America seems very worried that women are not having enough babies.
The headlines ask why women are opting out of motherhood. Cable news debates falling birthrates and the rising costs of raising children. Politicians float baby bonuses and newborn savings accounts. Billionaires warn of “population collapse” and the need to rebuild the family.
But as the founder of Irth App who has spent years listening to Black mothers describe what happens to them throughout pregnancy and in delivery rooms, I have a different question: Have you made it safe for us to have babies?
Because when this country suddenly starts begging women to reproduce, Black women have every reason to ask: Who exactly are you talking to?
For many Black women, the question has never been whether motherhood “fits” into their lives. The question, among many, is whether they will survive.
That reality rarely makes it into the current conversation about declining birthrates. Instead, we are told that women are choosing not to have children—because of cost, career, climate anxiety or a desire for freedom. And for some women, that is true.
But that framing assumes that all women are making decisions from the same baseline of safety and support.
They are not.
In the United States, pregnancy and childbirth remain profoundly unequal experiences. Black women are more than twice as likely to die from pregnancy-related causes as White women. In some cities, the disparity is far worse. This is not a footnote to the story of declining birthrates, it is central to it.
Yet, you would never know that from the way the pro-natalist movement is being sold.
From baby bonuses to tax-advantaged “Trump accounts,” the message is clear: have more babies for America. But that message lands differently depending on your lived reality. For some, having a child is framed as a patriotic contribution. For others, it is a potential risk to their life.
That gap did not happen by accident. It is rooted in a long history of how this country has treated Black women’s reproductive lives.
Our grandmothers and great-grandmothers lived through a time when the government was not concerned with encouraging births, but with limiting them. Beginning in 1907, 32 states passed eugenics laws that allowed forced sterilization of thousands. In Virginia, Carrie Buck was sterilized against her will after being labeled “feebleminded,” a category that often overlapped with poverty, disability or simply being poor and unwed. The Supreme Court upheld that decision in 1927, with Justice Oliver Wendell Holmes declaring, “three generations of imbeciles are enough.”
Black women were disproportionately targeted. In Mississippi, civil rights activist Fannie Lou Hamer coined the phrase “Mississippi appendectomy” to describe the routine, non-consensual hysterectomies performed on Black women in Southern hospitals. Many of those women wanted children, perhaps even large families. They were denied that right.
When that era of overt reproductive control began to fade, the narrative shifted, but the judgment remained. In 1965, the Moynihan Report warned of a “tangle of pathology” in the Black family, framing Black fertility as a social problem even as White families were being supported through federal housing policies and tax incentives that made suburban family life more attainable.
Today, birthrates among Black and White women have largely converged—about 1.7 and 1.5 children per woman, respectively, down from much higher levels in 1960. What was once framed as a problem—Black women having too many children—is now framed as a crisis: Americans are not having enough.
The loudest voices in the pro-natalist movement are overwhelmingly White, male and well-resourced. Tech billionaires invest in fertility startups and surrogacy services. Politicians propose savings accounts for newborns that assume families have extra income to invest. The language of “saving civilization” and “population resilience” often carries an unspoken anxiety about the country’s changing demographics.
What is missing from this conversation is the reality of Black maternal health.
At Irth, the platform I founded where Black and Brown parents rate and review their prenatal, birthing and pediatric care, we do not have to guess why some Black women hesitate to have another child. They tell us every day.
They tell us about pain that was dismissed. Symptoms that were ignored. Complications that were caught too late. They tell us about being talked down to, not listened to, not believed. They recount near-death experiences and the type of trauma that does not exactly beckon you to return to childbearing.
These are not isolated experiences. They are patterns. And those patterns shape decisions.
When childbirth is experienced as dangerous or dehumanizing, it does not invite expansion. It creates hesitation and fear. It can make the idea of having another child feel less like a choice and more like a risk. We receive far too many direct messages at Irth from expecting Black families asking if they should prepare a will before going into labor.
This reality is almost entirely absent from the pro-natalist agenda.
A movement that treats a $1,000 seed deposit as urgent but a 3.5-to-1 maternal mortality gap as an afterthought, and that kept 31-year-old Atlanta nurse Adriana Smith on life support for months after she was declared brain-dead, over her family’s objections, solely to sustain her pregnancy, reveals its priorities. It wants more babies, not necessarily more living mothers.
Even when Black families embody the ideals that pro-natalists claim to celebrate, they are not embraced in the same way. Karen and Deon Derrico, the Black parents of 14 children featured on the TLC show Doubling Down with the Derricos, represent everything the movement says it wants: a large, loving family raising the next generation with intention.
But as Karen Derrico shared with me, their experience has been markedly different from that of similar white families. Despite strong ratings and a devoted audience, they have not received the same endorsement deals, brand partnerships or opportunities that have flowed to other large White families with TV shows.
Proponents argue that their policies are race-neutral. Every baby gets the same benefit. But neutral policies in an unequal system do not produce equal outcomes. The median White household still holds significantly more wealth than the median Black household, meaning that programs requiring additional investment disproportionately benefit those who already have resources.
Meanwhile, many Black and working-class families still lack basic supports: paid leave, affordable childcare, accessible housing and quality health care. If the goal is to support families, these are the policies that would make the biggest difference.
So, let America debate declining birthrates. Let politicians offer baby bonuses. Let billionaires worry about population collapse.
But Black women are allowed to ask these questions: Do you want more non-Black babies or do you want more Black babies too? And if you do, are you willing to protect the Black women who birth them?
Until the answer is yes in policy, in hospitals, in budgets and in culture this pro-natalist movement is not about all of us. This handwringing about declining fertility rates is not about us. It is about preserving a version of America that has never fully valued us in the first place.
Kimberly Seals Allers is an award-winning writer, author, founder of Irth (as in birth, but without the B for bias) and mom of two. Follow her at @theirthapp and @iamKSealsAllers.
