Private capital piled in, incentives got completely misaligned (yes, clinics are private businesses incentivised to drive increased revenue as much as any other business, which means they push IVF hard and push IVF prices higher). We’ve arrived at a system where the default fertility treatment costs as much as the down payment on the house you want to raise your child in.

People who need IVF to conceive and pay out-of-pocket arrive at parenthood $50k (or more) down, wondering how to make it all work when the baby arrives. And politicians wonder why we don’t have a second child.

Let’s imagine we get through all of this, and we have the baby we so desperately wanted. Yay! Now what? It’s not sunshine and unicorn farts, I’ll tell you that. It’s a constant stream of really hard questions: How do I pay for childcare? When do I go back to work? Will my career survive this? There is a website called opensourcenanny.com and the fact that this website exists should tell you everything you need to know about why it feels so hard, and why there are so few babies per family.

I see it in our team at Béa every day. Most of the team either have a young family, or are creating a family. Kids pop up on calls. Emails written from hospital rooms. Somehow juggling everything whilst still being the best team I’ve ever worked with. That “make it look easy” narrative did no one any favors here, and watching the Béa team over the years has taught me that whilst we cannot have it all, we’ll fight like hell to get as much as we can.

The drop in the fertility rate is not about our desire to have families. Talk to anyone going through infertility and you’ll learn what desire means.

Let’s stop framing the declining birth rate as women being too selfish for motherhood and start talking about the frankly enormous mountains we have to scale to become mothers in the first place. I don’t have all the answers (as evidenced by this rant without solutions), but I know this much: the answers will never come from a conversation that doesn’t include the people fighting to create a family. It’s on us in the infertility world to keep talking loudly, and it’s National Infertility Awareness Week, so it’s a good time to talk. Talk to us, talk to a partner, talk to a friend. It’s about as good a first step as we can take towards building a better solution.

Take care of yourself this weekend.

Warmly,

Tess

Co-founder & CEO