Wanting Children: Family Planning Policies with Dr. Len Lopoo

While the definition is broader, the term “family planning” has long meant contraception.

Dr. Leonard Lopoo wrote Wanting Children, a deep dive into 50 years of U.S. family policy and why it was never built with fertility in mind. He joins Dr. Susan Fox to talk about what pronatalism actually means, and why the goal was never just more births.

Dr. Lopoo explains the difference between wanting a policy that increases births and wanting a policy that supports the families already trying to have them. He also busts the myth that IVF is simply too expensive to cover nationally, and talks about the five year rule that quietly runs out the clock on women trying to qualify for help.

This episode is for you if:

• you've ever paid taxes without realizing it shapes your fertility choices
• you're curious what "pronatalism" actually means and why it's suddenly everywhere
• you've hit a wall with insurance that won't cover ovulation meds, let alone IVF
• you're a policymaker, physician, or med student who wants the 30,000-foot view
• you're weighing genetic testing and want the ethics laid out plainly
• you want to understand why this is so much harder in America than it needs to be

Support your fertility journey with Preconception Plan at Health Youniversity. Learn more here: https://healthyouniversity.co/programs 

Wanting Children by Leonard M. Lopoo: Available through University of Chicago Press, Amazon, and Barnes & Noble

💻 About Susan Fox: https://www.healthyouniversity.co/about

Take your 5-Element Fertility Quiz:  http://yourfertilityquiz.com/

Detox to De-Stress:  View the FREE Masterclass on the importance of detoxification to prepare for a healthy pregnancy:  https://susanfox1.easywebinar.live/gentle-detox

Learn about our program entitled Your Fertile Health: https://www.healthyouniversity.co/programs

Schedule a Fertile Health Assessment: https://www.healthyouniversity.co/your-fertile-health-call

Let us journey with you as you navigate your fertile health. Connect with me:

🎧 iTunes: https://podcasts.apple.com/us/podcast/health-youniversity-with-dr-susan-fox/id1592763186 

🔊 Spotify: https://open.spotify.com/show/08U9QJf...

📸 Instagram: @dr.susan.fox

💗 Facebook: ...

Transcript

SPEAKER_01 1:25

Hello and welcome to today's episode of Health University, where we talk all things fertility, pregnancy, and postpartum, and that short step across the bridge for women into pre-perimenopause. And today we're going to have a slightly different conversation than we often have, in that it's a 30,000-foot view above the conversation around infertility and a view about something that I'm about to learn as well called pronatalism. And so we have Dr. Len Lopo, who's going to uh share his book with us, his findings, and sort of the, you know, he's going to make us a lot smarter. Leonard M. Lopo is the Paul Volcker Chair in Behavioral Economics and an associate dean for public and international affair programs at Syracuse University's Maxwell School. He's a nationally recognized expert on family policies, particularly as they relate to fertility, marriage, and maternal employment. He's written over 50 academic articles and reports on these topics and is the author of the recently published book, Wanting Children, Family Planning Policies and the Engineering of America's Population. So grateful to have you. Really looking forward to this conversation because, as I just shared off camera, you know, in our conversations, we often are dealing with the nitty gritties of fertility, whether it be, you know, the IVF route or the emotional route or the nutrition route or some of the latest testing. But we don't often get a peek behind the curtain as to like what is going on here. So I'm I'm really looking forward to learning more from you. Would you do us all a favor? And uh I'm gonna start by saying, could you hold up your book so folks can take a screenshot? And then there it is, wanting children. I love it. Um, and then um we'll be sure to have links to where they can purchase in the show notes because I think that this is something that everyone will benefit from learning more about this. So really happy to have you. And tell us, if you will, you know, what was the impetus for writing this book?

SPEAKER_00 3:32

Well, first let me say, Susan, it's a pleasure to be here. I'm really excited um uh to have our conversation today. Uh I I completely agree this is an incredibly important topic, and that I think your your audience will be very um curious to participate in our conversation. Uh I think the thing that um made me most interested in writing the book, um, you you mentioned um you know I'm not I'm not a youngster anymore. I've spent uh decades now um doing a lot of research on what I call family policies or fertility policies. These are attempts to um uh change family decision making, uh uh things, uh things that we all um are familiar with, things like uh child care subsidies or a health insurance program that makes having a child less expensive. All of those things affect families. And we often don't realize when we pay our taxes, it has an influence on the decisions we make about our families. So, this long history of looking at these questions. And what I what I realized was our policy makers aren't thinking at all about the family implications of most of the policies that they create. Um, uh, take abortion policy that's often thought of as a legal issue or a moral issue, but we never really consider the impact that that would have on a family. And so the book is really about saying, hey, let's take a step back here and recognize the inconsistency in what we do. And can we come up with uh guiding principle for policymakers across the aisle to find common ground and to start making decisions about the policies they're creating that can be the most helpful to us as we think about our fertility?

SPEAKER_01 5:25

That's beautiful. That's beautiful, yes. And and I think that you you you you really hit the nail on the head when you when you stated we don't realize how much the the path toward infertility that we have been experiencing over the last five or six, 10 years, perhaps longer, has been the the um the the result of a lot of the in the uh policies that had been implemented, you know, even 25 years ago and then and then onward. Um and then we're and we are reacting to some of these um these policies, you know, women going into the staying in the workforce later because they need to, because there isn't you know support for family building, and then finding them themselves having started perhaps too late. So I really, really think that it is important that we you know kind of just get that 30,000-foot view and come to understand how we can as United States citizens and voters have an influence on what these family planning um policies might look like, because it's it's it's right in front of our faces right now.

SPEAKER_00 6:31

Yeah, it you know, I I I could not agree more. There's so much that's involved. And and I would I would say sort of the the starting point in the book is to say, you know, our family planning programs in the United States, and we have many of them. We have local level, we have state level, we have federal level. A lot of what I focus on is the federal level. Most of those programs were created uh 50, 60 years ago. They still exist today. And the goal of those programs back then was to one focus almost exclusively on low-income Americans, and secondly, only to think about family planning as a um a contraception, um uh a source of contraception. And so the infertility questions, if you go to a country like France and talk about family planning or look at what their government programs look like, it would incorporate both helping people control when they have children so that they have them at the optimal time, as well as help helping people with infertility uh to um have resources to improve that and to potentially to have children. In the US, we don't do that.

SPEAKER_01 7:45

And helping families once that child is born with things like early childhood uh you know um uh uh support, if you will. Yeah.

SPEAKER_00 7:55

Absolutely. So that the evidence suggests, if if we don't even look specifically at the family planning programs, but that the pro the policies that seem to be the most effective are those designed to support families, uh family leave, child care support, early childhood education. Those really have important influences on the decisions that people make about having children when they have children. And um again, all of those programs you would never hear anyone discuss the fertility component or what that does for the family decision, but it absolutely needs to be included in the conversation.

SPEAKER_01 8:34

I couldn't agree more. You you had in your in your book and in our conversation the phrase pronatalism. Can you tell us what is pronatalism?

SPEAKER_00 8:44

Yeah, pronatalism is the idea that these, uh certainly with respect to these policies, that they would increase um fertility. We have in the United States been experiencing a decline in fertility for quite some time. Uh, that fertility decline, if you look at um, say the lot, well, actually the last 100 years, right? So you can go back in time and see that people are having fewer and fewer children. Uh, the United States has been a little um unlike most nations because of our immigration. So immigration has kept fertility levels fairly high in the US relative to other nations. In the United States, uh, sorry, in Europe, for example, you can see fertility rates at like one child per woman or just above that, and that will shrink your population. So in Europe and in Asia, they have been worried about um shrinking populations for quite some time. In the US, we haven't because again of the of the immigration, where fertility tends to be higher among first-generation um uh Americans. And so pronatalism is the idea that we should have programs designed to increase or to promote fertility so that we don't see these population declines, which could, you know, have already happened in a number of nations.

SPEAKER_01 10:08

Sure. And your book title is called Wanting Children. The let's talk about the wanting, but it you know, that that seems intentional, uh, that that that is you know the the the head title. So what what does that mean? And what you know, what how should we think about wanting children and wanted children?

SPEAKER_00 10:27

Yeah, uh thank you, Susan. Exactly right. Um, so you know, one of the things that I say is that um all children are not the same. We want to make sure that uh children have every benefit to succeed, that families have children when they want to have children. Um, a lot of the pronatalism policy discussions that are happening in the United States today are um the current administration, for example, has been very interested in uh pronatalism. Uh uh President Trump has called himself the fertility president. Uh, Vice President Vance has said that we need to have a lot more beautiful babies, I think was his quote. Um, so that this notion that we should have more children, again, is this is this interest in making sure that we're maintaining our numbers. But but my point is we shouldn't be asking or promoting everyone to have more children. For example, by making abortion illegal, you will drive up the number of children that we have in the United States. But that the evidence suggests isn't really, should not be our goal. Our goal shouldn't be to make um it um you know harder to harder to have an abortion if that's what someone wants to do, and that would drive up our numbers. What we should want to do is create options for people who want to have children, to have those children. And the social science evidence is very clear that children that are born from parents who prepare emotionally, financially, um, are ready in their points in their careers or their educations, that it's they believe time to have a child. Those children perform so much better on every dimension. They are more likely to have higher levels of education, they have better psychosocial outcomes, they're less likely to be poor, they're less likely to need government support in any way. And so, again, wanting children means should we should be thinking about creating policies that allow only the parents who want to have children to have them and to support those people who don't want to have children to not have them. And right now we're not doing that. We're only doing one half. We have not considered at all how we can help those, for example, who are infertile uh or have issues with their fertility to get the resources they need to um to become the parents that they want to be.

SPEAKER_01 13:08

Quite the contrary is what is what my experience is. Um thankfully there are some now statewide, you know, requirements to cover the cost of fertility treatments. But at the federal level, you know, our armed forces have had those rights taken away from them. So here they are. I could get a little verklempt, there they are serving our country, using these fertile years on behalf of serving the country and then being denied the care that they need in order to then have their their families when when they decide it's time, when maybe when they're finished their initial course of do course uh course of duty.

SPEAKER_00 13:49

So um a perfect example. Yeah, a perfect example. Yeah. And it's true, um, again, uh most of our family planning that's provided through government is only for low-income families. So there is no infertility support for them. But even in the private, you know, private health insurance, across if you look across states, the vast majority of states do not mandate that private health insurance covers things like even um fairly inexpensive medications that can improve ovulation, for example. So it's really kind of been left out of the equation. And people talk a lot about expenses for things like IVF, and and perhaps that's it. And my response is always there is no openness in the majority of states to any sort of support. There is no mandate. Um, we're starting, as you as you uh alluded to, we're starting to see more states mandate that. We're starting to see uh more states that have already mandated coverage of some infertility supports expand those resources, which I think is terrific and important to increase wanted children. Um but we're not we're not there, we're not doing enough. And um, and I think again, part of my goal with this book, wanting children, is to really facilitate discussion for people to become aware of that. Um, you know, the places where you see a lot of the support are um industries where there's great demand for um for for workers, you know, um uh private equity firms or high tech you know, technology firms often offer these as a way to have workers come in and and they support. But this is far from universal. And um, we need to really have a conversation about how do we increase the likelihood that someone who really wants to be a parent gets the kind of resources to support them.

SPEAKER_01 15:45

Right. And I've also noted that in those states that have mandates, uh the ingenuity, American ingenuity is such that there are now a lot of options for lower priced fertility support, lower-priced IVF uh um you know uh treatment plans. I mean, not everybody gets to benefit from them. It depends upon the the individual and you know why the infertility is happening. So not everybody can can in can expect to have a successful pregnancy with some of these lower priced options because some of the um you know testing and medications are changed. They're you know, they're using some of the you know less expensive medications. But to your point, uh when we have this conversation, and when people start thinking about, you know, in their 20s and early 30s, what do I want for my family to look like? And that and they can then begin to make uh educated decisions as to how can I then therefore get there. In my work as a doctor of Chinese medicine, a holistic practitioner, that includes things like prep with your nutrition and your hydration and proper targeted circulation and improving your sleep-wake cycles because those gonads and the ovaries and and and uh testes and the eggs and sperm are only a mirror reflection of one's whole health. So that's something that is relatively cheap because we we're all you know eating and drinking and sleeping and walking every day or moving every day. But if we can do it with more intentionality, that would be helpful. Then all the way up to the big IVF centers that can offer everything that one needs because you know, life is life. And sometimes we um, you know, we we find ourselves kind of uh up against a wall thinking, okay, I I I want a family now, and I've just discovered that I that I don't have you know good numbers in in for my egg and sperm count.

SPEAKER_00 17:41

Yeah, uh it it's so it's there there's uh again a not a lot of thoughtfulness, I think, on the part of some of the design and these and these policies. So I completely agree with everything that you that you've said. And even in states where there are mandates, there are rules that are that are not um help, you know, as helpful to families as they could be. For instance, you may be um you may gain access to IVF, but only after you have shown that you're infertile for five years. Well, if you wait five years, you know, if you have if you have a partner, and there's a very specific definition of infertility, it's consecutive uh you know, 12 consecutive months of sexual intercourse with the same partner, unprotected sexual intercourse, and that doesn't result in a pregnancy. If you have to go five years in order to become qualified for it, right? And you started in your late 30s, right? It's really sort of undermining uh the goals of providing these services to people. So I just think that there's so much we're not thinking about in a very systematic way. And again, it's because we're not thinking as much about the fertility or the family. We're often thinking about um costs, we're often thinking about this as a different sort of an issue. And it's really, you know, I am glad that the pronatalism is making its way into the conversation because I think much can be done, but we're not thinking um sort of in a systematic way about how to do these things in the most effective way.

SPEAKER_01 19:20

I would love to see your book as uh kind of required coursework in the college setting or postgraduate and certainly in the medical field, you know, especially anybody who's interested in going into Obigaine or pediatrics, where, you know, these are this, these are the people who the the women and couples are coming to saying, I I'm you know, I'm struggling. It's it's been three months or six months. And then again, as you say, with with policies being as they are, sometimes they're told, well, you know, you have to wait another three months or you have to wait for three miscarriages before you can are considered able to do some investigation, which is heartbreaking. When you take that down to the individual and the couple and the family, I mean, that's just torturous to say, we'll go home and try another three months and then and then come back and we'll and we'll begin a process.

SPEAKER_00 20:09

Um I could not agree more, Susan, and not to mention the obvious physiological um, you know, point here that the longer one waits, the the the older one gets, the the the harder it can be to become pregnant. So in some ways, the system itself is defeating the goal that uh both the the physician and the and the family is trying to accomplish. So it just doesn't it doesn't really work well. And and I think we can do a lot better. I should also say I'd love for physicians and and others to read the book. That'd be wonderful.

SPEAKER_01 20:49

With fertility benefits being offered as part of employee benefits packages, we encourage you to share our corporate wellness program to your human resources or employee benefits director. You can find the link below at healthuniversity.co forward slash corporate-wellness. Now, let's resume our conversation in today's episode. Well we'll we'll as I say we'll we'll have links because I do think it should it should be required reading for people to think about this differently. Not just, you know, the the IVF process, but the larger process at play. And to your point, in terms of waiting, not only is it waiting and possibly closing the fertility window for this person or couple, it's also possibly um aggravating a disease process that will affect this person's health and longevity and then become a financial burden on the system. Again, not to mention the emotional and physical and physiological burden on the individual, but the system as well. You know, if if if someone is is not being treated for her endometriosis or her, you know, PMOS, you know, 10 years down the road when baby making is done, guess what? Then you're paying for diabetic intervention, or then you're paying for surgical intervention because these things don't go away.

SPEAKER_00 22:08

Unquestionably, unquestionably. And and your point is is so right on often, even when people talk about the costs of providing even something like IVF uh more universally, uh, there are lots of reasons to think that this is actually very cost effective. There's a lot of evidence for the very reasons that you've said, um uh that that instead of having multiple um um implantation of multiple fertilized eggs, right, which can can have a variety of effects, you you could um have greater health or improved health outcomes that way. It's greater long-term um health for the for the eventual child, um drives down costs. There's a lot of technologies that um I think only become available at scale, meaning um the more that we actually use IVF and the more accessible we make, it could actually drive down costs because the technologies um that aren't available at a small scale become very economical at a larger scale. We just again, we aren't thinking about this the right way. We need to think more holistically about what we what we're offering for.

SPEAKER_01 23:19

Holistically for the for the holistically medically and holistically economically. You know, now we We're seeing IVF centers use AI-assisted technologies that help them improve their outcome. So, you know, the individual wins because they're not kind of just throwing spaghetti at the wall and hoping that the embryo sticks. They're actually able to really hone in on what is the likelihood that embryo one or embryo two is going to implant successfully, and what does that uterine environment need to look like in order for that to happen? So the cost savings is there and the speed with which the medicine can be delivered because you're then not going through multiple transfers, it it becomes it becomes a cost benefit to the individual, to the IVF clinic, to the corporate wellness group that's that's you know helping to provide some of the insurance benefits all the way.

SPEAKER_00 24:15

Yes, completely. I've had a number of really interesting conversations with um tech entrepreneurs, people using AI in this space. And um only to say that you know, I don't want to repeat what you said. It's absolutely true. Some of the things that they're doing are fascinating and can drive costs down uh considerably and have a healthier um outcome for both the mother and and hopefully the successful uh pregnancy.

SPEAKER_01 24:44

Yeah, and and I'll and I'll get I'll get a little bit political on a soapbox to say that we we don't just want to have a positive pregnancy test. We don't just want to have a baby, we are designing our families, hopefully, for a future that is healthier, smarter, happier, able to make better decisions for on behalf of you know the community, the country, the planet.

SPEAKER_00 25:08

Absolutely. And and and to just, you know, maybe tie this back to some of our the initial parts of our conversation. I mean, in the book, I do talk a lot about these technologies are currently available to people with a lot of affluence. And that's fantastic. And I'm very happy for them. And I and I think they should we should, I mean, what we know about parents is they will do what is in the best interest of their kid. And that's why I think what you know, wanting this, wantedness is so important. We can kind of guarantee that they will make their best judgments with for the for their children. Unfortunately, right now, that's only available to the affluent. And part of what I say in the book is we need to make these opportunities available for greater portions of our population. In fact, everyone, middle class men and women can often not afford these technologies, and certainly lower income men and women can't. It's not even a matter of being able to afford a child. It's a matter of being able to afford these technologies, which often come as a big lump sum at the beginning of when you're ready to start a family, often when you're younger and not quite as far along in your career. So the point here is we you know we don't want a huge financial barrier to stop anyone from having a child. It's not about being able to afford children, it's about really being able to afford these technologies. And the more that we can make them available and universal, that will drive down costs and allow more people to become parents. And that's good. We want the people as a society who want to have children to have those children.

SPEAKER_01 26:50

That's right. Um getting into the weeds a little bit, if you were to design these new policies and uh you know, what would give us an example of what a policy might look like or what you know, sort of some of the policies might look like, and where would they be implemented and by whom? And um is this federal level, is it state level, is it local level?

SPEAKER_00 27:11

Yeah, great question. So, I mean, I I think to to give an example that nearly everyone would be familiar with, uh, we could use our federalist system, right? We have lots of programs. Uh the Medicaid program, for example, has a family planning component, which I've been referring to, just not calling it the Medicaid program. Uh, there are rules. There are rules about what each state should provide, kind of minimums, and then each state has the discretion to make the choice and what they're going to provide. And I could I can envision a system just like that, where we say uh we should mandate that um uh health insurance providers, whether they're private or public. In fact, President Trump in February of 2025 said he was going to implement this. I mean Yeah, that that we would be a nation that either through our public or private insurance would make sure that IVF as well as other technologies are made available to everyone. And it's doable. Both sides of the aisle are actually have discussed this and are um many people are in favor of it. I think that there are different components that are stopping this from moving forward. So you could imagine something like the Medicaid program saying that we're going to make uh take let's take something like uh the example used in Scandinavian some Scandinavian countries.

SPEAKER_01 28:41

My next question gave me a good example.

SPEAKER_00 28:42

Up to six up to six cycles of IVF um uh available to um to families uh provided they have some you know health level or something like that. And um, and therefore we would be driving down costs, we would be making this universal. And some states might want to be more generous than that. Uh if the if the level was three cycles, we're already well above what you can get in most states in our nation. Whatever that level is, give that as um sort of the baseline and let states who who are more well positioned to understand what their citizens rewant, um, the opportunity to go forward uh with the actual um uh levels of infertility support. But we need to be much more open to providing this uh kind of universally. That to me is a starting point. And and I will I would say this, um Susan, it's interesting. Again, the cost, like I can imagine some of your some of your listeners saying, well, that's gonna be pretty expensive. It would, but we on average spend through our through our public insurance about $80,000 on end-of-life care for Americans. So we're willing to spend $80,000 on someone who's you know got less than a year of life to go, and we should, yet we aren't willing to invest $20,000, $30,000, $50,000 in someone who wants to have children, wants to love those children, nurture those children, educate those children. Those children become productive members of society, pay taxes, they create, they contribute. To me, like the the whole financial side of this just doesn't make a lot of sense, uh, or that we should rethink the way that we're we're we're making some of these judgments. So those would be some of the principles that I would say are good starting points for us as a from a policy perspective.

SPEAKER_01 30:42

And certainly we as taxpaying citizens are paying a lot for things over which we don't have a say or control. And if if these policies were in place, those dollars could be diverted back to the individuals who are paying in order to reap some benefits for their family planning and their, you know, and their health care.

SPEAKER_00 31:06

Absolutely right. And again, uh I mean, to state the obvious children are how societies grow. Um I I I've heard numbers that suggest we could increase births in the US right now by around 8% if we um provided support for people who have infertility issues. So if you want more children, if that's your thing, like this makes a lot of sense. These are people who want to have children. Um if you if you are interested in sort of health equity issues, I think this makes a lot of sense. We should be providing supports for everyone, not only those who can uh again, it's not afford children, it's a for the technologies to have children. And um, and and I think we could it would become a much more equitable system as well.

SPEAKER_01 31:55

Absolutely. And you mentioned Sweden as an example. And so I'm I'm I'm presuming in your research, you've studied lots of countries around the world. Um if you gave the top five, for instance, that that viewers and listeners might go out and say, what are they offering as compared to what are we offering? Just so that they, again, get get some education for themselves, because we don't hear this kind of thing. We just hear um, you know, sorry you have to wait until your third pregnancy loss, or sorry you have to wait until a year of of uh of unprotected sex with no pregnancy. Um but I think if they understood the comparison as to how it is being done, not just can be done, it is being done in other countries, then it might it might motivate some to say, you know what, let's get this on a ballot.

SPEAKER_00 32:43

Yes, uh absolutely. So there are again to go back to something we were discussing earlier. A lot of countries um around the world have been addressing issues of declining births for a very long time. In Asia, um, Korea, um Japan, they have really, really low fertility rates. Ireland, Italy, um very, very low fertility rates. So, you know, if you go back to a country like France, since World War II, when there was a big distinction in the number of men and women as a result of the war, they have been very, very worried about family. So they've always had kind of family-oriented policies. And so if you were to look at a country like France, they have public insurance that would cover a lot more than we do in the US. They would cover the contraception side, the helping you control your fertility, but they're also going to provide lots of support for people with infertility questions or issues. Um, so dramatically different, uh, dramatically different. Uh, even a country like Poland has a very generous policy at this point. We talked about Scandinavian countries. I would say the one that comes to mind that might surprise people the most is Estonia. Estonia would uh would um, you know, because a lot of uh there are variations across these countries. Some will give you three cycles of IVF, for example, some five. Some want you to be married um to a partner for a period of time. Some say it doesn't matter, some say you could be a same-sex couple. So there is variation, all of which is much beyond what we do in the US. The reason that I pick uh use Estonia as a good example for your listeners is not only are they very generous with the public provision of IVF, I think their numbers up to six cycles of IVF. They also don't have even a waiting time. So some countries you have to wait a little while to just go through the queue to get the services. In Estonia, um, at this point, there isn't even a waiting list. So if you if you're if you have some infertility issues and you had to pick a country that you probably want to reside in, Estonia actually might be the one that you would pick.

SPEAKER_01 35:02

Okay, all right. Anybody out there listening, go go check out you're getting a visa to Estonia and come back with your family.

SPEAKER_00 35:13

Exactly, exactly.

SPEAKER_01 35:15

Well, this has been so eye-opening, and um and I uh I'm in the category of I don't know what I don't know. So are there any any uh parts of the conversation that you really want to impart and impress upon us that that I've not asked the question about?

SPEAKER_00 35:31

The only thing that really comes to mind to me, because again, the the book Wanting Children is about um a conversation that we're not having that I think we need to have, is not just to think about our past. I think part of the reason our past, we've only done this is, you know, for for many noble reasons. Again, people were trying to be fair and make sure those without resources got the same resources to control their fertility as people with them. But I think there was also a bit of uh uh an unpleasant uh story that I talk about in the book that had something to do with wanting to stop low-income people from having more children, which is part of what I describe in the book, which is a tale that I think needs to be told and is not uh one that I think you know many Americans would be proud of. A lot of our conversation today has been about what does today look like? Are we better today? And we certainly are better today than we were five years ago, 20 years ago, 50 years ago with respect to questions of infertility. I think the other thing that's in the book that your audience might really find interesting is I talk a lot about the future. Yeah. What does the future look like? What does it mean with not just the technologies that we're seeing with IVF and ways to become pregnant, but the ways to think about genetic testing and what's happening there. I think there's a lot of conversation and questions that we should be we should be thinking about before the horse is completely out of the barn. So, questions of designer babies, which you you and your audience may be familiar with, the notion that some people can afford to test genetically their fetus and understand some of the health consequences for their child once it's born. And if you only limit that to certain segments of the population, what does that mean? Is that fair? Are some people going to be disadvantaged going forward? And who are those people? What should we be asking? What do the ethics look like there? So it's a it's a the it's really a very rich area. It changes day to day. Um, and I talk a little bit about that. Um, what the the policymakers are doing um, you know, in a in a year from now will look a little different from today. So for your for your audience to have kind of that background and that source material to kind of think through some of these questions, I think they might really enjoy as well.

SPEAKER_01 38:05

Yeah, thank you. And and you know, being a clinician and seeing patients go through the IVF process, and most are going through the genetic testing process, and they're going through that process for really good reasons. They're going through it so that they can be assured that the embryo that will be transferred, excuse me, will be viable, will not be uh, you know, carrying a genetic flaw that would either result in, you know, a pregnancy loss or you know, or a child that that has severe needs, which then again imposes a lot of burden on the child and the family. So being able to make those decisions beforehand, I think is actually a lowercase d democratic way to really let everyone have this opportunity. The science is there, the the you know, the medical knowledge is there. So why would we why would we withhold that from anybody?

SPEAKER_00 39:05

Precisely. I could not agree more. This is an incredible um advance, an important one. And I think nearly everyone would say this that there's a lot um that's incredibly important about um um going through that process, but that if it's only available to a small segment of our population, then we're gonna start to see um even more polarization, right? You're going to see some people with uh affluence who can afford to make these choices and have children who are healthier, um, at least at minimum healthier. And wouldn't we want to give everyone that option? Isn't it just as important for every part of our population? And again, that goes back to the universality of providing some of these resources to everyone and not limiting them, which is kind of what's happening now. We really need to think more broadly. And um, again, socially, it's advantageous.

unknown 40:04

Yeah.

SPEAKER_00 40:04

Um, it's it's really advantageous for us to take that approach rather than to take this very, you know, sort of short-sighted look on, oh, it might cost us a lot of money up front. I think the great costs come later if we aren't thinking about the consequences of making these technologies available.

SPEAKER_01 40:22

And I would say that I um I've experienced or and observed that the short-sightedness, the short-term approach to this is sometimes cloaked or hidden behind a conversation of morals, ethics, you know, religious values, and so forth. And yet, no one is saying that any one person, if your morals, ethics, and religious values are such that you would not want to have genetic testing, then you can choose not to. Um, it's just it is available to everyone, but not everyone has to go through it. I think sometimes people get a little scared that it's going to be something that will be imposed upon them. So I think what we're trying to say here is these are the policies that we're suggesting be offered, not imposed.

SPEAKER_00 41:08

Could not agree more. Uh, in fact, that is almost, you know, that is very much a point I make in the book. There will be people, and it's wonderful. There will be people who go through a process and may learn something through genetic testing that uh may be uh alarming to them as a parent and go forward for a variety of reasons because they they for religious reasons, for any of a variety of reasons, and that is wonderful. We we want to respect that. That is a wanted child, and um I'm very, very much in favor of that. Um, at the same time, some people will make different decisions, and that also is something that we want to make sure everyone gets the choice about. And today, not everyone has that choice, only those individuals who have access to that level of technology, which can be quite expensive.

SPEAKER_01 42:02

Yeah, and again, I think it's expensive now because it is a small slice of the pie. And I think if these if these policies get, or as these policies get enacted and utilized, that it will the price will drive down. It it's I mean, that's that's simple economics. I am I am not a I'm not a mathematician by any stretch of the imagination, but even I know that. You know, when there's when there's more demand, when there's more available, the price will come down.

SPEAKER_00 42:29

So um price will come down, more technologies will be made, um, investments will move into this space, even more investments for all those reasons, Susan. You're absolutely right. Um, it is a matter of thinking long term rather than short term. It is in it is um in the best interest of us to be thinking more more broadly on these very questions we're talking about.

SPEAKER_01 42:53

Yeah, and I think and in the best interest and to and to take it personally, as you say, wanted children. You know, if if if for whatever reason you don't want a child, that should be an equal right to someone who wants a child to be able to uh endeavor to have one with all of the resources that are available. Absolutely. I I I think we could probably keep this conversation going for another hour, but I in in the interest of your time and the listeners and viewers' time, I I think the next best step is to say go get the book. It's available through Chicago Press. Is that right? But but is it do you have a website that that uh people can just uh buy at all?

SPEAKER_00 43:34

It's available uh anywhere they would buy books. It's available at Barnes and Noble's, it's available on Amazon. Um there they can find the book at any in any place where they would ordinarily buy. Um again, it's called Wanting Children, and I would be um, you know, I have thoroughly enjoyed our conversation and I think they would really enjoy reading it.

SPEAKER_01 43:55

I agree. Is there a website, a wanting children website directly? I know that some other authors would say, yes, it's available on Amazon and Barnes and Noble and so forth. However, if you go to my website, then um Yes, it it is actually it is available.

SPEAKER_00 44:09

If you went to the University of Chicago Press, there is a website, it will describe the book. You can order the book there. Beautiful. Um, absolutely. And if I mean my name is unusual, L-O-P-O-O. If you just typed in Wanting Children Lopo, it will pop up. You will find the book.

SPEAKER_01 44:25

Perfect. Yes. I I I and I again, you know, since Chicago Press is is uh dutifully putting it out there, I would like to give them uh right of first refusal, but I doubt that they would refuse to sell a book.

unknown 44:37

Yes.

SPEAKER_01 44:37

So thank you so much for your time. Listeners, viewers, thank you for your time. I know it could be spent anywhere. If any of this you know sparked curiosity and interest in your mind, then it's likely sparking curiosity and or likely to spark curiosity and in and uh interest in someone else's mind. So think of five or six people you know who might be interested in this conversation, share this podcast with them, share the book with them so that we can really just begin to have a more thoughtful conversation around family planning and fertility. So once again, thank you for your time. Everything will be in the show notes. Um we'll also uh link to uh socials and so forth. So uh if you know, if you if you need to sign off now, you will you will there'll be other opportunities for us to remind you to go uh check out the book and and uh and share it. I think this conversation is so timely, so necessary. So once again, Len, thank you so much for your time.

SPEAKER_00 45:38

Thank you, Susan. I really enjoyed our conversation today.

SPEAKER_01 45:41

Likewise.