An Outsized Burden

Reflections on the mental health toll of large families and government pressure to build them

My friends, I worked on this post for a solid 12 hours and I’m hesitant to share it at all. One of the most painful things to me as a writer is to learn that my words have hurt someone, and writing about motherhood has endless potential to alienate and cause harm. We’re all touched by it: we had mothers, or our mothers left. We are all pressured to be mothers, and some say no, some say yes, some want to say yes but their bodies say no or they say yes and the precious life of their child is cut short.

So talking about family size is incredibly fraught. Yet in light of the political and cultural conversation on increasing family size, the threats to access to birth control, and the known mental health impacts of motherhood, it feels important to discuss. Please note, as you read this, that studies are aggregates: they represent common patterns, and your experience may vary. Nothing I share is intended as an attack or criticism on any individual’s choice. I resolutely affirm the right of every woman to pursue formation of the family that feels right to her, just as I affirm the right of every child to grow up in a home that is safe and nurturing. I hope every mother reading this feels seen, not criticized. The bottom line is no one should be pressured into a path that is not right for them.

My father was one of nine children, my mother one of six. All four of my grandparents were children of families ranging in size from 12-14 children in each nuclear home.

So when people commented that I came from a large family as one of four kids, I was always confused. Mores and values on family size are shifting sands.

Many of us have large ancestral families hailing from a time before birth control was available in the places they lived. Some continue the tradition based on religious values and beliefs, and a few based on preference, a genuine personal desire to love many children. The why makes some difference, but large families (defined in research as six or more children) too often share one thing in common: exhausted and depleted women.

16-child family in 1950s

Upon reading the research on the impacts of growing up in a large family, I set out to connect with my father with my newfound insight. I pictured his mom, my Nanny, anew: imagining her exhaustion, her love for her children, and her inability to take care of herself adequately amidst the endless demands. I remembered the pamphlet about depression tucked inside the cover of the Bible I inherited when she died. I hadn’t known.

But I did know the legacy of depression and mental illness flowed down through my mother’s side, as well. Even with just four, as fiercely as I treasure my younger siblings, I’ve often wondered whether, if my mother had had fewer children, been less constantly ragged with exhaustion, had more space to dedicate to healing from her own trauma, my mother might have found space to love me. Perhaps if she hadn’t grown up in the role of assistant mother, had been allowed to be a child herself, she might have had a vision of what cultivating a happy childhood could be. These musings factored, for better and for worse, into my tiny family of procreation, just my son, my partner, and me, pouring all my attention and care and playfulness into this child, unwilling that he ever question his belonging.

When I asked my dad about his experience of the common difficulties of being raised in a large family, he dismissed it, as he often does with my reflections on mental health factors impacting our family history. I let it drop. Perhaps it would have been more fruitful to ask one of my aunts, as the burdens on daughters in large families are magnified. Or, perhaps Nanny was one of those women who truly was able to love many children well. Studies show patterns; they don’t tell every story.

Here’s what the research shows: In very large families, the mental health of both women and children is compromised. Women become overwhelmed and exhausted, frequently experiencing a diminished or restricted sense of worth, as all their energies pour into others, and nothing remains for nurturing self or developing personal talents and interests. With an endless parade of babies, this experience of imbalanced energy output extends beyond a few difficult post-partum years of bleary-eyed early mornings and through-the-night waking and nursing into sometimes decades of non-stop post-partum demand, coupled simultaneously with the busyness of middle-grade children and the late nights and worries of parenting teenagers. All at once. It’s a sure-fire recipe for depression and anxiety with no recovery period.

As mothers, we are taught to put our children first, as they are the vulnerable ones, and we are shaping their very personalities and the neural structures of their brains, setting them up for mental health or illness throughout the lifespan. Oof. No pressure. So of course, we learn to put ourselves last.

The problem is, sometimes last never comes. With very large families, last may mean never. Never exercise. Never enough sleep. Never solitude in nature. Never tuning inward to listen to the whispers of your own body or soul. As a result, women with many children have higher rates of not only mental illness, but physical disease, as well[i]. It’s not a phase, this self-deprivation; it’s a self-destructive lifestyle motivated by love or duty or belief.

And though mothers of large families give, and give, and give endlessly, they cannot easily mitigate the negative impacts on their children. Studies show that children of large families, and in particular girls, are harmed by excessive household and child-care duties that are not commensurate with their own developmental phase. Yes, they learn important life skills, and they may learn teamwork and cooperation, but the parentification costs them childhood innocence and the self-organizing stage of play. Younger children suffer from being raised, at least in part, by siblings who are children themselves, who never chose the role, who are not adequately prepared to give the patience and nurturance a young child requires. Middle children suffer from both, and from being overlooked. There is more in-fighting amongst children of large families, more malnutrition, higher accident rates, increased violent punishment, diminished cognitive development, and subsequently higher rates of delinquency and substance addiction.[ii]

And yet, as with authoritarian regimes before them, the U.S. government is mulling ways to pressure married American women to have more babies. They cite a falling birth rate as a problem to be overcome, though really they belie the truth shared with other autocratic regimes with the same goals and strategies: the real fear is racial displacement. The global population continues to increase, with a population higher than our planet can healthfully sustain, and immigrants are have been eager to build lives in the U.S.A. But these families are being summarily removed, with children as young as two years old standing alone and unrepresented for immigration “hearings” and then deported from the country (including, in recent weeks, a two-year-old brown-skinned American citizen whose American father fought desperately and unsuccessfully to retain her[iii]). It’s not numbers the government fears. It’s color. When he says “we want beautiful babies from beautiful families,” he betrays not only the limits of his vocabulary but also of his vision: white babies from heteronormative white families. We all know what he means.

(And what is the message and its subsequent mental health impact on mothers of babies whose children are ousted from our borders along with them? Or to those whose children resemble the ones thrown out? We need more beautiful babies! the government declares. So, the immigrant is left to ask, are my babies not good enough, not beautiful enough? It’s a knife to the heart of a mother.)

So they mull “solutions”[iv] to this non-problem, including setting aside 30% of Fulbright scholarships for high-birthing mothers, as though they would have time, energy, or opportunity to study abroad. In a masterclass of mansplaining, they suggest educating women on their menstrual cycles, as though this self-knowledge isn’t intimately known by women already; as though we won’t harness this knowledge to regain control should they ban the birth control we use. A National Medal of Motherhood is proposed, borrowing a play used by Hitler[v] and Stalin[vi] and other autocrats before him[vii], to be bestowed upon women with six or more living children (no pity for infant or child loss; heartbroken and traumatized mothers are spit upon and led to understand their tragedies as personal failures at the elevated role of motherhood). A laughable $5,000 stipend per live childbirth is proposed[viii]: five thousand to offset the $30,000 price tag that comes with giving birth and the average $250,000 cost of raising a child to the hardly-independent age of eighteen. Five thousand in the face of removal of child welfare programs like Head Start, school meals, WIC, SNAP, Medicare, and the Department of Education. Five thousand, which won’t go far in paying for attorney fees should we have to defend ourselves in court against allegations that our miscarriages were crimes[ix].

In my therapy practice, Generation Z young adults discuss the gulf between a desire to parent one day and the practicalities that make having children a privilege they may never afford. The dreams former generations took for granted are switched off for all but the most privileged or the most reckless. Even one child or two feels out of reach when student loans burden and making rent is aspirational.

But those pushing for large families aren’t part of the generation tasked with reproducing. Those mulling strategy within gilded halls have no connection to modern pragmatics. They imagine a little prize, of cash or of metal, might move the needle when it has failed to do so every time it has been tried around the world[x].

High birth rates are correlated with weak economies – both resulting from lack of options, and causing them, by removing women from the workforce.

In the present age, shifting global social realities seem to support a decreased birth rate. The planet can’t sustain a ballooning population with its high resource and fossil fuel demands and toxic greenhouse gas emissions. With the advent of AI, new and future graduates face a landscape increasingly devoid of jobs as unpaid cyber intelligence reduces demand and opportunity. Countries with shrinking populations may be best set up for the changing social structure of fewer jobs and probable increased need for welfare support.

This is a move straight out of historical fascist playbooks just because it’s what their heroes did. Not because it serves any real need.

Many years ago, as a newly minted Marriage and Family Therapist, I led a group marriage preparation course, eight weeks, three times per year. Churches love to refer young couples to such programs in hopes it will decrease the divorce rate, a self-perceived measure of failure or success. During a session in which I facilitated couples’ communication around family planning and child-rearing values, a young, white Christian police officer asserted, “We need to have many children so we can outbreed the non-believers.” I was appalled.

It's not about any practical need to increase population size. It’s about overshadowing the population deemed less-than; about establishing and protecting a dominant culture in line with the values of the government. For Hitler, this was the Aryan race. For the USA, under the leadership of one who praised neo-Nazi white supremacists as “very fine people,”[xi] the ideal of ‘beautiful families” looks similar.

And the cost to women has been all-too-well dramatized by the writing of Margaret Atwood[xii] and the acting of Elisabeth Moss. When women are socially reduced to breeders, our wisdom, intelligence, talent, insight, and ingenuity is repressed. Society regresses for lack of female leadership. Women lose self-esteem, self-worth, self-love. We lose influence. Respect. Freedom.

This is what they want.

Know the game. Know the costs. And chose your path as whole-heartedly as you can. If your path truly is a large family, and you have the internal and external resources to nurture them and yourself, overcoming the obstacles that make this implausible for most, may you find joy and strength. If you long for a small family of children whose hands you can hold, may your heart’s desire be realized. If your dreams birth not from your womb but from your head or heart, may you find power and success at every turn.

May we never surrender the right to choose our families.

And may we never turn from supporting one another in the paths that we freely choose, in all the myriad manifestations of womanhood. That is freedom. That is liberation. That is love.

If you liked this post, help me fuel the next one!

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[i] https://pubmed.ncbi.nlm.nih.gov/3900289/

[ii] https://pubmed.ncbi.nlm.nih.gov/3900289/

[iii] https://www.politico.com/news/2025/04/25/us-citizen-deportation-donald-trump-00311631

[iv] https://www.nytimes.com/2025/04/21/us/politics/trump-birthrate-proposals.html

[v] The Cross of Honour of the German Mother for non-Jewish mothers of 8 or more children, inaugurated in 1939

[vi] The Order of Maternal Glory awarded to mothers of 8+ children, inaugurated in 1944

[vii] Hungarian Order of Merit for Mothers honored mothers with 6+ children, with different levels of honor up to 11+ children, inaugurated in 1951

[viii] https://www.forbes.com/sites/antoniopequenoiv/2025/04/23/trump-calls-5000-baby-bonus-for-new-mothers-a-good-idea-what-we-know-about-incentive-proposal/

[ix] https://www.nbcnews.com/news/us-news/georgia-arrest-miscarriage-fetal-personhood-rcna199400

[x] Italy, Japan, and Taiwan have all unsuccessfully experimented with cash incentives for babies.

[xi] https://www.theatlantic.com/politics/archive/2017/08/trump-defends-white-nationalist-protesters-some-very-fine-people-on-both-sides/537012/

[xii] Author of The Handmaid’s Tale