Today's Bioethics Isn't Ready for Tomorrow's Family Planning

Per Charles Fain Lehman, conservative vice lord extraordinaire, more Americans now use marijuana daily (21.4 million, or about one in every 20 Americans), than drink or smoke daily. 🥴. If it’s Friday, it’s Family Matters:

• On Assisted Reproduction, Full Speed Ahead is the Wrong Speed and the Wrong Direction: A review of Leonard Lopoo’s “Wanting Children”

• Housing as a Moral Issue: Catholics should get a little more YIMBY-pilled

• It’s Me, Hi: Politico, National Catholic Register, Relevant Radio, EWTN Radio

• Parting Shots

The entire caucus of Senate Democrats recognized “World IVF Day” by re-introducing their co-sponsored Right to IVF Act, a bill that would “promote the right and ability of an individual residing in any State to choose to receive ART or IUI provided by a health care provider who chooses to provide such services.” The bill would prohibit states from regulating the fertility industry beyond the current “Wild West” levels of federal regulation, require public and private insurers to include ART and IVF coverage in their benefits packages, and take other steps to remove limits on and expand access to assisted reproductive technologies.

The push may or may not be a smart move politically — while IVF access tends to have high levels of support on paper, it appears to move very few voters on the margin. But beyond the potential political payoff, it’s striking to see progressives blowing past the ethical questions around the future of human reproduction in the name of a maximalist, “reproductive autonomy” view of fertility. Recent high-profile foul-ups within the fertility industry indicate a field that could benefit from closer regulatory scrutiny, not the equivalent of a federal shield law protecting them from any state efforts to rein in bad actors.

But beyond the way the business of fertility is practiced now, we are entering brave new territory in bioethics. The next wave of assisted reproduction technologies have the potential to fundamentally change what it means to be a parent, or to procure a child, indelibly — something that deserves prudence rather than “full speed ahead.” Technologists tell us we are on the cusp of polygenic screening for intelligence, health, and cosmetic appearance; in vitro gametogenesis, or the process of making eggs out of skin cells; and AI-enabled embryo screening or even genetic enhancement. Yet the whole policy conversation around “protecting IVF” feels like legislation written for 2007 rather than 2027. Shouldn’t now, more than ever, be a time to favor prudence and humility in how policy treats the pursuit of parenthood, rather than Congress ham-handedly seeking to codify individual rights in ways that could pre-empt any future attempts at guardrails?

The same blind spot can be seen in a new book by Leonard Lopoo, an associate dean at Syracuse University’s Maxwell School of Citizenship and Public Affairs. “Wanting Children: Family-Planning Policies and the Engineering of America’s Population” picks up on some threads that pro-life conservatives have long critiqued. The federal focus on population policies, which flowered in the early 1970s with the establishment of Title X and other family planning approaches, were largely grounded in the assumption that the problem facing America would be low-income women having too many children. Lopoo is right to question how the conventional wisdom of yesteryear ended up looking stale with the benefit of hindsight.

Supreme Court justice Ruth Bader Ginsburg accurately, albeit infamously, characterized the decision in Roe v. Wade as reflecting “concern about population growth and particularly growth in populations that we don’t want to have too many of.” Lopoo quotes President Richard Nixon, recorded on the White House tapes, telling advisors in 1972 that “The people who don’t control their families are people that — the people that shouldn’t have kids.” In its report released the same year, the U.S. Commission on Population Growth and the American Future, led by John D. Rockefeller III, encouraged the American people to “challenge the tradition that population growth is desirable.” They looked at higher fertility among minority women and prescribed a simple diet of more closely following middle-class norms: “Those who have not been able to climb onto the socioeconomic escalator have also not adopted the pattern of smaller family size...Those minority people who have ‘made it’ into the system have adopted the small-family pattern. The problem is that so few of them have made it.”

Lopoo is quick to use these examples to argue for the “original eugenic intent of these programs” — that the idea that racial minorities and low-income Americans needed to curb their fertility in the pursuit of national prosperity was, in large part, misguided Malthusianism. He’s not wrong to note that some of our more coercive efforts to more strictly limit welfare spending to single moms — at times, directly, through “family caps” which froze benefit increases to low-income mothers who had additional children while on welfare — was grounded in this mindset. Today, he argues, “our choices have created a de facto fertility policy that only supports low-income women if they want to limit their fertility.”

Unfortunately, Lopoo overcorrects the other direction, captive to the conventional wisdom of today’s academic class. The second part of “Wanting Children” is a full-fledged endorsement of a universal commitment to public provision of artificial reproductive technologies (ARTs):

“Universal coverage of infertility supports within this family-planning structure would not only lead to greater social welfare; it would also move the United States closer to a society in which all Americans, regardless of social class, have the freedom to time, space, and have the number of children they desire, which includes the decision to have none. Viewed from another side, this same policy approach would bring the United States closer to a place in which more children are wanted. Research has shown that this end is justified by almost any means.”

“By almost any means”! That kind of sentiment should always be approached with extreme caution.

Conservatives, particularly those concerned with low birth rates, sometimes have an awkward tight rope to walk between wanting to support families (and lower abortion rates) and recognizing that kids do best when they are not being born into poverty or single parent homes. A concern with second-order effects (would more generous welfare benefits increase single parent families? would expanding subsidies for ARTs ultimately lower birth rates by inducing more women to wait until later, when odds of conception are lower? would stressing responsible parenthood raise abortion rates?) has long been a hallmark of family policy on the right.

Lopoo and the Right to IVF Act’s many sponsors would blow past those notes of caution. “Wanting Children” is a serious but incurious book — it treats long-standing political objections to single parenthood, and traditional conservative critiques of assisted reproductive technologies (ARTs) lightly, when it deigns to acknowledge them at all.

First off, while some of the energy behind welfare policy’s anti-natal turn may have been authentically eugenicist, surely no small energy came from the genuine belief — misguided or not — that poor kids would do better, overall, with fewer siblings, and that part of policymakers’ attention should be paid towards helping single parents enter into stable marriages. Secondly, making IVF and other ARTs an “individual” right, rather than a service that couples benefit from jointly, would absolutely increase the number of kids born to and raised by single parents, particularly if it was made available with no cost-sharing, as Lopoo suggests.

And, most damningly, the book unthinkingly adopts a professional-class mindset to family planning, in which every child should be “planned” and “wanted,” even if some are “mistimed.” Lopoo grounds much of his case for proactive fertility policy in “wantedness,” assuming that the biggest problem is that too many children are “unwanted” — roughly 13 percent, by his calculations. That motivating principle may have been the case when Title X was passed in the 70s; that seems less true today.

For one thing, women today appear more deliberate about conception; in the 2010s the rate of unintended pregnancies in the U.S. fell from 42.1 to 35.7 per 1,000 women over the span of less than a decade, as more women opted for more effective methods of contraception and the overall level of sexual intercourse fell. For another, an “unwanted” child is rarely an “unloved” one; if Lopoo has never met a family that had a wholly unplanned pregnancy turn into an unexpected bundle of joy, he should get out more. A system that is designed to only welcome children when they are comprehensively and deliberately “planned” will be one with fewer children than people want and one less accommodating of life’s happy accidents.

To counterbalance the traditional focus on fertility-reducing policies, and enable all families to enjoy the sense of control — illusory or not — that ARTs offer to the wealthy, Lopoo advocates for universal coverage of ARTs, on equity grounds. Currently, he notes, only New York allows Medicaid recipients to use their benefits for ovulation-stimulating drugs, and no state covers IVF. He would like to see something like the Right to IVF Act, including state-of-the-art genetic testing available for all recipients. After all, he suggests, wealthy parents are going to continue to adopt these technologies — he cites a study finding the share of IVF patients using preimplantation genetic testing rose from 5 percent of patients in 2015 to 43 percent in 2019. In so doing, he acknowledges, we would be “trading a [currently] health-inequitable system for one that is individually eugenic.” Eugenics, so long as it is freely chosen, is the price he is willing to pay when the only other alternative is a top-down eugenics softly imposed by government policies.

But…surely there is another option or two on the table? He rules out cutting funding for federal family planning programs, straightforwardly asserting that it would “violate the role of government, which most social scientists believe is the maximization of collective well-being.” Talk about assuming away a lot of good-faith disagreement about the means and ends of government! But, for the sake of argument, put aside the constitutional questions about the proper role of the state and assume Lopoo is right to be concerned about anti-natal pressures in the federal government’s current provision of contraceptive and family planning resources. Why wouldn’t we start by expanding the suite of benefits — fertility awareness, better evaluation of and treatment for endometriosis, more conversations about careers that are amenable to family life — before assuming an “if you can’t beat ‘em, join ‘em” approach to controversial technologies like preimplantation genetic testing and designer embryos? After all, the ethical questions raised by new technologies do not go away by making them universally accessible.

In fact, Lopoo and progressives concerned about inequities in health access could start by taking a page out of the Trump administration’s book — as covered by Kat Rosenfield for The Free Press last week — and seeking opportunities to revise sexual education, Title X, and other family planning dollars to make it easier for women to both avoid and achieve their fertility goals.

America tends to be a deeply practical nation, not a philosophical one. But choosing not to ask these deeper questions is as much of a way of answering them as coming down with a carefully considered legal regime. No legal guardrail about human cloning or gene editing will be completely impermeable, but the genie is not so far out of the bottle that we can’t design better approaches to hacking reproduction than the current light-touch approach. Some of the champions of the “Right to IVF Act” doubtless see human nature and the limits of biology as constraints to be overcome. Others — perhaps the majority — are more likely to think about sympathetic cases of couples experiencing infertility, and think the legislation will help them without a thought to the long-term consequences. They owe it to themselves to take a second look.

Treating the issues raised by new technologies — including the increasingly popular integration of AI into questions of reproduction — could look something like a new commission proposed by Senator Ted Cruz (R-Tex.) and Senator Rev. Raphael Warnock (D-Ga.). Their proposed Human Dignity and Emerging Technologies Act (bill text) would establish the United States Commission on Human Dignity within the legislative branch to advise Congress on the ethical and policy implications of emerging technologies, like artificial intelligence (AI). At National Review, Wesley Smith pays tribute to the idea of a commission that might take up the bioethical issues that the White House’s current Tech Right-guided race to AI supremacy seems to be too often neglecting. I’m confident the Commission wouldn’t necessarily get to the right answers — but it would at least be a more serious approach to these questions than pretending they don’t exist, or brushing past them in the service of “pro-natalist” or “health equity” concerns.

This article by the National Catholic Register’s Jonah McKeown does quote me, but it’s too good to tuck into the “It’s Me, Hi” section below. The article looks at the increasing pressures on housing affordability as a moral issue, talking to theologians and policy analysts (yr. obdt. svt.) about what happens when a lack of housing growth leads to more young adults feeling unable to get their life on track:

“Housing is directly tied to family formation and in that sense tied to what it means to be able to call people to mature, grow up, and become contributing members of a community,” said Patrick Brown, a fellow at the Ethics and Public Policy Center who has written extensively on the social impact of housing unaffordability…[F]inancial pressure created by housing is almost certainly causing people of all ages to “put their lives on hold,” including delaying or forgoing parenthood and staying in their parents’ homes well into adulthood, Brown said. (National Catholic Register)

I was happy to talk about the thesis behind the piece and some of my own work on the topic with Drew Mariani on his radio program, The Drew Mariani Show on the Relevant Radio Network, for a lengthy discussion about housing and family policy.

I also spoke with Teresa Tomeo for her radio program, Cultural Connections, on the EWTN Radio Network:

Politico’s Alice Ollstein talked to me about whether a new study looking at whether chemical compounds related to the abortion pill might be found in the water supply might change the politics of abortion:

“One study isn’t going to make or break the case, but it can change the conversation,” said Patrick Brown, a fellow with the anti-abortion think tank Ethics and Public Policy Center. He pointed to scientific advancements around fetal development in the 1980s as ultrasounds became more common as a catalyst for the movement’s success banning a commonly used surgical method for abortions later in pregnancy. (POLITICO)

• Indiana: Curt Smith, chairman of the Indiana Family Institute, praises his home state senators, Todd Young and Jim Banks, for advancing legislation to materially support families (Northwest Indiana Business Magazine)

• Kentucky: Following Covid, Gov. Andy Beshear relaxed restrictions on Medicaid coverage of substance abuse programs. A new report finds Kentucky now has more per capita long-term treatment slots than any other state — coupled with a troubling pattern of fraud and skyrocketing state spending (ProPublica/Lexington Herald-Leader)

• Maryland: This fall, Baltimore residents will be asked whether to establish a $15 million fund aimed at enhancing the economic wellbeing of families with newborn children - though the details are intentionally left open-ended (Baltimore Sun)

• Massachusetts: The House of Representatives passed a bill that would allow abortions after the 24th week of pregnancy. The Catholic bishops of the state say they are praying for “a renewal of reverence for every human life,” and advocating against the bill in the state Senate (Boston Pilot)

• Tennessee: Deputy House Speaker Jason Zachary writes against “radical pro-life abolitionists,” calling them a “threat to the very movement they claim to want to advance,” and stresses the pro-life gains made in the state and the need to materially support pregnant moms. (Chattanooga Times Free Press)

• My EPPC colleague Nathanael Blake argues that New York City’s progressive politics around gender means that Mayor Mamdani’s latest parents-night-out initiative should be looked at with extreme skepticism — I disagree! (The Federalist)

• My EPPC colleague Erika Bachiochi shared her personal journey with EWTN’s The Coming Home Network:

• Senators Ruben Gallego (D-Ariz.) and Dr. Roger Marshall (R-Ky.) introduced the “state of Men’s Health Act,” which would direct the Department of Health and Human Services to establish an Office of Men’s Health (bill text)

• Few writers are as convincingly dyspeptic about the future of AI and human achievement than Gregory Conti. His latest, for COMPACT, is no exception.

• Every night, at midnight, the sisters of the Bethlehem Priory of St. Joseph near Tehachapi, Calif., rise to pray for those in need. “Just as the mother rises in the middle of the night, so we rise.” A beautiful piece of reporting by Lauren Jackson (New York Times)

• Jessica H. Brown, an assistant professor of economics at the University of South Carolina, speaks to New America’s Aaron Loewenberg about her work debunking common measures of child care availability and developing more accurate measurement techniques: “I find that child care desert status does not predict whether providers have open slots…if our measure of child care access is not accurate, [public] funds may not go to areas most in need.”

Comments and criticism both welcome, albeit not quite equally; send me a postcard, drop me a line, and then sign up for more content and analysis from EPPC scholars.