By Dr Veena Gilbert, Dr Fiona Chua and Dr Christabel Samy, General Practitioners, Rockingham
Australia’s fertility landscape has experienced substantial transformations in recent decades, and we are confronted with the challenge of an aging population.
The persistent decline in fertility rates is coupled with increasing reliance on assisted reproductive technologies. This phenomenon significantly impacts the economy, social structure and labour market sustainability of the nation.
The decline in total fertility rate started exponentially since 1971. In 1976, it fell below the replacement rate and since then the drop has been gradual and perpetual. In 2023, Australia recorded its lowest birth rate of 1.5, far below the level of around 2.1 required to maintain population stability.
Meanwhile, Australia has one of the highest utilisations of assisted-reproduction technology. Every year, around 20,000 babies are born from IVF treatment in the country, representing one in 18 children. So, why are we still below the threshold required for population replacement?
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Understandably, the decline is complex and interconnected. Reversing the low birth rate in Australia is an intricate challenge, but it is not entirely impossible. First and foremost, we must explore the factors leading to the downturn.
Reproductive ageing
The average age of mothers has been rising over time, from 30 in 2010 to 31 in 2022. Societal norms have evolved.
Most individuals, especially women, emphasise career success and financial stability. They focus more on advancing their education, enhancing their career and travelling the world before starting a family.
Cultural dynamics have transformed and there is less societal pressure to build a family at a younger age, if at all, allowing individuals to prioritise other aspects of their lives.
Economics and demographics
Although the economy climate in Australia currently is characterised by modest growth, everyone is affected by inflationary pressures and external challenges arising from international trade tensions.
Rising housing costs, job insecurity and childcare affordability considerably constrain reproductive choices. Individuals with higher spending power have the upper hand, while those in lower socioeconomic standing may face challenges in obtaining adequate healthcare due to its cost, potentially impacting fertility outcomes.
Hence, they might choose to not have children or maybe just one child suffices.
Despite Australia being a leader in ART, access to fertility services remains limited, particularly in rural areas. While rural regions typically have higher fertility rates, access to healthcare, including fertility treatments, is more limited.
These areas frequently lack the infrastructure and specialised care found in urban centers, which can result in delayed diagnoses and treatments.
Long distances to urban fertility clinics impose both financial and emotional burdens on rural residents, and the shortage of healthcare professionals in remote areas can lead to underdiagnosis or delayed intervention for fertility concerns.
Contraception and family planning
Contraception education is widely provided, beginning in middle school. Additionally, contraceptives are accessible and affordable. This increased accessibility contributes declining birth rates.
Education in schools is actively promoted by the Australian Council of Natural Family Planning from year eight onwards. There is advice given to teachers on how to promote topics and services that are available, including assess to contraception.
In recent decades, family planning was heavily promoted. Campaigns highlighted its importance and benefits and government incentives encouraged adoption. This, however, led to a rise in infertility rates.
Lifestyle
Modern diets often include unhealthy food with pesticides, antibiotics, and high mercury levels. This can result in infertility in women and reduced sperm counts in men.
There is currently no conclusive research evidence indicating that RF-EMF (Radio Frequency and Electromagnetic Frequency) emissions from commonly used devices adversely affect the reproductive organs in women and men.
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There is a need for fertility awareness programs in schools and communities, covering family planning, genetics, menstrual cycles, menopause, and parenting fears.
Government support should include awareness initiatives, policies, digital health investments, and subsidies to make fertility support affordable and accessible.
Key messages
- Fertility rates in Australia have been declining since 1971and are well below replacement levels
- Australia has high rates of assisted reproductive technologies
- Fertility awareness programs are needed.
Author competing interests – nil
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