When desperate measures to persuade women to have children fail, it’s time for fresh thinking
For the past 75 years in global public health, one of the major priorities has been exponential population growth and Malthusian concerns that the supply of food on the planet won’t be able to keep up. In 1951, the world’s population was 2.5 billion, which increased to 4 billion by 1975, 6.1 billion by 2000, and 8 billion by 2023. Governments in the two most populous countries, India and China, even implemented, respectively, draconian policies such as forced sterilisation and a one-child restriction.
It now seems that many nations have switched to worrying about the opposite problem. Findings published last month from the Global Burden of Disease study, which examines epidemiological trends across the world, notes that fertility rates are falling in most countries. This can be seen as a public health success: lower fertility rates tend to reflect fewer children dying in the first 10 years of life, and an environment that protects women’s bodily autonomy and access to birth control, as well as girls’ education. Having mainly planned pregnancies is seen as societal progress.
But if low fertility is sustained, as the Global Burden of Disease study discusses, population decline follows roughly a generation later. In 2021, 110 countries were below replacement-level fertility. By 2050, the authors estimate population numbers will be falling in 155 countries. The problem is that with ageing populations, economies will struggle to have enough young workers to take up necessary jobs and to pay taxes and social security. Yet the problem of low fertility isn’t true for every part of the world: sub-Saharan Africa’s population is expected to keep growing. That region will have too many young people, and the rest of the world will have too few. One rational response to this demographic imbalance is for countries in population decline to encourage immigration from Africa. Does it matter where people come from, as long as they want to contribute to the workforce of a country and assimilate themselves and their children into the community? Aren’t we all human?
The immigration solution has faced pushback. For instance, the Hungarian prime minister, Viktor Orbán, has said, “Migration for us is surrender.” If you feel uncomfortable with this notion of a growing black or brown population, it’s worth asking what exactly this disquiet is about: skin colour? External appearance? Fear of another culture, or religion, taking over?
The other proposed solution has been trying to encourage people to have more children: some countries