Moving Beyond Fertility Targets

We’re often told that we’re living during a population crisis, a time of simultaneous concerns born of too many people to sustain necessary resources for a healthy planet, and too few working-age people to support a healthy economy. Population dynamics and trends are key to national and international security and contribute to the overall wellbeing of a society. Fertility, along with mortality and migration, is central to population and its importance to demographers, policymakers, economists, and a country’s development is without question. But focusing on population trends without considering the experiences of the billions of individuals who make up those trends—each with a unique life course, personal aspirations, and individual potential—establishes an unhealthy and dangerous tension that can strip women of their rights and leave them socially disenfranchised.

Globally, women are not always decision-makers in population policymaking, but their fertility is frequently seen as both the problem and the solution to a population’s composition, size, and growth. History shows an abundance of national policies that have sought to increase or decrease birth rates, often excluding women’s perspectives about their own fertility intentions. These target-driven fertility policies have had limited long-term success in affecting birth rates. At the same time, those policies that target the number of children a woman should have can have lasting consequences related to diminished autonomy for women and weakened gender equality.

Governments argue that hitting fertility targets, either by decreasing or increasing the number of children a woman has, will improve a nation’s economy and its ability to handle stressors.

Many fertility-related policies have targets that are based on achieving a total fertility rate—a demographic indicator that estimates the average number of children born per woman during her reproductive years—of at least replacement level, which is 2.1 children per woman. While there is nothing inherently wrong with an aggregate measure like the total fertility rate, tension arises when policy decisions favor those measures while failing to acknowledge the preferences, experiences, or desires of women and couples. Examining population data and how a trend changes over time is really just a shorthand way of understanding how people’s lives are changing for any number of reasons.

From Fertility Goals to Individual Choice

The way governments think about fertility and related policies has evolved greatly over the past century. Initially, governments focused on developing policies related to population change, but failed to consider individual—women’s—perspectives in the design, implementation, or impact of such policies. The use of demographic goals to advance development remained relatively unchallenged until 1994, when the International Conference on Population and Development (ICPD), that year held in Cairo, shifted global attention from policies that focus on achieving demographic targets to those grounded in individual choice and that consider the complex and interrelated issues of population, development, and human rights.

The ICPD Program of Action was adopted by 179 governments and highlighted individuals’ fundamental right to make informed decisions about their reproductive health, and clarified that women’s full and equal participation in civil, cultural, economic, political, and social life at all levels were priority objectives for this international community, as was eradicating all forms of sex discrimination. Efforts to achieve these goals have accelerated strategies to eradicate gender-based discrimination and promote tools that empower women to determine the timing and size of their families through better access to family planning, education, and healthcare. When women have access to these services, they can draw on their own life circumstances and personal aspirations to make decisions rather than being subjected to government-set fertility targets.

Thirty years after that groundbreaking meeting in Cairo, the global fertility rate is 2.3 live births per woman, a decrease from 3.3 in 1990. This trend was realized with women’s increased decision-making power about their reproductive health. Access to better healthcare and contraception have also been instrumental in reducing fertility and increasing reproductive choice, as have women marrying later, more girls going to school, and more women entering the workforce. Gender equality and women’s empowerment are the essence of the ICPD Program of Action. As UNFPA’s 1994-Executive Director Nafis Sadik said at that time, this approach to development is “liberating women from a system of values which insists reproduction is their only function.”

A History of Policies Used to Drive Fertility Levels

Despite advances coming from the 1994 conference, it is not unusual for governments to create policies focused on women’s reproductive health behaviors with the ultimate goal of affecting fertility rates. Governments argue that hitting fertility targets, either by decreasing or increasing the number of children a woman has, will improve a nation’s economy and its ability to handle stressors. Countries seeking higher fertility favor population growth to support the military, infrastructure, and services; conversely, countries seeking lower fertility see that decreasing population numbers will allow for more resources per person to invest in human capital.

Fertility policies enacted to achieve population goals and fertility targets almost always neglect the experience, needs, and desires of the women and couples they directly impact.

Some countries want to increase births through policies that aim to increase fertility rates (often referred to as pro-natalist), while others hope to slow population growth through policies that aim to inhibit fertility (often referred to as anti-natalist). Experience has shown that it’s too simplistic to assume that a country with high fertility only needs more contraception and family planning policies and a country with low fertility rates can resolve its challenges only with additional supportive family policies. Fertility related policies are just as complex and intricate as those related to migration and aging societies, or any other complex social issue, and policymakers need to consider how people’s lives—especially women—are impacted by attempts to shift fertility preferences. The ICPD paradigm change has demonstrated that policies focused solely on reaching fertility targets are shortsighted and often harmful to women and families.

Policies and practices to promote fertility

Some countries with decreasing fertility rates and projected shrinking populations have felt the need to implement policies to encourage women and couples to have larger families. These are largely financial incentives in the form of tax advantages, welfare benefits, childcare subsidies, and increased parental leave. In Singapore, for example, government policies have included state subsidized child care and 12 weeks of maternity leave for the first four children. Japan and France have both passed monetary transfer policies designed to consider the cost of child rearing and gender equality (despite these policies, France’s total fertility rate has been below replacement level since 1975). Hungary’s government has provided loans that can be forgiven if a couple has at least three children. At first glance, these policies may seem beneficial, but they tend to support women and families for only very short periods of time and are not always inclusive to everyone wanting to build a family. Evidence shows, like in South Korea, for example, that while such policies may cause an immediate surge in birth rates, they have not been shown to increase the number of children a woman will have during her lifetime.

Some fertility-promoting policies can have longer term negative effects by violating a person’s right to decide the timing and spacing of pregnancies. These policies, while encouraging reproduction, often discourage contraceptive use, including sterilization and abortion, which was the case in Singapore, Iran, China, Russia, and Poland. These policies can also be exclusionary—such as in Hungary, where in vitro fertilization (and the aforementioned loan benefits) is only offered for free to women under the age of 40 who are in a heterosexual relationship—or punitive, like the idea of applying an additional tax on the childless.

Conservative “pronatalist” movements typically urge women to return to more traditional roles and produce more voters, fighters, workers, and consumers to boost the economy. These movements have often been rooted in nationalistic ideals, infused with racism and xenophobia, with an emphasis on certain populations to have more children to improve the status of a nation. With the rise in conservative candidates in global elections this year, it is also quite possible that we will see an increase in national fertility focused policies that are not centered on how many children a couple wants but instead on fertility targets.

Policies and practices to inhibit fertility

Conversely, countries that deem their population to be too large or growing too quickly have enacted policies to reduce fertility that could have a significant effect on women’s autonomy, gender equity, and access to reproductive health services. In 1952, as a response to its then total fertility rate of 6.2 births, India became the first country to establish a population policy that coincided with a massive government-sponsored family planning campaign to slow their population growth. Other countries quickly followed suit with policies that focused on lowering fertility—largely based on the needs of the government and the idea that smaller families would lead to greater economic benefits. The thinking at that time (when the majority of countries had high fertility rates) was that population growth is both a cause and symptom of slow economic development and that slowing population growth (through lower fertility) would accelerate development.

Certainly, China’s one-child policy from 1980 to 2015 fits into this category and violated people’s rights while also leading to a population age structure that has had an unexpected effect on economic and social behaviors. When this policy was in place, millions of Chinese women were subjected to forced contraception use, sterilization, and abortions. Another unintended consequence of population reduction efforts: throughout South and East Asia the practice of sex selective abortion and female infanticide resulted in millions of aborted female fetuses due to the cultural preference for sons.

In addition to these national-level policies and practices to reduce fertility, researchers have documented policies that attempted to control fertility among targeted populations. For example, a 1970-law led to the sterilization of 25% of Native American women of reproductive age. Similarly, Indigenous women in Peru and Indonesia into the 1990s, and in Canada until the 1970s were also subject to policies that forced sterilization and coerced contraceptive use. Eugenic laws and practices have permitted coercive sterilization in many countries, particularly targeting racial and ethnic minority women, incarcerated women, disabled women, women living with HIV, and women in the LGBTQ community.

A Future of Policies that Promote Gender Equity

Fertility policies enacted to achieve population goals and fertility targets almost always neglect the experience, needs, and desires of the women and couples they directly impact. Gender equality and women’s empowerment and autonomy must be central to any policy related to fertility. We should also encourage a shift away from the pro- and anti-natalist discourse to one that is fully centered on reproductive health decisions that are voluntary, informed, and rights based.

Deconstructing aggregate indicators like total fertility rate and reflecting on what they mean for individuals helps policymakers better appreciate the intricate forces and dynamics that shape global population structure, changes, and trends. Many fertility-related policy solutions—meant to address growing and/or decreasing populations—have been tried unsuccessfully in part because they did not address the complex forces that shape people’s lives, and often they fail to respond to the real needs of the individual women, including their need to be equal members of society. Now, 30 years after the historic declaration in Cairo, it is a time for honest reflection and change based on evidence and human rights.

Sarah B. Barnes is director of the Wilson Center’s Maternal Health Initiative. Jay Gribble is senior director at Palladium, deputy director at PROPEL Health, and a global fellow at the Wilson Center.

Cover photo: A mobile clinical outreach team from Marie Stopes, a specialized sexual reproductive health and family planning organization on a site visit to Rabai hospital a rural area in the coastal region of Kenya, where they offer many sexual reproductive health services, including the full range of family planning options, emergency contraception, pre- and postnatal care, and cervical cancer screening and treatment. The main activity at Rabai hospital was implants of a five-year contraceptive solution for women. Photo by Jonathan Torgovnik/Getty Images/Images of Empowerment, licensed through Creative Commons.