Terrific well-research post, as always. And it's all correct. Yes, the US refuses to decide if basic healthcare is a right or a privilege, although with 60% of our citizens now covered by Medicaid, Medicare or Obamacare, I’d argue we’ve been deciding that passively, with a major storm on that coming this summer. But this particular move is also deeper and uglier. The US has a record low birthrate that keeps dropping. (Low birth rates are always economically rooted, a longer discussion than this comment.) US conservatives have always been against abortion and birth control generally, but what's new now is the economic impact of the falling birth rate. In the US, we're missing at least 12 million births since the 2008 recession. The oldest of those kids would have turned 16 in 2024, eligible for military enrollment and employment, both of which were already in trouble with historically low unemployment (~4%). Historically, immigrants have always backfilled our birth rates and taken low paying jobs White Americans won’t, and now we are aggressively removing immigrants, with a White House goal of deporting a million in 2025. (Also no time in this comment to talk about the inability of either party to tackle immigration wisely.) And while DC has been laying off droves of staff, those laid off are well-educated; they’re not going to do farm or manufacturing work. Add in outsourcing of US manufacturing to cheaper wage countries prior to all this, and you have the perfect storm for a Christian nationalist-fronted, economically motivated pronatal movement that's now out in the open. JD Vance, Hegseth and influential Tech Bros like Musk and Altman are all proponents, along with independently wealthy families like the couple in the attached WSJ video. It’s one thing for them to have a dozen kids: it’s another for the vast majority of American families—with both parents having to work to make a decent income. (Too long here also to talk about the impact of Trump’s tax cut on the middle class.) The WSJ—not noted for a liberal viewpoint—describes all this well in the attached YouTube video. Here's where things get ugly about your post: While the administration will talk about how this saves costs, and celebrate with conservative Christian voters, the impact of this—as you note—is targeted to poor women. From experience and reams of multi-country long-term data, we—those of us in healthcare and policy, and definitely these politicians— absolutely know that there will be two clear results: increased births among poor women, and that those births will consign them to a lifetime of poverty they might otherwise have escaped. And the latter ultimately means more low wage workers, another benefit to many of the odd bedfellows in the pronatal movement. And that’s why this is a far uglier question than ‘just’ denying healthcare to women. We live for the simple: it’s so much easier to punish people than to deal with the well-documented socio-economic issues that underwrite the decisions everyone makes every day—including every single childbearing age family in America.
Thank you for such a thoughtful and deeply informed response, Mary Anne. You’ve added important dimensions that reach far beyond health policy, especially the connections to labor economics, immigration, and how cultural narratives around family, productivity, and nationhood are being reshaped in real time.
It’s difficult to ignore how certain policies when combined tend to disproportionately affect people with the fewest resources, while also making it harder to access care, education, and autonomy. The cumulative impact raises important questions about the long-term direction of these decisions and who ultimately benefits.
I am grateful for readers like you who surface these complexities so clearly. These are hard but necessary conversations and they matter a lot as policies continue to evolve, often without broad public scrutiny. Thank you again for contributing your voice to this space.
I’ve been a little tuned out the last few weeks as I’ve been traveling and now in a blue state. And I’m one of those ones that keep saying, we should not be surprised at the next idiotic insane thing this administration does to dismantle our society. And yet hearing this, makes it so hard to live by my own words. So basically it sounds like people are being forced out of the Ruhl areas either by the farms that are going to be shutting down or cause they cannot get the healthcare. They need to are already mostly overcrowded cities. Where disease and crime are higher because when you start shoving more people in a smaller area, those are things that go up. Which makes everybody again easier to control. How can I help with my work?
Terrific well-research post, as always. And it's all correct. Yes, the US refuses to decide if basic healthcare is a right or a privilege, although with 60% of our citizens now covered by Medicaid, Medicare or Obamacare, I’d argue we’ve been deciding that passively, with a major storm on that coming this summer. But this particular move is also deeper and uglier. The US has a record low birthrate that keeps dropping. (Low birth rates are always economically rooted, a longer discussion than this comment.) US conservatives have always been against abortion and birth control generally, but what's new now is the economic impact of the falling birth rate. In the US, we're missing at least 12 million births since the 2008 recession. The oldest of those kids would have turned 16 in 2024, eligible for military enrollment and employment, both of which were already in trouble with historically low unemployment (~4%). Historically, immigrants have always backfilled our birth rates and taken low paying jobs White Americans won’t, and now we are aggressively removing immigrants, with a White House goal of deporting a million in 2025. (Also no time in this comment to talk about the inability of either party to tackle immigration wisely.) And while DC has been laying off droves of staff, those laid off are well-educated; they’re not going to do farm or manufacturing work. Add in outsourcing of US manufacturing to cheaper wage countries prior to all this, and you have the perfect storm for a Christian nationalist-fronted, economically motivated pronatal movement that's now out in the open. JD Vance, Hegseth and influential Tech Bros like Musk and Altman are all proponents, along with independently wealthy families like the couple in the attached WSJ video. It’s one thing for them to have a dozen kids: it’s another for the vast majority of American families—with both parents having to work to make a decent income. (Too long here also to talk about the impact of Trump’s tax cut on the middle class.) The WSJ—not noted for a liberal viewpoint—describes all this well in the attached YouTube video. Here's where things get ugly about your post: While the administration will talk about how this saves costs, and celebrate with conservative Christian voters, the impact of this—as you note—is targeted to poor women. From experience and reams of multi-country long-term data, we—those of us in healthcare and policy, and definitely these politicians— absolutely know that there will be two clear results: increased births among poor women, and that those births will consign them to a lifetime of poverty they might otherwise have escaped. And the latter ultimately means more low wage workers, another benefit to many of the odd bedfellows in the pronatal movement. And that’s why this is a far uglier question than ‘just’ denying healthcare to women. We live for the simple: it’s so much easier to punish people than to deal with the well-documented socio-economic issues that underwrite the decisions everyone makes every day—including every single childbearing age family in America.
https://www.youtube.com/watch?v=dx3NjGSrpQ8
Thank you for such a thoughtful and deeply informed response, Mary Anne. You’ve added important dimensions that reach far beyond health policy, especially the connections to labor economics, immigration, and how cultural narratives around family, productivity, and nationhood are being reshaped in real time.
It’s difficult to ignore how certain policies when combined tend to disproportionately affect people with the fewest resources, while also making it harder to access care, education, and autonomy. The cumulative impact raises important questions about the long-term direction of these decisions and who ultimately benefits.
I am grateful for readers like you who surface these complexities so clearly. These are hard but necessary conversations and they matter a lot as policies continue to evolve, often without broad public scrutiny. Thank you again for contributing your voice to this space.
I’ve been a little tuned out the last few weeks as I’ve been traveling and now in a blue state. And I’m one of those ones that keep saying, we should not be surprised at the next idiotic insane thing this administration does to dismantle our society. And yet hearing this, makes it so hard to live by my own words. So basically it sounds like people are being forced out of the Ruhl areas either by the farms that are going to be shutting down or cause they cannot get the healthcare. They need to are already mostly overcrowded cities. Where disease and crime are higher because when you start shoving more people in a smaller area, those are things that go up. Which makes everybody again easier to control. How can I help with my work?