Latin America’s history reveals how policies aimed at boosting births can backfire without safeguarding reproductive choice for families.
History rarely repeats itself, but it does often rhyme. We may feel like the expanding restrictions on reproductive freedom that is currently happening in the United States is unprecedented, but our Latin American neighbors have walked this path for decades. There are many lessons we can learn from their experience on the far-reaching impact of such restrictions on social justice, legal strategies and policymaking.
President Donald Trump signed an executive order on Feb. 18 aimed at expanding access to in vitro fertilization (IVF) by reducing costs and removing barriers to care. However, the current regulatory landscape, which is characterized by antiabortion language, poses significant threats to IVF access. Without safeguarding abortion rights, efforts to make fertility treatments more accessible may be undermined by legal precedents that restrict reproductive autonomy.
One year ago, the Alabama Supreme Court ruled that embryos (including those produced for IVF) could be considered children, citing Dobbs v. Jackson Women’s Health Organization as precedent. While Alabama’s governor later signed a law granting immunity to healthcare providers, the ruling set a dangerous precedent: Dobbs can be used to restrict not just abortion, but all forms of reproductive autonomy.
Restrictions on abortion can spiral into broader attacks on reproductive freedom—limiting access to medical technology, disrupting hospital systems and increasing costs for everyone.
We don’t have to imagine the consequences of restricting reproductive care; other countries have already lived through them.
What’s unfolding in the U.S. now mirrors what happened in Costa Rica more than two decades ago. There, legal definitions and protocols designed to ban abortion had far-reaching, unintended consequences—not just for people seeking to end a pregnancy, but for those trying to start one.
In 2000, Costa Rica’s Supreme Court effectively banned IVF. The rationale was that IVF creates multiple embryos, some of which are “inevitably destined to die.” Since the Costa Rican Constitution guarantees the right to life from the moment of conception, the procedure was deemed unconstitutional.
Antiabortion advocates celebrated the decision. But the consequences soon became clear.
Between 2003 and 2008, the rate of quadruplet births increased by 1,200 percent and the rate of quintuplets increased by 29,000 percent. Normally, a quadruplet birth happens once every 512,000 births. But in just six years, Costa Rica saw 11 of them—compared to just one in the six years prior.
The culprit? Medical tourism.
Couples who couldn’t access IVF in Costa Rica began traveling to neighboring Panama, where regulations were looser. To boost success rates, doctors there often implanted five or six embryos at a time, far exceeding the American Society for Reproductive Medicine’s guidelines of no more than one.
Dr. Gabriela Alvarado, a maternal health researcher based out of Washington, D.C., saw the impact up close in the early 2010s. “I was an intern at Costa Rica’s largest maternity hospital, and I remember the day a supervising physician burst into the break room: We were needed—urgently. A high-risk pregnancy involving quintuplets had arrived. We scrambled to assign teams to each baby and the mother, and redirected all other laboring patients to other hospitals. And even with all these measures, we knew we couldn’t save every baby.”
This is what happens when reproductive care is restricted: It forces families to take medical risks they would not otherwise choose and places enormous pressure on hospitals, especially in low-resource areas.
One in four married women in the U.S. experiences infertility. While IVF has become increasingly common—2.5 percent of all births in the U.S. between 2021 and 2022 were a result of assisted reproductive technologies—only a fraction of patients can afford it. And as with abortion, barriers to IVF access disproportionately affect low-income families and racial and ethnic minorities.
The Costa Rica example shows how restrictions on abortion can spiral into broader attacks on reproductive freedom—limiting access to medical technology, disrupting hospital systems and increasing costs for everyone.
While U.S. abortion bans may not be aimed directly at IVF, they end up hurting families who are desperate to have children.
Public support for abortion in the U.S. remains high—around 63%—but that support does not translate into meaningful protections. That may be because many people still see abortions as someone else’s issue. But it’s not. Whether we want to end a pregnancy or start one, reproductive freedom affects us all.
The current administration has recently emphasized the goal of increasing the nation’s birthrate and included IVF as a potential avenue for doing so. As policymakers begin to think about the operationalization of expanded IVF access and how to help families who want to have children, they must not overlook the foundation it rests on: the right to make personal medical decisions, free from political interference. That includes protecting access to abortion, in every state.
