The complicated ART of finding consensus on family-building health policy: a comment on the IFFS consensus document

The world has witnessed a substantial decline in fertility rates for the last five decades: from 4.8 children per woman in 1970 to 3.3 in 1990 and to 2.3 in 2022. These declines have been the focus of much research. In high-income countries (HICs), where fertility rates currently average 1.6 children per woman, the reductions below the magical 2.1 replacement level have been ascribed to a range of ideational factors, described in the rich literature on the ‘Second Demographic Transition’ (Lesthaeghe, 2010;Zaidi and Morgan, 2017). In low-income countries (LICs), the reduction is largely the product of longstanding population programs anchored in a neo-Malthusian paradigm: it associates high fertility rates with negative outcomes in terms of neonatal-maternal health, educational attainment, economic growth, and the natural environment. Other factors, such as sperm count decline, could also play a role (Levineet al., 2023). In either case, despite some variation across countries, population policies across most high- and low-income settings have promoted low fertility through a combination of maternal and child health, including family planning, and increased investment in human capital, with an emphasis on gender equity. This dual focus has been the dominant approach since the UN International Conference on Population and Development in Cairo in 1994.
Source: Human Reproduction Update - Category: OBGYN Source Type: research