In the Contemporary English Version of Genesis 9:7, the command by God to Adam and Eve as they leave the Garden of Eden to “be fruitful and multiply” clarifies the intent of the statement as, “I want you and your descendants to have many children, so people will live everywhere on the earth.” This pronatalist proclamation, especially rendered in contemporary language, seems positive and hopeful. But what happens when “everywhere on the earth” is transformed by the rhetoric of demographic anxiety? When it is used to bolster nationalism and racism as it has been in the twentieth and twenty-first centuries? How should we understand narratives of progress threaded through modern reproductive practices, particularly those rooted in IVF, in the context of these distinctly nonprogressive uses of demographic anxiety?
Consider how one group of global researchers has made the case for IVF in the midst of the global Covid-19 pandemic. This research group, funded largely by the multinational pharmaceutical company Merck, proposed a plan in May 2020 to help healthcare workers prioritize and remedy cases for infertile patients impacted by Covid-19 restrictions. The plan does include considerations of the patient’s circumstances, for instance giving priority to people undergoing treatment for cancer or to women of all ages with diminished ovarian reserves. Nevertheless, the rhetoric for rationalizing continuing reproductive services is couched in demographic anxiety. The study highlights the expected global death rate from the novel coronavirus alongside the projected number of infants who would not be born worldwide if infertility treatments are suspended. As the authors put it:
. . . the total number of Covid-19 deaths reported so far represents approximately 1.0% of the total deaths expected to occur worldwide over the first three months of the current year. It seems, therefore, that the number of infants expected to be conceived and born –but who will not be so due to the lockdown of infertility services– might be as significant as the total number of deaths attributed to the Covid-19 pandemic.
These researchers rationalize their calls for a medical plan to continue UVF and IVF by turning the coronavirus crisis into a source of demographic anxiety. While Covid-19 is a global threat that affects everyone regardless of citizenship, race, or class, demographic anxieties have not been universal. Historically, demographic anxieties have been voiced when one group worried about not reproducing as much or as fast as another. When white nationalists marched through Charlottesville, Virginia chanting, “You will not replace us,” they were expressing a racist demographic anxiety about the rising numbers of nonwhite citizens in the United States. In the hands of the Alt-Right Movement, this kind of racism can have a religious identification, as exemplified by the rise of what’s been called “Alt-Christianity Discrimination,” sometimes based on religious difference. Immigration restrictions have been classic responses to demographic anxieties, but so has pronatalism: the promotion of reproduction, often targeted as those considered most reproductively valuable.
Over the last two centuries, pronatalism has taken many forms. Some pronatalist policies have been formulated with the direct intention of promoting childbearing, such as those passed in France beginning in 1939. These direct policies included governmental loans to fund families and grants to cover birth expenses. Some nations, such as Singapore and Israel, have provided baby bonuses or allowances for children, while other countries, such as the United States, offer child tax exemptions. Child-friendly policies, such as subsidized family housing, free or subsidized childcare, and the construction of playgrounds and family neighborhoods, also have been implemented in different countries, including the United States, throughout the twentieth century.
When faced with declining birth rates, some national leaders turn to pronatalism, as US president Theodore Roosevelt did in 1905 when he declared that it was “the greatest duty of womanhood” to bear and raise children “numerous enough so that the race shall increase and not decrease.” Direct efforts in the early and mid-twentieth century often associated pronatalism with nationalist causes. The most infamous example of nationalist pronatalism from this period was the policies of Nazi Germany, although France, Romania, and other countries also associated their efforts with the good of the nation.
Demographic anxiety continues to shape national reproductive and public health policies in the present moment. What makes placing the advocacy of assistive reproductive technology (ART) in the context of demographic anxiety particularly worrisome is the fact that these costly medical interventions are not equally available to all groups. In these situations, ART has the potential to become a tool of reproductive discrimination. In fact, the highest use of IVF occurs in countries where religious perspectives on the moral status of the embryo coincide with support for a healthcare system and public funding for the procedures. In 2011, the International Committee for Monitoring Assisted Reproductive Technology, a group that helps standardize voluntary reporting for sixty-five countries, reported that the top five countries using ART per capita were Israel, Greece, Lebanon, Belgium, and Australia.
These statistics reflect a couple of factors, including government subsidies and support of reproduction motivated by the need to secure political stability. For example, the Israeli healthcare system provides free IVF treatments for the first two children born to someone below age forty-five, as part of the demographic struggle about land settlement. Hamas offers similar subsidies for Palestinian couples in Gaza. In this case, pronatalist demography has become a crucial dimension of a religious and geopolitical conflict.
Another reason for the high rates of ART in some countries, as in the case of Greece, is “medical tourism,” the practice of traveling to a locale for less-costly medical procedures. Where public reimbursement for ART is limited, patient income disparities are the biggest influence in determining who makes use of treatment. Although the United States does not subsidize the cost of ART, rates of utilization are still high—IVF produces almost 2 percent of babies born in the country. Access, however, is determined by economic status. In the United States, the cost of a treatment cycle averages 50 percent of annual income, in contrast to Australia where the same cycle would cost 6 percent because of government subsidies.
When states support reproductive technologies, they are supporting pronatalism. When access to that reproductive technology in unequal and intentionally directed at some and not others, then that pronatalism becomes a form of eugenics or selective reproductive control. As happened in the first iteration of eugenics in the United States, mainline eugenicists were aligned with Mainline Protestants and as Christina Rosen has demonstrated, popularized their vision through sermon contests. While some Protestants championed selective reproduction, the Catholic Church opposed it. One way to read Catholic opposition is that Catholic leaders saw large families as a means for expanding their religious base. When reproductive technologies are deployed to address demographic anxiety, the mandate to flourish is replaced by a fear of displacement. Genesis may encourage humanity to “be fruitful and multiply” and IVF may be a means to realize this end, but, in the context of demographic anxiety where reproduction is selective, racial, religious, and nationalist agendas may direct who is considered worthy of “being fruitful.”