We begin by deriving a negative right to procreative autonomy from autonomous agents’ right to control their own bodies. Turning to the ethics of deciding who will come into existence, we distinguish fixed-identity decisions, which address whether or not to bring a specific individual into being, and identity-determining decisions, which determine which of several possible individuals will come into existence. Regarding fixed-identity decisions, we defend a liberal view of abortion based primarily on the thesis that death does not harm pre-sentient fetuses. An example will help to clarify the less familiar category of identity-determining decisions: a couple might attempt to get pregnant now or – concerned about an outbreak of an infectious disease that might damage a fetus – wait several months, thereby determining which of two possible individuals will later exist. We argue that in at least some of these “nonidentity” cases, it is permissible to cause to exist someone whose life is expected to go worse than that of another possible individual. Finally, we apply our theoretical conclusions to two practical issues: the use of medical technologies in sex selection and public health measures in the context of a Zika virus outbreak.