IVF Babble

Mark Trolice MD looks at the reasons behind the decline in US birth rates

It has recently been reported that birth rates in the United States reached a 30-year all-time low. The number of babies born in 2017 in the US, about 3.85 million, was the lowest since 1987

Ironically, this occurred while the number of in vitro fertilization (IVF) cycles increased annually. IVF accounts for up to two per cent of all US births. But a woman’s age when she desires procreation will always be the dominant factor in a country’s fertility rate.

What are the concerns over a country’s lower fertility rate?

How did the US do in 1987? Well, the replacement rate should be 2,100 births per 1,000 women but in 1987, it was only 1,765. If this trend continues, the US population, excluding immigrants, could vanish, theoretically.

Consistent with this 30-year decline in the US, a woman’s total fertility rate – the number of births she will have in her lifetime, dropped by 18 per cent. This drop is being seen across all races, including up to 30 per cent in the Hispanic population, a group who has traditionally demonstrated the highest fertility rate.

The US is not the only country whose demographers are facing this vital concern. Greece, Spain, and Japan have been dealing with steady declining birth rates for decades. In fact, in 2018, Japan had its lowest birth rate in its history.

Why the drop in fertility?

The average American woman’s age at the time of her first child rose from 21.4 in 1970 to 25.6 in 2011 according to the CDC. Though no definitive reason is evident, there are several factors at play shown in a study from Europe in 2011 – more contraceptive options, professional, personal and financial.

Women and couples may need to delay childbearing due to postgraduate education and career choices. The number of ethnic minorities, first-time graduate students have increased while women remain the highest percentage of graduates. Women have increased their numbers in many professions previously dominated by men, including law, business, and medicine. A very common reason that people cite for not having children is lack of a suitable partner. Finally, lack of economic certainty further contributes to planning conception at a later age.

Yet, it’s not all doom and gloom. In the US in 2017, women in their 40s had the highest birth rate of all groups studies. Also, women over age 35 showed an increase in first-time births. So, from a biological standpoint, fertility is not declining. Rather, we are seeing a shift to parenting at an older age. While this may have its advantages in terms of maturity, financial and relationship stability, the downside is the natural biologic decline in fertility as well as the duration of time a woman can remain fertility.

Can a country reverse this trend? Certainly, there are more questions than answers. Should parents be given a lower tax burden, and should this increase based on the number of children in the household? Should the Family Medical Leave Act be extended? Should day-care centres be funded by the state similar to public schools? Should government subsidies be increased to help support industries related to child care?

Unfortunately, there is no immediate answer, but this discussion should begin promptly in order to stave potentially damaging effects on countries facing declining fertility rates.

Dr Trolice is the director of Fertility Care, The IVF Center and Clinical Associate Professor, UCF-College of Medicine.



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