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I've previously posted on the Motte about the Swedish state-funded Investigative Committee For a Future with Children (Swed. Utredningen för en framtid med barn) with instructions to look into the recent decline in fertility and suggest solutions to the problem. The fourth report dropped a few weeks back, this time focusing on involuntary childlessness and infertility: “Involuntary childlessness: prevalence, causes, treatment and consequences” As before, here's a link in case you know Swedish or want to use an AI to give you the uptake. https://framtidmedbarn.se/rapport/nr-4-ofrivillig-barnloshet-forekomst-orsaker-behandling-och-konsekvenser/
In contrast to the other three reports previously released, this one actually got some major government attention, and shorly after it was made public an extra investment into fertility treatments was announced. That's all well and good, and I'm sure it will help suffering couples – but I am also increasingly worried that the committee is losing the thread. These last two reports (the previous of which focused on economic differences between different family formations) have deftly dodged all the bigger questions at play in this crisis. Biologically-related infertility is obviously an exceedingly small cause of declining fertility, and in any serious discussion it must be pretty far down the list of priorities. I get the feeling this particular issue is getting a whole report's worth of attention not because it's key to a solution, but because it's conveninent and doesn't involve questioning anyone's life choices by wrestling with difficult and dangerous questions.
One of the difficult and dangerous questions I've wrestled with recently is a particular form of dissonance. It might surprise a few of you, but Sweden actually has an extensive Total Defense Duty (yes, literal translation) technically applicable to all Swedish citizens between the age of 16 and 70. Everyone and their grandma really is expected to make significant sacrifices, perhaps even give their lives, in the event of war. In the information pamphlet the government regularly sends out to facilitate crisis-preparation there's a classic mantra (in the more literal Sanskrit meaning of that noun, man-tra, i.e. support or instrument for the mind) that I think has been included since centuries back – alla uppgifter om att motståndet ska upphöra är falska – all reports that resistance is to cease are false. Liberty or death. Noble stuff!
Yet the most central part of ensuring the continued existence of a sovereign Swedish state, i.e. the creation of a new generation of Swedes, is apparently not even a moral, let alone a legal, duty on the part of the citizen? Everyone is expected to die fighting the Russians, but it's wholly acceptable to make choices whose aggregate consequences ends with Sweden going the way of the Dodo? That old Goldfinger-line pops into my head. "You expect me to have children?" "No, Mr. Bond, I expect you to die!" Really, what is the point of this gung-ho never-surrender sentiment, and for that matter all the increases in defence spending in Europe, if we're just going to allow death to conquer us all from within? There are ideas here which should be connected, yet they seem to lie strewn all about in disorder in a way that's both frustrating and disheartening to see.
Apart from that, I'm also not entirely sure unreservedly making it even easier to postpone getting children is truly the right way to approach this problem. Unpopular though it might be among certain cohorts to point out, the solution to declining fertility reasonably also should somehow involve convincing women to have children while they're still young; not enabling every pregnancy to be geriatric.
In short, the material focus in the debate is starting to worry me. I hope that the next reports will be a bit meatier and tackle the larger cultural and ideological questions at play.
I'm not going to get into the whole cultural debate around declining TFR or putative causes. I am painfully pragmatic, and what I intend to demonstrate is that there is a technological solution to the problem (the best kind of solution, mwah):
A country as wealthy as Sweden can circumvent the dysgenic concerns raised by @sleepyegg through embryo selection. The primary costs are the IVF itself, which should be in the realm of affordability for the middle class and above (who suffer disproportionately from reduced TFR). If not, I think any sane government should be willing to spend enormous sums of money to prevent population collapse.
You can screen for a lot of things, including strong proxies for health/mutational load. The screening itself is a trivial fraction of the cost compared to the egg extraction, freezing and IVF, and as mentioned it's the IVF that's the costly part.
Further, implantation success rates are remarkably stable even for older women. It's the age of the ova itself that matters, someone using eggs they harvested at 25 when they're in their late 30s is way more likely to succeed (for a given number of cycles) than that person using recently harvested eggs.
In other words, the uterus can handle things just fine for a very long time. The eggs continue to degrade the longer they stay in the ovary. You're already born with all the eggs you'll ever have if you're a woman, or as man, though that depends on when you last went to the supermarket. The success rate for implantation or the dysgenic effects of mutational load on the viability or overall health of the eggs/children increase precipitously once you're in your 30s. It's no coincidence that the risk of Down syndrome shoots up with increasing maternal age around that time.
The problem is, of course, that few governments have crossed the minimum sanity threshold to do these things. The fruit couldn't hang much lower without already being in the dirt.
Recommended reading:
https://www.lesswrong.com/posts/dxffBxGqt2eidxwRR/the-optimal-age-to-freeze-eggs-is-19
As a matter of fact, I would strongly recommend everything GeneSmith has ever written on the topic. I'd trust him to smith my genes, or those of my children.
Have you read Dune? It makes a compelling case that's the opposite of true. Maybe people who are so bad that they won't reproduce until 35 should just stop existing. Why save them with technology invented for them? What's the point?
The Logical Fallacy of Generalization from Fictional Evidence
You know what, maybe we shouldn't have invented treatments for malaria, chemotherapy for aggressive cancers, ozempic for the obesity epidemic. Maybe reducing infant-and-child mortality rates from the ~50% they hovered around for most of human history to the rounding error they are today was deeply misguided. Maybe doctors should all retire en masse and society should return to the state of nature, however we're defining that this Sunday.
If you disagree, then I think the arguments for trying to fix demographic collapse write themselves. If you don't, then we're not going to get anywhere.
Apologies for that, I was trying to speak to the audience. More seriously, it's not that Dune is empirical evidence, but that the author's underlying reasoning for Butlerian Jihad being good is itself a philosophical case for what I am arguing. My own case for it, without reference to fiction and with reference to real science, would lead me to write a book about dynastic aristocracies with supermen who control technology instead of letting technology control them.
We spend way too much on healthcare and it really doesn't improve human happiness much. These medicines have pros and cons. You seem to fixate on the pros without acknowledging any cons. Why is that?
In some cases the pros outweight the cons. You rush to cases where most people would say that's that case. I don't disagree that much. I would probably say that some chemotherapies are actually scams and I would like to think I would be one of the patients who follows through on that and just dies earlier instead of having a wretched 6 to 12 month life extension. Others are life-savers and cures. It depends on the type of cancer. In the case of malaria, the impact of the cure and its widespread free distribution depends on what you think about a billion subsaharan Africans existing. Can't get anywhere negative on that topic with normies because it is impolite thought crime. The one downside of ozempic is that obesity was a mark of shame for people with terrible self-control, but I think that tattoos and other vices neatly fill the obesity void, so I see it as a positive on net.
Ultimately with these technologies, you must judge the life-form they help and weigh the externalities of that life form against the costs of the aid. Yes, this is so mean to do, because everyone is exactly the same and equal and equally valuable and so on, unless you want to be impolite. But is truth always polite? Anyway, IVF is extremely expensive and basically works to perpetuate people who barely want to reproduce. That attitude correlates positively with other negative behaviors that punish those around them as well. The babies it makes are sicker on average. Why should we have more sick people who hate family life at such a high cost? Who does that benefit? I'm not seeing it pass the pros and cons audit.
I wish to note that I put serious weight on an oligarchic future where a few elites control AGI, and thus the rest of us. I am far more skeptical of genetic engineering being the primary driver behind the creation of a permanent underclass, for the same reason that cars went from being something that were the playthings of the rich to available to most. Everything I've described has gotten cheaper over time, often drastically so.
This is more reflective of your unfamiliarity with me. I mean that without insult. I've written on exactly that topic at length, multiple times, over years. I have very long effort-posts on the importance of using metrics like QALY/DALY and cost-benefit/cost-utility when it comes to dictating policy on medical care. If that weren't true, that would be a fair critique, but this is one of the rare occasions where I genuinely can't afford to be as thorough as I'd desire. I am not writing a policy white paper, I am crunched for time because of exams, and in all honesty, I shouldn't even be here in the first place. I have not pretended to have done a comprehensive cost-benefit analysis here, but I have linked to the work of people who have.
But considering my own output:
https://www.themotte.org/post/2899/culture-war-roundup-for-the-week/359026?context=8#context
In other words, I am the last person who you should accuse of not considering the diminishing returns to further healthcare expenditure. Also, note that diminishing returns are not the same thing as no returns, let alone negative returns. If you have a billion dollars and want to spend all of it on care that has a negligible chance of healing you, be my guest. I'm more concerned with public policy and public funds.
I am also a transhumanist, so I want medical technology to get even cheaper (which it mostly has), alongside society getting wealthier. The expected result is that we end up with cheaper, better treatments, and can provide them to more people. Be it privately or through public funding.
There is very, very good reason that I advocated for embryo selection above and beyond subsidized IVF. Consider that that cuts down the majority of your arguments at the knee. The "sicker IVF babies" finding is largely driven by maternal age, multiple-embryo transfers (now declining as standard practice), and underlying parental subfertility rather than the IVF procedure itself. You can't accuse me of not acknowledging that, when I have already offered a solution.
I also do not particularly care about whether people "barely want to reproduce", as long as the answer is more yes than it is no. I'm not a gynaecologist, but in general, if someone tells me that they want children, I support them. Even if it would be easy to scold them for being irrational or indecisive and making things harder for themselves. In psychiatry, it's all too common for depressed people to not want to be helped, because depression strongly correlates with reduced self-esteem and a sense of being unworthy of care. Many people show up in front of me who just care enough to get out of bed and see a psychiatrist. I treat them nonetheless, and I am happy doing so.
The IVF population is overwhelmingly composed of couples who want children intensely (often more than the median fertile couple) and whose biology has betrayed them, and that conflating them with "people who barely want to reproduce" is incorrect.
Humans are fallible, non-omniscient and imperfectly rational actors, and society should make some concession to those unfortunate facts.
If you disagree with this on moral grounds, be my guest. I am on Scott's side, in the sense that Society is fixed, Biology is mutable.
Society is biology, so this is not literally true. Although changing the biology of 300 million people is much harder than changing the biology of one. And if you can change the biology of one cooperatively, you might be able to do the same for 300 million people, but if you need to change 300 million people uncooperatively, that's going to have a big, probably unreachable cost.
It's not that I think these people can be effectively bullied into reproducing earlier, if anything them failing to replace themselves is better. Because what they do is unnatural, it both costs a lot of money to fix, and it comes off as extremely ugly to other people. I believe their lives are unhappy and that it is wrong to delay reproduction to 35. In the meantime I would enjoy it if a government of people who think like me lower the status those who live that lifestyle through the trumpeting the virtues of reproducing naturally at the appropriate age. I also think the late-reproducing people have a ton of negative externalities on the rest. of us and as they fail to replace themselves those externalities will fade and all of the well-adapted people will be happier and wealthier.
I mean, I expect that selection pressure will eventually result in a return to normal or historical TFRs, if only because the high fecundity populations replace the ones who act like pandas in captivity.
I am somewhat perplexed by how you, after telling me that I haven't done a basic cost-benefit analysis, happen to casually gloss over the rather catastrophic near to medium term economic and societal damage of societies with far more old people than children, or drastic population decline as projected.... in pretty much every developed country. And many developing ones.
I don't lose sleep over this, because I expect technological interventions like AGI+robotics, artificial wombs etc to reduce or eliminate the current coupling between population growth/composition and the stability of national economies. I genuinely don't think we're going to need humans for their physical or cognitive labor in a decade or change, possible less. It's the same reason I don't worry particularly hard about the worst case projections for global warming, if it gets that bad, someone is going to burn a billion dollars of sulphur or inject it into the stratosphere. Inertia only goes so far.
You do not seem as optimistic, nor even as open to technological solutions, and I do not see how you can reasonably claim that your distaste for nudging or assisting the sub-fertile into having more children (by any means) can compensate for decaying infrastructure or potential collapse in a generation or two. If it's business as usual with no major technological breakthroughs and serious social engineering (or even just the widespread adoption of the suggestions I've endorsed), I don't see how you account for the disaster that represents.
@self_made_human where does your optimism for near term AGI come from? I am practically ignorant of AI, but my totally uneducated impression is that it is unlikely to happen within the next 10 years. I would prefer to be wrong, though.
You mentioned in other comments on educational savings for children that you were somewhat certain in would happen within 5 years. Knowing you, you must have some sources you find reliable on AGI progress. Again, from my uneducated view it seems like promises of AI / AGI is merely slick marketing to separate wealthy investors from their money.
The most impactful part of AI on my life so far is the elimination of customer facing jobs on the phone, who have been replaced with AI chatbots which can never fix the unique problems I need addressed. I end up waiting longer to speak to a real person to get the work or chore done.
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The solution to this is redistributing from the old to the young. He who does not work shall not eat. Easy.
That would be awesome. Can we design ourselves to be extremely beautiful, moral, and intelligent after that? Considering we will no longer will need the lower classes.
I think the people who made the disaster, so the old generation at that time, should suffer the consequences of their behavior. They are being told how to be good, by several voices at the moment, and they are not listening at all. That is wrong, and I'm fine with it if they pay the price. They deserve it.
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I do think there are some technological solutions, but many of them have nothing to do with pregnancy. From my perspective as a stay at home dad and parent of 3, in a neighborhood full of kids, I think most parents are accurately estimating the number of kids they can have and then having that many kids.
Shout-out to @HereAndGone2's post below pointing out the difficulties involved in potential surgery options. Throwing out surgery options feels easy, but actually going through with it is generally scary.
I'll go through the list of blockers and how I think Tech is impacting them:
I'll just end with the general observation that if you give parents more money but there aren't areas where they can trade money for more time then the money doesn't help them. As a single person you might think of money as the incentive in and of itself. But the calculations change a bit when you are a parent. Money is fully a means to an end. The ends being providing childcare, and enjoying your children. Technology that allows for that tradeoff is good. Technology that cheapens that tradeoff rate is great. Technology that adds a new time burden as part of the rat race or through regulation is terrible.
Is that really the case? I could see all kind of medical devices that would help, for example, implantable devices to support the pelvic floor. There's always that feminist argument that medications are not sufficiently tested on women. Probably because there is too much variability on hormonal profiles and so on, but with AI-enabled calculation power, it shouldn't be such a huge burden to take into account.
It's dangerous? So are oil fields, roofs, or highways. It's dangerous to the fetus? Not a concern when it's a woman's choice.
Perhaps we need some strong legislation and cash-in-hand to enable more widespread research into these issues. If the government was putting as much money into solving 'pregnancy is uncomfortable' as they do blowing up enemies of Israel, we'd have solutions.
Alternatively, if we want to get around this whole thing, we could just have a more painful culture. Get rid of probation or even detention in schools and replace them with cannings and lashings. If we want to get extreme, we could beat fornication, abortion and contraception out of people, but even without that, having experienced some physical pain and gotten over it would help young women get over the concept that childbirth is painful.
The human body is not really meant to be cut open. We have figured out ways to do it that minimize harm and damage, but the risk doesn't go away. Roll the dice enough and eventually some bad luck arises and someone dies or gets a life altering injury.
Doctors don't want to kill people, insurance companies and hospitals don't want to get sued, patients don't want to die or be disfigured. It's generally in everyone's interest to minimize the number of major surgeries or at least only do them when the danger of not doing them is greater.
An implantable pelvic floor device sounds exactly like the kind of thing that fails a risk reward test for surgery.
A government that overrides all the other people involved in the situation and says "do it anyway" is not going to be popular for saying that. If it's a democracy, they are likely to be replaced.
Just apply such media control that this can all be hand-waved away. It's 2020+6, this is a well-known playbook.
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More likely that if the woman later gets pregnant, or turns out to be pregnant despite you not allowing pregnant women in your study, the child, who signed no waivers, has an unlimited right to sue.
Perhaps it's time for a total and complete shutdown of family law and birth-related regulations until our country's representatives can figure out what's going on.
Blue tribe just need a strong Dr Fauci-like leader and the usual media campaign to spin it into a world-ending emergency to exempt the relevant corporations from legal consequences. Shouldn't be a big deal, barely an inconvenience. 'We need bodies for Russia/China/Iran/...'
Your objections seem maximally hand wavey 'yeah just massively alter society to fit this new goal, democrats did it back during covid'
Collapsing birthrates are a much bigger problem than covid. You're the one who cares about democracy, presumably. You should use the available tools of democracy to further goals that allow democracy to exist in the future. I for one am fine with democracy-skeptical high-birth-rates minorities taking over the future.
Where did I say I care about democracy?
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Seems unworkable because while the process and technology is sound, the main barrier is individual lack of planning. Suppose you made IVF 100% subsidized and free, you still have to convince young women to undergo an invasive surgical procedure. Many women would probably delay it until it was too late to be worth doing. Countries like Israel which make heavy use of IVF have religious-cultural-social pressure for young women to bear children, so the women are more likely to freeze their eggs early.
Still, there would be some takers for free or partially subsidized IVF. Just need to convince the voting public it is worth the cost, a benefit for future generations that will not generate direct benefits for them.
Young women, the demographic known to be particularly fond of cosmetic surgery? Hmm..
The easiest answer is to
bribepay them. I expect plenty of takers if it's a $10k one-off, with heavy government encouragement.As far as I can tell, my proposal involves less demanding all-encompassing public propaganda or government intervention than any alternative I can name. Is it a perfect solution? Of course not, but praying away cratering TFRs might be cheap and also wouldn't work.
Guys, have you ever spoken to any women about how many kids they want to have, if they want to have kids, and why don't they want ten kids like their grandmothers' generation?
Any of you men who are not circumcised, would you get circumcised for $10k? Remembering, before you go "yeah sure why not?" that there is an anti-circumcision movement and plenty of men who are even going through expensive surgery to restore the foreskin (or at least an ersatz one) because of the perceived disadvantages?
Would you undergo circumcision for any money if it was a repeated operation?
It's not just "pay 24 year old Mandii to have a baby", it's that women even today still will be responsible for the majority of the childcare on top of looking after the house and holding down a job (even a part-time job). Men will be dissatisfied if their wife isn't feeling ready for as much sex after having a baby. Men will leave because "you pay more attention to the kids than me". This isn't simply "blame men for being selfish", it's complicated problems of intimacy, biology, societal structures, and the rest of it.
Put yourself into those shoes: you are now the person who goes back to work after maternity leave (only now we're saying paternity leave). You have a young baby to take care of, and to arrange that they are being taken care of while you work. If there's any problems, you are the one gets the phone call at work to sort it out. You are the one doing the lion's share of the child-minding and housework, even if your spouse is sympathetic and helpful. If you have a couple of kids, you are the one managing schedules around parent-teacher meetings, birthdays, extracurricular activities, taking time off to bring them to the dentist/doctor, whose salary is going towards paying childcare. Oh, and your partner still expects intimacy on a regular basis and will leave if they feel neglected. Do you think your current life and job as the man of the house can change around to accommodate all that? Would you change around to accommodate all that?
Try imagining being a mother and see how much of that life you want to devote to having four kids, when you could be "one and done" or even none, or put it off till you're forty and established in life.
Plenty of young women want children though. They just postpone it as they want to focus their early and mid twenties on partying, travelling, and education. Only to realise too late that finding a lover worth starting a family with is much harder than expected and can easily take years. Suddenly they find themselves in their mid thirties where pregnancy and childbirth is much more risky and their fertility lowers year by year.
I imagine this is the group @self_made_human is trying to cater to. Pay them to freeze their eggs while they are still young, so that they are more likely to still be able to get pregnant once they feel ready to start a family.
Considering that children is something they actually want, and supposing that this makes it significantly more likely, I could easily imagine that a lot of young women would actually be okay with this.
Then, when they have daughters, they can tell them about the experience, and this is how civilizations goes through various phases.
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Why yes, I've had this conversation with my serious partners. The answer ranged between 0 and 3, with the modal value being 2.
Any money? Like, how much money we talking about here? I'd do it for $250k, maybe even $100k. Hell, if they were pretty reasonable and made sure I was well anesthesized, I'd do for it much less. Presuming the foreskin grew back, and this isn't just the equivalent of removing my dick with a cheese grater. I would charge at least a few hundred million dollars for that.
Sadly this must remain a hypothetical, since I was circumcised for medical reasons, and I didn't even get paid for it.
The biggest problem with the rest of your arguments is that they're emotive/rhetorical, not numerate or quantitative.
How many men? How often? Ballpark figures, even? Because lurid anecdotes are not a good argument.
At the end of the day, I'm a weak policy pro-natalist. I do not make it a general point of going around ordering women to have kids. I think the government should encourage people to have more kids, for a form of encouragement that is closer to an anti-smoking campaign than it is to a breeding camp. Personally? I simply wouldn't marry a lady who didn't want to have kids, and I am perfectly willing to make the sacrifices necessary to support them. No hypocrisy here.
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Well, I'd vote for $10k subsidies, but good luck to any politican who tries to get the public behind it. There would probably be serious opposition from women too old to benefit from it, and it would be reframed as a form of neo-patriarchal enslavement of wombs.
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It's no longer a technological solution and has become a social and political problem, so you're kind of back where you began.
Why not cut out the middleman and pay them $10k for their first baby, no IVF required? Or $10k for each baby born before whatever cut-off age where IVF becomes relevant. There's a few dials you can adjust there and it seems like less government involvement and propaganda required than adding in the IVF step.
It's not paying for having a baby, it's the necessity to pay for childcare after the birth. Even when the child gets to be five years old, now they're going to school. Someone has to arrange to pick them up and bring them to the childminder after school, when both parents are working full-time jobs, until Mommy and Daddy get home.
There's a lot of expenses, and even more juggling around of schedules, to taking care of children unless you're full-time home-maker, and being a full-time home-maker is both low-status and only feasible if the main breadwinner is making huge money.
The average male wage in the USA is around $1k/wk, a perfectly doable household income for four people. People just don't prioritize having/being a homemaker as much. I'm given to understand that Scandi tax structures brutally penalize households for having adults outside of formal employment and so SAHMs straight up don't exist there as deliberate policy choice, regardless of partner income(but that much higher percentages of women work part time).
BTW, subsidizing childcare has very limited to nil effects on birthrates, although it does increase the labour force participation of mothers. This suggests that childcare costs do not feature strongly in decisions of whether or not to have kids.
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I wish to note that my proposal is not mutually exclusive with anything you've said.
What differentiates $10k for egg-harvesting from a direct reward for natality?
So the real target for my proposal are people who want kids, but have a tendency to postpone things till it's way too late. At that point, having eggs preserved (preferably from way earlier) would be an absolute godsend. To contrast, if they wanted to get the $10k for the child then, it's far more likely that it's too late. That's true regardless of how badly they want the kids.
The benefit of the wider embryo-selection policy is that avoids or minimizes dysgenic effects. Even if $10k means a lot more to the poor, you can still screen and select for the higher quality potential children. Conveniently, the same markers that promise general good health also correlate positively with IQ. Follow the LW link for a better exploration of that point. You don't even need to do the politically difficult thing of actively selecting for IQ, you can just say you want healthier kids (by pretty standard definitions of health) and get IQ points as a happy little accident.
And even if there's no embryo selection? Well, at least we have good eggs for the IVF. That should make a difference. There's plenty of other things you could reasonably try, but I'm not writing a policy whitepaper here.
I honestly think this makes sense. There very much seems to be a fantasy where you can spend most of your 20s partying, travelling, and getting educated, and postpone children to later. Having a child early significantly interferes with your freedom to do whatever you want when you are young. In other words, the fantasy of extending your adolescence for as long as possible is worth much more than the state is willing to pay you to have a kid. $10k surely wouldn't cut it. You would need life-altering amounts of money to convince the average 21-year old middle class woman to give it up and pursue a family instead.
The state could pay for every expense associated with child rearing, from diapers to education to the sports they play in their free time. And young people would likely still not consider themselves ready to have kids.
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