fertility – Chasing Tales

NB: This whole argument takes for granted that the objective is a sustainable, voluntary economic system with enough future workers and taxpayers. If a society’s real goal is simply to extract reproduction by force, then it has already stepped outside the world of incentives and into slavery, and economics can only describe the damage, not justify it.

NB 2: I’ve tried to make this as explanatory as I can, while still trying to not exasperate any passing economist.

Once, back in 2013, during an internship, I fainted at my desk from period pain. Luckily, I was seated, so my head just hit the table.

Nearly everyone who has ever menstruated has at least one horror story. Mine is relatively tame. Other people can tell you about bleeding through clothes, sitting examinations and meetings with cramps that feel like food poisoning, working full shifts in cramped factories without access to toilets, or being scolded for “unprofessionalism” because endometriosis made them miss a meeting. These stories are usually related as private misfortunes or personal failures of resilience. Economically, they are counted as nothing at all.

This is a mistake, and not just a moral one. It is a category error^{(a category error is when you count something in a category in which it does not belong, and therefore assign it characteristics it cannot possibly have)} in how we think about production.

What this essay argues is simple:

Menstruation, pregnancy, childbirth, childrearing, and menopause are not “women’s issues”. They are the long production process through which societies manufacture their future workers and taxpayers.
That production process is economic work. It creates an economic good called “children”, which becomes (economically) tomorrow’s labour supply, consumer base, and tax base.
The current system does two things at once: it underprices this work and then actively charges girls and women for doing it, via health risks, lost earnings, and literal taxes. Economically, that’s a textbook (negative) externality^{(an externality is when someone not part of a transaction receives a gain or bears a cost that results from it- a negative externality is when the cost is borne by the unrelated party)}: private cost, social benefit, underpriced input^{(the input here being women’s fertility)}. When you treat a crucial input as free, rational producers under‑produce it.

If you follow that logic all the way through, fainting at your desk and falling fertility rates turn out to be points on the same curve.

Menarche to menopause
We usually talk about “having a baby” as if fertility were a single event. Economically, that’s like describing “building a car” as the moment a finished vehicle rolls off the assembly line, and ignoring every step before it. Women’s fertility does not begin with pregnancy and it does not end at childbirth. It begins at menarche and runs to menopause, a multi‑decade production line that converts biological capacity into actual future people. Every part of that line has costs attached:

Menarche and menstruation: Once bleeding starts, there are monthly expenditures on pads, cups, tampons, painkillers, clinic visits, iron supplements. There are also missed school days when products or toilets are unavailable,¹ and missed work days when the pain or blood loss is severe.² None of this is optional if the body is going to remain capable of a healthy pregnancy later.
Fertility management³ ⁴ ⁵: Contraception, abortions, miscarriages, and their follow‑up care all consume time, money, and physical resilience. This is the work of deciding when and whether reproduction will happen, which any economist will recognise as intertemporal optimisation^{(which is when you try to balance how you use your resources through time, such as balancing current consumption/investment against future goals}⁶⁾ with a body on the line.
Pregnancy and childbirth⁷ ⁸: Nine months of metabolic and bodily strain, often accompanied by nausea, gestational diabetes, hypertension, and anaemia, followed by a physically risky delivery. Even a “normal” pregnancy can force women out of certain jobs; a complicated one can remove them from the labour force- or life- entirely. There is also the plain fear associated with birth women are often expected to not talk about, and metabolise without complaint.
Postpartum and childrearing⁹: Months or years of sleep deprivation, breastfeeding, carrying, cleaning, managing illness, making appointments, supervising homework, and often postpartum depression¹⁰ ¹¹. This is “reproductive labour”: the daily work that keeps children alive long enough to become workers. The opportunity cost is foregone wages, stalled promotions, career shifts into “flexible” but lower‑paid jobs.
Perimenopause and menopause¹² ¹³: Hot flashes, insomnia, brain fog, joint pain, and mood changes can all interfere with work, but very few workplaces account for this as anything other than an individual performance issue.

There is no such thing as “children” that exist independently of this long chain. Every future worker and taxpayer is embodied evidence that at least one person has paid these costs. That means children are not just sentimental “blessings”. They are an economic good. They are the raw material for what the textbooks call human capital: the future labour that will show up in productivity statistics and fiscal projections. No children, no labour supply. No labour supply, no GDP. It is that blunt.¹⁴ ¹⁵

What makes this category slippery is that children are not only an economic good in the narrow sense. They are also a source of private value: people have children because they want them, love them, and derive meaning, identity, and security from them. In economic terms, children are both consumption goods (privately valued by families) and investment goods (inputs into the future labour force and tax base).¹⁶ ¹⁷ For economically weaker people, children may even be an old-age insurance product.¹⁸ ¹⁹

Once you state this clearly, the next step is unavoidable: the work that produces and maintains this good (periods, pregnancies, childrearing) is economic work. It is as structurally necessary as work on an assembly line or in a software firm. The problem is not that markets ignore the private value- they do not. The problem is that the public value of the work associated with fertility is systematically underpriced²⁰ ²¹, while a large share of the costs remains private²² ²³.

The hidden invoice
In theory, if something is essential to production, we expect to see it priced, paid for, and protected. That is not how reproduction is treated.

Start with menstruation. For years, India taxed sanitary pads at 12% under GST²⁴, treating them closer to a semi‑luxury than to a basic need. Activism eventually pushed the rate to zero, but research from other countries suggests that when “tampon taxes” are removed, manufacturers and retailers often adjust prices so that the full benefit does not reach consumers.²⁵ ²⁶ In other words: even when the formal tax disappears, the underlying reality remains the same- periods are expensive, and the person bleeding pays.²⁷ ²⁸

The same logic runs through pregnancy and childbirth. In systems without universal coverage, antenatal check‑ups, diagnostic tests, delivery, and emergency care often come with substantial out‑of‑pocket bills.²⁹ ³⁰ ³¹ Even where public health care is nominally free, women pay with time spent queuing, with travel costs, with foregone daily wages.³² ³³ Nutrition during adolescence, pregnancy, and breastfeeding is a private line‑item in a household budget, not a public investment in the quality of the next generation.³⁴

Then there is the loss you cannot put on a receipt: days or years lost from school and work. Period pain and heavy bleeding are common reasons girls miss school, and lack of toilets or products turns discomfort into absence (“Period Poverty” is a real phrase that exists in our world). Women in manual or informal jobs such as factory lines, domestic work, agricultural labour, rarely have the option of calling in sick for their uterus.³⁵ ³⁶ They work through the pain, or they don’t work and lose pay, or they exit the labour market entirely. (NO. 5)

And then there are miscarriages. An estimated 23 million miscarriages occur every year worldwide, translating to roughly 44 pregnancy losses every minute.³⁷ In low- and middle-income countries like India, the risk is even more acute; longitudinal data from 2026 indicates a total pregnancy loss risk of approximately 103 per 1,000 pregnancies after the 8th week of gestation.³⁸ ³⁹ Economically, this represents a catastrophic failure, whose costs are nearly 100% borne by the mother.⁴⁰ ⁴¹

Also, in any other sector, a manufacturing defect or a workplace injury would be covered by insurance or a social safety net. In the reproductive economy, a miscarriage is treated as a private medical event. The woman or her family pay⁴² ⁴³ for the hospital stay, lost wages, nutritional requirement, product requirements, etc. while also experiencing psychological and physical pain.⁴⁴

All of this is the cost side of reproduction. It is spent in cash, in time, in health, in future earnings.

The benefit side is much more widely distributed. Everyone who relies on the future existence of workers and taxpayers gains: firms, governments, pension systems, future consumers. That is what makes this an externality.

In textbook microeconomics, when one economic agent bears costs that generate benefits for others who do not pay, markets underprice the activity.⁴⁵ That is what is happening here. The private cost of reproduction, like period products, health risks, lost earnings, is mostly borne by women and their families. The social benefit- a stable or growing population that can work, consume, and pay taxes, is captured by a large set of actors who are not paying the full bill.

Put differently, reproduction is a hybrid case. Part of the return accrues directly to the people raising the child. But a substantial share spills outward to employers, states, and future consumers who did not pay for the child’s upbringing. It is this gap, between private return and social return, that creates the distortion (that is, social benefit – private benefit = value of externality). The result is not that reproduction stops, but that it occurs under conditions of strain, inequality, and, increasingly, shortfall relative to what people say they actually want.

The logic is not mysterious; it is familiar. When polluters are allowed to dump waste into a river for free, they will pollute too much. Here, when the cost of producing the next generation is loaded onto one group while the payoff is spread across the entire economy, reproduction is pushed into the territory of “too costly to do safely, too necessary (or too desired) to abandon”.

The career penalty⁴⁶ ⁴⁷ ⁴⁸
Sometimes this is described as a “motherhood penalty”⁴⁹, as though it were an unfortunate bug in the system. It isn’t. It is the mechanism by which the externality is enforced and accounted for monetarily. Men also do unpaid work, and that matters, but this argument is specifically about reproductive labour such as menstruation, pregnancy, birth, breastfeeding-work that by biology cannot be split evenly, and the data on who takes the wage and pension hit from that work are not ambiguous.

Across many countries, women’s wages and employment trajectories look similar to men’s until the first child arrives.⁵⁰ ⁵¹ Then there are career interruptions for pregnancy and childbirth, reduced availability due to childcare, and discrimination, sometimes subtle, sometimes blatant. The outcome is lower annual wages, slower wage growth, and more part‑time or precarious work.

This does not stop at retirement. Smaller pay packets during working life mean smaller contributions to pensions and savings. Analyses from places like the UK repeatedly find that women’s pension pots are significantly smaller than men’s, with gaps widening in later life.⁵² ⁵³ The compounded effect over a lifetime is a pension gap and a wealth gap built directly on the scaffolding of reproductive labour.⁵⁴

Written as a flow: Fertility (menstruation, pregnancy, childbirth, childrearing, menopause)→ monetary costs, lost school and work days, career interruptions, lower hours, discrimination→ lower wages and slower wage growth→ smaller lifetime earnings→ smaller pensions and assets→ higher risk of old‑age poverty for the people who produced the next generation.

A point to make here is to wonder, if reproductive labour is underpriced, shouldn’t competition eventually push wages up to compensate? The answer is structural, not incidental. The primary beneficiaries of reproductive labour, such as future employers, the state, pension systems, future consumers, are not party to any wage negotiation with the woman currently pregnant. There is no contracting party on the other side of the transaction who could, even in theory, offer higher pay in exchange for the output. The wage market operates between a woman and her current employer, who captures only a small fraction of the lifetime value of the child she is raising. The failure cannot be corrected through wages because the people who owe the payment are not in the room.

(There is a similar issue in climate discussions too- the work put into climate change mitigation and adaptation will benefit future generations, and not current ones. It leaves climate workers to negotiate with people who often cannot see any benefit to curbing their lifestyles or doing the work required now to prevent further climate damage.)

Also, reproduction sits awkwardly between a private decision, an externality, and a quasi-public good⁵⁵ ⁵⁶^{(a product or service that everyone can use, cannot be stopped from using, and whose use by one person does not reduce its availability to others, like clean air- and here, the benefits of more children in an economy – because while a specific child or pregnancy is not a public good in that narrow sense, but: the fiscal and social benefits of children—taxes that fund pensions, schools, hospitals do have public‑good‑like characteristics: they are widely shared and hard to exclude people from}.⁵⁷⁾. Not to mention, households are not firms, and fertility decisions are not made with spreadsheets alone.⁵⁸ Preferences, norms, uncertainty, and identity all play a role.

But prices still matter. When the financial, physical, and career costs of having children rise, they interact with those preferences, often suppressing outcomes below stated intentions. This is visible in the persistent gap between desired and actual fertility across many countries: people report wanting more children than they end up having, and cite cost, job insecurity, and unequal care burdens as the reasons.⁵⁹ That is not a cultural mystery; it is a constrained choice.

The “motherhood penalty” is the accounting system writing down, in money, what the externality looks like at the household level.

The state’s revealed preference
There is another piece of this that rarely gets said: the state is not neutral in this arrangement. It has a revealed preference^{(instead of asking people what they like, you watch what they actually choose to have or do}⁶⁰⁾.

Consider what it would cost a government to assume direct responsibility for raising children: full public childcare from infancy, universal meals, clothing, schooling, health care, and the equivalent of parental time in trained staff. Nordic countries get closest to this, with extensive parental leave and heavily subsidised childcare, and even there, the state does not pay for everything.⁶¹ ⁶² ⁶³ Those programmes are expensive, and they work partially by recognising reproduction as a public good that must be financed collectively.⁶⁴

Whether by design or by constraint, the pattern elsewhere is consistent. Building a fully public system of childrearing, including comprehensive childcare, income support, and care infrastructure, would require high taxes and visible redistribution.⁶⁵ Most states stop well short of that point. The gap is not empty; it is filled inside households, largely by women’s unpaid or underpaid labour.⁶⁶ ⁶⁷ The result functions like a policy choice even when it is not explicitly framed as one: reproduction is treated as a privately financed activity with selectively socialised benefits.

The state’s preference for private financing of reproduction is also visible in how legal systems allocate parental responsibility. Across most jurisdictions, the costs of raising a child are quickly and firmly assigned to the household rather than shared with the broader beneficiaries (employers, pension funds, the state itself).⁶⁸ ⁶⁹ ⁷⁰ ⁷¹ Whatever the stated rationale in any individual jurisdiction, the pattern is widespread and its economic consequence is clear: the state acts to avoid becoming the payer of last resort for reproduction.

The state’s revealed preference is clear: enjoy the tax revenue, avoid the childrearing bill.

From tampon tax to hysterectomy⁷² ⁷³ ⁷⁴ ⁷⁵
At one end of this spectrum are policies that make reproduction incrementally more expensive: a tax on period products, the period products themselves being expensive, no sick leave for period pain, no maternity protection in informal work. At the other end are policies and labour regimes that make reproduction incompatible with survival.

In the sugarcane fields of Maharashtra, the externality stops being metaphorical and becomes surgical. Reports from Beed district, one of the poorest in India, document that thousands of women sugarcane cutters have undergone hysterectomies in their 20s and 30s, not because of health requirements, but because their work contracts and poverty made menstruation and pregnancy intolerable risks. Sugarcane cutting is backbreaking seasonal work. Couples are hired together, paid by the ton of cane they deliver. Missing a day for period pain, for heavy bleeding, for pregnancy complications, can mean fines of 500 to 1,000 rupees, often more than the day’s wage. For families already living on the edge, a week of lost income can mean debt or hunger. In that context, hysterectomy can be seen as a “solution”. Government and academic studies have found hysterectomy rates in Beed many times higher than the national average, concentrated among women who cut cane.

The line from a tax on menstrual products to mass hysterectomies is not a single mechanism, and it would be wrong to treat it as one. What links them is not identical policy design but a common direction of pressure: making the biological realities of reproduction economically costly to bear. At one end, that cost is marginal and dispersed^(marginal⁷⁶^{and dispersed}⁷⁷^{– in economics, “marginal” means additional, the cost of menstrual products is a marginal cost attached to each extra individual and each extra period, and dispersed- smaller spread out costs borne by the women or their families)}. At the other, it becomes so acute that removing the capacity to menstruate is treated as a form of labour discipline, and sometimes the only viable option when the other is chronic hunger.

From a cold economic perspective, what is happening in Beed is this: the labour market is sending a price signal^{(a price signal is information carried by prices that tells people how to behave in a market, so, for example, when price goes up, it signals that something is more in demand}⁷⁸⁾ that a menstruating, potentially pregnant body is too expensive. Removing the uterus reduces downtime. It also removes any future pregnancies and imposes long‑term health risks. But those future cost to the woman’s body and to her family’s fertility are not priced into the immediate wage contract. They are written off as collateral damage.

At one end of this spectrum, you are asked to pay a little extra for bleeding. At the other, you are asked to give up the organ that bleeds so you can keep your job.

The other hand
Now flip to another corner of the world. Nordic welfare states are often held up, as good places to be a mother.⁷⁹ The details matter, because they spell out what it looks like when a state tries, to internalise some of the externality. Countries like Sweden, Norway, Denmark, Finland, and Iceland combine relatively high female employment with generous, earnings‑linked parental leave, job protection, and heavily subsidised childcare. Parents can take months of leave without losing their jobs; part of the leave is reserved for fathers to push men into the care side. Places in public daycare are widely available, and fees are capped or heavily subsidised.

Demographic research links these policies with two outcomes.

First, they raise mothers’ labour force participation and reduce the lifetime earnings penalty of having children.⁸⁰
Second, they are associated with higher and more stable fertility than in otherwise similar rich countries with weak family support; parents, especially mothers, are more likely to go on to have a second or third child when they can expect support and re‑entry into the work they want to do.⁸¹ ⁸²

What the Nordics are doing, in economic terms, is straightforward: they are socialising a slice of the cost of reproduction⁸³, and they are forcing men and employers to bear some of it.⁸⁴ Taxes are higher. Public spending is higher. The state writes cheques for a part of the reproductive bill rather than assuming that women will quietly pay it in unpaid hours and lost earnings. The Beed sugarcane worker and the Swedish software engineer inhabit different universes. One is asked to remove her uterus to remain employable. The other is given months of paid leave and a daycare place to remain employable. Between them lies the full spectrum of how an economy can choose to treat an input it depends on.

What the Nordic model does not resolve is also instructive. Even in Sweden and Finland, women still perform more unpaid care work than men⁸⁵ ⁸⁶, the pension gap persists⁸⁷, and fertility has continued to drift downward despite extensive state support⁸⁸. The partial correction produces a partial result.⁸⁹ This is not a failure of the Nordic model, it’s just that the distortion has not been fully priced out; it has been partially offset- and that personal preferences still apply to such decisions. To be noted, while India and the Nordics are not comparable economic systems, the contrasting realities reveal the range of how costs can be distributed.

What would correct pricing look like?
If this is a pricing problem, then the outline of a solution is not mysterious. Internalising the externality would mean shifting a larger share of the cost of reproduction onto the same broad base that captures its benefits. In practice, that implies some mix of publicly financed reproductive healthcare, income support around childbirth, accessible childcare, and labour market structures that do not permanently penalise time spent raising children. The details vary by country, but the principle is simple: when an activity generates wide social returns, its costs cannot be left almost entirely to the individuals performing it without distorting the outcome. This is not about charity for parents; it is about paying for the labour that keeps the system supplied with workers and taxpayers.

Rational collapse
This is where the externality argument completes its arc. We have an input (reproductive labour from menarche to menopause) that is essential to producing an economic good (children, i.e., future labour and taxpayers). We systematically underprice that input by treating most of the work as unpaid and most of the costs as “personal”. We then occasionally add explicit charges (taxes on menstrual products, unpaid maternity leave, fines for missed days) for good measure.

On the other side, we have beneficiaries: firms that rely on a steady supply of labour they did not pay to raise; states that rely on a steady supply of taxpayers and soldiers; pension systems that rely on young workers’ contributions; men whose own employment and pensions ride on someone else staying home with the kids (in fact, fathers often reap economic benefits from becoming fathers, the opposite of what happens to mothers⁹⁰ ⁹¹– even though they have not borne the physical and general career costs of reproduction). They capture the benefit of reproduction without bearing its full cost.

When the cost of producing children is high and rising, and the private return for the producer is lower than the social return, the aggregate result is under‑investment in reproduction (meaning people choose to have fewer kids). The UN and demographers are already documenting that people in many countries say they want more children than they end up having, citing the cost of living, insecure jobs, and unequal domestic labour as reasons. That gap between desired and actual fertility is the shadow of the externality. It’s the quantity response to cost under constraint (that is, the quantity produced is limited because resources are scarce).

A common counterargument holds that falling fertility is simply the consequence of rising female education and autonomy- that women with better options are rationally choosing smaller families, and that this is a success story, not a market failure. Yes. More education and autonomy for women are unambiguously good. In economic terms, though, they also raise the opportunity cost of childbearing: the better a woman’s career prospects, the more she stands to lose from stepping back for pregnancy and childcare. When women have better careers, the cost of interrupting those careers rises.⁹²That makes the pricing problem worse, not better. A higher opportunity cost with the same absent compensation means the gap between what it costs to have children and what you receive for having them grows wider.

Falling fertility rates are often described as a cultural crisis: young people are selfish; women are too educated; nobody wants families anymore. That story is tidy, and wrong. It treats the collapse in output as a moral failure instead of as a predictable response to a price signal.

However, when an essential input is persistently underpriced, economists do not reach for moral explanations. They look for who is paying, who is free‑riding, and how incentives are misaligned. Reproduction is no different. The difficulty is not that the logic is obscure. It is that applying it requires admitting that a large share of the economy has been quietly subsidised by work that is unpaid, underpaid, and treated as natural.

Falling fertility is not a just a ‘lifestyle choice’ (it can be for some people, it is just not that for everyone); it is the market finally reflecting the fact that the producers can no longer afford to subsidize the rest of the world’s ‘free’ labor supply. The fertility bill has come due.

Sources

Tag: fertility

The Bill Comes Due

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