The latest PET event continued to explore the theme of falling birthrates and decreasing population sizes, focusing on the role that assisted conception can play in addressing these challenges. An earlier event on this theme, 'Is Fertility Treatment a Solution to Population Decline?', was held two weeks previously (see BioNews 1283).
The event, chaired by Sarah Norcross, director of PET, brought together five experts from different disciplines to assess the topic from different perspectives.
The first speaker was Ann Berrington, professor of demography and social statistics at the University of Southampton and director of the Fertility and Family research group. Professor Berrington is also principal investigator of two current research projects at the Centre for Population Change and at the Connecting Generations research programme.
Professor Berrington outlined some of the determinants affecting fertility behaviours, from 'remote' factors such as reduced child mortality, perceived economic uncertainty and attitudes to gender roles to 'proximate' factors, such as infertility, relationship status and use of contraception.
Looking at policies that may affect childbearing, she noted that the impact of cash incentives is generally small compared to cultural factors. She added that supportive family policies – such as those found in the Nordic countries – are necessary but not sufficient, as the birthrate is still declining in these countries.
She finished by suggesting five areas that governments need to address in order to ensure that families wanting more children will feel secure enough to have them. The first two areas were increasing gender equity in terms of sharing childcare and domestic labour more evenly between partners, and improving the availability of affordable housing available.
The third area was reducing economic barriers (a Finnish study showed that childlessness is growing fastest among those with the least education), and the fourth was addressing subjective economic insecurity. Fifth, Professor Berrington argued that governments should enhance access to assisted conception, making it more affordable and more accessible to diverse types of families.
The second speaker was Professor David Bell, emeritus professor of economics at the University of Stirling. Professor Bell is also principal investigator at the Healthy Ageing in Scotland study and co-investigator at the Centre for Population Change and the Connecting Generations programme.
He began by adding historical context to the discussion: in the 1950s, the global total fertility rate (TFR) was around five children per woman, and it is now 2.3, only slightly above the 2.1 needed to keep populations stable (the 'replacement rate'). While there are regional variations in birthrates, the trend is worldwide.
In the UK, the TFR is now 1.49. In Scotland, it is even lower, at 1.3. This is interesting, as Scotland has the most generous NHS-funded IVF policy in the UK.
Professor Bell went on to discuss economic causes of fertility decline in the UK. Among these, he mentioned housing cost as being a major issue, with home ownership seen by many couples as a prerequisite for starting a family. Other economic concerns include the cost of childcare, career pressure, financial insecurity and student debt.
Social factors that have influenced the falling birthrate include changing attitudes (reduced stigma around being child-free), people forming partnerships later, the desire for work/life balance, and the rise of individualism. To this, Professor Bell added environmental factors such as inadequate family policies and housing policies, the backdrop of austerity, healthcare issues, and concerns about climate change.
Overall, said Professor Bell, addressing fertility decline requires a comprehensive approach, respecting individual choice and balancing that with societal needs.
The third speaker, was Søren Ziebe, professor of clinical embryology at the University of Copenhagen's Faculty of Health and Medical Sciences in Denmark. Professor Ziebe has coauthored research exploring how to talk to young adults about fertility, and exploring the pros and cons of fertility awareness and information.
He began with a definition: 'Fertility awareness – the understanding of reproduction, fecundity and related risk factors, including the awareness of societal and cultural factors affecting options to meet reproductive family-planning and family-building needs'.
Fertility treatment can help, but only when the problem is infertility – or subfertility – in people who want to have children. However, Professor Ziebe argued that the need for fertility treatment could be reduced by fertility awareness and education. In Denmark, around 12 percent of women do not become mothers. Many are 'childless by circumstance', and would like to have had children, but it didn't happen for reasons such as not meeting a suitable partner.
Eleven percent of children born in Denmark are conceived at a fertility clinic, and the government is now increasing the number of funded IVF cycles available, including opening up state-funded treatment for families wanting a second child. However, even if this provision were extended across Europe, it is unlikely that it could compensate for projected population decline.
Professor Ziebe added that fertility treatment cannot offer a complete solution to population decline. However, it can be part of the solution, alongside fertility awareness and education.
The fourth speaker was Satu Rautakallio-Hokkanen, general director of Fertility Europe and contributed to the recent Economist Impact report, Fertility Policy and Practice: A Toolkit for Europe. She explored fertility treatment and population growth from the patients' perspective.
Approximately 20 percent of people of reproductive age face infertility for medical and/or social reasons. These can include lack of a partner, one's economic situation, or state restrictions (such as lack of access to donor gametes for same-sex couples).
Finland offers excellent access to assisted conception, and when Finns are surveyed, they most commonly desire a family size with two children. Only round 13 percent of adults wish to remain child-free, but by age 45, 30 percent of men and 20 percent of women are childless. In other words, there is a gap between the families that people say they want, and the families they are actually having.
A 2024 report from Finland's Ministry of Social Affairs and Health made suggestions about how to help people have their desired number of children. These included increasing fertility awareness in schools, offering reproductive health counselling and services, investing in fertility treatments and prevention of mental health problems, and supporting family-friendly workplaces and work/life balance.
Rautakallio-Hokkanen concluded that everyone facing infertility deserves support, and reiterated the need for better education and rights-based care.
The final speaker was Professor Roger Gosden, a visiting scholar at William and Mary, Virginia, and former director of research at Weill Cornell Medicine, New York. He studied and collaborated with the IVF pioneer Professor Sir Robert Edwards, and went on to write the authorised biography Let There Be Life: An Intimate Portrait of Robert Edwards and His IVF Revolution.
Professor Gosden's presentation was titled 'The Infertility Trap: When Population Decline from Low Birthrates Gets Harder to Reverse'. This incorporated an acknowledgement of the book The Infertility Trap by R John Aitken.
Offering a perspective from the USA, Professor Gosden opened with a quote from Elon Musk, who said in 2023 that 'low birthrates are a much bigger risk to civilisation than global warming'. Professor Gosden said that he didn't agree that the risk was more serious than that posed by climate change. More importantly, he added that Musk's one-man attempt to reverse population decline does nothing to advance our understanding of women, and their decisions about childbearing and childrearing.
He explained that while today's US right is anti-immigration, and embraces pronatalism along with Musk, it is also responsible for fertility research funding being cut. For example, a drug called Rapamycin has been shown to protect egg quality later in life in rats, and clinical trials are being conducted in humans. But research like this, which could help people to prolong their fertility and have more children over the course of their lives, is likely to be impeded by cuts to funding.
Professor Gosden outlined six key areas affecting the population growth or decline: the environment, education, social factors, demography, fertility, and immigration. He argued that research into male fertility lapsed after the invention of ICSI, and that some genetic mutations that affect sperm formation are being passed down, meaning that sons who inherit these mutations will themselves need to use ICSI to conceive in future.
It was then time for the panel to answer questions from the audience. Professor Geeta Nargund, who had been a panellist at the previous event, asked whether a focus on fertility rate undermines women's wellbeing, reproductive choices and rights. Professor Berrington agreed that a population's TFR tells us nothing about what proportion of women can make decisions about reproductive health and choices. Professor Ziebe added that TFR places the focus on women, but in most cases the decision to have a child is made jointly by couplesr.
Another attendee asked about writing off student debt for first-time parents. Professor Bell agreed it would be interesting to compare Scotland, which does not charge tuition fees, to the rest of the UK. However, he added that housing costs are probably a more important factor.
One audience member then asked which countries are closest to solving their population decline issues. Professor Berrington said we should ask which governments have the best policies to adjust to low fertility. For example, in Finland, a focus on improving education and maximising the number of young people in education can expand the labour force, thereby helping compensate for the lower TFR.
The discussion was lively, and the number of questions posted by the audience far exceeded the time available. Even after two in-depth PET events, there is still plenty more to be discussed on this topic.
PET is grateful to the Scottish Government for supporting this event.
The next free-to-attend PET events will be:
- Our Future Health, UK BioBank, Genomics England: Exploring the Impact, taking place online on Wednesday 30 April 2025 – register here.
- IVF and Miscarriage: Reducing Risks, Providing Support, taking place online on Wednesday 21 May 2025 – register here.
- Lifestyle, Obesity, Diabetes: Optimising IVF Outcomes for Patients, taking place in person in Edinburgh on Wednesday 28 May 2025 – register here.
- Diversity in Health Data: Achieving Benefit for All, taking place online on Wednesday 4 June 2025 – register here.
- Rare Disease Genomic Testing: How Do We Make Access Equitable and Timely?, taking place online on Wednesday 18 June 2025 – register here.
- 40 Years of the Surrogacy Arrangements Act: What Next for Surrogacy?, taking place online on Wednesday 16 July 2025 – register here.
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