Too many children on one side and too few on the other: fertility divides the world in two. Lancet: important social impacts

Too many children on one side and too few on the other: fertility divides the world in two.  Lancet: important social impacts


It’s not just economics that divides the world. Today it is above all the fertility rate. That is, the number of children brought into the world for each woman of childbearing age. This rate is indicated by TFR (total fertility rate) and should stand at 2.1 children per woman: this is the right number to be able to support a long-term generational replacement of the population. And what is happening and, above all, what will happen?

Few children in the West and too many in low-income countries

This rate continues to fall in many Western countries (Italy is among them: in 2021 it recorded a dramatic 1.3) and instead shows no signs of decreasing in low-income countries, drawing future projections that review all the concepts linked to the global population. THE results of the Gbd 2021 estimates, acronym for Global burden of Disease, Injuries and Risk Factors Study, results which are the result of global research by the Ihme (Institute for Health Metrics and Evaluation) of the University of Washington’s School of Medicine, were just published on Lancet and they draw a world divided in two, precisely by demographics. And from everything that follows from it.

Projections to 2050

But let’s get to some numbers: in 2050 more than three-quarters of countries (155 out of 204) will not have a sufficient fertility rate to support their population over time; and the number will rise further, reaching 97% of countries (198 out of 204) by 2100, i.e. after just 50 years. On the other hand, in some countries there will be the opposite problem, that is, limiting the excessive number of births: just think that one in two children on the planet, in 2100, will be born in sub-Saharan Africa. And that, in the absence of measures, in 2050 Niger’s fertility rate will be 5 births per woman of childbearing age.

How to intervene: the proposals

How to intervene, and with what tools do scholars ask? In the case of low-income countries, the study has an immediate solution: better access to contraceptives and education for women are two key factors, while in high-income countries but with low birth rates, support policies for parents and openness to immigration are needed for maintain the number of inhabitants and economic growth. “We are facing a profound social change – the professor said Stein Emil Vollset of the Ihme and first author of the study – in the world we simultaneously have a baby boom in some countries and a baby disaster in others”. Differences which translate into complex social, political and economic problems: on the one hand there are limited resources and with those we have to face an exponential growth of the population in economically unstable countries, with problems of global warming which are already having an impact and health systems in serious trouble; on the other hand, however, we have the problem of how to assist and support the costs of a constantly aging population.

And if it is true – as the study specifies – that policies in favor of the birth rate are unable to bring the rate back above that 2.1 which would guarantee generational turnover, it is equally true that it slows down the collapse below the threshold of 1.3 so much so that the recommendation is not only to implement policies in favor of those who want a child but to offer additional benefits such as a better quality of life, greater participation of women in the workplace, and an immigration policy. “We don’t have magic wands – admitted the co-author of the study Natalia V. Bhattacharjee – but social policies such as increased parental leave, free child care, financial incentives, greater rights in the workplace, can increase births.”

Fertility rate more than halved in 70 years

The global fertility rate in the last 70 years has more than halved, a particularly impactful trend for South Korea and Serbia, which with less than 1.1 children per woman have the lowest rate on the planet and, on the contrary, for Chad which has the highest rate with 7 births. And Europe, according to forecasts, faces a constant decline, going from 1.4 in 2050 to 1.37 in 2100 with some exceptions: Iceland, Denmark, France and Germany are doing better than the others.

In Italy

“That the situation in Italy is quite dramatic is nothing new – he reasons Filippo Ubaldi, reproductive doctor and past president of Sifes (Italian Fertility and Sterility Society) – and we only worry about it when the Istat data is published, for about a week. Then nothing more. From the years of the baby boom, in ’64 and ’65, just over one million children were born in Italy per year, we have moved on to 385 thousand in 2022: it means more than 600 thousand missing children per year, more or less a city like Turin or Palermo. The only one in Europe that has seriously worked to reverse the trend, starting thirty years ago, however, is France which has risen from 1.3 to 1.9 with extraordinary social and fiscal policies which however cost around 80 billion. What is certain is that we don’t have children to pay for grandparents’ pensions, but we must help those who would do so if they had help.”

Not just social policies

However, social policies, tax breaks, kindergartens and full-time schools are useful but not enough. “We need to provide information, in high schools and universities. Because even today young people don’t know that they need to have children as soon as possible. When I was born, in ’64, a 30-year-old first-time mother was considered elderly, today the average age at first child is 33 and 85% of the women who arrive at assisted reproduction centers are over 35. Just today I saw a 41 year and 9 month old woman who wanted to freeze her eggs to preserve her fertility and when I explained that he should have done it ten years ago, he replied that he had no idea. And so the kids need to know that children are born between the ages of 20 and 30, or in any case at 30 you have to decide what to do: you can do a child with the help of the family, do it without help, freeze the eggs. When Sifes like us did information campaigns in schools a few years ago, 50% of the high school principals replied that there was no interest. And without knowledge the girls think they being able to have children at 40, and the children aren’t coming.”



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