For all the aficionados of Olympic breakdancing out there, a new Netflix documentary promises to take you behind the scenes of one of the most viral moments of the 2024 Paris Olympics. Raygun: Breaking Badly premieres on the service September 1. If it’s Friday, it’s Family Matters:
Are You My Mother?: Surrogacy and the limits of reproductive autonomy
Head Start’s Fresh Start?: The Trump administration’s new proposed rule
Can Handyman Dads Fix the Birth Rate?: Two thoughts on Marc Novicoff’s Atlantic piece
It’s Me, Hi: The Bulwark, Catholic Register
These United States
Parting Shots
Are You My Mother?
Our hot bioethics summer continues — we’ll get back to Congress’ latest child care approach next week. But while the politics of parenthood have always been fraught, the world of commercialized reproduction has opened up new fronts in ethical dilemmas that call out for better policy responses. Consider these headlines from just over the past month:
In Florida, a surrogate who gave birth to triplets on behalf of a single Chinese man is suing for custody after she grew concerned about the babies’ welfare, as detailed in an excellent piece of reporting for New York magazine by Emi Nietfeld;
In Ontario, Canada, a same-sex couple is suing their surrogate for “emotional distress” after she refused to undergo an abortion after an ultrasound revealed the baby she was carrying had a cleft lip and possible heart abnormality;
And, in Texas, a court ruled that a surrogate-carried baby who had been diagnosed with a rare heart condition could be given life-saving surgery upon birth, against the wishes of the commissioning parents, who had wanted their surrogate to obtain an abortion and would have not have consented to surgery upon birth (the case is still ongoing).
All this comes on top of the flurry of investigative reports into the seamy side of the the global fertility industry, which, as the New York Times Magazine’s Sarah Topol reported last year, “has evolved by breaking procreation into different components — creating chains of reproduction, step by step, piece by piece, assembled to result in a baby…intended parents from China can import Ukrainian eggs or semen from Denmark, create embryos in Tbilisi and use Thai wombs to bear and birth babies before bringing a child home to Shanghai.”
For a long time, surrogacy was sufficiently rare for it to not garner much political attention outside religious conservative circles. But as technology advances, global travel gets cheaper, and the ethical questions raised by contract law seeking to cover the contingencies of pregnancy and parenthood become more common, we are well overdue for a policy conversation about which approaches — up to and including an outright ban on commercial surrogacy — would best protect mothers and the children they carry.
These kind of fraught legal cases — who gets to decide when a commissioned baby is no longer “wanted,” the commissioning parents or the mom who is bearing it? — are made possible when the law intentionally distinguishes between contractually-obtained and biological parenthood. For most of the 20th century, family law questions were brain teasers about purported paternity and trying to figure out who was responsible for the child a man and woman had created. Today’s family law edge cases can involve parties with no genetic relationship to the child in question. Blue states like Washington, Illinois, California, Michigan, and Hawaii, and more have changed family law definitions to allow for the establishment of legal parentage following gestational surrogacy even when neither commissioning parent bears any genetic relation to the child.
This is a different question than adoption, which asks what the best situation is for an already-born child whose parents are in no position to be able to care for it. This is about entering into a contract to bring a child into existence, which raises all sorts of questions about who should have the authority to make decisions when things go wrong (as they so often do.) The logic of treating children as consumer goods to be designed according to our desires and procured with the right to destroy a defective product leads us into the kind of legal regime that allows commissioning parents to direct their surrogate to undergo an abortion if they catch her on social media drinking a glass of wine during pregnancy, as happened in 2024.
Old-school feminists like Gena Corea and Janice Raymond used to criticize the practice of commercial surrogacy for, like prostitution, commodifying women’s bodies. You cannot treat the issue with any amount of seriousness without recognize there inherent power imbalance at play between wealthy commissioning parent and low- or middle-income surrogate moms — and that’s before you layer on the complication that one-third of surrogacy contracts are commissioned by foreign nationals (with China being the most common source.)1 Some of today’s leading feminist intellectuals, like Jill Filipovic, realize the need the practice be “very very very tightly regulated.”
Part of the reason why these regulations don’t exist is because activist groups aimed at “family building” don’t want them to exist. In our system of government, a motivated minority can achieve policy wins so long as opposition to the issue is not activated, and surrogacy has been insufficiently common to have not garnered widespread opposition — so far. But another part of the reason is that those on the center-left have tended to distrust those on the right, who would prefer much wider restrictions on the practice (and the distrust tends to go both ways.) To pass legislation regulating the current wild west that is our system of commercial surrogacy would likely require an alliance of social conservatives willing to not get everything they wish for and feminists willing to work with partners on whom they disagree vehemently on other issues.
Part of the problem with commercial surrogacy, in particular, is that it is most heavily utilized by wealthy, politically engaged individuals and couples who swim in elite circles — some have genuinely tragic circumstances that prevent them from conceiving naturally, and others have biological realities that prevent traditional conception. In order to regulate the excesses of the industry, policymakers would have to grant that there is a justification for limiting surrogacy because of the unavoidable imbalance between wealthy commissioning parents and surrogate, and the inherent risk for abuse in something as fraught as a contract for the delivery of a child. Any kind of regulation with teeth would place limits on the full range of autonomy to those who engage in commercial surrogacy, and thus signal their choice is something other than praiseworthy. That’s a normative stance too few on the left are willing to openly take.
On the contrary, progressives are much more comfortable with a framework of maximal reproductive autonomy — for the latest example, see Massachusetts, where Gov. Maura Healey just delivered on activist-led push to erase an upper gestational limit on abortions. Physicians will now be able to “terminate” a “pregnancy” beyond the 24 week limit that had previously been in place (though, as Ramesh Ponnuru points out, even that limit had a number of wide exceptions, including “mental health.”)
The same 25-week-old fetus that would be born and treated with state-of-the-art NICU technology, if needed, in Nashua, N.H., would, a mere half-hour down Route 3 in Lowell, Mass., be subject to having its heart stopped by a lethal injection before being dismembered — with the legal limit being little more than the “professional judgment of the physician.” We are told that such a scenario is vanishingly rare (though the Lozier Institute estimates the number of abortions after 15 weeks gestation may total between 60,000 and 70,000 per year, something like 170 a day,) and that they are all due to the worst kind of fetal abnormalities and complications — “these babies were wanted,” as the refrain goes; right up until the moment they weren’t wanted anymore.
But the logic of maximal reproductive autonomy has nothing to say against an abortion at 33 weeks, just as it has nothing but affirmation for the choice of the single Chinese businessman to buy triplets from a woman he’ll never meet in Florida, or the right of the couple forcing their surrogate to undergo an abortion because they’re concerned about raising a child with a cleft lip. To some, it feels as if to admit that any of these cases are wrong or an unhappy outcome would raise too many questions about the underlying practice, and so affirmation is the only choice. If both sides have freely agreed to enter into a contract, isn’t that “reproductive autonomy”? That, in its own way, leads to a reproductive rights-inflected version of the “tyranny of the edge case” thinking that characterizes so much of the progressive left that Jeremiah Johnson explored in a fantastic essay for The Argument:
“We can’t regulate against the worst abuses of the commercial surrogacy industry because it might imply judgment against those who have used commercial surrogacy” is this kind of thinking on steroids. (So, too, is “we can’t restrict abortion once a fetus is viable outside the womb because that would imply some abortions aren’t valid choices.”) Such cases may not make up a large share of commercial surrogacy arrangements, but they illustrate the weakness of our current autonomy-driven approach — whose autonomy should trump whose? Progressives unwilling to tackle the seamier stories of surrogacy gone wrong for fear of undermining their side’s ideological commitment to full reproductive autonomy ensure that more of these stories will continue to make headlines.
We can start to improve the way law treats commercial surrogacy — and the uncomfortable questions it raises about parentage — when we recognize that the bond between mother and child is something no contract is able to fully efface, and that treating women as incubators under contract to deliver a product rather than the figure whose heartbeat, voice, and body sustained the child in question for nine months is subjecting the most fundamental human relations to the logic of the market. This isn’t a wild, reactionary stance — many other countries, such as Finland, France, Germany, Italy, Spain, and Sweden already explicitly or implicitly prohibit commercial surrogacy.2
To rein in the worst excesses of commercial surrogacy run amok, conservatives may have to make peace with the fact that a new regulatory approach might not be their ideal. Laws that more carefully limited commercial surrogacy, with stronger safeguards for surrogates’ bodily autonomy and a presumption that she is acting in her child’s best interest, would likely be dissatisfying to those, like myself, who would like to see the practice ultimately banned. (Similarly, altruistic surrogacy, or the practice of bearing a child for someone else out of good will rather than as a paid service, has much more public support, probably because its rate of legal messiness is much lower). The nexus between commercial surrogacy and international birth tourism will continue to be the lowest-hanging fruit, politically, with more conservatives increasingly concerned about practices that make it possible for foreign nationals to procure a child who comes a with U.S. passport.
But progressives will need to acknowledge that a “reproductive autonomy” framework that continues to be pushed to its extreme, that says essentially no choice around procuring or avoiding a child can ever be subject to public scrutiny or regulatory interference, will continue to produce more of these complicated, horrific legal fights when the interests of the commissioning parents and the surrogate parents collide — and the interests of the child in question are, too often, ignored.
Head Start’s Fresh Start?
As mentioned in last week’s Family Matters, the Department of Health and Human Services recently announced sweeping changes to how the Head Start program is regulated and administered. It’s been greeted with cheers from some conservatives, for whom the program has been a long-time target,3 and lamentations from some progressives, who see Head Start as a sterling example of Great Society paternalism aimed at improving outcomes for low-income children.
To start with — the current Head Start regulations manual runs a cool 130 pages. I challenge anyone in Washington or any state capital to argue that a leaner, more focused set of regulations wouldn’t make the lives of Head Start officials or service providers easier, and a renewed emphasis on parental involvement shouldn’t strike anyone as beyond the pale. The question, from my point of view, should be closer to “did they get the balance of cutting regulation and ensuring proper support for low-income families correct?”, rather than “why is the Trump administration trying to ‘quietly dismantle’ Head Start?” And to answer that first question, we also need to ask “Is Head Start just child care, or should we treat it as more than that?”
At City Journal Substack, heather macdonald argues that the problem with Head Start is that it “has never worked,” which I think gets ahead of the evidence. We have plenty of papers finding the apparent bump in test scores due to Head Start fade out (though perhaps not over the long run), and some of the canonical papers looking at sibling effects have their critics. My general read on Head Start is that it did have a measurable impact for the first generations of kids in the program. The kids who benefitted from the programs intensive, wrap-around supports in the 1960s and 1970s did so because the quality of the alternative care arrangement — often, at home with a low-income single mom unable to find steady work or cared for under a neighbor’s less-than-watchful eye — was often low.
But we’ve grown richer, fertility has fallen, and more child care and preschools offer more focus on enrichment than their predecessors in the 1970s and 1980s. As such, the relevant counterfactual for today’s Head Start participant may look very different from the one facing a poor child in the 1960s, and I don’t think we necessarily need to treat Head Start as sacrosanct. Despite the hue and cry from the advocates and interest groups that rely on Head Start funding, we probably don’t need quite so prescriptive an approach today as when the alternatives were fewer and further between, and the field of early childhood education less developed. But neither do we want to needlessly tinker with the program without being sure that the alternative won’t be worse.
My first impression of the Trump administration’s revision of the Head Start guidance is that they went about as far as they could go in stripping the program down to its bare bones; maybe, truth be told, just a touch too far. There’s nothing wrong with reducing some adult:child ratios and cleaning out administrative overhead. But their decision to essentially remove all of the federal government’s role in shaping local curriculum — such as the existing requirements to teach lessons in math and literacy and perform general health screenings — seems like a case of potentially throwing the baby out with the bathwater, and they may end up wanting to add back some streamlined version of the program’s top-down guidance and restore a limited version of its focus on whole-child well-being. Interestingly enough, they did acknowledge the value of having a federal role for guidance in their inclusion of MAHA-aligned physical education and nutrition priorities and requiring English-only classroom instruction.
Streamlining federal regulations does not need to mean eliminating them. Instinctively, I agree federalism is the right approach, but some federal guardrails feel necessary to keep some of its traditional and statutory emphasis on child development, anti-poverty interventions, and school readiness. Or, if the Trump administration would prefer to treat Head Start as something closer to any other child care program and get rid of its wrap-around service model altogether, there’s at least a case to be made there — but they’d have to make it to Congress.
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Can Handyman Dads Fix the Birth Rate?
For The Atlantic, Marc Novicoff complicates the narrative around men’s household contributions and birth rates in a useful way. Lyman Stone has been the loudest voice critiquing the over-reliance on cross-sectional comparisons in Claudia Goldin’s more recent work on declining fertility, and Novicoff’s piece will help readers think a little harder about the “if only men did more chores” school of fertility decline analysis. Two thoughts:
Novicoff’s empirical work is helpful but not, I think, the full story. For instance, it’s true that Novicoff’s chart below pretty clearly shows that places where male partners do more household work have just as many (or as few) babies as places where there is more of a gender imbalance. For instance, we do have evidence from Spain that longer paternity leave may actually be correlated with lower birth rates, possibly because dads realize how much work babies are and ratchet down their willingness to have another.
But this is, by definition, selecting on the variable of men who are already in a relationship. We are now in a world in which women are — as I will continue to argue — selecting more on interpersonal characteristics than ever before, and marrying for personal and romantic compatibility over simply what Mr. Right may bring to the table economically. For example, cultures marked by machismo or traditional Confucian gender norms, where women are expected pull off a double-shift at home and at work, may be ones in which women are increasingly less interested in coupling off in the first place, and we have indeed seen some of the sharpest recent fall-offs in fertility in Latin America and East Asia. If our global fertility decline is most parsimoniously explained by people failing to couple off — and it is — looking at how housework is split by a given couple is less interesting than how much housework a woman expects a man to perform in order to be considered relationship material, knowing that she will likely end up bearing an asymmetric part of keeping the household running. And that expectation, I suspect — though am open to proof the other way! — continues to rise.
I’ve enjoyed Darby Saxbe’s Substack, Natal Gazing, and appreciate the work she has done to help her audience (broadly, from what I can tell, sensible progressives) talk about the contributions that dads make in a helpful way. If Marc, Darby, Lyman, and I were locked in a room for a day, I bet we could come up with some really great policies for helping families and celebrating parents. But in tracking down the numbers behind her Slate piece on dads’ contributions at home, Novicoff discovers that Saxbe’s numbers weren’t able to be replicated because she had relied on data compiled by AI that turns out to have been hallucinated. For a profession that relies on credibility, this kind of error needs to be recognized for the disappointment that it is. Part of the reason why this newsletter remains painstakingly artisanally-crafted, typos and all, is precisely because of my fear of this kind of scenario. Without The Atlantic giving Novicoff support to track down and double-check the numbers, we all — Slate readers, Saxbe herself, probably me — would have been operating under a false conception about what the data actually say. For those of us in the line of work of trying to better understand and explain the world, that should be one of the biggest pitfalls to try to avoid. Of course Saxbe won’t be the first, or last, to be misled by AI, but if we don’t all take this vignette as further evidence to be cautious, and always verify what our algorithmically powered research assistants may be serving up, we might not be as lucky as to have The Atlantic uncover where we’ve been led astray.
It’s Me, Hi
For The Bulwark, Jonathan Cohn looks at the “Project 2029” child care plan that includes an at-home payment option for families that do not use formal child care. He has quotes from Matt Bruenig, Julie Kashen, and me expressing various levels of intrigue and curiosity into a plan that breaks from the traditional Democratic mold:
“It’s fascinating to see Democrats responding to what was always the conservative critique of universal child care programs—namely, that they don’t do anything to support parents who don’t want or need child care…If a presidential candidate picks this idea up, it could be a sign that the party really is starting to recognize some of its policy blind spots.”
In her column for the Catholic Register in Canada, Andrea Mrozek cites me and Lyman Stone as being among those who “certainly believe government can and should do something to encourage higher fertility.” Guilty as charged!
These United States
The Centers for Medicare & Medicaid Services announced it will end any federal Medicaid and CHIP funding from going towards sex-rejecting procedures for children and youth.
According to the Department of Education, 22 states have received waivers to use federal education dollars more flexibly, including six that have allowed waivers entitled “Returning Education to the States” which will allow them to experiment with new pilot approaches. (Stateline)
A new report commissioned by the Department of Health and Human Services, to which my EPPC colleagues Aaron Kheriaty, MD and Rachel Morrison contributed, highlights the degree to which over 225 hospitals and health systems were able to profit from the expansion of sex-rejecting procedures, such as puberty blockers, cross-sex hormones, and plastic surgery, performed on children and young adults.
Idaho: The campaign around the state’s upcoming vote on whether to eliminate restrictions on abortion has included some back-and-forth over whether the number of OB-GYNs has fallen in the state. There isn’t good data on the question. (Idaho Capital Sun)
Michigan: Voters in Kalamazoo County approved a property tax increase by about $50 to $100 per homeowner to go towards a county fund aimed at increasing access to child care. (WOOD-TV)
New York: Mayor Zohran Mamdani has launched what his office is calling the “Emergency Microgrant Fund” for licensed home-based child care providers, allowing them to tap microgrants of up to $10,000 to address immediate needs.
Parting Shots
My EPPC colleague Andrew Walker has an essay arguing, perhaps counterintuitively, that “social conservatism is in a markedly stronger intellectual and cultural position than at any point in the last twenty or so years.” (Public Discourse)
W. Bradford Wilcox and James Lynch join the chorus of conservative commentators, like Charles Fain Lehman, Saagar Enjeti, and myself, criticizing the Trump-era GOP for its embrace of the industry of “vice” and what it will do to the fortunes of young men. (COMPACT)
The Independent Women’s Forum has released a new report summarizing areas of family policy that deserve to be taken seriously, including sections by Carrie Lukas on paid leave, Heather Madden on child care, Neeraja Deshpande on education, Patrice Onwuka: The Pink Files on workplace flexibility, and more.
Ian Frisch reports on parents who have run afoul of child protective services, or even arrested, for letting their children play or run errands independently. (New York Times)
Étienne-Alexandre Beauregard has written a report on why the Quebec child care model continues to suffer from long waits and variable quality (Cardus)
A new Zillow analysis finds approximately one-third of families with children under the age of 18 today are renting, and more than half of them are “rent burdened,” highlighting the “structural” affordability hurdle facing families.
Joseph Davis, Michael Toscano, and Ken Burchfiel have published another installment of their series of reports on young men (Institute for Family Studies)
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Extrapolating from a 2025 paper in the journal Fertility and Sterility, we can estimate that surrogacy contracts commissioned by Chinese citizens (where surrogacy remains illegal) make up a full 13 percent of all surrogacy-enabled births in the US from 2014-2020.
In 2024, the European Parliament added “the exploitation of surrogacy” to its statement of concern around human trafficking, recognizing the high risk of coercion within the industry internationally.