“Spoiler alert: COVID made it even worse,” said Natascha Braumann, Director of Global Government and Public Affairs for Fertility at EMD Serono, of declining fertility trends across the globe. Braumann spoke at a recent Wilson Center event highlighting pre-pandemic fertility, demographic trends, and the impact of COVID-19. The panel was co-sponsored by EMD Serono, the healthcare business of Merck KGaA, Darmstadt, Germany.

Fertility rates in many countries have been falling for decades, and population growth has been slowing as a result. In 2021, Korea’s total fertility rate (TFR)—the average number of births per woman—is projected to fall to a record low of 0.72, said Kwang-Hee Jun, Ph.D., Professor of Demography and Sociology at Chungnam National University in South Korea. This rate is below the 2.1 births per woman demographers consider “replacement level,” which means parents are not having enough children to replace the number of parents in the population. In the United States, the TFR fell from 2.1 to 1.6 between 2007 and 2020. This change may not sound like much, said Mark Mather, Ph.D., Associate Vice President of U.S. Programs at the Population Reference Bureau. “But for demographers, that’s a pretty big change in a short period of time.”

Behind the Fertility Decline

These trends are partially a result of increasing access to reproductive health care and contraception. But in countries where reproductive choice is limited, such as in Latin America, teen birth rates remain high, said Felicia Knaul, Ph.D., Economist and Director of the Institute for Advanced Study of the Americas at the University of Miami. First and foremost, women don’t have control over whether to start a family or not if they don’t have a choice about their reproductive health, she said.  

Even increased choice does not fully account for the trends that demographers are seeing. When surveyed, couples indicate that they do want children, but most end up having fewer children than they originally said would be ideal, said Braumann. The factors driving this gap are complex, but there are some basic trends, she said. For instance, in recent decades, women have been pursuing higher education at higher rates and participating more in the workforce, leading many to delay marrying and having children, said the panelists.

We can view this fertility decline as a good thing if it’s because more women are going to college, entering the workforce, with more control over the number of children that they’re having, said Mather. “But the other side of that coin is, you know, there’s lots of people who don’t feel like they have the resources to start a family.” Labor market challenges and soaring housing prices are making financial security increasingly elusive for young adults, especially for women, he said.  Not only is the dual-income couple becoming the norm but, especially in urban areas, two incomes are required to sustain a family financially, said Braumann. “So, you know, this is a calculation that couples clear across the world have to make of living standards versus childbearing choices,” she said.

These effects are being felt acutely in South Korea, said Jun. Job prospects in rural areas are limited, pushing many young people to urban centers, where the cost of living is prohibitively high. These conditions leave young people powerless to make their own choices about how, when, and if to start a family, said Jun. Similar trends can be seen in the United States and Europe, said Mather and Braumann.

COVID-19 is exacerbating these challenges. The pandemic has caused many young people to delay major life events, such as marriage. This delay will likely manifest in lower birthrates in the years to come. Likewise, pandemic-related unemployment and financial insecurity, particularly among young people, women, and marginalized groups, may cause further decline.

Implications for Economics and Caregiving

The decision of whether or not to have a child is intensely personal, said Braumann, but when made in aggregate millions of times by millions of couples, it can have huge implications. For instance, slower population growth likely means slower economic growth, as the proportion of working-age individuals in a country shrinks, said Mather.

These trends also have implications for the care economy. As fertility rates decline, societies will see a “shifting center of gravity” in their populations from younger ages to older ages, said Jennifer Dabbs Sciubba, Ph.D., Global Fellow at the Wilson Center and Associate Professor of International Studies at Rhodes College. In Latin America, 1 in 5 individuals will be over the age of 65 by 2050, said Knaul. Meanwhile, there will be fewer younger individuals to care for them.

At the same time, chronic conditions and non-communicable diseases are becoming increasingly common. These conditions are more costly, more complex, more long-term, and require much more caregiving, said Knaul. Furthermore, as the average age of people having children creeps up, so does the likelihood that individuals will face a double caregiving burden due to “sandwiching”—having to care for both an elderly family member and a child under the age of 18, said Sciubba.

This burden will fall most heavily on women, particularly poor and marginalized women, said the panelists. For many women, caregiving comes at a high personal cost. For instance, exiting the workforce to care for family members can have lifelong effects on women’s earnings, said Mather. Overall, women’s contributions to health and health care are valued at 7 to 8 percent of global GDP, said Knaul. About half of that value comes from unpaid, undervalued caregiving work. As populations age, this workforce will be stressed even further, she said. 

Policy Responses to Boost Fertility

Some countries have turned to policies that incentivize women to have more children, such as China’s recently unveiled three-child policy. Another strategy is to promote immigration, which can help create “population momentum” by bringing more young people and families into a country, said Mather. Immigration can also relieve the burden on the care economy by increasing the number of working age individuals available to care for the elderly, said Jun. We need more immigrants, he said. More babies and more immigrants.

However, policymakers also need to address the larger economic and social issues driving low birthrates, said the panelists. It’s perhaps less about promoting pro-natalist policies—policies designed to increase an area’s fertility rate—and more about removing barriers from life-planning choices, said Braumann. This could include increasing access to affordable child and elder care, strengthening general economic assistance and social support programs, and providing paid family and medical leave, said the panelists. These efforts are especially critical in the United States, where women face very severe challenges due to the country’s comparatively weak social safety nets, said Mather.

We are still at the beginning of understanding the impact of the pandemic, said Sciubba. Trends of declining fertility and slowing population growth were here before COVID-19 and will linger long after. As policymakers recover from and build beyond the pandemic, the key is not to become too fixated on the fertility rate or the number of births, said Mather. Instead, countries need to develop strategies to adapt to the needs of a changing population, he said.

COVID-19 has also presented a learning opportunity to policymakers. For example, the advent of telemedicine opens the door for other digital health services, like tele-caregiving, that could reduce women’s caregiving burden, said Knaul. However, policymakers need to proactively incorporate provisions to promote equity to realize these gains. Until we have “gender proactive policymaking” where the joy and privilege of taking care of one’s family is a joy and privilege that is shared, said Knaul, we are going to continue being in this situation, where women bear the brunt of the caregiving.

Read more:

• Taking a “gender transformative” approach to COVID-19, a conversation with Felicia Knaul, Ph.D.
• How has COVID-19 impacted maternal, child, and reproductive health services?
• Meeting individuals modern contraceptive needs could have dramatic benefits
• How can policymakers craft a mental health response to COVID-19?