Home / Maternal Health Task Force / Blog / Declining Fertility Rates, Growing Concerns: Where Does Maternal and Child Health Fit In?

Declining Fertility Rates, Growing Concerns: Where Does Maternal and Child Health Fit In?

November 9, 2026

A Changing Landscape

Since 2007, the U.S. fertility rate has declined by nearly 23%, and experts expect this trend to continue (Adashi et al., 2026; Hamilton et al., 2026). Public discourse around declining fertility rates often centers on the economic impacts: fewer births today mean fewer workers tomorrow, which could put pressure on programs like Medicare and Social Security (Walsh, 2026).

In response, many conservative policymakers have embraced pronatalism, and they seek to increase births by promoting heterosexual marriage, discouraging divorce and abortion, and urging women to prioritize family over career (Glass, 2026; Guzzo, 2026). This debate centers on how many children the country needs, overlooking a more fundamental question: Are people having the number of children they want?

Research suggests the answer is no. While some people want few or no children, many end up with fewer than they hoped for. Personal preferences, work and home responsibilities, finances, and access to health care can all shape these decisions about desired fertility (Badolato & Hayford, 2026; Guzzo & Hayford, 2020). Various fields have explored this gap between desired and actual fertility. Demographers and epidemiologists track delayed parenthood and changing family-size goals (Gemmill, 2019), while economists study how finances, social expectations, and gender roles shape family formation and economic growth (Goldin, 2025).

From a Maternal and Child Health (MCH) perspective, the distinctive question is not simply whether a gap exists, but whether people are having the families they want, what might prevent them from doing so, and what the field can do to help people realize their own reproductive goals. Understanding these questions offers another way to understand declining fertility rates in the United States and should inform MCH policies and programming.

The Role of MCH

Traditionally, MCH has not played a central role in discussions about fertility. Fertility has mostly been the domain of reproductive health, which focuses on preventing pregnancy (e.g., contraception and safe abortion access) and on the biological factors involved in having children (e.g., in vitro fertilization). Still, MCH has not been entirely absent from the conversation. Until federal layoffs in April 2025 largely dismantled the CDC’s Division of Reproductive Health, the division collected fertility and maternal health data through national surveillance programs that helped inform research and policy (Malhi & Kornfield, 2025). With that infrastructure diminished, MCH’s already limited role in fertility has grown even smaller.

Yet, MCH should be more vocal in this conversation. Fertility is not just about one person’s decision to have a child. It depends on whether people have the resources and support they need to build the families they want, which is precisely the terrain MCH knows best.

The field can begin with understanding why individuals and families are not meeting their reproductive goals through meaningful engagement with communities. By listening to families and partnering with state and local leaders, MCH can better identify the challenges people face and ensure that its responses reflect their lived experiences and needs.

From there, MCH can support policies and programs that create the conditions in which families can thrive. Many of these efforts are already central to the field’s mission, including promoting affordable childcare, paid parental leave, access to quality maternal health care, and economic supports for families. MCH can also strengthen and expand programs such as WIC and Medicaid while continuing to support access to contraception and reproductive health services so individuals can achieve their reproductive goals on their own terms. Other opportunities include expanding coverage for doulas and midwives and investing in services that improve parents’ health and well-being before, during, and after pregnancy.

Rather than treating fertility decline as a demographic or economic issue outside its scope, MCH can draw on its existing strengths to address the social and structural conditions that shape family formation.

A Call to Action

For MCH, declining fertility should serve as a wake-up call. Concerns about falling birth rates are already fueling pronatalist policies, and if those efforts gain momentum, they could test the field’s core commitments to equity, autonomy, and family well-being.

What happens if MCH fails to answer that call in time? Who will set the fertility policy agenda instead, and whose needs will it reflect?

MCH must help inform public debate, advocate for those whose reproductive goals remain unmet, and ensure that responses to fertility decline remain grounded in reproductive autonomy and the health and well-being of individuals and families.

Join the Conversation

This reflection is just the first in an ongoing conversation about what fertility decline means for the field and how MCH can help shape the path forward.

We invite readers to join us in this conversation on Wednesday, November 18 at 1:00 PM EST for Reproductive Realities: Are Families Achieving Their Desired Size?, a symposium hosted by the Harvard T.H. Chan School of Public Health Center of Excellence in Maternal and Child Health and the Harvard Center for Population and Development Studies.

References

1. Adashi, E. Y., O’Mahony, D. P., & Cohen, I. G. (2026). Declining US fertility rates: The specter of a demographic cliff. The American Journal of Medicine, 139(5), 564–565. https://doi.org/10.1016/j.amjmed.2025.10.028
2. Badolato, L., & Hayford, S. R. (2026). Trends and Levels in Men’s and Women’s Fertility Goals in the United States. Population Research and Policy Review, 45(1), 6. https://doi.org/10.1007/s11113-025-09989-5
3. Gemmill, A. (2019). From Some to None? Fertility Expectation Dynamics of Permanently Childless Women. Demography, 56(1), 129–149. https://doi.org/10.1007/s13524-018-0739-7
4. Glass, J. (2026, October 8). Raise a family, then pursue a career? The math doesn’t work. Los Angeles Times. https://www.latimes.com/opinion/story/2026-10-08/mothers-breadwinners-birthrate-policy
5. Goldin, C. (2025). Babies and the Macroeconomy. National Bureau of Economic Research, NBER WORKING PAPER SERIES. https://www.nber.org/system/files/working_papers/w33311/w33311.pdf
6. Guzzo, K. B., & Hayford, S. R. (2020). Pathways to Parenthood in Social and Family Context: Decade in Review, 2020. Journal of Marriage and the Family, 82(1), 117–144. https://doi.org/10.1111/jomf.12618
7. Guzzo, K. B. (2026, February 12). How to raise birth rates is the wrong question: Here’s what we should be asking. The Hill. https://thehill.com/opinion/healthcare/5733847-childbearing-policies-population-challenges/
8. Hamilton, B. E., Osterman, M. J. K., & Gregory, E. C. W. (2026). Births: Provisional Data for 2025. Vital Statistics Rapid Release, (Report No. 43).
9. Malhi, S., & Kornfield, M. (2025, April 21). Fertility and maternal health programs slashed, alarming experts. The Washington Post. https://www.washingtonpost.com/health/2025/04/19/cdc-cuts-maternal-mortality-fertility/
10. Walsh, R. (2026, January 6). Is the U.S. Birth Rate Declining? | Johns Hopkins | Bloomberg School of Public Health. Johns Hopkins Bloomberg School of Public Health. https://publichealth.jhu.edu/2026/is-the-us-birth-rate-declining