Image: A mother teaching her children in Matunga, Mumbai, India
Declining total fertility rates in urban areas are causing a re-examination of traditional responses to pro-natal policy. Gary Humphreys reports.
Puja Varaprasad wasn’t thinking about having a baby. “My grandmother had eight children and my mother had two. I wasn’t sure I wanted any,” says the 40-year-old shipping lawyer based in Singapore. “It wasn’t something I could talk about openly because childbearing is supposed to be such a gift. In the end I had a boy, and that was enough for me.”
Varaprasad is one of millions of young women worldwide who have opted to have one child or to forego childbearing altogether, a decision which is contributing to a decline in the global total fertility rate (TFR) – the average number of children that a woman would be expected to have over her lifetime.
According to the United Nations Department of Economic and Social Affairs, the global TFR currently stands at approximately 2.25 children per woman, slightly above the 2.2 replacement rate (the number of children needed to replace the parents and compensate for child mortality).
This represents an 18.2% decline from the 2.75 reported in 2000 and – according to a recent projection by the Institute for Health Metrics and Evaluation – the TFR may drop to 1.83 by 2050, with significant implications for population health and socio-economic sustainability. “The decline is most pronounced in highly urbanized, higher-income countries such as Japan, South Korea and Singapore, the latter of which currently is reporting a TFR of 0.97, but it is making itself felt in developing countries too, especially those that are rapidly urbanizing,” says Nathalie Roebbel, cross-cutting lead of the World Health Organization’s (WHO) Urban Health unit in the Department of Social Determinants of Health. Thailand is one example, the national average TFR standing at around 1.3 and 1.1 in urban areas. India is another, a country with a national average TFR of 2.1 and 1.6 in urban areas….
The article continues by pointing to three major changes in women’s lives that have led to this situation. These include access to family planning (mention of abortion is avoided). Another is full-time education leading to full-time work for women. Yes, what we fought for, for the past 50 and more years. But the article goes on to wringe its hands at the consequences of very low birth rates and declining total fertility rates, leading to – according to the author – the need to promote childbearing and alleviate the costs of childbearing in urban areas.
Caring for children is far more challenging in urban environments. “In rural villages in India, the extended family and wider community often help with child-rearing. However, in cities, the family usually consists only of parents and their children, and both parents often work. And because the government has not invested in childcare, urban parents typically face the additional expense of hiring someone to care for their children.” Similar problems are faced by urban parents across the country income spectrum, including those high-income countries implementing pro-natal policies. In Singapore, for example, although the government introduced a Baby Bonus Scheme in 2001 that includes a cash gift distributed over a child’s early years, parents still struggle. “I have yet to meet a parent in any of our studies who feels that the measures significantly reduce the financial stress of having children,” says Kalpana Vignehsa, a senior research fellow at the Institute of Policy Studies in Singapore. “Indeed, because health care is paid out of pocket in Singapore, many parents say they have exhausted most of the Baby Bonus by the time they have left the hospital after giving birth.”
The article argues that the “focus” changed with the 1994 Cairo Programme of Action, “with attention shifting to individual rights, and has remained there ever since… particularly women’s reproductive health and freedom from coercion. Since then, according to the authors, there has been a tendency to avoid discussing the topic in any other terms.”
Both “Poonam Muttreja, executive director of the Population Foundation of India”, and “Anna Rottkirch, a sociologist and demographer at the Population Research Institute of the Family Federation of Finland”, quoted extensively in the article, believe “the shift to individual rights… particularly women’s reproductive health and freedom from coercion” indicate a tendency to avoid discussing the topic in any other terms…”
Rottkirch agrees and, while supporting freedom of choice and acknowledging the wide diversity of interpersonal relationships, believes a start could be made by looking at the narrative around motherhood and partnerships. “We need to be increasing fertility awareness through education on reproductive biology and the optimal timing for having children, supporting partnerships by emphasizing the benefits of committed relationships, while avoiding overtly pro-natalist policies of the kind being used in some authoritarian regimes,” she says.
Kalpana Vignehsa, a senior research fellow at the Institute of Policy Studies in Singapore. also argues for a more balanced discussion (sic). “It’s great that people are no longer pressured into having children, and that choosing not to have children doesn’t affect one’s status,” she says. “However, it’s crucial to support those who do choose to become parents.”
In spite of their hesitations, however, these three highly successful professional women from India, Singapore and Finland, were calling for the promotion of more childbearing in the WHO Bulletin.
SOURCE: Bulletin of the World Health Organization, by Gary Humphreys. News: Declining fertility in urban areas. 2024;102:774–775. DOI: http://dx.doi.org/10.2471/BLT.24.021124 ; PHOTO: Faisal Magray, UNICEF