A Review of Leonard M. Lopoo’s Wanting Children: Family-Planning Policies and the Engineering of America’s Population (University of Chicago Press, 2026).

Shelby LaBonte-Torres

Since its inception in 1970, Title X – the United States government’s federal family planning program – has primarily focused on helping low-income women prevent unwanted pregnancies through contraceptive access. However, in April 2026, the Department of Health and Human Services signaled a policy shift to help women achieve, rather than prevent, pregnancies in response to the government’s fears about declining fertility rates.^[1] This shift aligns with behavioral economist Leonard M. Lopoo’s recommendations in Wanting Children: Family-Planning Policies and the Engineering of America’s Population (University of Chicago Press, 2026). Lopoo investigates the relationship between family planning policy, health equity, and reproductive justice and argues that federal family-planning programs are incomplete because they focus solely on pregnancy prevention. Furthermore, he contends that the eugenic intent of birth control developers influenced early governmental family-planning frameworks, and that its legacy continues in modern policy. Lopoo’s slim volume provides a quick, though uneven, overview of reproductive policy in the United States and offers suggestions for improving equal access to reproductive technology.

The first half of Wanting Children examines the history of family-planning policy in the United States. Lopoo frontloads much of his argument in his first chapter through his overview of government-sponsored programs. He traces successful family planning methods to the turn of the twentieth century, revealing that large families were common in both rural and urban areas, regardless of race. Lopoo asserts that the century’s dramatic reduction in birthrate is due to advances in healthcare and reproductive technology, as well as shifts in social norms and economic opportunities for women.

While these changes have allowed women to time their pregnancies, he notes that social class is now the determining factor in women’s ability to access fertility control. According to Lopoo, while the birth control pill and abortion access through Roe v. Wade became available mid-century, only affluent women had consistent access to these methods. Lopoo introduces health scholar Paula Braverman’s concept of health equity, “a policy framework centered on delivering equal access to healthcare” (p.6) as the central argument for federally funded family-planning programs. Though cloaked as “health equity” programs, Lopoo argues that both early and modern advocates for federally-sponsored family-planning programs were driven by concerns about population growth and fears of the tax and social burdens of unwanted children rather than women’s empowerment and choice. Lopoo also contends that race, class, and sexual-identity have become factors in equitable access to reproductive healthcare, noting that unlike much of the rest of the world, family-planning programs in the United States are focused solely on limiting fertility through contraception and abortion, rather than support for overcoming involuntary infertility.

Lopoo’s second and third chapters explore the eugenics movement of the late 1800s to the “population stabilization” of the 1970s. He argues these eras demonstrate that, despite claims of desires for “health equity,” federal family planning was never meant to be equitable. Rather, he suggests that government-led population stabilization efforts through programs such as Medicaid and Title X had eugenic foundations. Furthermore, he argues that policymakers designed these programs to limit the fertility of people of color and low-income Americans.

In the second half of Wanting Children, Lopoo turns his attention to the present, investigating health inequity in reproductive health services provided by public health insurance and access to modern fertility technologies. He compares contraceptive services provided for low-income people through Medicaid with those provided through private, employer-provided health insurance policies available to the middle-class. Unsurprisingly, Lopoo finds that higher income families have greater access to assisted reproductive technology (ART), allowing them greater choice over their future child’s genetic characteristics through treatments such as genetic testing and in vitro fertilization. Low-income families, on the other hand, often do not have access to infertility treatments, particularly those who rely on Medicaid for health services. Lopoo argues that, as technologies advance, continued inequitable access to ART will widen the gap between advantaged and disadvantaged Americans.

For Lopoo, “wantedness” – preventing unwanted pregnancies and achieving wanted births – is central to understanding federal family planning policy. In the book’s final two chapters, he argues that federal family-planning programs and policies should emphasize wantedness, and contends the United States will not achieve its stated goal of health equity until it provides infertility support for low-income couples who desire to have children along with contraceptive access to those who do not. His conclusion explores data on wantedness and sorts unintended pregnancies into those that were reported as “mistimed” and those that were “unwanted.”

Ultimately, Lopoo concludes that family-planning policy in the United States is highly effective at helping low-income individuals and families control their fertility; however, this efficacy also changes the country’s population composition. He finds that low-income Americans, particularly people of color and the LGBT+ community, are disproportionately affected by current policies and have fewer children than they would have had without publicly-sponsored programs. Lopoo adds a twist to the existing scholarship with this argument for federal support for access to ART. While he acknowledges the benefits of contraceptive access, he believes that adding access to ART support to publicly funded programs would increase the number of wanted children, maximize social welfare, and remedy current population composition restraints by helping underserved communities build families.

Although it brings an innovative perspective to the history of American family planning, Lopoo’s work occasionally feels disjointed. At times, Wanting Children reads as a collection of stand-alone essays rather than a narrative with a cohesive argument. Though the title of his work signals a central theme of wantedness, he does not fully interweave this concept throughout the book. Lopoo mentions wantedness in the conclusions of several chapters, but this seems almost as if it was an afterthought. As a result, the penultimate chapter, which focuses on wantedness, comes across as somewhat disconnected from the rest of the book.

Despite this criticism, Wanting Children is a timely addition to the existing scholarship. It is a quick, accessible read that will interest students of twentieth-century U.S. history, particularly those interested in health, economic, and social policy and reproductive rights. As current events and contemporary debates reignite interest in the history of federal family planning policy, Lopoo’s work feels particularly relevant. Readers will come away not only with a deeper understanding of federal family planning policy, but also with greater context for making sense of the issues unfolding around them today.

Featured image caption: Display of Planned Parenthood literature, 1983. (Courtesy Library of Congress)

Shelby LaBonte-Torres

Shelby LaBonte-Torres is a doctoral student of history at Texas A&M University. She studies 20th century US conservative women, focusing on religion and sexuality.