The latest PET event focused on how assisted conception could help address the growing challenges of falling birth rates and shrinking populations.
Globally, and in the UK in particular, declining birth rates are raising concerns. Combined with longer life expectancies, they are contributing to aging populations and shifting demographics. On the same day as the event, it was reported that a maternity unit in the London borough where PET’s office is located would close due to the area’s low birth rate.
Sarah Norcross, director of PET, who chaired the event, referenced this news and highlighted a new section of the PET website that gathers articles on population decline and related issues. She then introduced the first speaker, Professor Geeta Nargund, lead consultant for reproductive medicine at St George’s University Hospitals in London, and medical director of CREATE Fertility and ABC IVF.
Professor Nargund began by explaining key terms, such as the total fertility rate (TFR)—the average number of children born to each woman. For a population to remain stable without migration, the TFR must be 2.1. However, in England and Wales, the TFR currently stands at 1.44, the lowest on record. In 2024, deaths outnumbered births for the first time in 50 years.
Professor Nargund also discussed the “Fertility Policy and Practice: A Toolkit for Europe” report, which reviews various policies’ impact on birthrates. The panel of experts found that improving the availability, accessibility, and affordability of childcare would likely have the greatest effect on birthrates. Assisted conception and workplace policies tied for second place. The evidence suggested that better access to fertility treatments could raise the TFR by 0.04, while also reducing social stigma, improving mental health, and providing a strong return on investment.
The second speaker, Professor Bart Fauser, scientific director of the International Federation of Fertility Societies (IFFS) and emeritus professor at Utrecht University, discussed global fertility trends. He noted that fertility rates are declining across most countries in the Organisation for Economic Co-operation and Development (OECD). A significant trend is that more people are choosing not to have children, and those who do tend to have them later in life.
Professor Fauser also shared insights from the IFFS consensus document on declining fertility, which emphasizes the human right to have a family and the need for family-friendly policies. He warned, however, that IVF cannot fully address the issue of declining birthrates, especially as many individuals delay having children. Better education about fertility risks is crucial.
Dr. Chris Skedgel, director of the Office of Health Economics and research fellow at the University of East Anglia, examined the factors contributing to the decline in birth rates. He highlighted that advances in quality of life—such as better education for women and lower child mortality—have led to fewer children being born. He noted that population decline is not necessarily a crisis, as it reflects societal progress.
Dr. Skedgel pointed out that infertility affects one in six couples globally. He suggested that improving access to fertility treatments could address up to 10% of the TFR gap. He also referenced Professor Andrew Scott’s idea that, instead of trying to change demographics to fit current institutions, society should adapt institutions to work for an aging population.
The final speaker, Dr. Paul Morland, a demographer and author, discussed fertility from two perspectives: biological fertility and TFR. He noted that biological infertility affects only a minority of people, so IVF is just one piece of the solution. Dr. Morland argued that societal and cultural factors, such as a lack of family-friendly cities and the rise of anti-natalist rhetoric, play a larger role in declining birthrates. He proposed that governments and societies adopt a “pro-natal” culture, where raising children is seen as a social responsibility.
Dr. Morland pointed to Israel, which has the highest TFR among OECD countries, as a successful example. The country’s government offers generous fertility treatments and promotes pro-natal values.
Audience members raised questions about immigration’s role in mitigating population decline. Dr. Skedgel acknowledged the issue but noted that immigration is often politically sensitive. Dr. Morland added that immigration could be seen as a form of “biological imperialism” if it involves attracting only the most educated individuals.
The panel also discussed concerns about the association between pro-natalism and far-right movements. Dr. Morland argued that the focus should be on the global nature of population decline, which is not confined to any one racial or ethnic group.
Education on the consequences of delaying family building emerged as another key issue. The panel agreed that young people need to be better informed about fertility risks, allowing them to make informed decisions about their futures.
The discussion highlighted the complex factors influencing birth rates, and the role that assisted conception could play in reversing the trend. However, it also emphasized the need for broader societal and policy changes to support families and encourage higher birthrates.
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