France Tells 29-Year-Olds to Think About Fertility. Is That Coercion or Respect?

A government letter about biology is not a command. Silence is not neutrality. And autonomy without information is a fiction.

France just mailed a letter to every 29-year-old in the country. The message: here is what you should know about your fertility before time narrows your options. The reaction was predictable. Critics called it patronizing, intrusive, even coercive. But the real question is not whether a government should send a letter. The real question is whether withholding biological facts from young adults is somehow more respectful than sharing them.

It is not.

What France Actually Did

In 2025, for the first time since the end of World War II, France recorded more deaths than births. That demographic milestone prompted two parallel government responses. The first: a 16-point fertility strategy from the health ministry, driven by a 2022 report showing 3.3 million people in France facing infertility challenges. One component of that plan is a personalized letter sent to every person turning 29, informing them about age-related fertility decline in both women and men. The letter also explains that egg freezing is available without a medical indication starting at age 29, covered by public health insurance through age 37. France is expanding fertility preservation centers from 40 to 70 nationwide to support this effort.

The second response came from French lawmakers, who released a parliamentary report urging a comprehensive family policy overhaul. Their recommendations go well beyond a letter. They propose 250 euros (about $300) per month per child for all families, regardless of income, until the child reaches age 20. They call for 12 months of paid parental leave shared between both parents, a dramatic expansion from the current system that provides just under four months of paid maternity leave for a first child and 25 days for fathers. They even recommend half-days off for parents and grandparents during key moments in a child’s education.

France, in other words, is not just sending a letter. It is proposing the structural support that makes acting on reproductive choices realistic. That distinction matters.

The Autonomy Argument, Properly Understood

The loudest objection is that this letter pressures women. Feminists countered, in the words of French critics, that the state should not dictate whether women should have children or when. A British columnist wondered how she would feel receiving a fertility letter from a childless president. The French satirical publication Le Gorafi joked that Macron should hang his photo above French couples’ beds to encourage reproduction.

The humor is understandable. But the underlying objection reveals a deep misunderstanding of what autonomy means in medical ethics.

Autonomy is the right to make informed decisions about your own body and your own life. The key word is informed. Autonomy is not protected by silence. It is weakened by it. A woman who reaches 38 and learns for the first time that her fertility began declining years ago has not been respected. She has been failed. Her autonomy was not preserved. It was hollowed out by the absence of information she needed to exercise it.

We do not call it coercion when a physician tells a patient that smoking causes lung cancer. We do not call it pressure when public health campaigns inform people that alcohol in pregnancy harms the fetus. We do not call it patronizing when the evidence shows that homebirth carries higher neonatal risk than hospital birth. We call it medicine. We call it informed consent. We call it the basic professional obligation to tell people the truth so they can decide what to do with it.

Fertility is no different. The biology is not a political opinion. Ovarian reserve declines with age. This is measurable, well documented, and consequential. Telling people about it is not telling them what to do. It is giving them the information they need to do whatever they choose.

The Real Coercion Is Silence

There is a strange assumption in the criticism of France’s campaign: that not informing people is a neutral act. It is not neutral. It is a choice with consequences.

When we fail to inform patients about time-sensitive health realities, we make their future decisions for them. A 29-year-old who does not know that fertility preservation exists cannot choose it. A 34-year-old who has never been told that conception takes longer after 35 cannot plan for it. The absence of information is not freedom. It is a constraint disguised as respect.

In obstetrics, we see this pattern constantly. Physicians who withhold risk information because they do not want to “scare” patients. Guidelines that soften language to the point of meaninglessness. A culture that confuses medical paternalism with compassion. The result is not empowered patients. The result is patients who are blindsided when biology does what biology does, on its own timeline, regardless of anyone’s career plans or housing market anxieties.

Information Plus Support: The Only Honest Answer

What makes France’s approach worth watching is that the letter does not stand alone. The parliamentary report makes clear that French lawmakers understand something many critics miss: information and structural support are not competing strategies. They are complementary necessities.

The report’s lead author, Jeremie Patrier-Leitus, framed the proposals as enabling the French “to fulfil their desire to have children.” The data supports him. France holds the second-highest fertility rate in the European Union, after Bulgaria. French women report wanting more children than they have. The gap between desired and actual fertility is not caused by ignorance of biology alone. It is caused by economic conditions that make parenthood feel like a financial risk.

Psychologist Marie-Estelle Dupont argues that extending paid maternity leave from 16 to 26 weeks would do more for birth rates than any letter. She is probably right about the birth rates. But that does not make the letter wrong. Both things can be true: people deserve biological facts, and they deserve economic conditions that make acting on those facts realistic. The answer is not to withhold information until the structural problems are solved. The answer is to provide both.

That is exactly what France is attempting. A letter that respects people enough to share the biology. And a policy overhaul that respects them enough to remove the barriers.

The Ethical Principle

In medical ethics, the obligation of veracity, telling the truth, is not conditional on whether the truth is convenient or comfortable. Beneficence, acting in the patient’s interest, requires that we share information the patient needs to make decisions aligned with their own values. And respect for autonomy demands that we never substitute our judgment about what people “should” want for the facts they need to decide for themselves.

France’s letter does exactly this. It says: here is what is true about human fertility. Here are your options. Here is where to access them. The decision is yours.

That is not coercion. That is the opposite of coercion. That is what informed consent looks like when a society takes it seriously.

My Take

I have spent 50 years in obstetrics. I have sat with patients who did not know their fertility had a timeline. Patients who were told “you have plenty of time” by well-meaning friends, by busy clinicians, by a culture that treats reproductive biology as an uncomfortable topic better left unmentioned.

Every one of those patients deserved better. They deserved the truth at 29, not surprise at 39. This should be told to everyone in College.

France is doing something that the rest of the developed world should be watching carefully. Not because a government letter will solve a demographic crisis. It will not. But because France is combining two things that are rarely offered together: honest information about biology, and real policy changes that support families. The letter respects adults enough to tell them the truth. The policy proposals respect them enough to make the truth actionable.

Autonomy is not weakened by information. It is built on it. And it is sustained by the structural support that turns knowledge into genuine choice.