We investigate women’s fertility, labor, and marriage market responses to large declines in child mortality in the U.S. Fertility declined on the intensive margin as expected. However, despite the increasing value of having at least one child, a larger share of women remained childless. We explain these findings with a new theory of fertility that includes fertility timing and labor force participation as choices. Consistent with the model’s predictions, we find that reductions in child mortality led women to delay childbearing, increase their labor force participation, improve their occupational status, and to be less likely to have ever married.