Up the duff and in the red

As policymakers attempt to reverse falling fertility rates in Australia, one part of the puzzle still requires societal recognition: pregnancy is civic work, and as such, it must be adequately supported and compensated.

Suppose we lived in a society where a medical breakthrough had allowed young men to act as “immune tissue donors” for the elderly. They could volunteer to grow tissue for nine months in their prostatic utricle (the male equivalent of the female uterus), which would then be used to improve the immune system of elderly people.

This miraculous procedure which would increase the quality of life of the elderly would come at a cost for the young, however. It would often cause pain, headaches, tiredness, vomiting and nausea. There would also be health risks associated with the procedure. It would increase the risk of high blood pressure, diabetes, depression and infections. Most troubling, dozens of young men would die every year as a result of complications during tissue removal.

Now suppose the procedure had a high level of uptake at the beginning, but slowly volunteer numbers started to decrease, making policymakers bemoan the consequences for the beneficiaries. As participation decreased, no one seemed to acknowledge the decline had something to do with the costs and risks of the procedure.

I hope we all agree this would have been a very strange situation. Yet this is exactly the status of our conversations around declining fertility rates. There is wide recognition that parents provide an important public good by ensuring that, through reproduction, there will be enough working citizens one day to provide aged care and healthcare and other important services, as well as pay the taxes that we need to fund welfare payments, pension systems and broader social infrastructure.

But at the same time, public debate proceeds as if pregnancy is costless or risk-free. As if it is just women’s lot to suffer back pain, headaches, vomiting, nausea, heartburn, indigestion, tiredness and sleep problems (among other symptoms). Or as if healthcare workers don’t routinely advise us all to minimise our risk of high blood pressure, anaemia, depression and infections, precisely the conditions that pregnancy makes more likely.

Neither do we confront the fact that around two dozen women die from childbirth every year in Australia. This silence is problematic for two reasons. The first is a failure to recognise that when it comes to procreation, society benefits as a whole, and yet, not everyone is required to bear the burdens of pregnancy. Indeed, our public conversations about depopulation rarely acknowledge that pregnancy involves real costs and serious risks, and that nine months is a long time to find oneself in this position.

The second is a failure of public policy: society does not adequately support pregnant women in bearing these burdens. I suspect part of the reason we are seeing this drop in fertility is precisely because women are rejecting the expectation that it is their lot to spend nine months in this vulnerable position, especially when they cannot always access adequate maternal services or receive adequate paid parental leave.

If the tissue donation program I mentioned above existed, and we saw a rapid decline in volunteers, I suspect we would be asking questions about how to better support young men, and how to compensate them for the risks and burdens of donation. And we would be asking those questions even if we knew that many of them loved to serve as donors.

The fact that many young women enjoy being pregnant doesn’t mean they are any less vulnerable to the costs and risks of pregnancy. But when it comes to a decline in fertility rate, we seem more interested in passing judgment about women’s decisions when it comes to their career, relationships and other commitments.

We often respond to the statistics by assuming that women are not dating properly or not planning their life properly. That they are somehow failing at womanhood. But it is society that is failing them. In societies such as Australia, we have organised reproductive labour in such a way that women invisibly bear the costs and risks while the benefits are distributed widely. This means we have, for a long time, been free-riding on the gestational work of a subset of our citizens.

No wonder young women have started to loudly reject this unfair bargain. If society needs women to fall pregnant to maintain the inter-age-social contract, then it needs to adequately support and compensate them for doing so. Policymakers will need to both challenge problematic cultural norms and implement fit-for-purpose policies.

We can begin by making maternal care in Australia accessible and of high quality in every part of the country, thereby addressing many of the costs and minimising many of the risks of pregnancy for all our citizens, not just those lucky enough to reside in more affluent corners.

We must also adequately support women in taking leave before and after birth by providing parental leave that actually covers their regular income.

As we come to grips with the rapid and significant decline in fertility rate in Australia, we must not forget for a moment that women are free and equal citizens and that their gestational work is not something society is simply entitled to.

Luara Ferracioli is an associate professor in political philosophy in the School of Humanities at the University of Sydney.