Worried about a 'baby bust'? Then prevent pregnancy 'wastage'

Hardly a day goes by now without anxiety-laden news about falling birthrates across the globe. These are routinely accompanied by dire warnings about the anticipated long-term economic and societal consequences of too few babies. The main worries are a depleted workforce, reduced consumer spending, inadequate care for the elderly and declining tax revenues.

Even nations at odds with each other are united in decrying this current trend. South Korea has a plan to avoid population collapse and North Korea may issue punishments to reverse its falling birthrate. While Asia is a particular focal point for this panic, it is echoed across Europe and the other OECD countries, too.

For instance, the Prime Minister in Greece has called the baby bust a national threat and a 'ticking time bomb' and is offering tax breaks, repatriation incentives and cash benefits to address the problem. The Greek government is far from alone in emphasising economic measures to deal with this demographic dilemma.

And yet.

And yet, there are two essential realities largely missing from the leading analyses and proposed solutions. The first is a disconnect between pregnancies and babies. The remedies intended to reverse declining birthrates – from more affordable housing to better pay and leave policies – are built on the assumption that people of childbearing potential are increasingly choosing not to become parents. There are, of course, some people whose priorities militate against having children. And, for some of them, the remedies being proposed might make a difference in their attitudes and actions.

However, the 'choice' assumption blithely ignores the contradictory fact that these are pregnancies intended to be full term and produce healthy babies, who will grow up to become net assets to their economies and societies. An 'unhappy ending' includes miscarriages, stillbirths, therapeutic terminations, very premature deliveries, harm to the mother's health and/or her future reproductive life, as well as babies born with lifelong and life-limiting birth defects.

Turning all 'unhappy endings' into happy ones is well beyond our collective capacity. Still, many of these unwelcome outcomes could, and should, have been through robust, universal, effective policies and practices under the umbrella of of preconception and interconception health, education and care.

To cite only one of many examples, 80 percent of the babies currently born with, and burdened by, neural tube defects (NTDs) could have been prevented from ever developing NTDs by implementing fully effective fortification of staple foods with vitamin B9 (folic acid). Think about the implications of the rate of 'unhappy endings' dropping from one in four to one in 14 or eventually to only one in 40. That alone would eliminate the panic over lower birthrates.

The second flaw in the current remedies is a disregard for the quality versus the quantity of births. Everyone wants a healthy, productive and thriving citizenry. But we all know this is not what has been true. Thus the panic over falling birthrates is predicated, in part, on the belief that the current proportion of any birth cohort who will become successful net contributors to the economy and society will remain stable.

However, there is no natural law dictating the inevitability of this pessimistic prediction. What if a significantly higher percentage of babies in each birth cohort are just fine? Think about the implications of preventing (before and during pregnancy) most of the large number of children born with, and hampered for life by, fetal alcohol spectrum disorders (FASD). Actually preventing preventable harm to babies, from FASD and dozens of other conditions, would neutralise many negative impacts of declining birthrates. Moreover, it would do so far less expensively than the economic measures being considered today.

On a more personal note, I am writing this column from the perspective of a 'Boomer' (someone born between the mid-1940s and mid-1960s). During my life, I have witnessed the rise and fall of numerous, diametrically opposed demographic trends predicted to have disastrous impacts. The first was the Malthusian, society-shaking book, 'The Population Bomb', written by Paul and Anne Ehrlich in 1968. To them, rapidly falling birthrates across the globe would have been an undiluted Godsend and a dream come true.

In my view, choosing to prevent harm by preparing well for pregnancy – in other words, preconception and interconception health, education and care – could become the silver lining in the present population panic. In fact, this silver lining offers us a golden opportunity, but only if we have the precious mettle to finally accord priority in thought, word and deed to promoting healthier pregnancies and better lives.

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This article was originally published in the International Journal of Birth and Parent Education. The issues discussed in this article will be explored in two free-to-attend online events, the first of which is taking place this coming Wednesday.

• The first event, Is Fertility Treatment a Solution to Population Decline?, will take place on Wednesday 26 March 2025. Find out more and register here.
• The second event, Fertility in Flux: What Can State-Funded IVF Do for Population Growth?, will take place on Wednesday 9 April 2025. Find out more and register here.