Fertility Figures: Dwindling Birth Rates and the Infertility Epidemic
As birth rates decline and reproductive health suffers, the future seems uncertain especially in developed countries like the US.
Fertility rates are falling in almost every country. The global fertility rate has decreased from 4.84 in 1950 to 2.23 in 2021, with projections indicating a further drop to 1.59 by 2100. The global fertility crisis is characterized by a significant decline in birth rates across many countries, leading to potential demographic and economic challenges. This decline is attributed to various factors, including socio-economic changes, increased access to education and contraception, and shifting societal values. Rising living costs, economic uncertainty, and increased female participation in the workforce contribute to delayed family planning and reduced birth rates. Along with external factors such as these, infertility is also a growing concern globally amongst both males and females. Various factors, including medical, lifestyle, and environmental influences, are contributing to this issue. With a rapidly aging population, our low birth rate is having a significant impact on demographics and economics around the world.
The general cultural shifts that have taken place in the past few decades have encouraged child-free lifestyles. Women are increasingly focusing on establishing their careers and achieving professional goals before considering parenthood. Shifting societal norms are also allowing women to prioritize their careers and personal aspirations over traditional roles as mothers above all else. The lessening stigma around a childless life have allowed women and parents to make this decision without outside pressure. The absence of national paid parental leave and affordable childcare in countries like the U.S. makes parenthood challenging. Only 21% of US workers have access to paid family leave through their employers, forcing many women to make the decision between a career and a baby. Increased access to contraception has also given women more autonomy over their bodies and choice around when to have a child.
Women are also opting to have children later in life instead. In doing so, they can prioritize their careers and higher education but often leads to smaller families given the timeline on a woman’s childbearing years. More than two decades ago the average age a woman had her first child was 24.9, now it is 27.5, a record high in the US. High costs of childcare, housing, and education are all deterrents from having kids without the financial means to support them; therefore, many mothers are prioritizing financial stability before deciding to get pregnant, pushing the average age of first-time mothers out. The advancements of assisted reproductive technologies and widening access to fertility benefits through certain employers have also encouraged women to freeze their eggs and use alternative methods to get pregnant later in life.
Beyond choosing to not have children or having them later in life, an overall decline in reproductive health has inhibited many people’s ability to have children, further exacerbating the declining birth rate issue. Around 17.5% of the adult population or 1 in 6 worldwide, experience infertility. The rate of infertility is expected to increase for women aged 15-24 from 6% in 1995 to 8% in 2025. For women, fertility also significantly declines with age, especially after 35, and today about 20% of woman have their first child after the age of 35. Being overweight or underweight can affect hormonal balance and ovulation. 27.5% of women in the US are overweight which can lead to infertility, while on the other end of the spectrum, many women who exercise excessively or complete in athletics at a high level also have a hard time getting pregnant.
There are a number of common female-specific conditions that impact fertility and have been increasing in prevalence in recent years. One study showed that the prevalence of PCOS had increased 65% over the past decade, with a significantly higher prevalence of obesity, hyperandrogenism, and primary infertility. 1 in 10 reproductive age women have endometriosis and more than 12% of women will develop a thyroid issue at some point in their life. Other issues such as fibroids (non-cancerous growths in or around the womb), scarring from surgeries and pelvic inflammatory disease can block or damage reproductive pathways. More commonly, hormone imbalances, which can be caused by a multitude of things, can disrupt ovulation and prevent pregnancy. In more recent years, birth control pills have been shown to cause hormonal imbalances because the synthetic hormones bind to the wrong receptors. While the pill itself is not a direct cause of infertility, the accompanying hormonal issues can make it hard to regulate hormones involved in fertility therefore leading to difficulty getting pregnant.
Smoking, alcohol, and drug use can negatively impact fertility as can environmental toxins. Exposure to endocrine-disrupting chemicals (EDCs) in the environment has been linked to increased time-to-pregnancy and increased infertility amongst men and women. There are many types of EDCs found in our daily lives, from pesticides to lubricants to lavender oils and teas to pharmaceutical products such as estradiol, they are difficult to avoid, and we have likely ben exposed to them our entire lives. DES is one of the most common chemicals and was actually used in the 50s and 60s primarily in pregnant mother for miscarriage prevention until it was associated with offspring developing PCCAV, a rare form of vaginal cancer that affects fertility, and cervical cancer. Contact with other toxins, heavy metals, and radiation can impair fertility for both men and women.
For males, low sperm count, poor motility, and abnormal sperm shape can all hinder conception. Conditions related to hormones, such as low testosterone or hyperprolactinemia (abnormally high levels of the hormone prolactin) can affect sperm production, while enlarged veins in the scrotum can impact sperm quality. Male fertility may decline with age, affecting sperm quality as well, but it is far less drastic than the impact of age on women’s fertility. Their fertility starts to reduce around 40-45 years, but many men have been able to conceive well into their old age, with one man having his ninth child at age 92 year and 10 months. Tobacco, alcohol, and drug use can also reduce sperm count and quality, as well as frequent use of hot tubs or saunas.
Why does this matter?
By 2050, over three-quarters of countries are expected to have fertility rates below the replacement level of 2.1, leading to population shrinkage unless offset by immigration. While in low-income regions with higher fertility rates, improving access to contraceptives and expanding female education can help lower birth rates, high-income countries with low-fertility economies, are exploring policies that support parents and encourage immigration will be crucial for sustaining population size and economic growth. Some of these policies to encourage higher birth rates include paid parental leave, childcare support, and financial incentives.
The decline in fertility rates adds to the already looming issue of our aging population, increasing the burden on social welfare systems and creating labor shortages. Low birth rates threaten economic growth by reducing the future labor force and increasing dependency ratios, where fewer workers support retirees. Lower birth rates also result in fewer consumers, which can contribute to slowed economic growth and domestic market activity.
Governments may face fiscal pressures due to shrinking tax from income earning citizens and increased spending on healthcare and pensions for the aging population. In the US, Social Security retirement and disability funds are projected to be depleted by 2035. While the government will still be able to provide funds, they will be limited to less that 100% of what Americans are owed through the program and without young, working age individuals refilling reserves, payouts will continue to dwindle.
As birth rates in developed countries around the world decline, governments will need to plan for threats to economics, food security, health, environment, and geopolitical security because of these demographic shifts. It is crucial that through both modernized healthcare tools and better benefits for individuals of reproductive age, we encourage stable population growth and encourage healthy pregnancies.