The United States saw the lowest birthrate since 1979 in 2023, the year I had my fourth child. I call him my “spite” baby. We already had three, and my husband was pushing for a fourth. I thought I was done — until a doctor at UCLA dramatically suggested I get a hysterectomy due to a cyst she worried was cancerous.

When I pushed back and said I thought removing my uterus was a little extreme, her response was, “Well, I see on your chart here you already have three kids. It’s not like you’d want any more.”