This chapter examines the policies/fertility nexus in Italy, a country known for its persistently low fertility rates, often attributed to its familistic and sub-protective welfare state. Italy’s “lowest-low” fertility regime diverges significantly from the fertility aspirations of individuals, creating a substantial gap between desired and actual fertility—an area ripe for policy intervention. We explore the role of policies in influencing fertility by considering both “pronatalist” measures (e.g., financial incentives, such as baby bonuses or tax breaks) and “structural” approaches (e.g., access to childcare, stable employment, and adequate housing). The chapter reflects on key theoretical and methodological challenges in understanding the policy/fertility relationship and reviews recent empirical evidence specific to Italy. Drawing on well-established micro-level research and findings from experimental studies, our analysis rejects the exclusive reliance on pronatalist policies to address low fertility. Instead, we advocate for a more comprehensive structural approach, emphasizing social policies that promote youth independence throughout their life course. In addition, medically assisted reproduction is likely to play an increasingly important role in shaping Italy’s fertility landscape.