O-242 Why do we need to act NOW?
Authors: Fauser B  C J M 
Published: July 2024

In the early 1970s, the Report of Rome represented a powerful wake up call to the world. If the world population would continue to grow the way it did until then, catastrophe was predicted and the future of the planet would be in danger. All attempts should focus on decreasing world population growth. At that time the global total fertility rate (the number of children born per woman) was around 5. Policies were implemented worldwide aiming to reduce the number of children born, and the widespread introduction – at least in the more developed world - of various contraceptive strategies in the 1970s certainly helped to reach this goal. Especially in Western societies, the liberation in women (increased participation in higher education, more focus on work and career, and control over when to start a family if at all) was significantly enhanced, dramatically reducing the number of children born. In this context, it is no surprise that organizations like the European Union or the World Health Organization gave very low priority to fertility care, which would potentially increase the number of children born.

For a population to remain stable, approximately 2.1 child needs to be born per woman. At present, in more than 50% of all countries worldwide – mainly the more prosperous ones – the number of children born is below replacement level. It is anticipated that societies below replacement will increase up to 90% of all countries worldwide during the 21th century. Hence, underpopulation - causing distinct society challenges - rapidly becomes of distinct concern to many governments, especially in European countries, China, and Japan.

It is a generally recognized human right, in case individuals or couples wish to establish a family. However, historically little attention has been dedicated by policy makers to fertility care, mainly because the justified concerns for overpopulation. However, the incidence of infertility remains around 15% worldwide and treatment options have significantly improved. In addition, demand for fertility care is increasing year by year, especially by single individuals, lesbian or gay couples and other members from the LGBTQ+ community who wish to establish a family. At present, at least 10% of all children born are due to infertility therapies in some wealthy countries. However, access to fertility care varies dramatically due to high cost of treatment and lack of insurance coverage of such treatments in the great majority of countries.

At present, governments increasingly introduce so called “child friendly” policies (such as financial compensations, extended pregnancy and parental leave, free child care, tax benefits, etc), aiming to decrease barriers for people who wish to have children. Unfortunately, improved access to fertility care is not yet part of this discussion.

Over half a century, family planning strategies exclusively focused on the prevention of unwanted pregnancies aiming to reduce world population growth. However, at present family building strategies (helping people who wish to establish a family) should also be included in future family planning strategies.