Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Abstract

Background Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios.

Full text

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1
Global fertility in 204 countries and territories, 1950–2021,
with forecasts to 2100: a comprehensive demographic
analysis for the Global Burden of Disease Study 2021
GBD 2021 Fertility and Forecasting Collaborators*
Summary
Background Accurate assessments of current and future fertility—including overall trends and changing population
age structures across countries and regions—are essential to help plan for the profound social, economic,
environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are
necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and
family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced
up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national
levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent
alternative scenarios.
Methods To estimate fertility indicators from 1950 to 2021, mixed-eects regression models and spatiotemporal
Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations,
1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age
groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility
rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across
ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME)
forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number
of children born over time to females from a specified birth cohort), which yields more stable and accurate measures
of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models
(with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need,
population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted
utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in
CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a
proportion of each 5-year ASFR was predicted using a linear mixed-eects model with fixed-eects covariates (female
educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs
were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast
is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical
relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in
each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met
need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give
birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was
propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future
forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the
2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed
skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from
the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the
baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates
that the evaluated model performs worse than baseline.
Findings During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to
2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to
129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining
above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This
included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths
in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021
was below replacement experienced one or more subsequent years with higher fertility; only three of these locations
rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching
a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of
countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and
Published Online
March 20, 2024
https://doi.org/10.1016/
S0140-6736(24)00550-6
See Online/Comment
https://doi.org/10.1016/
S0140-6736(24)00490-2
*Collaborators are listed at the
end of the Article
Correspondence to:
Prof Simon I Hay, Institute for
Health Metrics and Evaluation,
University of Washington,
Seattle, WA 98195, USA
sihay@uw.edu

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only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group,
all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa
was forecast to increase to more than half of the world’s livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and
54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the
six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1)
in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and
high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG
targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global
TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME
model were positive across all age groups, indicating that the model is better than the constant prediction.
Interpretation Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below
replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small
number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching
replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion
occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low
even under successful implementation of pro-natal policies. These changes will have far-reaching economic and
societal consequences due to ageing populations and declining workforces in higher-income countries, combined
with an increasing share of livebirths among the already poorest regions of the world.
Funding Bill & Melinda Gates Foundation.
Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0
license.
Introduction
Characterising trends in key demographic indicators of
fertility and projecting estimates into the future are
essential to understand the impact of changing birth
rates on social, economic, and geopolitical systems, both
now and in the coming century. Dynamics in fertility
patterns are central to the well established concept of the
demographic transition,1,2 which classically holds that
societies will passage from a condition of high fertility
and high mortality with more young than old people to a
state of low fertility and low mortality with an
increasingly older population. Some theorists have
proposed the concept of a demographic dividend,
whereby declining fertility rates lead temporarily to
higher proportions of working adults available to
generate resources and capital, potentially stimulating
economic growth and eventual rebounds in fertility
rates.3 Demographic data in the 5 years preceding 2021
demonstrate that the total fertility rate (TFR) in some
countries has fallen below replacement levels—the
minimum rate necessary for generational replacement
of the population assuming no migration—with no
evidence of this predicted rebound.4–7 The replacement
level is generally accepted to be a TFR of at least 2·1,
although the true replacement level depends on the
specific mortality rate and sex ratio at birth in a
population.8 Low levels of fertility have the potential over
time to result in inverted population pyramids with
growing numbers of older people and declining
working-age populations. These changes are likely to
place increasing burdens on health care and social
systems, transform labour and consumer markets, and
alter patterns of resource use. Accurate estimates and
future forecasts of fertility rates and their impact on
population age structures are therefore essential to
anticipate potential economic and geopolitical
consequences and to inform the development of eective
health, environmental, and economic policies.
At present, an important source of fertility estimates
and future forecasts for countries and areas throughout
the world has been the Population Division of the UN
Department of Economic and Social Aairs, which
most recently produced the 2022 Revision of World
Population Prospects (WPP 2022).5 The UN Population
Division estimates of past fertility are not compliant
with the Guidelines on Accurate and Transparent
Health Estimates Reporting (GATHER) statement in
important respects; notably, they do not provide all
code for statistical models or explicit details on criteria
for exclusion or adjustment of primary data sources.
Furthermore, the validity of UN Population Division
projections has been questioned due to the assumptions
applied in countries experiencing low post-transition
fertility dropping below replacement level.9,10 Previous
UN Population Division forecasts have assumed that,
in such circumstances, fertility rates will increase
towards replacement levels,11–13 and WPP 2022 assumes
convergence to a rate that is a combination of country-
specific historical rates and the mean rate in low-
fertility countries that have experienced fertility
increases.14 The WPP 2022 projects gradual increases in
TFR even in countries that have shown no evidence of
fertility rate increases, such as South Korea and
Thailand.6,14–17 Additionally, UN Population Division

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models are based on TFR, which is a period measure
and therefore does not account for change over time in
fertility behaviours. For example, in settings where
fertility rates in older women increase due to choices to
delay births, TFR would underestimate fertility
forecasts. Reliance on TFR can also lead to short-term
fluctuations in estimated fertility forecasts that are
especially impactful in countries with low fertility
rates.18 Moreover, their projections forecast TFR solely
as a function of time and do not include other covariates
to inform the models, which disregards potentially
explanatory data and precludes investigating the eects
of alternative policy-related scenarios or other drivers of
fertility. The US Census Bureau International Database
has also provided worldwide fertility estimates and
projections, currently in 227 countries, since the 1960s,
but country-specific updates are not performed on a
regular basis.19 Since the 1990s, global and regional
fertility forecasts have also been generated by the World
Population Program of the International Institute for
Applied Systems Analysis,20 with country-level
projections more recently produced by an aliated
group, the Wittgenstein Centre for Demography and
Global Human Capital.21,22 These forecasts rely on
Research in context
Evidence before this study
Since the 1950s, global and national estimates and projections
of key fertility indicators have been produced and regularly
updated by the Population Division of the UN Department of
Economic and Social Affairs, with the most recent iteration
being the 2022 Revision of World Population Prospects.
Assessments of fertility at national and subnational levels
worldwide have also been conducted by the US Census Bureau
since the 1960s, with estimates reported in the Bureau’s
International Database. More recently, fertility estimates and
projections have been generated by the Wittgenstein Centre for
Demography and Global Human Capital and by the Global
Burden of Diseases, Injuries, and Risk Factors Study (GBD),
an ongoing, large-scale research enterprise that systematically
analyses worldwide data to assess global health trends. Past
estimates of fertility have been produced as part of GBD since
2017, and future forecasts based on GBD findings were first
published in 2020.
Added value of this study
Of the existing large-scale efforts to estimate worldwide trends
in fertility, only GBD analyses are compliant with the Guidelines
on Accurate and Transparent Health Estimates Reporting
(GATHER) statement. This study also incorporates several
important innovations introduced by the GBD population
forecasting study by Vollset and colleagues in 2020 that support
forecasting accuracy assessment and provide a framework by
which to explore the impact of various policy scenarios on
fertility patterns. These methods include: basing the GBD
forecasting model on a measure of cohort fertility (completed
cohort fertility at age 50 years, CCF50) that reflects the number
of children born over time to females from a specific cohort,
which better captures long-term choices people make about
childbearing—such as delaying having children—than does the
classic period-based measure of total fertility rate; and
incorporating measures of female education and met need for
modern contraceptives as covariates, which improves accuracy
and allows for modelling alternative scenarios by changing levels
of these indicators. In contrast to other models that assume rates
in countries currently experiencing low fertility will tend to
increase over time, or those that base their projections on expert
judgements, GBD fertility forecasting methods are grounded in
existing, real-world evidence about fertility patterns in long-
term cohorts of females and in data on related evidence-based
covariates such as education and contraception. GBD 2021 has
further improved the estimation of past, current, and future
fertility in four important ways. First, an additional 147 surveys,
21 censuses, and 634 country-years of vital and sample
registration data were added for estimation of past fertility
trends. Second, smoothing parameters for estimating past
fertility trends were updated to better fit available data. Third, to
further improve specificity and accuracy of future fertility
projections, two additional covariates were included that
account for urbanicity (defined here as population density in
habitable areas) and under-5 mortality in the CCF50 model.
Fourth, we added a pro-natal alternative scenario to help policy
makers plan interventions in countries with fertility rates below
replacement level. Based on a skill metric designed to evaluate
forecasting accuracy, the model presented here performed better
across all age groups compared with a constant prediction.
Implications of all the available evidence
Our past estimates and future forecasts indicate that fertility
rates are declining everywhere and are projected to continue to
decrease over the coming century. By 2100, we estimate that
fertility rates will be below replacement level in more than
95% of the world’s countries and territories but that marked
disparities in rates will remain. Our forecasts also suggest that,
by 2100, the largest concentrations of livebirths will shift to
low-income settings, particularly a subset of countries and
territories in sub-Saharan Africa, which are among the most
vulnerable to economic and environmental challenges. Extreme
shifts in the global distribution of livebirths can be partially
ameliorated by improved female education and met need for
modern contraception. Outside of this subset of low-income
areas, most of the world’s countries will experience the
repercussions of low fertility, with ageing populations,
declining workforces, and inverted population pyramids, which
are likely to lead to profound fiscal, economic, and social
consequences. National policy makers and the global health
community must plan to address these divided sets of
demographic challenges emerging worldwide.

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assumptions informed by expert opinions from
demographic scientists to predict future fertility
rates.21–23
The Global Burden of Diseases, Injuries, and Risk
Factors Study (GBD) is an ongoing, large-scale research
enterprise that characterises the state of global health by
estimating key health metrics at global, regional, and
national levels.24 Beginning with the 2017 GBD cycle, past
and current fertility estimates generated as part of the
GBD analytic framework were published;25 before that,
estimates from the UN Population Division were used as
inputs to GBD analytic processes.26,27 For GBD 2019, past
and current fertility estimates were reported jointly with
mortality, life expectancy, and population measures in a
publication focused on overall demographic estimates,28
and GBD-based forecasts of population and fertility
up to 2100 were reported separately by Vollset and
colleagues in 2020.5 GBD fertility estimates are based on
clear data and methods applying a standardised approach,
providing publicly available code. Vollset and colleagues
addressed some of the existing issues regarding the use
of TFR in the modelling process by developing an
Institute for Health Metrics and Evaluation (IHME)
forecasting model based instead on completed cohort
fertility at age 50 years (CCF50: the average number of
children born over time to females from a specified birth
cohort)29 to capture change over time in fertility
behaviours, which yields more stable and accurate fertility
estimates. Vollset and colleagues4 also included covariates
representing female educational attainment and
contraceptive met need (a measure of the proportion of
females of reproductive age whose need for contraception
has been met with modern contraceptive methods) to
better inform fertility estimates and facilitate exploration
of alternative future scenarios associated with
achievement of UN Sustainable Development Goals
(SDGs) related to education and contraception.
The present GBD 2021 study focuses on fertility
metrics, presenting past estimates (1950–2021) along
with forecasts up to 2100. Results were improved since
GBD 2019 and the 2020 study by Vollset and colleagues
by incorporating newly available demographic data and
through key methodological advances. This paper
provides a high-level overview of our findings. We
anticipate that the results will provide insights for policy
makers and will be used as a tool to help plan and shape
future policies to better prepare for profound changes in
global fertility.
This paper was produced as part of the GBD
Collaborator Network and in accordance with the GBD
Protocol.30
Methods
Overview
For each subsequent GBD round, newly available data
and updated methods are used to update the full time
series of estimates from 1950 up to the latest year of
analysis. As a consequence, GBD 2021 estimates
supersede all previous estimates. GBD 2021 estimated
key fertility metrics in females between ages 10 years and
54 years in 204 countries and territories grouped into
21 regions and seven super-regions. GBD regions are
made up of countries and territories that are
geographically close and epidemiologically similar.31
These regions are then grouped into super-regions based
on cause of death patterns. The full GBD location
hierarchy is shown in appendix 1 (table S1). GBD 2021
drew on the expertise of more than 11 000 collaborators
across more than 160 countries and territories. The
GBD 2021 fertility analysis framework produced
estimates for every year from 1950 to 2021 and forecasts
up to 2100.
The methods used to produce fertility estimates from
1950 to 2021 closely followed those of GBD 2019.28
Methods used to generate fertility forecasts to 2100 were
based on a modified and revised version of the modelling
approach used in the 2020 study by Vollset and
colleagues.4 These methods have been peer-reviewed
over previous GBD rounds and as part of the peer-review
process for GBD 2021. Here we provide an overview of
the methods with an emphasis on the main changes
since GBD 2019 and the 2020 study by Vollset and
colleagues;4,28 a more comprehensive description of the
analytical methods for GBD 2021 is provided in
appendix 1. Additional details on specific data inputs are
accessible through the GBD Sources Tool.
Data sources and processing
We systematically searched for accurate and complete
data on livebirths reported according to the age of
mothers. In many high-income countries and territories,
these data were available from high-quality vital
registration systems, but in many lower-income
countries, birth registries were incomplete, interrupted,
or delayed; in these instances, we instead relied on
complete and summary birth histories in censuses and
household surveys. Fertility rates from vital registration
data were calculated as observed births divided by
population estimates. Complete and summary birth
history data were collapsed from the available microdata
and sample weights applied to calculated age-specific
fertility rates (ASFRs) and number of children ever born,
respectively. A full description of data seeking and
synthesis is provided in appendix 1 (section 2.1). In total,
we compiled 58 072 unique location-source-years of data
for females aged 10–54 years for the period between
1950 and 2021 (number of sources by location and by
year can be found in appendix 1 tables S3 and S4). At the
national level, we obtained 8680 unique country-source-
years of vital registration data, with an additional
29 country-source-years of data from sample registration
systems. We additionally extracted data on period ASFR,
or average number of children ever born from surveys
and censuses that yielded 735 complete birth histories,
For the GBD Sources Tool see
https://ghdx.healthdata.org/
gbd-2021/sources
See Online for appendix 1

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879 summary birth histories, and 28 unclassified forms
of birth histories (details are in appendix 1
tables S3 and S4).
Throughout the forecasting modelling processes, we
used female education, under-5 mortality, met need for
contraceptive use, and population density in habitable
areas as covariates. Details of these covariates are
available in appendix 1 (section 3.1).
Fertility from 1950 to 2021
GBD 2021 estimates of fertility metrics between
1950 and 2021 were based on a systematic synthesis of all
available data for all GBD locations. The fertility
estimation process was closely connected to parallel,
concordant modelling of population and mortality, with
population estimates used iteratively to generate inputs
to fertility estimation models and vice versa.28 GBD
methods are designed to account for the diversity of data
available and the dierent biases inherent in various data
sources, with customised data processing and data
synthesis steps implemented to account for known
biases, missing data, and heterogeneous measurement
metrics used across data sources. Estimation of fertility
rates between 1950 and 2021 for females ages 10–54 years
largely followed the methods used in GBD 2019.28 First,
ASFRs were estimated for 5-year age groups between
15 years and 49 years only using age-specific vital
registration and complete birth history data. These
results were used to split all-age data from vital
registration, summary birth history, and other sources
into ASFRs, and then another model was fit to estimate
ASFRs using the original age-specific ASFR data from
vital registration and complete birth history along with
these age-split data. Next, we extended these estimates to
the age groups of 10–14 years and 50–54 years using data
from these ages and adjacent age groups. Finally, ASFR
estimates were used to calculate TFR. A summary of
these methods follows, with a comprehensive description
provided in appendix 1 (section 2).
To estimate ASFRs by 5-year age groups for females
aged 15–49 years, we implemented mixed-eects
regression models using bounded logit(ASFR) as the
outcome. The 20–24-years age group was estimated first,
and these estimates were used to model the remaining
age groups. Both sets of models were fit separately for
the high-income, sub-Saharan Africa, and central Europe,
eastern Europe, and central Asia super-regions to account
for dierences in the relationships between the ASFR of
the 20–24-years age group and that of other age groups.
ASFRs in the 20–24-years age group were modelled with
female educational attainment as a covariate and random
intercepts for each location source. Then, we separately
modelled ASFRs in the remaining age groups between
15 years and 49 years using a linear spline on the
logit(ASFR) in the 20–24-years age group. The selection
of spline knots varied by super-region and age group.
These models also included female educational
attainment as a covariate, except in the high-income
super-region, and random intercepts for each location
source. After running these mixed-eects models, we
corrected for systematic dierences across data sources
by selecting a reference source for each location and
adjusting other sources based on their discrepancy from
the reference source. Last, a spatiotemporal Gaussian
process regression (ST-GPR) was used to smooth ASFRs
across location and time, producing final point estimates
and uncertainty intervals (UIs).
First-round ASFR estimates were generated from this
modelling approach using age-specific vital registration
and complete birth history data. To split total birth data
from vital registration data, summary birth histories, and
other sources into ASFRs, we calculated the ratio of the
parity implied by each total birth data source to the parity
estimated in this first-round ASFR model. This ratio was
then multiplied by the estimated ASFRs from the first-
round model. These age-split data were incorporated into
a second round of estimation for each location using the
same modelling approach described earlier. To generate
estimates for ages 10–14 years and 50–54 years, we
estimated the ratio of ASFR to the adjacent age group
using all available data, then applied these ratios to the
second-round ASFR estimates. We used a mixed-eects
regression model to estimate location-specific ratios for
ages 10–14 years, whereas we calculated the average ratio
across all locations for ages 50–54 years. Finally, TFR was
calculated by multiplying the ASFRs from each 5-year
age group by five and summing.
Fertility forecasting
We produced forecasts of fertility using an updated
modelling framework (appendix 1 section 3) that
improved on the methods in the 2020 study by Vollset
and colleagues.4 In our updated methods, we used not
only estimates of female educational attainment and
contraceptive met need as covariates, but also estimates
of under-5 mortality and population density in habitable
areas to account for a larger variation in CCF50 across all
countries in the sub-models (appendix 1 section 3.1,
appendix 2 figure S2). Similar to Vollset and colleagues,
we continued to forecast fertility with CCF50 rather than
TFR, because modelling in cohort space is more stable
than in period space. For this analysis, we used past
CCF50 estimates for birth cohorts from 1945 to 1972 to
forecast CCF50 up to the 2085 birth cohort of females,
followed by predicting ASFR for each 5-year age interval
as a proportion of CCF50. CCF50 was defined as the
average number of children born to an individual female
from an observed birth cohort (indexed by year of birth)
if she lived to the end of her reproductive lifespan (ages
15–49 years). CCF50 was forecast using an ensemble
modelling approach with three equally weighted sub-
models (with two, three, and four covariates) in which
each sub-model utilised the MR-BRT (meta-regression—
Bayesian, regularised, trimmed) tool.32 For example, the
See Online for appendix 2

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four-covariate sub-model was represented by the
following equation:
logit(0·7,10)(CCF50lc) =
β
0
+
spline(educationlc)
×
β
+
met needlc
×
β
2
1
+
under
-5 mortalitylc
×
β
3
+
population density per habitable arealc
×
β
4
+
εlc,
where CCF50 is scaled from more than 0·7 to less than
10 and modelled in logit space for location (l) and
cohort (c), β0 is an intercept, β1 is a vector of the spline
coecients of female educational attainment covariate,
β2 is a slope on proportion of met need for contraception,
β3 is a slope on under-5 mortality, β4 is a slope on
population density in habitable areas, and ε is a residual
term. Further details are provided in appendix 1
(section 3.2, figure S1).
From forecast CCF50, we then derived ASFR forecasts
for the years 2022 to 2100 using a combination of a linear
mixed-eects model, spline interpolation, and an
autoregressive integrated moving average (ARIMA)
model (1,0,0) on residuals to estimate the age pattern of
fertility for each cohort. Once ASFR values for ages
15–49 years were obtained, we inferred the ASFR values
for the 10–14-years and 50–54-years age groups based on
their ratios to the rest of the age pattern during the last
observed year (2021). Single-year age interval ASFRs
were summed over all ages to yield the TFR for each
calendar year (appendix 1 section 3.3).
We also produced fertility forecasts for four alternative
scenarios applied to all 204 countries and territories.
These scenarios explore shifting forecast values of
two known drivers of fertility (education and met need
for contraceptives) as well as a proxy pro-natal policy.
More specifically, the scenarios included were: the UN
SDG target 4.1 for education is achieved by 2030; the
contraceptive met need SDG target 3.7 is achieved
by 2030; pro-natal policies are enacted that create
supportive environments for those who give birth; and
the previous three scenarios combined (more details are
provided in appendix 1 section 3.4). For the education
SDG scenario, the forecasts assume that by 2030, all
people will have 12 years or more of education by the age
of 25 years and then maintains the same rate of change
as the reference scenario up to 2100. For the contraceptive
met need scenario, to reflect the SDG scenario of
universal access, the forecasts assumed a linear increase
in contraceptive coverage to reach 100% by 2030 and then
stay constant up to 2100.
In the pro-natal scenario, we assumed a country will
introduce pro-natal policies, such as childcare subsidies,
extended parental leave, insurance coverage expansion for
infertility treatment,33 and other forms of support for
parents to aord high-quality child-care services, once TFR
decreases to less than 1·75. We then made three
assumptions on the eects of such policies. First, we
assumed the full eect of pro-natal policies will be to
increase TFR by 0·2. Second, it will take 5 years after the
policy is introduced for the full increase in TFR to occur,
and TFR will rise linearly over that time span. Last, we
assumed that both the policies and the increase in
TFR by 0·2 will endure for the remainder of the century.
For each pro-natal year, the TFR increase was distributed
proportionally among the single-year ages according to
their reference forecast ASFR values. The pro-natal
scenario parameters were drawn from previously observed
increases in TFR that coincided with pro-natal policies and
broader empirical evidence regarding eects of pro-natal
policies in low-fertility contexts. Further details on the pro-
natal scenario can be found in appendix 1 (section 3.4.3).
In the combined scenario, we applied the
aforementioned changes to the covariate forecasts
simultaneously without assigning any weights because
these covariates were already embedded in our model
and the coecients for each covariate were calculated
based on the observed data.
GBD 2021 updates
To estimate ASFRs from 1950 to 2021, GBD 2021 added
147 surveys, 21 censuses, and 634 country-years of vital
and sample registration data compared with GBD 2019,
for a total of 1455 surveys and censuses, 8709 country-
years of vital and sample registration data, and 150 other
sources. Methods were updated for GBD 2021 by
changing the time weight in ST-GPR to use a beta density
function, in which hyperparameters were assigned based
on quality of available data sources and the number of
available datapoints. This better accounted for increased
data availability, which improved precision and produced
more plausible time trends compared with GBD 2019.
Updates to the fertility forecasting methods first
introduced in the 2020 study by Vollset and colleagues4
included the incorporation of two new covariates in the
CCF50 model—namely, under-5 mortality and population
density in habitable areas—in addition to those previously
used (ie, female educational attainment and contraceptive
met need). Furthermore, the current iteration of the
IHME model employed a linear fixed-eect model to
forecast 5-year ASFRs, which were interpolated to 1-year
estimates using an ARIMA model on the residuals to
quantify variation not explained by the covariates.
Comparison with other models
We evaluated the IHME fertility forecasting model
performance based on out-of-sample predictions during
the validation period 2007–21. We used the following skill
metric34 for model evaluation and comparison (see
appendix 1 section 3.6 for more details):
skill =
1
–
RMSE(Model)
RMSE(Baseline Model),

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
7
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
Global 4·84
(4·63–5·06)
3·61
(3·53–3·69)
2·23
(2·09–2·38)
1·83
(1·59–2·08)
1·59
(1·25–1·96)
92 675·8
(88 663·5–96 630·8)
122 023·7
(119 441·0–
124 623·8)
129 383·6
(121 382·9–
138 206·0)
112 073·6
(93 698·4–
133 329·8)
723 86·8
(40 812·5–118 843·5)
1·0
(1·0–1·1)
Central Europe,
eastern Europe, and
central Asia
3·01
(2·91–3·11)
2·24
(2·21–2·28)
1·81
(1·72–1·92)
1·68
(1·56–1·81)
1·57
(1·42–1·73)
7452·5
(7227·2–7699·6)
7113·3
(7020·5–7211·4)
4906·1
(4635·7–5195·7)
3874·8
(3409·2–4396·4)
2344·9
(1739·5–3067·1)
0·9
(0·8–0·9)
Central Asia 4·45
(4·32–4·59)
3·73
(3·65–3·80)
2·79
(2·68–2·91)
2·31
(2·16–2·47)
1·95
(1·76–2·13)
1016·0
(986·0–1046·1)
1676·9
(1642·3–1709·2)
2073·1
(1990·1–2158·2)
1913·2
(1629·7–2201·3)
1418·0
(1007·6–1927·4)
1·3
(1·3–1·4)
Armenia 4·14
(3·95–4·33)
2·49
(2·39–2·61)
1·68
(1·53–1·84)
1·45
(1·27–1·65)
1·24
(1·01–1·49)
49·0
(46·8–51·1)
76·5
(73·2–79·9)
35·0
(31·6–38·5)
16·9
(11·9–22·2)
6·7
(3·5–11·3)
0·8
(0·7–0·9)
Azerbaijan 4·38
(4·09–4·69)
3·33
(3·18–3·48)
1·75
(1·55–1·95)
1·51
(1·27–1·76)
1·29
(1·01–1·59)
107·5
(100·2–114·9)
162·2
(155·0–169·6)
138·7
(123·5–154·9)
93·5
(69·0–122·7)
38·3
(17·9–69·8)
0·8
(0·7–0·9)
Georgia 2·60
(2·42–2·79)
2·21
(2·07–2·33)
2·05
(1·92–2·18)
1·80
(1·65–1·96)
1·52
(1·34–1·71)
84·2
(78·4–90·3)
91·8
(86·3–96·9)
45·2
(42·4–48·1)
36·1
(28·7–43·7)
21·3
(14·2–30·4)
1·0
(0·9–1·0)
Kazakhstan 3·94
(3·79–4·11)
3·02
(2·93–3·11)
3·02
(2·85–3·20)
2·43
(2·21–2·65)
1·94
(1·69–2·19)
253·8
(244·5–264·1)
365·1
(353·6–376·9)
424·9
(400·9–448·7)
392·9
(325·0–461·4)
261·4
(147·7–409·6)
1·4
(1·4–1·5)
Kyrgyzstan 4·19
(4·03–4·35)
4·12
(3·98–4·27)
2·92
(2·66–3·21)
2·35
(2·05–2·70)
1·95
(1·63–2·33)
57·9
(55·6–60·2)
111·9
(107·3–116·3)
159·2
(145·4–175·1)
139·1
(104·2–181·6)
72·0
(21·5–145·6)
1·4
(1·3–1·5)
Mongolia 5·09
(4·78–5·41)
5·76
(5·55–5·97)
3·16
(2·86–3·49)
2·46
(2·02–2·88)
1·87
(1·35–2·35)
30·2
(28·4–32·1)
61·9
(59·7–64·1)
80·0
(72·4–88·0)
100·9
(76·4–124·5)
104·2
(46·7–179·1)
1·5
(1·4–1·6)
Tajikistan 6·65
(6·33–6·96)
5·65
(5·47–5·84)
3·40
(3·17–3·64)
2·66
(2·33–2·97)
2·13
(1·75–2·49)
86·2
(82·6–89·9)
159·7
(154·8–164·5)
286·4
(268·0–306·6)
301·0
(229·2–381·8)
243·2
(101·7–421·6)
1·6
(1·5–1·7)
Turkmenistan 4·82
(4·63–5·01)
4·75
(4·55–4·94)
2·83
(2·54–3·15)
2·25
(1·87–2·66)
1·81
(1·38–2·28)
48·7
(46·7–50·5)
96·4
(92·9–99·8)
110·5
(99·4–122·7)
105·2
(80·2–139·0)
75·9
(33·1–146·2)
1·3
(1·2–1·5)
Uzbekistan 5·68
(5·32–6·06)
4·58
(4·47–4·69)
2·87
(2·66–3·10)
2·34
(2·08–2·62)
1·97
(1·69–2·27)
298·6
(280·9–316·8)
551·5
(538·2–564·1)
793·1
(733·9–854·3)
727·6
(491·2–993·0)
595·0
(307·1–992·9)
1·3
(1·2–1·4)
Central Europe 3·22
(3·13–3·30)
2·21
(2·18–2·24)
1·48
(1·36–1·61)
1·34
(1·19–1·50)
1·21
(1·03–1·41)
2336·9
(2276·3–2399·1)
2085·5
(2056·7–2113·8)
1038·3
(954·3–1129·1)
668·1
(567·7–786·3)
283·6
(185·8–412·4)
0·7
(0·7–0·8)
Albania 5·88
(5·63–6·13)
3·44
(3·31–3·58)
1·50
(1·33–1·69)
1·34
(1·10–1·61)
1·17
(0·86–1·50)
48·0
(45·9–50·0)
71·4
(68·8–74·3)
27·9
(24·7–31·4)
16·4
(11·6–22·4)
6·3
(2·9–12·3)
0·7
(0·6–0·8)
Bosnia and
Herzegovina
3·68
(3·31–4·08)
2·21
(1·97–2·46)
1·33
(1·20–1·46)
1·16
(0·99–1·35)
0·95
(0·71–1·19)
92·6
(83·8–102·1)
79·0
(70·7–87·8)
26·7
(24·2–29·4)
12·4
(8·8–16·8)
3·5
(1·7–6·2)
0·6
(0·6–0·7)
Bulgaria 2·77
(2·65–2·91)
2·07
(2·02–2·12)
1·58
(1·47–1·70)
1·43
(1·29–1·59)
1·26
(1·08–1·45)
167·6
(160·5–175·7)
127·8
(124·7–130·8)
58·1
(53·7–62·4)
36·6
(29·6–44·0)
13·9
(8·5–21·6)
0·8
(0·7–0·8)
Croatia 2·89
(2·78–3·00)
1·83
(1·78–1·87)
1·37
(1·22–1·53)
1·27
(1·08–1·46)
1·14
(0·92–1·38)
90·2
(87·0–93·5)
67·4
(65·9–69·2)
34·8
(31·0–38·9)
16·8
(12·3–22·0)
3·2
(0·3–7·2)
0·7
(0·6–0·7)
Czechia 2·81
(2·69–2·94)
2·08
(2·03–2·13)
1·74
(1·57–1·93)
1·54
(1·34–1·76)
1·36
(1·13–1·60)
186·6
(178·6–194·9)
152·3
(148·6–155·8)
105·9
(95·4–117·6)
82·1
(67·2–98·5)
44·9
(27·3–68·3)
0·8
(0·8–0·9)
Hungary 2·58
(2·43–2·72)
1·89
(1·84–1·94)
1·56
(1·40–1·75)
1·42
(1·22–1·65)
1·29
(1·06–1·55)
193·1
(182·7–203·9)
147·0
(143·1–151·2)
87·9
(78·5–98·4)
77·0
(61·9–94·7)
51·6
(32·1–78·9)
0·8
(0·7–0·8)
Montenegro 4·12
(3·89–4·37)
2·22
(2·13–2·30)
1·72
(1·61–1·83)
1·56
(1·43–1·70)
1·40
(1·23–1·58)
12·5
(11·8–13·2)
10·5
(10·1–10·9)
7·0
(6·5–7·4)
4·5
(3·7–5·4)
1·6
(0·9–2·5)
0·8
(0·8–0·9)
North Macedonia 3·62
(3·26–4·02)
2·45
(2·21–2·71)
1·23
(1·16–1·30)
1·10
(1·01–1·20)
0·97
(0·84–1·09)
37·6
(34·0–41·5)
39·9
(36·0–44·0)
18·7
(17·7–19·8)
9·4
(7·3–11·9)
1·8
(0·9–3·0)
0·6
(0·6–0·6)
Poland 3·63
(3·53–3·72)
2·28
(2·24–2·32)
1·37
(1·22–1·53)
1·21
(1·04–1·40)
1·07
(0·87–1·29)
757·4
(737·3–776·6)
693·3
(680·1–706·4)
342·0
(304·9–381·1)
206·2
(163·3–254·7)
74·4
(43·4–116·7)
0·7
(0·6–0·7)
(Table 1 continues on next page)

Articles
8
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Romania 3·02
(2·84–3·22)
2·32
(2·25–2·39)
1·70
(1·57–1·84)
1·48
(1·32–1·66)
1·26
(1·06–1·48)
415·0
(390·9–442·4)
387·3
(375·7–399·2)
177·6
(163·6–192·6)
114·9
(89·2–143·0)
37·7
(18·8–62·7)
0·8
(0·8–0·9)
Serbia 3·31
(3·22–3·40)
2·22
(2·17–2·28)
1·08
(0·99–1·16)
1·01
(0·90–1·11)
0·96
(0·82–1·09)
183·9
(179·1–188·1)
157·5
(153·3–161·7)
61·6
(56·8–66·7)
34·0
(27·8–40·6)
10·5
(7·1–14·6)
0·5
(0·5–0·6)
Slovakia 3·65
(3·56–3·75)
2·32
(2·27–2·36)
1·63
(1·53–1·73)
1·46
(1·34–1·59)
1·31
(1·16–1·46)
99·6
(97·2–102·2)
94·6
(92·9–96·3)
56·3
(52·9–59·8)
40·0
(34·2–45·7)
20·9
(15·1–27·4)
0·8
(0·7–0·8)
Slovenia 2·86
(2·54–3·20)
2·01
(1·97–2·06)
1·63
(1·53–1·74)
1·51
(1·39–1·64)
1·38
(1·24–1·54)
32·3
(28·8–36·2)
29·5
(28·8–30·1)
18·8
(17·6–20·0)
17·9
(15·7–20·5)
13·2
(10·3–16·9)
0·8
(0·7–0·8)
Eastern Europe 2·70
(2·59–2·82)
1·91
(1·88–1·95)
1·38
(1·27–1·49)
1·28
(1·15–1·42)
1·19
(1·05–1·35)
4099·6
(3935·2–4285·2)
3350·8
(3289·2–3418·5)
1794·7
(1651·3–1949·2)
1293·5
(1082·3–1534·3)
643·2
(456·2–881·7)
0·7
(0·6–0·7)
Belarus 3·00
(2·83–3·18)
2·01
(1·94–2·09)
1·42
(1·23–1·64)
1·29
(1·06–1·55)
1·19
(0·95–1·47)
192·3
(181·8–203·2)
156·4
(150·9–162·4)
82·5
(70·6–95·6)
59·8
(43·0–80·3)
30·5
(16·3–53·1)
0·7
(0·6–0·8)
Estonia 2·30
(2·18–2·43)
2·06
(2·01–2·11)
1·60
(1·49–1·71)
1·37
(1·24–1·50)
1·21
(1·06–1·36)
20·1
(19·1–21·2)
22·5
(21·9–23·1)
13·1
(12·2–14·0)
9·4
(8·0–11·2)
4·2
(2·8–5·9)
0·8
(0·7–0·8)
Latvia 1·98
(1·84–2·14)
1·90
(1·86–1·94)
1·52
(1·35–1·71)
1·35
(1·16–1·56)
1·22
(1·01–1·49)
32·9
(30·7–35·5)
35·6
(34·9–36·4)
16·8
(14·9–18·9)
9·7
(7·5–12·4)
3·9
(2·2–6·6)
0·7
(0·6–0·8)
Lithuania 2·92
(2·78–3·10)
2·00
(1·95–2·05)
1·40
(1·30–1·51)
1·23
(1·11–1·35)
1·09
(0·96–1·25)
58·6
(55·7–62·0)
51·3
(49·9–52·6)
23·6
(21·9–25·4)
12·4
(10·0–15·4)
4·2
(2·7–6·1)
0·7
(0·6–0·7)
Moldova 3·77
(3·61–3·92)
2·46
(2·38–2·54)
1·18
(1·06–1·33)
1·09
(0·94–1·25)
1·03
(0·87–1·24)
84·7
(81·4–88·0)
86·1
(83·4–88·9)
28·4
(25·4–32·0)
9·5
(5·6–13·4)
2·7
(1·3–4·7)
0·6
(0·5–0·6)
Russia 2·77
(2·62–2·95)
1·87
(1·83–1·93)
1·48
(1·37–1·60)
1·33
(1·20–1·47)
1·21
(1·06–1·37)
2819·9
(2671·0–2995·4)
2237·6
(2184·0–2299·0)
1352·4
(1251·9–1464·1)
1053·8
(871·5–1239·4)
562·8
(408·0–758·1)
0·7
(0·7–0·8)
Ukraine 2·44
(2·33–2·55)
1·95
(1·90–2·01)
1·05
(0·94–1·18)
1·01
(0·88–1·16)
0·98
(0·83–1·16)
891·1
(853·1–930·3)
761·3
(739·2–783·2)
277·9
(246·7–311·8)
138·8
(104·8–185·4)
34·9
(19·2–60·5)
0·5
(0·4–0·6)
High income 2·85
(2·78–2·92)
1·88
(1·86–1·90)
1·51
(1·41–1·61)
1·43
(1·30–1·56)
1·37
(1·22–1·53)
13 626·1
(13 275·0–13 959·1)
12 483·6
(12 339·3–12 633·7)
10 399·8
(9728·0–11 116·3)
9387·4
(8381·2–10 552·0)
6961·9
(5348·6–8941·5)
0·7
(0·7–0·8)
Australasia 3·13
(3·06–3·21)
1·93
(1·90–1·97)
1·64
(1·48–1·80)
1·45
(1·25–1·68)
1·33
(1·08–1·59)
251·9
(246·1–258·0)
278·2
(273·0–283·7)
357·9
(324·6–393·9)
404·9
(338·5–481·9)
363·9
(250·1–516·0)
0·8
(0·7–0·9)
Australia 3·06
(2·98–3·14)
1·92
(1·88–1·97)
1·64
(1·47–1·82)
1·45
(1·23–1·70)
1·32
(1·06–1·61)
202·2
(196·9–207·7)
227·7
(222·7–232·9)
299·3
(268·5–332·1)
339·1
(278·3–411·8)
307·8
(204·0–447·8)
0·8
(0·7–0·9)
New Zealand 3·49
(3·41–3·57)
1·96
(1·92–2·00)
1·62
(1·53–1·72)
1·45
(1·33–1·58)
1·35
(1·20–1·51)
49·7
(48·7–50·8)
50·5
(49·4–51·6)
58·6
(55·2–62·0)
65·7
(57·4–74·2)
56·1
(42·5–72·1)
0·8
(0·7–0·8)
High-income Asia
Pacific
3·72
(3·59–3·86)
1·94
(1·89–2·00)
1·12
(1·03–1·22)
1·14
(1·00–1·30)
1·14
(0·96–1·35)
3059·8
(2947·5–3174·6)
2467·7
(2400·6–2541·4)
1169·5
(1075·7–1275·1)
908·3
(784·1–1047·7)
499·8
(348·5–707·9)
0·5
(0·5–0·6)
Brunei 6·41
(6·24–6·57)
3·87
(3·65–4·10)
1·65
(1·43–1·88)
1·40
(1·08–1·78)
1·25
(0·87–1·70)
2·7
(2·6–2·7)
5·8
(5·4–6·1)
6·4
(5·6–7·3)
3·4
(2·4–4·7)
1·0
(0·2–2·5)
0·8
(0·7–0·9)
Japan 3·27
(3·12–3·42)
1·69
(1·64–1·76)
1·26
(1·14–1·41)
1·26
(1·09–1·45)
1·21
(1·00–1·43)
2188·1
(2087·3–2289·4)
1573·3
(1518·2–1636·1)
838·0
(754·0–933·3)
667·4
(555·1–790·8)
387·8
(259·2–572·2)
0·6
(0·5–0·7)
Singapore 6·03
(5·75–6·31)
1·77
(1·66–1·88)
1·20
(1·05–1·39)
1·15
(0·93–1·41)
1·12
(0·88–1·41)
48·0
(45·7–50·3)
42·0
(39·2–44·8)
55·5
(48·5–64·0)
56·0
(44·0–70·8)
45·3
(28·5–69·5)
0·6
(0·5–0·7)
South Korea 5·72
(5·37–6·08)
2·56
(2·48–2·64)
0·82
(0·75–0·89)
0·82
(0·73–0·92)
0·82
(0·71–0·95)
821·1
(774·1–869·0)
846·6
(822·3–873·2)
269·6
(246·4–294·2)
181·5
(155·9–209·6)
65·6
(45·4–90·3)
0·4
(0·4–0·4)
High-income North
America
3·10
(3·03–3·18)
1·78
(1·75–1·81)
1·63
(1·53–1·73)
1·51
(1·38–1·64)
1·43
(1·27–1·60)
4023·2
(3927·9–4124·2)
3948·6
(3866·5–4026·4)
4014·6
(3772·1–4278·3)
3732·8
(3300·8–4245·6)
2967·3
(2256·1–3805·1)
0·8
(0·7–0·8)
(Table 1 continues on next page)

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
9
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Canada 3·31
(3·23–3·40)
1·65
(1·62–1·69)
1·46
(1·31–1·62)
1·39
(1·21–1·58)
1·32
(1·12–1·54)
361·9
(353·0–370·7)
357·7
(350·4–365·1)
361·6
(324·1–401·3)
442·0
(374·4–521·9)
415·5
(299·8–570·6)
0·7
(0·6–0·8)
Greenland 5·62
(5·37–5·87)
2·32
(2·21–2·43)
1·94
(1·78–2·13)
1·84
(1·60–2·10)
1·67
(1·36–2·00)
1·0
(0·9–1·0)
1·0
(0·9–1·0)
0·8
(0·7–0·9)
0·7
(0·5–0·8)
0·5
(0·3–0·7)
0·9
(0·8–1·0)
USA 3·08
(3·01–3·17)
1·79
(1·76–1·83)
1·64
(1·55–1·75)
1·52
(1·40–1·65)
1·45
(1·30–1·60)
3660·2
(3569·5–3758·9)
3589·8
(3510·8–3663·5)
3652·2
(3445·3–3878·2)
3290·0
(2928·9–3719·1)
2551·2
(1954·8–3256·2)
0·8
(0·7–0·8)
Southern Latin
America
3·20
(3·11–3·30)
2·97
(2·93–3·01)
1·49
(1·32–1·67)
1·32
(1·10–1·57)
1·23
(0·97–1·53)
673·6
(653·6–693·9)
987·3
(972·7–1001·9)
769·3
(683·8–862·6)
584·3
(452·6–745·4)
293·8
(159·6–482·9)
0·7
(0·6–0·8)
Argentina 3·03
(2·92–3·15)
3·17
(3·11–3·23)
1·52
(1·34–1·72)
1·33
(1·09–1·60)
1·22
(0·91–1·56)
440·7
(424·2–457·7)
683·1
(669·7–696·0)
536·7
(473·3–606·6)
389·6
(284·0–511·3)
173·1
(80·2–310·7)
0·7
(0·6–0·8)
Chile 4·05
(3·94–4·16)
2·59
(2·53–2·65)
1·39
(1·23–1·54)
1·29
(1·09–1·51)
1·24
(0·99–1·51)
188·2
(183·3–193·1)
250·2
(244·2–256·4)
197·2
(175·7–219·6)
169·6
(136·6–210·7)
109·6
(69·1–169·7)
0·7
(0·6–0·7)
Uruguay 2·44
(2·31–2·57)
2·53
(2·47–2·60)
1·47
(1·30–1·64)
1·36
(1·14–1·60)
1·25
(0·97–1·56)
44·8
(42·3–47·1)
53·9
(52·5–55·4)
35·4
(31·5–39·6)
25·1
(19·6–32·2)
11·1
(5·8–19·3)
0·7
(0·6–0·8)
Western Europe 2·41
(2·34–2·47)
1·79
(1·77–1·81)
1·53
(1·44–1·63)
1·44
(1·32–1·57)
1·37
(1·23–1·52)
5617·5
(5459·1–5774·9)
4801·7
(4750·3–4856·9)
4088·4
(3844·3–4353·4)
3757·3
(3360·8–4160·6)
2837·2
(2247·8–3546·1)
0·7
(0·7–0·8)
Andorra 2·79
(2·44–3·18)
1·59
(1·51–1·66)
0·98
(0·91–1·05)
1·02
(0·92–1·11)
1·01
(0·89–1·13)
0·1
(0·1–0·1)
0·5
(0·5–0·5)
0·5
(0·5–0·6)
0·3
(0·3–0·3)
0·1
(0·1–0·1)
0·5
(0·4–0·5)
Austria 2·08
(2·01–2·15)
1·67
(1·63–1·70)
1·46
(1·37–1·55)
1·42
(1·29–1·55)
1·34
(1·18–1·51)
105·8
(102·3–109·7)
91·3
(89·3–93·3)
85·7
(80·5–91·1)
81·0
(71·2–91·5)
63·4
(48·1–80·5)
0·7
(0·7–0·7)
Belgium 2·30
(2·22–2·38)
1·70
(1·66–1·73)
1·56
(1·41–1·72)
1·43
(1·24–1·63)
1·34
(1·13–1·57)
142·4
(137·8–147·2)
123·3
(120·9–125·7)
113·3
(102·2–124·9)
114·6
(95·9–137·7)
99·9
(69·0–140·3)
0·8
(0·7–0·8)
Cyprus 3·96
(3·80–4·11)
2·42
(2·35–2·49)
1·33
(1·15–1·53)
1·18
(0·97–1·43)
1·13
(0·89–1·40)
13·9
(13·4–14·5)
13·4
(13·0–13·8)
15·1
(13·1–17·4)
11·0
(8·5–13·8)
7·6
(4·7–11·6)
0·6
(0·6–0·7)
Denmark 2·54
(2·46–2·63)
1·49
(1·45–1·52)
1·73
(1·63–1·83)
1·57
(1·46–1·69)
1·47
(1·34–1·60)
78·2
(75·8–81·1)
55·3
(53·9–56·7)
63·2
(59·7–66·7)
62·4
(55·2–70·2)
58·0
(46·1–70·9)
0·8
(0·8–0·9)
Finland 3·08
(2·99–3·19)
1·65
(1·60–1·70)
1·44
(1·35–1·53)
1·36
(1·24–1·49)
1·32
(1·18–1·48)
95·6
(92·8–98·9)
63·9
(62·1–65·7)
48·5
(45·3–51·7)
41·9
(36·2–48·5)
30·1
(23·3–38·7)
0·7
(0·7–0·7)
France 2·80
(2·72–2·87)
1·90
(1·85–1·95)
1·75
(1·57–1·93)
1·56
(1·35–1·79)
1·43
(1·19–1·69)
840·4
(817·3–862·6)
795·3
(774·5–816·9)
693·1
(623·0–766·7)
561·9
(448·3–683·9)
348·5
(214·5–542·2)
0·8
(0·8–0·9)
Germany 2·09
(1·94–2·24)
1·52
(1·48–1·55)
1·53
(1·44–1·62)
1·47
(1·35–1·58)
1·40
(1·27–1·53)
1105·0
(1023·7–1188·6)
852·3
(833·8–873·0)
790·3
(742·4–837·6)
742·6
(647·9–832·5)
609·5
(489·2–740·4)
0·7
(0·7–0·8)
Greece 2·50
(2·41–2·60)
2·07
(2·03–2·12)
1·40
(1·25–1·56)
1·36
(1·17–1·57)
1·28
(1·06–1·54)
154·7
(148·6–160·8)
143·4
(140·4–146·8)
82·3
(73·4–92·1)
52·3
(39·8–66·9)
26·1
(15·2–42·2)
0·7
(0·6–0·8)
Iceland 3·81
(3·57–4·08)
2·40
(2·32–2·49)
1·97
(1·81–2·13)
1·73
(1·54–1·93)
1·58
(1·36–1·82)
4·0
(3·8–4·3)
4·3
(4·2–4·5)
4·7
(4·3–5·1)
5·4
(4·5–6·4)
5·4
(3·8–7·5)
0·9
(0·9–1·0)
Ireland 3·18
(3·09–3·28)
3·14
(3·08–3·20)
1·76
(1·65–1·88)
1·54
(1·40–1·70)
1·40
(1·22–1·58)
63·9
(62·1–66·0)
74·1
(72·8–75·4)
57·7
(54·0–61·4)
61·5
(52·5–70·8)
46·8
(34·4–61·9)
0·9
(0·8–0·9)
Israel 3·79
(3·68–3·90)
3·14
(3·08–3·20)
2·90
(2·76–3·05)
2·38
(2·20–2·59)
2·09
(1·86–2·34)
47·0
(45·6–48·4)
92·9
(91·1–94·7)
183·2
(174·1–192·7)
208·6
(174·7–248·4)
231·4
(167·3–315·1)
1·4
(1·3–1·5)
Italy 2·45
(2·37–2·53)
1·63
(1·60–1·66)
1·21
(1·08–1·36)
1·18
(1·00–1·37)
1·09
(0·88–1·32)
883·2
(855·0–912·8)
640·5
(628·7–652·9)
398·2
(354·1–445·2)
285·5
(236·9–343·9)
136·4
(84·0–209·0)
0·6
(0·5–0·7)
Luxembourg 2·00
(1·87–2·15)
1·51
(1·46–1·55)
1·38
(1·28–1·48)
1·30
(1·17–1·44)
1·24
(1·09–1·40)
4·5
(4·2–4·9)
4·2
(4·0–4·3)
6·6
(6·1–7·1)
8·8
(7·7–10·1)
8·8
(6·8–11·1)
0·7
(0·6–0·7)
(Table 1 continues on next page)

Articles
10
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Malta 4·04
(3·88–4·22)
1·98
(1·91–2·05)
1·53
(1·37–1·71)
1·39
(1·18–1·64)
1·26
(1·01–1·55)
9·8
(9·4–10·2)
5·7
(5·5–6·0)
4·3
(3·9–4·8)
4·8
(3·9–5·9)
4·0
(2·6–6·0)
0·7
(0·7–0·8)
Monaco 2·21
(1·91–2·55)
1·64
(1·43–1·88)
1·52
(1·29–1·80)
1·44
(1·16–1·76)
1·37
(1·06–1·73)
0·3
(0·3–0·4)
0·3
(0·3–0·3)
0·3
(0·2–0·3)
0·2
(0·2–0·3)
0·1
(0·1–0·2)
0·7
(0·6–0·8)
Netherlands 3·12
(3·04–3·22)
1·60
(1·56–1·63)
1·68
(1·58–1·78)
1·54
(1·41–1·67)
1·42
(1·27–1·57)
229·6
(223·4–236·8)
178·6
(174·7–182·6)
177·7
(167·2–188·3)
165·6
(146·4–186·7)
142·0
(112·1–177·0)
0·8
(0·8–0·9)
Norway 2·52
(2·44–2·60)
1·61
(1·57–1·65)
1·55
(1·46–1·64)
1·43
(1·32–1·54)
1·36
(1·24–1·49)
61·9
(60·1–63·9)
47·8
(46·8–48·9)
55·9
(52·8–59·1)
54·8
(48·5–61·5)
46·2
(37·2–57·5)
0·7
(0·7–0·8)
Portugal 3·04
(2·94–3·16)
2·13
(2·09–2·18)
1·30
(1·22–1·39)
1·27
(1·13–1·42)
1·17
(1·00–1·37)
206·3
(199·2–214·4)
154·5
(151·0–158·2)
80·6
(75·2–86·2)
70·9
(59·7–83·9)
46·0
(32·1–63·2)
0·6
(0·6–0·7)
San Marino 2·47
(2·14–2·84)
1·58
(1·48–1·69)
1·30
(1·15–1·48)
1·27
(1·09–1·49)
1·20
(0·99–1·46)
0·3
(0·2–0·3)
0·2
(0·2–0·3)
0·2
(0·2–0·3)
0·2
(0·1–0·2)
0·1
(0·0–0·1)
0·6
(0·5–0·7)
Spain 2·47
(2·38–2·55)
2·13
(2·09–2·17)
1·26
(1·17–1·35)
1·23
(1·10–1·38)
1·11
(0·93–1·30)
560·3
(542·4–579·3)
549·2
(538·5–559·9)
336·7
(312·8–362·0)
377·6
(319·2–439·7)
248·3
(169·5–331·8)
0·6
(0·6–0·7)
Sweden 2·27
(2·20–2·36)
1·65
(1·62–1·69)
1·71
(1·61–1·81)
1·51
(1·39–1·64)
1·38
(1·24–1·53)
113·9
(110·3–118·3)
95·5
(93·4–97·5)
113·9
(107·4–120·7)
135·0
(119·4–151·5)
136·8
(108·5–166·8)
0·8
(0·8–0·9)
Switzerland 2·35
(2·28–2·43)
1·58
(1·54–1·61)
1·48
(1·39–1·59)
1·40
(1·28–1·52)
1·33
(1·20–1·47)
83·2
(80·7–85·8)
75·8
(74·2–77·4)
89·1
(83·5–95·3)
83·8
(74·0–94·7)
68·5
(54·8–84·4)
0·7
(0·7–0·8)
UK 2·19
(2·13–2·25)
1·85
(1·80–1·90)
1·49
(1·33–1·67)
1·38
(1·18–1·58)
1·30
(1·08–1·53)
809·2
(786·1–832·5)
735·5
(715·4–755·5)
683·8
(608·2–762·0)
623·3
(504·8–743·2)
470·8
(303·6–664·1)
0·7
(0·6–0·8)
Latin America and
Caribbean
5·82
(5·58–6·06)
4·09
(4·01–4·18)
1·98
(1·83–2·13)
1·57
(1·38–1·79)
1·31
(1·08–1·57)
6278·2
(6037·0–6525·3)
10 310·9
(10 111·1–10 514·4)
9377·7
(8692·9–10 090·5)
6763·5
(5627·9–8076·1)
3002·6
(1769·5–4786·3)
0·9
(0·9–1·0)
Andean Latin America 6·72
(6·47–6·95)
4·97
(4·86–5·08)
2·32
(2·14–2·51)
1·80
(1·58–2·05)
1·45
(1·19–1·73)
679·8
(655·9–702·4)
1115·9
(1089·4–1141·9)
1242·6
(1146·2–1345·6)
961·5
(782·6–1184·9)
457·7
(242·3–768·2)
1·1
(1·0–1·2)
Bolivia 6·84
(6·49–7·19)
5·65
(5·45–5·85)
2·53
(2·31–2·77)
1·84
(1·55–2·17)
1·40
(1·07–1·77)
150·5
(143·0–157·8)
216·0
(208·8–223·4)
245·0
(223·7–270·0)
208·5
(162·6–277·0)
113·0
(53·3–210·1)
1·2
(1·1–1·3)
Ecuador 6·09
(5·78–6·44)
4·24
(4·10–4·40)
2·20
(1·95–2·50)
1·74
(1·42–2·10)
1·45
(1·10–1·86)
149·7
(142·2–157·9)
249·6
(241·3–259·0)
321·5
(285·0–363·6)
269·3
(194·5–367·0)
152·8
(66·7–298·3)
1·1
(0·9–1·2)
Peru 6·95
(6·68–7·22)
5·10
(4·96–5·24)
2·30
(2·08–2·55)
1·83
(1·56–2·13)
1·44
(1·14–1·80)
379·7
(366·2–392·8)
650·3
(630·8–669·5)
676·2
(611·2–748·3)
483·7
(374·1–630·9)
192·0
(79·6–384·3)
1·1
(1·0–1·2)
Caribbean 5·02
(4·90–5·14)
3·39
(3·31–3·47)
2·19
(2·02–2·39)
1·77
(1·50–2·08)
1·43
(1·11–1·88)
699·5
(682·6–715·4)
837·0
(818·1–856·6)
797·4
(734·1–868·9)
570·0
(432·5–738·2)
241·7
(98·1–477·6)
1·0
(0·9–1·1)
Antigua and
Barbuda
4·63
(4·38–4·88)
2·33
(2·24–2·42)
1·49
(1·33–1·68)
1·30
(1·11–1·52)
1·15
(0·93–1·41)
1·7
(1·6–1·7)
1·2
(1·2–1·3)
1·0
(0·9–1·2)
0·7
(0·5–0·9)
0·3
(0·1–0·5)
0·7
(0·6–0·8)
The Bahamas 3·97
(3·77–4·17)
2·65
(2·56–2·76)
1·23
(1·05–1·45)
1·24
(1·02–1·49)
1·24
(0·99–1·52)
2·6
(2·5–2·7)
5·0
(4·8–5·2)
3·9
(3·3–4·5)
3·1
(2·3–4·2)
1·9
(1·0–3·2)
0·6
(0·5–0·7)
Barbados 3·54
(3·36–3·73)
1·94
(1·86–2·04)
1·30
(1·09–1·56)
1·18
(0·95–1·47)
1·10
(0·85–1·42)
6·7
(6·4–7·1)
4·3
(4·1–4·5)
2·6
(2·2–3·1)
1·7
(1·1–2·3)
0·7
(0·3–1·3)
0·6
(0·5–0·7)
Belize 5·47
(5·21–5·76)
5·42
(5·27–5·57)
1·96
(1·74–2·20)
1·58
(1·28–1·90)
1·28
(0·93–1·67)
2·8
(2·7–3·0)
5·7
(5·5–5·8)
7·6
(6·7–8·5)
7·5
(5·5–9·8)
5·2
(2·4–9·0)
0·9
(0·8–1·1)
Bermuda 3·58
(3·38–3·81)
1·62
(1·55–1·70)
1·28
(1·15–1·43)
1·19
(1·04–1·36)
1·07
(0·88–1·28)
1·1
(1·1–1·2)
0·8
(0·8–0·9)
0·5
(0·4–0·5)
0·3
(0·2–0·4)
0·1
(0·1–0·2)
0·6
(0·6–0·7)
Cuba 3·29
(3·13–3·45)
1·65
(1·59–1·71)
1·44
(1·34–1·55)
1·31
(1·18–1·44)
1·23
(1·07–1·39)
151·3
(144·0–158·5)
141·1
(136·2–146·2)
99·6
(92·7–107·0)
58·5
(46·8–71·0)
19·4
(11·9–29·3)
0·7
(0·6–0·7)
(Table 1 continues on next page)

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
11
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Dominica 5·12
(4·88–5·37)
3·50
(3·32–3·69)
1·29
(1·09–1·52)
1·18
(0·96–1·45)
1·13
(0·89–1·42)
1·9
(1·8–2·0)
1·9
(1·8–2·0)
0·6
(0·5–0·7)
0·4
(0·3–0·6)
0·2
(0·1–0·3)
0·6
(0·5–0·7)
Dominican Republic 7·83
(7·60–8·04)
4·72
(4·50–4·94)
2·32
(2·10–2·56)
1·84
(1·55–2·15)
1·51
(1·19–1·86)
132·5
(129·1–135·6)
210·1
(199·5–220·2)
213·5
(192·9–236·2)
159·1
(118·5–211·1)
70·4
(27·8–142·4)
1·1
(1·0–1·2)
Grenada 5·27
(5·05–5·48)
3·57
(3·39–3·75)
1·74
(1·49–2·05)
1·41
(1·09–1·79)
1·19
(0·81–1·62)
3·5
(3·3–3·6)
2·7
(2·5–2·8)
1·4
(1·2–1·6)
0·8
(0·5–1·1)
0·1
(0·0–0·4)
0·8
(0·7–1·0)
Guyana 6·17
(5·96–6·41)
3·91
(3·73–4·09)
2·35
(2·06–2·67)
1·91
(1·54–2·32)
1·58
(1·15–2·04)
19·4
(18·7–20·2)
26·1
(24·8–27·3)
15·3
(13·5–17·4)
8·6
(5·7–12·8)
5·5
(2·0–11·1)
1·1
(1·0–1·2)
Haiti 6·67
(6·36–6·96)
5·98
(5·76–6·18)
3·16
(2·82–3·55)
2·10
(1·68–2·61)
1·44
(0·92–2·05)
175·3
(167·4–182·9)
228·7
(221·2–235·7)
344·4
(308·5–386·7)
271·1
(179·5–381·4)
120·8
(30·5–290·6)
1·4
(1·2–1·5)
Jamaica 4·06
(3·78–4·34)
3·28
(3·18–3·39)
1·37
(1·18–1·56)
1·16
(0·93–1·39)
1·04
(0·79–1·31)
50·1
(46·9–53·6)
58·2
(56·3–60·2)
32·8
(28·4–37·5)
15·8
(11·3–21·6)
2·9
(0·7–6·8)
0·7
(0·6–0·7)
Puerto Rico 5·20
(5·10–5·31)
2·60
(2·53–2·66)
0·90
(0·84–0·97)
0·84
(0·76–0·92)
0·81
(0·72–0·93)
84·9
(83·2–86·8)
71·7
(69·8–73·7)
19·0
(17·7–20·5)
6·7
(5·0–8·5)
1·4
(0·8–2·0)
0·4
(0·4–0·5)
Saint Kitts and
Nevis
3·90
(3·73–4·06)
3·32
(3·14–3·52)
1·27
(1·13–1·42)
1·08
(0·92–1·27)
1·00
(0·81–1·20)
1·9
(1·8–1·9)
1·2
(1·1–1·3)
0·6
(0·5–0·6)
0·3
(0·2–0·4)
0·1
(0·0–0·1)
0·6
(0·5–0·7)
Saint Lucia 5·03
(4·80–5·26)
4·24
(4·10–4·38)
1·28
(1·08–1·51)
1·04
(0·79–1·32)
0·87
(0·58–1·19)
2·9
(2·8–3·1)
3·9
(3·8–4·0)
1·7
(1·4–2·0)
1·0
(0·7–1·4)
0·3
(0·1–0·7)
0·6
(0·5–0·7)
Saint Vincent and
the Grenadines
4·83
(4·66–4·99)
3·89
(3·76–4·05)
1·60
(1·41–1·82)
1·35
(1·10–1·64)
1·16
(0·87–1·51)
2·8
(2·7–2·9)
3·2
(3·1–3·3)
1·3
(1·1–1·5)
0·8
(0·6–1·1)
0·3
(0·1–0·6)
0·8
(0·7–0·9)
Suriname 5·56
(5·33–5·78)
3·76
(3·65–3·88)
2·09
(1·87–2·33)
1·73
(1·41–2·05)
1·39
(1·02–1·78)
7·8
(7·5–8·1)
10·3
(10·0–10·7)
9·0
(8·1–10·0)
7·4
(5·4–9·8)
3·3
(1·1–6·7)
1·0
(0·9–1·1)
Trinidad and
Tobago
4·60
(4·44–4·78)
3·29
(3·18–3·40)
1·52
(1·34–1·72)
1·35
(1·13–1·60)
1·19
(0·94–1·49)
23·7
(23·0–24·6)
31·0
(29·9–32·1)
14·7
(13·0–16·7)
6·6
(4·5–8·9)
0·5
(0·0–2·0)
0·7
(0·6–0·8)
Virgin Islands 4·85
(4·61–5·09)
2·91
(2·73–3·08)
1·68
(1·46–1·94)
1·49
(1·28–1·77)
1·37
(1·13–1·69)
0·9
(0·8–0·9)
2·5
(2·3–2·6)
0·8
(0·7–0·9)
0·5
(0·3–0·6)
0·2
(0·1–0·4)
0·8
(0·7–0·9)
Central Latin America 5·73
(5·49–5·99)
4·32
(4·22–4·42)
1·87
(1·68–2·08)
1·47
(1·23–1·74)
1·21
(0·93–1·53)
2327·7
(2229·7–2431·0)
4477·0
(4375·7–4578·5)
3877·3
(3483·8–4308·1)
2704·0
(2091·0–3465·5)
1064·5
(501·2–1993·8)
0·9
(0·8–1·0)
Colombia 5·67
(5·27–6·12)
3·62
(3·41–3·84)
1·67
(1·43–1·96)
1·35
(1·02–1·71)
1·14
(0·77–1·54)
499·9
(466·3–537·1)
823·8
(774·8–875·5)
675·0
(576·7–788·6)
444·7
(296·9–633·1)
176·8
(59·7–379·0)
0·8
(0·7–0·9)
Costa Rica 6·04
(5·87–6·22)
3·60
(3·52–3·70)
1·38
(1·26–1·51)
1·18
(1·02–1·36)
1·03
(0·84–1·26)
38·2
(37·1–39·4)
69·7
(68·0–71·6)
54·6
(49·8–59·7)
33·8
(26·6–42·3)
11·3
(6·2–18·4)
0·7
(0·6–0·7)
El Salvador 6·47
(6·31–6·64)
5·14
(5·02–5·26)
2·05
(1·80–2·32)
1·58
(1·23–1·93)
1·28
(0·86–1·72)
97·8
(95·4–100·5)
181·2
(177·2–185·3)
115·9
(101·7–130·8)
50·9
(30·9–74·0)
0·2
(0·0–1·7)
1·0
(0·9–1·1)
Guatemala 6·47
(6·38–6·56)
6·66
(6·56–6·77)
2·41
(2·16–2·68)
1·62
(1·26–1·98)
1·16
(0·73–1·61)
146·1
(144·2–148·2)
303·8
(298·8–308·6)
344·7
(309·1–383·9)
228·2
(158·2–314·1)
66·4
(12·7–166·4)
1·1
(1·0–1·3)
Honduras 6·84
(6·49–7·18)
6·38
(6·23–6·52)
2·40
(2·11–2·75)
1·71
(1·35–2·11)
1·27
(0·82–1·76)
73·7
(70·0–77·2)
154·7
(151·1–158·0)
220·5
(195·1–252·5)
175·5
(119·4–238·7)
76·9
(23·0–174·0)
1·1
(1·0–1·3)
Mexico 5·66
(5·39–5·95)
4·29
(4·18–4·40)
1·77
(1·61–1·94)
1·39
(1·19–1·62)
1·15
(0·91–1·41)
1172·2
(1115·3–1232·6)
2275·4
(2222·6–2330·8)
1857·4
(1689·0–2038·3)
1343·9
(1065·2–1696·2)
564·3
(296·0–956·2)
0·9
(0·8–0·9)
Nicaragua 6·12
(5·82–6·43)
6·14
(6·00–6·28)
2·20
(1·93–2·49)
1·65
(1·30–2·01)
1·29
(0·86–1·73)
54·6
(52·0–57·5)
127·7
(125·0–130·3)
126·9
(111·4–143·2)
84·4
(56·0–123·5)
22·2
(1·3–66·1)
1·0
(0·9–1·2)
(Table 1 continues on next page)

Articles
12
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Panama 4·04
(3·90–4·20)
3·54
(3·43–3·65)
2·13
(1·91–2·37)
1·76
(1·49–2·05)
1·49
(1·20–1·81)
26·2
(25·3–27·2)
53·9
(52·2–55·5)
69·8
(62·7–77·3)
70·4
(53·4–93·0)
55·5
(31·8–93·2)
1·0
(0·9–1·1)
Venezuela 5·38
(5·22–5·54)
4·09
(3·99–4·20)
2·13
(1·84–2·43)
1·79
(1·43–2·19)
1·51
(1·10–1·97)
219·1
(212·3–225·6)
486·7
(472·9–501·5)
412·7
(355·6–471·4)
272·2
(186·9–399·4)
90·9
(4·0–255·5)
1·0
(0·9–1·1)
Tropical Latin America 5·95
(5·54–6·36)
3·83
(3·72–3·94)
1·94
(1·79–2·12)
1·57
(1·36–1·81)
1·32
(1·08–1·59)
2571·2
(2402·6–2735·9)
3881·0
(3774·3–3985·9)
3460·4
(3188·0–3775·6)
2528·0
(1966·2–3181·6)
1238·7
(691·6–2043·1)
0·9
(0·9–1·0)
Brazil 5·93
(5·51–6·36)
3·81
(3·70–3·92)
1·93
(1·78–2·12)
1·57
(1·35–1·81)
1·31
(1·06–1·59)
2504·7
(2335·7–2669·2)
3773·8
(3670·2–3875·7)
3332·2
(3059·7–3648·5)
2440·4
(1881·9–3096·7)
1207·6
(654·5–2015·8)
0·9
(0·8–1·0)
Paraguay 6·62
(6·35–6·90)
4·90
(4·50–5·29)
2·15
(1·83–2·50)
1·66
(1·25–2·11)
1·39
(0·93–1·89)
66·5
(63·7–69·6)
107·1
(98·7–115·7)
128·2
(109·5–148·5)
87·5
(53·2–131·0)
31·1
(3·6–88·8)
1·0
(0·9–1·2)
North Africa and
Middle East
5·93
(5·56–6·31)
6·25
(6·14–6·37)
2·53
(2·33–2·76)
1·94
(1·62–2·28)
1·64
(1·28–2·06)
4777·2
(4479·4–5080·5)
10 964·6
(10 754·6–11 168·9)
12 137·4
(11 185·8–13 232·1)
11 415·2
(8900·7–14 116·1)
8157·0
(4021·1–14 491·3)
1·2
(1·1–1·3)
Afghanistan 6·94
(6·60–7·27)
7·25
(7·04–7·46)
5·39
(5·10–5·72)
3·34
(2·78–3·89)
1·61
(0·90–2·32)
353·5
(336·6–370·1)
616·1
(597·7–632·9)
1211·5
(1147·5–1283·0)
1785·5
(1104·3–2491·9)
1349·7
(348·0–2742·3)
2·3
(2·2–2·4)
Algeria 6·55
(6·18–6·91)
6·82
(6·72–6·91)
2·64
(2·38–2·91)
1·79
(1·37–2·18)
1·48
(1·04–1·89)
415·5
(392·0–438·9)
793·9
(781·7–807·2)
907·7
(818·7–1000·0)
704·6
(502·0–930·0)
342·7
(128·4–657·3)
1·2
(1·1–1·4)
Bahrain 6·15
(5·75–6·56)
4·41
(4·31–4·52)
1·71
(1·52–1·91)
1·39
(1·10–1·68)
1·26
(0·92–1·57)
4·0
(3·7–4·3)
10·0
(9·8–10·3)
16·9
(15·0–18·8)
17·6
(13·1–22·1)
13·3
(6·9–21·5)
0·8
(0·7–0·9)
Egypt 3·54
(3·12–4·02)
5·91
(5·73–6·10)
3·16
(2·82–3·54)
2·38
(1·97–2·82)
2·05
(1·62–2·50)
557·4
(491·3–629·7)
1850·4
(1789·0–1913·1)
2611·0
(2335·5–2921·4)
2968·5
(2235·8–3819·0)
3117·2
(1456·3–5603·2)
1·5
(1·3–1·7)
Iran 6·21
(5·79–6·62)
7·41
(7·32–7·51)
1·52
(1·33–1·73)
1·31
(1·03–1·58)
1·28
(0·97–1·58)
772·2
(721·6–822·6)
1948·0
(1921·2–1973·2)
1027·8
(897·0–1168·0)
776·4
(560·5–1032·3)
456·1
(215·5–786·6)
0·7
(0·6–0·8)
Iraq 6·37
(5·98–6·76)
7·06
(6·83–7·26)
2·87
(2·63–3·16)
1·95
(1·63–2·35)
1·59
(1·25–2·01)
223·0
(209·4–236·5)
606·4
(587·4–624·5)
932·7
(853·6–1028·2)
873·0
(596·0–1223·7)
626·4
(284·1–1129·5)
1·3
(1·2–1·5)
Jordan 8·53
(8·41–8·64)
7·05
(6·96–7·14)
2·33
(2·06–2·62)
1·78
(1·44–2·10)
1·57
(1·20–1·93)
23·4
(23·0–23·7)
91·6
(90·1–93·1)
211·7
(187·4–238·2)
289·6
(219·8–367·5)
362·8
(205·1–553·3)
1·1
(1·0–1·2)
Kuwait 5·21
(4·77–5·67)
5·24
(5·11–5·37)
1·13
(0·98–1·30)
1·07
(0·89–1·30)
1·14
(0·93–1·39)
2·7
(2·5–2·9)
50·2
(48·9–51·6)
50·9
(44·1–59·0)
47·2
(37·1–60·8)
40·3
(26·2–60·8)
0·5
(0·5–0·6)
Lebanon 6·90
(6·55–7·24)
4·25
(3·95–4·55)
1·76
(1·49–2·09)
1·44
(1·12–1·80)
1·33
(0·98–1·73)
59·0
(56·0–61·9)
79·4
(74·3–84·5)
81·3
(69·4–96·1)
49·3
(34·2–68·0)
24·2
(8·6–49·8)
0·8
(0·7–1·0)
Libya 7·60
(7·39–7·81)
7·10
(6·92–7·25)
1·37
(1·14–1·63)
1·13
(0·87–1·43)
1·03
(0·75–1·37)
52·0
(50·6–53·3)
121·6
(118·8–124·4)
79·1
(66·1–94·5)
45·8
(31·7–66·0)
14·9
(4·8–34·7)
0·6
(0·5–0·8)
Morocco 7·18
(6·86–7·49)
5·71
(5·45–5·97)
2·26
(2·05–2·49)
1·36
(1·05–1·70)
1·02
(0·67–1·40)
463·2
(443·0–482·8)
806·7
(771·6–842·5)
646·6
(586·7–714·3)
373·2
(262·4–500·7)
90·9
(20·3–206·9)
1·1
(1·0–1·2)
Oman 7·48
(7·25–7·71)
7·57
(7·39–7·76)
2·48
(2·24–2·73)
1·64
(1·27–2·02)
1·29
(0·88–1·72)
23·9
(23·1–24·7)
59·1
(57·5–60·7)
81·7
(74·1–89·8)
76·9
(56·8–99·4)
53·4
(23·6–95·4)
1·2
(1·1–1·3)
Palestine 7·61
(7·37–7·84)
6·75
(6·50–6·98)
2·88
(2·64–3·16)
2·08
(1·79–2·44)
1·77
(1·43–2·15)
36·8
(35·7–38·0)
62·8
(60·4–65·1)
119·8
(109·5–132·2)
108·4
(82·3–139·7)
66·4
(26·4–129·3)
1·4
(1·3–1·5)
Qatar 7·04
(6·75–7·33)
5·35
(5·17–5·54)
1·95
(1·75–2·16)
1·43
(1·17–1·69)
1·29
(1·01–1·57)
1·2
(1·2–1·3)
8·2
(8·0–8·5)
38·0
(34·4–42·0)
59·8
(47·0–72·7)
58·2
(35·0–85·0)
0·9
(0·9–1·0)
Saudi Arabia 6·84
(6·51–7·15)
6·79
(6·48–7·09)
1·44
(1·24–1·68)
1·09
(0·80–1·39)
0·97
(0·65–1·31)
131·3
(124·7–137·8)
396·7
(377·1–416·4)
461·9
(396·5–535·4)
291·3
(195·0–395·8)
128·2
(48·7–242·9)
0·7
(0·6–0·8)
Sudan 6·63
(6·35–6·90)
6·72
(6·51–6·92)
3·38
(3·08–3·72)
1·93
(1·48–2·44)
1·40
(0·93–1·95)
238·8
(229·1–248·2)
702·4
(679·3–723·8)
1168·4
(1067·7–1281·7)
1011·1
(689·4–1360·9)
504·2
(148·5–1154·4)
1·5
(1·4–1·7)
(Table 1 continues on next page)

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
13
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Syria 7·68
(7·47–7·88)
6·79
(6·60–6·98)
2·06
(1·76–2·42)
1·57
(1·21–1·98)
1·39
(1·01–1·84)
165·5
(160·5–170·3)
373·0
(360·4–385·6)
196·6
(165·8–234·5)
167·9
(110·2–241·9)
100·5
(38·4–217·1)
1·0
(0·8–1·1)
Tunisia 6·48
(6·15–6·82)
5·07
(4·90–5·23)
1·82
(1·59–2·09)
1·36
(1·02–1·73)
1·19
(0·82–1·59)
166·5
(157·7–175·1)
222·0
(214·0–230·2)
166·5
(145·6–191·5)
99·5
(68·0–136·0)
28·7
(6·9–67·4)
0·9
(0·7–1·0)
Türkiye 5·73
(5·31–6·16)
4·81
(4·61–5·01)
1·67
(1·52–1·85)
1·32
(1·13–1·56)
1·17
(0·95–1·42)
859·4
(797·8–921·8)
1611·4
(1541·0–1680·6)
1052·9
(955·7–1164·2)
634·5
(497·4–793·2)
218·5
(114·1–382·4)
0·8
(0·7–0·9)
United Arab
Emirates
7·14
(6·83–7·46)
5·88
(5·69–6·07)
1·90
(1·68–2·14)
1·53
(1·26–1·81)
1·31
(1·00–1·64)
3·6
(3·4–3·7)
35·5
(34·6–36·5)
74·0
(64·1–84·7)
160·2
(122·7–198·1)
155·8
(88·6–234·7)
0·9
(0·8–1·0)
Yemen 7·36
(7·07–7·64)
7·91
(7·77–8·04)
3·87
(3·47–4·31)
1·91
(1·32–2·54)
1·22
(0·54–1·95)
224·0
(214·9–232·8)
513·9
(504·7–522·7)
989·2
(886·4–1105·7)
863·3
(536·7–1288·7)
396·3
(56·2–1154·2)
1·8
(1·6–1·9)
South Asia 6·35
(5·95–6·75)
4·96
(4·74–5·16)
2·07
(1·89–2·28)
1·36
(1·09–1·64)
1·10
(0·80–1·43)
20 472·6
(19 194·5–21 717·6)
31 555·9
(30 245·2–32 782·2)
32 043·4
(29 175·4–35 206·1)
18 743·1
(13 775·0–24 181·6)
5272·8
(1922·0–10 462·8)
0·9
(0·9–1·0)
Bangladesh 7·30
(6·99–7·59)
6·03
(5·87–6·18)
1·90
(1·68–2·14)
1·20
(0·84–1·54)
0·97
(0·57–1·37)
2067·5
(1988·9–2140·7)
3641·1
(3563·4–3718·0)
2806·8
(2477·5–3152·8)
1370·6
(828·0–1977·2)
224·3
(6·5–644·2)
0·9
(0·8–1·0)
Bhutan 6·70
(6·35–7·04)
5·89
(5·59–6·18)
1·92
(1·74–2·09)
1·07
(0·73–1·34)
0·69
(0·33–1·00)
8·5
(8·1–8·9)
19·4
(18·5–20·2)
12·6
(11·5–13·8)
6·1
(3·9–8·2)
1·1
(0·2–2·3)
0·9
(0·8–1·0)
India 6·18
(5·75–6·59)
4·60
(4·35–4·83)
1·91
(1·69–2·13)
1·29
(0·97–1·62)
1·04
(0·67–1·42)
16 366·5
(15 255·4–17 463·8)
23 512·7
(22 306·6–24 656·5)
22 393·2
(19 926·1–25 068·0)
13 026·2
(8946·1–17 555·0)
3792·9
(1086·0–7903·8)
0·9
(0·8–1·0)
Nepal 6·33
(6·03–6·60)
6·17
(5·93–6·41)
2·14
(1·92–2·38)
1·18
(0·80–1·53)
0·82
(0·40–1·22)
416·7
(397·7–436·2)
727·6
(702·1–752·3)
642·2
(576·4–711·9)
273·0
(160·3–402·5)
14·6
(0·0–69·7)
1·0
(0·9–1·1)
Pakistan 7·26
(6·95–7·56)
6·75
(6·54–6·96)
3·22
(2·87–3·62)
1·76
(1·25–2·28)
1·16
(0·59–1·77)
1613·4
(1542·5–1682·1)
3655·1
(3533·0–3773·2)
6188·5
(5530·6–6957·2)
4067·1
(2636·1–5810·4)
1239·9
(85·1–3558·0)
1·4
(1·3–1·6)
Southeast Asia, east
Asia, and Oceania
5·76
(5·44–6·09)
2·99
(2·89–3·08)
1·55
(1·44–1·66)
1·37
(1·22–1·54)
1·30
(1·11–1·53)
31 218·7
(29 613·6–32 875·9)
31 743·5
(30 751·9–32 760·5)
22 805·8
(21 221·6–24 442·9)
15 544·8
(13 337·3–18 252·3)
6819·6
(4409·9–10 247·2)
0·7
(0·7–0·8)
East Asia 5·57
(5·25–5·90)
2·46
(2·35–2·56)
1·23
(1·12–1·34)
1·14
(0·99–1·30)
1·16
(0·99–1·34)
22 400·1
(21 213·3–23 644·8)
18 856·4
(18 088·5–19 630·1)
11 202·9
(10 243·8–12 246·4)
6621·8
(5397·9–8088·3)
2201·4
(1341·4–3394·0)
0·6
(0·5–0·6)
China 5·55
(5·24–5·89)
2·44 (2·33–
2·55)
1·23
(1·12–1·34)
1·14
(0·99–1·31)
1·16
(0·99–1·35)
21 609·2
(20 451·1–22 827·1)
18 000·3
(17 240·4–18 768·2)
10 747·2
(9807·6–11 774·1)
6360·0
(5139·5–7778·2)
2105·2
(1273·0–3268·7)
0·6
(0·5–0·6)
North Korea 5·41
(5·06–5·77)
3·25
(2·96–3·59)
1·51
(1·32–1·71)
1·24
(1·00–1·48)
1·16
(0·90–1·42)
424·7
(399·0–451·2)
450·7
(408·9–500·1)
299·0
(263·4–339·7)
172·2
(119·0–227·4)
63·4
(27·8–111·8)
0·7
(0·6–0·8)
Taiwan (province of
China)
6·82
(6·66–6·98)
2·42
(2·34–2·51)
0·98
(0·87–1·09)
0·90
(0·78–1·04)
0·90
(0·77–1·05)
366·2
(357·7–375·6)
405·5
(391·4–420·2)
156·8
(139·6–175·5)
89·6
(73·8–107·7)
32·8
(22·0–46·8)
0·5
(0·4–0·5)
Oceania 6·63
(6·37–6·90)
5·36
(5·18–5·53)
4·02
(3·68–4·41)
2·93
(2·45–3·46)
1·67
(1·01–2·35)
121·4
(116·7–126·1)
193·5
(186·9–199·5)
430·7
(393·9–472·2)
590·1
(457·1–736·3)
566·7
(224·7–1096·8)
1·8
(1·6–1·9)
American Samoa 5·97
(5·71–6·25)
4·24
(4·08–4·40)
2·42
(2·14–2·71)
1·98
(1·67–2·31)
1·68
(1·34–2·05)
0·8
(0·8–0·8)
1·1
(1·1–1·1)
0·8
(0·7–0·9)
0·8
(0·6–1·0)
0·6
(0·3–1·0)
1·1
(1·0–1·3)
Cook Islands 5·79
(5·49–6·08)
3·66
(3·48–3·84)
1·74
(1·52–2·00)
1·40
(1·14–1·72)
1·25
(0·96–1·58)
0·6
(0·6–0·6)
0·4
(0·4–0·5)
0·2
(0·2–0·3)
0·2
(0·1–0·2)
0·1
(0·0–0·1)
0·8
(0·7–0·9)
Federated States of
Micronesia
7·69
(7·48–7·88)
5·87
(5·58–6·14)
2·37
(2·04–2·78)
1·82
(1·39–2·33)
1·46
(0·96–2·05)
2·0
(2·0–2·1)
3·2
(3·1–3·4)
1·9
(1·6–2·2)
1·4
(0·8–2·0)
0·8
(0·2–1·9)
1·1
(1·0–1·3)
Fiji 5·64
(5·38–5·90)
3·34
(3·21–3·46)
2·42
(2·15–2·73)
1·95
(1·61–2·31)
1·64
(1·28–2·04)
11·5
(11·0–12·0)
18·8
(18·0–19·6)
16·7
(14·8–18·8)
12·6
(9·3–17·0)
8·7
(4·2–15·8)
1·1
(1·0–1·3)
(Table 1 continues on next page)

Articles
14
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Guam 5·38
(5·12–5·68)
3·06
(2·94–3·17)
2·59
(2·30–2·86)
2·07
(1·76–2·38)
1·76
(1·42–2·09)
1·8
(1·7–1·8)
2·9
(2·8–3·1)
2·7
(2·4–3·0)
1·9
(1·4–2·4)
1·4
(0·7–2·4)
1·2
(1·1–1·3)
Kiribati 6·40
(6·25–6·54)
4·81
(4·50–5·12)
2·95
(2·63–3·32)
2·13
(1·70–2·62)
1·67
(1·19–2·21)
1·3
(1·3–1·3)
2·3
(2·1–2·4)
2·9
(2·6–3·3)
2·3
(1·7–3·1)
1·0
(0·2–2·3)
1·3
(1·2–1·5)
Marshall Islands 7·08
(6·77–7·38)
5·25
(5·02–5·50)
2·56
(2·31–2·84)
1·98
(1·67–2·32)
1·65
(1·31–2·02)
0·6
(0·6–0·6)
1·3
(1·3–1·4)
1·2
(1·0–1·3)
1·1
(0·8–1·4)
0·7
(0·4–1·3)
1·2
(1·1–1·3)
Nauru 6·62
(6·45–6·80)
4·95
(4·54–5·35)
3·24
(2·86–3·67)
2·40
(1·93–2·95)
1·91
(1·39–2·51)
0·1
(0·1–0·1)
0·3
(0·3–0·4)
0·3
(0·3–0·3)
0·3
(0·2–0·4)
0·3
(0·1–0·6)
1·5
(1·3–1·6)
Niue 6·36
(6·07–6·69)
4·10
(3·87–4·32)
2·09
(1·84–2·38)
1·71
(1·37–2·08)
1·50
(1·13–1·90)
0·2
(0·2–0·2)
0·1
(0·1–0·1)
0·0
(0·0–0·0)
0·0
(0·0–0·0)
0·0
(0·0–0·0)
0·9
(0·8–1·0)
Northern Mariana
Islands
6·06
(5·66–6·46)
2·90
(2·58–3·28)
1·93
(1·68–2·21)
1·67
(1·36–2·01)
1·50
(1·17–1·88)
0·2
(0·2–0·2)
0·4
(0·3–0·4)
0·6
(0·5–0·7)
0·5
(0·4–0·7)
0·3
(0·2–0·6)
0·9
(0·8–1·0)
Palau 5·86
(5·44–6·27)
2·75
(2·44–3·09)
1·93
(1·72–2·15)
1·65
(1·37–1·92)
1·44
(1·14–1·74)
0·3
(0·3–0·3)
0·2
(0·2–0·3)
0·2
(0·2–0·2)
0·1
(0·1–0·2)
0·1
(0·0–0·1)
0·9
(0·8–1·0)
Papua New Guinea 6·73
(6·39–7·06)
5·81
(5·59–6·02)
4·26
(3·86–4·71)
3·03
(2·50–3·58)
1·64
(0·94–2·35)
81·5
(77·4–85·4)
125·1
(120·4–129·4)
345·1
(312·9–381·6)
500·2
(374·6–636·3)
491·1
(180·0–958·2)
1·9
(1·7–2·0)
Samoa 7·45
(7·24–7·64)
5·99
(5·70–6·26)
4·25
(3·91–4·61)
3·18
(2·69–3·68)
2·57
(1·98–3·14)
4·5
(4·4–4·6)
5·8
(5·5–6·0)
6·2
(5·7–6·8)
7·8
(6·1–9·6)
11·5
(5·6–19·0)
2·0
(1·8–2·1)
Solomon Islands 7·10
(6·89–7·30)
6·51
(6·25–6·76)
3·90
(3·61–4·20)
2·51
(2·10–2·90)
1·70
(1·21–2·21)
4·8
(4·7–4·9)
9·9
(9·5–10·2)
20·5
(19·0–22·1)
19·7
(14·8–25·6)
10·5
(3·6–21·0)
1·8
(1·7–1·9)
Tokelau 6·71
(6·46–6·97)
4·18
(3·87–4·49)
1·89
(1·61–2·20)
1·54
(1·17–1·94)
1·34
(0·94–1·78)
0·1
(0·1–0·1)
0·0
(0·0–0·0)
0·0
(0·0–0·0)
0·0
(0·0–0·0)
0·0
(0·0–0·0)
0·8
(0·7–0·9)
Tonga 6·66
(6·47–6·86)
5·88
(5·73–6·03)
4·08
(3·75–4·42)
3·04
(2·58–3·50)
2·45
(1·93–2·98)
2·2
(2·1–2·3)
3·6
(3·5–3·7)
3·0
(2·7–3·2)
3·2
(2·5–4·1)
4·3
(2·3–7·1)
1·9
(1·7–2·0)
Tuvalu 6·69
(6·37–7·01)
5·98
(5·67–6·28)
3·08
(2·74–3·45)
2·20
(1·71–2·70)
1·71
(1·17–2·26)
0·2
(0·2–0·2)
0·4
(0·4–0·4)
0·3
(0·2–0·3)
0·3
(0·2–0·4)
0·2
(0·1–0·4)
1·4
(1·3–1·6)
Vanuatu 7·08
(6·77–7·38)
6·10
(5·88–6·31)
3·52
(3·23–3·84)
2·44
(2·06–2·87)
1·79
(1·33–2·31)
2·1
(2·0–2·2)
5·1
(4·9–5·3)
8·7
(8·0–9·5)
9·8
(7·7–12·5)
8·2
(3·8–15·6)
1·6
(1·5–1·8)
Southeast Asia 6·40
(6·08–6·72)
4·31
(4·20–4·43)
2·05
(1·89–2·23)
1·60
(1·40–1·83)
1·35
(1·14–1·60)
8697·2
(8276·7–9096·0)
12 693·6
(12 352·2–13 033·5)
11 172·2
(10 297·5–12 144·2)
8332·9
(7018·9–10 074·5)
4051·6
(2523·7–6469·1)
1·0
(0·9–1·0)
Cambodia 6·60
(6·26–6·93)
5·89
(5·64–6·13)
2·61
(2·39–2·82)
1·65
(1·32–1·93)
1·10
(0·71–1·45)
211·5
(200·4–222·5)
351·8
(337·4–366·1)
372·7
(341·8–403·6)
267·3
(193·9–342·9)
102·9
(35·5–192·8)
1·2
(1·1–1·3)
Indonesia 6·07
(5·71–6·42)
4·28
(4·15–4·41)
1·97
(1·77–2·22)
1·53
(1·25–1·84)
1·29
(0·99–1·63)
3626·7
(3445·3–3802·8)
5175·0
(5017·4–5342·6)
4393·8
(3937·5–4935·6)
3147·3
(2402·1–4049·5)
1453·3
(684·5–2718·1)
0·9
(0·8–1·0)
Laos 6·65
(6·27–7·03)
6·22
(5·88–6·56)
2·76
(2·54–2·98)
1·61
(1·29–1·88)
1·09
(0·73–1·40)
84·4
(79·7–89·0)
147·1
(139·3–154·9)
177·4
(162·5–192·1)
116·7
(88·2–149·0)
32·4
(10·7–63·5)
1·3
(1·2–1·4)
Malaysia 6·89
(6·56–7·22)
3·98
(3·88–4·08)
1·81
(1·62–2·05)
1·39
(1·11–1·70)
1·17
(0·86–1·52)
303·5
(289·8–317·0)
421·1
(409·4–432·6)
474·2
(424·4–534·7)
364·6
(271·6–471·1)
203·4
(106·1–366·8)
0·9
(0·8–1·0)
Maldives 4·97
(4·69–5·25)
6·46
(6·35–6·57)
1·64
(1·47–1·84)
1·07
(0·79–1·34)
0·77
(0·42–1·11)
2·7
(2·5–2·9)
6·8
(6·6–6·9)
6·0
(5·4–6·7)
5·4
(3·9–7·0)
2·6
(1·1–4·8)
0·8
(0·7–0·9)
(Table 1 continues on next page)

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
15
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Mauritius 6·31
(6·17–6·45)
2·61
(2·52–2·71)
1·39
(1·23–1·57)
1·17
(0·94–1·42)
1·03
(0·77–1·32)
23·3
(22·7–23·8)
23·4
(22·6–24·2)
12·7
(11·2–14·3)
6·7
(5·0–9·1)
1·8
(0·6–3·8)
0·7
(0·6–0·8)
Myanmar 6·45
(6·08–6·82)
5·44
(5·18–5·67)
2·40
(2·20–2·62)
1·69
(1·42–1·97)
1·22
(0·89–1·57)
869·3
(819·0–919·4)
1328·9
(1263·1–1389·9)
1073·6
(983·0–1169·8)
754·4
(596·8–943·5)
248·2
(96·8–474·8)
1·1
(1·0–1·2)
Philippines 6·75
(6·43–7·05)
4·77
(4·57–4·98)
2·40
(2·21–2·60)
1·84
(1·61–2·11)
1·50
(1·23–1·79)
937·1
(891·5–982·6)
1767·1
(1681·8–1852·7)
2185·7
(2000·9–2368·9)
1967·3
(1575·7–2425·6)
1254·1
(747·7–2010·5)
1·1
(1·0–1·2)
Seychelles 4·00
(3·75–4·27)
3·55
(3·44–3·68)
2·31
(2·10–2·53)
1·86
(1·60–2·14)
1·60
(1·31–1·91)
1·0
(1·0–1·1)
1·7
(1·6–1·8)
1·6
(1·4–1·7)
1·7
(1·4–2·2)
1·6
(1·0–2·4)
1·1
(1·0–1·2)
Sri Lanka 5·19
(4·94–5·46)
3·39
(3·24–3·53)
1·85
(1·64–2·08)
1·50
(1·24–1·81)
1·30
(0·99–1·66)
306·2
(290·5–323·7)
421·2
(402·2–441·1)
298·6
(265·2–335·8)
179·5
(124·6–245·5)
45·9
(5·8–121·4)
0·9
(0·8–1·0)
Thailand 6·89
(6·58–7·19)
3·15
(3·02–3·27)
1·32
(1·20–1·46)
1·13
(0·96–1·31)
1·04
(0·86–1·24)
1003·1
(956·7–1048·8)
1181·9
(1131·0–1233·1)
573·1
(520·0–635·5)
300·0
(225·5–379·9)
87·3
(44·3–144·5)
0·6
(0·6–0·7)
Timor-Leste 7·00
(6·76–7·26)
6·72
(6·54–6·90)
3·85
(3·43–4·29)
2·27
(1·62–2·90)
1·58
(0·85–2·30)
22·5
(21·6–23·4)
28·8
(27·9–29·6)
41·0
(36·7–45·6)
35·7
(22·7–51·3)
17·5
(1·7–48·6)
1·8
(1·6–1·9)
Viet Nam 6·72
(6·40–7·04)
4·40
(4·25–4·55)
2·06
(1·88–2·28)
1·63
(1·38–1·93)
1·38
(1·10–1·70)
1293·3
(1232·9–1353·8)
1819·8
(1761·6–1875·2)
1546·1
(1416·2–1708·8)
1175·5
(928·2–1496·6)
595·3
(314·7–1084·8)
1·0
(0·9–1·1)
Sub-Saharan Africa 6·94
(6·62–7·25)
6·78
(6·60–6·94)
4·29
(4·03–4·58)
2·72
(2·32–3·15)
1·82
(1·35–2·32)
8850·5
(8455·5–9233·0)
17 852·0
(17 412·0–18 264·8)
37 713·3
(35 513·3–40 151·9)
46 344·7
(37 509·8–55 394·7)
39 828·0
(19 422·1–69 747·3)
1·9
(1·8–2·0)
Central sub-Saharan
Africa
7·19
(6·93–7·42)
7·07
(6·84–7·28)
4·44
(4·15–4·72)
2·52
(2·05–2·94)
1·86
(1·37–2·31)
1010·4
(975·5–1042·7)
2065·0
(1997·0–2125·8)
4459·3
(4183·3–4730·0)
5233·7
(3753·5–6919·5)
4873·6
(2153·5–8575·8)
2·0
(1·9–2·1)
Angola 6·94
(6·61–7·26)
7·29
(7·06–7·52)
5·02
(4·66–5·38)
2·76
(2·21–3·35)
1·97
(1·37–2·62)
241·6
(230·2–252·6)
374·6
(361·9–386·9)
1202·7
(1115·3–1294·1)
1594·1
(1152·6–2079·7)
1735·5
(690·4–3385·4)
2·2
(2·1–2·4)
Central African
Republic
5·79
(5·46–6·12)
6·47
(6·18–6·74)
4·36
(4·00–4·74)
2·36
(1·86–2·88)
1·35
(0·77–2·03)
59·7
(56·4–62·7)
110·6
(105·9–115·3)
191·1
(176·5–205·8)
142·5
(93·6–203·7)
29·6
(0·0–98·2)
1·8
(1·7–1·9)
Congo (Brazzaville) 6·65
(6·25–7·03)
6·16
(5·88–6·42)
2·95
(2·69–3·23)
1·90
(1·54–2·32)
1·49
(1·11–1·93)
40·8
(38·4–43·1)
76·4
(73·1–79·5)
128·6
(117·3–141·1)
118·9
(86·6–159·7)
78·2
(34·3–146·1)
1·3
(1·2–1·5)
Democratic
Republic of the
Congo
7·56
(7·27–7·83)
7·16
(6·90–7·40)
4·40
(4·02–4·77)
2·46
(1·82–3·03)
1·76
(1·09–2·38)
639·8
(615·5–662·2)
1459·4
(1404·9–1507·8)
2856·0
(2620·9–3089·5)
3277·7
(1995·4–4613·9)
2910·6
(858·8–5975·8)
2·0
(1·8–2·1)
Equatorial Guinea 7·18
(6·84–7·50)
6·83
(6·50–7·15)
3·09
(2·69–3·57)
2·19
(1·70–2·75)
1·83
(1·29–2·43)
9·6
(9·1–10·0)
14·4
(13·7–15·0)
37·4
(32·6–42·9)
55·9
(39·6–75·8)
82·7
(37·9–154·9)
1·4
(1·2–1·5)
Gabon 6·51
(6·10–6·91)
5·74
(5·37–6·10)
2·84
(2·46–3·30)
1·93
(1·41–2·52)
1·56
(1·02–2·19)
18·9
(17·7–20·0)
29·6
(27·7–31·4)
43·5
(37·7–50·3)
44·7
(29·8–63·8)
36·9
(12·5–80·6)
1·3
(1·1–1·5)
Eastern sub-Saharan
Africa
7·15
(6·86–7·45)
7·02
(6·84–7·17)
4·09
(3·80–4·39)
2·50
(2·04–2·96)
1·68
(1·17–2·22)
3378·3
(3239·4–3512·6)
7091·2
(6932·8–7242·3)
13 778·4
(12 785·2–14 858·1)
15 968·4
(12 317·1–19 784·1)
12 206·9
(4940·5–23 355·8)
1·8
(1·7–1·9)
Burundi 7·14
(6·84–7·43)
6·86
(6·72–6·99)
4·93
(4·55–5·35)
2·74
(2·16–3·31)
1·55
(0·83–2·25)
124·8
(119·4–130·0)
213·9
(209·1–218·4)
468·8
(431·5–510·0)
552·4
(389·3–723·9)
381·8
(97·3–874·8)
2·2
(2·1–2·3)
Comoros 5·53
(5·12–5·90)
7·20
(6·95–7·44)
2·93
(2·55–3·35)
1·73
(1·17–2·33)
1·23
(0·60–1·92)
6·5
(6·0–6·9)
17·2
(16·6–17·7)
17·3
(15·1–19·8)
11·5
(6·5–17·6)
3·5
(0·0–11·1)
1·3
(1·2–1·5)
Djibouti 5·75
(5·35–6·19)
5·18
(4·92–5·44)
2·52
(2·22–2·85)
1·41
(0·92–1·88)
0·95
(0·38–1·51)
2·4
(2·3–2·6)
9·5
(9·0–10·0)
25·2
(22·2–28·4)
22·5
(13·9–31·8)
12·8
(2·9–28·1)
1·1
(1·0–1·3)
Eritrea 6·88
(6·52–7·22)
6·64
(6·35–6·90)
3·85
(3·41–4·34)
2·20
(1·52–2·86)
1·28
(0·49–2·09)
54·3
(51·4–57·2)
118·9
(113·7–123·7)
195·7
(173·8–220·4)
163·7
(88·6–262·8)
66·9
(2·5–221·8)
1·7
(1·5–1·9)
(Table 1 continues on next page)

Articles
16
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
where
Model
is our
IHME
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Ethiopia 6·73
(6·35–7·08)
6·93
(6·67–7·17)
4·10
(3·79–4·43)
2·40
(1·86–2·89)
1·29
(0·64–1·87)
868·1
(819·0–914·9)
1786·6
(1715·1–1853·9)
3498·1
(3239·1–3788·0)
3957·1
(2829·4–5150·9)
2375·2
(637·3–4829·0)
1·8
(1·7–2·0)
Kenya 7·64
(7·41–7·86)
7·03
(6·84–7·21)
2·75
(2·43–3·13)
1·84
(1·39–2·35)
1·45
(0·96–2·01)
310·2
(302·7–317·4)
811·8
(792·2–830·5)
1186·7
(1053·2–1340·0)
1050·1
(715·7–1486·9)
551·7
(134·8–1299·0)
1·3
(1·1–1·4)
Madagascar 7·44
(7·12–7·73)
6·72
(6·54–6·89)
3·77
(3·48–4·07)
2·33
(1·91–2·78)
1·70
(1·23–2·22)
230·8
(221·6–239·4)
427·6
(416·9–438·2)
877·1
(815·6–945·5)
958·9
(730·1–1221·2)
735·6
(307·9–1382·5)
1·7
(1·6–1·8)
Malawi 6·17
(5·76–6·57)
7·62
(7·42–7·80)
3·46
(3·07–3·87)
2·03
(1·46–2·57)
1·55
(0·94–2·14)
130·2
(121·2–138·9)
348·4
(339·0–356·9)
574·2
(511·5–639·8)
570·3
(363·3–776·9)
417·2
(95·9–891·8)
1·5
(1·4–1·7)
Mozambique 6·95
(6·69–7·19)
6·67
(6·49–6·85)
4·50
(4·15–4·88)
2·44
(1·91–2·93)
1·55
(0·95–2·14)
337·7
(324·7–348·9)
596·5
(581·4–612·7)
1104·9
(1015·0–1202·2)
1221·8
(875·5–1614·2)
790·1
(242·4–1762·7)
1·9
(1·8–2·1)
Rwanda 7·39
(7·15–7·61)
7·45
(7·35–7·55)
3·55
(3·28–3·84)
1·97
(1·54–2·42)
1·24
(0·76–1·77)
137·3
(132·6–141·8)
267·5
(263·5–271·5)
373·6
(345·4–404·5)
405·7
(303·0–518·7)
298·1
(121·9–552·8)
1·6
(1·5–1·7)
Somalia 7·77
(7·51–8·01)
7·68
(7·50–7·84)
6·54
(6·27–6·81)
4·30
(3·92–4·68)
2·45
(1·92–3·00)
109·7
(105·8–113·3)
334·0
(326·2–341·2)
960·1
(919·1–1004·4)
1464·1
(1008·1–2005·2)
1425·7
(492·7–2833·8)
2·7
(2·6–2·8)
South Sudan 6·13
(5·69–6·56)
6·12
(5·79–6·45)
5·45
(5·04–5·87)
4·09
(3·59–4·64)
1·98
(1·22–2·75)
111·3
(103·6–118·7)
208·7
(196·9–219·7)
384·1
(353·8–414·9)
690·1
(519·9–872·8)
791·2
(304·1–1536·2)
2·2
(2·1–2·3)
Tanzania 7·60
(7·30–7·86)
6·94
(6·71–7·14)
4·04
(3·74–4·37)
2·42
(2·02–2·86)
1·70
(1·23–2·20)
481·7
(463·9–498·1)
943·5
(913·1–972·0)
1902·1
(1762·2–2057·9)
2091·0
(1582·8–2666·8)
1577·3
(661·3–2941·2)
1·8
(1·7–1·9)
Uganda 7·86
(7·60–8·09)
7·53
(7·36–7·69)
4·76
(4·47–5·07)
2·72
(2·26–3·19)
1·98
(1·48–2·50)
339·2
(329·0–348·4)
703·0
(688·9–716·8)
1591·6
(1490·7–1704·3)
2049·6
(1533·6–2610·7)
2014·5
(858·0–3620·6)
2·1
(2·0–2·2)
Zambia 7·58
(7·29–7·86)
7·22
(7·01–7·41)
3·84
(3·52–4·21)
2·39
(1·88–2·91)
1·83
(1·28–2·40)
132·3
(127·4–136·7)
300·2
(292·5–307·8)
606·9
(552·7–668·9)
747·0
(534·7–1007·7)
755·7
(306·5–1475·5)
1·7
(1·6–1·9)
Southern sub-
Saharan Africa
6·20
(5·77–6·63)
4·86
(4·69–5·05)
2·42
(2·25–2·61)
1·94
(1·67–2·21)
1·63
(1·29–1·99)
792·2
(739·1–844·6)
1517·8
(1465·6–1572·3)
1636·8
(1518·7–1764·9)
1416·1
(1138·4–1739·9)
876·3
(453·7–1528·0)
1·1
(1·0–1·2)
Botswana 7·01
(6·65–7·35)
6·06
(5·78–6·33)
2·31
(2·05–2·61)
1·70
(1·31–2·12)
1·38
(0·94–1·84)
19·4
(18·4–20·4)
40·8
(38·8–42·7)
48·7
(43·1–55·2)
37·7
(26·2–50·8)
21·1
(7·3–43·8)
1·0
(0·9–1·2)
Eswatini 7·19
(6·84–7·52)
6·17
(5·96–6·38)
2·89
(2·65–3·15)
1·98
(1·62–2·36)
1·53
(1·13–1·95)
12·5
(12·0–13·1)
27·7
(26·8–28·5)
29·4
(27·0–32·1)
21·3
(15·1–28·1)
6·7
(0·7–16·1)
1·3
(1·2–1·3)
Lesotho 6·54
(6·14–6·93)
5·66
(5·46–5·84)
2·61
(2·31–2·93)
1·88
(1·50–2·34)
1·47
(1·03–1·98)
29·9
(28·1–31·7)
55·8
(54·2–57·4)
42·5
(37·8–48·1)
34·6
(23·5–48·4)
16·1
(4·1–39·0)
1·1
(1·0–1·2)
Namibia 7·16
(6·81–7·49)
5·63
(5·42–5·84)
2·80
(2·58–3·08)
2·03
(1·70–2·40)
1·62
(1·24–2·03)
22·1
(21·0–23·1)
40·6
(39·2–41·9)
58·0
(53·3–63·7)
54·7
(40·5–71·4)
39·4
(18·8–69·9)
1·3
(1·2–1·4)
South Africa 5·91
(5·46–6·37)
4·35
(4·16–4·56)
2·07
(1·92–2·23)
1·69
(1·46–1·89)
1·45
(1·20–1·67)
572·2
(529·6–614·5)
1007·6
(963·8–1054·9)
988·1
(913·4–1065·5)
785·7
(619·2–968·1)
470·7
(286·1–706·9)
0·9
(0·9–1·0)
Zimbabwe 7·24
(6·90–7·56)
6·63
(6·50–6·75)
3·60
(3·34–3·89)
2·56
(2·12–3·01)
2·01
(1·52–2·51)
136·0
(129·9–141·8)
345·3
(339·1–351·1)
470·0
(437·0–506·3)
482·1
(360·8–626·6)
322·3
(97·3–699·7)
1·6
(1·5–1·7)
Western sub-
Saharan Africa
6·87
(6·54–7·17)
7·03
(6·83–7·22)
4·79
(4·51–5·09)
3·03
(2·60–3·48)
1·89
(1·39–2·44)
3669·7
(3499·6–3827·7)
7177·9
(6992·5–7355·4)
17 838·8
(16 834·6–18 900·8)
23 726·4
(19 422·7–28 301·3)
21 871·2
(10 771·0–37 177·5)
2·1
(2·0–2·2)
Benin 6·52
(6·12–6·92)
7·00
(6·79–7·19)
5·17
(4·86–5·50)
3·12
(2·65–3·60)
1·58
(0·95–2·18)
92·8
(87·0–98·3)
171·2
(166·5–175·6)
522·3
(488·8–559·3)
724·6
(552·9–910·7)
568·0
(197·5–1084·8)
2·3
(2·2–2·4)
Burkina Faso 6·30
(5·93–6·65)
7·32
(7·17–7·46)
5·52
(5·18–5·86)
3·76
(3·23–4·28)
1·62
(0·89–2·26)
187·8
(178·1–197·5)
379·6
(371·6–386·8)
950·8
(893·8–1010·0)
1519·4
(1216·6–1833·9)
1193·7
(384·0–2296·1)
2·4
(2·3–2·5)
(Table 1 continues on next page)

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17
Total fertility rate Livebirths (thousands) Net
reproductive
rate, 2021
1950 1980 2021 2050 2100 1950 1980 2021 2050 2100
(Continued from previous page)
Cabo Verde 5·08
(4·78–5·37)
5·14
(4·99–5·28)
1·78
(1·53–2·04)
1·09
(0·73–1·48)
0·91
(0·51–1·34)
7·0
(6·5–7·4)
10·9
(10·5–11·3)
8·5
(7·4–9·7)
4·3
(2·5–6·6)
1·0
(0·1–2·7)
0·8
(0·7–1·0)
Cameroon 6·40
(5·98–6·80)
6·73
(6·56–6·89)
4·13
(3·76–4·54)
2·44
(1·92–3·03)
1·71
(1·13–2·36)
216·3
(202·6–229·5)
394·4
(385·4–402·9)
1032·5
(940·4–1137·6)
1138·8
(768·0–1579·8)
811·5
(241·3–1828·0)
1·8
(1·7–2·0)
Chad 7·36
(7·03–7·66)
7·60
(7·39–7·80)
6·99
(6·75–7·24)
4·81
(4·45–5·18)
2·15
(1·65–2·71)
127·4
(121·9–132·5)
242·8
(236·2–248·8)
860·2
(829·3–892·5)
1841·1
(1531·6–2177·8)
2491·7
(1487·4–3800·2)
2·9
(2·8–3·0)
Côte d’Ivoire 6·89
(6·52–7·25)
6·95
(6·77–7·11)
4·54
(4·23–4·90)
2·57
(2·11–3·04)
1·44
(0·87–1·99)
127·5
(120·7–133·9)
405·3
(395·4–414·8)
950·1
(879·5–1027·5)
1000·2
(744·1–1262·9)
521·1
(150·7–1089·8)
2·0
(1·9–2·1)
The Gambia 5·90
(5·45–6·35)
6·57
(6·39–6·76)
4·12
(3·89–4·38)
2·21
(1·81–2·61)
1·37
(0·92–1·87)
10·7
(10·0–11·4)
34·0
(33·2–34·9)
77·9
(73·1–83·1)
67·4
(50·8–86·7)
29·8
(9·4–59·0)
1·9
(1·8–1·9)
Ghana 5·37
(4·92–5·84)
6·71
(6·49–6·90)
3·40
(3·01–3·81)
2·12
(1·57–2·71)
1·57
(0·97–2·20)
204·3
(187·1–223·2)
551·2
(532·4–567·7)
966·8
(855·7–1082·9)
922·4
(602·0–1318·0)
636·0
(168·0–1417·0)
1·5
(1·4–1·7)
Guinea 7·05
(6·76–7·34)
6·81
(6·59–7·01)
4·67
(4·33–5·00)
3·02
(2·58–3·43)
1·42
(0·81–2·00)
127·4
(122·3–132·2)
245·1
(238·0–251·7)
495·4
(462·6–528·8)
633·0
(506·6–787·0)
366·2
(114·2–728·3)
2·0
(1·9–2·1)
Guinea-Bissau 7·11
(6·82–7·38)
6·13
(5·86–6·41)
4·42
(4·08–4·78)
2·41
(1·88–2·91)
1·26
(0·63–1·86)
31·2
(29·9–32·4)
37·4
(35·6–39·0)
72·0
(66·1–78·3)
75·6
(52·9–99·7)
35·5
(8·0–81·5)
1·9
(1·8–2·1)
Liberia 6·78
(6·40–7·15)
6·93
(6·74–7·12)
3·81
(3·39–4·26)
2·10
(1·52–2·71)
1·47
(0·85–2·14)
44·2
(41·8–46·6)
100·9
(98·2–103·2)
163·5
(145·6–183·0)
157·0
(100·9–229·0)
101·5
(22·7–247·4)
1·7
(1·5–1·8)
Mali 7·33
(7·00–7·64)
7·51
(7·29–7·71)
6·15
(5·85–6·46)
4·21
(3·83–4·63)
1·85
(1·30–2·42)
182·8
(174·7–190·4)
389·4
(379·0–398·7)
1064·4
(1007·3–1123·0)
1863·5
(1522·4–2237·3)
1675·3
(779·9–2834·3)
2·6
(2·5–2·7)
Mauritania 6·68
(6·29–7·06)
6·70
(6·53–6·88)
4·22
(3·86–4·64)
2·50
(1·98–3·08)
1·66
(1·04–2·34)
33·5
(31·5–35·4)
71·1
(69·1–72·9)
135·3
(122·6–149·5)
153·2
(109·3–206·1)
113·3
(32·7–258·4)
1·9
(1·8–2·1)
Niger 7·64
(7·36–7·89)
7·98
(7·82–8·12)
6·97
(6·71–7·24)
5·15
(4·68–5·64)
2·24
(1·48–2·92)
144·4
(139·4–149·1)
349·4
(342·8–355·8)
1174·8
(1126·7–1224·8)
2766·0
(2211·9–3290·7)
3891·3
(1737·1–6484·1)
3·0
(2·9–3·1)
Nigeria 7·08
(6·72–7·42)
6·99
(6·71–7·24)
4·75
(4·35–5·14)
2·69
(2·06–3·31)
1·87
(1·19–2·54)
1826·3
(1735·3–1911·0)
3200·3
(3085·6–3310·7)
8333·3
(7671·1–8973·3)
9845·1
(6861·8–13037·8)
8949·4
(2670·4–18113·0)
2·0
(1·9–2·2)
São Tomé and
Príncipe
6·22
(6·01–6·42)
6·24
(6·03–6·44)
2·84
(2·51–3·19)
1·77
(1·29–2·28)
1·37
(0·83–1·94)
2·4
(2·3–2·5)
3·7
(3·6–3·9)
4·9
(4·3–5·6)
3·1
(1·9–4·6)
0·3
(0·0–1·9)
1·3
(1·2–1·5)
Senegal 7·17
(6·82–7·49)
7·39
(7·27–7·51)
4·02
(3·72–4·34)
2·32
(1·79–2·79)
1·25
(0·60–1·83)
135·9
(129·3–142·0)
303·8
(298·8–308·7)
479·3
(441·8–520·9)
489·6
(354·1–621·1)
233·5
(50·6–499·9)
1·8
(1·7–2·0)
Sierra Leone 6·60
(6·19–7·00)
6·55
(6·27–6·81)
4·20
(3·86–4·56)
2·43
(1·99–2·85)
1·31
(0·78–1·82)
91·7
(86·2–97·0)
159·2
(152·9–164·8)
302·8
(278·5–327·5)
303·3
(228·2–373·7)
144·7
(42·3–292·0)
1·8
(1·7–1·9)
Togo 7·46
(7·16–7·74)
6·93
(6·76–7·08)
3·72
(3·44–4·02)
2·01
(1·61–2·42)
1·24
(0·79–1·72)
75·8
(72·8–78·7)
127·9
(124·9–130·7)
243·6
(225·8–263·1)
218·3
(157·3–281·1)
107·1
(35·6–216·8)
1·7
(1·6–1·8)
Numbers in parentheses are 95% uncertainty intervals. Super-regions, regions, and countries are listed in alphabetical order.
Table 1: Total fertility rate and number of livebirths (thousands) by location in 1950, 1980, and 2021, and for the reference scenario in 2050 and 2100; and net reproductive rate in 2021

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18
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model, and Baseline Model is a simplistic model in
which ASFR of the most recent past year is held
constant in the future.34 Out-of-sample predicted values
for our forecasts were based on the GBD fertility model
fit using a dataset in which data sources from
2007 to 2021 were excluded, and these were compared
to our final GBD 2021 estimates to compute root mean
square error (RMSE) values. This skill metric was
calculated across locations and reported for each 5-year
age group. A positive skill metric indicates that a model
being evaluated performs better than the baseline
model, whereas a negative skill metric suggests the
opposite.
GBD research and reporting practices
Point estimates were computed using the mean across
1000 draws from the estimated distribution of the given
metric for past and present fertility estimates and
500 draws for future forecasts (see appendix 1
section 2 and 3.5, respectively, for details), and 95% UIs
were obtained by taking the 2·5 and 97·5 percentile
values from the draws. UIs were computed for forecast
alternative scenarios but are only reported in the text and
Figure 1: TFR, globally and by GBD super-region, 1950–2100
The dashed horizontal line indicates replacement TFR (2·1), and the dashed vertical line indicates the year 2022
(the first forecast year). GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. TFR=total fertility rate.
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100
0
1
2
3
4
5
6
7
TFR
Year
Global
Central Europe, eastern Europe, and central Asia
High income
Latin America and Caribbean
North Africa and Middle East
South Asia
Southeast Asia, east Asia, and Oceania
Sub-Saharan Africa
(Figure 2 continues on next page)
0 1·0 2·0 4·0 5·0 6·0 8·07·06·5 7·5 8·55·54·53·02·5 3·51·50·5 9·0
0
7·5
6·5
5·5
4·5
3·5
2·5
1·5
0·5
7·0
6·0
5·0
4·0
3·0
2·0
1·0
TFR in 2021
TFR in 1950
Dominican
Republic
Uganda
Jordan
Chad Niger
Nigeria
Guinea
Mali
Somalia
Afghanistan
Angola
Burundi
Côte d'Ivoire
Mozambique
Guinea-Bissau Samoa
Tanzania
DR Congo
Zambia
Madagascar
Togo
Eritrea
Solomon Isl
Yemen
Senegal
Palestine
Pakistan
Kenya
Zimbabwe
Equatorial Guinea
Rwanda
Vanuatu
Eswatini
Namibia
Marshall Isl
Bolivia
Oman
Honduras
Botswana Peru Morocco Syria
Indonesia
India
Bangladesh
Malaysia Lebanon Libya
Saudi Arabia Thailand
Taiwan (province of China)
China
Puerto Rico South Korea
USA
TLS
FSM
Qatar
United Arab Emirates
A
Central Europe, eastern Europe, and central Asia
High income
Latin America and Caribbean
North Africa and Middle East
South Asia
Southeast Asia, east Asia, and Oceania
Sub-Saharan Africa
GBD super-region
Annual rate of change (%)
0 to <0·8
0·8 to <1·6
1·6 to <2·4
2·4 to <3·2
3·2 to <4·0
≥4·0
Burkina Faso

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19
tables. For readability, figures only include UIs for the
past and for the future reference scenario. GBD 2021
complies with the GATHER statement (appendix 1
table S2).35
Analyses were completed with Python version 3.10.12,
Stata 15, and R version 3.5.1. Statistical code used for
GBD estimation is publicly available online.
Role of the funding source
The funder of this study had no role in study design, data
collection, data analysis, data interpretation, or writing of
the report.
Results
Fertility estimates 1950–2021
There were 129 million (95% UI 121–138) livebirths
globally in 2021 (table 1). This is an increase from
92·7 million (88·7–96·6) livebirths in 1950, but a decline
from the peak of 142 million (137–147) in 2016 (appendix 2
table S1). The global TFR was 2·23 (95% UI 2·09–2·38)
in 2021, a decrease from 4·84 (4·63–5·06) in 1950 and
3·61 (3·53–3·69) in 1980 (table 1, figure 1). This
approximate halving constitutes an annualised rate of
decline in TFR of 1·1% (1·0–1·2). Across GBD super-
regions, the distribution of livebirths changed
substantially over the previous seven decades, as did
relative levels of TFR. More than one-third of global
livebirths in 1950 occurred in southeast Asia, east Asia,
and Oceania, which was the largest proportion across
super-regions (for livebirth counts, see table 1),
corresponding to a TFR of 5·76 (5·44–6·09). This
proportion decreased to less than 20% of global livebirths
in 2021, with a TFR of 1·55 (1·44–1·66). By contrast,
livebirths in south Asia increased from approximately
20% to 25% of global livebirths between 1950 and 2021,
and contributed the largest proportion from 1981 to 2011.
Figure 2: TFR by country or territory, 1950 vs 2021 (A) and 2021 vs 2100 (B)
Each circle represents the TFR for a country or territory in 1950 and 2021 (A) or in 2021 and 2100 (B). The size of the circle indicates the absolute annual rate of
change in TFR between the two years. Circles above the diagonal line show countries or territories that have seen an increase in TFR over the study period, whereas
those below the diagonal had a decline in TFR over the study period. The horizontal and vertical dashed lines indicate replacement TFR (2·1). Country name labels are
provided for locations that have the largest TFR values, those with large TFR values and annualised rates of change, and the five most populous countries with a low
TFR value. FSM= Federated States of Micronesia. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. Isl=Islands. TLS=Timor-Leste. TFR=total fertility
rate.
0 1·0 2·0 4·0 5·0 6·0 8·07·06·5 7·5 8·55·54·53·02·5 3·51·50·5 9·0
0
4·5
3·5
2·5
1·5
0·5
5·0
4·0
3·0
2·0
1·0
TFR in 2100
TFR in 2021
B
Central Europe, eastern Europe, and central Asia
High income
Latin America and Caribbean
North Africa and Middle East
South Asia
Southeast Asia, east Asia, and Oceania
Sub-Saharan Africa
GBD super-region
Somalia
Niger
Chad
Samoa
Tonga
Israel Egypt
Tajikistan
Pakistan
Zimbabwe
USA
Indonesia
India
Saudi Arabia
The Bahamas
Kuwait
Andorra
South Korea
China
7·5
6·5
5·5
7·0
6·0
Annual rate of change (%)
0 to <0·8
0·8 to <1·6
1·6 to <2·4
2·4 to <3·2
3·2 to <4·0
≥4·0
Burkina Faso
For the GBD 2021 statistical
code see http://ghdx.healthdata.
org/gbd-2021/code

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TFR in this super-region decreased from 6·35 (5·95–6·75)
in 1950 to 2·07 (1·89–2·28) in 2021. After 2011,
sub-Saharan Africa contributed the largest share of
livebirths, up to approximately 30% by 2021 (up from
8% in 1950). Large numbers of livebirths in
sub-Saharan Africa in 2021 resulted from a much less
steep decrease in TFR over the study period compared
with other super-regions, falling from 6·94 (6·62–7·25)
in 1950 to 4·29 (4·03–4·58) in 2021. Livebirths and TFRs
over time for all locations are presented in table 1.
At the national level, estimates of TFR in 2021 ranged
from 0·82 (95% UI 0·75–0·89) in South Korea to
6·99 (6·75–7·24) in Chad, with below-replacement levels
of fertility (TFR <2·1) in 110 of 204 countries and territories
(table 1, figures 2A, 3). This was an increase from
82 countries and territories below replacement level
in 2000. Since 2000, the steepest declines in TFR were
seen in São Tomé and Príncipe, Puerto Rico, and Kuwait,
all of which had declines of more than 36%. Overall,
fertility has declined steadily at the global level and across
nearly all countries and territories since 1950, with
rebounds in low fertility levels (ie, below-replacement
fertility in the year with lowest TFR followed by higher
fertility in at least one subsequent year) observed in
47 countries and territories (appendix 2 figure S1). The
magnitude of these rebounds was small, with an average
increase of 0·20 from lowest estimated TFR to the TFR
in 2021, and only three countries rebounded above
replacement levels: Georgia, Kazakhstan, and Seychelles.
Cohort-completed fertility is a better indicator of fertility
trends due to controlling for general shifts in the timing of
childbearing. Since the 1940 birth cohort, CCF50 declined
from peak levels in all countries and territories (the
1971 birth cohort is the last one for which we have complete
age-specific fertility estimates up to age 50 years).
Temporal rebounds from below-replacement CCF50 are
less common compared with TFR, with only 15 countries
or territories having a cohort that dropped below
replacement fertility followed by a subsequent cohort with
higher CCF50. These rebounds were also of smaller
magnitude, with an average increase of 0·02 from lowest
estimated CCF50 to the CCF50 in the 1971 birth cohort,
and no rebounds exceeded replacement levels.
Reference scenario fertility forecasts
Our forecasting estimates suggest that fertility rates will
continue to decline worldwide from a global TFR of 2·21
(95% UI 2·06–2·36) in 2022 to 1·83 (1·59–2·08) in 2050
and 1·59 (1·25–1·96) in 2100 (table 1, figure 1). Except for
four locations (South Korea, Andorra, The Bahamas, and
Kuwait), we project that every country and territory will
experience a decrease in TFR between 2021 and 2100
(figure 2B). Across GBD super-regions, forecasts of TFR
in 2050 range from 1·36 (1·09–1·64) in south Asia to
2·72 (2·32–3·15) in sub-Saharan Africa; in 2100, TFRs in
these two super-regions are forecast to be 1·10 (0·80–1·43)
and 1·82 (1·35–2·32), respectively (table 1, figure 1).
Countries projected to have the highest fertility rates
in 2050 are Chad (4·81 [4·45–5·18]) and Niger (5·15
[4·68–5·64]); in 2100, the highest rates are forecast in
Tonga (2·45 [1·93–2·98]) and Samoa (2·57 [1·98–3·14];
table 1). Countries projected to have the lowest fertility
rates in 2050 are South Korea (0·82 [0·73–0·92]) and
Puerto Rico (0·84 [0·76–0·92]), with the lowest rates
in 2100 forecast in Bhutan (0·69 [0·33–1·00]) and
the Maldives (0·77 [0·42–1·11]; table 1). TFRs are projected
to decline between 2021 and 2100 at rates of more than
1% per year in 45 (22·1%) of 204 countries and territories.
Burkina Faso and Guinea-Bissau are forecast to have the
fastest annualised declines at rates of around
1·6% per year (figure 2B).
Global CCF50 is projected to decrease from 3·59
(95% UI 3·52–3·66) for females who were born in 1950
to 1·64 (1·33–1·97) for females born in 2050 who will
have transitioned out of their reproductive years by 2100
(see figure 4, a Lexis diagram heatmap that simultaneously
displays single-year ASFR, TFR, and CCF50 estimates
for comparison). Globally, ASFRs are forecast to decline
from 2022 to 2100, especially between ages 22 years and
32 years (as reflected in the change in pixel colours from
lighter green to darker green moving rightward across
the horizontal axis). This reflects that in some areas—
particularly countries in the high-income GBD super-
region and some in the central Europe, eastern Europe,
and central Asia super-region—maternal age structure
has shifted and will continue to shift dramatically towards
females being older when they have children. Country-
specific heatmaps that provide insight into dierent
fertility patterns for a range of countries are shown in
appendix 2 (figure S3).
103 (50·5%) of the 204 countries and territories
included in the study had already reached TFRs below
replacement level in 2018, and we project that
Figure 3: Number of countries and territories with TFR below replacement level (2·1) and with a negative rate
of natural increase, 1950–2100
The number of countries and territories is out of a total of 204. The rate of natural increase is calculated as the birth
rate minus the death rate; a negative rate indicates more deaths than births in a particular year and location. The
vertical dashed line is at year 2022 (the first forecast year). TFR=total fertility rate.
TFR below replacement level
Negative rate of natural increase
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100
25
0
50
75
100
125
150
175
200
Number of countries
Year

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21
100 (49·0%) countries will have negative rates of natural
increase (ie, the number of deaths will exceed the
number of livebirths) by 2050 (figure 3). The concept of
population momentum is illustrated in figure 3, which is
the tendency of a population to continue to grow beyond
the time it falls below replacement-level fertility.
Population growth is heavily influenced by the age
structure of the population; in locations with relatively
large cohorts of young people (particularly younger than
15 years), the population will continue to grow well
beyond the first year of below-replacement fertility as
these young cohorts move through their reproductive
years.36,37 Our estimates indicate that there is
approximately a 30-year gap between the time when TFR
falls below 2·1 and when the natural rate of population
increase turns negative. We forecast that 155 (76·0%)
countries and territories will have fertility rates below
replacement level in 2050; by 2100, we project this
number will increase to 198 (97·1%), with 178 (87·3%)
having a negative natural rate of increase (figure 3).
We project that the 2021 World Bank low-income and
lower-middle-income groups38 combined will contribute
the majority of the global share of livebirths in 2100,
at 77·4% (95% UI 69·1–83·6; figure 5, appendix 1
table S6, figure S2). Our results indicate that the
proportion of global livebirths in the World Bank low-
income group will increase from 17·8% (17·3–18·2)
in 2021 to 26·5% (24·4–28·5) in 2050 and
34·6% (26·4–40·5) in 2100. In 1992, the number of births
in the low-income group (14·9 million [14·6–15·3])
surpassed the number of births in the high-income
group (14·0 million [13·8–14·2]; appendix 2 figure S4).
We forecast that the number of births in the low-income
group will exceed the number in the upper-middle-
income group in 2026. In 1972, the number of births in
the lower-middle-income group exceeded the number of
births in the upper-middle-income group. We project
that the lower-middle-income group will have the highest
number of births among the four income groups during
the 2022–2100 period even though it will decrease from
52·7% (51·7–53·7) of births in 2021 to 48·1% (45·2–50·5)
in 2050 and 42·7% (37·5–48·7) in 2100 (figure 5). We
forecast that the number of births in the lower-middle-
income group will reach 53·9 million (43·3–67·1)
by 2050 and 31·2 million (16·2–53·8) by 2100 (appendix 2
figure S4). By contrast, the share of livebirths contributed
by the upper-middle-income group will decrease from
20·4% (19·8–21·2) in 2021 to 16·1% (14·7–17·8) in 2050
and 11·6% (8·9–15·3) in 2100 (figure 5). The proportion
of the world’s livebirths in the high-income group will
remain relatively stable at 9·3% (8·3–10·6) in 2050 and
11·1% (7·2–16·2) in 2100 (figure 5). We also computed
the global proportion of livebirths projected by GBD
super-region (appendix 1 table S5), showing that the
share of livebirths in sub-Saharan Africa is
forecast to increase from 29·2% (28·7–29·6) in 2021 to
Figure 4: Lexis diagram of CCF50, single-year age interval ASFR, and TFR by age of mother, globally, 1950–2100
These Lexis diagram heatmaps simultaneously display single-year ASFR (colour fill), TFR (numbers at the top), and CCF50 estimates (white numbers at the bottom).
The horizontal axis of the Lexis diagrams extends from 1950 (the beginning year of data availability) to 2100 (the final year of our forecasts), and the vertical axis
indicates age of mother. CCF50 estimates are shown for each 10-year birth cohort. CCF50 is the sum of ASFR cells on the diagonal (ie, representing birth cohort),
whereas TFR is the sum of ASFR cells vertically (ie, ASFR values from the same calendar year by age of mother). CCF50 is a cohort measure and years labelled on the
x-axis are in period space. CCF50 values correspond to those entering their reproductive age (15–49 years) at that year (in other words, the birth cohort 15 years
earlier). For example, the CCF50 value shown in 1950 represents CCF50 for those born in 1935. The vertical white lines indicate each decade, and the diagonal black
dashed lines assist with visualising cohort space. ASFR=age-specific fertility rate. CCF50=completed cohort fertility at age 50 years. TFR=total fertility rate.
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100
Age of mother (years)
Year
<0·025
0·025 to <0·05
0·05 to <0·1
0·1 to <0·15
0·15 to <0·20
0·20 to <0·25
0·25 to <0·30
0·30 to <0·35
0·35 to <0·40
0·40 to <0·45
≥0·45
ASFR
TFR
4·59
4·84 4·80 4·45 3·61 3·03 2·64 2·48 2·26 2·09 1·95 1·83 1·74 1·68 1·63 1·61
4·11 3·30 2·92 2·71 2·53 2·32 2·07 1·90 1·81 1·72 1·65 CCF50
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49

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22
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41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5)
in 2100. The two super-regions of south Asia and
southeast Asia, east Asia, and Oceania—which were the
primary sources of livebirths in the 1950s and 1980s—are
projected to contribute only 7·1% (4·4–10·1) and
9·6% (7·9–12·0) of livebirths, respectively, in 2100.
Considerable heterogeneity in livebirth counts exists at
the regional and country level within each super-region.
For example, the increase in livebirth counts between
2021 and 2100 is most notable in western and eastern
sub-Saharan Africa, especially countries in the Sahel
along with Somalia and South Sudan (table 1).
Alternative scenario fertility forecasts
We developed four alternative scenarios based on
independent drivers that are included in our model:
educational attainment, contraceptive met need,
implementation of pro-natal policies, and a combination
of these three drivers (appendix 1 section 3.4). The first
scenario, which assumes meeting the SDG education
target by 2030, is estimated to result in global TFRs of 1·65
(95% UI 1·40–1·92) in 2050 and 1·56 (1·26–1·92) in 2100
(table 2). The second scenario, which assumes meeting
the SDG contraceptive met need target by 2030, will
produce global TFRs of 1·64 (1·39–1·89) in 2050 and
1·52 (1·21–1·87) in 2100. The third scenario, which
incorporates pro-natal policy implementation, is forecast
to yield global TFRs of 1·93 (1·69–2·19) in 2050 and
1·68 (1·36–2·04) in 2100. The combined scenario, in
which all three other alternative scenarios are applied, is
projected to result in a global TFR of 1·65 (1·40–1·92)
in 2050 and 1·62 (1·35–1·95) in 2100. We also projected
country-level future fertility rates based on the reference
(presented here) and four alternative (presented in
appendix 1 section 3.8) scenarios for the world’s ten most
populous countries in 2021. Among these countries, only
Nigeria and Pakistan will remain above 1·75 (our
threshold for the pro-natal scenario implementation) well
into the future in our reference scenario (beyond 2100 for
Nigeria and 2050 in Pakistan). TFRs in both Brazil and
Indonesia are forecast to decrease below 1·75 in 2036.
Reference TFR values in Bangladesh and India are
projected to decrease below 1·75 by 2026 and 2027,
respectively. Mexico, Russia, the USA, and China already
experienced TFR values below 1·75 in or before 2021 and
are forecast to maintain flat future trends. Detailed results
on the alternative scenarios in the world’s ten most
populous countries are shown in appendix 1 (section 3.8).
Projections in all 204 countries and territories are shown
in appendix 2 (figure S5) and table 2.
Comparison with other models
The WPP 2022 revision projected a global TFR of 2·15
in 2050 and 1·84 in 2100 compared with the global TFRs
forecast by our model of 1·83 (95% UI 1·59–2·08) and
1·59 (1·25–1·96) in the same years (appendix 2 figure S6).
In 2100, WPP’s TFR forecasts converge to a narrower
range of 1·38–2·22 than do our model’s reference
scenario TFR values, which range from 0·69 to 2·57.
Additionally, for countries with low fertility levels, WPP
predicts that fertility rates will rebound to a much larger
extent than in our projections, which suggest they will
remain low or decline (appendix 2 figure S6). We forecast
that global TFR will fall below the replacement level of 2·1
after 2030, in contrast to WPP’s forecast that global TFR
will fall below replacement level in 2056.
Time-series country-level comparisons between ASFR
and TFR predictions from our model and WPP 2022 are
presented in appendix 2 (figures S5, S6). For example,
our model predicts that reference TFR in South Korea
will be low throughout the forecast period (0·82 [95% UI
0·73–0·92] in 2050 and 0·82 [0·71–0·95] in 2100), but
WPP 2022 forecasts an increase in TFR in South Korea
(1·17 in 2050 and 1·43 in 2100; appendix 2 figure S5).
These forecasting dierences are apparent in other
countries and territories, including in Taiwan (province
of China), where we forecast almost no change in TFR
from 2050 to 2100 (0·90 [0·78–1·04] and 0·90 [0·77–1·05],
respectively), compared with the WPP projection of a
rebound in TFR to 1·41 in 2050 and 1·53 in 2100. We
forecast that TFR will be lower in 200 of 204 countries
and territories in 2100, including those that already have
very low fertility rates, and projected a much steeper
decline in TFR in many African countries than did WPP.
For example, our model projected that TFR in Sudan will
fall below replacement in approximately 2045, whereas
the WPP model forecast that this will happen after 2095.
Overall, the WPP model predicted that 142 (69·6%) of
204 countries and territories will have fertility rates below
replacement level in 2050, whereas our model forecast
19601950 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100
0
100
80
60
40
20
Share of livebirths (%)
Year
Low income Lower-middle income Upper-middle income High income
Figure 5: Share of livebirths by 2021 World Bank income group
The World Bank income group is explicitly chosen to highlight the share of births according to resources per
person. Resources are defined as gross national income (gross domestic product plus net income) per person.

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
23
Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
Global 1·83
(1·59–2·08)
1·59
(1·25–1·96)
1·65
(1·40–1·92)
1·56 (1·26–1·92) 1·64
(1·39–1·89)
1·52
(1·21–1·87)
1·93
(1·69–2·19)
1·68
(1·36–2·04)
1·65
(1·40–1·92)
1·62
(1·35–1·95)
Central Europe, eastern Europe,
and central Asia
1·68
(1·56–1·81)
1·57
(1·42–1·73)
1·65
(1·52–1·78)
1·56
(1·41–1·72)
1·52
(1·39–1·66)
1·51
(1·36–1·65)
1·80
(1·68–1·93)
1·64
(1·49–1·79)
1·62
(1·49–1·75)
1·57
(1·42–1·71)
Central Asia 2·31
(2·16–2·47)
1·95
(1·76–2·13)
2·27
(2·11–2·43)
1·93
(1·75–2·11)
2·11
(1·95–2·26)
1·88
(1·70–2·07)
2·33
(2·18–2·48)
1·95
(1·77–2·14)
2·09
(1·94–2·25)
1·89
(1·70–2·08)
Armenia 1·45
(1·27–1·65)
1·24
(1·01–1·49)
1·41
(1·23–1·62)
1·21 (0·98–1·46) 1·18
(0·94–1·42)
1·11
(0·87–1·37)
1·65
(1·47–1·85)
1·44
(1·21–1·69)
1·35
(1·12–1·60)
1·29
(1·05–1·55)
Azerbaijan 1·51
(1·27–1·76)
1·29
(1·01–1·59)
1·48
(1·24–1·74)
1·28 (1·00–1·57) 1·15
(0·84–1·44)
1·04
(0·73–1·35)
1·71
(1·47–1·96)
1·49
(1·21–1·79)
1·34
(1·03–1·64)
1·23
(0·92–1·54)
Georgia 1·80
(1·65–1·96)
1·52
(1·34–1·71)
1·71
(1·57–1·88)
1·49 (1·31–1·68) 1·53
(1·34–1·72)
1·39
(1·20–1·60)
1·80
(1·65–1·96)
1·72
(1·54–1·91)
1·67
(1·49–1·87)
1·57
(1·38–1·78)
Kazakhstan 2·43
(2·21–2·65)
1·94
(1·69–2·19)
2·38
(2·16–2·60)
1·92 (1·68–2·16) 2·27
(2·05–2·49)
1·89
(1·64–2·13)
2·43
(2·21–2·65)
1·94
(1·69–2·19)
2·23
(2·01–2·46)
1·87
(1·62–2·11)
Kyrgyzstan 2·35
(2·05–2·70)
1·95
(1·63–2·33)
2·32
(2·01–2·67)
1·94 (1·62–2·31) 2·01
(1·68–2·38)
1·73
(1·40–2·10)
2·35
(2·05–2·70)
1·95
(1·63–2·33)
1·99
(1·65–2·37)
1·92
(1·59–2·29)
Mongolia 2·46
(2·02–2·88)
1·87
(1·35–2·35)
2·36
(1·90–2·80)
1·83 (1·32–2·32) 2·22
(1·79–2·64)
1·77
(1·28–2·24)
2·46
(2·02–2·88)
1·87
(1·35–2·35)
2·15
(1·70–2·58)
1·79
(1·29–2·26)
Tajikistan 2·66
(2·33–2·97)
2·13
(1·75–2·49)
2·59
(2·25–2·91)
2·10 (1·73–2·45) 2·18
(1·83–2·50)
1·84
(1·48–2·18)
2·66
(2·33–2·97)
2·13
(1·75–2·49)
2·13
(1·79–2·46)
1·81
(1·46–2·15)
Turkmenistan 2·25
(1·87–2·66)
1·81
(1·38–2·28)
2·10
(1·68–2·54)
1·74
(1·29–2·22)
2·02
(1·65–2·44)
1·72
(1·30–2·18)
2·25
(1·87–2·66)
1·81
(1·38–2·28)
1·91
(1·51–2·34)
1·86
(1·43–2·32)
Uzbekistan 2·34
(2·08–2·62)
1·97
(1·69–2·27)
2·32
(2·06–2·60)
1·97 (1·69–2·26) 2·27
(2·02–2·54)
1·97
(1·69–2·27)
2·34
(2·08–2·62)
1·97
(1·69–2·27)
2·26
(2·00–2·53)
1·97
(1·70–2·26)
Central Europe 1·34
(1·19–1·50)
1·21
(1·03–1·41)
1·33
(1·17–1·49)
1·21
(1·03–1·41)
1·18
(1·01–1·35)
1·15
(0·97–1·35)
1·54
(1·39–1·70)
1·41
(1·23–1·61)
1·37
(1·20–1·55)
1·34
(1·16–1·55)
Albania 1·34
(1·10–1·61)
1·17
(0·86–1·50)
1·29
(1·04–1·57)
1·15 (0·83–1·48) 0·86
(0·52–1·20)
0·80
(0·44–1·15)
1·54
(1·30–1·81)
1·37
(1·06–1·70)
1·04
(0·69–1·38)
0·99
(0·63–1·35)
Bosnia and Herzegovina 1·16
(0·99–1·35)
0·95
(0·71–1·19)
1·15
(0·98–1·35)
0·96 (0·73–1·20) 0·85
(0·61–1·08)
0·80
(0·55–1·05)
1·36
(1·19–1·55)
1·15
(0·91–1·39)
1·05
(0·80–1·28)
1·01
(0·75–1·25)
Bulgaria 1·43
(1·29–1·59)
1·26
(1·08–1·45)
1·40
(1·25–1·56)
1·26 (1·08–1·45) 1·25
(1·08–1·42)
1·18
(0·99–1·37)
1·63
(1·49–1·79)
1·46
(1·28–1·65)
1·43
(1·26–1·61)
1·38
(1·20–1·57)
Croatia 1·27
(1·08–1·46)
1·14
(0·92–1·38)
1·26
(1·08–1·46)
1·14 (0·92–1·38) 1·05
(0·83–1·26)
1·01
(0·78–1·25)
1·47
(1·28–1·66)
1·34
(1·12–1·58)
1·25
(1·03–1·46)
1·21
(0·98–1·45)
Czechia 1·54
(1·34–1·76)
1·36
(1·13–1·60)
1·53
(1·33–1·75)
1·35
(1·13–1·60)
1·44
(1·23–1·66)
1·31
(1·09–1·55)
1·74
(1·54–1·96)
1·56
(1·33–1·80)
1·62
(1·41–1·84)
1·50
(1·28–1·74)
Hungary 1·42
(1·22–1·65)
1·29
(1·06–1·55)
1·42
(1·22–1·65)
1·29 (1·06–1·55) 1·34
(1·13–1·57)
1·25
(1·02–1·51)
1·62
(1·42–1·85)
1·49
(1·26–1·75)
1·53
(1·33–1·77)
1·44
(1·22–1·71)
Montenegro 1·56
(1·43–1·70)
1·40
(1·23–1·58)
1·55
(1·42–1·69)
1·40 (1·23–1·58) 1·18
(0·95–1·39)
1·12
(0·89–1·34)
1·76
(1·63–1·90)
1·60
(1·43–1·78)
1·38
(1·15–1·58)
1·32
(1·09–1·53)
North Macedonia 1·10
(1·01–1·20)
0·97
(0·84–1·09)
1·08
(0·98–1·18)
0·97 (0·84–1·09) 0·80
(0·66–0·93)
0·76
(0·62–0·90)
1·30
(1·21–1·40)
1·17
(1·04–1·29)
0·99
(0·85–1·11)
0·96
(0·82–1·10)
Poland 1·21
(1·04–1·40)
1·07
(0·87–1·29)
1·21
(1·04–1·39)
1·07 (0·87–1·29) 1·06
(0·86–1·27)
1·00
(0·79–1·22)
1·41
(1·24–1·60)
1·27
(1·07–1·49)
1·26
(1·06–1·47)
1·20
(0·99–1·42)
Romania 1·48
(1·32–1·66)
1·26
(1·06–1·48)
1·45
(1·28–1·63)
1·26 (1·06–1·47) 1·34
(1·15–1·52)
1·23
(1·03–1·44)
1·68
(1·52–1·86)
1·46
(1·26–1·68)
1·51
(1·32–1·70)
1·43
(1·23–1·64)
Serbia 1·01
(0·90–1·11)
0·96
(0·82–1·09)
1·00
(0·90–1·11)
0·96 (0·82–1·09) 0·81
(0·66–0·94)
0·82
(0·66–0·96)
1·21
(1·10–1·31)
1·16
(1·02–1·29)
1·01
(0·85–1·13)
1·02
(0·86–1·16)
Slovakia 1·46
(1·34–1·59)
1·31
(1·16–1·46)
1·45
(1·32–1·58)
1·30 (1·15–1·46) 1·30
(1·15–1·44)
1·22
(1·06–1·38)
1·66
(1·54–1·79)
1·51
(1·36–1·66)
1·49
(1·34–1·63)
1·41
(1·26–1·57)
Slovenia 1·51
(1·39–1·64)
1·38
(1·24–1·54)
1·50
(1·38–1·64)
1·38 (1·24–1·54) 1·32
(1·16–1·47)
1·25
(1·08–1·42)
1·71
(1·59–1·84)
1·58
(1·44–1·74)
1·51
(1·35–1·67)
1·45
(1·28–1·62)
Eastern Europe 1·28
(1·15–1·42)
1·19
(1·05–1·35)
1·24
(1·12–1·39)
1·18 (1·04–1·34) 1·16
(1·02–1·32)
1·13
(0·99–1·30)
1·48
(1·35–1·62)
1·39
(1·24–1·55)
1·34
(1·20–1·49)
1·32
(1·18–1·49)
Belarus 1·29
(1·06–1·55)
1·19
(0·95–1·47)
1·28
(1·05–1·54)
1·19 (0·94–1·47) 1·14
(0·89–1·41)
1·09
(0·83–1·36)
1·49
(1·26–1·75)
1·39
(1·15–1·67)
1·33
(1·09–1·60)
1·28
(1·03–1·56)
(Table 2 continues on next page)

Articles
24
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Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
(Continued from previous page)
Estonia 1·37
(1·24–1·50)
1·21
(1·06–1·36)
1·30
(1·16–1·44)
1·19 (1·04–1·35) 1·30
(1·17–1·44)
1·18
(1·04–1·33)
1·57
(1·44–1·70)
1·41
(1·26–1·56)
1·44
(1·31–1·58)
1·37
(1·22–1·52)
Latvia 1·35
(1·16–1·56)
1·22
(1·01–1·49)
1·29
(1·10–1·52)
1·22 (1·00–1·48) 1·25
(1·04–1·47)
1·18
(0·96–1·44)
1·55
(1·36–1·76)
1·42
(1·21–1·69)
1·41
(1·20–1·63)
1·37
(1·15–1·64)
Lithuania 1·23
(1·11–1·35)
1·09
(0·96–1·25)
1·21
(1·09–1·33)
1·08 (0·95–1·24) 1·12
(0·99–1·26)
1·05
(0·91–1·20)
1·43
(1·31–1·55)
1·29
(1·16–1·45)
1·30
(1·18–1·44)
1·24
(1·10–1·40)
Moldova 1·09
(0·94–1·25)
1·03
(0·87–1·24)
1·07
(0·92–1·23)
1·03 (0·87–1·23) 0·95
(0·78–1·13)
0·95
(0·77–1·15)
1·29
(1·14–1·45)
1·23
(1·07–1·44)
1·13
(0·96–1·31)
1·15
(0·97–1·35)
Russia 1·33
(1·20–1·47)
1·21
(1·06–1·37)
1·29
(1·16–1·44)
1·20 (1·06–1·36) 1·21
(1·07–1·37)
1·15
(1·01–1·31)
1·53
(1·40–1·67)
1·41
(1·26–1·57)
1·38
(1·24–1·54)
1·34
(1·20–1·50)
Ukraine 1·01
(0·88–1·16)
0·98
(0·83–1·16)
0·99
(0·85–1·14)
0·97 (0·82–1·15) 0·92
(0·77–1·07)
0·93
(0·77–1·11)
1·21
(1·08–1·36)
1·18
(1·03–1·36)
1·10
(0·95–1·25)
1·12
(0·97–1·30)
High income 1·43
(1·30–1·56)
1·37
(1·22–1·53)
1·42
(1·29–1·55)
1·36 (1·22–1·52) 1·38
(1·24–1·52)
1·34
(1·19–1·50)
1·62
(1·50–1·76)
1·56
(1·41–1·72)
1·57
(1·43–1·71)
1·52
(1·38–1·68)
Australasia 1·45
(1·25–1·68)
1·33
(1·08–1·59)
1·46
(1·26–1·67)
1·33 (1·11–1·57) 1·40
(1·18–1·64)
1·31
(1·06–1·58)
1·65
(1·45–1·88)
1·53
(1·28–1·79)
1·60
(1·39–1·84)
1·51
(1·28–1·76)
Australia 1·45
(1·23–1·70)
1·32
(1·06–1·61)
1·46
(1·24–1·69)
1·32 (1·09–1·58) 1·41
(1·16–1·67)
1·31
(1·03–1·59)
1·65
(1·43–1·90)
1·52
(1·26–1·81)
1·61
(1·38–1·86)
1·51
(1·25–1·78)
New Zealand 1·45
(1·33–1·58)
1·35
(1·20–1·51)
1·45
(1·34–1·57)
1·35 (1·22–1·49) 1·39
(1·25–1·54)
1·31
(1·15–1·48)
1·65
(1·53–1·78)
1·55
(1·40–1·71)
1·59
(1·45–1·73)
1·51
(1·37–1·67)
High-income Asia Pacific 1·14
(1·00–1·30)
1·14
(0·96–1·35)
1·12
(0·99–1·28)
1·13 (0·97–1·33) 1·07
(0·91–1·24)
1·08
(0·89–1·30)
1·34
(1·20–1·49)
1·33
(1·15–1·54)
1·25
(1·10–1·42)
1·27
(1·10–1·48)
Brunei 1·40
(1·08–1·78)
1·25
(0·87–1·70)
1·38
(1·08–1·72)
1·26 (0·91–1·65) 1·28
(0·94–1·68)
1·19
(0·81–1·64)
1·60
(1·28–1·98)
1·45
(1·07–1·90)
1·45
(1·13–1·82)
1·39
(1·04–1·80)
Japan 1·26
(1·09–1·45)
1·21
(1·00–1·43)
1·24
(1·07–1·43)
1·20 (1·02–1·41) 1·16
(0·96–1·38)
1·14
(0·92–1·38)
1·46
(1·29–1·65)
1·41
(1·20–1·63)
1·35
(1·15–1·56)
1·33
(1·13–1·56)
Singapore 1·15
(0·93–1·41)
1·12
(0·88–1·41)
1·14
(0·94–1·39)
1·12 (0·90–1·38) 1·14
(0·92–1·39)
1·12
(0·89–1·40)
1·35
(1·13–1·61)
1·32
(1·08–1·61)
1·33
(1·13–1·57)
1·32
(1·11–1·58)
South Korea 0·82
(0·73–0·92)
0·82
(0·71–0·95)
0·82
(0·73–0·91)
0·82 (0·71–0·94) 0·79
(0·67–0·92)
0·82
(0·68–0·95)
1·02
(0·93–1·12)
1·02
(0·91–1·15)
0·99
(0·87–1·11)
1·01
(0·88–1·15)
High-income North America 1·51
(1·38–1·64)
1·43
(1·27–1·60)
1·50
(1·38–1·63)
1·43 (1·28–1·58) 1·44
(1·31–1·58)
1·38
(1·22–1·54)
1·71
(1·58–1·84)
1·63
(1·47–1·80)
1·64
(1·50–1·77)
1·57
(1·42–1·73)
Canada 1·39
(1·21–1·58)
1·32
(1·12–1·54)
1·39
(1·22–1·58)
1·32 (1·13–1·53) 1·36
(1·17–1·56)
1·30
(1·10–1·53)
1·59
(1·41–1·78)
1·52
(1·32–1·74)
1·56
(1·37–1·76)
1·50
(1·30–1·72)
Greenland 1·84
(1·60–2·10)
1·67
(1·36–2·00)
1·74
(1·46–2·02)
1·62 (1·28–1·94) 1·77
(1·52–2·03)
1·62
(1·30–1·94)
1·84
(1·60–2·10)
1·87
(1·56–2·20)
1·88
(1·60–2·16)
1·76
(1·44–2·09)
USA 1·52
(1·40–1·65)
1·45
(1·30–1·60)
1·51
(1·40–1·64)
1·44 (1·30–1·59) 1·46
(1·33–1·59)
1·39
(1·24–1·54)
1·72
(1·60–1·85)
1·65
(1·50–1·80)
1·65
(1·52–1·77)
1·58
(1·44–1·73)
Southern Latin America 1·32
(1·10–1·57)
1·23
(0·97–1·53)
1·30
(1·09–1·54)
1·22 (0·99–1·50) 1·27
(1·04–1·53)
1·22
(0·96–1·52)
1·52
(1·30–1·77)
1·43
(1·17–1·73)
1·45
(1·23–1·71)
1·41
(1·16–1·70)
Argentina 1·33
(1·09–1·60)
1·22
(0·91–1·56)
1·31
(1·07–1·57)
1·21 (0·93–1·51) 1·28
(1·01–1·55)
1·20
(0·89–1·54)
1·53
(1·29–1·80)
1·42
(1·11–1·76)
1·45
(1·20–1·73)
1·39
(1·10–1·71)
Chile 1·29
(1·09–1·51)
1·24
(0·99–1·51)
1·29
(1·10–1·50)
1·24 (1·01–1·50) 1·26
(1·05–1·50)
1·23
(0·98–1·51)
1·49
(1·29–1·71)
1·44
(1·19–1·71)
1·46
(1·25–1·70)
1·43
(1·19–1·70)
Uruguay 1·36
(1·14–1·60)
1·25
(0·97–1·56)
1·27
(1·05–1·52)
1·20 (0·95–1·50) 1·29
(1·05–1·56)
1·22
(0·93–1·55)
1·56
(1·34–1·80)
1·45
(1·17–1·76)
1·42
(1·16–1·69)
1·38
(1·10–1·70)
Western Europe 1·44
(1·32–1·57)
1·37
(1·23–1·52)
1·43
(1·32–1·56)
1·37 (1·24–1·51) 1·42
(1·30–1·55)
1·36
(1·23–1·51)
1·63
(1·52–1·76)
1·55
(1·42–1·70)
1·60
(1·49–1·73)
1·54
(1·42–1·68)
Andorra 1·02
(0·92–1·11)
1·01
(0·89–1·13)
1·01
(0·92–1·11)
1·01 (0·90–1·12) 1·00
(0·91–1·10)
1·00
(0·89–1·12)
1·22
(1·12–1·31)
1·21
(1·09–1·33)
1·20
(1·11–1·30)
1·20
(1·10–1·32)
Austria 1·42
(1·29–1·55)
1·34
(1·18–1·51)
1·41
(1·29–1·55)
1·34 (1·18–1·50) 1·40
(1·27–1·54)
1·34
(1·18–1·51)
1·62
(1·49–1·75)
1·54
(1·38–1·71)
1·60
(1·48–1·73)
1·53
(1·39–1·69)
Belgium 1·43
(1·24–1·63)
1·34
(1·13–1·57)
1·43
(1·25–1·63)
1·34 (1·15–1·56) 1·41
(1·23–1·61)
1·34
(1·13–1·57)
1·63
(1·44–1·83)
1·54
(1·33–1·77)
1·61
(1·43–1·81)
1·54
(1·35–1·76)
Cyprus 1·18
(0·97–1·43)
1·13
(0·89–1·40)
1·18
(0·97–1·41)
1·12 (0·90–1·38) 1·17
(0·96–1·41)
1·12
(0·89–1·38)
1·38
(1·17–1·63)
1·33
(1·09–1·60)
1·36
(1·16–1·60)
1·31
(1·09–1·57)
(Table 2 continues on next page)

Articles
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25
Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
(Continued from previous page)
Denmark 1·57
(1·46–1·69)
1·47
(1·34–1·60)
1·56
(1·45–1·68)
1·47 (1·34–1·59) 1·55
(1·44–1·67)
1·46
(1·33–1·59)
1·77
(1·66–1·89)
1·67
(1·54–1·80)
1·75
(1·63–1·86)
1·66
(1·54–1·79)
Finland 1·36
(1·24–1·49)
1·32
(1·18–1·48)
1·36
(1·25–1·49)
1·32 (1·19–1·47) 1·35
(1·23–1·48)
1·31
(1·18–1·46)
1·56
(1·44–1·69)
1·52
(1·38–1·68)
1·55
(1·43–1·67)
1·51
(1·38–1·66)
France 1·56
(1·35–1·79)
1·43
(1·19–1·69)
1·56
(1·36–1·78)
1·42 (1·20–1·67) 1·54
(1·33–1·77)
1·43
(1·19–1·69)
1·76
(1·55–1·99)
1·63
(1·39–1·89)
1·74
(1·53–1·97)
1·63
(1·40–1·87)
Germany 1·47
(1·35–1·58)
1·40
(1·27–1·53)
1·46
(1·35–1·58)
1·41 (1·28–1·53) 1·45
(1·33–1·57)
1·39
(1·26–1·52)
1·67
(1·55–1·78)
1·60
(1·47–1·73)
1·64
(1·52–1·77)
1·59
(1·47–1·72)
Greece 1·36
(1·17–1·57)
1·28
(1·06–1·54)
1·35
(1·17–1·56)
1·28 (1·07–1·52) 1·34
(1·15–1·55)
1·28
(1·06–1·52)
1·56
(1·37–1·77)
1·48
(1·26–1·74)
1·53
(1·35–1·74)
1·48
(1·27–1·71)
Iceland 1·73
(1·54–1·93)
1·58
(1·36–1·82)
1·73
(1·54–1·92)
1·58 (1·38–1·80) 1·71
(1·52–1·92)
1·59
(1·37–1·82)
1·89
(1·70–2·09)
1·78
(1·56–2·02)
1·91
(1·72–2·11)
1·78
(1·58–2·00)
Ireland 1·54
(1·40–1·70)
1·40
(1·22–1·58)
1·54
(1·40–1·69)
1·40 (1·24–1·57) 1·53
(1·38–1·68)
1·40
(1·23–1·57)
1·74
(1·60–1·90)
1·60
(1·42–1·78)
1·72
(1·58–1·87)
1·59
(1·44–1·76)
Israel 2·38
(2·20–2·59)
2·09
(1·86–2·34)
2·33
(2·15–2·54)
2·08 (1·87–2·31) 2·35
(2·16–2·56)
2·09
(1·87–2·34)
2·38
(2·20–2·59)
2·09
(1·86–2·34)
2·31
(2·12–2·52)
2·08
(1·88–2·31)
Italy 1·18
(1·00–1·37)
1·09
(0·88–1·32)
1·18
(1·00–1·37)
1·09 (0·90–1·32) 1·16
(0·99–1·35)
1·09
(0·89–1·32)
1·38
(1·20–1·57)
1·29
(1·08–1·52)
1·36
(1·19–1·55)
1·29
(1·10–1·51)
Luxembourg 1·30
(1·17–1·44)
1·24
(1·09–1·40)
1·30
(1·17–1·43)
1·24 (1·10–1·39) 1·28
(1·16–1·42)
1·24
(1·09–1·39)
1·50
(1·37–1·64)
1·44
(1·29–1·60)
1·48
(1·36–1·61)
1·44
(1·30–1·59)
Malta 1·39
(1·18–1·64)
1·26
(1·01–1·55)
1·39
(1·19–1·64)
1·26 (1·03–1·54) 1·38
(1·16–1·62)
1·26
(1·02–1·55)
1·59
(1·38–1·84)
1·46
(1·21–1·75)
1·58
(1·37–1·82)
1·46
(1·23–1·74)
Monaco 1·44
(1·16–1·76)
1·37
(1·06–1·73)
1·42
(1·14–1·75)
1·36 (1·06–1·72) 1·43
(1·15–1·75)
1·37
(1·06–1·72)
1·64
(1·36–1·96)
1·57
(1·26–1·93)
1·61
(1·33–1·94)
1·56
(1·27–1·92)
Netherlands 1·54
(1·41–1·67)
1·42
(1·27–1·57)
1·54
(1·41–1·67)
1·42 (1·28–1·57) 1·50
(1·37–1·64)
1·40
(1·25–1·56)
1·74
(1·61–1·87)
1·62
(1·47–1·77)
1·70
(1·57–1·83)
1·60
(1·46–1·75)
Norway 1·43
(1·32–1·54)
1·36
(1·24–1·49)
1·43
(1·33–1·54)
1·36 (1·25–1·48) 1·42
(1·31–1·53)
1·36
(1·24–1·48)
1·63
(1·52–1·74)
1·56
(1·44–1·69)
1·62
(1·52–1·73)
1·56
(1·44–1·68)
Portugal 1·27
(1·13–1·42)
1·17
(1·00–1·37)
1·27
(1·14–1·42)
1·17 (1·00–1·36) 1·23
(1·08–1·39)
1·17
(0·99–1·36)
1·47
(1·33–1·62)
1·37
(1·20–1·57)
1·43
(1·28–1·59)
1·37
(1·19–1·56)
San Marino 1·27
(1·09–1·49)
1·20
(0·99–1·46)
1·26
(1·08–1·48)
1·20 (1·00–1·44) 1·25
(1·07–1·47)
1·20
(0·99–1·45)
1·47
(1·29–1·69)
1·40
(1·19–1·66)
1·44
(1·26–1·66)
1·40
(1·20–1·64)
Spain 1·23
(1·10–1·38)
1·11
(0·93–1·30)
1·21
(1·07–1·35)
1·10 (0·93–1·29) 1·21
(1·07–1·35)
1·11
(0·93–1·30)
1·43
(1·30–1·58)
1·31
(1·13–1·50)
1·38
(1·24–1·53)
1·30
(1·13–1·49)
Sweden 1·51
(1·39–1·64)
1·38
(1·24–1·53)
1·48
(1·35–1·61)
1·37 (1·23–1·51) 1·47
(1·34–1·61)
1·36
(1·22–1·51)
1·71
(1·59–1·84)
1·58
(1·44–1·73)
1·64
(1·51–1·78)
1·54
(1·40–1·69)
Switzerland 1·40
(1·28–1·52)
1·33
(1·20–1·47)
1·39
(1·28–1·51)
1·33 (1·21–1·47) 1·38
(1·27–1·50)
1·33
(1·20–1·46)
1·60
(1·48–1·72)
1·53
(1·40–1·67)
1·58
(1·46–1·70)
1·53
(1·41–1·66)
UK 1·38
(1·18–1·58)
1·30
(1·08–1·53)
1·37
(1·18–1·56)
1·30 (1·09–1·52) 1·36
(1·17–1·56)
1·29
(1·07–1·51)
1·58
(1·38–1·78)
1·50
(1·28–1·73)
1·55
(1·36–1·75)
1·49
(1·29–1·70)
Latin America and Caribbean 1·57
(1·38–1·79)
1·31
(1·08–1·57)
1·50
(1·30–1·73)
1·31 (1·09–1·56) 1·49
(1·30–1·71)
1·31
(1·08–1·55)
1·72
(1·54–1·95)
1·50
(1·28–1·76)
1·64
(1·45–1·86)
1·50
(1·29–1·74)
Andean Latin America 1·80
(1·58–2·05)
1·45
(1·19–1·73)
1·75
(1·52–2·00)
1·46 (1·20–1·73) 1·66
(1·44–1·91)
1·44
(1·18–1·71)
1·82
(1·59–2·06)
1·65
(1·39–1·93)
1·82
(1·60–2·08)
1·64
(1·39–1·91)
Bolivia 1·84
(1·55–2·17)
1·40
(1·07–1·77)
1·80
(1·50–2·12)
1·44 (1·12–1·80) 1·67
(1·38–1·99)
1·40
(1·08–1·76)
1·84
(1·55–2·17)
1·60
(1·27–1·97)
1·84
(1·55–2·16)
1·63
(1·32–1·98)
Ecuador 1·74
(1·42–2·10)
1·45
(1·10–1·86)
1·73
(1·41–2·10)
1·45 (1·10–1·86) 1·65
(1·34–2·01)
1·44
(1·10–1·83)
1·78
(1·46–2·14)
1·65
(1·30–2·06)
1·85
(1·53–2·21)
1·64
(1·30–2·03)
Peru 1·83
(1·56–2·13)
1·44
(1·14–1·80)
1·74
(1·47–2·06)
1·43 (1·13–1·79) 1·67
(1·41–1·97)
1·42
(1·13–1·77)
1·83
(1·56–2·13)
1·64
(1·34–2·00)
1·80
(1·54–2·12)
1·62
(1·33–1·96)
Caribbean 1·77
(1·50–2·08)
1·43
(1·11–1·88)
1·67
(1·39–2·00)
1·45 (1·15–1·88) 1·57
(1·29–1·89)
1·37
(1·09–1·79)
1·82
(1·56–2·12)
1·61
(1·31–2·05)
1·71
(1·43–2·02)
1·58
(1·31–1·98)
Antigua and Barbuda 1·30
(1·11–1·52)
1·15
(0·93–1·41)
1·26
(1·06–1·48)
1·15 (0·93–1·41) 1·25
(1·06–1·46)
1·15
(0·93–1·40)
1·50
(1·31–1·72)
1·35
(1·13–1·61)
1·41
(1·22–1·64)
1·35
(1·13–1·60)
The Bahamas 1·24
(1·02–1·49)
1·24
(0·99–1·52)
1·21
(0·99–1·47)
1·24 (0·99–1·52) 1·19
(0·98–1·44)
1·21
(0·97–1·50)
1·44
(1·22–1·69)
1·44
(1·19–1·72)
1·37
(1·16–1·62)
1·41
(1·17–1·69)
(Table 2 continues on next page)

Articles
26
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
(Continued from previous page)
Barbados 1·18
(0·95–1·47)
1·10
(0·85–1·42)
1·17
(0·94–1·46)
1·10 (0·85–1·42) 1·10
(0·85–1·39)
1·06
(0·81–1·38)
1·38
(1·15–1·67)
1·30
(1·05–1·62)
1·29
(1·04–1·58)
1·26
(1·01–1·58)
Belize 1·58
(1·28–1·90)
1·28
(0·93–1·67)
1·46
(1·14–1·81)
1·25 (0·90–1·64) 1·38
(1·08–1·71)
1·18
(0·85–1·56)
1·78
(1·48–2·10)
1·48
(1·13–1·87)
1·49
(1·18–1·83)
1·36
(1·02–1·73)
Bermuda 1·19
(1·04–1·36)
1·07
(0·88–1·28)
1·13
(0·97–1·32)
1·06 (0·88–1·28) 1·15
(0·99–1·31)
1·05
(0·87–1·26)
1·39
(1·24–1·56)
1·27
(1·08–1·48)
1·29
(1·13–1·47)
1·25
(1·07–1·46)
Cuba 1·31
(1·18–1·44)
1·23
(1·07–1·39)
1·29
(1·16–1·43)
1·23 (1·07–1·38) 1·27
(1·15–1·40)
1·22
(1·06–1·37)
1·51
(1·38–1·64)
1·43
(1·27–1·59)
1·46
(1·33–1·59)
1·42
(1·27–1·57)
Dominica 1·18
(0·96–1·45)
1·13
(0·89–1·42)
1·15
(0·93–1·42)
1·13 (0·89–1·42) 1·13
(0·91–1·39)
1·11
(0·87–1·39)
1·38
(1·16–1·65)
1·33
(1·09–1·62)
1·30
(1·09–1·57)
1·31
(1·08–1·59)
Dominican Republic 1·84
(1·55–2·15)
1·51
(1·19–1·86)
1·80
(1·52–2·11)
1·53 (1·22–1·87) 1·72
(1·45–2·03)
1·47
(1·16–1·81)
1·84
(1·55–2·15)
1·71
(1·39–2·06)
1·90
(1·63–2·20)
1·69
(1·39–2·02)
Grenada 1·41
(1·09–1·79)
1·19
(0·81–1·62)
1·37
(1·05–1·76)
1·19 (0·82–1·63) 1·32
(0·99–1·70)
1·17
(0·81–1·60)
1·61
(1·29–1·99)
1·39
(1·01–1·82)
1·49
(1·16–1·87)
1·38
(1·02–1·81)
Guyana 1·91
(1·54–2·32)
1·58
(1·15–2·04)
1·87
(1·48–2·28)
1·58 (1·16–2·04) 1·63
(1·25–2·05)
1·43
(1·02–1·88)
1·91
(1·54–2·32)
1·78
(1·35–2·24)
1·81
(1·42–2·23)
1·63
(1·22–2·07)
Haiti 2·10
(1·68–2·61)
1·44
(0·92–2·05)
1·89
(1·43–2·44)
1·46 (0·95–2·06) 1·73
(1·27–2·28)
1·35
(0·84–1·94)
2·10
(1·68–2·61)
1·64
(1·12–2·25)
1·82
(1·34–2·37)
1·58
(1·07–2·17)
Jamaica 1·16
(0·93–1·39)
1·04
(0·79–1·31)
1·15
(0·93–1·39)
1·05 (0·80–1·32) 1·12
(0·90–1·35)
1·05
(0·80–1·31)
1·36
(1·13–1·59)
1·24
(0·99–1·51)
1·32
(1·10–1·55)
1·25
(1·00–1·51)
Puerto Rico 0·84
(0·76–0·92)
0·81
(0·72–0·93)
0·83
(0·75–0·92)
0·81 (0·72–0·93) 0·81
(0·73–0·89)
0·81
(0·71–0·93)
1·04
(0·96–1·12)
1·01
(0·92–1·13)
1·00
(0·92–1·09)
1·01
(0·91–1·13)
Saint Kitts and Nevis 1·08
(0·92–1·27)
1·00
(0·81–1·20)
1·08
(0·91–1·26)
1·01 (0·83–1·21) 1·05
(0·89–1·23)
1·00
(0·82–1·19)
1·28
(1·12–1·47)
1·20
(1·01–1·40)
1·24
(1·08–1·42)
1·20
(1·03–1·40)
Saint Lucia 1·04
(0·79–1·32)
0·87
(0·58–1·19)
1·03
(0·78–1·31)
0·87 (0·59–1·19) 0·96
(0·70–1·24)
0·86
(0·57–1·17)
1·24
(0·99–1·52)
1·07
(0·78–1·39)
1·15
(0·90–1·43)
1·06
(0·79–1·38)
Saint Vincent and the
Grenadines
1·35
(1·10–1·64)
1·16
(0·87–1·51)
1·30
(1·04–1·60)
1·16 (0·88–1·50) 1·30
(1·06–1·59)
1·17
(0·88–1·51)
1·55
(1·30–1·84)
1·36
(1·07–1·71)
1·46
(1·21–1·76)
1·37
(1·09–1·70)
Suriname 1·73
(1·41–2·05)
1·39
(1·02–1·78)
1·64
(1·31–1·98)
1·39 (1·02–1·77) 1·48
(1·18–1·81)
1·26
(0·90–1·63)
1·77
(1·45–2·09)
1·59
(1·22–1·98)
1·62
(1·31–1·97)
1·46
(1·11–1·83)
Trinidad and Tobago 1·35
(1·13–1·60)
1·19
(0·94–1·49)
1·33
(1·10–1·58)
1·19 (0·94–1·49) 1·16
(0·92–1·43)
1·10
(0·84–1·39)
1·55
(1·33–1·80)
1·39
(1·14–1·69)
1·35
(1·11–1·61)
1·30
(1·04–1·59)
Virgin Islands 1·49
(1·28–1·77)
1·37
(1·13–1·69)
1·44
(1·21–1·72)
1·36 (1·12–1·67) 1·44
(1·22–1·72)
1·35
(1·10–1·66)
1·69
(1·48–1·97)
1·57
(1·33–1·89)
1·59
(1·36–1·88)
1·54
(1·29–1·85)
Central Latin America 1·47
(1·23–1·74)
1·21
(0·93–1·53)
1·38
(1·13–1·66)
1·20 (0·93–1·52) 1·40
(1·16–1·67)
1·21
(0·94–1·52)
1·64
(1·40–1·91)
1·40
(1·13–1·72)
1·53
(1·28–1·81)
1·40
(1·14–1·71)
Colombia 1·35
(1·02–1·71)
1·14
(0·77–1·54)
1·32
(0·98–1·68)
1·14 (0·78–1·54) 1·32
(1·00–1·67)
1·16
(0·80–1·56)
1·55
(1·22–1·91)
1·34
(0·97–1·74)
1·49
(1·17–1·85)
1·37
(1·01–1·76)
Costa Rica 1·18
(1·02–1·36)
1·03
(0·84–1·26)
1·15
(0·98–1·34)
1·02 (0·83–1·25) 1·11
(0·96–1·29)
1·01
(0·83–1·23)
1·38
(1·22–1·56)
1·23
(1·04–1·46)
1·29
(1·13–1·47)
1·20
(1·02–1·42)
El Salvador 1·58
(1·23–1·93)
1·28
(0·86–1·72)
1·47
(1·10–1·85)
1·29 (0·88–1·72) 1·52
(1·18–1·88)
1·29
(0·89–1·72)
1·78
(1·43–2·13)
1·48
(1·06–1·92)
1·63
(1·28–2·01)
1·50
(1·10–1·92)
Guatemala 1·62
(1·26–1·98)
1·16
(0·73–1·61)
1·40
(1·02–1·80)
1·15 (0·74–1·58) 1·49
(1·13–1·87)
1·17
(0·76–1·59)
1·82
(1·46–2·18)
1·36
(0·93–1·81)
1·53
(1·16–1·93)
1·37
(0·98–1·79)
Honduras 1·71
(1·35–2·11)
1·27
(0·82–1·76)
1·48
(1·07–1·94)
1·25 (0·80–1·73) 1·63
(1·27–2·04)
1·29
(0·87–1·76)
1·79
(1·43–2·19)
1·47
(1·02–1·96)
1·65
(1·25–2·09)
1·48
(1·06–1·95)
Mexico 1·39
(1·19–1·62)
1·15
(0·91–1·41)
1·31
(1·09–1·54)
1·14 (0·90–1·39) 1·33
(1·13–1·55)
1·15
(0·92–1·41)
1·59
(1·39–1·82)
1·35
(1·11–1·61)
1·46
(1·25–1·69)
1·35
(1·12–1·59)
Nicaragua 1·65
(1·30–2·01)
1·29
(0·86–1·73)
1·51
(1·13–1·91)
1·29 (0·87–1·73) 1·64
(1·29–1·99)
1·33
(0·92–1·76)
1·85
(1·50–2·21)
1·49
(1·06–1·93)
1·72
(1·35–2·11)
1·54
(1·13–1·96)
Panama 1·76
(1·49–2·05)
1·49
(1·20–1·81)
1·72
(1·45–2·02)
1·49 (1·21–1·81) 1·64
(1·38–1·93)
1·45
(1·17–1·76)
1·76
(1·49–2·05)
1·69
(1·40–2·01)
1·82
(1·55–2·11)
1·65
(1·37–1·97)
Venezuela 1·79
(1·43–2·19)
1·51
(1·10–1·97)
1·72
(1·35–2·14)
1·52 (1·12–1·97) 1·65
(1·29–2·05)
1·45
(1·04–1·89)
1·79
(1·43–2·19)
1·71
(1·30–2·17)
1·80
(1·44–2·21)
1·66
(1·27–2·10)
Tropical Latin America 1·57
(1·36–1·81)
1·32
(1·08–1·59)
1·52
(1·30–1·76)
1·32 (1·08–1·58) 1·52
(1·31–1·76)
1·32
(1·08–1·59)
1·77
(1·56–2·01)
1·52
(1·28–1·79)
1·68
(1·47–1·92)
1·52
(1·29–1·79)
(Table 2 continues on next page)

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
27
Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
(Continued from previous page)
Brazil 1·57
(1·35–1·81)
1·31
(1·06–1·59)
1·52
(1·29–1·77)
1·31 (1·06–1·59) 1·52
(1·31–1·76)
1·32
(1·07–1·60)
1·77
(1·55–2·01)
1·51
(1·26–1·79)
1·68
(1·46–1·93)
1·52
(1·27–1·79)
Paraguay 1·66
(1·25–2·11)
1·39
(0·93–1·89)
1·61
(1·19–2·06)
1·39 (0·94–1·88) 1·62
(1·21–2·06)
1·41
(0·96–1·90)
1·86
(1·45–2·31)
1·59
(1·13–2·09)
1·77
(1·36–2·22)
1·61
(1·17–2·09)
North Africa and Middle East 1·94
(1·62–2·28)
1·64
(1·28–2·06)
1·80
(1·48–2·14)
1·67 (1·35–2·06) 1·72
(1·40–2·06)
1·63
(1·30–2·04)
2·00
(1·68–2·34)
1·75
(1·40–2·15)
1·76
(1·44–2·10)
1·73
(1·42–2·12)
Afghanistan 3·34
(2·78–3·89)
1·61
(0·90–2·32)
2·30
(1·67–2·92)
1·62 (0·98–2·28) 2·63
(2·00–3·24)
1·52
(0·87–2·18)
3·34
(2·78–3·89)
1·81
(1·10–2·52)
1·95
(1·31–2·57)
1·75
(1·16–2·37)
Algeria 1·79
(1·37–2·18)
1·48
(1·04–1·89)
1·74
(1·32–2·13)
1·49 (1·06–1·89) 1·59
(1·19–1·96)
1·37
(0·96–1·77)
1·79
(1·37–2·18)
1·68
(1·24–2·09)
1·75
(1·36–2·12)
1·58
(1·17–1·97)
Bahrain 1·39
(1·10–1·68)
1·26
(0·92–1·57)
1·37
(1·07–1·65)
1·27 (0·94–1·57) 1·22
(0·91–1·51)
1·17
(0·84–1·49)
1·59
(1·30–1·88)
1·46
(1·12–1·77)
1·41
(1·10–1·69)
1·38
(1·06–1·69)
Egypt 2·38
(1·97–2·82)
2·05
(1·62–2·50)
2·38
(1·97–2·80)
2·06 (1·65–2·50) 2·35
(1·94–2·78)
2·07
(1·64–2·51)
2·38
(1·97–2·82)
2·05
(1·62–2·50)
2·34
(1·95–2·77)
2·07
(1·66–2·51)
Iran 1·31
(1·03–1·58)
1·28
(0·97–1·58)
1·30
(1·02–1·58)
1·28 (0·98–1·58) 1·18
(0·91–1·44)
1·20
(0·90–1·49)
1·51
(1·23–1·78)
1·48
(1·17–1·78)
1·38
(1·11–1·63)
1·40
(1·11–1·68)
Iraq 1·95
(1·63–2·35)
1·59
(1·25–2·01)
1·92
(1·61–2·31)
1·60 (1·28–2·01) 1·69
(1·36–2·09)
1·50
(1·15–1·90)
1·95
(1·63–2·35)
1·79
(1·45–2·21)
1·88
(1·56–2·26)
1·71
(1·38–2·10)
Jordan 1·78
(1·44–2·10)
1·57
(1·20–1·93)
1·75
(1·41–2·08)
1·57 (1·21–1·93) 1·50
(1·09–1·88)
1·40
(0·99–1·80)
1·78
(1·44–2·10)
1·77
(1·40–2·13)
1·68
(1·27–2·06)
1·60
(1·20–1·99)
Kuwait 1·07
(0·89–1·30)
1·14
(0·93–1·39)
1·05
(0·87–1·28)
1·14 (0·93–1·39) 1·04
(0·86–1·26)
1·13
(0·92–1·37)
1·27
(1·09–1·50)
1·34
(1·13–1·59)
1·22
(1·04–1·44)
1·33
(1·13–1·57)
Lebanon 1·44
(1·12–1·80)
1·33
(0·98–1·73)
1·40
(1·09–1·77)
1·33 (0·99–1·73) 1·28
(0·93–1·66)
1·24
(0·88–1·65)
1·64
(1·32–2·00)
1·53
(1·18–1·93)
1·45
(1·11–1·84)
1·45
(1·09–1·85)
Libya 1·13
(0·87–1·43)
1·03
(0·75–1·37)
1·09
(0·84–1·40)
1·03 (0·75–1·36) 0·91
(0·62–1·23)
0·90
(0·60–1·24)
1·33
(1·07–1·63)
1·23
(0·95–1·57)
1·09
(0·80–1·41)
1·10
(0·80–1·44)
Morocco 1·36
(1·05–1·70)
1·02
(0·67–1·40)
1·22
(0·88–1·57)
1·04 (0·69–1·42) 1·28
(0·97–1·61)
1·03
(0·69–1·39)
1·56
(1·25–1·90)
1·22
(0·87–1·60)
1·37
(1·04–1·72)
1·26
(0·92–1·62)
Oman 1·64
(1·27–2·02)
1·29
(0·88–1·72)
1·59
(1·23–1·97)
1·31 (0·92–1·72) 1·30
(0·87–1·73)
1·18
(0·76–1·62)
1·84
(1·47–2·22)
1·49
(1·08–1·92)
1·47
(1·05–1·90)
1·40
(0·98–1·83)
Palestine 2·08
(1·79–2·44)
1·77
(1·43–2·15)
2·05
(1·75–2·40)
1·77 (1·45–2·15) 1·82
(1·47–2·22)
1·65
(1·30–2·05)
2·08
(1·79–2·44)
1·77
(1·43–2·15)
1·80
(1·46–2·19)
1·85
(1·51–2·25)
Qatar 1·43
(1·17–1·69)
1·29
(1·01–1·57)
1·40
(1·15–1·66)
1·28 (1·01–1·57) 1·25
(0·97–1·52)
1·20
(0·91–1·49)
1·63
(1·37–1·89)
1·49
(1·21–1·77)
1·43
(1·15–1·70)
1·40
(1·11–1·68)
Saudi Arabia 1·09
(0·80–1·39)
0·97
(0·65–1·31)
1·06
(0·77–1·37)
0·98 (0·66–1·31) 0·92
(0·62–1·23)
0·89
(0·57–1·22)
1·29
(1·00–1·59)
1·17
(0·85–1·51)
1·11
(0·80–1·41)
1·10
(0·78–1·42)
Sudan 1·93
(1·48–2·44)
1·40
(0·93–1·95)
1·83
(1·37–2·34)
1·42 (0·96–1·96) 1·54
(1·06–2·07)
1·30
(0·83–1·85)
1·93
(1·48–2·44)
1·60
(1·13–2·15)
1·69
(1·22–2·22)
1·53
(1·07–2·07)
Syria 1·57
(1·21–1·98)
1·39
(1·01–1·84)
1·55
(1·20–1·96)
1·40 (1·03–1·84) 1·40
(1·03–1·83)
1·33
(0·95–1·77)
1·77
(1·41–2·18)
1·59
(1·21–2·04)
1·59
(1·22–2·01)
1·53
(1·16–1·97)
Tunisia 1·36
(1·02–1·73)
1·19
(0·82–1·59)
1·33
(0·99–1·71)
1·19 (0·83–1·59) 1·22
(0·88–1·59)
1·14
(0·78–1·53)
1·56
(1·22–1·93)
1·39
(1·02–1·79)
1·40
(1·06–1·76)
1·34
(0·98–1·73)
Türkiye 1·32
(1·13–1·56)
1·17
(0·95–1·42)
1·29
(1·09–1·52)
1·17 (0·96–1·41) 1·15
(0·95–1·39)
1·10
(0·88–1·34)
1·52
(1·33–1·76)
1·37
(1·15–1·62)
1·33
(1·12–1·57)
1·30
(1·09–1·54)
United Arab Emirates 1·53
(1·26–1·81)
1·31
(1·00–1·64)
1·52
(1·26–1·79)
1·31 (1·00–1·63) 1·44
(1·13–1·73)
1·30
(0·97–1·62)
1·73
(1·46–2·01)
1·51
(1·20–1·84)
1·63
(1·33–1·92)
1·50
(1·18–1·82)
Yemen 1·91
(1·32–2·54)
1·22
(0·54–1·95)
1·66
(1·04–2·32)
1·29 (0·64–2·00) 1·63
(1·03–2·26)
1·23
(0·59–1·93)
1·91
(1·32–2·54)
1·42
(0·74–2·15)
1·67
(1·07–2·33)
1·49
(0·88–2·18)
South Asia 1·36
(1·09–1·64)
1·10
(0·80–1·43)
1·27
(1·00–1·56)
1·10 (0·80–1·43) 1·24
(0·97–1·53)
1·09
(0·78–1·41)
1·53
(1·26–1·81)
1·28
(0·97–1·61)
1·38
(1·10–1·67)
1·29
(0·98–1·61)
Bangladesh 1·20
(0·84–1·54)
0·97
(0·57–1·37)
1·17
(0·80–1·52)
1·03 (0·64–1·41) 1·18
(0·83–1·52)
1·02
(0·63–1·41)
1·40
(1·04–1·74)
1·17
(0·77–1·57)
1·36
(1·01–1·71)
1·26
(0·88–1·64)
Bhutan 1·07
(0·73–1·34)
0·69
(0·33–1·00)
0·93
(0·62–1·20)
0·80 (0·48–1·09) 1·05
(0·76–1·30)
0·75
(0·44–1·03)
1·27
(0·93–1·54)
0·89
(0·53–1·20)
1·15
(0·86–1·40)
1·06
(0·76–1·33)
India 1·29
(0·97–1·62)
1·04
(0·67–1·42)
1·22
(0·89–1·57)
1·04 (0·67–1·41) 1·20
(0·88–1·53)
1·04
(0·67–1·41)
1·49
(1·17–1·82)
1·24
(0·87–1·62)
1·35
(1·01–1·69)
1·24
(0·87–1·62)
(Table 2 continues on next page)

Articles
28
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Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
(Continued from previous page)
Nepal 1·18
(0·80–1·53)
0·82
(0·40–1·22)
1·13
(0·77–1·49)
0·94 (0·55–1·32) 1·04
(0·66–1·39)
0·82
(0·43–1·20)
1·38
(1·00–1·73)
1·02
(0·60–1·42)
1·22
(0·86–1·57)
1·11
(0·75–1·48)
Pakistan 1·76
(1·25–2·28)
1·16
(0·59–1·77)
1·56
(1·04–2·11)
1·18 (0·64–1·77) 1·47
(0·93–2·04)
1·12
(0·58–1·72)
1·76
(1·25–2·28)
1·36
(0·79–1·97)
1·54
(1·01–2·11)
1·34
(0·81–1·92)
Southeast Asia, east Asia, and
Oceania
1·37
(1·22–1·54)
1·30
(1·11–1·53)
1·32
(1·16–1·49)
1·29 (1·11–1·51) 1·31
(1·15–1·47)
1·27
(1·09–1·50)
1·53
(1·38–1·70)
1·49
(1·30–1·71)
1·45
(1·30–1·62)
1·46
(1·28–1·66)
East Asia 1·14
(0·99–1·30)
1·16
(0·99–1·34)
1·11
(0·96–1·27)
1·16 (0·99–1·34) 1·13
(0·99–1·29)
1·16
(1·00–1·34)
1·34
(1·19–1·50)
1·36
(1·19–1·54)
1·31
(1·16–1·47)
1·36
(1·20–1·54)
China 1·14
(0·99–1·31)
1·16
(0·99–1·35)
1·12
(0·97–1·28)
1·16 (1·00–1·35) 1·14
(0·99–1·30)
1·16
(1·00–1·35)
1·34
(1·19–1·51)
1·36
(1·19–1·55)
1·31
(1·17–1·48)
1·37
(1·20–1·55)
North Korea 1·24
(1·00–1·48)
1·16
(0·90–1·42)
1·19
(0·95–1·43)
1·15 (0·90–1·41) 1·18
(0·94–1·41)
1·13
(0·88–1·39)
1·44
(1·20–1·68)
1·36
(1·10–1·62)
1·34
(1·10–1·58)
1·33
(1·08–1·59)
Taiwan (province of China) 0·90
(0·78–1·04)
0·90
(0·77–1·05)
0·89
(0·77–1·03)
0·90 (0·77–1·05) 0·89
(0·77–1·03)
0·89
(0·76–1·05)
1·10
(0·98–1·24)
1·10
(0·97–1·25)
1·08
(0·96–1·22)
1·10
(0·97–1·25)
Oceania 2·93
(2·45–3·46)
1·67
(1·01–2·35)
2·09
(1·51–2·70)
1·58 (0·98–2·22) 2·38
(1·83–2·96)
1·55
(0·93–2·20)
2·93
(2·45–3·46)
1·86
(1·20–2·54)
1·81
(1·22–2·43)
1·68
(1·10–2·32)
American Samoa 1·98
(1·67–2·31)
1·68
(1·34–2·05)
1·84
(1·50–2·19)
1·68 (1·34–2·04) 1·84
(1·51–2·18)
1·61
(1·27–1·97)
1·98
(1·67–2·31)
1·88
(1·54–2·25)
1·89
(1·56–2·24)
1·81
(1·48–2·17)
Cook Islands 1·40
(1·14–1·72)
1·25
(0·96–1·58)
1·36
(1·10–1·68)
1·24 (0·96–1·57) 1·37
(1·11–1·67)
1·25
(0·97–1·58)
1·60
(1·34–1·92)
1·45
(1·16–1·78)
1·53
(1·27–1·84)
1·45
(1·17–1·77)
Federated States of Micronesia 1·82
(1·39–2·33)
1·46
(0·96–2·05)
1·74
(1·30–2·27)
1·46 (0·97–2·04) 1·56
(1·11–2·09)
1·35
(0·87–1·93)
1·82
(1·39–2·33)
1·66
(1·16–2·25)
1·71
(1·26–2·24)
1·56
(1·07–2·13)
Fiji 1·95
(1·61–2·31)
1·64
(1·28–2·04)
1·92
(1·58–2·30)
1·65 (1·30–2·04) 1·84
(1·52–2·20)
1·62
(1·27–2·01)
1·95
(1·61–2·31)
1·84
(1·48–2·24)
1·82
(1·50–2·19)
1·83
(1·48–2·21)
Guam 2·07
(1·76–2·38)
1·76
(1·42–2·09)
2·01
(1·70–2·33)
1·73 (1·40–2·07) 1·98
(1·66–2·30)
1·71
(1·38–2·05)
2·07
(1·76–2·38)
1·76
(1·42–2·09)
1·93
(1·62–2·25)
1·89
(1·56–2·22)
Kiribati 2·13
(1·70–2·62)
1·67
(1·19–2·21)
2·12
(1·69–2·60)
1·68 (1·22–2·21) 1·78
(1·34–2·27)
1·52
(1·06–2·05)
2·13
(1·70–2·62)
1·87
(1·39–2·41)
1·78
(1·34–2·26)
1·74
(1·28–2·26)
Marshall Islands 1·98
(1·67–2·32)
1·65
(1·31–2·02)
1·86
(1·53–2·20)
1·64 (1·31–2·00) 1·94
(1·64–2·27)
1·66
(1·33–2·03)
1·98
(1·67–2·32)
1·85
(1·51–2·22)
1·84
(1·52–2·18)
1·86
(1·53–2·22)
Nauru 2·40
(1·93–2·95)
1·91
(1·39–2·51)
2·27
(1·79–2·84)
1·90 (1·40–2·49) 2·04
(1·53–2·62)
1·76
(1·25–2·36)
2·40
(1·93–2·95)
1·91
(1·39–2·51)
1·95
(1·45–2·54)
1·76
(1·26–2·35)
Niue 1·71
(1·37–2·08)
1·50
(1·13–1·90)
1·66
(1·32–2·04)
1·50 (1·13–1·90) 1·61
(1·28–1·97)
1·47
(1·10–1·86)
1·87
(1·53–2·24)
1·70
(1·33–2·10)
1·78
(1·44–2·14)
1·67
(1·31–2·06)
Northern Mariana Islands 1·67
(1·36–2·01)
1·50
(1·17–1·88)
1·58
(1·27–1·94)
1·49 (1·17–1·86) 1·57
(1·26–1·91)
1·44
(1·11–1·81)
1·87
(1·56–2·21)
1·70
(1·37–2·08)
1·70
(1·38–2·06)
1·64
(1·31–2·00)
Palau 1·65
(1·37–1·92)
1·44
(1·14–1·74)
1·58
(1·29–1·85)
1·43 (1·14–1·72) 1·51
(1·24–1·76)
1·38
(1·09–1·66)
1·85
(1·57–2·12)
1·64
(1·34–1·94)
1·66
(1·38–1·92)
1·57
(1·29–1·85)
Papua New Guinea 3·03
(2·50–3·58)
1·64
(0·94–2·35)
2·08
(1·45–2·72)
1·52 (0·87–2·22) 2·45
(1·84–3·06)
1·53
(0·88–2·22)
3·03
(2·50–3·58)
1·84
(1·14–2·55)
1·79
(1·15–2·46)
1·65
(1·02–2·33)
Samoa 3·18
(2·69–3·68)
2·57
(1·98–3·14)
3·07
(2·56–3·59)
2·54 (1·95–3·12) 2·51
(1·90–3·07)
2·17
(1·55–2·75)
3·18
(2·69–3·68)
2·57
(1·98–3·14)
2·45
(1·83–3·03)
2·16
(1·54–2·75)
Solomon Islands 2·51
(2·10–2·90)
1·70
(1·21–2·21)
2·19
(1·73–2·67)
1·74 (1·25–2·26) 2·01
(1·53–2·47)
1·49
(1·00–1·99)
2·51
(2·10–2·90)
1·90
(1·41–2·41)
1·82
(1·34–2·31)
1·73
(1·26–2·24)
Tokelau 1·54
(1·17–1·94)
1·34
(0·94–1·78)
1·46
(1·09–1·88)
1·33 (0·94–1·76) 1·42
(1·07–1·82)
1·30
(0·92–1·73)
1·74
(1·37–2·14)
1·54
(1·14–1·98)
1·56
(1·21–1·97)
1·49
(1·12–1·92)
Tonga 3·04
(2·58–3·50)
2·45
(1·93–2·98)
2·90
(2·43–3·39)
2·43 (1·92–2·95) 2·47
(1·91–3·00)
2·14
(1·58–2·68)
3·04
(2·58–3·50)
2·45
(1·93–2·98)
2·38
(1·83–2·91)
2·13
(1·59–2·65)
Tuvalu 2·20
(1·71–2·70)
1·71
(1·17–2·26)
2·15
(1·65–2·65)
1·72 (1·19–2·25) 1·84
(1·34–2·35)
1·58
(1·06–2·11)
2·20
(1·71–2·70)
1·91
(1·37–2·46)
1·81
(1·31–2·31)
1·79
(1·28–2·31)
Vanuatu 2·44
(2·06–2·87)
1·79
(1·33–2·31)
2·21
(1·79–2·69)
1·79 (1·34–2·30) 2·04
(1·63–2·50)
1·62
(1·18–2·13)
2·44
(2·06–2·87)
1·79
(1·33–2·31)
1·90
(1·48–2·38)
1·84
(1·40–2·33)
Southeast Asia 1·60
(1·40–1·83)
1·35
(1·14–1·60)
1·54
(1·34–1·78)
1·35 (1·13–1·60) 1·48
(1·28–1·71)
1·31
(1·10–1·57)
1·74
(1·54–1·98)
1·54
(1·32–1·80)
1·63
(1·43–1·87)
1·51
(1·29–1·76)
Cambodia 1·65
(1·32–1·93)
1·10
(0·71–1·45)
1·36
(1·00–1·68)
1·08 (0·70–1·43) 1·49
(1·14–1·78)
1·12
(0·75–1·44)
1·77
(1·44–2·05)
1·30
(0·91–1·65)
1·47
(1·11–1·78)
1·30
(0·93–1·62)
(Table 2 continues on next page)

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
29
Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
(Continued from previous page)
Indonesia 1·53
(1·25–1·84)
1·29
(0·99–1·63)
1·51
(1·23–1·82)
1·30 (1·00–1·63) 1·44
(1·17–1·74)
1·26
(0·97–1·60)
1·73
(1·45–2·04)
1·49
(1·19–1·83)
1·62
(1·35–1·92)
1·47
(1·18–1·80)
Laos 1·61
(1·29–1·88)
1·09
(0·73–1·40)
1·43
(1·08–1·72)
1·14 (0·78–1·44) 1·53
(1·22–1·79)
1·14
(0·79–1·44)
1·81
(1·49–2·08)
1·29
(0·93–1·60)
1·60
(1·25–1·89)
1·39
(1·02–1·70)
Malaysia 1·39
(1·11–1·70)
1·17
(0·86–1·52)
1·35
(1·07–1·67)
1·19 (0·88–1·53) 1·32
(1·06–1·62)
1·17
(0·87–1·50)
1·59
(1·31–1·90)
1·37
(1·06–1·72)
1·49
(1·23–1·80)
1·38
(1·09–1·71)
Maldives 1·07
(0·79–1·34)
0·77
(0·42–1·11)
0·97
(0·67–1·27)
0·79 (0·45–1·13) 0·84
(0·52–1·15)
0·71
(0·37–1·05)
1·27
(0·99–1·54)
0·97
(0·62–1·31)
0·98
(0·67–1·30)
0·93
(0·60–1·27)
Mauritius 1·17
(0·94–1·42)
1·03
(0·77–1·32)
1·16
(0·93–1·41)
1·04 (0·78–1·33) 0·97
(0·72–1·24)
0·92
(0·66–1·21)
1·37
(1·14–1·62)
1·23
(0·97–1·52)
1·16
(0·92–1·43)
1·13
(0·87–1·42)
Myanmar 1·69
(1·42–1·97)
1·22
(0·89–1·57)
1·48
(1·17–1·81)
1·22 (0·88–1·56) 1·63
(1·37–1·91)
1·27
(0·95–1·61)
1·77
(1·50–2·05)
1·42
(1·09–1·77)
1·66
(1·37–1·98)
1·47
(1·14–1·81)
Philippines 1·84
(1·61–2·11)
1·50
(1·23–1·79)
1·78
(1·54–2·05)
1·48 (1·21–1·77) 1·62
(1·36–1·90)
1·43
(1·16–1·72)
1·84
(1·61–2·11)
1·70
(1·43–1·99)
1·78
(1·52–2·06)
1·62
(1·35–1·91)
Seychelles 1·86
(1·60–2·14)
1·60
(1·31–1·91)
1·85
(1·58–2·13)
1·61 (1·33–1·91) 1·83
(1·57–2·10)
1·61
(1·33–1·91)
1·86
(1·60–2·14)
1·80
(1·51–2·11)
1·81
(1·55–2·09)
1·82
(1·54–2·12)
Sri Lanka 1·50
(1·24–1·81)
1·30
(0·99–1·66)
1·47
(1·20–1·79)
1·29 (0·99–1·66) 1·40
(1·14–1·72)
1·28
(0·99–1·63)
1·70
(1·44–2·01)
1·50
(1·19–1·86)
1·58
(1·31–1·89)
1·48
(1·19–1·83)
Thailand 1·13
(0·96–1·31)
1·04
(0·86–1·24)
1·13
(0·97–1·31)
1·04 (0·86–1·24) 1·08
(0·92–1·25)
1·02
(0·83–1·21)
1·33
(1·16–1·51)
1·24
(1·06–1·44)
1·28
(1·12–1·45)
1·22
(1·04–1·41)
Timor-Leste 2·27
(1·62–2·90)
1·58
(0·85–2·30)
2·18
(1·54–2·83)
1·61 (0·92–2·32) 1·86
(1·18–2·53)
1·45
(0·75–2·15)
2·27
(1·62–2·90)
1·78
(1·05–2·50)
1·83
(1·14–2·50)
1·70
(1·01–2·39)
Viet Nam 1·63
(1·38–1·93)
1·38
(1·10–1·70)
1·59
(1·34–1·88)
1·36 (1·09–1·69) 1·53
(1·29–1·82)
1·35
(1·07–1·67)
1·83
(1·58–2·13)
1·58
(1·30–1·90)
1·70
(1·44–1·99)
1·53
(1·26–1·85)
Sub-Saharan Africa 2·72
(2·32–3·15)
1·82
(1·35–2·32)
2·27
(1·83–2·74)
1·80 (1·37–2·28) 2·29
(1·88–2·73)
1·73
(1·29–2·22)
2·73
(2·33–3·16)
1·89
(1·42–2·40)
2·03
(1·60–2·49)
1·82
(1·41–2·31)
Central sub-Saharan Africa 2·52
(2·05–2·94)
1·86
(1·37–2·31)
2·38
(1·91–2·82)
1·89 (1·42–2·34) 2·06
(1·61–2·48)
1·77
(1·31–2·21)
2·52
(2·05–2·94)
1·86
(1·38–2·31)
2·01
(1·55–2·43)
1·93
(1·48–2·36)
Angola 2·76
(2·21–3·35)
1·97
(1·37–2·62)
2·61
(2·06–3·22)
2·03 (1·46–2·67) 2·30
(1·74–2·91)
1·87
(1·30–2·51)
2·76
(2·21–3·35)
1·97
(1·37–2·62)
2·23
(1·69–2·83)
1·93
(1·39–2·55)
Central African Republic 2·36
(1·86–2·88)
1·35
(0·77–2·03)
1·94
(1·38–2·54)
1·41 (0·81–2·10) 1·74
(1·22–2·29)
1·17
(0·59–1·83)
2·36
(1·86–2·88)
1·55
(0·97–2·23)
1·73
(1·17–2·35)
1·45
(0·85–2·13)
Congo (Brazzaville) 1·90
(1·54–2·32)
1·49
(1·11–1·93)
1·86
(1·51–2·27)
1·49 (1·13–1·92) 1·64
(1·29–2·05)
1·45
(1·08–1·88)
1·90
(1·54–2·32)
1·69
(1·31–2·13)
1·81
(1·46–2·22)
1·65
(1·29–2·07)
Democratic Republic of the
Congo
2·46
(1·82–3·03)
1·76
(1·09–2·38)
2·34
(1·69–2·93)
1·78 (1·13–2·40) 2·00
(1·37–2·56)
1·67
(1·02–2·27)
2·46
(1·82–3·03)
1·76
(1·09–2·38)
1·93
(1·31–2·49)
1·89
(1·26–2·49)
Equatorial Guinea 2·19
(1·70–2·75)
1·83
(1·29–2·43)
2·19
(1·71–2·74)
1·83 (1·32–2·42) 1·90
(1·35–2·49)
1·76
(1·23–2·37)
2·19
(1·70–2·75)
1·83
(1·29–2·43)
1·90
(1·37–2·49)
1·77
(1·25–2·36)
Gabon 1·93
(1·41–2·52)
1·56
(1·02–2·19)
1·88
(1·37–2·47)
1·56 (1·03–2·17) 1·68
(1·17–2·27)
1·51
(0·97–2·12)
1·93
(1·41–2·52)
1·76
(1·22–2·39)
1·85
(1·34–2·44)
1·71
(1·18–2·31)
Eastern sub-Saharan Africa 2·50
(2·04–2·96)
1·68
(1·17–2·22)
2·11
(1·64–2·61)
1·70 (1·22–2·21) 2·17
(1·72–2·65)
1·61
(1·12–2·13)
2·50
(2·04–2·96)
1·80
(1·29–2·34)
1·98
(1·51–2·48)
1·77
(1·30–2·27)
Burundi 2·74
(2·16–3·31)
1·55
(0·83–2·25)
2·11
(1·45–2·77)
1·55 (0·86–2·24) 2·20
(1·53–2·84)
1·48
(0·80–2·18)
2·74
(2·16–3·31)
1·75
(1·03–2·45)
1·80
(1·11–2·48)
1·69
(1·03–2·39)
Comoros 1·73
(1·17–2·33)
1·23
(0·60–1·92)
1·66
(1·10–2·26)
1·26 (0·66–1·92) 1·42
(0·82–2·05)
1·17
(0·56–1·84)
1·73
(1·17–2·33)
1·43
(0·80–2·12)
1·58
(1·00–2·21)
1·40
(0·81–2·05)
Djibouti 1·41
(0·92–1·88)
0·95
(0·38–1·51)
1·26
(0·78–1·76)
1·00 (0·47–1·54) 1·27
(0·79–1·75)
0·96
(0·43–1·50)
1·61
(1·12–2·08)
1·15
(0·58–1·71)
1·36
(0·89–1·86)
1·20
(0·71–1·73)
Eritrea 2·20
(1·52–2·86)
1·28
(0·49–2·09)
1·84
(1·15–2·55)
1·32 (0·59–2·09) 1·62
(0·87–2·35)
1·15
(0·41–1·92)
2·20
(1·52–2·86)
1·48
(0·69–2·29)
1·63
(0·91–2·37)
1·39
(0·69–2·13)
Ethiopia 2·40
(1·86–2·89)
1·29
(0·64–1·87)
1·73
(1·15–2·27)
1·30 (0·72–1·86) 2·14
(1·60–2·63)
1·32
(0·75–1·86)
2·40
(1·86–2·89)
1·49
(0·84–2·07)
1·83
(1·28–2·35)
1·53
(1·00–2·06)
Kenya 1·84
(1·39–2·35)
1·45
(0·96–2·01)
1·80
(1·34–2·31)
1·48 (1·00–2·03) 1·77
(1·33–2·26)
1·46
(0·98–2·01)
1·84
(1·39–2·35)
1·65
(1·16–2·21)
1·77
(1·34–2·28)
1·68
(1·22–2·23)
Madagascar 2·33
(1·91–2·78)
1·70
(1·23–2·22)
2·14
(1·69–2·61)
1·71 (1·24–2·21) 2·19
(1·77–2·62)
1·73
(1·25–2·25)
2·33
(1·91–2·78)
1·90
(1·43–2·42)
2·04
(1·60–2·50)
1·93
(1·46–2·45)
(Table 2 continues on next page)

Articles
30
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
(Continued from previous page)
Malawi 2·03
(1·46–2·57)
1·55
(0·94–2·14)
1·94
(1·36–2·48)
1·59 (1·01–2·16) 2·00
(1·42–2·53)
1·62
(1·02–2·22)
2·03
(1·46–2·57)
1·75
(1·14–2·34)
1·92
(1·35–2·47)
1·86
(1·27–2·45)
Mozambique 2·44
(1·91–2·93)
1·55
(0·95–2·14)
2·09
(1·52–2·65)
1·64 (1·07–2·21) 2·16
(1·62–2·67)
1·56
(0·99–2·13)
2·44
(1·91–2·93)
1·75
(1·15–2·34)
1·93
(1·37–2·49)
1·85
(1·29–2·42)
Rwanda 1·97
(1·54–2·42)
1·24
(0·76–1·77)
1·60
(1·15–2·08)
1·22 (0·76–1·73) 1·76
(1·35–2·20)
1·21
(0·77–1·70)
1·97
(1·54–2·42)
1·44
(0·96–1·97)
1·67
(1·25–2·14)
1·40
(0·97–1·89)
Somalia 4·30
(3·92–4·68)
2·45
(1·92–3·00)
3·15
(2·68–3·62)
2·37 (1·87–2·90) 2·73
(2·15–3·28)
1·69
(1·14–2·24)
4·30
(3·92–4·68)
2·45
(1·92–3·00)
2·15
(1·59–2·69)
1·91
(1·39–2·44)
South Sudan 4·09
(3·59–4·64)
1·98
(1·22–2·75)
2·67
(1·98–3·34)
1·91 (1·18–2·65) 2·54
(1·77–3·26)
1·35
(0·58–2·11)
4·09
(3·59–4·64)
1·98
(1·22–2·75)
1·77
(1·00–2·53)
1·56
(0·82–2·32)
Tanzania 2·42
(2·02–2·86)
1·70
(1·23–2·20)
2·25
(1·81–2·72)
1·74 (1·28–2·24) 2·20
(1·79–2·64)
1·70
(1·24–2·20)
2·42
(2·02–2·86)
1·90
(1·43–2·40)
2·08
(1·66–2·54)
1·75
(1·30–2·25)
Uganda 2·72
(2·26–3·19)
1·98
(1·48–2·50)
2·59
(2·13–3·07)
2·01 (1·54–2·51) 2·49
(2·05–2·96)
2·00
(1·51–2·51)
2·72
(2·26–3·19)
1·98
(1·48–2·50)
2·40
(1·95–2·88)
2·03
(1·56–2·53)
Zambia 2·39
(1·88–2·91)
1·83
(1·28–2·40)
2·31
(1·80–2·83)
1·83 (1·31–2·39) 2·25
(1·77–2·77)
1·85
(1·32–2·43)
2·39
(1·88–2·91)
1·83
(1·28–2·40)
2·19
(1·70–2·72)
1·85
(1·33–2·43)
Southern sub-Saharan Africa 1·94
(1·67–2·21)
1·63
(1·29–1·99)
1·92
(1·66–2·20)
1·63 (1·30–2·00) 1·86
(1·61–2·13)
1·62
(1·29–2·00)
2·07
(1·80–2·34)
1·76
(1·44–2·09)
1·99
(1·73–2·25)
1·75
(1·44–2·10)
Botswana 1·70
(1·31–2·12)
1·38
(0·94–1·84)
1·70
(1·32–2·12)
1·39 (0·96–1·85) 1·68
(1·30–2·10)
1·41
(0·98–1·88)
1·82
(1·43–2·24)
1·58
(1·14–2·04)
1·88
(1·51–2·30)
1·62
(1·20–2·08)
Eswatini 1·98
(1·62–2·36)
1·53
(1·13–1·95)
1·93
(1·56–2·32)
1·55 (1·16–1·97) 1·96
(1·60–2·34)
1·59
(1·20–2·03)
1·98
(1·62–2·36)
1·73
(1·33–2·15)
1·92
(1·55–2·30)
1·81
(1·42–2·24)
Lesotho 1·88
(1·50–2·34)
1·47
(1·03–1·98)
1·78
(1·38–2·25)
1·45 (1·01–1·95) 1·82
(1·45–2·27)
1·49
(1·06–2·01)
1·88
(1·50–2·34)
1·67
(1·23–2·18)
1·78
(1·39–2·24)
1·67
(1·25–2·18)
Namibia 2·03
(1·70–2·40)
1·62
(1·24–2·03)
2·00
(1·67–2·37)
1·63 (1·26–2·04) 1·96
(1·63–2·32)
1·63
(1·26–2·04)
2·03
(1·70–2·40)
1·82
(1·44–2·23)
1·93
(1·60–2·29)
1·84
(1·47–2·25)
South Africa 1·69
(1·46–1·89)
1·45
(1·20–1·67)
1·67
(1·45–1·88)
1·44 (1·19–1·66) 1·60
(1·39–1·79)
1·41
(1·17–1·62)
1·89
(1·66–2·09)
1·65
(1·40–1·87)
1·79
(1·58–1·98)
1·60
(1·37–1·82)
Zimbabwe 2·56
(2·12–3·01)
2·01
(1·52–2·51)
2·55
(2·11–3·00)
2·04 (1·55–2·53) 2·51
(2·09–2·95)
2·05
(1·57–2·56)
2·56
(2·12–3·01)
2·01
(1·52–2·51)
2·50
(2·08–2·94)
2·07
(1·59–2·58)
Western sub-Saharan Africa 3·03
(2·60–3·48)
1·89
(1·39–2·44)
2·40
(1·93–2·91)
1·85 (1·38–2·39) 2·49
(2·05–2·95)
1·80
(1·32–2·33)
3·04
(2·60–3·48)
1·94
(1·44–2·49)
2·08
(1·61–2·57)
1·83
(1·38–2·36)
Benin 3·12
(2·65–3·60)
1·58
(0·95–2·18)
2·26
(1·70–2·80)
1·55 (0·96–2·14) 2·33
(1·75–2·87)
1·46
(0·88–2·03)
3·12
(2·65–3·60)
1·78
(1·15–2·38)
1·81
(1·21–2·36)
1·66
(1·08–2·22)
Burkina Faso 3·76
(3·23–4·28)
1·62
(0·89–2·26)
2·12
(1·42–2·73)
1·53 (0·84–2·15) 3·20
(2·61–3·75)
1·62
(0·93–2·24)
3·76
(3·23–4·28)
1·82
(1·09–2·46)
1·95
(1·27–2·56)
1·75
(1·08–2·38)
Cabo Verde 1·09
(0·73–1·48)
0·91
(0·51–1·34)
1·07
(0·71–1·46)
0·94 (0·55–1·35) 1·08
(0·73–1·46)
0·95
(0·57–1·37)
1·29
(0·93–1·68)
1·11
(0·71–1·54)
1·26
(0·92–1·65)
1·17
(0·80–1·58)
Cameroon 2·44
(1·92–3·03)
1·71
(1·13–2·36)
2·35
(1·82–2·94)
1·74 (1·19–2·36) 2·12
(1·62–2·69)
1·69
(1·13–2·31)
2·44
(1·92–3·03)
1·91
(1·33–2·56)
2·06
(1·55–2·64)
1·92
(1·38–2·53)
Chad 4·81
(4·45–5·18)
2·15
(1·65–2·71)
3·04
(2·57–3·57)
2·10 (1·63–2·65) 3·28
(2·77–3·82)
1·73
(1·26–2·28)
4·81
(4·45–5·18)
2·15
(1·65–2·71)
2·26
(1·73–2·83)
1·77
(1·30–2·33)
Côte d’Ivoire 2·57
(2·11–3·04)
1·44
(0·87–1·99)
2·03
(1·53–2·53)
1·45 (0·93–1·98) 2·13
(1·65–2·63)
1·42
(0·91–1·94)
2·57
(2·11–3·04)
1·64
(1·07–2·19)
1·78
(1·28–2·29)
1·65
(1·15–2·18)
The Gambia 2·21
(1·81–2·61)
1·37
(0·92–1·87)
1·88
(1·49–2·33)
1·41 (0·98–1·88) 1·73
(1·31–2·18)
1·25
(0·81–1·73)
2·21
(1·81–2·61)
1·57
(1·12–2·07)
1·75
(1·33–2·21)
1·50
(1·08–1·97)
Ghana 2·12
(1·57–2·71)
1·57
(0·97–2·20)
2·04
(1·48–2·63)
1·57 (0·98–2·19) 1·81
(1·26–2·39)
1·51
(0·92–2·13)
2·12
(1·57–2·71)
1·77
(1·17–2·40)
1·76
(1·20–2·34)
1·71
(1·14–2·32)
Guinea 3·02
(2·58–3·43)
1·42
(0·81–2·00)
2·02
(1·44–2·54)
1·40 (0·81–1·95) 2·20
(1·62–2·70)
1·28
(0·70–1·80)
3·02
(2·58–3·43)
1·62
(1·01–2·20)
1·81
(1·23–2·33)
1·49
(0·95–2·01)
Guinea-Bissau 2·41
(1·88–2·91)
1·26
(0·63–1·86)
1·80
(1·23–2·35)
1·30 (0·72–1·87) 2·01
(1·47–2·54)
1·25
(0·68–1·82)
2·41
(1·88–2·91)
1·46
(0·83–2·06)
1·81
(1·26–2·37)
1·51
(0·97–2·07)
Liberia 2·10
(1·52–2·71)
1·47
(0·85–2·14)
1·94
(1·34–2·58)
1·52 (0·91–2·18) 1·83
(1·25–2·45)
1·45
(0·85–2·11)
2·10
(1·52–2·71)
1·67
(1·05–2·34)
1·77
(1·18–2·41)
1·70
(1·11–2·36)
Mali 4·21
(3·83–4·63)
1·85
(1·30–2·42)
2·42
(1·86–3·01)
1·70 (1·15–2·28) 3·37
(2·87–3·88)
1·79
(1·26–2·33)
4·21
(3·83–4·63)
1·85
(1·30–2·42)
2·12
(1·56–2·70)
1·89
(1·35–2·49)
(Table 2 continues on next page)

Articles
www.thelancet.com Published online March 20, 2024 https://doi.org/10.1016/S0140-6736(24)00550-6
31
that the number will be 155 (76·0%). By 2100, the
two models reach similar conclusions globally, with
197 countries and territories (96·6%) projected by
WPP to reach TFR below replacement level and
198 (97·1%) predicted by our model.
We validated the IHME model over the period 2007–21
using a forecasting skill metric based on RMSE values.
The predicted values for our ASFR forecasts were
compared with our final GBD 2021 estimates to compute
RMSE values across locations for each 5-year age group.
Our model had a positive skill value across all age groups,
indicating that it is better than the baseline model (here,
simply holding 2007 ASFR values constant over the
period 2007–21). The lowest skill value was 0·15 (age
30–34 years), and the highest skill value was 0·46 (age
45–49 years; appendix 1 figure S3).
Discussion
Main findings
This study presents comprehensive estimates of past and
future trends in fertility in 204 countries and territories
from 1950 to 2100. We broadly found that human
civilisation is rapidly converging on a sustained low-
fertility reality, although comparatively high fertility rates
in low-income regions, particularly in a subset of countries
and territories in western and eastern sub-Saharan Africa,
will result in a demographically divided world. As much of
the planet contends with challenges related to low fertility,
many low-income countries will still be facing issues
associated with high fertility during the 21st century.
Overall, fertility has declined steadily at the global level
and across almost all countries and territories since 1950
and is likely to continue to do so until 2100, from a global
TFR of more than 4·8 births per female in 1950 to
approximately 2·2 in 2021, with TFRs of approximately
1·8 and 1·6 projected in our reference scenario in
2050 and 2100, respectively. Only six of 204 countries and
territories (Samoa, Somalia, Tonga, Niger, Chad, and
Tajikistan) are projected to have above-replacement levels
of fertility by 2100, and only 26 will still have a positive rate
of natural increase (ie, the number of births will exceed
the number of deaths).
Historically, fertility rates have varied dramatically
between GBD super-regions, with the highest rates in
sub-Saharan Africa and the lowest in the high-income
super-region (eg, TFR of approximately 4·3 vs 1·5 in 2021),
driven by many factors, such as wealth, education, and
sociocultural behaviours and practices.39,40 By 2100, TFRs
will continue to dier, but to a smaller extent, from just
over 1·8 in sub-Saharan Africa to approximately
1·1 in south Asia, all converging well below replacement
levels. Patterns in livebirths will shift dramatically over
the coming century, with the proportion of livebirths
occurring in sub-Saharan Africa increasing from less
than 30% in 2021 to almost 55% in 2100. Likewise, we
forecast that the proportion of livebirths occurring in the
World Bank low-income group will increase from just
under 18% in 2021 to 35% in 2100. The proportion of
global livebirths in the low-income and lower-middle-
income groups combined will surpass 77% by 2100.
Implications of sustained low fertility
The aforementioned changes in fertility over the coming
century will have profound eects on populations,
economies, geopolitics, food security, health, and the
environment, with a clear demographic divide between
the impacts on many middle-to-high-income locations
versus many low-income locations. For nearly all
countries and territories outside of sub-Saharan Africa,
sustained low fertility will produce a contracting
Reference scenario Education SDG achieved Contraceptive met need
SDG achieved
Pro-natal policies enacted Combined scenario
2050 2100 2050 2100 2050 2100 2050 2100 2050 2100
(Continued from previous page)
Mauritania 2·50
(1·98–3·08)
1·66
(1·04–2·34)
2·24
(1·68–2·85)
1·66 (1·07–2·32) 1·97
(1·40–2·57)
1·54
(0·95–2·19)
2·50
(1·98–3·08)
1·86
(1·24–2·54)
1·81
(1·23–2·43)
1·75
(1·17–2·39)
Niger 5·15
(4·68–5·64)
2·24
(1·48–2·92)
2·74
(2·00–3·40)
1·99 (1·28–2·64) 4·34
(3·75–4·89)
2·20
(1·50–2·85)
5·15
(4·68–5·64)
2·24
(1·48–2·92)
2·52
(1·83–3·17)
2·02
(1·36–2·67)
Nigeria 2·69
(2·06–3·31)
1·87
(1·19–2·54)
2·54
(1·88–3·17)
1·90 (1·22–2·56) 2·25
(1·63–2·82)
1·78
(1·12–2·43)
2·69
(2·06–3·31)
1·87
(1·19–2·54)
2·16
(1·53–2·76)
1·81
(1·15–2·46)
São Tomé and Príncipe 1·77
(1·29–2·28)
1·37
(0·83–1·94)
1·67
(1·18–2·19)
1·38 (0·87–1·93) 1·61
(1·12–2·12)
1·35
(0·83–1·90)
1·77
(1·29–2·28)
1·57
(1·03–2·14)
1·74
(1·25–2·26)
1·57
(1·06–2·11)
Senegal 2·32
(1·79–2·79)
1·25
(0·60–1·83)
1·66
(1·08–2·18)
1·24 (0·62–1·80) 1·98
(1·44–2·48)
1·26
(0·67–1·79)
2·32
(1·79–2·79)
1·45
(0·80–2·03)
1·70
(1·14–2·22)
1·45
(0·88–1·97)
Sierra Leone 2·43
(1·99–2·85)
1·31
(0·78–1·82)
1·78
(1·27–2·28)
1·28 (0·76–1·80) 2·04
(1·59–2·47)
1·29
(0·77–1·80)
2·43
(1·99–2·85)
1·51
(0·98–2·02)
1·79
(1·29–2·29)
1·49
(0·97–2·02)
Togo 2·01
(1·61–2·42)
1·24
(0·79–1·72)
1·75
(1·32–2·18)
1·28 (0·84–1·74) 1·65
(1·24–2·08)
1·21
(0·78–1·67)
2·01
(1·61–2·42)
1·44
(0·99–1·92)
1·69
(1·26–2·14)
1·45
(1·03–1·90)
Numbers in parentheses are 95% uncertainty intervals. Super-regions, regions, and countries are listed in alphabetical order. SDG=Sustainable Develop ment Goal.
Table 2: Total fertility rate for the reference scenario and four alternative scenarios by location, 2050 and 2100

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population with fewer young people relative to older
people before the end of the 21st century. These changes
in age structure are likely to present considerable
economic challenges caused by a growing dependency
ratio of older to working-age population and a shrinking
labour force.41,42 Unless governments identify unforeseen
innovations or funding sources that address the
challenges of population ageing, this demographic shift
will put increasing pressure on national health insurance,
social security programmes, and health-care infra-
structure. These same programmes will receive less
funding as working-age, tax-paying populations decline,
further exacerbating the problem.43,44
Sustained low fertility rates might likewise lead to
labour shortages in some sectors, potentially hindering
economic growth. If productivity per working-aged adult
does not increase in accordance with declines in the
working-age population, growth in gross domestic
product will slow.4 Reliance on immigrants will become
increasingly necessary to sustain economic growth in
low-fertility countries.45 The shifting global distribution
of livebirths, with a higher proportion occurring in
current lower-income countries, could make immigration
a viable way to address these issues. However, this
approach will only work if there is a shift in current
public and political attitudes towards immigration in
many lower-fertility countries and if there are sucient
incentives in place for people to migrate from higher-
fertility countries. Continued skilled worker migration to
high-income, low-fertility economies—a concept referred
to as brain drain—can also have devastating eects on
the economies these workers leave behind.46,47 This
underscores the importance of developing ethical and
eective immigration policies with global cooperation.
Aside from immigration, innovations to the labour force,
such as advancements in artificial intelligence and
robotics, could reduce the economic eects of changes in
age structure, but the potential landscape is dicult to
predict and would undoubtedly vary between nations.48
Furthermore, shifts in productivity in older ages, years of
education required to participate fully in certain sectors
of the workforce, the proportion of people who could give
birth in the workforce, the ability to fulfil fertility
intentions in older ages, and other factors could also
aect the impact of ageing on economic growth, but
these are likewise complex, and the impacts are largely
unknown and beyond the scope of this study to consider.
To date, one strategy to reverse declining fertility in low-
fertility settings has been to implement pro-natal policies,
such as child-related cash transfers and tax incentives,
childcare subsidies, extended parental leave, re-
employment rights, and other forms of support for
parents to care and pay for their children.49,50 Yet there are
few data to show that such policies have led to strong,
sustained rebounds in fertility, with empirical evidence
suggesting an eect size of no more than 0·2 additional
livebirths per female.51,52 The pro-natal alternative scenario
we present here thus assumes that pro-natal policies will
be implemented once the TFR of a country or territory
falls below 1·75 and that the eect will be to increase TFR
by 0·2 births per female 5 years later. Under this scenario,
we project a global TFR of 1·68 in 2100 compared with
1·59 in the reference scenario. This modest increase
suggests that even under optimistic assumptions on the
impact of pro-natal policies based on current data, global
TFR will remain low—and well below replacement
level—up to 2100. Nevertheless, our pro-natal scenario
forecasts also suggest that pro-natal policies might
prevent some countries from dropping below very-low
(<1·6 TFR) or the lowest-low (<1·3 TFR) fertility in the
future. We projected that 64 fewer countries and
territories would fall below lowest-low fertility levels
in 2100 in the pro-natal scenario compared with the
reference scenario (30 vs 94). Moreover, although pro-
natal policies primarily aim to increase births, they also
oer additional benefits to society, including better quality
of life, greater household gender equality (ie, more equal
division of household labour),53 higher rates of female
labour force participation,54 lower child-care costs,55 and
better maternal health outcomes,56 depending on policy
design and contextual factors. In the future, it will be
beneficial to perform an in-depth analysis on varying
impacts of pro-natal policies in selected countries that
have a meaningful impact on population.
Importantly, low fertility rates and the modest eects
that pro-natal policies might have on them should not be
used to justify more draconian measures that limit
reproductive rights, such as restricting access to modern
contraceptives or abortions. For example, in Romania
during and in the aftermath of severely restricting
abortions and the sale of contraceptives in the 1960s–80s,
coercive policies led to dramatic increases in maternal
mortality rates from illegal abortions; large numbers of
children placed in orphanages; harmful, long-lasting
eects on the labour market and educational outcomes
for the population born under the restrictions; and other
negative impacts, including long-term trauma to women
and children.6,57,58 Access to modern contraceptives is not
only fundamental to the principles of basic human rights
and reproductive justice, but also has demonstrated
positive eects on the economy; contraceptive access and
use is positively associated with formal labour force
participation and higher incomes.59–63
Although sustained below-replacement fertility will
pose serious potential challenges for much of the world
over the course of the century, it also presents
opportunities for environmental progress. Alongside
strong pro-environmental regulations, a smaller global
population in the future could alleviate some strain on
global food systems, fragile environments, and other
finite resources, and also reduce carbon emissions.64–69 A
2012 study suggests that if global population were to
follow a low-growth rather than a medium-growth path,
worldwide carbon emissions would be 15% lower by 2050

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33
and 40% lower by 2100.70 The 2023 Intergovernmental
Panel on Climate Change (IPCC) report likewise suggests
that low population growth (a result of low fertility) is an
important factor in limiting global warming.71 However,
increasing consumption per capita due to economic
development could oset the benefits of smaller
populations.72,73
Implications of the changing global distribution of
livebirths
While the world faces the challenges that arise from
sustained low fertility in most locations, it will
simultaneously be confronted with challenges that arise
from the concentration of the world’s livebirths shifting
from middle-to-high-income towards low-income
countries and territories. In the coming decades, the
majority of children will be born in some of the poorest
regions of the world, with the proportion of global
livebirths almost doubling in low-income countries and
territories (as defined by the World Bank) between
2021 and 2100, from 18% to 35%. Sub-Saharan Africa is
projected to contribute over half of the world’s livebirths—
more than 54%—by 2100, up from approximately
29% in 2021. Countries in eastern and western
sub-Saharan Africa, many in the Sahel, are projected to be
primary drivers of livebirths by 2100, but considerable
heterogeneity exists across countries within these regions.
Child mortality rates are disproportionately high in low-
income settings, with the highest rates in western
sub-Saharan Africa (at more than 85 deaths per 1000
among children younger than 5 years in 2021 compared
with approximately 35 per 1000 at the global level).74 Thus,
this shift in fertility and livebirths from higher-income to
lower-income settings will make the challenge of
continued progress on improving health outcomes—
particularly child mortality—even more dicult.
Many higher-fertility, low-income countries will also
face increasingly frequent droughts, flooding, and
extreme heat as climate change worsens.71 All of these
aspects of climate change threaten food, water, and other
resource security and dramatically increase the risk of
heat-related illness and death.71,75–78 For example, the IPCC
projects substantial declines in crop yields across many
low-income settings due to climate change, including a
20–40% decrease in millet yield in the Sahel region in
response to a potential 30-year mean increase of 2–3°C in
maximum temperature.79,80 Population growth will only
worsen the growing strain on food supplies in this region
in the future.81 Food and resource scarcity, along with
several other issues including the long legacy of
colonialism, contribute to political instability and
security issues in some vulnerable areas. Between
January, 2020, and July, 2023, there were coups in
six Sahel nations82 and, in 2022, 43% of all global
terrorism deaths occurred in this region.83 Broadly, over
the coming decades, the majority of livebirths will
become concentrated in the areas of the world that are
most vulnerable to climate change, resource insecurity,
political instability, poverty, and child mortality. High
numbers of births in these regions will further strain all
areas of vulnerability.
Our projections suggest that improving access to
modern contraceptives and female education—the
two primary drivers of fertility4,84–86—would reduce
fertility rates in higher-fertility countries and territories,
limiting the increasing concentration of livebirths in
these areas. We project that in sub-Saharan Africa,
achieving universal female education or universal
contraceptive met need by 2030 would each result in
TFRs of approximately 2·3 in 2050, compared with
approximately 2·7 in the reference scenario. By
combining universal access to both drivers of fertility,
plus an increase in TFR of 0·2 in locations with a TFR
less than 1·75 from the pro-natal scenario (which will not
apply to most locations in this super-region until
almost 2100, if at all), our combined scenario highlights
opportunities for even larger declines in fertility to
2·03 in sub-Saharan Africa in 2050. Although we project
that global TFRs will eventually converge to 1·52–1·68
in 2100 across the reference and three alternative
scenarios, the considerably steeper fertility declines in
the next several decades achieved through the rapid
scale-up of education and contraceptive access would
reduce the number of livebirths in sub-Saharan Africa
in 2100. For the highest-fertility countries, the
opportunities are even greater; in Niger, for example, our
reference scenario forecasts a TFR of 5·15 (95% UI
4·68–5·64) in 2050 versus 2·74 (2·00–3·40) in the
education SDG target scenario, 4·34 (3·75–4·89) in the
contraceptive SDG target scenario, and 2·52 (1·83–3·17)
in the combined scenario. Although achieving both SDG
targets in all locations by 2030 is likely to be unattainable,
our SDG-related scenarios demonstrate that increasing
levels of access to female education and contraceptives in
higher-fertility countries will result in fewer individuals
in the future being born into severely heat-stressed,
politically fragile, economically weak environments.
Policy makers can and should use these projections to
inform priorities.
In addition to its direct impact on fertility rates,
expanding female access to education and contraceptives
has important societal benefits. First, access to education
contributes to women’s empowerment: the process
through which women gain the freedom to make their
own choices and the opportunity to participate fully in
society.87 Quality education increases the knowledge,
skills, and self-confidence needed to challenge traditional
gender roles, and equips women to make more informed
decisions about their health, careers, and lives as a
whole.88–90 It also improves women’s decision-making
power in the household and lowers their risk of exposure
to abuse in the home.87,90–92 Furthermore, higher female
educational attainment is associated with higher paid
labour-force participation and higher wages. In fact, the

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financial returns on female education exceed those of
males (which is not to say that earnings are higher for
females; they remain lower for females at the same level
of education), as do the returns in low-income settings
compared with high-income settings, making female
education a valuable personal and societal investment.93
Finally, universal access to modern contraceptives and
education are fundamental human rights that the world
should be working towards for all populations regardless
of their outcomes on fertility, society, and the economy.
Comparisons with estimates from WPP 2022
TFR estimates from 1950 to 2021 generated by UN
Population Division WPP 2022 generally align with the
estimates produced by our model in countries with high-
quality vital registration data (appendix 2 figure S5).
However, estimates dier in some locations with less
reliable data sources, particularly in the sub-Saharan Africa
and north Africa and the Middle East super-regions. This
is mostly due to dierences in data sources used and data
processing steps. For example, in locations without vital
registration data, our methods use complete birth
histories as a reference source and correspondingly
adjust the estimates of sources such as summary birth
histories that do not give information on fertility by
mother’s age. By contrast, estimates from WPP 2022
more closely follow estimates from these less reliable
sources. This process aects estimates in countries for
which the most recent data come from summary birth
histories, leading to dierences in recent time trends
that can heavily influence forecasts. For example, in
South Sudan, we estimated a decline in TFR from 5·98
(95% UI 5·61–6·33) in 2000 to 5·45 (5·04–5·87) in 2021,
compared with the WPP estimates of a decline from
7·51 (6·99–8·09) in 2000 to 4·47 (3·42–5·76) in 2021.
Other countries in which there are large discrepancies
in 2021 estimates from the two models include the
Democratic Republic of the Congo and Central African
Republic.
In a comparison between our IHME model forecasts
and those of the WPP 2022 revision, we found that the
WPP global TFR forecasts were higher throughout the
2022–2100 period and the country-level TFR forecasts
converged to a much narrower range in 2100 than the
projections from our model (appendix 2 figure S6).
Broadly, for countries with low fertility levels, WPP
predicts that fertility rates will rebound, whereas our
projections suggest they will remain low or decline. The
higher TFRs predicted by WPP are primarily a reflection
of dierences in how post-transition countries were
modelled. The WPP forecasting methodology is based in
demographic transition theory and assumes that all
countries follow the historically observed three-phase
pattern of fertility.14 However, there is some evidence that
current higher-fertility countries—especially those in
sub-Saharan Africa—have experienced fertility patterns
that do not perfectly reflect these phases, such as periods
with stalling declines.94,95 Our method does not make this
structural assumption. Furthermore, WPP denotes a
country moving from phase II (fertility decline) to
phase III (low-fertility post-transition) when it
experiences two successive periods of TFR increase after
falling below a TFR of 2·0. This threshold of 2·0 might
not hold in the future for all countries. In fact, our
estimates in Seychelles show a transition into phase III
after a TFR of 2·04 (95% UI 1·95–2·12). Due to these
assumptions, WPP reference forecasts in all locations
might rely too heavily on the fertility patterns of a subset
of low-fertility countries that have experienced increases
in TFR.
Limitations
This study has a number of limitations, many of which
are related to data availability and quality. First, sparsity of
recent census data and lags between censuses aected the
availability of birth history data for certain locations. This
absence of data means that past fertility estimates in some
locations—particularly countries in sub-Saharan Africa as
well as others such as Afghanistan, Haiti, Syria, and
Yemen—were based on modelled projections. Similarly,
the absence of high-quality vital registration systems
aected the precision of fertility estimates in many
locations, resulting in large UIs. This eect was especially
apparent during the 2020–21 COVID-19 pandemic period,
during which reporting from vital registration systems
was particularly limited and delayed. Furthermore, our
forecasts rely on past time-series data not only for fertility,
but also the drivers of fertility, such as met need for
contraceptives. These data were not always available for
each location, and even when they were, they were only
available as far back as 1970.
Second, we made several simplifying assumptions in
the modelling of past fertility. Due to sparse data, we
estimated fertility in the age groups of 10–14 years and
50–54 years solely based on neighbouring age groups
using data from locations with complete vital registration
data. Other factors could be driving fertility rates in these
age groups that are not captured in the available data, but
the eect of our models for these age groups on TFR is
minimal. We compared the TFR in 2021 calculated with
and without these age groups across GBD regions and
found that the maximum dierence was 0·03 (95% UI
0·02–0·04; appendix 2 table S3). Additionally, estimates
of uncertainty were simplified due to computational
resource constraints. Uncertainty for some covariates was
not propagated through our analytical process, including
female educational attainment and lag-distributed
income in our first-stage regression model. Furthermore,
we do not account for correlations between locations
when producing geographical aggregate values, which
might underestimate uncertainty because estimates in
nearby locations are likely to have positive correlation. We
could improve accuracy of UIs in the future by accounting
for correlations when aggregating estimates.

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35
Third, our forecasting analysis modelled
four covariates as potential drivers of fertility: female
educational attainment, contraceptive met need,
population density in habitable areas, and under-5
mortality. This method contrasts with non-causal time-
series models by UN Population Division, in which
time is the only driver of fertility and no covariates are
used. Our inclusion of covariates can be considered
both a strength and a limitation.13,96,97 Explicitly modelling
associations between drivers and outcomes requires us
to separately forecast future trends for each driver,
which has advantages in that we capture potentially
important eects and can vary covariate levels to model
fertility outcomes of policy choices related, for example,
to education or contraception. However, modelling such
associations also presents a challenge in that accurate
fertility forecasts rely heavily on accurately forecasting
each of these independent drivers into the future.
Although we have not studied mechanisms by which
our covariates impact fertility, living in urban areas may
give better access to education, family planning services,
and employment opportunities for women, all of which
are associated with lower fertility.98
Fourth, more research is needed on determinants of
fertility in low-fertility locations; most of the dierence
between our forecasts and those produced by the UN
Population Division WPP 2022 are due to the projected
level of fertility to which locations ultimately converge
after dropping below replacement levels. Our use of
CCF50 captures the eects of age-related declines in
each cohort of females.
Fifth, we encountered a range of additional limitations
specific to our forecasting models. All long-range
forecasting models, regardless of the modelling strategy,
face the challenge that the past is not always predictive of
the future—ie, there will be potential changes in the
future that cannot be predicted. Also, we applied the pro-
natal scenario to all locations even if the location has
already implemented pro-natal policies, such as Australia,
Japan, South Korea, and countries in Scandinavia. We
further describe this in appendix 1 (section 3.2–3.3).
Additionally, we did not incorporate into any scenarios
the possibility that certain locations could exceed their
capacity to feed their people. In most locations, any
insuciencies in domestic food production could be
solved by importing food. But for several countries with
growing food production concerns71,99 that are forecast to
have large population growth and remain low income—
including Niger, Chad, and South Sudan—it is possible
that our forecast levels of fertility will be unsustainable
due to food insecurity. Finally, due to paucity of data, we
did not define the pro-natal scenario based on a specific
policy or policies that have a known impact on fertility
rates. Rather, we considered policies such as paid parental
leave, the right to return to work, and subsidised or
universal childcare as pro-natal—in other words, policies
that have been enacted in countries such as Australia,
Sweden, Denmark, Norway, Finland, and elsewhere that
are thought of as making it more financially feasible to
have children.
Conclusions
Fertility rates have declined dramatically around the
world since 1950 and will continue to decline in almost
all countries and territories up to 2100. While human
civilisation is converging on a sustained low-fertility
reality, comparatively high fertility rates in some low-
income countries and territories will result in a clear
demographic divide between a subset of low-income
countries and the rest of the world. On one side,
sustained low fertility rates—and a resulting contraction
and ageing of the population—will lead to serious
economic challenges and increasing pressure on health
systems, social security programmes, and the labour
force. On the other hand, a dramatic shift in the
concentration of livebirths from middle-income and
high-income settings to low-income settings will lead to
serious challenges related to sustaining and supporting a
growing young population in some of the most heat-
stressed, politically unstable, economically vulnerable,
health system-strained locations. In low-fertility settings,
implementing pro-natal policies that support parents
and children might provide a small boost to fertility rates,
whereas in higher-fertility settings, rapidly expanding
access to female education and contraceptives will
accelerate declines in fertility and lessen the concentration
of livebirths in these locations. Future trends in fertility
rates and livebirths will propagate shifts in global
population dynamics, driving changes to international
relations and a geopolitical environment, and
highlighting new challenges in migration and global aid
networks. All of these issues will necessitate focused and
collaborative work to address.
GBD 2021 Fertility and Forecasting Collaborators
Natalia V Bhattacharjee*, Austin E Schumacher*, Amirali Aali,
Yohannes Habtegiorgis Abate, Rouzbeh Abbasgholizadeh,
Mohammadreza Abbasian, Mohsen Abbasi-Kangevari,
Hedayat Abbastabar, Samar Abd ElHafeez, Sherief Abd-Elsalam,
Mohammad Abdollahi, Mohammad-Amin Abdollahifar,
Meriem Abdoun, Auwal Abdullahi, Mesfin Abebe,
Samrawit Shawel Abebe, Olumide Abiodun, Hassan Abolhassani,
Meysam Abolmaali, Mohamed Abouzid, Girma Beressa Aboye,
Lucas Guimarães Abreu, Woldu Aberhe Abrha, Michael R M Abrigo,
Dariush Abtahi, Hasan Abualruz, Bilyaminu Abubakar,
Eman Abu-Gharbieh, Niveen ME Abu-Rmeileh,
Tadele Girum Girum Adal, Mesafint Molla Adane,
Oluwafemi Atanda Adeagbo Adeagbo, Rufus Adesoji Adedoyin,
Victor Adekanmbi, Bashir Aden, Abiola Victor Adepoju,
Olatunji O Adetokunboh, Juliana Bunmi Adetunji,
Daniel Adedayo Adeyinka, Olorunsola Israel Adeyomoye,
Qorinah Estiningtyas Sakilah Adnani, Saryia Adra, Rotimi Felix Afolabi,
Shadi Afyouni, Muhammad Sohail Afzal, Saira Afzal, Shahin Aghamiri,
Antonella Agodi, Williams Agyemang-Duah, Bright Opoku Ahinkorah,
Austin J Ahlstrom, Aqeel Ahmad, Danish Ahmad, Firdos Ahmad,
Muayyad M Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmed,
Ayman Ahmed, Haroon Ahmed, Luai A Ahmed, Meqdad Saleh Ahmed,
Syed Anees Ahmed, Marjan Ajami, Budi Aji, Gizachew Taddesse Akalu,
Hossein Akbarialiabad, Rufus Olusola Akinyemi,

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Mohammed Ahmed Akkaif, Sreelatha Akkala, Hanadi Al Hamad,
Syed Mahfuz Al Hasan, Mohammad Al Qadire,
Tareq Mohammed Ali AL-Ahdal, Samer O Alalalmeh, Tariq A Alalwan,
Ziyad Al-Aly, Khurshid Alam, Rasmieh Mustafa Al-amer,
Fahad Mashhour Alanezi, Turki M Alanzi, Almaza Albakri,
Mohammed Albashtawy, Mohammad T AlBataineh, Hediyeh Alemi,
Sharifullah Alemi, Yihun Mulugeta Alemu, Ayman Al-Eyadhy,
Adel Ali Saeed Al-Gheethi, Khalid F Alhabib, Noora Alhajri,
Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Abid Ali,
Beriwan Abdulqadir Ali, Liaqat Ali, Mohammed Usman Ali, Rafat Ali,
Syed Shujait Shujait Ali, Sheikh Mohammad Alif, Mohammad Aligol,
Mehran Alijanzadeh, Mohammad A M Aljasir, Syed Mohamed Aljunid,
Sabah Al-Marwani, Joseph Uy Almazan, Hesham M Al-Mekhlafi,
Omar Almidani, Mahmoud A Alomari, Basem Al-Omari,
Jaber S Alqahtani, Ahmed Yaseen Alqutaibi, Rajaa M Al-Raddadi,
Salman Khalifah Al-Sabah, Awais Altaf, Jaar A Al-Tawfiq,
Khalid A Altirkawi, Deborah Oyine Aluh, Farrukh Jawad Alvi,
Nelson Alvis-Guzman, Hassan Alwafi, Yaser Mohammed Al-Worafi,
Hany Aly, Safwat Aly, Karem H Alzoubi, Edward Kwabena Ameyaw,
Tarek Tawfik Amin, Alireza Amindarolzarbi, Mostafa Amini-Rarani,
Sohrab Amiri, Irene Gyamfuah Ampomah, Dickson A Amugsi,
Ganiyu Adeniyi Amusa, Robert Ancuceanu, Deanna Anderlini,
Pedro Prata Andrade, Catalina Liliana Andrei, Tudorel Andrei,
Abhishek Anil, Sneha Anil, Adnan Ansar, Alireza Ansari-Moghaddam,
Catherine M Antony, Ernoiz Antriyandarti, Saeid Anvari, Saleha Anwar,
Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo,
Razman Arabzadeh Bahri, Elshaimaa A Arafa, Mosab Arafat, Ana
Margarida Araújo, Aleksandr Y Aravkin, Abdulfatai Aremu, Timur
Aripov, Mesay Arkew, Benedetta Armocida, Johan Ärnlöv, Mahwish
Arooj, Anton A Artamonov, Judie Arulappan, Raphael Taiwo Aruleba,
Ashokan Arumugam, Mohsen Asadi-Lari, Zatollah Asemi, Saeed Asgary,
Mona Asghariahmadabad, Mohammad Asghari-Jafarabadi, Mubarek
Yesse Ashemo, Muhammad Ashraf, Tahira Ashraf, Marvellous O Asika,
Seyyed Shamsadin Athari, Maha Moh’d Wahbi Atout, Alok Atreya,
Avinash Aujayeb, Marcel Ausloos, Abolfazl Avan, Amlaku Mulat Aweke,
Getnet Melaku Ayele, Seyed Mohammad Ayyoubzadeh,
Sina Azadnajafabad, Rui M S Azevedo, Ahmed Y Azzam,
Muhammad Badar, Ashish D Badiye, Soroush Baghdadi,
Nasser Bagheri, Sara Bagherieh, Najmeh Bahmanziari, Ruhai Bai,
Atif Amin Baig, Jennifer L Baker, Abdulaziz T Bako,
Ravleen Kaur Bakshi, Madhan Balasubramanian,
Ovidiu Constantin Baltatu, Kiran Bam, Maciej Banach,
Soham Bandyopadhyay, Biswajit Banik, Palash Chandra Banik,
Hansi Bansal, Mehmet Firat Baran, Martina Barchitta, Mainak Bardhan,
Erfan Bardideh, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen,
Francesco Barone-Adesi, Hiba Jawdat Barqawi, Amadou Barrow,
Sandra Barteit, Zarrin Basharat, Asma’u I J Bashir,
Hameed Akande Bashiru, Afisu Basiru, João Diogo Basso, Sanjay Basu,
Abdul-Monim Mohammad Batiha, Kavita Batra, Bernhard T Baune,
Mohsen Bayati, Tahmina Begum, Emad Behboudi,
Amir Hossein Behnoush, Maryam Beiranvand,
Diana Fernanda Bejarano Ramirez, Alehegn Bekele,
Sefealem Assefa Belay, Uzma Iqbal Belgaumi, Michelle L Bell,
Olorunjuwon Omolaja Bello, Apostolos Beloukas, Isabela M Bensenor,
Zombor Berezvai, Alemshet Yirga Berhie, Amiel Nazer C Bermudez,
Paulo J G Bettencourt, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj,
Pankaj Bhardwaj, Prarthna V Bhardwaj, Sonu Bhaskar, Vivek Bhat,
Gurjit Kaur Bhatti, Jasvinder Singh Bhatti, Manpreet S Bhatti,
Rajbir Bhatti, Antonio Biondi, Catherine Bisignano, Atanu Biswas,
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Shayom Debopadhaya, Somayeh Delavari, Ivan Delgado-Enciso,
Dessalegn Demeke, Berecha Hundessa Demessa, Xinlei Deng,
Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis,
Hardik Dineshbhai Desai, Rupak Desai,
Vinoth Gnana Chellaiyan Devanbu, Arkadeep Dhali, Kuldeep Dhama,
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Robert Kokou Dowou, Ashel Chelsea Dsouza, Haneil Larson Dsouza,
Viola Dsouza, John Dube, Joe Duprey, Andre Rodrigues Duraes,
Senbagam Duraisamy, Oyewole Christopher Durojaiye, Sulagna Dutta,
Laura Dwyer-Lindgren, Paulina Agnieszka Dzianach,
Arkadiusz Marian Dziedzic, Alireza Ebrahimi, Hisham Atan Edinur,
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Michael Ekholuenetale, Maha El Tantawi, Noha Mousaad Elemam,
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Ramy Mohamed Ghazy, Sailaja Ghimire, Asadollah Gholamian,
Ali Gholamrezanezhad, Mahsa Ghorbani, Aloke Gopal Ghoshal,
Arun Digambarrao Ghuge, Artyom Urievich Gil, Tiany K Gill,
Matteo Giorgi, Alem Girmay, James C Glasbey, Laszlo Göbölös,
Amit Goel, Ali Golchin, Mahaveer Golechha, Pouya Goleij,
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37
Najah R Hadi, Nils Haep, Ramtin Hajibeygi, Sebastian Haller,
Rabih Halwani, Randah R Hamadeh, Nadia M Hamdy, Sajid Hameed,
Samer Hamidi, Qiuxia Han, Alexis J Handal, Graeme J Hankey,
Md Nuruzzaman Haque, Josep Maria Haro, Ahmed I Hasaballah,
Ikramul Hasan, Mohammad Jahid Hasan, S M Mahmudul Hasan,
Hamidreza Hasani, Md Saquib Hasnain, Amr Hassan, Ikrama Hassan,
Soheil Hassanipour, Hadi Hassankhani, Simon I Hay, Jerey J Hebert,
Omar E Hegazi, Mohammad Heidari, Bartosz Helfer, Mehdi Hemmati,
Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Kamran Hessami,
Kamal Hezam, Yuta Hiraike, Nguyen Quoc Hoan, Ramesh Holla,
Nobuyuki Horita, Md Mahbub Hossain,
Mohammad Bellal Hossain Hossain, Hassan Hosseinzadeh,
Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc,
Mohamed Hsairi, Vivian Chia-rong Hsieh, Chengxi Hu, Junjie Huang,
M Mamun Huda, Ayesha Humayun, Javid Hussain, Nawfal R Hussein,
Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye,
Pulwasha Maria Iftikhar, Olayinka Stephen Ilesanmi, Irena M Ilic,
Milena D Ilic, Mustapha Immurana, Leeberk Raja Inbaraj, Afrin Iqbal,
Md. Rabiul Islam, Nahlah Elkudssiah Ismail, Hiroyasu Iso,
Gaetano Isola, Masao Iwagami, Mahalaxmi Iyer, Linda Merin J,
Jalil Jaafari, Louis Jacob, Farhad Jadidi-Niaragh, Khushleen Jaggi,
Kasra Jahankhani, Nader Jahanmehr, Haitham Jahrami, Akhil Jain,
Nityanand Jain, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic,
Elham Jamshidi, Sabzali Javadov, Tahereh Javaheri,
Sathish Kumar Jayapal, Shubha Jayaram, Sun Ha Jee,
Jayakumar Jeganathan, Anil K Jha, Ravi Prakash Jha, Heng Jiang,
Mohammad Jokar, Jost B Jonas, Tamas Joo, Nitin Joseph,
Charity Ehimwenma Joshua, Farahnaz Joukar, Jacek Jerzy Jozwiak,
Mikk Jürisson, Vaishali K, Billingsley Kaambwa, Abdulkareem Kabir,
Ali Kabir, Hannaneh Kabir, Zubair Kabir, Rizwan Kalani,
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Molly B Kassel, Joonas H Kauppila, Foad Kazemi, Sara Kazeminia,
John H Kempen, Evie Shoshannah Kendal, Kamyab Keshtkar,
Mohammad Keykhaei, Himanshu Khajuria, Amirmohammad Khalaji,
Nauman Khalid, Anees Ahmed Khalil, Alireza Khalilian,
Faham Khamesipour, Ajmal Khan, Asaduzzaman Khan,
Ikramullah Khan, M Nuruzzaman Khan, Maseer Khan,
Mohammad Jobair Khan, Moien AB Khan, Young-Ho Khang,
Shaghayegh Khanmohammadi, Khaled Khatab, Armin Khavandegar,
Hamid Reza Khayat Kashani, Feriha Fatima Khidri, Moein Khormali,
Mohammad Ali Khosravi, Mahmood Khosrowjerdi,
Wondwosen Teklesilasie Kidane, Zemene Demelash Kifle,
Julie Sojin Kim, Min Seo Kim, Ruth W Kimokoti, Kasey E Kinzel,
Girmay Tsegay Kiross, Adnan Kisa, Sezer Kisa, Ali-Asghar Kolahi,
Farzad Kompani, Gerbrand Koren, Oleksii Korzh, Soewarta Kosen,
Sindhura Lakshmi Koulmane Laxminarayana, Kewal Krishan,
Varun Krishna, Vijay Krishnamoorthy, Barthelemy Kuate Defo,
Connor M Kubeisy, Burcu Kucuk Bicer, Md Abdul Kuddus,
Mohammed Kuddus, Ilari Kuitunen, Mukhtar Kulimbet, Harish Kumar,
Satyajit Kundu, Kunle Rotimi Kunle, Om P Kurmi, Asep Kusnali,
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Chandrakant Lahariya, Daphne Teck Ching Lai, Dharmesh Kumar Lal,
Ratilal Lalloo, Judit Lám, Demetris Lamnisos, Iván Landires,
Francesco Lanfranchi, Berthold Langguth, Ariane Laplante-Lévesque,
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Kamaluddin Latief, Kaveh Latifinaibin, Long Khanh Dao Le,
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Kashish Malhotra, Ahmad Azam Malik, Iram Malik,
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Chernet Tafere Negesse, Ionut Negoi, Ruxandra Irina Negoi,
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Virginia Nuñez-Samudio, Dieta Nurrika, Jerry John Nutor,
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James Odhiambo Oguta, In-Hwan Oh, Sylvester Reuben Okeke,
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Patrick Godwin Okwute, Andrew T Olagunju, Omotola O Olasupo,
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Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya,
Gideon Olamilekan Oluwatunase, Hany A Omar, Goran Latif Omer,
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Olayinka Osuolale, Adrian Otoiu, Stanislav S Otstavnov, Amel Ouyahia,
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Mahesh Padukudru P A, Mohammad Taha Pahlevan Fallahy, Feng Pan,
Hai-Feng Pan, Adrian Pana, Paramjot Panda, Songhomitra Panda-Jonas,
Helena Ullyartha Pangaribuan, Georgios D Panos, Leonidas D Panos,
Ioannis Pantazopoulos, Anca Mihaela Pantea Stoian, Romil R Parikh,
Seoyeon Park, Ashwaghosha Parthasarathi, Ava Pashaei,
Roberto Passera, Hemal M Patel, Jay Patel, Shankargouda Patil,
Dimitrios Patoulias, Venkata Suresh Patthipati, Uttam Paudel,
Mihaela Paun, Hamidreza Pazoki Toroudi, Spencer A Pease,
Amy E Peden, Paolo Pedersini, Minjin Peng, Umberto Pensato,
Veincent Christian Filipino Pepito, Prince Peprah, Gavin Pereira,
Mario F P Peres, Arokiasamy Perianayagam, Norberto Perico,
Simone Perna, Richard G Pestell, Fanny Emily Petermann-Rocha,
Hoang Tran Pham, Anil K Philip, Daniela Pierannunzio,
Manon Pigeolet, David M Pigott, Evgenii Plotnikov, Dimitri Poddighe,
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Akram Pourshams, Naeimeh Pourtaheri, Disha Prabhu, Sergio I Prada,
Pranil Man Singh Pradhan, Manya Prasad, Akila Prashant,
Bharathi M Purohit, Jagadeesh Puvvula, Nameer Hashim Qasim,
Ibrahim Qattea, Deepthi R, Mehrdad Rabiee Rad, Amir Radfar,
Venkatraman Radhakrishnan, Pourya Raee, Hadi Raeisi Shahraki,
Alireza Rafiei, Seyedeh Niloufar Rafiei Alavi, Cat Raggi,
Pankaja Raghav Raghav, Fakher Rahim, Md Jillur Rahim,
Md. Mosfequr Rahman, Mohammad Hifz Ur Rahman, Mosiur Rahman,
Muhammad Aziz Rahman, Vahid Rahmanian,
Masoud Rahmati, Niloufar Rahnavard, Pramila Rai, Diego Raimondo,
Ali Rajabpour-Sanati, Prashant Rajput, Prasanna Ram,
Shakthi Kumaran Ramasamy, Juwel Rana, Kritika Rana,
Shailendra Singh Rana, Chhabi Lal Ranabhat, Nemanja Rancic,
Amey Rane, Shubham Ranjan, Chythra R Rao, Indu Ramachandra Rao,
Deepthi Rapaka, Davide Rasella, Sina Rashedi, Vahid Rashedi,
Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan,
Giridhara Rathnaiah Babu, Santosh Kumar Rauniyar, Nakul Ravikumar,
David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Bharat Rawlley,
Murali Mohan Rama Krishna Reddy,
Elrashdy Moustafa Mohamed Redwan, Giuseppe Remuzzi,
Bhageerathy Reshmi, Nazila Rezaei, Aida Rezaei Nejad,
Mohsen Rezaeian, Abanoub Riad, Mavra A Riaz, Jennifer Rickard,
Reza Rikhtegar, Hannah Elizabeth Robinson-Oden,
Célia Fortuna Rodrigues, Jeerson Antonio Buendia Rodriguez,
Ravi Rohilla, Debby Syahru Romadlon, Luca Ronfani,
Himanshu Sekhar Rout, Bedanta Roy, Nitai Roy, Priyanka Roy,
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Morteza SaberiKamarposhti, Siamak Sabour, Fatos Sada, Basema Saddik,
Bashdar Abuzed Sadee, Ehsan Sadeghi, Erfan Sadeghi,
Mohammad Reza Saeb, Umar Saeed, Sher Zaman Safi, Dominic Sagoe,
Manika Saha, Amirhossein Sahebkar, Soumya Swaroop Sahoo,
Monalisha Sahu, Zahra Saif, Joseph W Sakshaug, Payman Salamati,
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Mohammed Z Y Salem, Sohrab Salimi, Sara Samadzadeh,
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Juan Sanabria, Nima Sanadgol, Francesca Sanna,
Milena M Santric-Milicevic, Haaris Saqib,
Sivan Yegnanarayana Iyer Saraswathy, Aswini Saravanan, Babak Saravi,
Yaser Sarikhani, Tanmay Sarkar, Rodrigo Sarmiento-Suárez,
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Md Abu Sayeed, Nikolaos Scarmeas, Winfried Schlee, Art Schuermans,
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Mahan Shafie, Jaer Shah, Pritik A Shah, Ataollah Shahbandi,
Samiah Shahid, Moyad Jamal Shahwan, Ahmed Shaikh,
Masood Ali Shaikh, Muhammad Aaqib Shamim,
Mehran Shams-Beyranvand, Mohammad Anas Shamsi,
Mohd Shanawaz, Abhishek Shankar, Mohammed Shannawaz,
Medha Sharath, Sadaf Sharfaei, Amin Sharifan, Javad Sharifi-Rad,
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Rajesh P Shastry, Amin Shavandi, David H Shaw, Amir Mehdi Shayan,
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Peilin Shi, Desalegn Shiferaw, Mika Shigematsu, Rahman Shiri,
Reza Shirkoohi, Aminu Shittu, Velizar Shivarov, Farhad Shokraneh,
Sina Shool, Seyed Afshin Shorofi, Kanwar Hamza Shuja, Kerem Shuval,
Emmanuel Edwar Siddig, João Pedro Silva,
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Jacques Lukenze Tamuzi, Ker-Kan Tan, Haosu Tang,
Derbie Alemu DA Tareke, Mengistie Kassahun Tariku, Vivian Y Tat,
Seyed Mohammad Tavangar, Mojtaba Teimoori,
Mohamad-Hani Temsah, Reem Mohamad Hani Temsah,
Masayuki Teramoto, Dufera Rikitu Terefa, Riki Tesler,
Enoch Teye-Kwadjo, Ramna Thakur, Pugazhenthan Thangaraju,
Kavumpurathu Raman Thankappan, Rekha Thapar, Samar Tharwat,
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Jansje Henny Vera Ticoalu, Tenaw Yimer Tiruye,
Mariya Vladimirovna Titova, Marcello Tonelli,
Marcos Roberto Tovani-Palone, Eugenio Traini, Jasmine T Tran,
Nghia Minh Tran, Indang Trihandini, Samuel Joseph Tromans,
Thien Tan Tri Tai Truyen, Aristidis Tsatsakis, Evangelia Eirini Tsermpini,
Munkhtuya Tumurkhuu, Stefanos Tyrovolas,
Sayed Mohammad Nazim Uddin, Aniefiok John Udoakang,
Arit Udoh, Atta Ullah, Saeed Ullah, Sana Ullah, Srikanth Umakanthan,
Chukwuma David Umeokonkwo, Brigid Unim, Bhaskaran
Unnikrishnan, Era Upadhyay, Jibrin Sammani Usman, Marco Vacante,
Seyed Mohammad Vahabi, Asokan Govindaraj Vaithinathan,
Rohollah Valizadeh, Jef Van den Eynde, Elena Varavikova, Orsolya Varga,
Priya Vart, Shoban Babu Varthya, Tommi Juhani Vasankari,
Balachandar Vellingiri, Deneshkumar Venugopal,
Nicholas Alexander Verghese, Madhur Verma, Massimiliano Veroux,
Georgios-Ioannis Verras, Dominique Vervoort, Jorge Hugo Villafañe,
Manish Vinayak, Francesco S Violante, Mukesh Vishwakarma,
Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Bay Vo,
Simona Ruxandra Volovat, Theo Vos, Isidora S Vujcic, Hatem A Wafa,
Yasir Waheed, Elias Bekele Wakwoya, Cong Wang, Denny Wang,
Fang Wang, Shu Wang, Yanzhong Wang, Yuan-Pang Wang, Paul Ward,
Emebet Gashaw Wassie, Stefanie Watson, Marcia R Weaver,
Kosala Gayan Weerakoon, Daniel J Weiss, Katherine M Wells,
Yi Feng Wen, Ronny Westerman, Taweewat Wiangkham,
Dakshitha Praneeth Wickramasinghe,
Nuwan Darshana Wickramasinghe, Peter Willeit,
Yohannes Addisu Wondimagegene, Felicia Wu, Juan Xia, Hong Xiao,
Gelin Xu, Suowen Xu, Xiaoyue Xu, Ali Yadollahpour,
Shirin Yaghoobpoor, Tina Yaghoobpour, Sajad Yaghoubi,
Zwanden Sule Yahaya, Danting Yang, Lin Yang, Yuichiro Yano,
Habib Yaribeygi, Pengpeng Ye, Renjulal Yesodharan,
Subah Abderehim Yesuf, Saber Yezli, Amanuel Yigezu, Paul Yip,
Dong Keon Yon, Naohiro Yonemoto, Yuyi You, Mustafa Z Younis,
Zabihollah Yousefi, Chuanhua Yu, Yong Yu, Chun-Wei Yuan,
Nima Zafari, Fathiah Zakham, Nazar Zaki, Giulia Zamagni,
Milad Zandi, Ghazal G Z Zandieh, Moein Zangiabadian,
Mikhail Sergeevich Zastrozhin, Haijun Zhang, Meixin Zhang,
Yunquan Zhang, Chenwen Zhong, Juexiao Zhou, Bin Zhu, Lei Zhu,

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39
Magdalena Zielińska, Zhiyong Zou, Samer H Zyoud,
Christopher J L Murray†, Amanda E Smith†, Stein Emil Vollset†.
*Joint first authors. †Joint senior authors.
Affiliations
Institute for Health Metrics and Evaluation (N V Bhattacharjee PhD,
A E Schumacher PhD, A J Ahlstrom MSc, C M Antony MA,
A Y Aravkin PhD, C Bisignano MPH, E Bliss MSc, Prof M Brauer DSc,
D Bryazka BA, K Burkart PhD, S Cao MS, J Chalek BS, K Coberly BS,
H Comfort MPH, B Dalton BA, M A Dirac MD, J Duprey MS,
L Dwyer-Lindgren PhD, K Estep MPA, S Farmer BA,
Prof V L Feigin PhD, J E Fuller MLIS, A Haakenstad ScD,
Prof S I Hay FMedSci, N J Kassebaum MD, M B Kassel BA, J S Kim MS,
K E Kinzel MSPH, Prof H J Larson PhD, Prof S S Lim PhD,
P A Lindstedt MPH, K L Maass PhD, E A May, A L W McKowen,
S A McLaughlin PhD, T Mestrovic PhD, A H Mokdad PhD,
Q P Nguyen BS, Y Ozten MS, S A Pease BS, D M Pigott PhD,
C Raggi MS, H E Robinson-Oden MLIS, T Runghien MSc, H Saqib MA,
D H Shaw BA, G Smith MS, R J D Sorensen PhD, N A Verghese BA,
Prof T Vos PhD, D Wang BA, S Watson MS, Prof M R Weaver PhD,
K M Wells BA, C Yuan PhD, M Zhang MS, Prof C J L Murray DPhil,
A E Smith MPA, Prof S E Vollset DrPH), Department of Applied
Mathematics (A J Ahlstrom MSc, A Y Aravkin PhD), Department of
Health Metrics Sciences, School of Medicine (A Y Aravkin PhD,
K Burkart PhD, M A Dirac MD, L Dwyer-Lindgren PhD,
Prof S I Hay FMedSci, N J Kassebaum MD, J S Kim MS,
Prof S S Lim PhD, A H Mokdad PhD, D M Pigott PhD, Prof T Vos PhD,
Prof M R Weaver PhD, Prof C J L Murray DPhil, Prof S E Vollset DrPH),
Department of Internal Medicine (Y Chahine MD), Department of
Cardiology (Y Chahine MD), Department of Family Medicine
(M A Dirac MD), Department of Neurology (R Kalani MD), Department
of Anesthesiology & Pain Medicine (N J Kassebaum MD,
V Krishnamoorthy MD), Division of Plastic and Reconstructive Surgery
(S D Morrison MD), Department of Global Health
(R J D Sorensen PhD), University of Washington, Seattle, WA, USA;
Faculty of Medicine (A Aali MD, N Rahnavard MD), Dental Research
Center (E Bardideh DDS), Orthodontics Department (M Ghorbani DDS),
Clinical Research Development Unit (N Morovatdar MD), Metabolic
Syndrome Research Center (G Pourali MD), International UNESCO
Center for Health-related Basic Sciences and Human Nutrition
(G Pourali MD), Applied Biomedical Research Center (A Sahebkar PhD),
Biotechnology Research Center (A Sahebkar PhD), Department of
Medical Genetics (N Zafari MD), Mashhad University of Medical
Sciences, Mashhad, Iran; Department of Clinical Governance and
Quality Improvement (Y H Abate MSc), Aleta Wondo Hospital, Aleta
Wondo, Ethiopia; Doheny Eye Institute (R Abbasgholizadeh MD),
University of California Los Angeles, Pasadena, CA, USA; Department
of Orthopedic Surgery (M Abbasian MD), Department of Pediatrics
(S Aly MD), T H Chan School of Public Health (Prof T W Bärnighausen
MD, P M S Pradhan MD), Center for Primary Care (S Basu PhD),
Harvard Business School (F Caetano dos Santos PhD), Division of
Cardiovascular Medicine (G Chi MD), Department of Neurological
Surgery at Brigham and Women’s Hospital (A H Feroze MD), Maternal
Fetal Care Center (K Hessami MD), Department of Ophthalmology
(Prof J H Kempen MD), Department of Health Policy and Management
(C M Kubeisy BA), Department of Radiology and Data Science
(X Liu PhD), Department of Health Policy and Oral Epidemiology
(Z S Natto DrPH), Department of Global Health and Social Medicine
(M Pigeolet MD), Beth Israel Deaconess Medical Center (S Sharfaei
MD), Division of General Internal Medicine (Prof A Sheikh MD),
Harvard University, Boston, MA, USA; Department of Orthopaedic
Surgery (M Abbasian MD), Department of Anesthesiology
(D Abtahi MD, S Salimi MD, A Tajbakhsh MD), Department of
Biotechnology (S Aghamiri PhD), National Nutrition and Food
Technology Research Institute (M Ajami PhD), Research Institute of
Dental Sciences (Prof S Asgary MSc), Urology Department
(M Bonakdar Hashemi MD), Department of Medical Genetics
(M Ghasemi PhD), Center for Comprehensive Genetic Services
(M Ghasemi PhD), Department of Immunology (K Jahankhani MSc),
Department of Health Policy and Management (N Jahanmehr PhD),
Safety Promotion and Injury Prevention Research Center (N Jahanmehr
PhD), Department of Epidemiology (M Karami PhD, S Sabour PhD),
Department of Neurosurgery (H Khayat Kashani MD), Social
Determinants of Health Research Center (A Kolahi MD,
A Nikoobar DipSc, M Rashidi MD), Department of Microbiology and
Infectious Diseases (M Nasiri PhD), School of Medicine
(S Nejadghaderi MD, M Zangiabadian MD), Department of Biology and
Anatomical Sciences (P Raee PhD), Ophthalmic Research Center (ORC)
(M Shayan MD), Emergency Department (S Shool MD), Department of
Medical Education (S Tabatabai PhD), Shahid Beheshti University of
Medical Sciences, Tehran, Iran (S Yaghoobpoor MD); Non-
communicable Diseases Research Center (M Abbasi-Kangevari MD,
S Azadnajafabad MD, M Keykhaei MD, P Mousavi MD, M Rashidi MD,
N Rezaei MD), Advanced Diagnostic and Interventional Radiology
Research Center (H Abbastabar PhD), The Institute of Pharmaceutical
Sciences (TIPS) (Prof M Abdollahi PhD), School of Pharmacy
(Prof M Abdollahi PhD), Research Center for Immunodeficiencies
(H Abolhassani PhD), Hematology, Oncology and Stem Cell
Transplantation Research Center (H Alemi MD), Urology Research
Center (R Arabzadeh Bahri MD), Department of Health Information
Management (S Ayyoubzadeh PhD), Translational Ophthalmology
Research Center (N Bahmanziari PhD), School of Medicine
(A Behnoush BS, A Khalaji BS, S Khanmohammadi MD, M Mayeli MD,
M Merati MD, S Mohammadi MD), Department of Scientific Research
(F Chichagi MD), Multiple Sclerosis Research Center
(S Eskandarieh PhD), Digestive Diseases Research Institute
(S Fahimi MD, Prof A Pourshams MD, S G Sepanlou MD), Department
of Ophthalmology (Prof F Ghassemi MD), Department of Radiology
(R Hajibeygi MD), Students’ Scientific Research Center (SSRC)
(M Keykhaei MD), Center for Research and Training in Skin Diseases
and Leprosy (F Khamesipour PhD), Sina Trauma and Surgery Research
Center (A Khavandegar MD, M Khormali MD, Prof P Salamati MD,
S Shool MD), Children’s Medical Center (F Kompani MD), Department
of Pediatric Cardiology (Prof E Malakan Rad MD), Department of
Obstetrics and Gynecology (Z Mansouri MD), Department of
Epidemiology and Biostatistics (M Mansournia PhD), Tehran Heart
Center (E Mehrabi Nasab MD), Water Quality Research Center
(R Mirzaei PhD), Department of Pharmacology (N Noroozi DVM),
Department of Medicine (M Pahlevan Fallahy MD, A Shahbandi MD),
Department of Cardiology (S Rashedi MD), Stem Cell and Center of
Regenerative Medicine (A Rezaei Nejad MD), Iranian Research Center
for HIV/AIDS (S SeyedAlinaghi PhD), Endocrinology and Metabolism
Research Center (EMRC) (S Seyedi MD, O Tabatabaei Malazy PhD),
Department of Neurology (M Shafie MD), Department of
Pharmaceutical Care (A Sharifan PharmD), Research Center for Rational
Use of Drugs (A Sharifan PharmD), Cancer Research Center
(R Shirkoohi PhD), Cancer Biology Research Center (R Shirkoohi PhD),
Department of Pathology (Prof S Tavangar MD), Faculty of Medicine
(S Vahabi MD), Tehran University of Medical Sciences, Tehran, Iran;
Department of Epidemiology (S Abd ElHafeez DrPH), Department of
Pediatric Dentistry and Dental Public Health (Prof M El Tantawi PhD,
Prof O A A Elmeligy PhD), Department of Tropical Health
(R M Ghazy PhD), Department of Pathology (Prof I M Talaat PhD),
Alexandria University, Alexandria, Egypt; Department of Tropical
Medicine (S Abd-Elsalam PhD), Tanta University, Tanta, Egypt;
Department of Small Animal Clinical Sciences (M Abdollahifar PhD),
Department of Community Health and Epidemiology
(D A Adeyinka PhD), University of Saskatchewan, Saskatoon, SK,
Canada; Department of Medicine (Prof M Abdoun BMedSc), University
of Setif Algeria, Sétif, Algeria; Department of Physiotherapy
(A Abdullahi PhD, J S Usman PhD), Department of Community
Medicine (Prof M A Gadanya FMCPH), Department of Nursing Science
(M Ladan PhD), Bayero University Kano, Kano, Nigeria; Department of
Rehabilitation Sciences (A Abdullahi PhD, M U Ali MSc, M Khan MPH,
J S Usman PhD), School of Nursing (S Tyrovolas PhD), Hong Kong
Polytechnic University, Hong Kong, China; Department of Midwifery
(M Abebe MSc, G M Ayele MSc), Department of Public Health
(T L Lerango MPH, Y A Wondimagegene PhD), Dilla University, Dilla,
Ethiopia; Department of Public Health (S S Abebe MPH), Department of
Medical Laboratory Sciences (M Arkew MSc), Department of Health
Policy and Management (A T Debele MSc), Department of Clinical
Pharmacy (M D Gudeta MSc), Haramaya University, Harar, Ethiopia;
Department of Community Medicine (O Abiodun MPH), Department of

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Medical Physiology (P G Okwute MSc), Babcock University, Ilishan-
Remo, Nigeria; Department of Medical Biochemistry and Biophysics
(H Abolhassani PhD), Department of Neurobiology, Care Sciences, and
Society (Prof J Ärnlöv PhD, S Fereshtehnejad PhD), Department of
Molecular Medicine and Surgery (Prof J H Kauppila MD), Department
of Global Public Health (Prof L Laflamme PhD), Karolinska Institute,
Stockholm, Sweden; Department of Neurosurgery (M Abolmaali MD),
Health Management and Economics Research Center (J Arabloo PhD),
Department of Epidemiology (M Asadi-Lari PhD), Center for
Educational Research in Medical Educaion (CERMS) (S Delavari PhD),
Minimally Invasive Surgery Research Center (A Kabir MD), Eye
Research Center (H Kasraei MD), Department of Anesthesiology
(K Latifinaibin MD), Comprehensive Research Laboratory
(R Mirzaei PhD), Department of Physiology (H Pazoki Toroudi PhD),
Physiology Research Center (H Pazoki Toroudi PhD), Colorectal
Research Center (A Sarveazad PhD), Iran University of Medical
Sciences, Tehran, Iran (M Moradi MD); Khatam Al-anbia Hospital
(M Abolmaali MD), Shefa Neuroscience Research Center, Tehran, Iran;
Department of Physical Pharmacy and Pharmacokinetics
(M Abouzid PharmD), Poznan University of Medical Sciences, Poznan,
Poland; Department of Public Health (G B Aboye MSc), Madda Walabu
University, Addis Ababa, Ethiopia; Nutrition and Dietetics Department
(G B Aboye MSc), USAID-JSI Digital Health Activity
(B H Demessa MPH), Jimma University, Addis Ababa, Ethiopia;
Department of Pediatric Dentistry (Prof L G Abreu PhD), Department of
Nutrition (Prof R M Claro PhD), Department of Maternal and Child
Nursing and Public Health (Prof D C Malta PhD), Department of
Clinical Medicine (Prof B R Nascimento PhD), Clinical Hospital
(Prof B R Nascimento PhD), Federal University of Minas Gerais, Belo
Horizonte, Brazil; Department of Adult Health Nursing
(W A Abrha MSc), Department of Nursing (A Girmay MSc), Aksum
University, Aksum, Ethiopia; Department of Research
(M R M Abrigo PhD), Philippine Institute for Development Studies,
Quezon City, Philippines; Department of Nursing (H Abualruz PhD),
Al Zaytoonah University of Jordan, Amman, Jordan; Department of
Pharmacology and Toxicology (B Abubakar PhD), Department of
Veterinary Public Health and Preventive Medicine (A Shittu MSc),
Usmanu Danfodiyo University, Sokoto, Sokoto, Nigeria; Nigerian
Institute of Medical Research (B Abubakar PhD), Nigerian Institute of
Medical Research, Lagos, Nigeria; Clinical Sciences Department
(E Abu-Gharbieh PhD, S Adra MD, H J Barqawi MPhil,
Prof R Halwani PhD, Prof A A Maghazachi PhD, M M Saber-Ayad MD,
Prof I M Talaat PhD), College of Medicine (F Ahmad PhD,
Prof R Halwani PhD, Prof B Saddik PhD, M A Saleh PhD), Department
of Pharmacy Practice and Pharmacotherapeutics
(Prof K H Alzoubi PhD, Prof H A Omar PhD), Department of
Physiotherapy (A Arumugam PhD), Department of Basic Biomedical
Sciences (Y Bustanji PhD), Sharjah Institute for Medical Research
(N M Elemam PhD), Department of Clinical Nutrition and Dietetics
(M E M Faris PhD), Department of Medicinal Chemistry
(S S M Soliman PhD), University of Sharjah, Sharjah, United Arab
Emirates (K A Altirkawi MD); Institute of Community and Public Health
(Prof N M Abu-Rmeileh PhD), Birzeit University, Ramallah, Palestine;
Department of Public Health (T G G Adal MPH), Department of
Midwifery (Y F Geda MSc), Wolkite University, Wolkite, Ethiopia;
College of Medicine and Health Sciences (M M Adane PhD, S A Belay
MSc), Department of Epidemiology and Biostatistics (Y Alemu MPH,
K A Bogale MPH), Department of Midwifery (A M Aweke MSc), School
of Health Science (A Y Berhie MSc), Department of Health Promotion
and Behavioural Science (E K Bogale MPH), Department of Physiology
(D Demeke MSc), Department of Pharmacy (C T Negesse MSc), Bahir
Dar University, Bahir Dar, Ethiopia; Department of Health Promotion,
Education, and Behavior (O A A Adeagbo PhD, T Mi PhD), University of
South Carolina, Columbia, SC, USA; Department of Public Health
(O A A Adeagbo PhD), University of KwaZulu-Natal, Durban, South
Africa; Department of Medical Rehabilitation (Prof R A Adedoyin PhD),
Department of Animal Sciences (H A Bashiru MSc), Department of
Child Dental Health (Prof M O Folayan FWACS), Obafemi Awolowo
University, Ile-Ife, Nigeria; Department of Obstetrics and Gynecology
(V Adekanmbi PhD), University of Texas Medical Branch, Galveston, TX,
USA; Department of Molecular Biology and Genetics
(Prof M T AlBataineh PhD), Department of Biology
(W M S Osman PhD), Khalifa University, Abu Dhabi, United Arab
Emirates (B Aden PhD); Institute of Public Health (B Aden PhD),
Walden University, Al Ain, United Arab Emirates; Department of HIV
and Infectious Diseases (A V Adepoju MD), Jhpiego, Abuja, Nigeria;
Department of Adolescent Research and Care (A V Adepoju MD),
Adolescent Friendly Research Initiative and Care, Ado Ekiti, Nigeria;
DSI-NRF Centre of Excellence for Epidemiological Modelling and
Analysis (SACEMA) (O O Adetokunboh PhD), Stellenbosch University,
Stellenbosch, South Africa; Division of Epidemiology & Biostatistics
(O O Adetokunboh PhD), South African Centre for Epidemiological
Modelling and Analysis (SACEMA) (L Mhlanga PhD), Department of
Epidemiology (J L Tamuzi MSc), Department of Industrial Psychology
(E Teye-Kwadjo PhD), Stellenbosch University, Cape Town, South Africa;
Department of Biochemistry (J B Adetunji PhD), Osun State University,
Osogbo, Nigeria; Department of Public Health (D A Adeyinka PhD),
Federal Ministry of Health, Abuja, Nigeria; Department of Physiology
(O I Adeyomoye PhD), Department of Microbiology (O O Bello PhD),
Department of Anatomy (G O Oluwatunase MSc), Department of
Biosciences and Biotechnology (A J Udoakang PhD), University of
Medical Sciences, Ondo, Nigeria; Faculty of Medicine
(Q E S Adnani PhD), Center of Excellence in Higher Education for
Pharmaceutical Care Innovation (Prof M J Postma PhD), Universitas
Padjadjaran (Padjadjaran University), Bandung, Indonesia; Department
of Epidemiology and Medical Statistics (R F Afolabi PhD,
M Ekholuenetale MSc, A F Fagbamigbe PhD, K R Fowobaje MSc),
Institute for Advanced Medical Research and Training (R O Akinyemi
PhD), Faculty of Public Health (M Ekholuenetale MSc), Department of
Health Promotion and Education (S E Ibitoye MPH), Department of
Community Medicine (O S Ilesanmi PhD), College of Medicine
(A P Okekunle PhD), Department of Medicine (Prof M O Owolabi DrM),
University of Ibadan, Ibadan, Nigeria; Department of Radiology
(S Afyouni PhD, A Amindarolzarbi MD, G G Z Zandieh MD),
Department of Epidemiology and Population Health (N Alhajri MD),
Department of Biostatistics (A Columbus MS), Department of
Neurosurgery (F Kazemi MD), Department of Health Policy and
Management (D Vervoort MD), Department of International Health
(H Zhang MS), Johns Hopkins University, Baltimore, MD, USA
(E Jamshidi PharmD); Department of Life Sciences (M S Afzal PhD),
University of Management and Technology, Lahore, Pakistan;
Department of Community Medicine (Prof S Afzal PhD), King Edward
Memorial Hospital, Lahore, Pakistan; Department of Public Health
(Prof S Afzal PhD), Public Health Institute, Lahore, Pakistan;
Department of Medical and Surgical Sciences and Advanced
Technologies “GF Ingrassia” (Prof A Agodi PhD, M Barchitta PhD,
A Maugeri PhD, Prof M Veroux PhD), Department of General Surgery
and Medical-Surgical Specialties (Prof A Biondi PhD, Prof G Isola PhD,
M Vacante PhD), Department of Biomedical and Biotechnological
Sciences (L Falzone PhD), Department of Clinical and Experimental
Medicine (C Ledda PhD), University of Catania, Catania, Italy;
Department of Geography and Planning (W Agyemang-Duah MSc),
Department of Biomedical and Molecular Sciences (A Nikpoor PhD),
Queen’s University, Kingston, ON, Canada; School of Public Health
(B O Ahinkorah MPhil), University of Technology Sydney, Sydney, NSW,
Australia; Department of Medical Biochemistry (A Ahmad PhD),
Department of Pharmacology (M Tabish MPharm), Shaqra University,
Shaqra, Saudi Arabia; School of Medicine and Psychology
(D Ahmad PhD), National Centre of Epidemiology and Population
Health (Y Alemu MPH), Research School of Population Health
(N Bagheri PhD, R A Burns PhD), Australian National University,
Canberra, ACT, Australia; Public Health Foundation of India,
Gandhinagar, India (D Ahmad PhD); Department of Clinical Nursing
(Prof M M Ahmad PhD), University of Jordan, Amman, Jordan;
Department of Health and Biological Sciences (S Ahmad PhD), Abasyn
University, Peshawar, Pakistan; Department of Natural Sciences
(S Ahmad PhD), Lebanese American University, Beirut, Lebanon;
Department of Epidemiology and Health Statistics (T Ahmad MS),
Southeast University, Nanjing, China; Department of Pharmacy Practice
(A Ahmed PhD), Riphah Institute of Pharmaceutical Sciences,
Islamabad, Pakistan; Division of Infectious Diseases and Global Public
Health (IDGPH) (A Ahmed PhD), University of California, San Diego,

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CA, USA; Institute of Endemic Diseases (A Ahmed MSc), Unit of Basic
Medical Sciences (E E Siddig MD), University of Khartoum, Khartoum,
Sudan; Swiss Tropical and Public Health Institute (A Ahmed MSc),
University of Basel, Basel, Switzerland; Department of Biosciences
(H Ahmed PhD), COMSATS Institute of Information Technology,
Islamabad, Pakistan; Institute of Public Health (L A Ahmed PhD),
College of Medicine and Health Sciences (Prof M Grivna PhD,
J Nauman PhD), Department of Family Medicine (M A Khan MSc),
Department of Computer Science and Software Engineering
(Prof N Zaki PhD), United Arab Emirates University, Al Ain, United
Arab Emirates; Department of Pathology and Microbiology
(M S Ahmed MSc), University of Duhok, Duhok, Iraq; Brody School of
Medicine (S Ahmed PhD), Department of Computer Science
(A O Bodunrin MSc), Department of Physiology (M Tumurkhuu PhD),
East Carolina University, Greenville, NC, USA (R T Aruleba PhD);
Department of Food and Nutrition Policy and Planning Research
(M Ajami PhD), National Institute of Nutrition, Tehran, Iran; Faculty of
Medicine and Public Health (B Aji DrPH), Jenderal Soedirman
University, Purwokerto, Indonesia; Department of Microbiology,
Immunology and Parasitology (G T Akalu MSc), St Paul’s Hospital
Millennium Medical College, Addis Ababa, Ethiopia; Department of
Microbial, Cellular and Molecular Biology (G T Akalu MSc), School of
Public Health (K Deribe PhD), Addis Ababa University, Addis Ababa,
Ethiopia; St George and Sutherland Clinical School (H Akbarialiabad
MD), School of Population Health (Z Dai PhD, X Xu PhD), School of
Psychiatry (Prof P B Mitchell MD), Centre for Social Research in Health
(S R Okeke PhD), School of Public Health and Community Medicine
(A E Peden PhD), The George Institute for Global Health (P Ye MPH),
University of New South Wales, Sydney, NSW, Australia; Institute of
Neuroscience (R O Akinyemi PhD), Newcastle University, Newcastle
upon Tyne, UK; Department of Cardiology (M A Akkaif PhD),
Department of Health Management Center (X Li PhD), Fudan
University, Shanghai, China; Department of Management, Policy, and
Community Health (S Akkala MPH), University of Texas, Houston, TX,
USA; Department of Geriatric and Long Term Care (H Al Hamad MD,
B Sathian PhD), Rumailah Hospital (H Al Hamad MD), Hamad Medical
Corporation, Doha, Qatar; Department of Surgery (S Al Hasan PhD),
Washington University School of Medicine, St Louis, MO, USA;
Department of Nursing (Prof M Al Qadire PhD), Department of
Community and Mental Health (Prof M Albashtawy PhD), Al Al-Bayt
University, Mafraq, Jordan; Institute of Global Health
(T M A AL-Ahdal MPH), Heidelberg Institute of Global Health (HIGH)
(Prof T W Bärnighausen MD, S Chen DSc, B Moazen MSc), Heidelberg
University, Heidelberg, Germany; Department of Clinical Sciences
(S O Alalalmeh Bpharm, Prof E A Arafa PhD, O E Hegazi BPharm),
Center for Medical and Bio-Allied Health Sciences Research
(Prof M J Shahwan PhD, M A Shamsi PhD, S H Zyoud PhD), Ajman
University, Ajman, United Arab Emirates; Department of Biology
(T A Alalwan PhD, Prof S Perna PhD), University of Bahrain, Sakhir,
Bahrain; John T Milliken Department of Internal Medicine
(Z Al-Aly MD), Brown School (C Wang MPH), Department of Surgery
(C Wang MPH), Washington University in St Louis, St Louis, MO, USA;
Clinical Epidemiology Center (Z Al-Aly MD), US Department of
Veterans Aairs (VA), St Louis, MO, USA; Murdoch Business School
(K Alam PhD), Health Administration, Policy & Leadership Program
(M Hasan MPH), Murdoch University, Perth, WA, Australia; School of
Nursing (R M Al-amer PhD), Yarmouk University, Irbid, Jordan; School
of Nursing and Midwifery (R M Al-amer PhD), Department of
Engineering (G R Naik PhD), Western Sydney University, Sydney, NSW,
Australia; Health Information Management and Technology Department
(T M Alanzi PhD), Division of Forensic Medicine (Prof R G Menezes
MD), Imam Abdulrahman Bin Faisal University, Dammam, Saudi
Arabia (F M Alanezi PhD); Department of Medicine (A Albakri MD),
Royal Jordanian Medical Services, Amman, Jordan; Global Health
Entrepreneurship (S Alemi PhD), Tokyo Medical and Dental University,
Tokyo, Japan; Pediatric Intensive Care Unit (A Al-Eyadhy MD, M Temsah
MD), Department of Cardiac Sciences (Prof K F Alhabib MD), Section of
Adult Hematology (Prof G M T ElGohary MD), Department of
Physiology (Prof S A Meo PhD), King Saud University, Riyadh, Saudi
Arabia; Global Centre for Environmental Remediation
(A A S Al-Gheethi PhD), Department of Women’s Health
(G T Kiross MPH), University of Newcastle, Newcastle, NSW, Australia;
Cooperative Research Centre for Contamination Assessment and
Remediation of the Environment, Newcastle, NSW, Australia
(A A S Al-Gheethi PhD); College of Nursing (Prof F A N Alhalaiqa PhD),
Department of Physical Education (Prof M A Alomari PhD), QU Health
(M Mohammed PhD), Department of Population Medicine
(Prof G Rathnaiah Babu PhD), Qatar University, Doha, Qatar;
Psychological Sciences Association, Amman, Jordan
(Prof F A N Alhalaiqa PhD); Institute of Health Research
(R K Alhassan PhD, M Immurana PhD), Department of Health Policy
Planning and Management (M K Boachie PhD), Department of
Epidemiology and Biostatistics (R K Dowou MPhil), Department of
Microbiology and Immunology (V N Orish PhD), University of Health
and Allied Sciences, Ho, Ghana; Department of Zoology (A Ali PhD),
Department of Botany (Prof I Khan PhD), Abdul Wali Khan University
Mardan, Mardan, Pakistan; Erbil Technical Health College
(B A Ali PhD), Erbil Polytechnic University, Erbil, Iraq; School of
Pharmacy (B A Ali PhD), Tishk International University, Erbil, Iraq;
Department of Biological Sciences (L Ali PhD), National University of
Medical Sciences (NUMS), Rawalpindi, Pakistan; Department of Medical
Rehabilitation (Physiotherapy) (M U Ali MSc), University of Maiduguri,
Maiduguri, Nigeria; Department of Biosciences (R Ali MPhil), Centre for
Interdisciplinary Research In Basic Sciences (CIRBSc) (M A Shamsi
PhD), Jamia Millia Islamia, New Delhi, India; Center for Biotechnology
and Microbiology (S S Ali PhD), University of Swat, Swat, Pakistan;
School of Public Health and Preventive Medicine (S M Alif PhD,
S Li PhD, P Rai MPH), School of Public Health and Preventative
Medicine (Prof M Asghari-Jafarabadi PhD), Department of Human-
Centred Computing, Faculty of Information Technology (M Saha MSc),
Monash University, Melbourne, VIC, Australia; Department of Public
Health (M Aligol PhD), Qom University of Medical Sciences, Qom, Iran;
Social Determinants of Health Research Center (M Alijanzadeh PhD),
Qazvin University of Medical Sciences, Qazvin, Iran; Medical
Laboratories (M A M Aljasir PhD), Qassim University, Buraydah, Saudi
Arabia; Department of Molecular and Clinical Pharmacology
(M A M Aljasir PhD), Institute of Infection and Global Health
(Prof A Beloukas PhD), Liverpool Orthopaedic and Trauma Service
(SioopD), Department of Surgery (Prof R Lunevicius DSc), University of
Liverpool, Liverpool, UK; Department of Health Policy and Management
(Prof S M Aljunid PhD), Department of Surgery (S K Al-Sabah MD),
Kuwait University, Kuwait City, Kuwait; International Centre for Casemix
and Clinical Coding (Prof S M Aljunid PhD), National University of
Malaysia, Bandar Tun Razak, Malaysia; Sana’a, Yemen
(S Al-Marwani MSc); Irbid, Jordan (S Al-Marwani MSc); Department of
Medicine (J U Almazan PhD, Prof D Poddighe PhD), Nazarbayev
University, Astana, Kazakhstan; Department of Parasitology
(Prof H M Al-Mekhlafi PhD), University of Malaya, Kuala Lumpur,
Malaysia; Department of Parasitology (Prof H M Al-Mekhlafi PhD),
Sana’a University, Sana’a, Yemen; Department of Urology
(O Almidani MSc), Department of Cardiac Surgery (L Göbölös PhD),
Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Nueld
Department of Surgical Sciences (O Almidani MSc, S Bandyopadhyay
BA), Nueld Department of Orthopaedics (S M Graham PhD), Nueld
Department of Population Health (B Lacey PhD), Nueld Department
of Medicine (Prof R J Maude PhD, T Runghien MSc), Health Economics
Research Centre (Prof J A B Rodriguez PhD), University of Oxford,
Oxford, UK; Department of Rehabilitation Sciences and Physical
Therapy (Prof M A Alomari PhD), Department of Clinical Pharmacy
(Prof K H Alzoubi PhD), Jordan University of Science and Technology,
Irbid, Jordan; Department of Epidemiology and Population Health
(B Al-Omari PhD), Khalifa University of Science, Technology &
Research, Abu Dhabi, United Arab Emirates; Department of Respiratory
Care (J S Alqahtani PhD), Prince Sultan Military College of Health
Sciences, Dammam, Saudi Arabia; Department of Prosthodontics and
Implant Dentistry (A Alqutaibi PhD), Taibah University, Medinah, Saudi
Arabia; Department of Prosthodontics (A Alqutaibi PhD), Ibb University,
Ibb, Yemen; Department of Community Medicine
(R M Al-Raddadi PhD), Department of Family and Community Medicine
(N S Butt PhD), Department of Pediatric Dentistry
(Prof O A A Elmeligy PhD), Rabigh Faculty of Medicine
(A A Malik PhD), Department of Dental Public Health

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(Z S Natto DrPH), King Abdulaziz University, Jeddah, Saudi Arabia;
Jaber Al Ahmad Al Sabah Hospital (S K Al-Sabah MD), Ministry of
Health, Kuwait City, Kuwait; Institute of Molecular Biology and
Biotechnology (A Altaf PhD, S Shahid PhD), University Institute of
Public Health (F J Alvi MPH, S Hameed MPH, A A Malik PhD),
University College of Medicine & Dentistry (Prof M Arooj PhD),
University Institute of Radiological Sciences and Medical Imaging
Technology (T Ashraf MS), University Institute of Diet and Nutritional
Sciences (A Khalil PhD), Department of Technology (M Muzaar MBA),
Research Centre for Health Sciences (RCHS) (M Muzaar MBA,
S Shahid PhD), The University of Lahore, Lahore, Pakistan
(Prof M Ashraf PhD, M A Riaz Mcom); Department of Specialty Internal
Medicine (Prof J A Al-Tawfiq MD), Johns Hopkins Aramco Healthcare,
Dhahran, Saudi Arabia; Department of Medicine
(Prof J A Al-Tawfiq MD, J T Tran BS), Indiana University School of
Medicine, Indianapolis, IN, USA; Lisbon Institute of Global Mental
Health (D O Aluh MSc), Nova University of Lisbon, Lisbon, Portugal;
Department of Clinical Pharmacy and Pharmacy Management
(D O Aluh MSc), University of Nigeria Nsukka, Nsukka, Nigeria;
Research Group in Hospital Management and Health Policies
(Prof N Alvis-Guzman PhD), Universidad de la Costa (University of the
Coast), Barranquilla, Colombia; Research Group in Health Economics
(Prof N Alvis-Guzman PhD), University of Cartagena, Cartagena,
Colombia; Department of Clinical Pharmacology and Toxicology
(H Alwafi PhD), Umm Al-Qura University, Makkah, Saudi Arabia;
Department of Medical Sciences (Prof Y M Al-Worafi PhD), Azal
University for Human Development, Sana’a, Yemen; Department of
Clinical Sciences (Prof Y M Al-Worafi PhD), University of Science and
Technology of Fujairah, Fujairah, United Arab Emirates; Department of
Pediatrics (Prof H Aly MD), Department of Internal Medicine
(M Gupta MD), Lerner Research Institute (X Liu PhD), Cleveland Clinic,
Cleveland, OH, USA; Department of Pediatric Cardiology (S Aly MD),
Boston Children’s Hospital, Boston, MA, USA (T Aripov PhD); School of
Graduate Studies (E K Ameyaw MPhil), Lingnan University, Hong Kong,
China; Department of Public Health (Prof T T Amin MD), Department
of Neurology (A Hassan MD), Cairo University, Cairo, Egypt; Social
Determinants of Health Research Center (M Amini-Rarani PhD), School
of Medicine (S Bagherieh BSc, G Ghasempour Dabaghi MD,
M Rabiee Rad MD), Department of Environmental Health Engineering
(A Fatehizadeh PhD), Cardiac Rehabilitation Research Center
(K Mehrabani-Zeinabad PhD), Isfahan University of Medical Sciences,
Isfahan, Iran; Medicine, Quran and Hadith Research Center
(S Amiri PhD), Baqiyatallah University of Medical Sciences, Tehran,
Iran; College of Public Health, Medical and Veterinary Sciences
(I G Ampomah MPhil), College of Public Health, Medical, and
Veterinary Sciences (A E Peden PhD), James Cook University,
Townsville, QLD, Australia (K O Obamiro PhD); Department of
Maternal and Child Wellbeing (D A Amugsi PhD), African Population
and Health Research Center, Nairobi, Kenya; Department of Medicine
(G A Amusa MD), Department of Obstetrics and Gynecology
(J Musa MD), University of Jos, Jos, Nigeria; Department of Internal
Medicine (G A Amusa MD), Jos University Teaching Hospital, Jos,
Nigeria; Faculty of Pharmacy (Prof R Ancuceanu PhD), Department of
Cardiology (C Andrei PhD), Department of Internal Medicine and
Rheumatology (A V Bobirca PhD), Department of Dermatology and
Venereology (Prof S R Georgescu PhD), Department of Internal
Medicine (M Hostiuc PhD), Department of Legal Medicine and
Bioethics (S Hostiuc PhD), Department of General Surgery
(I Negoi PhD, D Serban PhD, B Socea PhD), Department of Anatomy
and Embryology (R I Negoi PhD), Department of Diabetes, Nutrition
and Metabolic Diseases (A Pantea Stoian PhD), Department of
Dermatology (M Tampa PhD), Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania; Centre for Sensorimotor Performance
(D Anderlini MD), Center of Research Excellence in Stillbirth
(T Begum MPH), Department of Urology (Prof E Chung MD), Institute
for Social Science Research (M Huda MSc, E Kanmiki MPH,
J C Maravilla PhD), School of Health and Rehabilitation Sciences
(A Khan PhD, M Moni PhD), School of Dentistry (R Lalloo PhD),
Queensland Brain Institute (Prof J J McGrath MD), The University of
Queensland, Brisbane, QLD, Australia; Neurology Department
(D Anderlini MD), Royal Brisbane and Women’s Hospital, Brisbane,
QLD, Australia; Department of Health Care Management
(P P Andrade MD, S Mohammed PhD), Technical University of Berlin,
Berlin, Germany; European University, Lisbon, Portugal
(P P Andrade MD); Department of Statistics and Econometrics
(Prof T Andrei PhD, Prof C Herteliu PhD, A Otoiu PhD), Department of
Statistics and Economics (Prof M Ausloos PhD), Faculty of Management
(A Dima PhD, S Stefan PhD), Bucharest University of Economic
Studies, Bucharest, Romania; Department of Pharmacology
(A Anil MD, M Shamim MBBS, S B Varthya MD), Department of
Anatomy (Prof N Bhardwaj MD), Department of Community Medicine
and Family Medicine (P Bhardwaj MD, M K Gupta MD,
Prof P R Raghav MD), School of Public Health (P Bhardwaj MD),
Department of Forensic Medicine and Toxicology (T Kanchan MD),
Department of Surgical Oncology (Prof S Misra MCh), Department of
Pharmacology and Research (A Saravanan MD), All India Institute of
Medical Sciences, Jodhpur, India; Department of Urology (P Ram MS),
All India Institute of Medical Sciences, Bhubaneswar, India
(A Anil MD); Department of Obstetrics and Gynecology (S Anil MBBS),
Ernakulam Medical Centre, Kochi, India; School of Nursing and
Midwifery (A Ansar PhD, F Efendi PhD, M Rahman PhD), Department
of Public Health (H Jiang PhD), La Trobe University, Melbourne, VIC,
Australia; Special Interest Group International Health (A Ansar PhD),
Public Health Association of Australia, Canberra, ACT, Australia;
Department of Epidemiology and Biostatistics (Prof A Ansari-
Moghaddam PhD), Zahedan University of Medical Sciences, Zahedan,
Iran; Agribusiness Study Program (E Antriyandarti DrAgrSc), Sebelas
Maret University, Surakarta, Indonesia; Regenerative Medicine, Organ
Procurement and Transplantation Multi-diciplinary Center
(S Anvari MD), Gastrointestinal and Liver Diseases Research Center
(S Hassanipour PhD, F Joukar PhD), Caspian Digestive Disease
Research Center (S Hassanipour PhD, F Joukar PhD), Department of
Environmental Health Engineering (J Jaafari PhD), Guilan University of
Medical Sciences, Rasht, Iran; Centre for Interdisciplinary Research in
Basic Sciences (CIRBSc) (S Anwar PhD), Jamia Millia Islamia,
New Delhi, India; SCLS (S Anwar PhD), Jamia Hamdard, New Delhi,
India; Department of Pathology (R Anwer PhD), Imam Mohammad Ibn
Saud Islamic University, Riyadh, Saudi Arabia; School of Dentistry and
Medical Sciences (A E Anyasodor PhD), Charles Sturt University,
Orange, NSW, Australia; Faculty of Pharmacy, Department of
Pharmacology and Toxicology (Prof E A Arafa PhD, Prof H A Omar
PhD), Beni-Suef University, Beni-Suef, Egypt; College of Pharmacy
(M Arafat PhD), Al Ain University, Abu Dhabi, United Arab Emirates;
Associated Laboratory for Green Chemistry (LAQV) (A M Araújo PhD,
Á M Madureira-Carvalho PhD), Institute for Research and Innovation in
Health (Prof N Cruz-Martins PhD), Research Unit on Applied Molecular
Biosciences (UCIBIO) (Prof D Dias da Silva PhD, J P Silva PhD),
Department of Community Medicine, Information and Health Decision
Sciences (A Freitas PhD), Department of Chemical Engineering
(Prof C F Rodrigues PhD), Universidade do Porto (University of Porto),
Porto, Portugal; Department of Veterinary Pharmacology and Toxicology
(A Aremu PhD), Department of Veterinary Physiology and Biochemistry
(A Basiru PhD), Department of Veterinary Public Health and Preventive
Medicine (I A Odetokun PhD), University of Ilorin, Ilorin, Nigeria;
Department of Public Health and Healthcare Management
(T Aripov PhD), Tashkent Institute of Postgraduate Medical Education,
Tashkent, Uzbekistan; Department of Cardiovascular, Endocrine-
metabolic Diseases and Aging (B Armocida MSc, B Unim PhD),
National Institute of Health, Rome, Italy; Division of Tropical and
Humanitarian Medicine (B Armocida MSc), University of Geneva,
Geneva, Switzerland; School of Health and Social Studies
(Prof J Ärnlöv PhD), Dalarna University, Falun, Sweden; Department of
Biophysics (A A Artamonov PhD), K A Timiryazev Institute of Plant
Physiology (M V Titova PhD), Russian Academy of Sciences, Moscow,
Russia; Department of Maternal and Child Health (J Arulappan DSc),
Sultan Qaboos University, Muscat, Oman; Community Medicine and
Rehabilitation—Physiotherapy Section (A Arumugam PhD),
Department of Epidemiology and Global Health (M P Chavula MPH),
Umeå University, Umea, Sweden; International Relations Department
(M Asadi-Lari PhD), National Agency for Strategic Research in Medical
Education (NASRME) (Prof S Asgary MSc), Ministry of Health and
Medical Education, Tehran, Iran; Research Center for Biochemistry and

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43
Nutrition in Metabolic Diseases (Z Asemi PhD), Kashan University of
Medical Sciences, Kashan, Iran; Neurological Surgery Department
(M Asghariahmadabad MD), School of Nursing, Family Health Care
Department (J Nutor PhD), Department of Epidemiology and
Biostatistics (M Teramoto MD), Department of Bioengineering and
Therapeutic Sciences (Prof M S Zastrozhin PhD), University of
California San Francisco, San Francisco, CA, USA; Cabrini Research
(Prof M Asghari-Jafarabadi PhD), Cabrini Health, Malvern, VIC,
Australia; Department of Public Health (M Y Ashemo PhD,
U Gerema MSc, M E Getachew MPH), Institute of Health Science
(A I Mohamed MSc), Department of Epidemiology (D Shiferaw MPH),
Jimma University, Jimma, Ethiopia; Department of Public Health
(M Y Ashemo PhD, L T Elilo MPH), Wachemo University, Hossana,
Ethiopia; Department of Medical Laboratory Sciences
(M O Asika BMLS), Department of Pharmacology and Therapeutics
(Prof O E Onwujekwe PhD), University of Nigeria Nsukka, Enugu,
Nigeria; Department of Telemedicine (M O Asika BMLS), Society For
Disease Prevention, Hummelstown, PA, USA; Department of
Immunology (S Athari PhD), Zanjan University of Medical Sciences,
Zanjan, Iran; Faculty of Nursing (M M W Atout PhD,
Prof A M Batiha PhD), Philadelphia University, Amman, Jordan;
Department of Forensic Medicine (A Atreya MD), Lumbini Medical
College, Palpa, Nepal; Northumbria Healthcare NHS Foundation Trust,
Newcastle upon Tyne, UK (A Aujayeb MBBS); School of Business
(Prof M Ausloos PhD), Department of Health Sciences (P H Lee PhD,
S J Tromans PhD), University of Leicester, Leicester, UK; Robarts
Research Institute (A Avan MD), The University of Western Ontario,
London, ON, Canada; Department of Sciences (Prof R M S Azevedo
PhD), Instituto Universitário de Ciências da Saúde (IUCS/CESPU)
(University Institute of Health Sciences), Gandra, Portugal; Department
of Neurovascular Research (A Y Azzam MBBCh), Nested Knowledge,
Saint Paul, MN, USA; Faculty of Medicine (A Y Azzam MBBCh),
October 6 University, 6th of October City, Egypt; Gomal Center of
Biochemistry and Biotechnology (M Badar PhD), Gomal University,
Dera Ismail Khan, Pakistan; Department of Forensic Science
(A D Badiye PhD, H Bansal MSc, N Kapoor PhD), Government Institute
of Forensic Science, Nagpur, India; Division of Orthopaedics
(S Baghdadi MD), Children’s Hospital of Philadelphia, Philadelphia, PA,
USA; Health Research Institute (N Bagheri PhD), University of
Canberra, Canberra, ACT, Australia; School of Public Aairs (R Bai MD),
Nanjing University of Science and Technology, Nanjing, China;
International Medical School (A A Baig PhD), Management and Science
University, Alam, Malaysia; Center for Clinical Research and Prevention
(J L Baker PhD), Bispebjerg University Hospital, Frederiksberg,
Denmark; Department of Neurosurgery (A T Bako PhD), Houston
Methodist Hospital, Houston, TX, USA; Maternal and Child Health Unit
(R K Bakshi MD), Indian Council of Medical Research, New Delhi, India
(D K Lal MD); Health Care Management Department
(M Balasubramanian PhD), Flinders Health and Medical Research
Institute (N B Bulamu PhD), Population Health Department
(T G Gebremeskel PhD), Health Economics Unit (B Kaambwa PhD),
College of Medicine and Public Health (B Kaambwa PhD,
G R Naik PhD), Health and Social Care Economics Group
(C Mpundu-Kaambwa PhD), Department of Nursing and Health
Sciences (S Shorofi PhD), Flinders University, Adelaide, SA, Australia;
Menzies Centre for Health Policy and Economics (M Balasubramanian
PhD), Charles Perkins Centre (R Biswas PhD), School of Pharmacy and
Charles Perkins Centre (Z Dai PhD), Department of Public Health
(M Khan PhD), School of Veterinary Science (B B Singh PhD), Save
Sight Institute (Y You PhD), University of Sydney, Sydney, NSW,
Australia; Center of Innovation, Technology and Education (CITE)
(Prof O C Baltatu PhD), Anhembi Morumbi University, Sao Jose dos
Campos, Brazil; Department of Medicine (K Bam MPH), Monash
University, Clayton, VIC, Australia; Department of Hypertension
(Prof M Banach PhD), Medical University of Lodz, Lodz, Poland; Polish
Mothers’ Memorial Hospital Research Institute, Lodz, Poland
(Prof M Banach PhD); Department of Neurosurgery
(S Bandyopadhyay BA), Faculty of Medicine (R Thayakaran PhD),
University of Southampton, Southampton, UK; Institute of Health and
Wellbeing (B Banik PhD), Federation University Australia, Melbourne,
VIC, Australia; Manna Institute (B Banik PhD), University of New
England, Armidale, NSW, Australia; Department of Non-communicable
Diseases (P C Banik MPhil), Bangladesh University of Health Sciences,
Dhaka, Bangladesh; Vocational School of Technical Sciences (M Baran
PhD), Batman University, Batman, Türkiye; Miami Cancer Institute
(M Bardhan MD), Baptist Health South Florida, Miami, FL, USA; School
of Psychology (Prof S L Barker-Collo PhD), University of Auckland,
Auckland, New Zealand; Department of Translational Medicine
(F Barone-Adesi PhD), University of Eastern Piedmont, Novara, Italy;
Department of Epidemiology (A Barrow MPH, D Braithwaite PhD,
D D Ding BS, D Yang MPH), College of Medicine (M J Diaz BS),
Department of Computer and Information Science and Engineering
(P Naghavi MSc), University of Florida, Gainesville, FL, USA;
Department of Public & Environmental Health (A Barrow MPH),
University of The Gambia, Brikama, The Gambia; Heidelberg Institute
of Global Health (S Barteit PhD), Department of Translational Health
Economics (Prof S Listl PhD), Heidelberg University Hospital,
Heidelberg, Germany; Alpha Genomics, Islamabad, Pakistan
(Z Basharat PhD); Department of Pharmacology and Toxicology
(A I J Bashir PhD), Department of Pharmaceutics and Industrial
Pharmacy (Z S Yahaya PhD), Kaduna State University, Kaduna, Nigeria;
Faculty of Pharmacy (J D Basso PharmD, S Silva MSc), Coimbra
Chemistry Centre (J D Basso PharmD), Coimbra Institute for
Biomedical Imaging and Translational Research (S Silva MSc),
University of Coimbra, Coimbra, Portugal; School of Public Health
(S Basu PhD), Department of Primary Care and Public Health
(Prof A Majeed MD, Prof S Rawaf MD), Department of Surgery and
Cancer (Prof E Mossialos PhD), WHO Collaborating Centre for Public
Health Education and Training (D L Rawaf MRCS), Imperial College
London, London, UK; Department of Medical Education (K Batra PhD),
Department of Social and Behavioral Health (Prof M Sharma PhD),
University of Nevada, Las Vegas, Las Vegas, NV, USA; Department of
Psychiatry (Prof B T Baune PhD), University of Münster, Münster,
Germany; Department of Psychiatry (Prof B T Baune PhD), Melbourne
Medical School, Melbourne, VIC, Australia; Health Human Resources
Research Center (M Bayati PhD), Student Research Committee
(A Faramarzi MD), Department of Otolaryngology (A Faramarzi MD),
Trauma Research Center (P Fazeli MSc, M Karajizadeh PhD),
Department of Medical Immunology (P Fazeli MSc), Maternal Fetal
Medicine Research Center (K Hessami MD), Health Policy Research
Center (H Kasraei MD, Y Sarikhani PhD), Department of Biostatistics
(H Molavi Vardanjani PhD, E Sadeghi PhD), Non-communicable
Disease Research Center (S G Sepanlou MD), Department of Clinical
Science (T Yaghoobpour DVM), Shiraz University of Medical Sciences,
Shiraz, Iran (Y Mansoori MD); Health System and Population Studies
Division (T Begum MPH), Maternal and Child Health Division
(A Iqbal MPH, A Sayeed MSc, M Siraj MSc), International Centre for
Diarrhoeal Disease Research, Dhaka, Bangladesh; Department of Basic
Sciences (E Behboudi PhD), Khoy University of Medical Sciences, Khoy,
Iran; Department of Epidemiology (S Khanmohammadi MD,
S Nejadghaderi MD, S Rashedi MD, H Soleimani MD), Non-
Communicable Diseases Research Center (NCDRC), Tehran, Iran
(A Behnoush BS, A Khalaji BS); Division of Pulmonary, Critical Care,
and Sleep (M Beiranvand PhD), University of Florida, Jacksonville, FL,
USA; Department of Medicine (D F Bejarano Ramirez BN), Faculty of
Medicine (J N Malagón-Rojas MSc), El Bosque University, Bogota,
Colombia; Transplant Service Department (D F Bejarano Ramirez BN),
University Hospital Foundation Santa Fe de Bogotá, Bogota, Colombia;
Department of Medical Anatomy (A Bekele MSc), Department of
Nursing (A M Mersha MSc), Medical Laboratory Sciences (D A D Tareke
MSc), Arba Minch University, Arba Minch, Ethiopia; Department
of Oral Pathology and Microbiology (U I Belgaumi MD), Krishna Vishwa
Vidyapeeth Deemed to be University, Karad, India; School of the
Environment (Prof M L Bell PhD, Y Song PhD), Department of Internal
Medicine (F Etaee MD), Department of Psychiatry (W Li PhD), Yale
University, New Haven, CT, USA; Department of Biomedical Sciences
(Prof A Beloukas PhD), University of West Attica, Athens, Greece;
Department of Internal Medicine (I M Bensenor PhD), Department of
Medicine (Prof P A Lotufo DrPH), Department of Psychiatry
(Prof M F P Peres MD, Y Wang PhD), University of São Paulo, São
Paulo, Brazil; Institute of Marketing (Z Berezvai PhD), Corvinus
University of Budapest, Budapest, Hungary; Competition Economics

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44
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and Market Research Section (Z Berezvai PhD), Hungarian Competition
Authority, Budapest, Hungary; Department of Epidemiology and
Biostatistics (A C Bermudez MD), University of the Philippines Manila,
Manila, Philippines; Department of Epidemiology (A C Bermudez MD),
Department of Internal Medicine (M F H Mohamed MSc), Brown
University, Providence, RI, USA; Faculty of Medicine
(P J G Bettencourt PhD), Catholic University of Portugal, Rio de Mouro,
Portugal; Department of Public Health (A S Bhagavathula PhD), North
Dakota State University, Fargo, ND, USA; Department of Hematology
Oncology (P V Bhardwaj MD), University of Massachusetts Medical
School, Springfield, MA, USA; Global Health Neurology Lab
(S Bhaskar PhD), NSW Brain Clot Bank, Sydney, NSW, Australia;
Department of Neurology and Neurophysiology (S Bhaskar PhD), South
West Sydney Local Heath District and Liverpool Hospital, Sydney, NSW,
Australia; Department of Internal Medicine (V Bhat MBBS), St John’s
National Academy of Health Sciences, Bangalore, India; Medical Lab
Technology (G K Bhatti PhD), University Centre for Research and
Development (S Kalra DM), Chandigarh University, Mohali, India;
Human Genetics and Molecular Medicine Department (Prof J S Bhatti
PhD, U Sharma PhD), Department of Zoology (B Vellingiri PhD),
Central University of Punjab, Bathinda, India; Department of Botanical
and Environmental Sciences (Prof M S Bhatti PhD), Department of
Pharmaceutical Sciences (R Bhatti PhD), Guru Nanak Dev University,
Amritsar, India; Department of Neurology (Prof A Biswas DM),
Department of GI Surgery (A Dhali MBBS), Institute of Post-Graduate
Medical Education and Research and Seth Sukhlal Karnani Memorial
Hospital, Kolkata, India; Clinical Research Centre (R Biswas PhD),
Sydney Local Health District, Sydney, NSW, Australia; Faculty of Health
Sciences (V R Bitra PhD), University of Botswana, Gaborone, Botswana;
Department of Global Public Health and Primary Care
(Prof T Bjørge PhD, O Dadras DrPH), Department of Psychosocial
Science (D Sagoe PhD), University of Bergen, Bergen, Norway; Cancer
Registry of Norway, Oslo, Norway (Prof T Bjørge PhD); SAMRC Centre
for Health Economics and Decision Science (PRICELESS SA)
(M K Boachie PhD), University of the Witwatersrand, Johannesburg,
South Africa; School of Business Administration (Prof V Bodolica PhD),
American University of Sharjah, Sharjah, United Arab Emirates;
General Directorate of Health Information Systems (B Bora Basara
PhD), Ministry of Health, Ankara, Türkiye; Department of Medicine
(Prof S Bouaoud MD), Faculty of Medicine (Prof A Ouyahia PhD),
University Ferhat Abbas of Setif, Sétif, Algeria; Department of
Epidemiology and Preventive Medicine (Prof S Bouaoud MD),
University Hospital Saadna Abdenour, Setif, Algeria; Cancer Population
Sciences Program (D Braithwaite PhD), University of Florida Health
Cancer Center, Gainesville, FL, USA; School of Population and Public
Health (Prof M Brauer DSc), School of Nursing (A Pashaei MSc),
University of British Columbia, Vancouver, BC, Canada; Department of
Psychiatry and Behavioral Health (Prof N J K Breitborde PhD),
Department of Psychology (Prof N J K Breitborde PhD), Ohio State
University, Columbus, OH, USA; Department of Woman and Child
Health and Public Health (D Buonsenso MD), Fondazione Policlinico
Universitario A Gemelli IRCCS (Agostino Gemelli University Polyclinic
IRCCS), Rome, Italy; Global Health Research Institute (D Buonsenso
MD), Università Cattolica del Sacro Cuore (Catholic University of Sacred
Heart), Rome, Italy; Department of Biopharmaceutics and Clinical
Pharmacy (Y Bustanji PhD), The University of Jordan, Amman, Jordan;
School of Public Health and Health Systems (Z A Butt PhD), University
of Waterloo, Waterloo, ON, Canada; Al Shifa School of Public Health
(Z A Butt PhD), Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan;
Department of Clinical Pharmacy (Prof D Calina PhD), University of
Medicine and Pharmacy of Craiova, Craiova, Romania; Center for
Nutrition and Health Research (I R Campos-Nonato PhD,
E Denova-Gutiérrez DSc), Center for Health Systems Research
(S M Cuadra-Hernández PhD, D V Ortega-Altamirano DrPH,
E Serván-Mori PhD), National Institute of Public Health, Cuernavaca,
Mexico; Department of Ophthalmology (F Cao MD), Beijing Institute of
Ophthalmology, Beijing, China; Department of Biomedical and
Neuromotor Sciences (A Capodici MD, S Guicciardi MD,
L Muccioli MD), Dipartimento di Scienze Biomediche e Neuromotorie
(DIBINEM) (F Esposito MD), Department of Medical and Surgical
Sciences (Prof F S Violante MD), University of Bologna, Bologna, Italy;
Management and Healthcare (EMbeDS) (A Capodici MD), Sant’Anna
School of Advanced Studies, Pisa, Italy; Institute for Cancer Research,
Prevention and Clinical Network, Florence, Italy (G Carreras PhD);
Dermatology Unit (A Carugno MD), Azienda Socio Sanitaria Territoriale
Papa Giovanni XXIII (Territorial Healthcare Company Pope John XXIII),
Bergamo, Italy; Colombian National Health Observatory
(C A Castañeda-Orjuela MD), Department of Public Health Research
(J N Malagón-Rojas MSc), National Institute of Health, Bogota,
Colombia; Epidemiology and Public Health Evaluation Group
(C A Castañeda-Orjuela MD), National University of Colombia, Bogota,
Colombia; Department of Medicine (G Castelpietra PhD), University of
Udine, Udine, Italy; Department of Mental Health (G Castelpietra PhD),
Healthcare Agency “Friuli Occidentale”, Pordenone, Italy; Department of
Public Health and Infectious Diseases (M S Cattaruzza PhD),
La Sapienza University, Rome, Italy; Department of Psychiatry
(A Caye PhD), Federal University of Rio Grande do Sul, Porto Alegre,
Brazil; Department of Medical, Surgical, and Health Sciences
(L Cegolon PhD, Prof M D’Oria MD), University of Trieste, Trieste, Italy;
Public Health Unit (L Cegolon PhD), University Health Agency
Giuliano-Isontina (ASUGI), Trieste, Italy; Department of Nutrition
(Prof F Cembranel DSc), Federal University of Santa Catarina,
Florianópolis, Brazil; Mary MacKillop Institute for Health Research
(Prof E Cerin PhD), Australian Catholic University, Melbourne, VIC,
Australia; School of Public Health (Prof E Cerin PhD), Department of
Urban Planning and Design (C Guo PhD), Centre for Suicide Research
and Prevention (Prof P Yip PhD), Department of Social Work and Social
Administration (Prof P Yip PhD), University of Hong Kong, Hong Kong,
China; ICMR School of Public Health (J Chadwick MD), National
Institute of Epidemiology, Chennai, India; Department of Biotechnology
(Prof C Chakraborty PhD), Adamas University, Kolkata, India;
Department of Skeletal Aging and Orthopedic Surgery
(Prof C Chakraborty PhD), Hallym University, Chuncheon, South Korea;
Heart Failure and Structural Heart Disease Unit (J Chan MBChB),
Cardiovascular Analytics Group, Hong Kong, China; Department of
Public Health (P Charalampous PhD), Erasmus University Medical
Center, Rotterdam, Netherlands; Temerty Faculty of Medicine
(V Chattu MD), University of Toronto, Toronto, ON, Canada;
Department of Community Medicine (V Chattu MD), Datta Meghe
Institute of Medical Sciences, Sawangi, India; Dr D Y Patil Medical
College Hospital and Research Centre (S Chaturvedi PhD), Dr D Y Patil
Vidyapeeth, Pune, India; School of Public Health (M P Chavula MPH),
University of Zambia, Lusaka, Zambia; Fuwai Hospital (A Chen PhD),
Chinese Academy of Medical Sciences & Peking Union Medical College,
Beijing, China; Department of Computer Science (A Chen PhD),
University of Texas Austin, Austin, TX, USA; Clinical Research Center
(H Chen MB), Stomatological Hospital (A Li PhD), Southern Medical
University, Guangzhou, China; Department of Laboratory Medicine
(J Chien PhD), Taichung Tzu-Chi Hospital Buddhist Tzu-Chi Medical
Foundation, Tanzih, Taiwan; Department of Medical Laboratory Science
and Biotechnology (J Chien PhD), Central Taiwan University of Science
and Technology, Taiwan; Division of Infectious Diseases (P R Ching
MD), Virginia Commonwealth University, Richmond, VA, USA;
Department of Clinical Oncology (W C S Cho PhD), Queen Elizabeth
Hospital, Hong Kong, China; College of Medicine (S Choi MD Cand),
Department of Epidemiology and Health Promotion (Prof S Jee PhD),
Yonsei University, Seoul, South Korea; Department of Medicine
(B Chong MBBS), Department of Surgery (K Tan PhD), National
University of Singapore, Singapore; Department of Biosciences
(H Chopra PhD), Saveetha Dental College and Hospitals
(M R Tovani-Palone PhD), Saveetha Institute of Medical and Technical
Sciences, Chennai, India; Department of Community Medicine
(Prof S G Choudhari MD, Prof A M Gaidhane MD), Datta Meghe
Institute of Medical Sciences, Wardha, India; Department of Pulmonary
Medicine (Prof D J Christopher MD), Department of Endocrinology,
Diabetes and Metabolism (Prof N Thomas PhD), Christian Medical
College and Hospital (CMC), Vellore, India; Center for Biomedicine and
Community Health (D Chu PhD), Viet Nam National-International
School, Hanoi, Viet Nam; Department of Paediatric Surgery
(I S Chukwu BMedSc), Federal Medical Centre, Umuahia, Nigeria;
Department of AndroUrology (Prof E Chung MD), AndroUrology
Centre, Brisbane, QLD, Australia; Department of Health Informatics

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45
(S Chung PhD), Institute of Cardiovascular Science
(A S Oguntade MSc), University College London, London, UK; Health
Data Research UK, London, UK (S Chung PhD); Department of
Genetics (Z Cindi PhD), School of Veterinary Medicine
(F Musaigwa PhD), Department of Biostatistics Epidemiology and
Informatics (J Puvvula PhD), University of Pennsylvania, Philadelphia,
PA, USA; Department of Food, Environmental and Nutritional Sciences
(I Cio PhD), University of Milan, Milan, Italy; Department of Law,
Economics, Management and Quantitative Methods
(R Ciureda MSc, Prof B Simonetti PhD), University of Sannio,
Benevento, Italy; Nova Medical School (J Conde PhD), Nova University
of Lisbon, Lisbon, Portugal; Department of Family Medicine and Public
Health (Prof M H Criqui MD), University of California San Diego,
La Jolla, CA, USA; Department of Therapeutic and Diagnostic
Technologies (Prof N Cruz-Martins PhD), Toxicology Research Unit
(TOXRUN) (Prof D Dias da Silva PhD, Á M Madureira-Carvalho PhD),
Cooperativa de Ensino Superior Politécnico e Universitário (CESPU)
(University Polytechnic Higher Education Cooperative), Gandra,
Portugal; Department of Internal Medicine (S Dadana MD), Cheyenne
Regional Medical Center, Cheyenne, WY, USA; Department of Addiction
Medicine (O Dadras DrPH), Haukland University Hospital, Bergen,
Norway; Department of Community Medicine (Prof T Dahiru MA),
Department of Surgery (A Kabir MD), Health Systems and Policy
Research Unit (S Mohammed PhD), Ahmadu Bello University, Zaria,
Nigeria; IRCCS Istituto Ortopedico Galeazzi (G Damiani MD), Galeazzi
Orthopedic Institute IRCCS (University of Milan), Milan, Italy;
Department of Dermatology (G Damiani MD), Lerner College of
Medicine (L Göbölös PhD), Department of Quantitative Health Science
(X Liu PhD), Department of Neonatology (I Qattea MD), Department of
Nutrition and Preventive Medicine (Prof J Sanabria MD), Case Western
Reserve University, Cleveland, OH, USA; Department of Information
Technology (A M Darwesh PhD), Department of Computer Science
(Prof M Hosseinzadeh PhD), University of Human Development,
Sulaymaniyah, Iraq; Division of Women and Child Health (J K Das MD),
Aga Khan University, Karachi, Pakistan; Department of Biochemistry
(S Das MD), Ministry of Health and Welfare, New Delhi, India;
Department of Radiology (M Dashti MD, A Ghasemzadeh MD),
Department of Health Policy and Management (L Doshmangir PhD),
School of Nursing and Midwifery (H Hassankhani PhD), Department of
Immunology (F Jadidi-Niaragh PhD), School of Management and
Medical Informatics (L R Kalankesh PhD), Department of Midwifery
(Prof M Mirghafourvand PhD, Prof S Mohammad-Alizadeh-Charandabi
PhD), Social Determinants of Health Research Center
(Prof S Mohammad-Alizadeh-Charandabi PhD), Tabriz University of
Medical Sciences, Tabriz, Iran; 2nd University Ophthalmology
Department (A Dastiridou MD), Department of Ophthalmology
(N Dervenis MD), Second Department of Cardiology (D Patoulias PhD),
Aristotle University of Thessaloniki, Thessaloniki, Greece;
Ophthalmology Department (A Dastiridou MD), University of Thessaly,
Thessaly, Greece; Department of Population and Development
(C A Dávila-Cervantes PhD), Latin American Faculty of Social Sciences
Mexico, Mexico City, Mexico; Health Research Institute
(K Davletov PhD), Asfendiyarov Kazakh National Medical University,
Almaty, Kazakhstan; Medical College (S Debopadhaya BS), Albany
Medical College, Albany, NY, USA; School of Medicine
(I Delgado-Enciso DSc), University of Colima, Colima, Mexico;
Department of Research (I Delgado-Enciso DSc), Colima State Health
Services, Colima, Mexico; Epidemiology Branch (X Deng PhD), National
Institute of Environmental Health Sciences, Durham, NC, USA;
Wellcome Trust Brighton and Sussex Centre for Global Health Research
(K Deribe PhD), Brighton and Sussex Medical School, Brighton, UK;
St Paul’s Eye Unit (N Dervenis MD), Royal Liverpool University
Hospital, Liverpool, UK; Graduate Medical Education (H D Desai MD),
Gujarat Adani Institute of Medical Sciences, Bhuj, India; Division of
Cardiology (R Desai MBBS), Atlanta Veterans Aairs Medical Center,
Decatur, GA, USA; Department of Community Medicine
(V G C Devanbu MD), Chettinad Academy of Research and Education,
Chennai, India; Division of Pathology (K Dhama PhD), ICAR-Indian
Veterinary Research Institute, Bareilly, India; Research Department
(M Dhimal PhD, S Ghimire MPH, U Paudel PhD), Nepal Health
Research Council, Kathmandu, Nepal; The Zena and Michael A Wiener
Cardiovascular Institute (V R Dhulipala MD), Institute of Critical Care
Medicine (A Shaikh MD), Department of Cardiology (M Vinayak MD),
Icahn School of Medicine at Mount Sinai, New York, NY, USA (A Shaikh
MD); Faculty of Science (Prof D Diaz PhD), National Autonomous
University of Mexico, Mexico City, Mexico; Department of Medicine
(T C Do MD), Medical School (H Pham MD), Pham Ngoc Thach
University of Medicine, Ho Chi Minh City, Viet Nam; Department of
Medicine (T H Do MD), Can Tho University of Medicine and Pharmacy,
Can Tho, Viet Nam; Center for Health Sciences (C B do Prado MSc),
Department of Pathology (Prof B Fux PhD), Federal University of
Espirito Santo, Vitória, Brazil; Department of Epidemiology
(S Dohare MD, M Khan MD), Department of Health Education and
Promotion (M Shanawaz MD), Jazan University, Jazan, Saudi Arabia;
School of Elderly Care Services and Management (W Dong MD),
Nanjing University of Chinese Medicine, Nanjing, China; Cardio-
Thoraco-Vascular Department (Prof M D’Oria MD), Azienda Sanitaria
Universitaria Giuliano Isontina, Trieste, Italy; Responsabilidade Social
(W M dos Santos PhD), Hospital Alemão Oswaldo Cruz
(Oswaldo Cruz German Hospital), São Paulo, Brazil; Brazilian Centre for
Evidence-based Healthcare (W M dos Santos PhD), Joanna Briggs
Institute, São Paulo, Brazil; Department of Medicine
(A C Dsouza MBBS, A Sathyanarayan MD, M Sharath MD), Bangalore
Medical College and Research Institute, Bangalore, India; Department of
Forensic Medicine and Toxicology (H L Dsouza MD, V Krishna MD),
Department of General Medicine (J Jeganathan MD), Department of
Community Medicine (N Joseph MD, R Motappa MD, R Thapar MD),
Department of Internal Medicine (M M R Reddy MD), Department of
Forensic Medicine (P H Shetty MD), Kasturba Medical College
(Prof B Unnikrishnan MD), Manipal Academy of Higher Education,
Mangalore, India; Department of Forensic Medicine and Toxicology
(H L Dsouza MD), Kasturba Medical College Mangalore, Mangalore,
India; Health Policy Department (V Dsouza MSc), Kasturba Medical
College, Mangalore (R Holla MD), Department of Physiotherapy
(Prof V K PhD), Prasanna School of Public Health (R Kamath MHA),
Manipal Institute of Management (S Kamath MHA), Department of
Pharmacy Management (V S Ligade PhD), Department of Forensic
Medicine and Toxicology (A Mishra MD, Prof V C Nayak MD), Manipal
TATA Medical College (M Rahman PhD), Department of Community
Medicine (C R Rao MD), Department of Nephrology (I Rao DM),
Department of Health Information Management (B Reshmi PhD),
Manipal Academy of Higher Education, Manipal, India (B Reshmi PhD);
Oce of Institutional Analysis (J Dube MA), University of Windsor,
Windsor, ON, Canada; School of Medicine (Prof A R Duraes PhD),
Institute of Collective Health (Prof D Rasella PhD), Federal University of
Bahia, Salvador, Brazil; Department of Internal Medicine
(Prof A R Duraes PhD), Escola Bahiana de Medicina e Saúde Pública
(Bahiana School of Medicine and Public Health), Salvador, Brazil;
Department of Biotechnology (S Duraisamy PhD), SRM College of
Pharmacy (M R Tovani-Palone PhD), SRM Institute of Science and
Technology (SRMIST), Chennai, India; Department of Infection and
Tropical Medicine (O C Durojaiye MPH), School of Health and Related
Research (J O Oguta MSc), Department of Psychology
(A Yadollahpour PhD), University of Sheeld, Sheeld, UK; School of
Life Sciences (S Dutta PhD), Manipal Academy of Higher Education,
Dubai, United Arab Emirates; Child Health Analytics Research Program
(P A Dzianach PhD, Prof P W Gething PhD, F Sanna PhD, D J Weiss
PhD), Geospatial Health and Development Team (J Lubinda PhD), The
Malaria Atlas Project (S F Rumisha PhD), Telethon Kids Institute, Perth,
WA, Australia; Department of Conservative Dentistry with Endodontics
(A M Dziedzic DSc), Medical University of Silesia, Katowice, Poland;
Department of Orthopaedic Surgery (A Ebrahimi MD), Department of
Radiology (X Liu PhD), Division of Cardiology (D H Nguyen BS),
Massachusetts General Hospital, Boston, MA, USA; School of Health
Sciences (H A Edinur PhD), Universiti Sains Malaysia (University of
Science Malaysia), Kubang Kerian, Malaysia; College of Science, Health
and Engineering (K Edvardsson PhD), La Trobe University, Bundoora,
VIC, Australia; Department of Community Health Nursing
(F Efendi PhD), Universitas Airlangga (Airlangga University), Surabaya,
Indonesia; Centre for Global Health Inequalities Research (CHAIN)
(Prof T Eikemo PhD), Department of Circulation and Medical Imaging
(J Nauman PhD), Norwegian University of Science and Technology,

Articles
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Trondheim, Norway; Department of Internal Medicine and Hematology
Unit (Prof G M T ElGohary MD), Biochemistry Department
(Prof N M Hamdy PhD), Department of Entomology (A M Samy PhD),
Medical Ain Shams Research Institute (MASRI) (A M Samy PhD), Ain
Shams University, Cairo, Egypt; Faculty of Medicine (M Elhadi MD),
University of Tripoli, Tripoli, Libya; Egypt Center for Research and
Regenerative Medicine (ECRRM), Cairo, Egypt (M A Elmonem PhD);
Clinical Pathology Department (M Elshaer MD), Faculty of Pharmacy
(M A Saleh PhD), Rheumatology and Immunology Unit
(S Tharwat MD), Mansoura University, Mansoura, Egypt; Department of
Infectious Diseases and Public Health (I Elsohaby PhD), City University
of Hong Kong, Hong Kong, China; Department of Animal Medicine
(I Elsohaby PhD), Department of Cardiology (Prof A M A Saad MD),
Zagazig University, Zagazig, Egypt; Department of Medical-Surgical
Nursing (A Emami Zeydi PhD, S Shorofi PhD), Department of
Immunology (Prof A Rafiei PhD), Molecular and Cell Biology Research
Center (Prof A Rafiei PhD), Department of Environmental Health
(Prof Z Yousefi PhD), Mazandaran University of Medical Sciences, Sari,
Iran; Lincoln International Institute for Rural Health
(L Engelbert Bain PhD), University of Lincoln, Lincoln, UK; Bologna,
Italy (N Fabin MD); Research Centre for Healthcare and Community
(A F Fagbamigbe PhD), Faculty of Health and Life Sciences
(O P Kurmi PhD), Coventry University, Coventry, UK; Department of
Food Hygiene and Quality Control (A Fakhri-Demeshghieh DVM),
University of Tehran, Tehran, Iran; Epidemiology and Biostatistics Unit
IRCCS Pascale (L Falzone PhD), IRCCS, Naples, Italy; Department of
Psychology (Prof A Faro PhD), Federal University of Sergipe, São
Cristóvão, Brazil; Satcher Health Leadership Institute
(A O Fasanmi PhD), Morehouse School of Medicine, Atlanta, GA, USA;
School of Medicine (A O Fasanmi PhD), Department of Family and
Preventive Medicine (T Sathish PhD), Emory University, Atlanta, GA,
USA; Centre for Health Policy Research (Prof P Ward PhD), Torrens
University Australia, Adelaide, SA, Australia (N K Fauk MSc); Institute
of Resource Governance and Social Change, Kupang, Indonesia
(N K Fauk MSc); National Institute for Stroke and Applied
Neurosciences (Prof V L Feigin PhD), Auckland University of
Technology, Auckland, New Zealand; Research Center of Neurology,
Moscow, Russia (Prof V L Feigin PhD); Division of Neurology
(S Fereshtehnejad PhD), University of Ottawa, Ottawa, ON, Canada;
Research Center on Public Health (P Ferrara MD), University of Milan
Bicocca, Monza, Italy; Department of Social Sciences
(Prof N Ferreira PhD), University of Nicosia, Nicosia, Cyprus;
Department of Nursing (G Fetensa MSc), Department of Public Health
(M E Getachew MPH, D R Terefa MSc), Wollega University, Nekemte,
Ethiopia; Department of Psychiatry (I Filip MD), Kaiser Permanente,
Fontana, CA, USA; School of Health Sciences (I Filip MD), A T Still
University, Mesa, AZ, USA; Institute of Public Health (F Fischer PhD),
Department of Surgery (N Haep MD), Department of Neurology
(S Samadzadeh MD), Charité Universitätsmedizin Berlin
(Charité Medical University Berlin), Berlin, Germany; School of Social
Sciences (J Flavel PhD), Stretton Health Equity, Adelaide, SA, Australia;
Institute of Gerontology (N A Foigt PhD), National Academy of Medical
Sciences of Ukraine, Kyiv, Ukraine; Clinical Science Department
(Prof M O Folayan FWACS), Nigerian Institute of Medical Research,
Yaba, Nigeria; Department of Cell Biology and Biotechnology
(A A Fomenkov PhD), K A Timiryazev Institute of Plant Physiology,
Moscow, Russia; Department of Pharmacology (Prof B Foroutan PhD),
Iranshahr University of Medical Sciences, Iranshahr, Iran; Department
of Biotechnological and Applied Clinical Sciences (DISCAB)
(M Foschi MD), University of L’Aquila, L’Aquila, Italy; Department of
Neuroscience (M Foschi MD), Hospital Santa Maria delle Croci,
Ravenna, Italy; Child Survival Unit (K R Fowobaje MSc), Centre for
African Newborn Health and Nutrition, Ibadan, Nigeria; Centre for
Adolescent Health (K L Francis MBiostat), Murdoch Children’s Research
Institute, Melbourne, VIC, Australia; Center for Health Technology and
Services Research (CINTESIS), Porto, Portugal (A Freitas PhD);
Department of Dermatology (T Fukumoto PhD), Kobe University, Kobe,
Japan; Health Services Management Training Centre
(P A Gaal PhD, T Joo PhD, J Lám PhD), Institute of Digital Health
Sciences (P Pollner PhD), Faculty of Health and Public Administration
(M Szócska PhD), Semmelweis University, Budapest, Hungary;
Department of Applied Social Sciences (P A Gaal PhD), Sapientia
Hungarian University of Transylvania, Targu Mures, Romania;
Department of Community Medicine (Prof M A Gadanya FMCPH),
Aminu Kano Teaching Hospital, Kano, Nigeria; Department of Food
Technology (Y Galali ResM, B A Sadee PhD), Salahaddin University-
Erbil, Erbil, Iraq; Department of Nutrition and Dietetics
(Y Galali ResM, B A Sadee PhD), Cihan University-Erbil, Erbil, Iraq;
Department of Environmental Health Sciences
(S Gallus DSc, A Lugo PhD), Mario Negri Institute for Pharmacological
Research, Milan, Italy; Department of Community Medicine and Family
Medicine (A P Gandhi MD), All India Institute of Medical Sciences,
Nagpur, India; Institute of Health and Wellbeing (B Ganesan PhD),
Federation University, Churchill, VIC, Australia; Department of General
Medicine (M Ganiyani MD), Grant Medical College & Sir J J Group of
Hospitals, Mumbai, India; Department of Medicine (M Ganiyani MD),
Miami Cancer Institute, Miami, FL, USA; Faculty of Business and
Management (M Garcia-Gordillo PhD), Universidad Autonóma de Chile
(Autonomous University of Chile), Talca, Chile; University School of
Management and Entrepreneurship (N Garg PhD, R Sharma PhD),
Delhi Technological University, Delhi, India; Department of
Pharmacology (Prof R K Gautam PhD), Indore Institute of Pharmacy,
Indore, India; Institute and Faculty of Actuaries, London, UK
(F Gazzelloni BSc); Department of Epidemiology (S O Gbadamosi MD),
Florida International University, Miami, FL, USA; Department of
Midwifery (M W Gebregergis MSc), Department of Medical Laboratory
Sciences (H Negash MSc), Adigrat University, Adigrat, Ethiopia;
Department of Environmental Health (M Gebrehiwot DSc), Wollo
University, Dessie, Ethiopia; Department of Public Health
(T B Gebremariam MPH), Debre Berhan University, Debre Berhan,
Ethiopia; Addis Ababa, Ethiopia (T B Gebremariam MPH,
S A Yesuf MSc); Department of Public Health Nutrition
(T B Gebremariam MPH), Aksum University, Mekelle, Ethiopia;
Reproductive and Family Health Department (T G Gebremeskel PhD),
Axum College of Health Science, Axum, Ethiopia; School of Population
Health (Prof P W Gething PhD), School of Public Health
(T R Miller PhD), Curtin School of Population Health (D J Weiss PhD),
Curtin University, Perth, WA, Australia; Department of Dermatology
(Prof S R Georgescu PhD), “Victor Babes” Clinical Hospital of Infectious
and Tropical Diseases, Bucharest, Romania; College of Health Science
(H Geremew MPH), Oda Bultum University, Chiro, Ethiopia; Young
Researchers and Elite Club (A Gholamian MSc), Islamic Azad
University, Rasht, Iran; Department of Biology (A Gholamian MSc),
Islamic Azad University, Tehran, Iran; Department of Radiology
(A Gholamrezanezhad MD), University of Southern California, Los
Angeles, CA, USA; Department of Respiratory Medicine
(Prof A G Ghoshal MD), National Allergy Asthma Bronchitis Institute,
Kolkata, India; Department of Respiratory Medicine
(Prof A G Ghoshal MD), Fortis Hospital, Kolkata, India; Department of
Forensic Biology (A D Ghuge MPhil), Government Institute of Forensic
Science, Aurangabad, India; Department of Clinical Research
(A D Ghuge MPhil), National Institute for Research In Reproductive and
Child Health, Mumbai, India; NCD Surveillance Unit (A U Gil PhD),
World Health Organization (WHO), Moscow, Russia; Institute for
Leadership and Health Management (A U Gil PhD), Moscow Medical
Academy, Moscow, Russia; Adelaide Medical School (T K Gill PhD),
University of Adelaide, Adelaide, SA, Australia; Department of Molecular
and Developmental Medicine (M Giorgi MD), Post Graduate School of
Public Health (G Guarducci MD), University of Siena, Siena, Italy;
NIHR Global Health Research Unit on Global Surgery
(J C Glasbey MSc), Institute of Applied Health Research
(R Thayakaran PhD), University of Birmingham, Birmingham, UK;
Department of Hepatology (Prof A Goel DM), Sanjay Gandhi
Postgraduate Institute of Medical Sciences, Lucknow, India; Department
of Applied Cell Sciences (A Golchin PhD), Cellular and Molecular
Medicine Institute (A Golchin PhD), School of Medicine
(P Mokhtarzadehazar MD), Urmia University of Medical Sciences,
Urmia, Iran (R Valizadeh PhD); Department of Health Systems and
Policy Research (M Golechha PhD), Indian Institute of Public Health,
Gandhinagar, India; Department of Genetics (P Goleij MSc), Sana
Institute of Higher Education, Sari, Iran; Universal Scientific Education
and Research Network (USERN) (P Goleij MSc), Substance Abuse

Articles
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47
Prevention Research Center (B Mansouri PhD), Research Center for
Environmental Determinants of Health (Prof E Sadeghi PhD),
Kermanshah University of Medical Sciences, Kermanshah, Iran;
Hudson College of Public Health (S V Gopalani MPH), University of
Oklahoma Health Sciences Center, Oklahoma City, OK, USA;
Department of Health and Social Aairs (S V Gopalani MPH),
Government of the Federated States of Micronesia, Palikir, Federated
States of Micronesia; Department of Respiratory Medicine
(H Goudarzi PhD), Center for Environmental and Health Sciences
(H Goudarzi PhD), Hokkaido University, Sapporo, Japan; Department of
Epidemiology (Prof A C Goulart PhD), Universidade de São Paulo
(University of São Paulo), São Paulo, Brazil; Blood and Marrow
Transplantation and Cellular Therapy Program (A Goyal MD), Stanford
University, Palo Alto, CA, USA; Department of Public Health and
Preventive Medicine (Prof M Grivna PhD), Charles University, Prague,
Czech Republic; Department of Epidemiology and Biostatistics
(S Guan MD, Prof H Pan PhD), Anhui Medical University, Hefei, China;
Department of Family and Community Medicine (M I M Gubari PhD),
University Of Sulaimani, Sulaimani, Iraq; Health Directorate
(S Guicciardi MD), Local Health Authority of Bologna, Bologna, Italy;
Department of General Surgery (S Gulati MD), Dignity Health, Phoenix,
AZ, USA; Diagnostic Radiology and Nuclear Medicine
(D Gulisashvili MD), University of Maryland, Baltimore, MD, USA;
Department of Community Medicine (D A Gunawardane MD),
University of Peradeniya, Kandy, Sri Lanka; Department of Internal
Medicine (A K Gupta PharmD), Shree Guru Gobind Singh Tricentenary
University, Gurugram, India; Non-communicable Division (NCD)
(A K Gupta PharmD), Indian Council of Medical Research, Delhi, India;
Department of Public Health (B Gupta PhD), Torrens University
Australia, Melbourne, VIC, Australia; Department of Toxicology
(S Gupta MSc), Shriram Institute for Industrial Research, Delhi, India;
School of Medicine (V Gupta PhD), Deakin University, Geelong, VIC,
Australia; School of Biotechnology (V Gupta PhD), Dublin City
University, Glasnevin, Ireland; Faculty of Medicine Health and Human
Sciences (Prof V K Gupta PhD), Macquarie Medical School (Y You PhD),
Macquarie University, Sydney, NSW, Australia; Department of Global
Health and Population (A Haakenstad ScD), T H Chan School of Public
Health, Boston, MA, USA; Global Virus Network, Middle East Region,
Shiraz, Iran (F Habibzadeh MD); Department of Clinical Pharmacology
and Medicine (Prof N R Hadi PhD), University of Kufa, Najaf, Iraq;
Clinician Scientist Program (N Haep MD), Berlin Institute of Health,
Berlin, Germany; Department of Infectious Disease Epidmiology
(S Haller MD), Robert Koch Institute, Berlin, Germany; Department of
Public Health (S Haller MD), Charité Insitute of Public Health, Berlin,
Germany; Department of Family and Community Medicine
(Prof R R Hamadeh PhD), College of Medicine and Medical Sciences
(H Jahrami PhD), Arabian Gulf University, Manama, Bahrain; School of
Health and Environmental Studies (Prof S Hamidi DrPH), Hamdan Bin
Mohammed Smart University, Dubai, United Arab Emirates;
Department of Nephrology (Q Han PhD), Beijing Chao-yang Hospital,
Beijing, China; Department of Epidemiology (A J Handal PhD),
University of Michigan, Ann Arbor, MI, USA; Centre for Neuromuscular
and Neurological Disorders (Prof G J Hankey MD), University of
Western Australia, Perth, WA, Australia; Perron Institute for
Neurological and Translational Science, Perth, WA, Australia
(Prof G J Hankey MD); Department of Population Science and Human
Resource Development (Prof M Haque PhD, Prof M Rahman PhD,
M Rahman DrPH), Department of Mathematics (M Kuddus PhD),
University of Rajshahi, Rajshahi, Bangladesh; Research Unit
(J M Haro MD), University of Barcelona, Barcelona, Spain; Biomedical
Research Networking Center for Mental Health Network (CiberSAM),
Barcelona, Spain (J M Haro MD); Department of Zoology and
Entomology (A I Hasaballah PhD), Al Azhar University, Cairo, Egypt;
Department of Pharmaceutical Technology (I Hasan MPharm),
Department of Population Sciences (Prof M B H Hossain PhD),
University of Dhaka, Dhaka, Bangladesh; Department of Public Health
(M Hasan MPH), Tropical Disease and Health Research Center,
Bangladesh, Dhaka, Bangladesh; Department of Biomedical Engineering
and Public Health (S Hasan PhD), World University of Bangladesh,
Dhaka, Bangladesh; Department of Ophthalmology (H Hasani MD),
Iran University of Medical Sciences, Karaj, Iran; Department of
Pharmacy (Prof M S Hasnain PhD), Palamau Institute of Pharmacy,
Daltonganj, India; Department of Public Health (I Hassan MPH),
Dalhatu Araf Specialist Hospital, Lafia, Nigeria; Public Health
Department (I Hassan MPH), Federal University of Lafia, Lafia, Nigeria;
Tabriz, Iran (H Hassankhani PhD); Faculty of Kinesiology
(Prof J J Hebert PhD), University of New Brunswick, Fredericton, NB,
Canada; School of Allied Health (Prof J J Hebert PhD), Murdoch
University, Murdoch, WA, Australia; Community-Oriented Nursing
Midwifery Research Center (M Heidari PhD), Department of
Epidemiology and Biostatistics (A Mohammadian-Hafshejani PhD),
Department of Health in Disasters and Emergencies
(R Sheikhi BHlthSci), Shahrekord University of Medical Sciences,
Shahrekord, Iran; Institute of Psychology (B Helfer PhD), University of
Wrocław, Wrocław, Poland; Meta Research Centre (B Helfer PhD),
University of Wrocław, Wrocław, Poland; Department of Medicine
(M Hemmati MD), MedStar Health, Columbia, MD, USA; Department
of Medicine (M Hemmati MD), Georgetown University, Washington,
DC, USA; Departamento de Salud Oral (Department of Oral Health)
(B Y Herrera-Serna PhD), Universidad Autónoma de Manizales
(Autonomous University of Manizales), Manizales, Colombia; School of
Business (Prof C Herteliu PhD), London South Bank University,
London, UK; Department of Microbiology (K Hezam PhD), Department
of Applied Microbiology (E A Noman PhD), Taiz University, Taiz,
Yemen; School of Medicine (K Hezam PhD), Nankai University, Tianjin,
China; Division for Health Service Promotion (Y Hiraike PhD),
Department of Global Health Policy
(S Nomura PhD, S K Rauniyar PhD), University of Tokyo, Tokyo, Japan;
School of Dentistry (N Q Hoan DDS), Hanoi Medical University, Hanoi,
Viet Nam; Department of Pulmonology (N Horita PhD), Yokohama City
University, Yokohama, Japan; National Human Genome Research
Institute (NHGRI) (N Horita PhD), Center for Translation Research and
Implementation Science (G A Mensah MD), National Institutes of
Health, Bethesda, MD, USA; Social and Environmental Health Research
(M Hossain MPH), Nature Study Society of Bangladesh, Khulna,
Bangladesh; Department of Health Promotion and Community Health
Sciences (M Hossain MPH), Texas A&M University, College Station, TX,
USA; School of Health and Society (H Hosseinzadeh PhD, Z Ratan
MSc), University of Wollongong, Wollongong, NSW, Australia; Institute
of Research and Development (Prof M Hosseinzadeh PhD), Faculty of
Medicine (H T H Nguyen MD), Institute for Research and Training in
Medicine, Biology and Pharmacy (H T H Nguyen MD), Duy Tan
University, Da Nang, Viet Nam; Department of Clinical Legal Medicine
(S Hostiuc PhD), National Institute of Legal Medicine Mina Minovici,
Bucharest, Romania; Faculty of Medicine of Tunis (Prof M Hsairi MPH),
University Tunis El Manar, Tunis, Tunisia; Department of Health
Services Administration (V Hsieh PhD), Department of Occupational
Safety and Health (Prof B Hwang PhD), College of Public Health
(R Lin PhD), China Medical University, Taichung, Taiwan; Department
of Psychology (C Hu PhD), Tsinghua University, Beijing, China; Jockey
Club School of Public Health and Primary Care
(J Huang MD, C Zhong MD), The Chinese University of Hong Kong,
Hong Kong, China; Department of Public Health and Community
Medicine (Prof A Humayun PhD), Shaikh Khalifa Bin Zayed Al-Nahyan
Medical College, Lahore, Pakistan; Department of Biological Sciences
and Chemistry (Prof J Hussain PhD), Natural and Medical Sciences
Research Center (A Khan PhD, A Ullah MS, S Ullah MSc), School of
Pharmacy (A K Philip PhD), University of Nizwa Oman, Nizwa, Oman;
Department of Biomolecular Sciences (N R Hussein PhD), University of
Zakho, Zakho, Iraq; International Master Program for Translational
Science (H Huynh BS), Department of Global Health and Health
Security (K Latief MS), International PhD Program in Medicine
(L Minh MD), Research Center for Artificial Intelligence in Medicine
(L Minh MD), School of Public Health (Y L Samodra MPH), Taipei
Medical University, Taipei, Taiwan; Department of Occupational Therapy
(Prof B Hwang PhD), Asia University, Taichung, Taiwan; Health Policy
and Management Department (P M Iftikhar MD), City University of
New York, New York, NY, USA; Department of Community Medicine
(O S Ilesanmi PhD), Department of Medicine (A S Oguntade MSc,
Prof M O Owolabi DrM), Department of Oral and Maxillofacial Surgery
(A A Salami BDS), University College Hospital, Ibadan, Nigeria; Faculty
of Medicine (I M Ilic PhD, Prof M M Santric-Milicevic PhD), School of

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Public Health and Health Management
(Prof M M Santric-Milicevic PhD), Faculty of Medicine Institute of
Epidemiology (I S Vujcic PhD), University of Belgrade, Belgrade, Serbia;
Department of Epidemiology (Prof M D Ilic PhD), University of
Kragujevac, Kragujevac, Serbia; Department of Health Research
(L R Inbaraj MD), ICMR National Institute for Research in Tuberculosis,
Chennai, India; Department of Pharmacy (M R Islam PhD), University
of Asia Pacific, Dhaka, Bangladesh; Department of Clinical Pharmacy
and Pharmacy Practice (Prof N Ismail PhD), Asian Institute of Medicine,
Science and Technology, Kedah, Malaysia; Malaysian Academy of
Pharmacy, Puchong, Malaysia (Prof N Ismail PhD); Public Health
Department of Social Medicine (Prof H Iso MD), Osaka University,
Suita, Japan; Department of Health Services Research (M Iwagami PhD),
University of Tsukuba, Tsukuba, Japan; Department of Non-
Communicable Disease Epidemiology (M Iwagami PhD), Department of
Infectious Disease Epidemiology (Prof H J Larson PhD), Department of
Health Services Research and Policy (Prof M McKee DSc), London
School of Hygiene & Tropical Medicine, London, UK; Department of
Biotechnology (M Iyer PhD, S Muthu MS), Karpagam Academy of
Higher Education (Deemed to be University), Coimbatore, India;
Department of Orthodontics & Dentofacial Orthopedics (L J BDS),
Department of Oral Pathology and Microbiology
(Prof G S Sarode PhD, Prof S C Sarode PhD), Dr D Y Patil University,
Pune, India; Research and Development Unit (L Jacob MD), Biomedical
Research Networking Center for Mental Health Network (CiberSAM),
Sant Boi de Llobregat, Spain; Faculty of Medicine (L Jacob MD),
University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-
Bretonneux, France; Department of Nephrology (K Jaggi MD),
San Mateo Medical Center, San Mateo, CA, USA; Department of
Nephrology, Internal Medicine (K Jaggi MD), Mills Peninsula Medical
Center, Burlingame, CA, USA; Psychiatric Hospital (H Jahrami PhD),
Department of Psychiatry (Z Saif MBA), Ministry of Health, Manama,
Bahrain; Department of Leukemia (A Jain MD), The University of MD
Anderson Cancer Center, Houston, TX, USA; Statistics Unit
(N Jain MD), Riga Stradins University, Riga, Latvia; Department of
Health and Safety (A A Jairoun PhD), Dubai Municipality, Dubai, United
Arab Emirates; The World Academy of Sciences UNESCO, Trieste, Italy
(Prof M Jakovljevic PhD); Shaanxi University of Technology, Hanzhong,
China (Prof M Jakovljevic PhD); Department of Physiology
(Prof S Javadov PhD), University of Puerto Rico Medical Sciences
Campus, San Juan, Puerto Rico; Health Informatic Lab (T Javaheri PhD),
Department of Computer Science (R Rawassizadeh PhD), Boston
University, Boston, MA, USA; Centre of Studies and Research
(S Jayapal PhD), Ministry of Health, Muscat, Oman; Department of
Biochemistry (Prof S Jayaram MD), Government Medical College,
Mysuru, India; Department of Cardiovascular Medicine (A K Jha MD),
Saint Vincent Hospital, Worcester, MA, USA; Department of
Community Medicine (R P Jha MSc), Dr Baba Saheb Ambedkar Medical
College and Hospital, Delhi, India; Department of Community Medicine
(R P Jha MSc), Banaras Hindu University, Varanasi, India; Melbourne
School of Population and Global Health (H Jiang PhD), School of Health
Sciences (A Meretoja MD), University of Melbourne, Melbourne, VIC,
Australia; Zoonoses Research Center (M Jokar DVM), Islamic Azad
University, Karaj, Iran; Department of Clinical Sciences (M Jokar DVM),
Department of Public Health (Y Sarikhani PhD), Jahrom University of
Medical Sciences, Jahrom, Iran; Institute of Molecular and Clinical
Ophthalmology Basel, Basel, Switzerland (Prof J B Jonas MD);
Department of Ophthalmology (Prof J B Jonas MD), Heidelberg
University, Mannheim, Germany; Hungarian Health Management
Association, Budapest, Hungary (T Joo PhD); Department of Economics
(C E Joshua BSc), National Open University, Benin City, Nigeria;
Department of Family Medicine and Public Health (J J Jozwiak PhD),
University of Opole, Opole, Poland; Institute of Family Medicine and
Public Health (M Jürisson PhD), University of Tartu, Tartu, Estonia;
Department of Bioengineering (H Kabir MSc), University of California
Berkeley, Berkeley, CA, USA; School of Public Health (Z Kabir PhD),
University College Cork, Cork, Ireland; Department of Dermatology
(F Kaliyadan MD), King Faisal University, Hofuf, Saudi Arabia;
Department of Endocrinology (S Kalra DM), Bharti Hospital Karnal,
Karnal, India; Care and Public Health Research Institute (CAPHRI)
(R Kamath MHA), Maastricht University, Maastricht, Netherlands;
Regional Institute for Population Studies (E Kanmiki MPH), University
of Ghana, Accra, Ghana; Faculty of Dentistry (K K Kanmodi MPH),
University of Puthisastra, Phnom Penh, Cambodia; Oce of the
Executive Director (K K Kanmodi MPH), Campaign for Health and Neck
Cancer Education (CHANCE) Programme (A A Salami BDS), Cephas
Health Research Initiative, Ibadan, Nigeria; Department of Community
Medicine (S Kannan S MD), ESIC Medical College and Hospital
Chennai, Chennai, India; Dr S S Bhatnagar University Institute of
Chemical Engineering and Technology (Prof S K Kansal PhD),
Department of Anthropology (Prof K Krishan PhD), Department of
Community Medicine (R Rohilla MD), Institute of Forensic Science and
Criminology (V Sharma PhD), Panjab University, Chandigarh, India;
The Hansjörg Wyss Department of Plastic and Reconstructive Surgery
(R S Kantar MD), Nab’a Al-Hayat Foundation for Medical Sciences and
Health Care, New York, NY, USA; Cleft Lip and Palate Surgery Division
(R S Kantar MD), Global Smile Foundation, Norwood, MA, USA; School
of Health Professions and Human Services (I M Karaye MD), Hofstra
University, Hempstead, NY, USA; Department of Anesthesiology
(I M Karaye MD), Montefiore Medical Center, Bronx, NY, USA;
Department of Physical Therapy and Health Rehabilitation
(F Z Kashoo MPT), Majmaah University, Majmaah, Saudi Arabia;
Surgery Research Unit (Prof J H Kauppila MD), University of Oulu,
Oulu, Finland; Division of Nephrology and Hypertension
(S Kazeminia MD), Radiology Department (P Metanat MD), Division of
General Internal Medicine (N M Odogwu PhD), Mayo Clinic, Rochester,
MN, USA; Eye Unit (Prof J H Kempen MD), MyungSung Medical
College, Addis Ababa, Ethiopia; Department of Health Sciences and
Biostatistics (E S Kendal PhD), Swinburne University of Technology,
Hawthorn, VIC, Australia; Biomedical Informatics Department
(K Keshtkar BSc), Arizona State University, Phoenix, AZ, USA; Amity
Institute of Forensic Sciences (H Khajuria PhD, B P Nayak PhD), Amity
Institute of Pharmacy (K Munjal PhD), Amity Institute of Public Health
(M Shannawaz PhD), Amity University, Noida, India; College of Health
Sciences (N Khalid PhD), Abu Dhabi University, Adu Dhabi, United
Arab Emirates; Department of Biostatistics (Prof A Khalilian PhD),
Mazandaran University of Medical Sciences, Mazandaran, Iran;
Research Center for Hydatid Disease (F Khamesipour PhD), Kerman
University of Medical Sciences, Kerman, Iran; Population Science
Department (M Khan PhD), Jatiya Kabi Kazi Nazrul Islam University,
Mymensingh, Bangladesh; Department of Primary Care
(M A Khan MSc), NHS North West London, London, UK; Department of
Health Policy and Management (Prof Y Khang MD), Institute of Health
Policy and Management (Prof Y Khang MD), Department of Food and
Nutrition (A P Okekunle PhD), Seoul National University, Seoul, South
Korea; College of Health, Wellbeing and Life Sciences
(Prof K Khatab PhD), Sheeld Hallam University, Sheeld, UK;
College of Arts and Sciences (Prof K Khatab PhD), Ohio University,
Zanesville, OH, USA; Department of Biochemistry (F Khidri PhD),
Liaquat University Of Medical and Health Sciences, Jamshoro, Pakistan;
Molecular Medicine Department (M Khosravi PhD), Pasteur Institute of
Iran, Tehran, Iran; Research Department (M Khosrowjerdi PhD), Inland
Norway University of Applied Sciences, Elverum, Norway; School of
Public Health (W T Kidane PhD), Hawassa University, Hawassa,
Ethiopia; Department of Pharmacology (Z D Kifle MSc), School of
Nursing (H B Netsere MS), University of Gondar, Gondar, Ethiopia;
Cardiovascular Disease Initiative (M Kim MD), Broad Institute of MIT
and Harvard, Cambridge, MA, USA; Millennium Prevention, Westwood,
MA, USA (R W Kimokoti MD); Department of Public Health
(G T Kiross MPH), Debre Markos University, East Gojjam, Ethiopia;
School of Health Sciences (Prof A Kisa PhD), Kristiania University
College, Oslo, Norway; Department of International Health and
Sustainable Development (Prof A Kisa PhD), Tulane University,
New Orleans, LA, USA; Department of Nursing and Health Promotion
(S Kisa PhD), Oslo Metropolitan University, Oslo, Norway; Copernicus
Institute of Sustainable Development (G Koren PhD), Institute for Risk
Assessment Sciences (IRAS) (E Traini MSc), Utrecht University, Utrecht,
Netherlands; Department of General Practice (Prof O Korzh DSc),
Department of Infectious Diseases (A Sokhan PhD), Kharkiv National
Medical University, Kharkiv, Ukraine; Jakarta, Indonesia (S Kosen MD);
Kasturba Medical College (S Koulmane Laxminarayana MD), Manipal
College of Nursing (R Yesodharan MSc), Manipal Academy of Higher

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49
Education, Udupi, India; Department of Anesthesiology
(V Krishnamoorthy MD), Duke University, Durham, NC, USA;
Department of Demography (Prof B Kuate Defo PhD), Department of
Social and Preventive Medicine (Prof B Kuate Defo PhD), University of
Montreal, Montreal, QC, Canada; Smart Approaches to Marijuana/
Foundation for Drug Policy Solutions, Washington, DC, USA
(C M Kubeisy BA); Faculty of Medicine (B Kucuk Bicer PhD), Gazi
University, Ankara, Türkiye; Department of Biochemistry
(Prof M Kuddus PhD), University of Hail, Hail, Saudi Arabia;
Department of Pediatrics (I Kuitunen PhD), Kuopio University Hospital,
Kuopio, Finland; Institute of Clinical Medicine (I Kuitunen PhD),
University of Eastern Finland, Kuopio, Finland; Department of Health
Research (M Kulimbet MSc), Atchabarov Scientific Research Institute of
Fundamental and Applied Medicine (M Kulimbet MSc), Kazakh National
Medical University, Almaty, Kazakhstan; Department of Food
Technology (Prof H Kumar PhD), Shri Vishwakarma Skill University,
Palwal, India; Department of Biotechnology (Prof H Kumar PhD), Amity
University Rajasthan India, Jaipur, India; Global Health Institute
(S Kundu MPH), North South University, Dhaka, Bangladesh;
Department of Nutrition and Food Science (S Kundu MPH),
Department of Biochemistry and Food Analysis (N Roy PhD),
Department of Post-Harvest Technology and Marketing (A Sayeed MSc),
Patuakhali Science and Technology University, Patuakhali, Bangladesh;
Department of Public Health/Malaria (K R Kunle MSc), Malaria
Consortium, Abuja, Nigeria; Public Health Pharmacy Department
(K R Kunle MSc), West African Postgraduate College of Pharmacists,
Lagos, Nigeria; Department of Medicine (O P Kurmi PhD), Department
of Psychiatry and Behavioural Neurosciences (A T Olagunju MD),
McMaster University, Hamilton, ON, Canada; National Research and
Innovation Agency, Jakarta, Indonesia
(A Kusnali LLB, H U Pangaribuan MSc); Department of Health Services
Research and Management (D Kusuma DSc), City University of London,
London, UK; Faculty of Public Health
(D Kusuma DSc, Prof I Trihandini PhD), Centre for Family Welfare
(K Latief MS), University of Indonesia, Depok, Indonesia; Department
of Nursing (E F Kyei MSc), University of Massachusetts Boston, Boston,
MA, USA; Department of Health Policy (I Kyriopoulos PhD,
Prof E Mossialos PhD), London School of Economics and Political
Science, London, UK; Department of Clinical Sciences and Community
Health (Prof C La Vecchia MD), University of Milan, Milan, Italy;
National Institute for Health Research (NIHR) Oxford Biomedical
Research Centre, Oxford, UK (B Lacey PhD); Institute for Social and
Health Sciences (Prof L Laflamme PhD), University of South Africa,
Pretoria, South Africa; Department of Health Policy and Strategy
(Prof C Lahariya MD), Foundation for People-centric Health Systems,
New Delhi, India; SD Gupta School of Public Health
(Prof C Lahariya MD), Indian Institute of Health Management Research
University, Jaipur, India; School of Digital Science (D T C Lai PhD),
Institute of Applied Data Analytics (D T C Lai PhD), Universiti Brunei
Darussalam (University of Brunei Darussalam), Gadong, Brunei;
NEVES Society for Patient Safety, Budapest, Hungary (J Lám PhD);
Department of Health Sciences (D Lamnisos PhD), European University
Cyprus, Nicosia, Cyprus; Unit of Genetics and Public Health
(Prof I Landires MD), Unit of Microbiology and Public Health
(V Nuñez-Samudio PhD), Institute of Medical Sciences, Las Tablas,
Panama; Department of Public Health (V Nuñez-Samudio PhD),
Ministry of Health, Herrera, Panama (Prof I Landires MD); Department
of Health Sciences (DISSAL) (F Lanfranchi MD), University of Genoa,
Genoa, Italy; Department of Psychiatry and Psychotherapy
(B Langguth PhD, W Schlee PhD), University of Regensburg,
Regensburg, Germany; Department of Behavioural Sciences and
Learning (A Laplante-Lévesque PhD), Linköping University, Linköping,
Sweden; Department of Medical Sciences (Prof A O Larsson PhD),
Uppsala University, Uppsala, Sweden; Department of Clinical Chemistry
and Pharmacology (Prof A O Larsson PhD), Uppsala University
Hospital, Uppsala, Sweden; Department of Otorhinolaryngology
(S Lasrado MS), Father Muller Medical College, Mangalore, India;
Health Economcs Division (L K D Le PhD), Monash University,
Burwood, VIC, Australia; Faculty of Medicine (N Le MD), Department of
General Medicine (V T Nguyen MD), University of Medicine and
Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
(T D T Le MD); Cardiovascular Research Department (N Le MD),
Methodist Hospital, Merrillville, IN, USA; Ho Chi Minh City, Viet Nam
(T D T Le MD); Department of Medical Science (M Lee PhD), Ajou
University School of Medicine, Suwon, South Korea; Department of
Precision Medicine (Prof S W Lee MD), Sungkyunkwan University,
Suwon-si, South Korea; Department of Preventive Medicine
(Prof Y Lee PhD), Korea University, Seoul, South Korea; Department of
Reproductive Health (G Lema MPH), Department of Medical
Microbiology and Immunology (S Muthupandian PhD), Mekelle
University, Mekelle, Ethiopia; Faculty of Science (E Leong PhD),
Universiti Brunei Darussalam (University of Brunei Darussalam),
Bandar Seri Begawan, Brunei; Center for Dentistry and Oral Hygiene
(A Li PhD), Unit of Pharmacotherapy, Epidemiology and Economy
(S Mubarik MS), University Medical Center Groningen
(Prof M J Postma PhD), Department of Internal Medicine (P Vart PhD),
University of Groningen, Groningen, Netherlands; Department of
Health Promotion and Health Education (M Li PhD), National Taiwan
Normal University, Taipei, Taiwan; Asbestos Diseases Research Institute,
Concord, NSW, Australia (R Lin PhD); Department of Dentistry—
Quality and Safety of Oral Health Care (Prof S Listl PhD), Radboud
University, Nijmegen, Netherlands; School of Life Sciences (G Liu PhD),
University of Technology Sydney, Ultimo, NSW, Australia; Centre for
Inflammation (G Liu PhD), Centenary Institute, Camperdown, NSW,
Australia; Department of Epidemiology and Biostatistics
(Prof J Liu PhD), School of Public Health (H Zhang MS), Institute of
Child and Adolescent Health (Z Zou MD), Peking University, Beijing,
China; School of Public Health (Y Liu PhD), Sun Yat-sen University,
Guangzhou, China; Department of Molecular Epidemiology
(E Llanaj PhD), German Institute of Human Nutrition Potsdam-
Rehbrücke, Potsdam, Germany; German Center for Diabetes Research
(DZD), Munich-Neuherberg, Germany (E Llanaj PhD); Department of
Physical Medicine and Nursing (R López-Bueno PhD), University of
Zaragoza, Zaragoza, Spain; Department of Musculoskeletal Disorders
(R López-Bueno PhD), National Research Centre for the Working
Environment, Copenhagen, Denmark; Department of Epidemiology and
Evidence-Based Medicine (P D Lopukhov PhD), Department of
Information and Internet Technologies (S K Vladimirov PhD),
I M Sechenov First Moscow State Medical University, Moscow, Russia;
Department of Health Economics (L Lorenzovici MSc), Syreon Research
Romania, Targu Mures, Romania; Department of Doctoral Studies
(L Lorenzovici MSc), George Emil Palade University of Medicine,
Pharmacy, Science, and Technology of Targu Mures, Targu Mures,
Romania; School of Medicine (Prof G Lucchetti PhD), Federal University
of Juiz de Fora, Juiz de Fora, Brazil; Department of General Surgery
(Prof R Lunevicius DSc), Liverpool University Hospitals NHS
Foundation Trust, Liverpool, UK; Department of Epidemiology
(H Lv BA), Chinese Center for Disease Control and Prevention,
Shenyang, China; Centre for Public Health and Wellbeing (Z Ma PhD),
University of the West of England, Bristol, UK; Periodontal Department,
Faculty of Medicine and Dentistry (Prof M Machoy PhD), Department of
Propedeutics of Internal Diseases & Arterial Hypertension
(Prof T Miazgowski MD), Pomeranian Medical University, Szczecin,
Poland; Ophthalmology Department (M Magdy Abd El Razek MSc),
Ministry of Health and Population, Aswan, Egypt; Cellular and
Molecular Biology Research Center (Prof S Mahjoub PhD), Department
of Clinical Biochemistry (Prof S Mahjoub PhD, A Mosapour PhD), Babol
University of Medical Sciences, Babol, Iran; Department of Clinical and
Hospital Pharmacy (M A Mahmoud PhD), Taibah University,
Al-Madinah Al-Munawarrah, Saudi Arabia; Department of Internal
Medicine (K Malhotra MBBS), Dayanand Medical College and Hospital,
Ludhiana, India; Department of Electrical Engineering (I Malik PhD),
Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia; Institute
for Social Science Research (A A Mamun PhD), The University of
Queensland, Indooroopilly, QLD, Australia; Smidt Heart Institute
(Y Manla MD), Cedars-Sinai Medical Center, Los Angeles, CA, USA;
STIC (Prof A Mansour PhD), ENSTA Bretagne, Brest, France; Security,
Intelligence and Integrity of Information Team (SI3)
(Prof A Mansour PhD), Laboratoire des Sciences et Techniques de
l’Information de la Communication et de la Connaissance (LABSTICC),
Brest, France; Department of Food, Environmental and Nutritional
Sciences (M Marino PhD), University of Milan, Milan, Italy; Department

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of Biochemistry (A Marjani PhD), Golestan University of Medical
Sciences, Gorgan, Iran; Department of Economics
(Prof G Martinez PhD), Autonomous Technology Institute of Mexico,
Mexico City, Mexico; Noncommunicable Diseases and Mental Health
Department (R Martinez-Piedra BSc), Pan American Health
Organization, Washington, DC, USA; Campus Fortaleza
(F R Martins-Melo PhD), Federal Institute of Education, Science and
Technology of Ceará, Fortaleza, Brazil; Department of Nutrition and
Dietetics (M Martorell PhD), Centre for Healthy Living
(M Martorell PhD), University of Concepción, Concepción, Chile;
Department of Pharmacy (S Maryam PharmD), Bahauddin Zakariya
University, Multan, Pakistan; Faculty of Humanities and Health Sciences
(Prof R R Marzo MD), Curtin University, Sarawak, Malaysia; Jerey
Cheah School of Medicine and Health Sciences (Prof R R Marzo MD),
Monash University, Subang Jaya, Malaysia; Department of
Pharmacology (A Masoudi PhD), Shahroud University of Medical
Sciences, Shahroud, Iran; Department of Medicine
(J Mattumpuram MD), University of Louisville, Louisville, KY, USA;
Department of Epidemiology (Prof R J Maude PhD), Mahidol Oxford
Tropical Medicine Research Unit, Bangkok, Thailand; Department of
Social Medicine and Family (M Mazaheri PhD), Dezful University of
Medical Sciences, Dezful, Iran; National Centre for Register-based
Research (Prof J J McGrath MD), Aarhus University, Aarhus, Denmark;
Australian Centre for Health Services Innovation
(Prof S M McPhail PhD), Queensland University of Technology, Kelvin
Grove, QLD, Australia; Digital Health and Informatics Directorate
(Prof S M McPhail PhD), Queensland Health, Brisbane, QLD, Australia;
Department of Food Science and Technology (R Mehra PhD), Maharishi
Markandeshwar (Deemed to be University), Ambala, India; Department
of Public Health (T Mekene Meto MPH), Arba Minch University,
Arbaminch, Ethiopia; Department of Medical Oncology and Hematology
(M A M Mendez-Lopez PhD), Kantonsspital St Gallen, St Gallen,
Switzerland; Peru Country Oce (W Mendoza MD), United Nations
Population Fund (UNFPA), Lima, Peru; Department of Medicine
(G A Mensah MD), School of Public Health and Family Medicine
(C A Nnaji MPH), University of Cape Town, Cape Town, South Africa;
International Dx Department (A A Mentis MD), BGI Genomics,
Copenhagen, Denmark; Neurology Unit (A Meretoja MD), Breast
Surgery Unit (T J Meretoja MD), Helsinki University Hospital, Helsinki,
Finland; Department of Virology (F Zakham PhD), University of
Helsinki, Helsinki, Finland (T J Meretoja MD); University Centre
Varazdin (T Mestrovic PhD), University North, Varazdin, Croatia;
Department of Pharmacology (Prof K D Mettananda PhD), Department
of Paediatrics (Prof S Mettananda DPhil), University of Kelaniya,
Ragama, Sri Lanka; Clinical Medicine Department
(Prof K D Mettananda PhD), North Colombo Teadhing Hospital,
Ragama, Sri Lanka; University Paediatrics Unit
(Prof S Mettananda DPhil), Colombo North Teaching Hospital, Ragama,
Sri Lanka; Stritch School of Medicine (A Mhlanga PhD), Loyola
University Chicago, Chicago, IL, USA; Department of Preventive
Medicine (L Mhlanga PhD), Center for Global Health (J Musa MD),
Northwestern University, Chicago, IL, USA; Anaesthesiology
Department (G Micha PhD), “Helena Venizelou” General and Maternity
Hospital, Athens, Greece; Department of Epidemiology
(I Michalek PhD), National Cancer Registry (I Michalek PhD), Maria
Sklodowska-Curie National Research Institute of Oncology, Warsaw,
Poland; Pacific Institute for Research and Evaluation, Calverton, MD,
USA (T R Miller PhD); Internal Medicine Programme
(Prof E M Mirrakhimov PhD), Kyrgyz State Medical Academy, Bishkek,
Kyrgyzstan; Department of Atherosclerosis and Coronary Heart Disease
(Prof E M Mirrakhimov PhD), National Center of Cardiology and
Internal Disease, Bishkek, Kyrgyzstan; Oce of the Minster
(M K Mirutse MPH), Federal Ministry of Health, Addis Ababa, Ethiopia;
Department of Hospital Administration (M Mirza MD), Department of
Dentistry (S S Rana MDS), Department of Community Medicine and
Family Medicine (S S Sahoo MD, M Verma MD), Department of
Anatomy (A Singal PhD), All India Institute of Medical Sciences,
Bathinda, India; Department of Forensic Medicine and Toxicology
(C Mittal MD), Dr B C Roy Multi-Specialty Medical Research Centre,
Kharagpur, India; Institute of Addiction Research (ISFF)
(B Moazen MSc), Frankfurt University of Applied Sciences, Frankfurt,
Germany; Thompson Institute (A Z Mohamed PhD), University of the
Sunshine Coast, Birtinya, QLD, Australia; College of Health Science
(A I Mohamed MSc), College of Applied and Natural Science
(J Mohamed MSc), University of Hargeisa, Hargeisa, Somalia; Molecular
Biology Unit (N S Mohamed MSc), Bio-Statistical and Molecular Biology
Department (N S Mohamed MSc), Sirius Training and Research Centre,
Khartoum, Sudan; Department of Pharmaceutical Sciences
(S Mohammed PhD), Notre Dame of Maryland University, Baltimore,
MD, USA; Department of Pharmacy (S Mohammed PhD), Mizan-Tepi
University, Mizan, Ethiopia; Institute of Clinical Physiology
(S Molinaro PhD), National Research Council, Pisa, Italy; Clinical
Epidemiology and Public Health Research Unit (L Monasta DSc,
L Ronfani PhD, E Traini MSc, G Zamagni MSc), Burlo Garofolo Institute
for Maternal and Child Health, Trieste, Italy; Department of
Epidemiology and Biostatistics (Y Moradi PhD), Kurdistan University of
Medical Sciences, Sanandaj, Iran; Computer, Electrical, and
Mathematical Sciences and Engineering Division (P Moraga PhD), King
Abdullah University of Science and Technology, Thuwal, Saudi Arabia;
Department of Public Health (Prof R S Moreira PhD), Oswaldo Cruz
Foundation, Recife, Brazil; Department of Public Health
(Prof R S Moreira PhD), Federal University of Pernambuco, Recife,
Brazil; Department of Biology and Biological Engineering
(J Morze PhD), Chalmers University of Technology, Gothenburg,
Sweden; College of Medical Sciences (J Morze PhD), SGMK Copernicus
University, Warsaw, Poland; Department of Clinical Biochemistry
(A Mosapour PhD), Tarbiat Modares University, Tehran, Iran;
Department of Fruit and Vegetable Product Technology
(Prof A Mousavi Khaneghah PhD), Prof Wacław Dąbrowski Institute of
Agricultural and Food Biotechnology State Research Institute, Warsaw,
Poland; Department of Surgery (F Mulita PhD, G Verras MD), General
University Hospital of Patras, Patras, Greece; Faculty of Medicine
(F Mulita PhD), Department of Emergency Medicine
(I Pantazopoulos PhD), University of Thessaly, Larissa, Greece; Clinical
Epidemiology Research Unit (E Murillo-Zamora PhD), Mexican Institute
of Social Security, Villa de Alvarez, Mexico; Postgraduate in Medical
Sciences (E Murillo-Zamora PhD), Universidad de Colima, Colima,
Mexico; Surgery Department (A Musina MD), Department of Medical
Oncology (S R Volovat PhD), University of Medicine and Pharmacy
Grigore T Popa, Iaşi, Romania; Second Surgical Unit (A Musina MD),
Department of Medical Oncology (S R Volovat PhD), Regional Institute
of Oncology, Iaşi, Romania; Department of Research Methodology
(S Muthu MS), Orthopaedic Research Group, Coimbatore, India;
Saveetha Dental College (S Muthupandian PhD), Saveetha Institute of
Medical and Technical Sciences (SIMATS), Chennai, India; Department
of Neuropsychiatry (W Myung PhD), Seoul National University,
Seongnam-si, South Korea; Research and Analytics Department
(A J Nagarajan MTech), Initiative for Financing Health and Human
Development, Chennai, India; Department of Research and Analytics
(A J Nagarajan MTech), Bioinsilico Technologies, Chennai, India;
Institute of Epidemiology and Medical Biometry (Prof G Nagel PhD),
Ulm University, Ulm, Germany; Comprehensive Cancer Center
(G Naik MPH), Department of Health Policy and Organization
(M Rahim MA), Department of Health Services Administration
(M Rahim MA), Department of Psychology (D C Schwebel PhD), School
of Medicine (Prof J A Singh MD), University of Alabama at
Birmingham, Birmingham, AL, USA; Laboratory of Public Health
Indicators Analysis and Health Digitalization (M Naimzada MD,
S S Otstavnov PhD), Department of Information Technologies and
Management (S K Vladimirov PhD), Moscow Institute of Physics and
Technology, Dolgoprudny, Russia; Experimental Surgery and Oncology
Laboratory (M Naimzada MD), Kursk State Medical University, Kursk,
Russia; Faculty of Pharmacy (F Nainu PhD), Hasanuddin University,
Makassar, Indonesia; Suraj Eye Institute, Nagpur, India (V Nangia MD);
Mysore Medical College and Research Institute
(Prof S Narasimha Swamy MD), Government Medical College, Mysore,
India; National Dental Research Institute Singapore
(G G Nascimento PhD), Duke-NUS Medical School, Singapore;
Department of Applied Pharmaceutical Sciences and Clinical Pharmacy
(A Y Naser PhD), Isra University, Amman, Jordan; Department of
Biotechnology (M Naveed PhD), University of Central Punjab, Lahore,
Pakistan; Department of Disease Control and Environmental Health

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(R Ndejjo MSc), Makerere University, Kampala, Uganda; School of
Pharmacy (S O Nduaguba PhD), West Virginia University, Morgantown,
WV, USA; Department of General Surgery (I Negoi PhD), Fourth
Department of General Surgery (D Serban PhD), Emergency University
Hospital Bucharest, Bucharest, Romania; Department of Cardiology
(R I Negoi PhD), Cardio-Aid, Bucharest, Romania; Faculty of Medicine
(Prof C Nejjari PhD), Euromed University of Fes, Fez, Morocco; Faculty
of Medicine (Prof C Nejjari PhD), University Sidi Mohammed Ben
Abdellah, Fez, Morocco; Department of Community Medicine
(S Nepal MD), Kathmandu University, Palpa, Nepal; College of Medicine
and Health Sciences (H B Netsere MS), Bahir Dar University, Gondar,
Ethiopia; Department of Public Health (G Nguefack-Tsague PhD),
University of Yaoundé I, Yaoundé, Cameroon; Department of Biological
Sciences (J W Ngunjiri DrPH), University of Embu, Embu, Kenya;
Department of Medical Engineering (D H Nguyen BS), University of
South Florida, Tampa, FL, USA; Institute for Cancer Control
(P T Nguyen MPH), National Cancer Center, Tokyo, Japan; Graduate
School of Public Health (P T Nguyen MPH), St Luke’s International
University, Chuo-ku, Japan; International Islamic University Islamabad,
Islamabad, Pakistan (R K Niazi PhD); Institute for Mental Health and
Policy (Y T Nigatu PhD), Centre for Addiction and Mental Health,
Toronto, ON, Canada; Department of General Surgery
(T K Nikolouzakis PhD), University Hospital of Heraklion, Heraklion,
Greece; Laboratory of Toxicology (T K Nikolouzakis PhD), Department of
Medicine (Prof A Tsatsakis DSc), University of Crete, Heraklion, Greece;
South African Medical Research Council, Cape Town, South Africa
(C A Nnaji MPH); Center for Public Health (L A Nnyanzi PhD), Teesside
University, Middlesbrough, UK; Faculty of Applied Sciences and
Technology (E A Noman PhD), Universiti Tun Hussein Onn Malaysia,
Johor, Malaysia; Department of Health Policy and Management
(S Nomura PhD), Keio University, Tokyo, Japan; Department of
Microbiology and Molecular Genetics (M Noreen PhD), The Women
University Multan, Multan, Pakistan; Department of Paediatrics
(C A Nri-Ezedi MD), Nnamdi Azikiwe University, Awka, Nigeria;
Department of Public Health (M H Nunemo MPH), Wachemo
University, Addis Ababa, Ethiopia; Department of Public Health
(D Nurrika PhD), Banten School of Health Science, South Tangerang,
Indonesia; Ministry of Research, Technology and Higher Education,
Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung,
Indonesia (D Nurrika PhD); Department of Applied Economics and
Quantitative Analysis (Prof B Oancea PhD), Department of Statistics and
Cybernetics (Prof M Paun PhD), University of Bucharest, Bucharest,
Romania; School of Public Health (N M Odogwu PhD), Department of
Epidemiology and Community Health (R R Parikh MD), Department of
Surgery (J Rickard MD), University of Minnesota, Minneapolis, MN,
USA; Department of Medicine (M J O’Donnell PhD), National
University of Ireland, Galway, Ireland; Department of Community
Health and Primary Care (O O Odukoya MSc), University of Lagos, Idi
Araba, Nigeria; Department of Family and Preventive Medicine
(O O Odukoya MSc), University of Utah, Salt Lake City, UT, USA;
Department of Preventive Medicine (I Oh PhD), Department of
Pediatrics (Prof D Yon MD), Kyung Hee University, Seoul, South Korea;
Sydney, NSW, Australia (S R Okeke PhD); School of Pharmacy
(O C Okonji MSc), University of the Western Cape, Cape Town,
South Africa; Department of Medical Physiology (P G Okwute MSc),
Department of Psychiatry (A T Olagunju MD), University of Lagos,
Lagos, Nigeria; Health Information Research Unit (O O Olasupo PhD),
McMaster University, Hamilton, Ontario, Canada; Department of
Nursing Science (M I Olatubi PhD), Bowen University, Iwo, Nigeria;
Cardiology Department (G M M Oliveira PhD), Federal University of Rio
de Janeiro, Rio de Janeiro, Brazil; Centre for Healthy Start Initiative,
Lagos, Nigeria (B O Olusanya PhD, J O Olusanya MBA); Department of
Anatomy (G O Oluwatunase MSc), Olabisi Onabanjo University,
Sagamu, Nigeria; Surgery Department (G L Omer MD), Sulaimani
University, Sulaimani, Iraq; ENT Department (G L Omer MD),
Tor Vergata University of Rome, Rome, Italy; Department of
Pharmacotherapy and Pharmaceutical Care (M Ordak PhD), Department
of Biochemistry and Pharmacogenomics (M Zielińska MPharm),
Medical University of Warsaw, Warsaw, Poland; University of Port
Harcourt, Port Harcourt, Nigeria (Prof O E Orisakwe PhD); Sickle Cell
Unit (V N Orish PhD), Ho Teaching Hospital, Ho Municipality, Ghana;
Department of Medicine (Prof A Ortiz MD), Universidad Autónoma de
Madrid (Autonomous University of Madrid), Madrid, Spain; Department
of Nephrology and Hypertension (Prof A Ortiz MD), The Institute for
Health Research Foundation Jiménez Díaz University Hospital, Madrid,
Spain; One Health Global Research Group (Prof E Ortiz-Prado PhD),
Universidad de las Americas, Quito, Ecuador; School of Medicine
(U L Osuagwu PhD), Translation Health Research Institute
(K Rana PhD), Western Sydney University, Campbelltown, NSW,
Australia; Department of Optometry and Vision Science
(U L Osuagwu PhD), University of KwaZulu-Natal, KwaZulu-Natal,
South Africa; Department of Biological Sciences (O Osuolale PhD),
Elizade University, Ilara-Mokin, Nigeria; Department of Project
Management (S S Otstavnov PhD), Department of Health Care
Administration and Economics (Prof V Vlassov MD), National Research
University Higher School of Economics, Moscow, Russia; Division of
Infectious Diseases (Prof A Ouyahia PhD), University Hospital of Setif,
Setif, Algeria; Department of General Surgery (G Ouyang MD), Central
South University, ChangSha, China; Department of Respiratory
Medicine (Prof M P P A DNB), Department of Oral and Maxillofacial
Surgery (M S MDS, C S N PhD), Jagadguru Sri Shivarathreeswara
University, Mysore, India; Menzies Institute for Medical Research
(F Pan PhD), University of Tasmania, Hobart, TAS, Australia;
Department of Public Health (A Pana PhD), Babes Bolyai University,
Cluj Napoca, Romania; Department of Health Metrics (A Pana PhD),
Center for Health Outcomes and Evaluation, Bucharest, Romania;
School of Public Health (P Panda MPH), Asian Institute of Public
Health University, Bhubaneswar, India; Privatpraxis, Heidelberg,
Germany (S Panda-Jonas MD); Department of Ophthalmology
(G D Panos PhD), Nottingham University Hospitals—Queen’s Medical
Center Campus, Nottingham, UK; Division of Ophthalmology and
Visual Sciences (G D Panos PhD), People in Psychiatry and Applied
Psychology (F Shokraneh PhD), University of Nottingham, Nottingham,
UK; Department of Neurology (L D Panos MD), Department of
Emergency Medicine (I Pantazopoulos PhD), University of Bern, Bern,
Switzerland; Yonsei University College of Medicine, Seodaemun-gu,
South Korea (S Park MD); Center for Pharmacoepidemiology and
Treatment Science (A Parthasarathi MD), Rutgers University,
New Brunswick, NJ, USA; Research Center (A Parthasarathi MD),
Allergy Asthma and Chest Center, Mysore, India; Department of Medical
Sciences (R Passera PhD), University of Torino, Torino, Italy;
Department of Imaging (R Passera PhD), AOU Città della Salute e della
Scienza di Torino, Torino, Italy; Department of Physiotherapy
(H M Patel PhD), Charotar University of Science and Technology,
Anand, India; Global Health Governance Programme (J Patel BSc),
Centre for Medical Informatics (Prof A Sheikh MD), College of Medicine
and Veterinary Medicine (G Verras MD), University of Edinburgh,
Edinburgh, UK; School of Dentistry (J Patel BSc), University of Leeds,
Leeds, UK; College of Dental Medicine (Prof S Patil PhD), Roseman
University of Health Sciences, South Jordan, UT, USA; Centre of
Molecular Medicine and Diagnostics (COMManD) (Prof S Patil PhD),
Saveetha University, Chennai, India; Second Department of Internal
Medicine (D Patoulias PhD), European Interbalkan Medical Center,
Thessaloniki, Greece; Department of Internal Medicine
(V Patthipati MD), Advent Health, Palm Coast, FL, USA; Department of
Hospital Medicine (V Patthipati MD), Sound Physicians, Palm Coast, FL,
USA; Faculty of Humanities and Social Sciences (U Paudel PhD),
Department of Community Medicine (P M S Pradhan MD), Tribhuvan
University, Kathmandu, Nepal; Department of Bioinformatics and
Biostatistics (Prof M Paun PhD), National Institute of Research and
Development for Biological Sciences, Bucharest, Romania; Clinical
Research Department (P Pedersini MSc, J H Villafañe PhD), IRCCS
Fondazione Don Carlo Gnocchi, Milan, Italy; Outpatient Department
(M Peng MPH), Taihe Hospital, Shiyan, China; The First Clinical
College (M Peng MPH), School of Public Health and Management
(Y Yu MS), Hubei University of Medicine, Shiyan, China; Department of
Neurology (U Pensato MD), IRCCS Humanitas Research Hospital,
Milan, Italy; Center for Research and Innovation (V F Pepito MSc),
Ateneo De Manila University, Pasig City, Philippines; Centre for Primary
Health Care and Equity (P Peprah MSc), University of New South Wales,
Kensington, NSW, Australia; Curtin School of Population Health
(Prof G Pereira PhD), Curtin University, Bentley, WA, Australia; Centre

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for Fertility and Health (Prof G Pereira PhD), Norwegian Institute of
Public Health, Oslo, Norway; International Institute for Educational
Planning (IIEP) (Prof M F P Peres MD), Albert Einstein Hospital, São
Paulo, Brazil; Department of Development Studies
(Prof A Perianayagam PhD), International Institute for Population
Sciences, Mumbai, India; Mario Negri Institute for Pharmacological
Research, Bergamo, Italy (N Perico MD, Prof G Remuzzi MD);
Pennsylvania Cancer and Regenerative Medicine Center
(R G Pestell MD), Baruch S Blumberg Institute, Doylestown, PA, USA;
Department of Medicine (R G Pestell MD), Xavier University School of
Medicine, Woodbury, NY, USA; Facultad de Medicina
(F E Petermann-Rocha PhD), Universidad Diego Portales
(Diego Portales University), Santiago, Chile; School of Cardiovascular
and Metabolic Health (F E Petermann-Rocha PhD), University of
Glasgow, Glasgow, UK; National Centre for Disease Prevention and
Health Promotion (D Pierannunzio PhD), National Institute of Health,
Rome, Italy; Department of Pediatric Orthopedic Surgery
(M Pigeolet MD), Hôpital Necker–Enfants Malades, Paris, France;
Research School of Chemistry and Applied Biomedical Sciences
(E Plotnikov PhD), Tomsk Polytechnic University, Tomsk, Russia; Mental
Health Research Institute (E Plotnikov PhD), Tomsk National Research
Medical Center of the Russian Academy of Sciences, Tomsk, Russia;
Clinical Academic Department of Pediatrics (Prof D Poddighe PhD),
University Medical Center (UMC), Astana, Kazakhstan; Data Driven
Health Division (P Pollner PhD), Hungarian Healthcare Management
Association, Budapest, Hungary; Department of Data Management and
Analysis (R Poluru PhD), The INCLEN Trust International, New Delhi,
India; Non-communicable Diseases Research Center
(N Pourtaheri PhD), Bam University of Medical Sciences, Bam, Iran;
University of Mississippi, Oxford, MS, USA (D Prabhu PhD); Centro de
Investigaciones Clinicas (Clinical Research Center) (S I Prada PhD),
Fundación Valle del Lili (Valle del Lili Foundation), Cali, Colombia;
Centro de Estudios en Protección Social y Economía de la Salud
(PROESA) (Research Center for Social and Health Economics)
(S I Prada PhD), Universidad Icesi (ICESI University), Cali, Colombia;
Department of Clinical Research and Epidemiology (M Prasad MD),
Institute of Liver and Biliary Sciences, New Delhi, India; Department of
Biochemistry (Prof A Prashant PhD), Jagadguru Sri Shivarathreeswara
University, Mysuru, India; Centre for Dental Education and Research
(B M Purohit MDS), Department of Radiation Oncology
(A Shankar MD), All India Institute of Medical Sciences, New Delhi,
India; Department of Computer Science (N H Qasim PhD), Department
of Health Sciences (Prof F Rahim PhD), Cihan University Sulaimaniya,
Sulaymaniyah, Iraq; Department of Community Medicine (D R MD),
Government Medical College, Bengaluru, India; Cardiovascular
Research Center (M Rabiee Rad MD), Isfahan Cariovascular Research
Institute, Isfahan, Iran; College of Medicine (A Radfar MD), University
of Central Florida, Orlando, FL, USA; Department of Medical Oncology
(Prof V Radhakrishnan MD), Cancer Institute (WIA), Chennai, India;
Department of Epidemiology and Biostatistics (H Raeisi Shahraki PhD),
Shiraz University of Medical Sciences, Shahrekord, Iran; Department of
Radiology (S Rafiei Alavi MD), University of California Irvine, Irvine,
CA, USA; Cihan University Sulaimaniya Research Center (CUSRC),
Sulaymaniyah, Iraq (Prof F Rahim PhD); Institute of Health and
Wellbeing (M Rahman PhD), Federation University Australia, Berwick,
VIC, Australia; Department of Public Health (V Rahmanian PhD),
Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran; Department of
Physical Education and Sport Sciences (Prof M Rahmati PhD), Hepatitis
Research Center (M Zandi PhD), Lorestan University of Medical
Sciences, Khorramabad, Iran; Hospital of Women and Children, IRCCS
Azienda Ospedaliero (D Raimondo PhD), Occupational Health Unit
(Prof F S Violante MD), Sant’Orsola Malpighi Hospital, Bologna, Italy;
Faculty of Medicine (A Rajabpour-Sanati MD), Birjand University of
Medical Sciences, Birjand, Iran; Centre for Chronic Disease Control,
New Delhi, India (P Rajput PhD); Department of Radiology
(S Ramasamy MD), Stanford University, Stanford, CA, USA;
Department of Epidemiology, Biostatistics and Occupational Health
(J Rana MPH), McGill University, Montreal, QC, Canada; Research and
Innovation Division (J Rana MPH), South Asian Institute for Social
Transformation (SAIST), Dhaka, Bangladesh; Research Department
(C L Ranabhat PhD), Policy Research Institute, Kathmandu, Nepal;
Health and Public Policy Department (C L Ranabhat PhD), Global
Center for Research and Development, Kathmandu, Nepal; Centre for
Clinical Pharmacology (N Rancic PhD), University of Defence in
Belgrade, Belgrade, Serbia; Centre for Clinical Pharmacology
(N Rancic PhD), Medical College of Georgia at Augusta University,
Belgrade, Serbia; Department of Health Economics and Outcomes
Research (A Rane MS), Agios Pharmaceuticals, Cambridge, MA, USA;
Department of Pharmaceutical Economics and Policy (A Rane MS),
Massachusetts College of Pharmacy and Health Sciences, Boston, MA,
USA; School of Humanities and Social Sciences (S Ranjan MA,
R Thakur PhD), Indian Institute of Technology Mandi, Mandi, India;
College of Pharmaceutical Sciences (D Rapaka PhD), Andhra University,
Visakhapatnam, India; University of Social Welfare and Rehabilitation
Sciences, Tehran, Iran (V Rashedi PhD); Department of Geography
(A Rasul PhD), Soran University, Soran, Iraq; Department of Biomedical
Engineering (Z Ratan MSc), Khulna University of Engineering and
Technology, Khulna, Bangladesh; Section of Pulmonary and Critical Care
Medicine (N Ravikumar MD), University of Chicago, Chicago, IL, USA;
Inovus Medical, St Helens, UK (D L Rawaf MRCS); Academic Public
Health England (Prof S Rawaf MD), Public Health England, London,
UK; Department of Internal Medicine (B Rawlley MD), State University
of New York, Syracuse, NY, USA; Department Biological Sciences
(Prof E M M Redwan PhD), King Abdulaziz University, Jeddah, Egypt;
Department of Protein Research (Prof E M M Redwan PhD), Research
and Academic Institution, Alexandria, Egypt; Department of
Epidemiology and Biostatistics (Prof M Rezaeian PhD), Rafsanjan
University of Medical Sciences, Rafsanjan, Iran; Department of Public
Health (A Riad DDS), Czech National Centre for Evidence-based
Healthcare and Knowledge Translation (A Riad DDS), Masaryk
University, Brno, Czech Republic; Department of Surgery
(J Rickard MD), University Teaching Hospital of Kigali, Kigali, Rwanda;
Institute of Diagnostic and Interventional Radiology and Neuroradiology
(R Rikhtegar MD), Essen University Hospital, Essen, Germany; One
Health Toxicology Research Unit (1H-TOXRUN)
(Prof C F Rodrigues PhD), Instituto Universitário de Ciências da Saúde
(CESPU), Porto, Portugal; Department of Pharmacology and Toxicology
(Prof J A B Rodriguez PhD), Universidad de Antioquia
(University of Antioquia), Medellin, Colombia; Faculty of Nursing
(D S Romadlon PhD), Chulalongkorn University, Bangkok, Thailand;
Department of Analytical and Applied Economics
(Prof H S Rout PhD, C K Swain MPhil), Utkal University, Bhubaneswar,
India; Faculty of Medicine (B Roy PhD), Quest International University
Perak, Ipoh, Malaysia; Department of Labour (P Roy PhD), Directorate
of Factories, Government of West Bengal, Kolkata, India; Centro de
Investigación Palmira (Palmira Research Center) (E Rubagotti PhD),
Corporación Colombiana de Investigación Agropecuaria AGROSAVIA
(Colombian Agricultural Research Corporation), Bogota, Colombia;
Advanced Campus Governador Valadares (Prof G d Ruela MSc), Juiz de
For a Federal University, Governador Valadares, Brazil; Nursing
Department (Prof G d Ruela MSc), Universidade Presidente Antônio
Carlos (President Antônio Carlos University), Governador Valadares,
Brazil; Department of Health Statistics (S F Rumisha PhD), National
Institute for Medical Research, Dar es Salaam, Tanzania; Faculty of
Medicine (Z Saadatian PhD), Infectious Diseases Research Center
(Z Saadatian PhD), Gonabad University of Medical Sciences, Gonabad,
Iran; Department of Medical Pharmacology (M M Saber-Ayad MD),
Public Health and Community Medicine Department (M R Salem MD),
Cairo University, Giza, Egypt; Faculty of Computing and Informatics
(M SaberiKamarposhti PhD), Multimedia University, Cyberjaya,
Malaysia; Department of Anesthesiology and Reanimation (F Sada PhD),
University of Pristina, Pristina, Kosovo; Department of Anesthesiology
and Intensive Care (F Sada PhD), University Clinical Center of Kosovo,
Pristina, Kosovo; Department of Pharmaceutical Chemistry
(Prof M R Saeb PhD), Medical University of Gdańsk, Gdańsk, Poland;
Multidisciplinary Laboratory Foundation University School of Health
Sciences (FUSH) (Prof U Saeed PhD), Foundation University,
Islamabad, Pakistan; International Center of Medical Sciences Research
(ICMSR), Islamabad, Pakistan (Prof U Saeed PhD); Faculty of Medicine,
Bioscience and Nursing (S Z Safi PhD), MAHSA University, Selangor,
Malaysia; Interdisciplinary Research Centre in Biomedical Materials
(IRCBM) (S Z Safi PhD), COMSATS Institute of Information

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Technology, Lahore, Pakistan; Department of Humanities and Social
Sciences (M Saha MSc), Deakin University, Melbourne, VIC, Australia;
Department of Preventive and Social Medicine (M Sahu MD), All India
Institute of Hygiene and Public Health, Kolkata, India; Ludwig
Maximilian University of Munich, Munich, Germany
(J W Sakshaug PhD); Institute for Employment Research, Nuremberg,
Germany (J W Sakshaug PhD); Technology Management Department
(Prof M Z Y Salem PhD), University College of Applied Sciences, Gaza,
Palestine; School of Economics and Management
(Prof M Z Y Salem PhD), University of Kassel, Kassel, Germany;
Department of Neurology (S Samadzadeh MD), University of Southern
Denmark, Odense, Denmark; Department of Anatomy
(Prof V P Samuel PhD), Ras Al Khaimah Medical and Health Sciences
University, Ras Al Khaimah, United Arab Emirates; Department of
Surgery (Prof J Sanabria MD), Marshall University, Huntington, WV,
USA; Institute of Neuroanatomy (N Sanadgol PhD), Uniklinik Rhine-
Westphalia Technical University of Aachen, Aachen, Germany;
Thiruvananthapuram, India (S Y Saraswathy PhD); Indira Gandhi
Medical College and Research Institute, Puducherry, India
(A Saravanan MD); Department of Orthpaedics and Trauma Surgery
(B Saravi PhD), University of Freiburg, Freiburg, Germany; Department
of Orthopaedics (B Saravi PhD), Loretto Hospital Freiburg, Freiburg,
Germany; Department of Food Processing Technology (T Sarkar PhD),
West Bengal State Council of Technical Education, Malda, India;
Department of Health and Society (Prof R Sarmiento-Suárez MPH),
University of Applied and Environmental Sciences, Bogota, Colombia;
National School of Public Health (Prof R Sarmiento-Suárez MPH),
Carlos III Health Institute, Madrid, Spain; Faculty of Health & Social
Sciences (B Sathian PhD), Bournemouth University, Bournemouth, UK;
National Centre for Epidemiology and Population Health
(M Sayeed MS, A Talukder MSc), Australian National University, Acton,
ACT, Australia; Department of Neurology (Prof N Scarmeas PhD),
National and Kapodistrian University of Athens, Athens, Greece;
Department of Neurology (Prof N Scarmeas PhD), Columbia University,
New York, NY, USA; Cardiovascular Research Center
(A Schuermans BSc), Massachusetts General Hospital, Cambridge, MA,
USA; Department of Cardiovascular Sciences
(A Schuermans BSc, J Van den Eynde BSc), Katholieke Universiteit
Leuven, Leuven, Belgium; Clinic for Conservative Dentistry and
Periodontology (Prof F Schwendicke PhD), University Hospital of the
Ludwig-Maximilians-University Munich, Munich, Germany; Faculty of
Dentistry (S Selvaraj PhD), AIMST University, Bedong, Malaysia;
Department of Biomedical Sciences (P Sengupta PhD), Gulf Medical
University, Ajman, United Arab Emirates; Emergency Department
(S Senthilkumaran MD), Manian Medical Centre, Erode, India;
Department of Medicine and Surgery (Y Sethi MBBS), Government
Doon Medical College, Dehradun, India; National Heart, Lung, and
Blood Institute (A Seylani BS), National Institutes of Health, Rockville,
MD, USA; Medical Research Center (J Shah BS), Kateb University,
Kabul, Afghanistan; Department of Infectious Diseases and
Microbiology (P A Shah MBBS), Rajiv Gandhi University of Health
Sciences, Bangalore, India; HepatoPancreatoBiliary Surgery and Liver
Transplant Department (P A Shah MBBS), Healthcare Global Limited
Cancer Care Hospital, Bangalore, India; Karachi, Pakistan
(M A Shaikh MD); School of Medicine (M Shams-Beyranvand MSc),
Alborz University of Medical Sciences, Karaj, Iran; Department of
Clinical Review and Safety (S Sharfaei MD), Baim Institute for Clinical
Research, Boston, MA, USA; Facultad de Medicina (Faculty of Medicine)
(J Sharifi-Rad PhD), Universidad del Azuay (University of Azuay),
Cuenca, Ecuador; Department of Microbiology (R P Shastry PhD),
Yenepoya University, Mangalore, India; Department of Engineering
(A Shavandi PhD), Free University of Brussels (ULB), Brussels,
Belgium; Bioengineering Department (A Shayan BS), Clemson
University, Clemson, SC, USA; Department of Ophthalmology
(M Shayan MD), Harvard Medical School, Boston, MA, USA;
Department of Plant and Microbiology (A M E Shehabeldine PhD),
A C S Medical College and Hospital, Cairo, Egypt; Department of
Dermatology, Venereology and Leprosy (Prof M M Shenoy MD),
Yenepoya Medical College, Mangalore, India; Friedman School of
Nutrition Science and Policy (P Shi PhD), Tufts University, Boston, MA,
USA; Department of Public Health (D Shiferaw MPH), Dambi Dollo
University, Dembi Dollo, Ethiopia; National Institute of Infectious
Diseases, Tokyo, Japan (M Shigematsu PhD); Finnish Institute of
Occupational Health, Helsinki, Finland (R Shiri PhD); Department of
Clinical Immunology and Hematology (V Shivarov PhD), Sofiamed
University Hospital, Sofia, Bulgaria; Department of Genetics
(V Shivarov PhD), Sofia University “St Kliment Ohridiski”, Sofia,
Bulgaria; Department of Public Health and Primary Care
(F Shokraneh PhD, Prof P Willeit PhD), University of Cambridge,
Cambridge, UK; National Institute of Psychology (K Shuja MS),
Quaid-i-Azam University, Islamabad, Pakistan; The Cooper Institute,
Dallas, TX, USA (K Shuval PhD); Department of Medical Microbiology
and Infectious Diseases (E E Siddig MD), Erasmus University,
Rotterdam, Netherlands; Center of Potential and Innovation of Natural
Resources (Prof L M R Silva PhD), Polytechnic Institute of Guarda,
Guarda, Portugal; Health Sciences Research Centre
(Prof L M R Silva PhD), University of Beira Interior, Covilhã, Portugal;
WSB University in Gdańsk, Gdańsk, Poland (Prof B Simonetti PhD);
Department of Dentistry (A Singh MD), All India Institute of Medical
Sciences, Bhopal, India; School of Public Health and Zoonoses
(B B Singh PhD), Guru Angad Dev Veterinary and Animal Sciences
University, Ludhiana, India; Medicine Service Department
(Prof J A Singh MD), US Department of Veterans Aairs (VA),
Birmingham, AL, USA; Department of Surgery (B Socea PhD),
“Sf. Pantelimon” Emergency Clinical Hospital Bucharest, Bucharest,
Romania; Department of Systemic Pathology (R Solanki MD), Touro
College of Osteopathic Medicine, Middletown, NY, USA; Department of
Pathology (R Solanki MD), American University of the Caribbean School
of Medicine, Cupecoy, Saint Martin; Department of Biochemistry
(S Solanki MD), American University of Integrative Sciences, Barbados,
Barbados; Department of Nursing (Y Solomon MSc), Dire Dawa
University, Dire Dawa, Ethiopia; 3rd Department of Cardiology
(M Spartalis PhD), University of Athens, Athens, Greece; Division of
Community Medicine (C T Sreeramareddy MD), International Medical
University, Kuala Lumpur, Malaysia; Amity Institute of Biotechnology
(V K Srivastava PhD, E Upadhyay PhD), Amity University Rajasthan,
Jaipur, India; Department of Biosciences (V K Srivastava PhD), Indian
Institute of Science Education and Research, Bhopal, India; Department
of Public Health (M Stanikzai MPH), Kandahar University, Kandahar,
Afghanistan; Central Research Institute of Cytology and Genetics
(E Varavikova PhD), Federal Research Institute for Health Organization
and Informaticsof the Ministry of Health (FRIHOI), Moscow, Russia
(Prof V I Starodubov DSc); Nutrition and Dietetics Department
(A V Starodubova DSc), Federal Research Institute of Nutrition,
Biotechnology and Food Safety, Moscow, Russia; Department of Internal
Disease (A V Starodubova DSc), Pirogov Russian National Research
Medical University, Moscow, Russia; Department of Medicine
(P Steiropoulos MD), Democritus University of Thrace, Alexandroupolis,
Greece; Department of Psychology (M A Stokes PhD), Deakin
University, Burwood, VIC, Australia; School of Medicine
(V Subramaniyan PhD), Monash University, Sunway, Malaysia; Center
for Biotechnology and Microbiology (M Suleman PhD), University of
Swat, Mingora, Pakistan; School of Life Sciences (M Suleman PhD),
Xiamen University, Xiamen, China; National Institute of Epidemiology
(R Suliankatchi Abdulkader MD), Indian Council of Medical Research,
Chennai, India; Nature Study of Bangladesh (A Sultana MD), Khulna,
Bangladesh; Division of Global Mental Health (A Sultana MD), EviSyn
Health, Khulna, Bangladesh; Rural Health Research Institute
(Prof J Sun PhD), Charles Sturt University, Bathurst, NSW, Australia;
Institute of Integrated Intelligence and Systems (Prof J Sun PhD),
Grith University, Brisbane, QLD, Australia; Jeb E Brooks School of
Public Policy and the Department of Sociology (Prof B L Sykes PhD),
Cornell University, Ithaca, NY, USA; Department of Clinical Outcomes
(Prof L Szarpak PhD), Maria Sklodowska-Curie Medical Academy,
Warsaw, Poland; Department of Clinical Research and Development
(Prof L Szarpak PhD), LUXMED Group, Warsaw, Poland; Department of
Dermatology (M D Szeto BS), University of Colorado, Aurora, CO, USA;
Department of Neurology (P Tabaee Damavandi MD), Neurocenter of
Southern Switzerland (NSI), Lugano, Switzerland; Department of
Medicine (Prof R Tabarés-Seisdedos PhD), University of Valencia,
Valencia, Spain; Carlos III Health Institute
(Prof R Tabarés-Seisdedos PhD), Biomedical Research Networking

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Center for Mental Health Network (CiberSAM), Madrid, Spain;
Department of Basic Medical Sciences (S Tabatabaeizadeh PhD),
Department of Internal Medicine (S Tabatabaeizadeh PhD), Islamic
Azad University, Mashhad, Iran; School of Social Work
(Prof K M Tabb PhD), University of Illinois, Urbana, IL, USA;
Department of Biostatistics and Epidemiology
(M Taheri Soodejani PhD), Shahid Sadoughi University of Medical
Sciences, Yazd, Iran; Department of Environmental, Agricultural and
Occupational Health (J Taiba MPH), University of Nebraska Medical
Center, Omaha, NE, USA; Statistics Discipline (A Talukder MSc),
Khulna University, Khulna, Bangladesh; Department of Dermato-
Venereology (M Tampa PhD), Dr Victor Babes Clinical Hospital of
Infectious Diseases and Tropical Diseases, Bucharest, Romania;
Department of Medicine (J L Tamuzi MSc), Northlands Medical Group,
Omuthiya, Namibia; State Key Laboratory of Numerical Modeling for
Atmospheric Sciences and Geophysical Fluid Dynamics (LASG)
(H Tang PhD), Chinese Academy of Sciences, Beijing, China;
Department of Epidemiology and Biostatistics (M K Tariku MPH),
Department of Public Health (T Y Tiruye PhD), Department of Human
Nutrition and Food Sciences (E G Wassie MSc), Debre Markos
University, Debre Markos, Ethiopia; Department of Pathology
(V Y Tat BS), University of Texas, Galveston, TX, USA; Department of
Urology (M Teimoori MD), Sabzevar University of Medical Sciences,
Sabzevar, Iran; College of Pharmacy (R M H Temsah PharmD), Alfaisal
University, Riyadh, Saudi Arabia; Outpatient Department
(D R Terefa MSc), Wollega University, Bedele, Ethiopia; Health
Management Department (R Tesler PhD), Ariel University, Ariel, Israel;
Psychology Department (E Teye-Kwadjo PhD), University of Ghana,
Legon, Accra, Ghana; Department of Pharmacology (P Thangaraju MD),
All India Institute of Medical Sciences, Raipur, India; Public Health
Department (Prof K R Thankappan MD), Amrita Institute of Medical
Sciences, Kochi, India; Faculty of Biomedical Engeneering
(A Tichopad PhD), Czech Technical University, Prague, Czech Republic;
Faculty of Public Health (J H V Ticoalu MPH), Universitas Sam
Ratulangi, Manado, Indonesia; Department of Allied Health and Human
Performance (T Y Tiruye PhD), University of South Australia, Adelaide,
SA, Australia; Laboratory of Public Health Indicators Analysis and
Health Digitalization (M V Titova PhD), Moscow Institute of Physics and
Technology, Moscow, Russia; Department ofMedicine
(Prof M Tonelli MD), Department of Oncology (L Yang PhD), University
of Calgary, Calgary, AB, Canada; Department of Health (N M Tran MD),
Children’s Hospital 1, Ho Chi Minh City, Viet Nam; Adult Learning
Disability Service (S J Tromans PhD), Leicestershire Partnership
National Health Service Trust, Leicester, UK; School of Medicine
(T T Truyen MD), Nam Can Tho University, Can Tho, Viet Nam;
Department of Psychiatry (E Tsermpini PhD), Dalhousie University,
Halifax, NS, Canada; Department of Nutrition and Food Studies
(S Tyrovolas PhD), George Mason University, Fairfax, VA, USA;
Environmental Sciences Program (S Uddin PhD), Asian University for
Women, Chittagong, Bangladesh; Department of Geography
(S Uddin PhD), University of Victoria, Victoria, BC, Canada; Department
of Health and Community Sciences (A Udoh PhD), University of Exeter,
Exeter, UK; International Center for Chemical and Biological Sciences
(S Ullah MSc), University of Karachi, Karachi, Pakistan; Department of
Zoology (S Ullah PhD), Division of Science and Technology
(S Ullah PhD), University of Education, Lahore, Pakistan; Department of
Paraclinical Sciences (S Umakanthan MD), The University of the West
Indies, St Augustine, Trinidad and Tobago; Department of Community
Medicine (C D Umeokonkwo MPH), Alex Ekwueme Federal University
Teaching Hospital Abakaliki, Abakaliki, Nigeria; College of Health and
Sport Sciences (A G Vaithinathan MSc), University of Bahrain,
Salmanya, Bahrain; Department of Public Health and Epidemiology
(O Varga PhD), University of Debrecen, Debrecen, Hungary; UKK
Institute, Tampere, Finland (Prof T J Vasankari MD); Faculty of Medicine
and Health Technology (Prof T J Vasankari MD), Tampere University,
Tampere, Finland; Department of Human Genetics and Molecular
Biology (B Vellingiri PhD), Bharathiar University, Coimbatore, India;
Department of Statistics (D Venugopal PhD), Manonmaniam
Sundaranar University, Tirunelveil, India; Department of Mathematics
and Statistics (M Vishwakarma MSc), Banasthali Vidyapith, Tonk, India;
Department of Community Medicine (M Vishwakarma MSc),
Government Medical College, Barmer, India; Faculty of Information
Technology (B Vo PhD), HUTECH University, Ho Chi Minh City,
Viet Nam; School of Population Health and Environmental Sciences
(H A Wafa MPH, Y Wang PhD), King’s College London, London, UK;
Oce of Research, Innovation, and Commercialization (ORIC)
(Prof Y Waheed PhD), Shaheed Zulfiqar Ali Bhutto Medical University
(SZABMU), Islamabad, Pakistan; Gilbert and Rose-Marie Chagoury
School of Medicine (Prof Y Waheed PhD), Lebanese American
University, Byblos, Lebanon; Department of Midwifery
(E B Wakwoya MSc), Arsi University, Asella, Ethiopia; School of Public
Health (F Wang PhD), Xuzhou Medical University, Xuzhou, China;
Department of Neurosurgery (S Wang MD), School of Public Health
(J Xia PhD), Capital Medical University, Beijing, China; Department of
Parasitology (Prof K G Weerakoon PhD), Department of Community
Medicine (N D Wickramasinghe MD), Rajarata University of Sri Lanka,
Anuradhapura, Sri Lanka; Key Laboratory of Shaanxi Province for
Craniofacial Precision Medicine Research (Y Wen PhD), Stomatological
Hospital (College) of Xi’an Jiaotong University, Xi’an, China;
Competence Center of Mortality-Follow-Up of the German National
Cohort (R Westerman DSc), Federal Institute for Population Research,
Wiesbaden, Germany; Department of Physical Therapy
(T Wiangkham PhD), Naresuan University, Phitsanulok, Thailand;
Department of Surgery (D P Wickramasinghe MD), University of
Colombo, Colombo, Sri Lanka; Department of Medical Statistics,
Informatics and Health Economics (Prof P Willeit PhD), Medical
University Innsbruck, Innsbruck, Austria; Department of Food Science
and Human Nutrition (Prof F Wu PhD), Michigan State University, East
Lansing, MI, USA; School of Public Health (H Xiao PhD), Zhejiang
University, Zhejiang, China; Department of Public Health Science
(H Xiao PhD), Fred Hutchinson Cancer Research Center, Seattle, WA,
USA; School of Medicine (Prof G Xu MD), Nanjing University, Nanjing,
China; Department of Endocrinology (Prof S Xu PhD), University of
Science and Technology of China, Hefei, China; School of Medicine
(Prof S Xu PhD), University of Rochester, Rochester, NY, USA;
Cardiovascular Program (X Xu PhD), The George Institute for Global
Health, Sydney, NSW, Australia; Department of Basic Medical Sciences
(S Yaghoubi PhD), Neyshabur University of Medical Sciences,
Neyshabur, Iran; Department of Cancer Epidemiology and Prevention
Research (L Yang PhD), Alberta Health Services, Calgary, AB, Canada;
Faculty of Medicine (Y Yano MD), Department of Public Health
(N Yonemoto PhD), Juntendo University, Tokyo, Japan; Research Center
of Physiology (H Yaribeygi PhD), Semnan University of Medical
Sciences, Semnan, Iran; National Center for Chronic and
Noncommunicable Disease Control and Prevention (P Ye MPH),
Chinese Center for Disease Control and Prevention, Beijing, China;
Department of Family Medicine (S A Yesuf MSc), St Peter’s Specialized
Hospital, Addis Ababa, Ethiopia; Biostatics, Epidemiology, and Science
Computing Department (S Yezli PhD), King Faisal Specialist Hospital &
Research Center, Riyadh, Saudi Arabia; Trinity College Institute for
Neuroscience (A Yigezu MPH), School of Medicine (A Yigezu MPH),
Trinity College Dublin, Dublin, Ireland; Department of
Neuropsychopharmacology (N Yonemoto PhD), National Center of
Neurology and Psychiatry, Kodaira, Japan; Department of Health Policy
and Management (Prof M Z Younis PhD), Jackson State University,
Jackson, MS, USA; School of Business & Economics
(Prof M Z Younis PhD), Universiti Putra Malaysia
(University of Putra Malaysia), Kuala Lumpur, Malaysia; Department of
Epidemiology and Biostatistics (Prof C Yu PhD), Wuhan University,
Wuhan, China; Faculty of Medicine and Health Sciences
(F Zakham PhD), Hodeidah University, Hodeidah, Yemen; Addictology
Department (Prof M S Zastrozhin PhD), Russian Medical Academy of
Continuous Professional Education, Moscow, Russia; School of Public
Health (Y Zhang PhD), Hubei Province Key Laboratory of Occupational
Hazard Identification and Control (Y Zhang PhD), Wuhan University of
Science and Technology, Wuhan, China; Computational Bioscience
Research Center (J Zhou PhD), King Abdullah University of Science and
Technology, Jeddah, Saudi Arabia; School of Public Health and
Emergency Management (B Zhu PhD), Southern University of Science
and Technology, Shenzhen, China; School of Life Sciences (L Zhu PhD),
Yunnan University, Kunming, China; School of Physics
(S H Zyoud PhD), Universiti Sains Malaysia, Penang, Malaysia; GBD

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55
Collaborating Unit, Norwegian Institute of Public Health, Bergen,
Norway (Prof S E Vollset DrPH).
Contributors
Please see appendix 1 section 6 for detailed information about individual
author contributions to the research, divided into the following
categories: managing the overall research enterprise; writing the first
draft of the manuscript; primary responsibility for applying analytical
methods to produce estimates; primary responsibility for seeking,
cataloguing, extracting, or cleaning data; designing or coding figures and
tables; providing data or critical feedback on data sources; developing
methods or computational machinery; providing critical feedback on
methods or results; drafting the manuscript or revising it critically for
important intellectual content; and managing the estimation or
publications process. The lead, corresponding, and senior authors had
full access to the data in the study and had final responsibility for the
decision to submit for publication.
Declaration of interests
S Afzal reports payment or honoraria for lectures, presentations,
speakers bureaus, manuscript writing, or educational events and
webinars with King Edward Medical University and collaborative
partners including University of Johns Hopkins, University of
California, and University of Massachusetts; participation on a Data
Safety Monitoring Board or Advisory Board with the National Bioethics
Committee Pakistan, King Edward Medical University Institutional
Ethical Review Board, and the Ethical Review Board Fatima Jinnah
Medical University and Sir Ganga Ram Hospital; leadership or
fiduciary roles in board, society, committee, or advocacy groups, paid or
unpaid, with Pakistan Association of Medical Editors, Fellow of Faculty
of Public Health Royal Colleges UK (FFPH), the Society of Prevention,
Advocacy and Research of King Edward Medical University (SPARK),
and as a Member of the Pakistan Society of Infectious Diseases; and
other financial support as Dean of Public Health and Preventive
Medicine, King Edward Medical University, as the Chief Editor of
Annals of King Edward Medical University since 2014, as the Director of
Quality Enhancement Cell, King Edward Medical University, and with
the Member Research and Publications Higher Education Commission
Pakistan; all outside the submitted work. R Ancuceanu reports
consulting fees from AbbVie, Sandoz, B Braun, and Laropharm, all
outside the submitted work. J Ärnlöv reports payment or honoraria for
lectures, presentations, speakers bureaus, manuscript writing, or
educational events from AstraZeneca and Novartis; participation on a
Data Safety Monitoring Board or Advisory Board with AstraZeneca,
Astella, and Boehringer Ingelheim; all outside the submitted work.
M Ausloos reports grants or contracts from the Romanian National
Authority for Scientific Research and Innovation, CNDS-UEFISCDI
(project number PN-III-P4-ID-PCCF-2016-0084), outside the submitted
work. R Bai reports support for the present manuscript from the Social
Science Fund of Jiangsu Province (grant number 21GLD008).
O C Baltatu reports support for the present manuscript from the
National Council for Scientific and Technological Development (CNPq,
304224/2022-7) and from Anima Institute (AI research professor
fellowship); leadership or fiduciary roles in board, society, committee,
or advocacy groups, paid or unpaid, as a Biotech Board Member at São
José dos Campos Technology Park, outside the submitted
work. T Bärnighausen reports grants or contracts from the National
Institutes of Health (NIH), Alexander von Humboldt Foundation,
German National Research Foundation (DFG), EU, German Ministry
of Education and Research, German Ministry of the Environment,
Wellcome Trust, and KfW; payment or honoraria for lectures,
presentations, speakers bureaus, manuscript writing, or educational
events from PLOS Medicine as the Editor-in-Chief; participation on a
Data Safety Monitoring Board or Advisory Board for NIH-funded
research projects in Africa on climate change and health; and stock
ownership in CHEERS; outside the submitted work. S Barteit reports
support for attending meetings or travel from the Wellcome Trust, and
stocks or stock options with Climate Change and Health Evaluation
and Response System; all outside the submitted work. M L Bell reports
grants or contracts from US EPA, NIH, High Tide Foundation, Health
Eects Institute, Yale Women Faculty Forum, the Environmental
Defense Fund, Wellcome Trust Foundation, Yale Climate Change and
Health Center, Robert Wood Johnson Foundation, and the Hutchinson
Postdoctoral Fellowship; consulting fees from Clinique; honoraria for
lectures, presentations, or speakers bureaus from Colorado School of
Public Health, Duke University, University of Texas, Data4Justice,
Korea University, Organization of Teratology Information Specialists,
UPenn, and Boston University; honorarium for editorial duties from
IOP Publishing; honorarium for grant review from NIH, Health
Canada, PAC-10, UK Research and Innovation, and AXA Research
Fund Fellowship; honorarium for external advisory committee from
Harvard University and the University of Montana; support for
attending meetings or travel from Colorado School of Public Health,
University of Texas, Duke University, Boston University, UPenn,
Harvard University, and the American Journal of Public Health;
a leadership or fiduciary role in a board, society, committee, or
advocacy group, unpaid, with Fifth National Climate Assessment, the
Lancet Countdown, Johns Hopkins EHE Advisory Board, a Harvard
external advisory committee for training grants, WHO Global Air
Pollution and Health Technical Advisory group, and the National
Academies Panels and Committees; leadership or fiduciary role in a
board, society, committee, or advocacy group, paid, from the US EPA
Clean Air Scientific Advisory Committee (CASAC); all outside the
submitted work. P J G Bettencourt reports other financial or non-
financial support as a Project Reviewer at Botnar Foundation; outside
the submitted work. P V Bhardwaj reports stock or stock options with
Doximity, outside the submitted work. S Bhaskar reports grants or
contracts from Japan Society for the Promotion of Science (JSPS),
Japanese Ministry of Education, Culture, Sports, Science and
Technology (MEXT), Grant-in-Aid for Scientific Research (KAKENHI),
and JSPS and the Australian Academy of Science (JSPS International
Fellowship); leadership or fiduciary roles in board, society, committee,
or advocacy groups, paid or unpaid, with Rotary District 9675 as the
District Chair, Diversity, Equity, and Inclusion, the Global Health and
Migration Hub Community, Global Health Hub Germany (Berlin,
Germany) as the Chair and Manager, PLOS One, BMC Neurology,
Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health,
and BMC Medical Research Methodology as an Editorial Board Member;
and the College of Reviewers, Canadian Institutes of Health Research
(CIHR), Government of Canada as a Member; outside the submitted
work. A Biswas reports consulting fees from Lupin Pharmaceuticals
(India), Alkem Laboratories (India), and Intas Pharmaceuticals (India);
payment or honoraria for lectures, presentations, speakers bureaus,
manuscript writing, or educational events from Roche Diagnostics
(India); outside the submitted work. J Conde reports grants or contracts
from the European Research Council Starting Grant (ERC-
StG-2019-848325), outside the submitted work. S Das reports a
leadership or fiduciary role in a board, society, committee, or advocacy
group, unpaid, as an executive voluntary member and leadership
position in the Association for Diagnostic and Laboratory Medicine and
Women in Global Health India Chapter; outside the submitted work.
A Dastiridou reports payment or honoraria for lectures, presentations,
speakers bureaus, manuscript writing, or educational events from
AbbVie and Thea; outside the submitted work. A Faro reports support
for the present manuscript from Coordination of Superior Level Sta
Improvement (CNPq, Brazil) Productivity in Research Scholarship
(PQ Scholarship). A A Fomenkov reports support for the present
manuscript from the Ministry of Science and Higher Education of the
Russian Federation (theme number 121050500047-5). M Foschi reports
consulting fees from Roche, Biogen, Merck, Sanofi, and Novartis;
support for attending meetings or travel from Roche, Novartis, Biogen,
Sanofi, and Merck; leadership or fiduciary role in a board, society,
committee, or advocacy group, paid or unpaid, as a current member of
the MSBase collaboration scientific leadership group; outside the
submitted work. I Filip reports support for the present manuscript
from Avicenna Medical and Clinical Research Institute. I Ilic and M Ilic
report support for the present manuscript from the Ministry of
Science, Technological Development and Innovation of the Republic of
Serbia (grants 451-03-47/2023-01/200111 and 175042, 2011-2023).
N E Ismail reports a leadership or fiduciary role in a board, society,
committee, or advocacy group, unpaid, with The Bursar as a Council
Member of the Malaysian Academy of Pharmacy; outside the submitted
work. A Hassan reports consulting fees from Novartis, Sanofi

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Genzyme, Biologix, Merck, Hikma Pharma, Janssen, Inspire Pharma,
Future Pharma, and Elixir Pharma; payment or honoraria for lectures,
presentations, speakers bureaus, manuscript writing, or educational
events from Novartis, Allergan, Merck, Biologix, Janssen, Roche, Sanofi
Genzyme, Bayer, Hikma Pharma, Al Andalus, Chemipharm, Lundbeck,
Inspire Pharma, Future Pharma and Habib Scientific Oce, and
Everpharma; support for attending meetings or travel from Novartis,
Allergan, Merck, Biologix, Roche, Sanofi Genzyme, Bayer, Hikma
Pharma, Chemipharm, Al Andalus Pharmaceuticals, and Clavita
Pharmaceuticals; a leadership or fiduciary role in a board, society,
committee, or advocacy group, paid or unpaid, as a member of
educational, membership, and regional committees of international
headache societies; outside the submitted work. C Herteliu reports
grants or contracts from the Romanian Ministry of Research
Innovation and Digitalization (MCID, project number ID-585-CTR-42-
PFE-2021), a grant of the European Commission Horizon 4P-CAN
Personalised Cancer Primary Prevention Research through Citizen
Participation and Digitally Enabled Social Innovation Project “Societal
and Economic Resilience within multi-hazards environment in
Romania” funded by EU—NextgenerationEU and Romanian
Government, under National Recovery and Resilience Plan for
Romania (contract number 760050/23.05.2023, cod PNRR-C9-I8-CF
267/29.11.2022), through the Romanian Ministry of Research,
Innovation and Digitalization, within Component 9, Investment I8,
and Project “A better understanding of socio-economic systems using
quantitative methods from Physics’’ funded by EU—NextgenerationEU
and Romanian Government, under National Recovery and Resilience
Plan for Romania (contract number 760034/23.05.2023, cod
PNRR-C9-I8-CF 255/29.11.2022), through the Romanian Ministry of
Research, Innovation and Digitalization, within Component 9,
Investment I8; outside the submitted work. T Joo reports support for
the present manuscript from the National Research, Development and
Innovation Oce in Hungary (RRF-2.3.1-21-2022-00006), Data-Driven
Health Division of National Laboratory for Health Security. J Jozwiak
reports payment or honoraria for lectures, presentations, speakers
bureaus, manuscript writing, or educational events from Novartis,
ADAMed, and Amgen, outside the submitted work. J H Kempen
reports support for the present manuscript from Sight for Souls and
the Mass Eye and Ear Global Surgery Program; participation on a Data
Safety Monitoring Board or Advisory Board with Gilead; leadership or
fiduciary role in a board, society, committee, or advocacy group,
unpaid, on the board of Sight for Souls; stock or stock options with
Betaliq and Tarsier; outside the submitted work. K Krishan reports
other non-financial support from the UGC Centre of Advanced Study,
CAS II, awarded to the Department of Anthropology, Panjab University
(Chandigarh, India); outside the submitted work. B Lacey reports
support for the present manuscript from UK Biobank, funded largely
by the UK Medical Research Council and Wellcome Trust. J Lam
reports support for the present manuscript from the National Research,
Development and Innovation Fund (project number TKP2021-NVA-11).
H J Larson reports grants or contracts from GSK and Moderna;
consulting fees from the Gates Medical Research Institute and Apiject;
payment or honoraria for lectures, presentations, speakers bureaus,
manuscript writing, or educational events as a 2022 Merrimon Lecturer
(UNC); outside the submitted work. M Lee reports support for the
present manuscript from the Ministry of Education of the Republic of
Korea and the National Research Foundation of Korea (NRF-
2021R1I1A4A01057428) and Bio-convergence Technology Education
Program through the Korea Institute for Advancement Technology
(KIAT) funded by the Ministry of Trade, Industry and Energy
(P0017805). M-C Li reports grant support from the National Science
and Technology Council in Taiwan (NSTC 112-2410-H-003-031);
leadership or fiduciary role in a board, society, committee or advocacy
group, paid or unpaid, as the Technical Editor of the Journal of the
American Heart Association. M A Mahmoud reports grants or contracts
from Deputyship for Research & Innovation, Ministry of Education in
Saudi Arabia for funding this research work through the project
number 445-5-762; outside the submitted work. R J Maude reports
support for the present manuscript from Wellcome Trust (grant
number 220211) because it provides core funding for Mahidol Oxford
Tropical Medicine Research. A-F A Mentis reports grants or contracts
from MilkSafe: a novel pipeline to enrich formula milk using omics
technologies, a research co-financed by the European Regional
Development Fund of the EU and Greek national funds through the
Operational Program Competitiveness, Entrepreneurship and
Innovation, under the call RESEARCH–CREATE–INNOVATE (project
code T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for
Research and Innovation, MIMS-860), both outside of the present
manuscript; payment or expert testimony as a peer reviewer for
Fondazione Cariplo, Italy; participation on a Data Safety Monitoring
Board or Advisory Board as Editorial Board Member for Systematic
Reviews and Annals of Epidemiology, and as Associate Editor for
Translational Psychiatry; stock or stock options on a family winery; other
financial interests as a scientific ocer as part of the BGI Group;
outside the submitted work. P B Mentis reports payment or honoraria
for lectures, presentations, speakers bureaus, manuscript writing, or
educational events from Janssen (Australia) and Sanofi (Hangzhou);
participation on a Data Safety Monitoring Board or Advisory Board
from Janssen (Australia); outside the submitted work. L Monasta and
L Ronfani report support for the present manuscript from the Italian
Ministry of Health (Ricerca Corrente 34/2017) via payments made to
the Institute for Maternal and Child Health Istituto di Ricovero e Cura
a Carattere Scientifico (IRCCS) Burlo Garofolo. R S Moreira reports
grants or contracts from the National Council for Scientific and
Technological Development CNPq Research Productivity Scholarship
(scholarship registration number 316607/2021-5). J Morze reports
grants or contracts from SciLifeLab and Wallenberg Data Driven Life
Science Program (KAW 2020.0239); consulting fees from ALAB
Laboratoria; outside the submitted work. S Muthu reports leadership or
fiduciary role in other board, society, committee, or advocacy group,
paid or unpaid, on the NEXTGen Committee (ICRS), Grants
Committee (SICOT), and with the Knowledge Forum Degenerative
Associate as a member (AO Spine); outside the submitted work.
S Nomura reports support for the present manuscript from the
Ministry of Education, Culture, Sports, Science and Technology of
Japan (21H03203) and Precursory Research for Embryonic Science and
Technology from the Japan Science and Technology Agency
(JPMJPR22R8). A P Okekunle reports support for the present
manuscript from the National Research Foundation of Korea funded by
the Ministry of Science and ICT (2020H1D3A1A04081265); support for
attending meetings or travel from the National Research Foundation of
Korea funded by the Ministry of Science and ICT
(2020H1D3A1A04081265), outside the submitted work. A Pantea Stoian
reports payment or honoraria for lectures, presentations, speakers
bureaus, manuscript writing, or educational events from AstraZeneca,
Eli Lilly, Merck, Medtronic, Novo Nordisk, Servier, and Sanofi; support
for attending meetings or travel from Sanofi, Novo Nordisk, and Eli
Lilly; participation on a Data Safety Monitoring Board or Advisory
Board with Eli Lilly, Novo Nordisk, and Sanofi; leadership or fiduciary
role in other board, society, committee or advocacy group, paid or
unpaid, as the Vice-president of the Central European Diabetes
Association and as the President of the Romanian National Diabetes
Committee; outside the submitted work. R Passera reports
participation on a Data Safety Monitoring Board or Advisory Board as
the expert biostatistician member for the clinical trial Consolidation
with ADCT-402 (loncastuximab tesirine) after
immunochemotherapy: a phase II study in BTKi-treated/ineligible
Relapse/Refractory Mantle Cell Lymphoma (MCL) patients, sponsor
FIL, Fondazione Italiana Linfomi, Alessandria-I; outside the submitted
work. M Pigeolet reports grants or contracts from the Belgian Kids’
Fund for Pediatric Research; outside the submitted work. A E Peden
reports support for the present manuscript from the Australian
National Health and Medical Research Council (grant number
APP2009306). V C F Pepito reports grants or contracts from Sanofi
Consumer Healthcare and International Initiative for Impact
Evaluation; outside the submitted work. A Radfar reports support for
the present manuscript from Avicenna Medical and Clinical Research
Institute. A Rane reports support for the present manuscript from The
Bill & Melinda Gates Foundation; stock or stock options as a full-time
employee of Agios Pharmaceuticals; outside the submitted work. J
Sanabria reports a pending grant award from the NIH, National Cancer
Institute (NCI), and DoD; support for attending meetings or travel

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57
from Marshall University Medical School; three patents pending;
participation on a Data Safety Monitoring Board or Advisory Board as
the Chair of quality assessment and assurance for the Marshall
University Department of Surgery; leadership or fiduciary role in other
board, society, committee, or advocacy group, paid or unpaid with the
American Society of Transplant Surgeons, the American Association
for the Study of Liver Diseases, International Hepato-Pancreato Biliary
Association, the Americas Hepato-Pancreato-Biliary Association, the
Society for Surgery of the Alimentary Tract, and the Society of Surgical
Oncology; outside the submitted work. N Scarmeas reports grants or
contracts from Novo Nordisk; participation on a Data Safety Monitoring
Board or Advisory Board with the NIH; outside the submitted work.
A Sharifan reports leadership or fiduciary role in other board, society,
committee, or advocacy group, unpaid, with Cochrane as a steering
member of the Cochrane Early Career Professionals Network; receipt of
equipment, materials, drugs, medical writing, gifts, or other services
from Elsevier; outside the submitted work. V Sharma acknowledges
support from DFSS (MHA)’s research project (DFSS28[1]2019/EMR/6)
at Institute of Forensic Science and Criminology, Panjab University
(Chandigarh, India); outside the submitted work. V Shivarov reports
one patent and one utility model with the Bulgarian Patent Oce; stock
or stock options from ICONplc (RSUs); and other financial interests
from an ICONplc salary; outside the submitted work. J P Silva reports
support for the present manuscript from the Portuguese Foundation
for Science and Technology. J A Singh reports consulting fees from
AstraZeneca, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs,
Adept Field Solutions, Clinical Care Options, Clearview Healthcare
Partners, Putnam Associates, Focus Forward, Navigant Consulting,
Spherix, MedIQ, Jupiter Life Science, UBM, Trio Health, Medscape,
WebMD, and Practice Point Communications; and the NIH and the
American College of Rheumatology; payment for lectures,
presentations, speakers bureaus, manuscript writing, or educational
events as a member of the speakers bureau Simply Speaking; support
for attending meetings or travel as a past steering committee member
of OMERACT; participation on a Data Safety Monitoring Board or
Advisory Board for the FDA Arthritis Advisory Committee; leadership
or fiduciary role in a board, society, committee, or advocacy group, paid
or unpaid, as a past steering committee member of the OMERACT, an
international organisation that develops measures for clinical trials and
receives arm’s length funding from 12 pharmaceutical companies,
as Co-Chair of the Veterans Aairs Rheumatology Field Advisory
Committee, and as Editor and Director of the UAB Cochrane
Musculoskeletal Group Satellite Center on Network Meta-analysis;
stock or stock options in Atai Life Sciences, Kintara Therapeutics,
Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech,
Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics,
GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics,
Tonix Pharmaceuticals Holding, and Charlotte’s Web Holdings, and
previously owned stock options in Amarin, Viking, and Moderna
Pharmaceuticals; outside the submitted work. M V Titova reports
support for the present manuscript from the state assignment of the
Ministry of Science and Higher Education of the Russian Federation
(theme number 121050500047-5). H Zhang reports grants or contracts
from World Health Organization (WHO) funding; outside the
submitted work. M Zielinska reports other financial support as an
AstraZeneca employee; outside the submitted work. All other authors
declare no competing interests.
Data sharing
To download the data used in these analyses, please visit the Global
Health Data Exchange GBD 2021 website (http://ghdx.healthdata.org/
gbd-2021/sources).
Acknowledgments
Research reported in this publication was supported by the Bill &
Melinda Gates Foundation, the UK Department of Health and Social
Care, the Norwegian Institute of Public Health, and the New Zealand
Ministry of Health. The Palestinian Central Bureau of Statistics granted
the researchers access to relevant data in accordance with licence
number SLN2019-8-64, after subjecting data to processing aiming to
preserve the confidentiality of individual data in accordance with the
General Statistics Law, 2000. The researchers are solely responsible for
the conclusions and inferences drawn upon available data. This analysis
uses data or information from the LASI Pilot micro data and
documentation. The development and release of the LASI Pilot Study
was funded by the National Institute on Ageing, NIH (R21AG032572,
R03AG043052, and R01 AG030153), the Russia Longitudinal Monitoring
survey, RLMS-HSE, conducted by the National Research University
Higher School of Economics and ZAO Demoscope together with
Carolina Population Center, University of North Carolina at Chapel Hill
and the Institute of Sociology RAS. We would like to thank Statistics
Botswana and the Directorate of National Statistics, Somalia, for data
presented in this publication.
Editorial note: The Lancet Group takes a neutral position with respect to
territorial claims in published maps, tables, and institutional aliations.
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