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In Bogotá’s historic downtown, a modest government building sits in the shadow of a gilded statue of Simón Bolívar, the 19th-century liberator who freed much of South America from Spanish rule. Inside, on the fourth floor, a manzana del cuidado, or care block, pulses with a different kind of revolution.

On a bright October morning, a circle of small children sat around a turquoise table, wide-eyed as their teacher read a Halloween story. In another room, a group of mothers and grandmothers bent over glass jars and wicks, learning to turn used containers into candles during a recycling workshop led by an official from the city’s environmental division. In the main hall, a half-dozen women in sneakers and leggings followed an instructor’s aerobics routine, laughing as they stretched and lunged.

This space is one of 25 neighborhood hubs that have opened across Colombia’s capital since 2020, all part of an ambitious citywide effort to tackle “time poverty” — the lack of time for anything beyond the crushing, invisible burden of unpaid care work that falls overwhelmingly on women.

In Bogotá, a city of 8 million people, nearly 4 million women do some form of unpaid care work, and about 1.2 million dedicate most of their time to it, meaning 10 hours a day or more. Many commute for hours to reach paid care jobs, only to return home and do more unpaid care. 

At a care block, a woman can access a variety of services while the person she cares for is looked after by teachers and staff nearby. She can hand off her laundry to an attendant, finish her schooling, meet with a lawyer, consult a psychologist, or learn job skills. The scope of activities is not limited to errands, either: She can also read a novel, catch up with friends, or just get some rest. And the system extends beyond the physical blocks — mobile buses bring comprehensive services to rural areas, and an at-home program targets caregivers who support those with severe disabilities and therefore cannot leave their houses.

Bogotá is trying to do something tricky: elevate both care work and caregivers, while also saying, “You shouldn’t have to be doing this so much — you deserve a full life beyond caring for kids, for aging relatives, for your partner.” 

Understanding how Bogotá built its care system — and the challenges it faces — offers a template for other cities. And indeed, what started as a local experiment is now gaining traction internationally. Freetown, the capital of Sierra Leone, expects to open its first care block by this year’s end. Guadalajara in Mexico approved funding for several “care communities” earlier this summer, and care blocks are already operating in Mexico City and Santiago, Chile. Activists and public health officials in England are trying to adapt the model, and a funder is even seeking to pilot care blocks in an American city in 2026. 

The novel idea is putting caregivers — not just care recipients — at the center of policy, says Ai-jen Poo, a leading voice in the US care work movement and president of the National Domestic Workers Alliance. Poo traveled to Bogotá in 2023 to learn more and said the program “blew her mind.” Before the pandemic, she added, most people didn’t identify as caregivers per se — even if they saw themselves as moms, parents, children. 

“What could be the next big breakthrough is cities putting the idea of a caregiver and intergenerational care at the center of how you design access to services,” Poo said. “That’s the future.”

Behind Bogotá’s care revolution is a women’s movement with teeth. 

In 2010, Colombia became the first country to legally require that its government quantify how much unpaid work was being done and by whom. The initial time-use survey, conducted in 2012, found that caregivers provided more than 35 billion hours of labor each year, amounting to more than one-fifth of the country’s GDP. Women did 80 percent of that work.

The political will to do something about those statistics started to build. One movement bolstering women in the city was the Mothers of False Positives, led by women whose sons had been killed by the military in the mid-2000s; the military then falsely presented these men as guerrilla fighters to inflate its own body counts. The mothers transformed their grief into a public reckoning, marching, testifying, and demanding justice — reframing the work of motherhood itself as a form of political resistance.

Bogotá’s social landscape made space for that kind of organizing. Decades of civil war and displacement had reshaped the city, creating an openness to more fluid household structures. Extended families are common, with grandmothers, aunts, and sisters raising children together, often out of necessity. Single mothers aren’t whispered about as moral failures like they sometimes are in the US. 

All these factors paved the way for Claudia López’s 2019 mayoral campaign. López had already built a reputation as an anti-corruption crusader who unapologetically centered gender equity. The then-49-year-old ran as an openly gay woman in a Catholic country, aiming to become both Bogotá’s first female and its first LGBTQ mayor — and won with 35 percent of the vote in a tight four-way race. 

“The women’s vote was crucial in setting the stage for this,” Ai-jen Poo recalled. “And they were ready with their economic priorities and gave the mayor a mandate, if not the actual solution.”

Care blocks, the signature policy of López’s administration, are built around the “3 Rs”: recognize, redistribute, and reduce. Recognize that care work is real work that sustains society. Redistribute it — not just between women and men, but to care recipients when able, and to the state, employers, and communities. And reduce the overall burden so individual caregivers aren’t consumed by it.

López launched this District of Care System in 2020 through an executive decree, which gave her the authority to create the programs but also meant any future mayor could undo them just as easily. The initiative was allocated 5.2 trillion pesos (about $1.3 billion) in the city’s 2020–’24 development plan — much of it from reallocating existing service budgets and cost savings from turning single-use public facilities into new multi-purpose hubs. López’s administration later helped pass a law through the city council requiring different agencies to fund and run the care system. Unlike a decree, the law couldn’t be undone by a future mayor alone.

Colombia bars mayors from running for consecutive reelection, so as López’s term neared its end, no one knew whether the next leader would continue her signature policy. 

Her successor, Carlos Fernando Galán, couldn’t have been more different. The son of Luis Carlos Galán — a presidential candidate assassinated in 1989 for confronting narco-politics and corruption — the younger Galán billed himself as a centrist technocrat focused on fiscal responsibility and data-driven governance. In 2023, he won on a platform of public safety and restoring trust in government, far from López’s more liberal and feminist message.

Galán could have pushed to end the care blocks. But the system had momentum, having earned international attention from the United Nations, funding from Bloomberg Philanthropies for its at-home assistance component, and praise from leaders around the world. All this made it easy for Galán to ride the goodwill and claim credit for the accolades his city kept earning for running programs in spaces most people would never expect.

For 14 years, El Castillo was one of Bogotá’s most notorious brothels — a place where businessmen, mobsters, and foreign clients paid for access to its VIP floors. Its ties to drug trafficking networks made it the target of a 2017 raid, after which the building sat abandoned for three years. 

In 2020, the city converted the facility into the Castillo de las Artes — the Castle of the Arts — a cultural hub and care block.

Lebeb Infante, the care block’s director, was matter-of-fact about Castillo’s history and unapologetic about its current clients. “This neighborhood has the highest concentration of sex workers in the locality,” she said. “Many of them are caregivers — they have children, they’re supporting families. We also have a huge migrant population, people fleeing violence in Venezuela and rural Colombia. So the services here have to work differently.”

Offerings must account not only for gender, but for immigration status, which means helping people navigate bureaucracy when they don’t have papers or IDs and need to get certified for work or enroll in school. This particular block has two laundromats instead of one, plus a free clothing closet. “If someone needs pants to go to a job interview, we give them pants,” Infante said.

El Castillo is also home to an Arte de Cuidarte, or Art of Care center — the child care component that exists in every care block across the city.

On the day I visited, children’s voices rang out from behind an arched doorway. Streamers in purple and green — Halloween decorations — hung from the ceiling. Like any preschool classroom, it was bright and chaotic, with walls covered in artwork and educational posters.

Art of Care programs serve a wider age range than traditional day care, welcoming children from 11 months to 11 years old. Bogotá already has a robust public day care system: Free centers have existed since 1968, managed by the national child welfare agency and the city’s social integration office. These care block programs have a more specific purpose: free up time for caregivers so they can prioritize services, both for long-term goals and their immediate needs.

Parents don’t just drop off their children and leave to run errands all across the city. Many of the errands can be completed right there on-site. One of the key challenges for caregivers dealing with “time poverty” is finding space in their day for anything else — their own health concerns or new credentials that could put them on a more secure financial footing. The Art of Care tries to eliminate some of that friction. 

Juliana Martínez Londoño, the deputy secretary of Bogotá’s Women’s Secretariat, emphasized that the Art of Care was not meant to compete with the city’s existing day care infrastructure.“But the Art of Care is much more flexible,” she said. “It can be mobile, it can adapt to different schedules, it can go where caregivers are.” 

An even more ambitious vision for the future of child care comes from Camila Gómez, the director of Bogotá’s citywide care initiative. She imagines 24-hour mobile child care centers for women who work night shifts, like bus drivers or recyclers who sort trash before dawn. The service could be more widely available, coming to a university student on exam day, or an employee whose company would pay for the service and get a tax break in return. “The goal is to not limit the Art of Care to people who are taking services at the care block,” Gómez said. “We want to make it for anybody who needs it.”

My trip overlapped with a citywide graduation ceremony for women who had completed month-long trainings in topics such as digital literacy, entrepreneurship, or professional caregiving. 

The auditorium was packed with caregivers in purple graduation gowns and caps. Some had brought their children, who squirmed in seats or played quietly in the aisles. Others had wanted to come but couldn’t make it work, still home caring for someone who needed them.

One hundred and twenty-seven women were graduating that day. Many were over 65. For some, this was the first time they’d ever graduated from anything. The crowd sang along to the city’s anthem — “Bogotá! Bogotá! Bogotá!” — and women smiled proudly as they walked across the stage to receive their certificates.

The mayor and many of his high-ranking staff had come to congratulate the women. “You have to bet on their autonomy,” Laura Tami, the city’s women’s secretariat, said from the stage. Galán also laid out the administration’s strategy: freeing more women from violence, including economic violence, by giving them the tools to become more independent. It was a notably feminist message from a mayor who had run as a centrist technocrat.

The ceremony was moving, but it also raised real questions about scale. Over 3,500 women have completed these 30-day training programs, and the city hopes to increase that number to 9,000. This would be progress, but it’s a small fraction of Bogotá’s 1.2 million full-time caregivers. 

Plus, my conversations at different care blocks surfaced the same challenge over and over. Many caregivers just didn’t know that these supports existed. And plenty who did didn’t trust them and didn’t believe Bogotá would actually keep them running, or that the services would actually be free. Some had shown up to care blocks looking for food and had been turned away empty-handed.

“We really do need to work harder on spreading the word [and] improving trust,” said Jason Díaz, the manager of the laundry services at the San Cristóbal care block. “There is a lot of stigma with government institutions.”

And sometimes the services are just not enough. Blanca Liliana Rodríguez told me about the at-home assistance program her family had benefited from last year. Rodríguez cares for her two adult sons — one with physical disabilities, one with mental disabilities — plus her 77-year-old mother and her 82-year-old father-in-law, who lives elsewhere. She’d been cooking three meals a day for her father-in-law and delivering them to his house.

The psychologists who came through as part of the government program worked with her family for three months, teaching Rodríguez and her sons how to communicate better, and even leading couples therapy with one of her sons and his girlfriend. They helped her realize she was taking on far more than she needed to. Her sons started helping with cleaning and picking up medications and she joined a new WhatsApp group with 30 other caregivers in her neighborhood that remains active to this day. 

But when the time-limited services ended, Rodríguez was on her own again, still overwhelmed by the sheer scope of what she was managing. “Three months is definitely not enough time for the at-home assistance program,” she told me.

The city officials accompanying me on the visit immediately defended the short timeline. The program, they emphasized, was intentionally brief — designed to “install capacity” in caregivers and make them more resilient. It felt a bit like PR for a funding problem, not to mention condescending — these women were already extraordinarily resilient. They were just dealing with their own health and financial problems, their own exhaustion. Rodríguez said her memory had been getting worse.

At the beginning of this year, Bogotá stopped administering the at-home assistance program that had helped Rodríguez and her family. The Bloomberg funding that had supported the services had run out, and Galán’s team hadn’t figured out how to keep paying for it, let alone scale it up.

An independent evaluation, conducted over the last two years, found that the at-home program had freed up over 18,000 hours for caregivers and reduced their daily unpaid care work by more than an hour. Half of the caregivers reported feeling less burdened, and nearly half of people with disabilities became more independent.

But it was expensive. So the city tested a cheaper model, moving some therapeutic services into the care blocks rather than delivering everything at home. The new hybrid model cut costs per participant by 57 percent while still reducing caregiver depression and anxiety.

When I asked Galán’s administration whether the city would resume its at-home programming, Tami, the women’s secretary, responded that they planned to restart services next year. The city aims to run both models: full at-home assistance for caregivers who truly can’t leave their houses, and the lower-cost hybrid for others. 

Meanwhile, Galán has continued expanding the less expensive parts of the care system. His team opened two new care blocks this year and added programming like nature therapy sessions run by the city’s botanical garden.

James Anderson, who leads the government innovation program at Bloomberg Philanthropies, told me that he expects the care block idea to expand further around the world, and that the United Nations Development Programme has been working actively behind the scenes to help. At a 2024 Bloomberg event in Mexico City last year, more than 70 mayors toured the city’s own version of care blocks, known as Utopías, and showed “incredible interest.” 

Anderson thinks the model could follow the trajectory of climate action planning. Before 2005, he pointed out, mayors didn’t talk specifically about “climate”: They had water projects, sanitation projects, housing projects, all run by different agencies with no coordination. Twenty years later, every major city has a climate action plan that coordinates efforts across city hall. “That’s the trajectory that I imagine this issue will travel,” he said.

That vision is already underway. CHANGE, the City Hub and Network for Gender Equity, is a global network of city governments led by former mayoral staffers in London and Los Angeles. They’ve been working to spread the Bogotá model, developing an implementation guide and planning workshops for interested cities. Currently, they’re coordinating with a team in greater Manchester in England, have been helping Freetown in West Africa, and are actively involved in identifying a US city for a pilot next year, though conscious of the growing American backlash to anything associated with diversity, equity, and inclusion. 

“If you can’t make the case for why this won’t make your dollar stretch, there’s no point in having the conversation,” said Leslie Crosdale, CHANGE’s co-executive director. “It’s an efficient system and makes your city more resilient.”

Yvonne Aki-Sawyerr, the mayor of Freetown, credits both CHANGE and Claudia López with helping kick off the idea in her city. Their care block is expected to launch by mid-2026, and in the meantime, Freetown is opening three temporary spaces before the end of December to meet demand from women in the community. “What excited me was being able to give back an opportunity that many women lost — the opportunity for education, the opportunity to just get health care,” Aki-Sawyerr told me.

Poo, who leads the National Domestic Workers Alliance, pointed to a disconnect in the US, where cultural expectations assume families can manage needs independently, despite millions being nowhere close to affording enough care. “You have this mismatch between the infrastructure and the reality where the individual family is just bearing the brunt in an impossible situation,” she said. “I think there’s a use case in the US for care blocks. It probably won’t look exactly the same, but I do think that there’s a lot there.”

Back in Bogotá, Jason Díaz, the 36-year-old manager of laundry services at the San Cristóbal care block, offered a glimpse of what that could look like in practice. He told me his job had made him more sensitive, more humane, teaching him to slow down more, and notice when someone needs help before they ask. “You learn to do it everywhere — at home, on the street,” he said. “It teaches you how to help people without expecting anything in return. The important thing is to be part of the solution.”

At the Castillo de las Artes care block, a sign hung on the wall in bright purple and green: “Cuidar no es ayudar, es corresponsabilidad.” To care is not to help; it is co-responsibility.

Spanish-English interpretation for reporting was conducted by Catalina Hernandez. This work was supported by a grant from the Bainum Family Foundation. Vox Media had full discretion over the content of this reporting. 

Millennials moved to cities in droves during the 2000s and 2010s, drawn by the restaurants, the nightlife, and the high-paying jobs. Urban planners and local leaders celebrated, embracing what became known as the “creative class” theory — the idea that attracting educated, creative workers would drive cities’ economic growth.

Real estate developers built accordingly, constructing apartment buildings filled with studios, one-bedrooms, and two-bedrooms designed for singles, roommates, and childless couples. Young professionals could afford the rent, and investors got steady returns. Building larger apartments for families felt risky when the smaller units were working so well. As for single-family homes or townhouses, the types of housing that families with children typically seek out — well, cities weren’t building those either.

The strategy worked — until millennials aged out of it. As they now enter their 30s and 40s and start having children, they’re ditching cities where the housing stock never caught up to their changing needs. Across the nation, large urban counties lost roughly 8 percent of their under-5 population between 2020 and 2024, according to data from the Economic Innovation Group. In New York City, families with children under 6 have left at twice the rate of everyone else, a trend that became central to incoming mayor Zohran Mamdani’s winning affordability campaign.

When families leave, cities lose far more than tax revenue; they lose their highest earners, biggest spenders, and the next generation of workers. Because Gen Z is a smaller generation, and the rise of remote work means there’s less pressure for them to live in expensive cities to access high-paying jobs, they aren’t going to fill the gap left by millennial families. 

The creative class theory wasn’t wholly wrong, but it missed that cities need to retain those people through their peak earning years, which happen to coincide with when they have children. And as baby boomers retire, working parents become even more critical to a city’s economic strength.

If cities hope to remain economically healthy, they’ll need to build more housing for families with kids. 

Why cities haven’t been building for families

Several forces have worked against family-friendly development. Homeowners increasingly tend to be older and past their child-rearing years and often oppose changing zoning laws to allow more housing in their neighborhoods. Worried that the increased density could hurt their property values or quality of life, these more affluent, politically engaged residents tend to wield their outsized influence to keep newcomers out. 

As a result, American cities are overwhelmingly zoned for single-family housing, leaving little room for the kinds of duplexes, townhouses, and smaller apartment buildings that offer young families an affordable middle ground between cramped apartments and expensive homes.

There is also resistance to certain kinds of families moving in. “I’m sorry, but class and race matter in America,” said Mildred Warner, a professor of city and regional planning at Cornell University. Put differently, many cities have used exclusionary zoning over the years to keep out Black and low-income families. 

Upending these historic patterns will require policy changes beyond just fixing zoning codes. Ending parking minimums — which force developers to build a certain number of costly parking spaces per unit — would make it cheaper to construct family-sized apartments. Allowing single-stair buildings up to four stories — rather than requiring two staircases — would free up space for larger, more flexible floor plans better suited to families. Making it easier to approve smaller buildings (those under 50 units) would let developers experiment with different housing types.

Another option is to pass laws requiring developers to include more family-sized units, like three- or four-bedroom apartments, though real estate experts warn that such a prescriptive approach could backfire.

An alternative idea, proposed by the Institute of Family Studies (IFS) this year, is to change how governments measure the success of their affordable housing programs. Right now, funds that finance apartments at public expense focus on maximizing the number of units built. IFS researchers suggest they should instead prioritize the number of bedrooms and the number of people housed in order to incentivize family-sized apartments. 

A professional culture problem exists, too. Many planners simply don’t consider designing urban communities for families to be part of their job. Michael Huling, a senior county planner in Clark County, Nevada, traces the issue back to dynamics from the 1960s and 1970s, an era when people were flocking en masse to suburbs. Limits on density, rules on how far houses must be from streets, and onerous parking regulations all contributed to a development culture that treated families as a suburban concern, not an urban one.

“A lot of those anachronistic development patterns and development priorities are still lingering today and we’re still stuck with them,” he told Vox.

Still, there’s a structural problem that goes deeper than zoning and building codes, or even professional norms. Kids don’t pay taxes, but they do absorb plenty of government services, and cities crave population growth without the associated costs of funding it.

The economic reality is harsh and unevenly distributed. Public support for seniors can be up to three times higher than for children, but the federal government provides the vast majority of senior aid while covering less than a third of child subsidies. Instead, state and local governments bear the bulk of K-12 education costs, creating a negative incentive for cities to welcome families with school-age children.

Warner has found that many politicians restrict family housing, because they don’t want to pay for the schools those children would attend. Because schools are funded largely through local property taxes, cities treat school spending as a direct burden on local budgets while ignoring that businesses benefit enormously from having its future workforce educated nearby. They “ignor[e] the increasing importance of human capital investment as a critical economic development strategy,” she wrote.

Robert Verbruggen, a fellow at the Manhattan Institute, put it bluntly. “Kids don’t pay for themselves while they’re still kids,” he told Vox. “They pay for themselves later when they grow up and get jobs.”

His advice for mayors is pragmatic: If you want a thriving city, you need growth and more people paying taxes. Welcome families now and “you have a built-in fan base of the next generation of kids who grew up there and are already familiar with city life.”

A belated recognition of the consequences

In addition to city planners, more elected leaders are beginning to recognize the crisis of housing in their cities. They’re right to, given the compounding challenges their cities face if the crisis continues pushing families to leave. If people in their early-to-mid-30s leave cities right when they’re becoming most productive and experienced in their careers, then they take their mentorship skills and institutional knowledge with them. Cities tend to end up with extremes at both ends: lower-income residents and very wealthy residents in luxury housing, but fewer middle and upper-middle class families.

Once families leave, cities are left with fewer vocal advocates pushing for better schools, parks, and transit, making the areas even less attractive to the next generation of parents. And as stressful as more kids in schools might be to finance, in the long run, declining school enrollment (fueled in part by more people leaving cities) and fewer children born mean even fewer taxpayers and less consumer spending. 

Indeed, declining birth rates are another problem. Recent research has found clear links between housing costs, housing size, and birth patterns. Not only is a lack of suitable housing steering families out of cities, it’s contributing to some people choosing not to have kids at all. 

The Institute for Family Studies found that housing costs limit childbearing goals more than any other factor, including undesired singleness, preference for leisure, schooling, child care costs, and student debt. Housing costs can lead to living with one’s parents for longer, and that has a huge negative effect on fertility.

Another study published this month by an economist at the University of Toronto estimated that rising housing costs in the US since 1990 have led to 11 percent fewer children being born and building more two- and three-bedroom apartments could more than double the impact on birth rates compared to building more one-bedroom units. 

Ideas to stem the bleeding

These and other changes are forcing the real estate industry to shift. Some institutional buyers — the investors who purchase apartment buildings to operate as rentals — are starting to reject studio and one-bedroom heavy buildings, worried that tenants will keep moving out after short stays, driving up their operating expenses. And construction financing challenges driven by tariffs and high interest rates have created new openness among developers to rethink their more conservative approaches. The “built-to-rent” boom has also demonstrated to investors that families with kids will, in fact, rent homes. 

One developer is advocating for a range of other solutions. Bobby Fijan is one of the country’s most vocal critics of his industry’s inertia. He started the American Housing Corporation to build family-sized row homes, with the first one set to open in Austin in December. Eventually, Fijan wants to expand into apartments.

He’s pushing other ideas, too. In a study published in September, Fijan and IFS senior fellow Lyman Stone surveyed over 6,000 Americans about their housing preferences. When shown apartments of the same square footage but different bedroom configurations, many people preferred layouts with more rooms, even if they don’t currently have children.

One model emerged as particularly promising: the one bedroom plus a den. Dens, which often have no windows or closet, are commonly used for an office, a TV room, or nursery. Fifty-seven percent of childless-by-choice people preferred this layout over a standard one-bedroom of the same total size, as did 54 percent of people who say they’d one day want kids. 

For the real estate industry, the IFS pitch is straightforward. Since developers are already building apartments at 750 to 1,100 square feet, adding one more wall to divide the space could create units that appeal to a broader market. And because families with kids stay in apartments longer than singles, lower turnover could translate to lower operating costs.

If cities can keep couples expecting their first child even a half decade or so longer, they might begin to address the problems Warner and others have warned about. More families staying means more of the high earners and high spenders who drive local growth.

But Warner is skeptical of the bedroom-plus-den plan, which puts a ceiling on family size. People “like to stay where they are,” she said, and with that arrangement, you’d probably relocate as your family grows. It could accommodate babies and toddlers, but would be less ideal for teenagers who want real bedrooms with doors and windows (and parents of teenagers who’d want that, too). She’d rather see cities build actual two- and three-bedroom units — a return to how cities used to build before developers shifted to smaller apartments. 

Fijan and Stone don’t disagree but see their proposal as a way to work within existing constraints. Their hope is that keeping families in cities through their children’s early years could create ongoing political pressure for the deeper changes needed to truly fix the problem.

In the end, housing alone won’t keep families from leaving cities. Cities still need to address public safety concerns, improve schools, and fix basic infrastructure like broken sidewalks and unreliable buses. That will require substantial investments in education, transit, and child care, not just removing regulatory barriers. It will mean challenging homeowners who benefit from the status quo and making spending choices that might not pay off for years.

The cities that figure out how to keep their families will thrive. For local leaders watching parents flee and school enrollments drop, these are fights worth having.

This story was supported by a grant from Arnold Ventures. Vox had full discretion over the content of this reporting.

Correction, November 24, 2:30 pm ET: A previous version of this post misstated the city where American Housing Corporation is building its first family-sized row home.

One of President Donald Trump’s boldest campaign pledges was to make in vitro fertilization (IVF) completely free. Yesterday, the Trump administration released its long-awaited proposals — which come nowhere near making IVF free, or even significantly more affordable. 

That promise, a late gamble to win back women voters aggrieved by the GOP’s hostile stances on reproductive rights, had been immediately controversial within his own party. Even though seven in 10 Americans support access to IVF, some religious conservatives believe the procedure — which involves fertilizing eggs outside the body and then transferring embryos to a womb — violates the sacred connection between sex and conception. They also object to embryos being destroyed in the process. In June 2024, the Southern Baptist Convention, the largest Protestant denomination in the US, approved a resolution against IVF, and social conservatives have been lobbying the administration for more medically fringe “natural” solutions to tackling infertility instead.

Trump’s new proposals fall far short both of his campaign pledge and a February executive order soliciting recommendations to “aggressively reduc[e] out-of-pocket and health plan costs” for the treatment. (IVF can cost up to $25,000 per cycle and most patients undergo multiple cycles to achieve a live birth.) On offer is federal guidance (essentially a suggestion) for employers to provide fertility coverage as a stand-alone, optional benefit, similar to dental or vision insurance. The administration also secured an agreement with drugmaker EMD Serono to sell common IVF medications at steeply reduced prices through the forthcoming TrumpRx.gov portal, a new website where patients can buy prescriptions directly instead of using insurance. 

Neither move includes new subsidies, mandates, or funding — meaning most patients will see little to no relief.

The voluntary employer guidance proposal is unlikely to work in practice. First, employers already can offer fertility benefits if they want to. The guidance asks employers to shoulder as much as $25,000 per IVF cycle for an employee’s medical care when many businesses already struggle to provide basic health insurance to staff. 

And unlike vision or dental plans, where low costs are spread across most employees, a standalone IVF plan would only attract the small fraction of workers who need expensive treatment, meaning premiums would almost certainly go up for them. 

The TrumpRx discounts, meanwhile, would not help most patients. Most people purchase fertility drugs through their health insurance, meaning they can’t use the TrumpRx site even if its prices are lower. And even for those paying in cash, the discounts target a narrow slice of the overall bill. Drug costs make up a relatively small share of IVF expenses; most costs come from lab work, procedures, and embryo storage. The White House estimates their discounts will save patients up to $2,200, or less than one-fifth of the cost of one IVF cycle. Despite the lack of real relief for patients, many on the right were not thrilled, either.

Despite lobbying pressure, the Trump administration did not back down from vocally embracing IVF, either as a means to help patients experiencing infertility or as a tool to boost the country’s birth rate. When asked at his Thursday press conference what message Trump had for religious conservatives opposed to IVF, the president shrugged it off. “This is very pro-life,” he replied. “You can’t get more pro-life than this.”

What the Trump administration could have done to lower costs

The president declined to take the more ambitious steps available to him to expand access to IVF.

One option the administration left on the table was expanding the list of “essential health benefits” — the set of services that all individual and small-group insurance plans must cover, which already includes maternity and newborn care — under the Affordable Care Act. The Department of Health and Human Services had the power to  require marketplace insurers to cover at least part of the procedure and establish a basic national floor for fertility coverage. New York has already done something similar at the state level, mandating that large-group insurers cover up to three IVF cycles.

Adding IVF to the list of “essential health benefits” wouldn’t have made it free, but it could have reduced the out-of-pocket costs by tens of thousands of dollars, expanding coverage for nearly 50 million Americans. Yet, Republicans have long fought to weaken or roll back the list of  essential health benefits, arguing that the ACA’s coverage requirements drive up premiums and limit consumer choice.

The administration also could have expanded IVF coverage within the federal government’s own health plan, which covers roughly 8 million federal workers, retirees, and their families. The Office of Personnel Management has the authority to require participating insurers to offer fertility benefits, and the Biden administration used that same power in 2023 to mandate coverage for egg and sperm freezing.

Beyond executive action, the administration could have pushed Congress for more ambitious measures: tax credits for employers offering fertility benefits, direct federal subsidies for treatment costs, or expanded Medicaid coverage. It declined to spend political capital on any of these solutions.

Applause, outrage, and a familiar pattern

The rollout of Trump’s proposal was predictably fractured. Fertility groups lauded the White House for publicly championing IVF after months of uncertainty. In a statement, Sean Tipton of the American Society for Reproductive Medicine praised the administration for “using [its] platform to draw attention” to the fertility treatment gap in employer-provided health plans and for working with drug companies to tackle costs. RESOLVE: The National Infertility Association struck a similar tone, telling The 19th that Trump’s announcement marked “an important step forward.” Back in May, both national organizations said they had not been consulted by White House officials exploring IVF ideas. 

Democrats and abortion rights groups, meanwhile, dismissed the proposals as hollow.

Reproductive Freedom for All president Mini Timmaraju said the announcement was another attempt “to gaslight the American public into believing he’ll deliver on empty campaign promises.”

Other anti-abortion groups condemned the policy outright.  “IVF kills more babies than abortion,” Live Action’s Lila Rose wrote on X, while Students for Life president Kristan Hawkins said she was “thankful there’s no new healthcare mandate” but called the president’s ideas a disappointment. “It’s time to find real solutions that help families grow and flourish without killing Life in the process,” Hawkins stressed. Other anti-IVF groups like Us Before Them blasted the White House for delivering “a full federal endorsement of an industry that treats children as products to be ordered, screened, stored, and discarded.”

Some social conservatives initially tried to spin Thursday as a victory, since the administration had avoided more aggressive mandates. “It should be counted as a win for the traditional social conservative movement, which tirelessly pointed out the huge financial, ethical, and moral risks associated with a federal guarantee or mandate of IVF coverage,” Patrick Brown, of the conservative Ethics and Public Policy Center, said on X. He later walked that back slightly, telling me it was perhaps “not a ‘win’ but it’s also definitely not a ‘loss.’” 

Still, the expectation that Trump would mandate taxpayer-funded IVF was always far-fetched. Fiscal conservatives had loudly opposed the idea, with senators like Rand Paul calling it “ridiculous” and Lindsey Graham warning of unlimited costs. Even former Trump administration economist Vance Ginn — who used IVF for two of his own children — argued against a government mandate, pointing to soaring deficits and constitutional concerns.

In the end, the winner was Trump, who earned glowing national media coverage for his extremely modest proposals. For most Americans, “making IVF more affordable and accessible” sounds like meaningful progress, even if it falls far short of the campaign promise to make it free. It’s the same performative moderation that has worked for him since the overturn of Roe v. Wade — promising to veto a national abortion ban even as his administration quietly reinstates funding restrictions, backs lawsuits targeting abortion medication, and fills agencies and courts with officials eager to narrow access. 

The outcome was predictable: Trump gets credit for tackling a popular issue without spending the political capital to actually solve it.