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Declining birth rate in Developed Countries: A radical policy re-think is required

Authors:
Geeta Nargund at St George's, University of London
Geeta Nargund
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Declining birth rate in Developed Countries:
A radical policy re-think is required
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References
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Fig. 1. I%>;<;?10<;85/51?@;-00>1??01/85:5:3.5>@4>-@1?5:01B18;<10/;A:@>51?
... The underlying causes and implications of population growth patterns vary significantly across countries and regions, with some nations grappling with the consequences of rapid expansion, while others face the challenges of declining birth rates and aging populations. Below-replacement fertility, often seen in high-income countries, is attributed to factors such as higher living costs, delayed FP due to education and career priorities, and the prevalence of individualistic lifestyles [1]. This demographic trend poses potential challenges, including an aging population and a shrinking workforce, which can strain social security systems and economic growth [2]. ...
Contentious population policy-making and its consequences: a health policy analysis
Article
Full-text available
  • Apr 2025
Background Governments strategically shape their population policies to effectively harness and sustain vital human resources, responding to the evolving dynamics of demographic trends and the intricate interplay of economic, social, and political conditions. Nevertheless, they strive to uphold their populations'health and fundamental rights. Iran's population policies have undergone significant shifts over the past four decades, reflecting changing socio-political dynamics and demographic challenges. This study aims to analyze Iran's population policies, emphasizing their implications for health outcomes and the status of human rights, offering important insights for governance in population policy. Methods We conducted a qualitative study using Walt Gilson's Policy Analysis Triangle framework. Data were collected through in-depth interviews and national policy documents. Thematic analysis was employed to identify themes across policy context, content, process, and actors. Results In the realm of population policies that impact the health and rights of individuals, members of parliament and pressure groups wielded the greatest power and influence. The policy-making environment was intricate and turbulent; governance exhibited poor and biased implementation; and, regarding content, an ineffective and inconsistent population policy package existed. Conclusion Population policies that overlook ethical principles and do not adequately address social needs or adapt to the evolving dynamics of societies pose a risk to individual health and infringe upon fundamental human rights.
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... This association fundamentally alters the idea that a person's vulnerability to diseases solely arises from genetic and postnatal environmental interactions. The Developmental Origins of Health and Disease (DOHaD) hypothesis predominantly links fetal growth restriction (FGR), as a result of placental insufficiency and inadequate nutrient and oxygen delivery to the fetus, with increased risk of developing physiological deficits including glucose intolerance, insulin resistance and hypertension, as early as adolescence [3]. However, there is emerging evidence that fetal overgrowth, as a consequence of excessive nutrient supply to the fetus, can also have a profound impact on lifelong health and disease [4]. ...
A human cytotrophoblast-villous endothelium-fetal organ multi-cell model and the impact on gene and protein expression in placenta cytotrophoblast, fetal hepatocytes and fetal kidney epithelial cells
Preprint
  • Apr 2025
Appropriate fetal growth during pregnancy requires multi-directional communication from the maternal, placental and fetal systems. Disruption in any of these signaling arms can have deleterious consequences for fetal growth and initiate developmental adaptations within fetal tissues and organs that are associated with both short- and long-term morbidities. In this proof-of-concept translational, human cell model study we aimed to identify the impacts of altered trophoblast stress response mechanisms and human insulin-like 1 growth factor (hIGF1) nanoparticle gene therapy on gene and protein expression in fetal liver hepatocytes and fetal kidney epithelial cells. We utilized human cell lines: BeWo choriocarcinoma cells (trophoblast), Human Placental Micro-Vascular Endothelial Cells, and WRL68 (hepatocytes) or HEK293T/17 (kidney epithelium), in a co-culture model designed to mimic cytotrophoblast-villous endothelium-fetal organ communication. Trophoblast stress response mechanisms were increased by culturing BeWo cells in growth media without FBS. Stressed BeWo cells were also treated with a hIGF1 nanoparticle gene therapy known to mitigate cellular stress mechanisms. Stressed BeWo cells had increased expression of cellular stress mechanisms but not when IGF1 was over-expressed with a transient hIGF1 nanoparticle gene therapy. Stressed and Stressed+hIGF1 BeWo cells had increased expression of gluconeogenesis and glycolysis rate-limiting enzymes. Gene and protein expression in fetal liver and kidney cells was not impacted by increased trophoblast stress or hIGF1 nanoparticle gene therapy. In conclusion, our data demonstrated that cytotrophoblast under stress turn on mechanisms involved in glucose production. Whether this is reflected in vivo remains uninvestigated but may represent a placental compensation mechanism in complicated pregnancies.
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... Economic diversification has improved the standard of living in several developing countries which has led such countries to approach the level of low birthrates, population aging or both phenomena as in developed countries. Low birthrates have become a global social problem (Legislative, 2022;Nargund, 2009;Yang, 2019). ...
The influence of the low birthrate on Taiwan’s preschool enrollment and strategies implemented to cope with this influence
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Full-text available
  • Feb 2025
Article History Keywords Competitiveness Curriculum innovation Low birthrate Preschool enrollment Service quality Word-of-mouth marketing. This study explored the influence of the low birthrate in Taiwan on preschool enrollment and the preschools' strategies for coping with this influence. The researchers developed a questionnaire: Influence of Taiwan's declining birthrate on preschool enrollment. This questionnaire was administered along with the coping orientation to problems experienced scale to randomly sampled preschool teachers. The findings revealed that (1) the low birthrate has considerably affected Taiwanese preschool enrollment. Most preschools face insufficient enrollment, enrollment difficulties, increased marketing costs and (2) the influence of the low birthrate. Taiwanese preschools should increase their investment in improving their learning environments and equipment, software and hardware facilities and teaching quality and should establish characteristics specific to the preschool to improve recruitment. The findings of this study indicate that preschools should (1) increase their income and reduce their expenditures. (2) Strengthen their integrated marketing and focus on brand and word-of-mouth marketing. (3) Conduct internal and external evaluations of their service quality. (4) Consistently improve the professional quality of their teachers and childcare personnel, implement curriculum innovation and (5) improve their competitiveness in the market. This study presents this overview to clarify the necessity of this study and how this study can contribute to the academic understanding of this topic. Contribution/Originality: This paper contributes to understanding the influence of the low birthrate in Taiwan on preschool enrollment and the preschools' strategies for coping with this influence.
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POLICY RECOMMENDATIONS TO ALLEVIATE JAPAN’S FERTILITY CRISIS
Article
Full-text available
  • Sep 2024
The aim of this research paper is to carry out an extensive and nuanced investigation on how cross-country cultural differences may have a possible influence on how fertility rates respond to policy interventions. This paper will provide a comparative analysis in regards to the fertility issues observed in the Japanese and French population. This research will analyze the lessons that Japanese policy makers can obtain from policy interventions in France that have led to a recent rise in the fertility rate. My research will primarily rely on a comparative analysis framework to gather substantial and relevant information and perspectives through the reviewing of various excerpts of qualitative and quantitative data obtained from scientific journals and expert studies pertaining to fertility and cultural issues within the two countries. The paper will explore various aspects of fertility policies, including economic incentives, family support systems, and work-life balance initiatives, to understand their impact in different cultural contexts. The results of the research indicate that the overworking work-culture in Japan may have a significant influence on the trends observed in Japanese fertility rates. Though effective policy interventions have been shown to positively impact fertility rates in France, such regulatory action has not been nearly as effective in Japan. These findings suggest that Japan must focus on addressing an underlying cultural issue that may not be as prevalent, or even observed, in other countries, which is its dysfunctional work culture. The Japanese, therefore, cannot merely model their fertility regulations after the French as such actions would not address the core issue to Japan’s low fertility.
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The extraterrestrial hypothesis: an epistemological case for removing the taboo
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Full-text available
  • Feb 2025
The extraterrestrial hypothesis (ETH), the hypothesis that an extraterrestrial civilization (ETC) is active on Earth today, is taboo in academia, but the assumptions behind this taboo are faulty. Advances in biology have rendered the notion that complex life is rare in our Galaxy improbable. The objection that no ETC would come to Earth to hide from us does not consider all possible alien motives or means. For an advanced ETC, the convergent instrumental goals of all rational agents – self-preservation and the acquisition of resources – would support the objectives of removing existential threats and gathering strategic and non-strategic information. It could advance these objectives by proactively gathering information about and from inhabited planets, concealing itself while doing so, and terminating potential rivals before they become imminently dangerous. Other hypotheses of ETC behavior, including the zoo/interdict hypothesis and the dark forest hypothesis also undercut the claim that the ETH is highly improbable, and the ETH overturns none of our well-tested scientific knowledge. It follows that evidence offered in its support need not be extraordinary. The fact that most reports of unidentified anomalous phenomena (UAP) have natural or human explanations does not count against the ETH. Inference to the best explanation offers a way to find evidence for the hypothesis and some evidence exists, some of it taking the form of reliable witness reports. The most plausible alternative explanation for some UAP declines in probability over time. A hypothesis that does not contradict well-established facts or theories, is not highly improbable for other reasons, and explains otherwise unexplained evidence is a rational hypothesis. Since the ETH meets this test, it should be evaluated alongside other possibilities when the case-specific evidence warrants it.
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Sociological Study of Women's Reproductive Health in Almaty: Determinants and Diseases
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Full-text available
  • Dec 2024
This article presents the results of a sociological study aimed at studying the state of women's reproductive health in Almaty and identifying the factors influencing it. The main objective of the study is to analyze the socio-economic and socio-cultural determinants that determine the level of access to health services and awareness of women of reproductive age about preventive measures and disease risks. Particular attention is paid to the issues of accessibility and quality of health care, awareness of contraception and prevention methods, as well as the influence of existing cultural stereotypes on women's behavioral attitudes in the field of health. The methodological study is based on a sociological survey conducted among 320 women living in the districts of Almaty. The questionnaire included a wide range of questions related to reproductive behavior, frequency of seeking medical care and the level of awareness and health. The results showed that women with low income and education face greater barriers to obtaining quality health services, which is associated with both financial constraints and socio-cultural norms that influence their perception of the need for health care. The contribution of the study is to identify the need for comprehensive support aimed at improving women's reproductive health in Almaty. Based on the results, recommendations are proposed for the creation of programs that will increase access to health care and women's awareness of risks, as well as help overcome cultural barriers. The practical significance of the results lies in the possibility of their use in developing strategies that will increase women's awareness of health risks, ensure access to necessary health services, and create more favorable conditions for independent decision-making in the field of reproductive health.
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Mild ovarian stimulation for IVF
Article
Full-text available
  • Oct 2008
  • HUM REPROD UPDATE
Mild ovarian stimulation for in vitro fertilization (IVF) aims to achieve cost-effective, patient-friendly regimens which optimize the balance between outcomes and risks of treatment. Pubmed and Medline were searched up to end of January 2008 for papers on ovarian stimulation protocols for IVF. Additionally, references to related studies were selected wherever possible. Studies show that mild interference with the decrease in follicle-stimulating hormone levels in the mid-follicular phase was sufficient to override the selection of a single dominant follicle. Gonadotrophin-releasing hormone antagonists compared with agonists reduce length and dosage of gonadotrophin treatment without a significant reduction in the probability of live birth (OR 0.86, 95% CI 0.72-1.02). Mild ovarian stimulation may be achieved with limited gonadotrophins or with alternatives such as anti-estrogens or aromatase inhibitors. Another option is luteinizing hormone or human chorionic gonadotrophin administration during the late follicular phase. Studies regarding these approaches are discussed individually; small sample size of single studies along with heterogeneity in patient inclusion criteria as well as outcomes analysed does not allow a meta-analysis to be performed. Additionally, the implications of mild ovarian stimulation for embryo quality, endometrial receptivity, cost and the psychological impact of IVF treatment are discussed. Evidence in favour of mild ovarian stimulation for IVF is accumulating in recent literature. However, further, sufficiently powered prospective studies applying novel mild treatment regimens are required and structured reporting of the incidence and severity of complications, the number of treatment days, medication used, cost, patient discomfort and number of patient drop-outs in studies on IVF is encouraged.
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Socioeconomic Disadvantage and Adolescent Women's Sexual and Reproductive Behavior: The Case of Five Developed Countries
Article
Full-text available
  • Nov 2001
  • Fam Plann Perspect
Differences among developed countries in teenagers' patterns of sexual and reproductive behavior may partly reflect differences in the extent of disadvantage. However, to date, this potential contribution has received little attention. Researchers in Canada, France, Great Britain, Sweden and the United States used the most current survey and other data to study adolescent sexual and reproductive behavior. Comparisons were made within and across countries to assess the relationships between these behaviors and factors that may indicate disadvantage. Adolescent childbearing is more likely among women with low levels of income and education than among their better-off peers. Levels of childbearing are also strongly related to race, ethnicity and immigrant status, but these differences vary across countries. Early sexual activity has little association with income, but young women who have little education are more likely to initiate intercourse during adolescence than those who are better educated. Contraceptive use at first intercourse differs substantially according to socioeconomic status in some countries but not in others. Within countries, current contraceptive use does not differ greatly according to economic status, but at each economic level, use is higher in Great Britain than in the United States. Regardless of their socioeconomic status, U.S. women are the most likely to give birth as adolescents. In addition, larger proportions of adolescents are disadvantaged in the United States than in other developed countries. Comparatively widespread disadvantage in the United States helps explain why U.S. teenagers have higher birthrates andpregnancy rates than those in other developed countries. Improving U.S. teenagers' sexual and reproductive behavior requires strategies to reduce the numbers of young people growing up in disadvantaged conditions and to help those who are disadvantaged overcome the obstacles they face.
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Socioeconomic Disadvantage and Adolescent Women's Sexual and Reproductive Behavior: The Case of Five Developed Countries
Article
  • Nov 2001
Context: Differences among developed countries in teenagers' patterns of sexual and reproductive behavior may partly reflect differences in the extent of disadvantage. However, to date, this potential contribution has received little attention. Methods: Researchers in Canada, France, Great Britain, Sweden and the United States used the most current survey and other data to study adolescent sexual and reproductive behavior. Comparisons were made within and across countries to assess the relationships between these behaviors and factors that may indicate disadvantage. Results: Adolescent childbearing is more likely among women with low levels of income and education than among their better-off peers. Levels of childbearing are also strongly related to race, ethnicity and immigrant status, but these differences vary across countries. Early sexual activity has little association with income, but young women who have little education are more likely to initiate intercourse during adolescence than those who are better educated. Contraceptive use at first intercourse differs substantially according to socioeconomic status in some countries but not in others. Within countries, current contraceptive use does not differ greatly according to economic status, but at each economic level, use is higher in Great Britain than in the United States. Regardless of their socioeconomic status, U.S. women are the most likely to give birth as adolescents. In addition, larger proportions of adolescents are disadvantaged in the United States than in other developed countries. Conclusions: Comparatively widespread disadvantage in the United States helps explain why U.S. teenagers have higher birthrates and pregnancy rates than those in other developed countries. Improving U.S. teenagers' sexual and reproductive beha vior requires strategies to reduce the numbers of young people growing up in disadvantaged conditions and to help those who are disadvantaged overcome the obstacles they face.
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A mild treatment strategy for in-vitro fertilisation: a randomised non-inferiority trial
Article
  • Mar 2007
  • LANCET
Mild in-vitro fertilisation (IVF) treatment might lessen both patients' discomfort and multiple births, with their associated risks. We aimed to test the hypothesis that mild IVF treatment can achieve the same chance of a pregnancy resulting in term livebirth within 1 year compared with standard treatment, and can also reduce patients' discomfort, multiple pregnancies, and costs. We did a randomised, non-inferiority effectiveness trial. 404 patients were randomly assigned to undergo either mild treatment (mild ovarian stimulation with gonadotropin-releasing hormone [GnRH] antagonist co-treatment combined with single embryo transfer) or a standard treatment (stimulation with a GnRH agonist long-protocol and transfer of two embryos). Primary endpoints were proportion of cumulative pregnancies leading to term livebirth within 1 year after randomisation (with a non-inferiority threshold of -12.5%), total costs per couple up to 6 weeks after expected date of delivery, and overall discomfort for patients. Analysis was by intention to treat. This trial is registered as an International Standard Randomised Clinical Trial, number ISRCTN35766970. The proportions of cumulative pregnancies that resulted in term livebirth after 1 year were 43.4% with mild treatment and 44.7% with standard treatment (absolute number of patients=86 for both groups). The lower limit of the one-sided 95% CI was -9.8%. The proportion of couples with multiple pregnancy outcomes was 0.5% with mild IVF treatment versus 13.1% (p<0.0001) with standard treatment, and mean total costs were 8333 euros and 10745 euros, respectively (difference 2412 euros, 95% CI 703-4131). There were no significant differences between the groups in the anxiety, depression, physical discomfort, or sleep quality of the mother. Over 1 year of treatment, cumulative rates of term livebirths and patients' discomfort are much the same for mild ovarian stimulation with single embryos transferred and for standard stimulation with two embryos transferred. However, a mild IVF treatment protocol can substantially reduce multiple pregnancy rates and overall costs.
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Towards a more physiological approach to IVF
Article
  • Jun 2007
  • REPROD BIOMED ONLINE
The International Society for Mild Approaches in Assisted Reproduction (ISMAAR) is founded to promote a more physiological, less drug-oriented, lower risk, less expensive and more patient friendly approach to Assisted Reproduction embracing not only natural cycle treatment but also gentle stimulation protocols and in-vitro maturation of oocytes. Recent research suggests that IVF in modified natural cycle/mild stimulation with antagonist is likely to replace the current conventional approach in down-regulated cycles. The Society will focus both on the basic science and clinical aspects of assisted reproduction. It will be committed to promoting international multi-centre scientific research, regular practical workshops for training and also seminars for educating assisted reproduction technology professionals. ISMAAR aims to establish a direct dialogue with the voluntary sector and politicians to campaign for IVF to be a safer, softer and affordable treatment globally.
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Mild ovarian stimulation for IVF: Review
  • MF Verberg
  • NS Macklon
  • G Nargund
  • R Frydman
  • P Devroey
  • FJ Broekmans
  • BC Fauser
Mild ovarian stimulation for iVF: review. Hum reprod update
  • Jan 2009
  • 13-29
  • M F Verberg
  • Macklon Ns
  • G Nargund
  • P Frydman R, Devroey
  • F J Broekmans
  • Fauser Bc
Verberg MF, Macklon nS, nargund G, Frydman r, devroey P, broekmans FJ, Fauser bC. Mild ovarian stimulation for iVF: review. Hum reprod update. 2009;15(1):13-29.
1.-Proposed policies to address declining birth rates in developed countries
  • Fig
Fig. 1.-Proposed policies to address declining birth rates in developed countries.
(info@statistics.gov.uk) Population implosion? Low Fertility and Policy responses in the European union rand Corporation research brief; www.rand Socioeconomic disadvantage and adolescent women's sexual and reproductive behaviour: the case of five developed countries
  • Jan 2001
  • Fam Plann Perspect
  • 251-259
  • S Singh
  • Je Darroch
  • Jj Frost
Office for national Statistics 2009. (info@statistics.gov.uk) Population implosion? Low Fertility and Policy responses in the European union. (2005). rand Corporation research brief; www.rand.org Singh S, darroch JE, Frost JJ. Socioeconomic disadvantage and adolescent women's sexual and reproductive behaviour: the case of five developed countries. Fam Plann Perspect. 2001;33(6):251-8.