O-243 Promoting family building strategies - a global call to action
Authors: Gianaroli L , Sgargi S , Mocanu E 
Published: July 2024

Promoting family building strategies - a global call to action

Study question
Are there any strategies that can be improved or implemented to promote family building and slow down the global decline in fertility rates?

Summary answer
Fertility rates are dangerously decreasing worldwide, therefore current strategies need to be improved and new ones should be developed to face present-day challenges.

What is known already
Although to different extent, almost half of the countries in the world are below replacement level due to generalized fertility decline. Through the years, many of them have put in place policies to promote natality, with variable results depending on the kind of strategy adopted, on socio-cultural factors and on other local peculiarities. Most commonly used policies include prevention and education, plans aimed at allowing couples to have children (ensuring work stability, financial stability, housing stability), benefits and incentives for families and implementation of childcare services and facilities. Assisted Reproduction Techniques (ART) have also been considered a potential tool to boost fertility rates.

Main results and role of chance
Quite surprisingly, however, even countries who have been adopting high-quality family-friendly policies are experiencing a decline in fertility rates (e.g. Finland) and strategies that have been effective in the past century may be even counterproductive nowadays. In fact, cultural, psychological, biological and cognitive factors should also be taken into consideration (alongside social and economical ones) and it should not be forgotten that attitude towards having children is not stable and may be subject to sudden, unpredictable changes (e.g. war in Ukraine and Middle East).
With specific reference to ART, it has been undergoing tremendous scientific and technical development in the last few decades, fueling the unrealistic expectation that it might solve all fertility problems and allow people to have children at any age. Actually, however, ART success rates are relatively low, especially in specific categories of patients. On the other hand, costs of these treatments are particularly high, which also affect accessibility for some of the patients in need.
Financial, physical and emotional toll even of a single ART cycle can be burdensome for most couples, who tend to give up after a couple failed attempts. However, data in literature show that in specific categories of patients, repetition of up to 5-6 cycle can importantly increase success rates.
Based on this assumption, the scientific community worldwide should start considering an ART treatment not as a single cycle, but a succession of more cycles, as deemed appropriate based on the patients’ characteristics. Number of cycles offered, planning and pricing should of course be adjusted accordingly. This paradigm shift might be difficult to instill in both professionals’ and patients’ minds, but it might turn out to be tremendously useful for ones as well as the others.

Limitation, reasons for caution
Although a global intervention in favour of family building is required, individual countries should design multidisciplinary strategies taking into account local and regional peculiarities. The above mentioned paradigm shift might initially encounter resistance from couples and professionals until its benefits are clearly documented.

Wider implications of the findings
Data show that it is essential that policymakers, healthcare professionals and other institutional stakeholders team up to raise awareness on infertility and to develop long term plans aimed at inverting this insidious trend that is already affecting all society and is destined to get even worse if not immediately tackled in a determined and cooperative way.