Amish religious doctrine formally prohibits birth control, and most Amish families follow that teaching closely. The result is one of the highest sustained fertility rates of any population in the industrialized world, with total fertility rates consistently hovering around six children per woman or higher. But “forbidden” and “nonexistent” are not the same thing. Beneath the official prohibition, demographic research reveals subtle signs of family limitation in some communities, and ethnographic work has documented quiet channels through which some Amish individuals access contraceptive knowledge and supplies.
What the Religious Rules Actually Say
The Amish do not have a central governing authority like a pope or denominational headquarters. Instead, each local congregation follows its own Ordnung, a set of unwritten rules that govern daily life, from clothing styles to technology use. Despite this decentralization, the prohibition on artificial birth control is one of the most widely shared positions across Amish settlements. A review of Amish health practices published in the nursing literature described birth control and abortion as “forbidden by religious doctrine, even when pregnancy is life threatening.”1PubMed. The effects of religious beliefs on the health care practices of the Amish Children are viewed as blessings from God, and the decision about how many to have is understood as belonging to God rather than to the couple.
This theological stance is rooted in the Amish reading of biblical passages encouraging fruitfulness and their broader commitment to yielding personal autonomy to divine will and community norms. The prohibition covers hormonal contraceptives, barrier methods, and sterilization. Abortion is opposed in virtually all circumstances. These positions are reinforced socially: in a tight-knit community where family size is visible to everyone, using contraception would be difficult to hide and could invite church discipline if discovered.
The Fertility Numbers
The practical effect of this prohibition shows up clearly in demographic data. A 2025 study comparing Amish population registries with American Community Survey data found total fertility rates of just over six children per woman, with the highest age-specific fertility among women in their twenties and almost no births outside marriage.2PubMed Central. Amish fertility in the United States: Comparative evidence from the American Community Survey and Amish population registries For context, the average American woman today has roughly 1.6 children. The Amish rate is nearly four times that.
Some individual settlements produce even higher numbers. A study of one Old Order Amish community found a completed marital fertility rate of about 7.7 births per woman.3PubMed. Population growth and fertility patterns in an Old Order Amish settlement And these are not just averages pulled up by a few unusually large families. In a study of Amish women with a mean age of about 45, roughly 62 percent reported having four or more children, and 36 percent reported having seven or more.4PubMed Central. Association of Parity with BMI and Cardiometabolic Risk in High-Parous Women Large families are not outliers in Amish society; they are the norm.
These numbers have held remarkably steady over time. A 1979 demographic analysis concluded that Amish fertility had remained high and that there was “no evidence of a downward trend.”5Population Studies. Fertility patterns and trends among the Old Order Amish More recent work shows that while fertility has dipped slightly in some communities, the decline is modest. A 25-year restudy of Ohio Amish families found mean parity had dropped from about 5.3 to 4.85, a small shift that researchers attributed partly to fewer families farming and partly to differences among Amish subgroups.6PubMed Central. The persistently high fertility of a North American population: A 25-year restudy of parity among the Ohio Amish That same study noted that ideological pronatalism, measured by even higher fertility among church leaders, helps explain why the numbers have not dropped further despite economic pressures that would ordinarily push them down.
Quiet Signs of Family Limitation
If you read only the official prohibition, you might expect Amish fertility to be completely uncontrolled, approaching the biological maximum the way some historical populations did. But that is not quite what the data show. Researchers have found patterns suggesting that at least some Amish couples do exercise a degree of family planning, even if it falls short of modern contraceptive use.
The 1979 study of Old Order Amish fertility, while concluding there was no broad downward trend, did find “some limited evidence of fertility control among women of high parity and among non-farm wives.”7Population Studies. Fertility patterns and trends among the Old Order Amish In plain terms, women who already had many children and women whose husbands did not farm appeared to be spacing or stopping births in ways that went beyond what biology alone would predict. The methods involved are difficult to pin down from demographic data alone, but extended breastfeeding, periodic abstinence, and withdrawal are the most commonly discussed possibilities. None of these require purchasing a product or visiting a clinic, which makes them nearly invisible to outsiders and less likely to draw community scrutiny.
The important thing to understand is that “some limited evidence of fertility control” among Amish women is very different from widespread contraceptive use. The overall fertility pattern remains dramatically higher than the American average, and most of the variation in family size is explained by biological factors, including some that appear to run in families, rather than by deliberate limitation.
How Some Amish Access Contraceptive Information
The Amish world is not hermetically sealed. Amish people interact with non-Amish neighbors, employers, and especially healthcare providers. These interactions can become conduits for reproductive knowledge that would not circulate through normal Amish channels.
Ethnographic research has documented one striking example of this dynamic. A two-year study following a non-Amish midwife who served Amish families found that the midwife functioned as a bridge between worlds. The researcher reported that this midwife “provides Amish women and men access to knowledge about sex and sexuality, provides them resources such as books and condoms, and shapes the structure of Amish society through these channels.”8Sociological Research Online. In this World but Not of It: Midwives, Amish, and the Politics of Power This is a single ethnographic case, not a population-wide survey, so it would be a mistake to generalize it to all Amish communities. But it illustrates something important: the prohibition on birth control does not mean that every Amish person lacks access to it. Non-Amish healthcare providers occupy a unique position of trust, and some Amish individuals use that relationship to obtain information or materials they would not seek openly within their community.
Midwives are especially significant here because they are the primary birth attendants for many Amish families. Home birth is the norm in most Amish settlements, and the midwife often becomes the most trusted health advisor a family has. That trust can extend into conversations about spacing pregnancies, managing reproductive health, or simply answering questions that young Amish couples may have been too embarrassed to ask anyone else. Whether this leads to actual contraceptive use in any given case is impossible to quantify from the outside, but the channel clearly exists.
Wealth, Occupation, and Family Size
One of the more counterintuitive findings in Amish fertility research is that wealthier families tend to have more children, not fewer. This runs opposite to the pattern seen in most industrialized societies, where higher income and education are associated with smaller families. Among the Indiana Amish, researchers linked demographic records with property tax data and found positive correlations between wealth and family size at every stage of childbearing years. Wealthier women had higher marital fertility, were older at the birth of their last child, and ended up with larger families than poorer women.9Population Studies. Family limitation among the Old Order Amish
The researchers interpreted this as evidence that Indiana Amish families “regulate their marital fertility according to their family finances,” but in the opposite direction from what a secular demographer might expect. In a community where children represent both a theological value and a source of household labor, having more resources means being able to support more children, and potentially wanting to. Poorer families, by contrast, may have faced practical constraints that led to earlier stopping, whether through deliberate effort or through the biological effects of harder physical conditions and nutritional stress. The study also found fertility differences by occupation, with farming families tending toward larger broods.
This wealth-fertility relationship has implications for how we think about Amish family limitation. It suggests that when Amish couples do limit their families, economics plays a role, but the cultural incentive structure rewards large families rather than small ones. A couple with the means to raise ten children faces no social pressure to stop at three.
Variation Across Amish Groups
Talking about “the Amish” as a monolithic group misses a lot of internal diversity. There are hundreds of Amish settlements across North America, and they vary in how strictly they enforce different rules. The most conservative groups, sometimes called Swartzentruber Amish, maintain stricter limits on technology and outside contact, while more progressive groups, such as the New Order Amish, allow certain modern conveniences and sometimes maintain closer ties with non-Amish institutions.
These differences extend to fertility. The Ohio restudy found that denominational gradation, meaning the spectrum from more conservative to more progressive Amish affiliations, helped explain variation in family size.10PubMed Central. The persistently high fertility of a North American population: A 25-year restudy of parity among the Ohio Amish More progressive congregations showed somewhat lower fertility, while the most conservative groups maintained the highest rates. Church leaders across the spectrum tended to have larger families than rank-and-file members, reinforcing the pronatalist norm from the top down.
This variation matters for the birth control question. A blanket statement that “the Amish don’t use birth control” is truer for some communities than others. In the most conservative settlements, any form of family planning is deeply taboo, and social surveillance is tight enough that deviation would be noticed. In more progressive communities, the official teaching remains the same, but the practical enforcement and the degree of outside contact both differ, creating more room for individual choice. Researchers have not been able to quantify contraceptive use rates by affiliation because of the obvious difficulties of surveying people about a forbidden behavior, but the fertility differences by group strongly suggest that attitudes and practices are not uniform.
Comparisons With Other High-Fertility Anabaptist Groups
The Amish are not the only Anabaptist group with very high fertility. The Hutterites, who live communally in colonies across the northern United States and western Canada, have historically been one of the benchmark populations for near-natural fertility in demographic research. The Wenger Mennonites, an Old Order Mennonite group in Pennsylvania, have also maintained extremely high birth rates. A study comparing Wenger fertility to Amish, Hutterite, and Old Colony Mennonite fertility found that from 1966 to 1996, Wenger total fertility rates for married women ranged from about 10.7 down to 8.3, with no comparison group posting higher age-specific rates during the same period.11PubMed. The shape of high fertility in a traditional Mennonite population Even so, Wenger fertility dropped over 22 percent during those three decades, suggesting increasing regulation of family size even in a group with no official relaxation of its pronatalist stance.
The Wenger pattern is instructive because it shows what happens when a high-fertility Anabaptist population begins to limit births without any public change in doctrine. The decline happens gradually and without acknowledgment. This is almost certainly what is occurring, to a lesser degree, in some Amish communities as well. The theological position remains fixed, but individual behavior shifts incrementally in response to changing economic realities, declining farmland availability, and greater exposure to outside norms. The drop from 5.3 to 4.85 in the Ohio Amish restudy fits this pattern: slow, undramatic, and never officially endorsed.
Health Implications of Very High Parity
For Amish women, the prohibition on birth control is not just a demographic curiosity. It has real health consequences. Bearing many children affects the body in ways that accumulate over time, and Amish women experience these effects at rates that few other American women do.
Research on Amish women has explored the relationship between number of births and cardiometabolic health. A study of high-parity Amish women found that each additional child was associated with a modest increase in BMI, particularly among premenopausal women, where each additional birth corresponded to roughly an extra 0.4 kg/m² of body mass index. The effect was smaller in postmenopausal women. Reassuringly, parity was not associated with worsened blood sugar, blood pressure, or cholesterol levels in the adjusted analyses.12PubMed Central. Association of Parity with BMI and Cardiometabolic Risk in High-Parous Women This may partly reflect the Amish lifestyle, which involves substantially more physical activity and less processed food than the typical American diet, potentially buffering against some of the metabolic risks that high parity carries in more sedentary populations.
Beyond metabolic health, the sheer physical toll of many pregnancies raises concerns that are harder to capture in a single study. Pregnancy complications like gestational diabetes, preeclampsia, and postpartum hemorrhage all carry risks that compound with repeated pregnancies. Amish women with limited access to hospital-based obstetric care, who deliver at home with midwives, face these risks in a setting where emergency intervention is less immediately available. The prohibition on birth control means that a woman who has had a difficult or dangerous pregnancy has limited sanctioned options for preventing another one.
Genetic Considerations and Reproductive Outcomes
The Amish descend from a small number of founding families who immigrated to North America in the 18th and 19th centuries, and they have married almost exclusively within their own community since then. This means Amish couples are, on average, more closely related to each other than couples in the general population, a phenomenon geneticists call a founder effect. The genetic consequences intersect with reproduction in ways that are unique to this population.
A study of Old Order Amish families in Lancaster County examined how parental relatedness affected reproductive outcomes. Higher overall genetic relatedness between spouses was correlated with more live births, more total pregnancies, and more stillbirths.13PubMed. Impact of parental relatedness on reproductive outcomes among the Old Order Amish of Lancaster County The relationship between relatedness and fertility is complex and probably reflects multiple factors, including the possibility that the most closely related couples are also the most culturally conservative and therefore the least likely to practice any form of family limitation. The increased stillbirth risk, however, is a genuine genetic concern, as consanguinity raises the probability that both parents carry the same rare recessive mutations.
The Amish are well aware of genetic conditions that run in their community, including several rare metabolic disorders that are far more common among the Amish than in the general population. Genetic counseling programs have been established in some Amish areas, most notably the Clinic for Special Children in Lancaster County, which provides carrier testing and counseling. Couples who learn they are both carriers of a serious genetic condition face an agonizing situation in a community that forbids both contraception and abortion. Some couples in this position may quietly limit their families through natural methods, but the theological and social pressures to continue having children remain intense.
Why Outsiders Often Get the Picture Wrong
Popular accounts of the Amish tend to paint them in broad, simplistic strokes: either as paragons of wholesome family life or as victims of oppressive tradition. The birth control question sits right at the intersection of these competing narratives, and both oversimplify the reality.
The “no birth control, period” framing is the more common oversimplification. It treats the official prohibition as if it were universally and perfectly followed, which the demographic evidence suggests it is not. Family sizes vary by settlement, by denomination, by occupation, and by wealth in ways that point to at least some deliberate regulation. The existence of channels like non-Amish midwives who provide contraceptive resources further complicates the picture.14Sociological Research Online. In this World but Not of It: Midwives, Amish, and the Politics of Power
On the other hand, it would be equally wrong to imagine that significant numbers of Amish couples are secretly on the pill. The fertility data are unambiguous: Amish women have far more children than almost any other group in North America, and the rates have resisted the kinds of dramatic declines seen in nearly every other population that has undergone economic modernization. Whatever family limitation is happening, it is operating at the margins, nudging average family size down by fractions of a child over decades rather than cutting it in half. The prohibition is real, it is widely followed, and its demographic effects are enormous. The nuance lies in recognizing that “widely followed” and “universally followed without exception” are different things, and that even a small amount of individual variation deserves acknowledgment in any honest account of Amish reproductive life.