Fertility policy andpractice: a Toolkit for
the Asia-Pacific region

Supported byFertility policy and practice: a Toolkit for the Asia-Pacific region

2

Contents
3

About this Toolkit

4

Executive summary

5

Why is fertility an important issue?

8

How to use this Toolkit

11 The Toolkit
13 Applying the Toolkit at a country level
17 Country case-studies for the Policy Toolkit at a country level
24 Complementary policies
30 Afterword
31 References© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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About this Toolkit“Fertility policy and practice: a Toolkit for the
Asia-Pacific region” is an Economist Impact
report sponsored by Merck. The Toolkit provides
policymakers in the Asia-Pacific (APAC) region anevidence base that can be used when discussing
policies to address falling fertility rates. While
the Toolkit can be applied to all countries in theregion and conclusions are applicable to countries
at various stages of fertility transition, during thecreation of the Toolkit we have focused on thefollowing countries: Australia, Indonesia, Japan,
Malaysia, Republic of Korea, Singapore, Taiwan,
Thailand, and Viet Nam. We carried out an evidencebased literature review of global papers whichanalyse the impact of child-friendly policies, and held
two advisory workshops with local experts.

Ha Anh Duc, Chief of Cabinet Office, Ministry of
Health, Vietnam

The panel of experts represented diverse
views from across the region, and helped us tounderstand the current fertility landscape and the
difficulties faced when implementing policies. The
experts also facilitated the identification of thepolicy ideas that should be included, where thebarriers to implementation lie, and how best thisToolkit could be useful at a country level.

Ir. Dwi Listyawardani, Acting Deputy Chairman
for Population Management in the National
Population and Family Planning Board (BKKBN),
Indonesia

The majority of evidence which we have had todraw on has come from non-APAC countries. Suchis the nature of the evidence-base. Nevertheless,through engagement with the advisory panel wehave attempted to ensure that the Toolkit remains
especially relevant to APAC decision makers.
We would like to thank the following individuals forsharing their insights in the advisory workshops:
Georgina M Chambers, Director, National
Perinatal Epidemiology and Statistics Unit,
University of New South Wales, Australia

Osamu Ishihara, Professor, Clinical Medicine &Director of Nutrition Clinic at Kagawa Nutrition
University, Japan
Nai Peng Tey, Demographer and former associate
professor of Statistics, University of Malaya, Malaysia
Kamthorn Pruksananonda, Professor of OBGYN and Reproductive Medicine, Chulalongkorn
University and Chairman of the Reproductive
Medicine Subcommittee at The Royal Thai College ofObstetricians and Gynaecologists, Bangkok, Thailand
Lih Rong Wang, Professor, National Taiwan
University, Department of Social Work, Taiwan

P C Wong, Emeritus Consultant, Division of
Reproductive Endocrinology and Infertility,
National University Hospital, Singapore
Turro Wongkaren, Director, Institute for Advanced
Studies in Economics and Business, Indonesia
Nasuha Yaacob, Specialist in OB/GYN, andMember of Ministry of Health in National Assisted
Reproductive Technology (ART) Policy, Malaysia
Economist Impact bears sole responsibility
for the content of this report. The findings andviews expressed in the report do not necessarilyreflect the views of the sponsor, Merck, nor
the workshop participants. The project teamconsisted of Megha De, Martina Chow, Alan
Lovell, Alison Murphy, and Emily Tiemann.
© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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Executive Summary
Why is a Toolkit needed?
The fertility rates of many countries in the Asia
Pacific region (APAC) have been drastically declining
over the past 70 years. This has had an impact not
only on the population size of these countries, butalso on the structure of the population. South Korea
has the lowest total fertility rate (TFR) in the world
at 0.8, well below the replacement rate of 2.1, andSingapore and Japan are not much higher, at 1.1 and1.3 respectively. A long with this, the populationof older persons (aged over 60) in the region is
expected to triple between 2010 and 2050.
Policies such as parental leave, baby bonus
schemes, and assisted reproductive technology(ART) subsidies have been implemented as a way
to tackle these slowing fertility rates and help
couples achieve the family size they desire. But
what effect do these policies have on fertility
rates in practice, and how do they compare?
We have created a Policy Toolkit to present thisinformation in a user-friendly way, where theevidence behind effectiveness is clearly explained.
This Toolkit provides a menu of policy options
that APAC countries can explore, allowing them tochoose actions most appropriate for their economies
and where they stand along the fertility transition.
What does the Toolkit cover?
The Toolkit includes four categories of policies:
childcare polices, workplace policies, financial
incentives and assisted reproduction. Withinthese categories, we describe specific policy
ideas. These are given a score based on evidenceof impact on fertility rate, and a separate scoreshowing the economic benefits of the policy.
Other comparison elements include who thepolicy may be more impactful for, as well as
facilities and barriers. Finally we also include
examples of which groups of countries should
consider implementing which policies, dependingon where they stand within their own fertility
transition, examples of how these policies can be
implemented, and other ‘complementary policies’.
What are the next steps for policy makers?
The Toolkit shows how different policies compare
and how effective they might be. It is designed
to be used to support discussions on whichapproaches to fund. The Toolkit is a basis forfurther discussion, and individual policy groups
can add new interventions not already included in
our list. Policymakers need to retain a long-term,
investment mind-set, as the impact of many ofthese policies on fertility rates will inevitably takesome time to be emerge. But by exploring theevidence behind some of these policies and theirsuccess in other regions, we can begin to have faiththat change will come and impact will be seen.
While this Toolkit is based on insights gained
from research, many parameters need to beconsidered in order for specific policy decisions
to be made. These will be based largely on wherea country stands within its fertility transition andwhat its policy goals are. No policy Toolkit canreplace the deliberative and consensual processof the policy cycle, and different countries
will decide upon different approaches.
Nevertheless, we hope that this Toolkit will prove
useful for policymakers in the region. Our goal is that
it will help inspire the development of policy ideas toaddress falling fertility rates and support discussions
on where funding should best be targeted.
© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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Why is fertility an
important issue?

The population of a region and whether it grows
or declines depends on the interaction of three
key demographic factors: fertility, mortality
and migration, out of which fertility has thelargest effect on future population size. While
many countries in the world are continuing toexperience rapid population growth and theglobal human population reached 8.0 billion in
mid-November 2022,1 global total fertility rate
(TFR), the average number of children born
per woman, has more than halved since 1960.
In the East Asia & Pacific region, TFR was 5.4
in 1960, but has since fallen to 1.8 in 2020.2

The trend of fertility decline is evident from
Figure 1, which shows fertility rates for nine APAC
countries from 1960 to 2020. Except Indonesia,
which remains just above the replacement
rate (shown by the red-dashed line) every
country is below a TFR of 2.1 (considered as thereplacement rate: the TFR at which a population
exactly replaces itself from one generation to
the next, without migration). The drivers ofthese falls are many, and covered in previous
Economist Intelligence Unit reports.3-6

Figure 1. Total fertility rate from 1960-2020 in APAC
Australia

Indonesia

Japan

Malaysia

Republic of Korea

Singapore

TaiwanThailand

Viet Nam

Replacement rate

7.00
6.00
5.00
4.00
3.00
2.00
1.00
0
1960-1965 1965-1970 1970-1975 1975-1980 1980-1985 1985-1990 1990-1995 1995-2000 2000-2005 2005-2010 2010-2015 2015-2020
Source: UN World Population Prospects 2019

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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APAC is the fastest growing economic
powerhouse in the world,7 holding about aone-third share of global GDP.8 Yet it is also theregion with the biggest falls in TFR. Naturally,
many celebrate the reductions in fertility rates.
There are arguments to be made that it is moreenvironmentally sustainable, and may improvestandards of living, which comes from a smallerfamily and the resultant higher per capita
income. There are two responses to this. Firstis that for many countries it’s not about raising
the population size, but slowing the pace of its
decline. Second, it’s about trying to maintain asustainable relationship between generations.

a TFR of 2.1 would be 63% larger (an increase of¥456 trillion) than a Japan that remained at a TFR
of 1.3. Without such investments in family-friendly
policies, a shrinking GDP is expected due to lower
consumption and a smaller workforce, alongside
an increasingly burdened old-age support system.

Take Japan. A 2022 Economist Impact report
calculated that even if the country can keep a TFR
of 2.1 until 2100, which is more than the Japanese
government’s target of 1.8 and its current TFR of
1.3, the country’s population is still expected tobe 10% smaller in size than it is today.3 Howevereven with that fall, the economy of a Japan with

Much of Asia’s economic growth has been
associated with its demographic dividend dueto the rise in the proportion of working-age
population in the 1960s to 1990s.9 However, theregion’s ageing will impact its economic output.
With an increasing old-age dependency (ratio of
number of persons aged over 65 years divided by
the number of persons aged 15-64 years10) there
will be fewer people from the working age tosupport an aged person. For instance, from having
almost 15 people from the working age to support
one elderly person in 1980, Taiwan is projected
to have just over one person's equivalent support
for a person over 64 years of age by 2050.

Figure 2. Taiwan’s old-age dependency ratio
1980

2022

2030

2070

1:14.8

1:4

1:2.7

1:1.1

Source: Population Projections for the Republic of China (Taiwan): 2022-2070. National Development Council. Taiwan.
© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

While efforts should be made to support fertility
levels, policymakers also need to have a planfor how to sustain the economic outcomes of asmaller population. This may include policies toincrease labour productivity, invest in innovationand technology to attain higher productivity
from a limited working age population, increase
official retirement age, and expand educationand healthcare support for all.10 Our focus is on
supporting couples to be able to have the children
and the family size that they wish, however familyfriendly policies should not be seen as a solution
to long term demographic and cultural trends.

While efforts should be madeto support fertility levels,
policymakers also need tohave a plan for how to sustain
the economic outcomesof a smaller population.

7

Box 1: Immigration and fertility rate
The benchmark of a 2.1 replacement rate
per woman assumes no net migration.
In some parts of the world however,international migration is a major
component of population change and isdifficult to ignore. All countries have somelevel of immigration and emigration, andmany of the economic drawbacks thatcome from a low TFR can be offset from alarger flow of immigrants. As immigrants
are usually from younger, working age
groups, they can potentially reduce theage-dependency ratio, and the evidence
suggests that in general host countries
gain from the net fiscal contribution
from young and skilled migrants.11, 12
Immigrants also tend to have higher
TFRs, although these often decline overtime.13 Nevertheless, immigration brings
its own challenges and therefore, while
an important consideration, immigration
policy is not included in our Toolkit due
its wider contextual implications.

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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How to use this Toolkit
In 2019 28% of the world’s governments had
policies which aimed to raise fertility, compared
to only 9% in 1976. The most common policy
adopted by countries was paid or unpaid
maternity leave with job security followed bypublicly subsidized childcare, child or family
allowances, paid or unpaid parental leave andpaid or unpaid paternity leave with job security.14
But how effectively do these policies work? Wehave provided evidence, through case studies
in different countries, of how different policy
options can help boost fertility rates. However,we acknowledge that a particularly type of childfriendly policy may be suitable for one country oreven a province within a country, but unsuitable
for another. Also that single national policies may
be unfeasible, particularly in APAC countries, asdifferent regions within a country have different
fertility rates. For example, in Indonesia someprovinces have falling fertility rates, while others
have a growing population.* Differences can also
be seen between ethnicities within countries.
Keeping in mind this situation of ‘one size
doesn’t fit all’, a methodological Policy Toolkit
is built that offers a way to present the various
policies in a user-friendly way, providing a menu
of options that APAC countries can explore.
Intended beneficiaries of this Toolkit are thosewith the ability to influence, develop andimplement policies and programmes to improve
fertility rates in APAC. This Toolkit can be usedby policymakers in their respective regions to
support discussions on which approaches to fund,choosing actions appropriate for their economies.

* Personal communication from an interview with Turro Wongkaren,
Director of the Institute for Advanced Studies in Economics and Business in Indonesia© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

The Policy Toolkit has the following components:
1. Policies and policy area - we havecategorised the various policies that showed
impact on TFR into four policy areas:childcare; workplace policies, financial
incentives, and assisted reproduction.
2. Impact on fertility rate - each policy area
comes with a star rating to indicate thequality of the evidence-base of the respective
policies, and their impact on fertility rates. The
rationale behind the rating is given below.
3. Most impactful for… - different policies
impact different segments of the population
be it working mothers, parents with young
children or women over 35 years of age. Thissection offers a guide to policymakers of who
may be most impacted by the various policies.
4. Economic benefits - this offers a guide to
the likely size and timeframe of the returnon the investment for each policy area. The
rationale behind the rating is given below.
5. Facilitators - as child-friendly policies work bestin bundles, the ‘facilitators’ column will enablea reader to know which policies can showeven better results if combined with another.
6. Barriers - being aware of the potential barriers
for a policymaker is crucial before implementing
a policy; we list potential barriers here.
7. Country transition stage/archetypemost suited to policy - we suggest what
policies may be most suitable for countries atdifferent stages of their fertility transition.

98. Implementation examples - based on examples
seen around the world, we provide ideas of how
these policies could be implemented in practice.
9. Complementary policies – we list policies
and approaches that are less evidence-basedthat could complement the policies listed.
Following on from the tabulated Toolkit, wehave a section on country archetypes, which
we hope may act as an aide in stimulating
discussion on which are the most relevant typesof policies for different types of countries in
APAC (in particular, where each country is in
its journey along the “fertility transition”).15
To provide background information on the policies
selected, and expand on the ‘Implementation
examples’ section of the Toolkit, case studies
and short summaries from the literature review
scan are provided in the ‘country case-studies
for the Policy Toolkit’ section. It is worth notingthat while the majority of evidence cited comesfrom non-APAC countries (such is the natureof the evidence base) we have endeavoured
to place the evidence in an APAC context.
Finally, we have also drawn together a section
on complementary policies, this expands onthe ‘complementary policies’ section of the
Toolkit. These are policies, such as on eldercare or housing, which although not designed
to impact fertility rates, are likely to do soin real life. It is worth keeping these in mind
when considering family friendly policies.

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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Rationales for “Evidence of impact” and “Economic benefits” components
Evidence of impact on fertility rate, methods note

Evidence of a significant, long term increase in TFR, for a wide segment of
the population, from high quality experimental studies

Evidence of a long term increase in TFR, for a segment of the population,from experimental or observational studies

Evidence of a small, long term increase (or larger but short term increase) in
TFR, for some people, from experimental or observational studies



Weak evidence of an increase in TFR, or support from conjecture only

Little to no evidence available (either experimental or observational), or
evidence of no or negative impact

Economic benefits, methods note+++

Evidence of significant, immediate positive returns on investment (increases
in GDP, tax contributions)++

Some evidence of immediate positive returns on investment, evidence of
longer-term returns (due to life-time earnings and life-time tax contributions). Medium cost to implementation+

High cost to implementation, less evidence of positive returns on investment© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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The Toolkit
Policyarea

PolicyEvidenceof impact
on fertility
rate

Most impactful
for…

Economic
benefits

Facilitators

Barriers

Countrytransition stage/archetype mostsuited to policyT

Implementation
examples*Complementarypolicies^

Childcare

Increasing
childcareavailability

Working parents.
Contributes tobetter work/
life balance andmothers canreturn to work
sooner.

+++Childcare policies
work well withmaternity leave, as
they help alleviate
the conflict
between women'sroles as workers
and mothers.

Can beadministratively
complicated.
Caregivers andinfrastructure canbe in short supply,
particularly in lessurbanised places
and in the informal
sector.

#3: Countries with
sub-replacement
fertility (higher
urbanisation).
#4: Countries withultra-low fertility.

Expand publicchildcare slots forchildren under acertain age.
Encourage
workplaces toprovide childcare or
subsidise childcare
for their employees.

Subsidisingchildcare
costs



Lower income
working parents.
Reduces financial
constraints onfamilies and can
reduce social
inequalities.

Families may failto utilise childcare
subsidies for which
they are eligible.
There may bedifficulties, realor perceived,
associated withaccessing subsidies.

#1: Countries
approaching
sub-replacement
fertility

Introduce a cap onchild care charges
and standardized
fee schedules.

Childcare in thecommunity.
Extended family
as caregivers.
Childcareprovision in theworkplace.
Extended hours
for schools.
Domestic
workers providing
childcare.

Can lead to shortrun reductions in
employment andearnings, and makeit less likely for
women to return
to work. It can also
make it difficult forworkplaces to findcover, and is a highfinancial burden
for employers.

#1: Countries
approaching
sub-replacement
fertility#2: Countries with
sub-replacement
fertility (lower
urbanisation).

Introduce
government
incentives to
employers who
provide maternity
leave.
Provide income
replacement(maternal
compensation)
for time out of
the labour market
following childbirth.
Increase the lengthof paid maternity
leave.

Low uptake iscommonplace,
may need to be
mandated to havean effect. Highfinancial burden
for employers.

#4: Countries withultra-low fertility.

Introduce
government
incentives to
employers who
provide paternity
leave.
Make leave
exclusively reserved
for fathers andnon-transferable tomothers.
Introduce shorter
working hours forparents of children
under a certain age.
Encourage
employers to offer
more part-time roles
for mothers.

Workplace
Policies

Improved childcare
has been shown tohave many socialand economic
benefits. It canpromote childdevelopment, childwell-being, andsuccess later in life.

++

Introduce freepublic preschoolfor children under acertain age.

Improvingmaternity
leave



Professional,
college educatedwomen. Careerorientated womenare more likely toclaim maternity
leave, increasing
the probability of
having first andsecond births.

Improvingpaternity
leave



Professional,
college educatedmen, although
uptake often
remains low.

Flexibleworking:
shortenedor parttime
workinghours

Parents withyoung children
and with
other caring
responsibilities.
Provides a range ofoptions for womenconsidering
returning to theworkplace.

Can beadministratively
complicatedand expensive
for workplaces
to implement,
and reduce
advancement
opportunities for
women if usedinequitably.

#1: Countries
approaching
sub-replacement
fertility.
#2: Countries with
sub-replacement
fertility (lower
urbanisation).

Introducing
unpaid jobprotected
leave



Working parents
who may need totake sporadic time
off to look after
their children.

College-educatedfemales are more
likely to takeunpaid maternity
leave.

#4: Countries withultra-low fertility.

Workplace policies
work well withfinancial incentives
to reduce thefinancial burden
which may result
from taking timeaway from theworkplace.
The reach ofsuch provisions
is ensured when
it is guaranteed
or mandated, e.g.
as part of an act
introduced by thegovernment.
30.4
29.2

Childcareprovision in theworkplace (notethis is more likely
to be a possibility
in the formal
sector).
Lactation roomsin the workplace
for mothers.
Work-from-home
options.

T
See section titled ‘Applying the Toolkit at a country level’*See section titled ‘Country case-studies for the Policy Toolkit’^See section titled ‘Complementary policies’© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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Policyarea

PolicyEvidenceof impact
on fertility
rate

Most impactful
for…

Economic
benefits

Facilitators

Barriers

Countrytransition stage/archetype mostsuited to policyT

Implementation
examples*Complementarypolicies^

Financial
Incentives

Introducing
a babybonus

First-time parents,
particularly thoseon lower incomes.
It can help with
the initial costs ofnewborn babies.

+

Financial incentives
work well in
combination withworkplace policies,
to provide morefinancial freedom
when taking timeaway from theworkplace afterchildbirth.

Less cost-effective
than otherinterventions.
Susceptible toeconomic crises
and the country’s
economic
performance.
May just have ashort-term impact#2: Countries with
sub-replacement
fertility (lower
urbanisation).
$3: Countries with
sub-replacement
fertility (higher
urbanisation).

Provide a lump sum
for new births, either
for all new mothers
or just for those oflower income.

Offering
tax
incentives

Workingparents andhouseholds withyoung children,
particularly thoseon higher incomesin a higher tax
bracket.

None reported,though any tax
reform can becomplicated.

#4: Countries withultra-low fertility.

Housing subsidies
for families.
Reduced social
contributions forlarger families.
Subsidies forthe cost of baby
products/otherexpenses forfamilies.
Subsidies tocover the cost of
marriage.

Offering
monthlycashtransfers
per childHouseholds
without workers in
the formal sector.
Can be particularly
helpful for families
or parents withlower incomes.

Transfers may
make it difficult forpoor households
to escape poverty
if they encouragelarger families withlower family spend
per child.

#2: Countries with
sub-replacement
fertility (lower
urbanisation).
#3: Countries with
sub-replacement
fertility (higher
urbanisation).

Provide monthly
payments per child.

Improving
publicfunding of
IVF



Older, lowerincome womenwith fertility issues
hindering theirability to conceive.

Could lead to an
over-reliance on
fertility treatment,
and delays instarting a family.
There may bedifficulties inaccessing sociallyand culturally
appropriate
fertility care.

#3: Countries with
sub-replacement
fertility (higher
urbanisation).
#4: Countries withultra-low fertility.

Introduce freepublic coverage for
1-3 cycles of IVF,
with or without age
restrictions.
Subsidise ART
coverage forclinically infertile
couples.

Offering
infertility
insurance
mandates

As above, older,
lower-income
women withfertility issues.

Increasing
mandates maylead to insurancecompanies raising
their prices.

#4: Countries withultra-low fertility.

Introduce legislationthat requires healthplans to provide
infertility benefits.

Increasingtheavailabilityof IVF
services

Women withfertility issues
hindering theirability to conceive,
particularly those
who do not live inmajor cities.

Relies on clinics
themselves toexpand services.
There may be alack of trained
HCPs able toprovide fertility
treatments.

#4: Countries withultra-low fertility.

Encourage fertility
clinics to expand
beyond cities.
Expand training in
fertility for HCPs.

Assisted
Reproduction

Cash transfers per
child can be morecost-effective forthe government if
targeted only forpoor households.

++

ART policies
work well when
its expansion
is coupled withsubsidising
the treatment(insurance
mandates) as
financial pressure
can lead patientsto transfer multiple
embryos tomaximise successfrom one cycle. This
increases multiple
births which is
associated withincreased healthrisks to mother andinfants.
“Low-cost” IVF
innovations mayhelp improveaccess, but theevidence quality
remains poor.

Fertility education
to increaseawareness of ageassociated fertility
decline.
‘Low-cost’ IVF© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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Applying the Toolkit
at a country level
Country archetypes

fertility transitions that are being seen, especially as
they sit at different stages within this journey.

The Asia Pacific region is extremely diverse, and its
countries and sub-regions vary demographically,geographically, economically, culturally andinstitutionally. No single comprehensive policy canaddress all aspects of the dynamic population andBased on a number of impact indicators seenin Table 1, we suggest a series of archetypes forcountries in the region, based on where they sit intheir fertility transition: this can be seen in Figure 3.

Table 1: Impact indicators informing country archetypes16-20
High

Moderate

Low

Country

Income Group(World Bank)

ThailandUpper-middle-income
economyVietnam

Lower-middle income
economyMalaysia

Upper-middle-income
economyTaiwanHigh-income economy

Indonesia

Lower-middle income
economyJapan

High-income economy

Australia

High-income economy

Singapore

High-income economy

South
Korea

High-income economy

Urban population(% of total
population)

Labor force
participation
rate, female (% offemale population
ages 15+) (modeled
ILO estimate)(2021)

Ratio of female tomale labor force
participation rate(%) (modeled ILO
estimate)

Age at firstmarriage, female(2000-2017)

Wage and salaried
workers, female(% of female
employment)(modeled ILO
estimate) (2019)

Total fertility rate,
per woman, 201520 (UNPD)

51%

58.2

79

22.5

49.7

1.53

37%

68.2

88

22.8

41.1

2.06

77%

48.7

66

25.1

71.2

2.01

79.3%

51.5

76.5

30.4

44.6

1.15

57%

51.6

66

22.4

41

2.32

92%

51.9

75

29.2

91.6

1.37

86%

58.1

87

29.9

87.7

1.83

100%

57

77

26.5

91.3

1.21

81%

53

74

31.5

78

1.1

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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The archetypes are a general categorisation basedon few data points. Reality is more complicated.
Nevertheless, placing countries into archetype
categories allows policymakers to start the processof thinking about specific policies that may suit theneeds of the populations they serve. We describe
below how policy may be shaped based onarchetype categorisation. Importantly, the majorityof the evidence used to develop this Toolkit hascome from non-APAC countries, and there is alack of reliable information directly applicable tothis region. There is a need to gather more data toassess the effect of policy on fertility in the region,
as well as economic impact to ensure that this isespecially relevant to APAC decision makers.

Most countries follow similar strategies when it
comes to their fertility rates, and there is potential
for countries earlier in the fertility transition,
which are approaching sub-replacement fertility
and perhaps have variable TFRs across regions, tolearn from the experiences of those further along,those which may have already reached ultra-low
fertility. Of course a lot depends on how effectively
targeted and funded policies are and how muchappetite there is for them, and whether there arecultural or societal norms that prevent people fromtaking up the support offered by governments.

Figure 3: Country archetypes

Indicators

Approaching
Sub-replacement Sub-replacement
fertility
fertility

Fertility period
ArchetypeSub-replacement
fertility

Ultra-low
fertility

Ultra-low
fertility

Variable TFRAcross regions

Lower Urbanisation

Higher Urbanisation

Lower Gender Equality

Higher Gender Equality

URBANISATION

Low

Low

Moderate

High

High

FIRST
MARRIAGE

Early

Early

Moderately
early

Later

Later

FEMALE
WORKFORCE
PARTICIPATION

Low

Moderate

Moderate

ModerateHigh

PROPORTION OF
FEMALE SALARIED
WORKERS

Low

Low

Moderate

High

High

Example countries

Indonesia

Thailand

Vietnam

Malaysia

South Korea

Japan

Australia Singapore Taiwan© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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Archetype #1: Approaching sub-replacement
fertility (variable TFR across regions)Archetype #2: Sub-replacement
fertility (lower urbanisation)

Countries in this fertility transition stage may not
yet see falling fertility rates as a problem, andpublic funds are often understandably allocatedinto other more pressing areas. Additionally, TFR
can often be variable across regions, meaningthat policies to encourage larger family sizes may
not be appropriate or necessary in those regions
which continue to have a high TFR. In contrast,
these regions may benefit from polices to reduce
TFR. Evidence suggests that for countries at thisstage, a combination of cost efficient and longterm minded policies offer the best opportunity
to influence fertility rates and avoid drastic falls
in birth rates in the most affected regions.

Countries in this fertility transition stage havetypically seen a lot of economic growth in recent
decades, much of it driven by their flexible andskilled workforce. However this workforce is at
risk as the population ages and couples begin tohave smaller families, partly due to urbanisationand migration from the country to the city.

• Family friendly policies are recommended,such as parental leave, job security andworkplace regulations to help balance workand family duties, boost gender equality
and support women who may wish toremain in, or enter, the workforce.

• Shifts to cities mean higher costs of raisingchildren and lack of affordable housing.
Financial and tax incentives are therefore
recommended, to mitigate these risingcosts and encourage family building.
• As women participate increasingly in theworkforce, policies to support these choices
should be developed, such as flexibility
in work hours to foster better work-lifebalance, and extended maternity leave.

• To encourage higher female workforce
participation without sacrificing the option
for a family, childcare cost subsidies orpolicies that provide free childcare should beconsidered. Such policies will be particularly
important for lower-income families.

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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Archetype #3: Sub-replacement
fertility (higher urbanisation)

Archetype #4: Ultra low fertility (withor without wider gender equality)

Countries in this fertility transition are likely
to have seen steep declines in TFR over thelast decade, which is starting to dip below
replacement levels. Age of marriage is beginning
to increase, as more women remain in educationand enter the workforce. It is important for thesecountries to maintain their fertility levels.

Instead of maintaining the population size, efforts
should be focused on managing and slowing
the decline so that it remains sustainable andnot drastic. Any increase in fertility rate will bevaluable, even if still below replacement levels
and countries at this stage should be actively
encouraging policies to encourage familybuilding. High urbanization and high female
labour participation mean women are less likely
to pause their careers to marry and start a family.

• To maintain family sizes, financial transfers
per child could be encouraged, as well as tax
subsidies for larger families. Decent child careand parental leave also need to be maintained.
• As these countries continue to urbanize, lackof access to ART is seen, both geographicallyand economically. Policies to subsidise ART
through public funding therefore would provide
increased options for infertile couples.

• Childcare should not be seen as a deterrent
to start a family, especially in regions
where women are expected to provide
the majority of this, and therefore policies
that increase the availability of childcare
should be encouraged, so that the burden
does not fall exclusively on women.
• Due to later age of marriage and therefore
later age of first birth, infertility is increasingly
common, meaning that policies that
increase availability of fertility clinics andintroducing IVF subsidies would remove
this as a barrier to starting a family.

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

17

Country case-studies
for the Policy Toolkit

This section lists case studies and short summaries
from the literature review scan to provide
background information on the policies selected
and give a rational to the scores listed in the
Evidence of impact on fertility rates column andthe Economic benefits column. Additionally,
we expand on the ‘Implementation examples’
section of the Toolkit. Most of these studies
are experimental in nature, as fertility rate wasmeasured before a policy was implemented,
and again in the years following to measure theimpact. It is worth noting that the majority ofthese case studies come from non-APAC countries
as this is the nature of the evidence base, and not
due to policies in this region being ineffective.
1. Childcare policies
The rising participation of women in the workforce
is an important driver behind declining fertility
rates.21 Childcare services, when delivered
well, can facilitate family life alongside working
careers. There is much evidence from systematicand narrative reviews of the beneficial impacts
of increasing childcare. Expanding childcare
places together with lowering the cost ofchildcare increases fertility rates and reduces
social inequalities.22 For example, high-quality
childcare has long-term positive effects on health,educational attainment, and earnings, particularly
for children from poorer families. However, while
expanding childcare is beneficial for many families,
reducing childcare costs will not help families witha preference for parental care over formal care.
We have subcategorized childcare
policies into expanding childcare services
and reducing childcare cost.
1.1 Increasing childcare availability
Belgium: A longitudinal study from 20012004 showed that a 1%-point increase inlocal childcare coverage was associated witha 10.8% increase in first birth odds among
dual-earner couples.23 Smaller effects forsecond and third births were also seen.
Germany: The expansion of public childcare
slots for children under age 3 resulted in a 2.7%
increase in birth rates per 10% point increasein slots amongst women aged 15-44 years.24
Japan: An increase in childcare availability
in Japan from 2000 to 2010 led researchers
to estimate that a universal childcare policy
would increase TFR by up to 0.315.25© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region18

1.2 Subsidising childcare costs

2. Workplace policies

Sweden: A Child Care Reform in 2001 imposeda cap on child care charges and standardized
fee schedules across Swedish municipalities.26
Average reduction in total child care costs
was just over 50%, which increased fertility
rates by 4–6%. Stated differently, a USD$10,000 reduction in child care costs increased
fertility by 2–3 children per 1,000 women.

While there are many direct costs incurred withhaving children, indirect costs also exist in theform of forgone employment opportunities.
To try and compensate for these potential
lost opportunities, workplace policies exist to
encourage mothers to return to the workforce
post-childbirth. While earlier reviews havefound the evidence for parental leave to be“weak” or “mixed”,31-33 a recent systematic
review concluded that substantial expansionsof parental leave schemes do have a positive—
both in terms of lasting and substantive—
effect in increasing fertility, although theeffect is mostly beneficial to high-earning
couples.22 And a 2019 UNFPA report showedthat in highly developed countries, increases
in fertility rates were associated with higher
gender equality, including in the workplace.33

Israel: When the government introduced
free public preschool for children aged 3 and4, preschool enrolment increased sharply.
However, fertility appeared to have beenunchanged in the short-run. Importantly
though, the intervention increased mothers’
labour force participation by 7%.27
1.3 Childcare economic benefit
Studies have shown that providing childcare isassociated with higher female employment rates,
particularly for mothers, and countries with ahigher availability of affordable childcare havehigher maternal labour force participation.28, 29
This not only increases family income, but also
increases tax contributions, ideally generating
an immediate positive return. A cost-benefit
study by the Institute for Public Policy Researchin the UK showed that universal childcare paida return to the government of £20,050 overfour years in terms of tax revenue minus thecost of childcare for every woman returning
to full-time employment after one year ofmaternity leave. And in Quebec Canada, a 2008
policy which introduced universal access to
low-fee childcare allowed more than 70,000
additional mothers to be able to work (increaseof 3.8% in women employment), increasing
GDP by 1.7%.30 It could therefore be argued
that increasing the availability and decreasing
the cost of childcare is a positive investment.

Public childcare and parental leave can help
alleviate the conflict between women's roles
as workers and mothers. When implemented
together, they allow parents to retain their jobs
while they care for their newborn, and thengo back to paid work when their child is readyto be cared for by others. However, there is aconcern that very long compensated parental
leave may cement traditional gender roles.34 In
order to overcome some of the stigma fathers’
face in taking voluntary paternity leave, somejurisdictions have also started to introduce
periods of mandatory paternity leave.35 Time willtell what impact these may have on fertility rates.
We have subcategorized these policies
into maternity leave, paternity leave,
the offering of flexible working options,and unpaid job-protected leave.

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

2.1 Improving maternity leave
Germany: A 2007 maternity leave reformin Germany substantially changed maternal
compensation for time out of the labour
market following childbirth, providing income
replacement of at least 67% of annual pre-birthearnings, with a maximum 3,600 EUR. The
General Fertility Rate (GFR) of the 15–44-year-old
group increased from 2.12 births per 1000 women
per month in April 2006 to 4.20 in August 2007.36
Germany: Another study to assess the impactof the maternity leave reform in Germany in2007 (as mentioned above) reported that thepolicy induced highly educated women to givebirth to 8.5 additional children per 1,000 womenin a given year over the 5 years post reform.37
Austria: In 1990, the Austrian government
doubled paid maternity leave from one to
two years. An analysis of this reform showedthat it led to an increase in short-run fertility(5 additional children per 100 women within
three years) and long-run fertility (3 additionalchildren per 100 women within ten years).38
Increasing leave reduced the cost of childcare,encouraging mothers to give birth to about 7
additional second children per 100 women.
2.2 Improving paternity leave
Norway: In 1993 Norway introduced a fourweeks' father quota. A study compared families
with children born up to three months before
and after the reform, relative to the samepre-/post-reform difference.39 It found thatthe reform neither affected fertility rates nor
affected fathers’ work hours and yearly earnings.
Even with the reform only 24.6% fathers ofchildren born in April 1993 took leave.

19

Spain: In 2007 a reform of the family benefit
system extended the sixteen weeks of paid
parental leave by two additional weeks exclusively
reserved for fathers and non-transferable tomothers.40 This substantially increased the take-up
rate of fathers (by as much as 400%), but delayed
higher-order births and reduced subsequentfertility among older women by about 15%.
2.3 Shortened or part-time working hours
Japan: In 2009, the Japan government
announced that workers with children under
three could request shorter work hours (e.g.,six hours a day). The policy increased rates offirst child birth by 33%, although no significant
effect on overall fertility was observed.41
Europe: a study analysing the relationshipbetween availability of part-time work andfertility for eleven European Community
countries found that for working women, thepart-time schedule affected fertility positively
in Belgium, Germany, Ireland, Italy and The
Netherlands - women that made use of thispossibility were more likely to have a child.42
2.4 Introducing unpaid job-protected leave
USA: The Family and Medical Leave Act (FMLA),
1993, introduced 12 weeks of unpaid job-protected
leave to employees who have worked for at least 12
months. A study comparing changes in birth rates
between women eligible for leave and a control
group of women not eligible for such leave showedthat it increased the probability of having a first andsecond birth by about 1.5 and 0.6 % per annum,
respectively.43 Compared to other women, eligible
women gave birth to the first child a year earlier
and to the second child about 8.5 months earlier.

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

2.5 Workplace policy economic benefit
There is evidence that offering paid leave is generally
good for female employment as it encourages
women to enter work before childbirth and it
facilitates re-entry after childbirth.44 Implementationof paid leave programmes have been shown toincrease female employment rates by 1.5-2.5%
relative to male rates.45, 46 When introducing paid
leave, there can be financial and administrative
costs for employers to hire replacement workers
or retrain existing workers; on the other hand
it means better employee retention as workers
return after leave, and it could enhance employee
loyalty, productivity, and morale. Particularly in
Asia, it has also been shown that higher female
labour force participation leads to better economic
development, and it is important to have policies
in place to overcome constraints that can reduce
the level of women's participation in work.45
3. Financial Incentives
Financial incentives can support families byreducing the direct monetary cost of raisingchildren, improving the financial standing of thehousehold, and creating better conditions forchildren.33 Transfers given as a result of new births,
or on a regular basis throughout a child’s life,
have been shown to help increase fertility rates,
primarily amongst lower income households.
However, financial incentives are likely to justhave a transitory impact on fertility compared
to childcare services or parental leave.22

20

We have subcategorized financial incentives
into baby bonuses (one-off payments atbirth), monthly cash transfers, and tax
credits for families with children.
3.1 Introducing a baby bonus
Spain: In 2007, a lump-sum universal childbenefit of 2500 EUR was introduced for all new
mothers—although the policy was cancelledin 2010 following the 2008 economic crisis. A
study that tracked birth rates during the timeof the introduction and cancellation of thispolicy concluded that the introduction of the2007 policy led to a 3% increase in birth rates
and the cancellation in 2010 to a 6% drop.47
Canada: An allowance for Newborn Children
introduced in 1988 in Quebec, Canada, paid up to
Can$8,000 to families after the birth of a child.48
The fertility of those eligible was estimated to haveincreased by 12% on average, and up to 25% forfamilies eligible for the full amount. A Can$1,000
increase in first-year benefits was estimated toincrease the probability of having a child by 16.9%.
Australia: A study estimated a 12.8% increasein birth rates in Australia following a baby bonus
maternity payment introduced in 2004.49
3.2 Offering tax incentives
Spain: In 2003 a Spanish income tax reform
introduced a tax credit for working motherswith children under the age of three, while also
increasing child deductions for all householdswith children. A paper in 2010 concluded that
this reform led to a 5% increase in fertility.50© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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3.3 Offering monthly cash transfers per child

4. Assisted Reproduction

Argentina: In 2009 Argentina introduced apoverty-alleviation program (AUH) providing
monthly cash transfers per child to households
without workers in the formal sector. A
comparative study between the probability of
having a new child among eligible and ineligible
mothers both before and after the program
inception found that fertility increased by about
2% in households with at least one child.51

The increase in women’s education andemployment has meant that age of marriage andage of first birth have increased in many APAC
countries. As more births occur in a woman's 30s
than ever before, the potential need for assisted
reproductive technologies has also been increasing.33
A systematic review concluded that cheaper
health services in general and cheaper assisted
reproduction in particular have a positive effecton fertility.22 However, this conclusion was basedon findings from the United States, and it remains
a question whether this would apply elsewhere.
So called “low-cost” IVF services have been
described in some resource poor settings thatpromise improved access because of the lower
cost base.54 However, while some of these
innovations have been described in feasibility or
efficacy studies, most of these studies have beenof low quality.55 We have therefore not included
low-cost IVF as a separate policy category.
We have subcategorized assisted reproduction
policies into the provision of public funding
for ART, increasing its availability, andintroducing infertility insurance mandates.

Figure 4: Fertility and miscarriage
rates according to maternal age
Fertility

Spontaneous abortions

500

100

450

90

400

80

350

70

300

60

250

50

200

40

150

30

100

20

50

10

0

20-24 25-29 30-34 35-39 40-44 ≥45
Maternal age (yr)Rate of spontaneous abortions (%)

Child allowances and cash transfers have beenshown to also affect female employment but
this time negatively so, with a study conductedin Japan and Korea showing that regularfemale employment declined with more childallowance, as child cash allowances discouraged
women from taking up regular employment.52
Additionally, a study conducted in Quebec,
Canada which examined the labour supply
and fertility effects of fertility incentives
found that while increases in parental leave
benefits substantially increased birth rates andincreased female employment, cash-transfer
incentives only slightly increased birth rates anddecreased female labour supply. And the net
government cost of each additional birth due
to an increase in parental leave was $15,828,
compared to $223,625 for the cash-transfer
fertility incentives. The conclusions of this study
were that offering paid parental leave was amore cost-efficient way to increase fertility
compared to cash-transfer incentives.53

Fertility rate (per 1000 married women)

3.4 Financial incentive economic benefit

0

Source: Advanced Maternal Age — How Old Is Too Old?
Linda J. Heffner, M.D., Ph.D. The New England Journal of Medicine 2004

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Fertility policy and practice: a toolkit for the Asia-Pacific region

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4.1 Improving public funding of IVF

4.3 Increasing the availability of IVF services

Australia: Medicare, a national health insurance
scheme in Australia, subsidises ART treatment
which is considered clinically necessary without
any age limitations or restrictions based on
number of prior cycles performed and parity.
A study to explore the impact of having an
expanded ART coverage without any age
restrictions found that between 2010 and2017 TFR increased by 4 to 5% per annum.56

United Kingdom: A study in 2006 investigating
whether ART should be made part of population
policies found that if the UK increased its accessto ART from 625 cycles per million women to2106 cycles, it would increase TFR by 0.04.59

Canada: For 5 years (2010 to 2015) the Quebec
government initiated public coverage of ART.
A study of the impact of this public healthcoverage showed that more than 9232 babies
were born as a result of the programme.57
4.2 Offering infertility insurance mandates
United States: In 2003 legislation was
introduced at the federal level in the UnitedStates that required health plans to provide
infertility benefits. The mandates wereshown to have significantly increased firstbirth rates for women over 35 by 32%.58

Western countries: Based on the data from
Netherlands in 2002 for the age at which womenstart trying for their first child, a computerised
simulation study explored the impact of increased
IVF access on TFR.60 It analysed the effect offull access to three cycles of IVF given during a
12-month period after 1 or 3 years of trying toconceive unsuccessfully. The findings suggested
that full access to IVF after 3 years would increase
the TFR by 0.08 children and applying IVF after
1 year would lead to an additional TFR increaseof 0.04, with double the number of IVF cycles
and twin and triplet children, and a shift fromnaturally conceived children to IVF children.

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Fertility policy and practice: a Toolkit for the Asia-Pacific region

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4.4 Assisted reproduction economic benefit

SEK (the average investment costs required toconceive a child by IVF) resulted in approximately
a 24% return on capital62 and a study in South
Africa found that based on the average IVF
investment cost needed to achieve one live birth,the fiscal return on investment would be 5.64.63 In
Singapore, analysis has suggested that increasing
public reimbursement for assisted reproduction
from $3,000 to $5,000 per cycle for up to 3 cycles
would mean an additional 825 live births per year,
which can generate an additional $293 million
in discounted net taxes for the government.64

Perhaps the majority of studies diving into
return on investment of fertility policies arethose involving assisted reproduction. A study
assessing long-run economic benefits of a UK
state-funded IVF programme found that theinvestment needed to achieve an IVF singleton(£12,931) is worth 8.5 times this amount to the
UK Treasury in discounted future tax revenue
over the resulting child’s lifetime.61 Similarly, a
study in Sweden found that investing 205,000

Box 2: Which metrics should be used to monitor the impact of policies?
After implementation of a policy or package of policies it is necessary to track outcomes tosee if it is having the desired effect. However, measuring the impact of policies on fertility,
particularly in the short term, is a challenging business: it is often as much a question ofmodelling as of empirical measurement.65 It can be seen in the case studies above that a myriadof different metrics have been used. Useful metrics to track, if possible, are TFR and the mean
age of mothers at birth. However, we recommend working with an institute of demography
to ensure the most relevant measurements are being collected in each individual case.
1) Total fertility rate: The average number of children a hypothetical cohort of women
would have at the end of their reproductive period if they were subject during their whole
lives to the fertility rates of a given period and if they were not subject to mortality. TFR
is directly calculated as the sum of age-specific fertility rates (usually referring to women
aged 15 to 49 years), or five times the sum if data are given in five-year age groups.66
2) Mean age of mothers at birth: The average age of women at childbirth. The mean age of
mothers at birth can be calculated both for all births and also for first births only.67 The countries
with TFR below replacement rate generally has the highest mean age of childbearing, and ahigher mean age at childbirth increases the generation gap and reduces the size of the future
population growth.68 Postponement of family formation partly drives this increasing trend ofmean age of mothers at childbirth, which ultimately impacts the age-specific fertility rates.67© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

24Complementary policies
It is important to consider how other strategies
could work in combination with the familyfriendly policies that are covered in this Toolkit.
These are policies, ideas and approaches that
do not necessarily have the strong evidencebase as has been seen in the more conventional
policies listed, and therefore are not as easily
comparable as their direct impact on fertility
rates is hard to measure. They may also beapproaches that are not specifically designed tohave an impact on fertility rates, but are likely
to do so in real life particularly in the Asia Pacificregion. Although these policies are not listed in
our Toolkit and we have not provided an impact
rating for them, it is worth keeping these in mind
when considering family friendly policies.

“I think to increase fertility,
it has to be multifactorial.”
P C Wong, Emeritus Consultant, Division of
Reproductive Endocrinology and Infertility,
National University Hospital, Singapore“I think to increase fertility, it has to be
multifactorial”, says Dr P C Wong, Emeritus
Consultant in the Division of Reproductive
Endocrinology and Infertility at National
University Hospital, Singapore. “You haveto look at the whole process, it's not a single
sector.” In this section we will discuss thepolicies, issues and approaches that could
complement family-friendly policies.

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

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Parents, grandparents and community support
Multi-generational families are common in
APAC. As life expectancy increases, so does theoverlap of lifespan between generations, leading
to a greater chance of intergenerational coresidence.69 Living with a child or with extended
family members is the most common form ofliving arrangement among people aged 65 years
or over in APAC.70 This can be both a helperand a hindrance for the younger generation,
since while older people can provide care anddomestic support to the family, potentiallyrelieving work-life conflicts, they may needcare and support themselves.71 In Taiwan, forexample, there are many families simultaneously
taking care of children and of elderly parents.
“Maybe we should be promoting elder carepolicies simultaneously with child care policies”
says Professor Lih Rong Wang of the National
Taiwan University’s Department of Social Work,
who believes the growing number of “sandwich
families” is discouraging couples from having
children. Demographer Nai Peng Tey of the
University of Malaya in Malaysia, suggests thattax incentives could be provided to couples
residing with older parents, and it is important
to ensure that there are adequate rooms toaccommodate them “In this way, we can provide
care and support for older people, and this will
not be a reason for people to have less children.
So this is a way to promote the value of children
rather than the cost of children” he says.

In Indonesia, extended families are often the
caregivers, says Ir. Dwi Listyawardani, Acting
Deputy Chairman for Population Managementin the National Population and Family Planning
Board (BKKBN), and this is something that should
be considered as well as formal childcare facilities.
Turro Wongkaren, Director of the Institute forAdvanced Studies in Economics and Businessin Indonesia, agrees: “the government should
create policies that make it possible for childcare
to happen more easily among families”. Indeed,studies have shown that grandparents do provide
substantial support to their adult children,
especially those in the workforce.72, 73 The idea of
unconventional childcare can also be extended
further, says Dr Tey “I think community support
is important, and community centres can also
serve as daycare facilities where neighbours andolder people who are available can come help out,
whether it's for free, or with some allowances”.

“I think community
support is important,and community centres
can also serve as daycare
facilities where neighbours
and older people who areavailable can come help
out, whether it's for free,or with some allowances.”
Nai Peng Tey, Demographer andformer associate professor of Statistics,
University of Malaya, Malaysia© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

Some countries in APAC such as Singapore, Korea
and Japan also have a culture of employing foreign
domestic workers or ‘helpers’ to aid in childcare
and some studies have shown that this can have26

time-saving effects in the hours spent on andchildcare. However even with live-in help, many
working parents still tend to spend significantly
more time on childcare and managing helpers.74

Figure 5. Examples of complimentary childcare policies:
The central circle shows the two core policies relating to childcare (as described in the Toolkit table above).
The overlapping circles show example contextual societal, cultural and economic policies that may work alongside the core policies.

Childcare in thecommunity

Extended hours
for schools

Reduced costof childcareChildcareprovision in theworkplace

Increased
availability ofchildcare places

Families/
grandparents
providing childcare"On-demand"childcare© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

27

The inclusive workplace and affordable housing
Similarly, childcare should also be offered in theworkplace, says Dr Wong. “Places that have many
employees, for instance large offices, hospitals, schools,
factories, should have childcare facilities on-site so thatparents can drop off their kids, then they go upstairs
to work, then at lunchtime, they can pop in just to
see what's happening. And they should also havelactation rooms for nursing mothers; many offices in
Singapore are beginning to have that now”. In Korea,
The Equal Employment Act 1987 obliges employers
to provide facilities for childcare at workplaces,75 but
despite this, workplace childcare constitutes only 1%of the total number of such facilities, and employer
conformity with the legislation has been low.76
However importantly, workplace-based childcare
may only be a possibility in the formal employment
sector or within larger enterprises, whereas many
women work in more informal roles where provision ofchildcare is rare and would be difficult to implement.
Housing can play a vital role in shaping fertility
decisions. Expensive housing, particularly in densely

urbanised cities, significantly increases the cost ofchild rearing, leading many couples to keep theirfamily size small.77 In Korea, for example, it has beenshown that housing type and housing expenses havea significant influence on marriage and fertility.78 Ha
Anh Duc, Chief of Cabinet Office at the Ministry of
Health in Vietnam, thinks couples looking to starta family should be prioritised if they are looking tobuy a house or apartment. Such couples should
be considered for reduced pricing and reducedsocial contributions. “If couples have a second child,
their social contribution should also be reduced”
he suggests. A recent study in Singapore foundthat each unit increase in the price of flats reduced
TFR by 0.0036.77 It is not only the cost of housing
however that has an impact on decisions, cost
is a burden throughout a child’s life, from having
to purchase specialist baby products, food andfurniture, as well as educational costs throughout
early and teenage life.79 Policies that help alleviate
some of this more overshadowed costs would be
welcomed in APAC according to our experts.

© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

28

From first-date nerves to married with children
One of the biggest factors contributing to the lowbirth rates in many countries in Asia is the late ageof marriage, as this contributes to a later age ofchildbearing. In Taiwan, the average age of marriage
is now 31 for women, much higher than it used tobe according to Dr Wang. Involuntary non-marriage
is more common in Pacific Asia than in Westerncountries, and resultant involuntary childlessness
plays a substantial role in observed low fertility
rates.80 In Thailand the prevalence of delayedchildbearing has been doubling since 1998, and thisis leading to age-related fertility decline and higher
incidence of infertility, miscarriage and pregnancy
related complications.81 There may therefore be
room to expand policies which focus on encouraging
marriage and childbearing at an earlier age. An
example can be found in Singapore, where theSocial Development Network exists to coordinate
and facilitate dating activities for single people.
“They call it the government matchmaking service,”says Dr Wong. “And they have a lot of activities toencourage single men to meet single women”.
Later age of marriage is also a significant
contributor to fertility decline in Malaysia,
according to Dr Tey: “the leading factor for marriage
postponement is financial constraints, including
the high costs of marriage - men will postpone orforego marriage until they are financially stable
and able to afford the high costs of marriage andto support and family.” He goes on to say that“for highly educated women, the inability to finda suitable partner is also an important reason
because in our culture, there is this tendency fora woman not to marry downwards, so they mustfind someone of at least equal educational level and there are significantly more women in higher
education than men.” Such cultural norms are
difficult to manage at a policy level, but the state
can support marriage through a variety of means.79

Figure 6. Average age of women at marriage in APAC
Years
30

Korea
Japan
Australia
Singapore
Taiwan28
26

Malaysia
Thailand

24

VietnamIndonesia

22
20
18
16
14
1985

1990

1995

2000

2005

2010

2017

Source: UN World Data (2019) and OECD (2017)© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region29

Knowledge before success
Involuntary childlessness may also be caused
by a lack of awareness of fertility issues, andespecially of fertility decline in women. Evidence
suggests that although people are generally
aware of risk factors associated with age for
fertility, they overestimate the potential of
ART to compensate for age-related fertility
decline.82, 83 A study conducted with Chinese
university students found that a large proportionof them underestimated the age-related
fertility decline (92%) and overestimated thefertility treatment success rate (66%).84
Such findings suggest that fertility awarenesscampaigns from a young age for both sexes
may help. “What's really lacking in our country”
says Professor Georgina M Chambers, Directorof the National Perinatal Epidemiology andStatistics Unit at the University of New South
Wales in Australia, “is education around fertility,
and around when the best time is to accesssomething like fertility treatment, because
almost undoubtedly, many women who turnup at the fertility clinic have a higher opinionof how that's going to help them than it reallywill. And that education needs to happen froma young age”. Dr Wongkaren agrees, saying that
the Indonesian government “wants to implant
the norm to younger generations that having aplan is important”. Dr Listyawardani adds that
“we are trying to promote the value of family
to the younger generation”. It is important tonote, however, that while important, educational
campaigns are a long-term policy investment.

“What's really lacking in
our country is education
around fertility, and aroundwhen the best time is toaccess something likefertility treatment.”
Professor Georgina M Chambers, Directorof the National Perinatal Epidemiology
and Statistics Unit at the Universityof New South Wales in Australia© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region30

Afterword
The Asia Pacific Region has recently been
undergoing major demographic changes.
While countries may have competing priorities,
the importance of ensuring sustainablefertility rates should not be neglected. Earlyintervention is important, as the impact ofpolicies on fertility rates will inevitably takesome time to emerge. Governments need toretain a long-term, investment mind-set.
Policies such as those outlined in this Toolkit also
play an important role at the global level. Take
the United Nations Sustainable Development
Goals (SDGs), for example. Many of the goals andtargets deal with factors that directly or indirectly
influence fertility and population growth. Target
1 calls to end poverty in all its forms everywhere.
With the ageing population, the workforce isshrinking, and this is liable to cause significant
economic challenges. Women are a crucial part ofany country’s economy, and providing increased
incentives for women to remain in the workforce,for instance through improved workplace policies
and childcare, would significantly contribute toa country’s available work force and help limit
poverty. These policies would also help countries
meet target 5, which calls for greater genderequality and empowerment for women. Target 10also calls for reduced inequality, this time within
and among countries. Enforcing into law some ofthe policies explored in this Toolkit, for instanceparental leave, would ensure equal opportunity;
these should be seen as a basic necessity. Finallyand perhaps most relevant, target 3 calls for
ensuring healthy lives and promoting wellbeing for all at all ages. Within this, 3.7 calls foruniversal access to sexual and reproductive
health-care services, including for familyplanning, information and education, and theintegration of reproductive health into national
strategies and programmes; this may include
addressing the need for improved access to ART.
This fertility Policy Toolkit comprises acomprehensive set of policy recommendations
that are based on insights gained from research.
However, many parameters need to be considered
in order for specific policy decisions to be
made. These will be based largely on where acountry stands within its fertility transition andwhat its policy goals are. No Policy Toolkit canreplace the deliberative and consensual processof the policy cycle—and different countries
will decide upon different approaches.
Nevertheless, we hope that this Toolkit will prove
useful for policymakers in the region. Our goal isthat it will help inspire the development of policy
ideas to address falling fertility rates and support
discussions on which approaches to fund.

* For more details about the UN’s sustainable development goals,
see https://sdgs.un.org/#goal section or https://www.globalgoals.org/© The Economist Group 2023

Fertility policy and practice: a Toolkit for the Asia-Pacific region

31

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Fertility policy and practice: a Toolkit for the Asia-Pacific region

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© The Economist Group 2023

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