Low fertility: Choice or chance?

Abstract

Fertility rates are declining worldwide, and the number of nations with fertility rates below the population replacement level is growing. The primary determinant of this reduced fertility is the increasing voluntary use of contraception by couples of reproductive age. On rare occasions, a government may decide to impose fertility control on its citizens for 'the societal good. Debate about the ethical implications and the efficacy of such decisions inevitably focuses on the People's Republic of China, which introduced a one-child policy with the express purpose of limiting population growth. Increased infertility does not seem to play a role in the falling fertility rates. The levels of primary infertility, that is, the inability to have a live birth, have remained relatively constant in East and Southeast Asia from 1990 to 2010, though secondary infertility, that is, the inability to have another child after having given birth to at least one, has increased during the same period in the Republic of Korea, Singapore, Thailand and Mongolia. Even if used widely, assisted reproductive technology (ART) would have only a minor effect on fertility rates. A second major demographic change worldwide, and especially in East and South Asia, is rising life expectancy. The 'graying of populations is a demographic reality in both developed and developing nations. Among the resulting challenges are the economic dependency of a growing 'unproductive older generation on a shrinking productive younger generation and the increase in chronic, noncommunicable conditions burdening health systems.