My understanding is nano plastic in the water every where affects birth rates. Maybe a small effect, I don’t know.

If I were a women in US south where laws are in process to charge murder for any women who become pregnant and don’t carry to term means the 25% of women who miscarry are at serious risk. Use birth control and risk jail time. So maybe elective surgery becomes required for peace of mind.

Does the US policy encourage or discourage birth rates? Is pollution a factor?