Fertility rates are falling dramatically, and policymakers must wake up to this fact to prevent a global crisis. The developed world has gone from boom to bust in terms of population growth.
Such was the explosion in the birth rate after World War II that in the UK around 20 percent of the population is made up of people born between 1946 to 1964. But the offspring of baby boomers are reversing this trend by having fewer children or not having children, either through choice or circumstance. This scenario is also observed in many other countries worldwide. The Institute for Health Metrics and Evaluation predicts that the global population will peak at 9.7 billion in around 2064 then spiral downwards.
Excluding migration, many countries might even see their populations halve between 2017 and the end of this century. The forecast is just as alarming for the number of babies born per woman to the end of her childbearing years. By 2050, 77 percent of predominantly high-income countries will have a fertility rate below the replacement level of 2.1 children per woman; and 93 percent of all nations will be in this position by 2100.
Decades of one-sided policies have contributed to this decline. The focus has not been on family building but on family planning such as contraception and abortion to curb population growth, a policy driven mostly by the fear of overcrowding, mass migration and other factors such as environmental damage.
Another major issue responsible for a slowing in world population growth is infertility. The good news about this chronic disease is that it is often preventable. What’s more, there have been significant advances in fertility treatment and the technology available for this. The bad news is that fertility treatment remains out of reach for many despite infertility affecting one in six people, and there is an ever increasing demand for fertility treatment by single people and LGBTQ+ individuals and couples. High cost, legislative restrictions and varying availability continue to be barriers to worldwide access to care with too few countries providing public funding.
Whether or not infertility rates are increasing is a matter of some debate, and lifestyle factors such as smoking and obesity, as well as environmental factors such as pollution, have been considered as potential causes. Women are also delaying the birth of their first child and having them at an older age when fecundity naturally declines.
The lack of a suitable partner and of family-friendly working contracts are also to blame with women often deterred from having children by low maternity pay. Fertility treatments are also increasingly accessed by so-called 'modern families': single women and men, along with members of the LGBTQ+ community.
Some experts would have us believe that human population growth poses a threat to humanity itself. But people are not a threat – they boost economies by generating wealth, fund public services through taxation and their talent inspires innovation that can save lives.
So, what can and needs to be done? Some policymakers and corporations are introducing measures aimed at reversing depopulation. Just this week, France's president Emmanuel Macron proposed free fertility checkups for 25-year-olds among a package of measures to reverse a decline in the country's birth rate and to 'rearm' French fertility (see BioNews 1224). And paid fertility leave is becoming a workplace perk offered by some employers in their recruitment policies to help staff build families.
These progressive approaches are a step in the right direction. However, they are being introduced slowly and only by a minority. Too many policymakers are still ignoring the catastrophe unfolding before them and not committing to reversing this downward trend. Starting a family is generally considered a private matter, and many people try to stay away from population politics.
To scientifically document the extent of the problem, the International Federation of Fertility Societies (IFFS) commissioned a review of evidence around disparities in access to fertility care in the context of global population decline. The first of its kind, this analysis has provided the basis for a recently published consensus, authored by us alongside other experts from all over the world, and published in Human Reproduction Update.
The document outlines the challenges ahead and also calls for concrete measures that can be implemented. Increased public and insurance funding for fertility care, a focus on infertility prevention education and promoting the rights of all individuals to have children are among a series of recommendations suggested in the document.
Alongside this research, the IFFS has also launched a campaign as a call to action for those in a position to bring about change. This global initiative called More Joy is aimed specifically at healthcare professionals; policymakers and politicians; and companies and employers. The message for governments and companies is they need to facilitate fairer access to fertility care and prevent infertility risk factors, especially those linked to the environment. To have a family is a human right so access to fertility care is important to maintain social justice.
We need to better understand the reasons behind decreasing fertility rates and an increasing proportion of women who remain without children. It is crucial to know if this is really a positive choice, the perceived barriers for people who would like to start a family, and the role of men. Politicians must make fertility care a priority by drawing up policies to support the development of simpler, less intensive and more affordable high-quality assisted reproductive technologies. Improved infrastructure and support to expand care access is vital especially in low-resourced countries.
The More Joy campaign calls for businesses to support employees via insurance offerings that cover fertility treatment. There is no one-size-fits all approach to family building – it must suit the diverse needs of everyone.
Other solutions to bolster birth rates include policy measures to support families and working women. These encompass extended pregnancy leave compensation, childcare and parental leave. Education, about infertility prevention and fertility awareness should be incorporated into family planning and contraceptive education.
Without comprehensive reforms such as those outlined by the IFFS, there will be grave and potentially permanent impacts from underpopulation just as there are from overpopulation. Declining infertility rates will imperil economic growth and social stability.
When populations contract then the proportion of older people increases which in turns means rising healthcare and pension costs. With fewer working-age adults, businesses cannot fill essential roles because the supply of qualified workers declines.
It is time that policymakers focus on family building as a key part of family care – and to bring more joy to the world.
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