How Does Pronatalism Impact Therapy?

When mental health care is not childfree affirming.

Reviewed by Devon Frye

Key points

• The term "pronatalism" refers to the cultural and institutional forces that pressure people to have children.
• Many foundational theories of psychology contain themes of pronatalism.
• Currently, there are no specific therapeutic interventions tailored to the childfree community.
• Therapists must learn about the childfree population and examine their own biases about parenthood decisions.

As a therapist in training, I was unaware of the childfree by choice community. Despite my graduate program’s strong focus on multicultural issues, we never covered how to support individuals who choose to be childfree.

It wasn’t until later in life that I became aware of some of the challenges faced by this community and found myself surprised to learn there weren’t more mental health resources tailored for it. It turns out most other therapists didn’t learn about this as part of their training, either. This experience led me to explore what's known as pronatalism and how it can affect therapy.

What Is Pronatalism?

“In contemporary Western culture, it ironically appears that one needs to have reasons not to have children, but no reasons are required to have them. People who are childless are frequently and rudely criticized and called to account for their situation… the choice to procreate is not regarded as needing any thought or justification.” —Christine Overall

Pronatalism refers to the cultural and institutional forces that pressure individuals, especially women, to have children. This phenomenon permeates various aspects of society, including religion, politics, economics, and family life. For instance, pronatalist policies may include tax breaks for having children, humorously captured in memes about claiming pets as dependents.

Pronatalism overall grants parents a privileged status in our society. As Katie Maynard, LICSW, points out, our everyday language reflects this bias: terms like “family,” typically imply parents and children, while people who aren’t parents are defined by what they lack, using words like “non-parents” or “childless.”

Like other “-isms,” pronatalism can be psychologically harmful to those who deviate from the norm. Childfree individuals often face judgment and unsolicited comments, a phenomenon known in the community as being “bingo’d.” Imagine a bingo card, and each item on it is a pronatalist statement childfree people hear repeatedly, such as “You’ll change your mind,” “Your child could grow up to cure cancer,” and “You’ll never experience real love.” Childfree people hear these comments so often that they could carry the bingo card around and check the items off.

How Pronatalism Shows Up in Therapy

Unfortunately, pronatalism has also influenced the field of psychology. Psychotherapist Emma Palmer argues that this begins with the theories of human development that many psychotherapies are built around.

For example, Erik Erikson’s stages of development are characterized by a series of conflicts people must resolve to mature. One of these stages is called “Generativity vs. Stagnation/Self-Absorption,” where the developmental challenge is to find a way to impact the next generation. Traditionally, this was thought to occur through parenting.

Perhaps because of this bias in the foundational theories of psychology, there is very little research on childfree people in general, and even less on therapeutic interventions for the childfree population. This bias means many therapists are not knowledgeable about the childfree community.

It also means therapists don’t have evidenced-based interventions for challenges specific to the childfree lifestyle. For example, while there are standardized protocols for helping people parent an unruly child, there are no protocols for helping childfree people cope with being “bingo’d.”

Even more concerning is the fact that some therapists exhibit biased attitudes toward childfree clients. One childfree woman shared online about her experience of telling her therapist she did not want to have kids, only to be met with defensive responses like “opinions change” and even “you have no say in this since you’re 19.” Unfortunately, Palmer describes encountering childfree individuals who have been traumatized by pronatalist therapists who pathologize the decision to be childfree.

Such attitudes are clearly unethical. Many ethics codes for the helping professions, such as the American Counseling Association Code of Ethics, instruct clinicians to not impose their own values on clients. Therapists should evaluate their own cultural, spiritual/religious, and political backgrounds, and think about the biases they might bring into the therapy room.

Most of us can see how it would be unethical for a therapist to try to change a client’s religious beliefs or to treat a client differently because of these convictions. Similarly, therapists should not act in a biased way toward childfree people or attempt to influence a client’s reproductive decisions.

Next Steps

While the field of therapy is evolving, therapy clients should feel empowered to give their therapists feedback if they believe the therapist is acting in a biased way. Many therapists are eager to address their blind spots and grow as practitioners.

And as the number of childfree individuals grows, it’s important for therapists to learn about this population and its specific needs. Therapists must also examine their own experiences and beliefs about what it means to be childfree and be aware of how this background impacts their work with clients. This is an important step toward a world where all people get the attuned mental health care they deserve.