We can only solve our population crisis with family-friendly policies

Evidence suggests there is a “fertility gap” between the number of children that couples want and the number they have. Affordability is the key issue.

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The maternity unit at one of London’s biggest hospitals, the Royal Free, is closing in response to a 14% fall in the birthrate in just five years.

In Bristol, where the birthrate fell by 36% between 2013-2023, St Barnabas Primary School closed after 150 years because it could only fill a quarter of its places. The Dolphin School, built less than a half mile away in 2012, is now at risk of closure.

These are snapshots of a nationwide population crisis. The UK’s birthrate fell to an all-time low of 1.44 in 2023 – the replacement rate is 2.1 – and deaths are outstripping births for the first time in half a century.

Our population is ageing, with 23 million over 65s by 2032, so this is an economic crisis, placing an enormous demand on public services, as well as a societal issue.

Can immigration solve this existential problem? The benchmark of a 2.1 replacement rate assumes no net migration whereas the Office for National Statistics estimates the UK had a net migration figure of 782,000 in 2023.

Sustained immigration can be a population stabiliser in countries with lower fertility rates, avoiding depopulation and helping with their age structure. Several studies have found that immigrants have a positive fiscal contribution over their lifetimes, but in a country with an ageing population, such as the UK, negative attitudes to immigrants persist. This makes it difficult for any government to promote immigration as a political or economic solution.

It may not be effective either, in the long term. Immigrants often have a higher total fertility rate initially, but it will decline over time. The fertility rate of foreign-born women in the UK is 2.03, almost a third higher than that of UK-born women, but it has steadily declined from its peak of 2.46 two decades ago and is below the replacement rate. Immigration cannot solve population ageing except through very high and increasing inflows.

A better response is to tackle the underlying causes of our declining birthrate and the barriers to parenthood. Whilst smaller families have become normal and socially acceptable, numerous evidence suggests there is a “fertility gap” between the number of children that couples want and the number they have.

Affordability is the key issue. The cost of raising a child is £260,000 for a couple, or £290,000 for a lone parent. Concerns over the cost of living, rising housing costs and the affordability of childcare are a deterrent to starting or extending a family. The UK is the fourth most expensive country in the world for childcare, taking almost 20% of income. Despite the high cost of childcare, only 11% of employers provide any kind of childcare benefits.

The broader issue is the impact of workplace policies and the role of employers in encouraging a family-friendly approach. Government research on Shared Parental Leave (SPL) found only 1% of eligible mothers and 5% of eligible fathers or partners have taken it up – largely due to financial reasons.

A 2003 study analysed the relationship between the availability of part-time work and fertility in 11 European countries and found that women with a part-time working schedule were more likely to have a child.

A newly published Economist Impact report, to which I contributed as the UK medical expert, conducted an evidence-based literature review of global papers that analysed the impact of family-friendly policies on fertility rates across Europe. It found that the three most effective solutions were: the availability of childcare, longer maternity leave and higher-paid maternity leave.

Next on the list was financial incentives, including a one-time baby bonus, tax credits for families and a universal child allowance. Of equal importance was increasing the availability of assisted reproduction services and publicly funding them. In the UK, this is an area where we have failed; one in seven couples have difficulties conceiving but only 27% of IVF cycles are publicly funded, down from 40% a decade ago.

The World Health Organisation classifies infertility as a disease; access to treatment should be a medical right. Yet in the UK, access to IVF is often an accident of geography with single women and same sex couples denied access to IVF in more than half of Integrated Care Boards unless they have already paid for 6-12 cycles of artificial insemination.

But it is important to emphasise that we will not solve our population crisis simply by throwing money at the problem. The issue is more complex and multi-faceted than that and it requires a holistic approach beyond government, reaching into our workplaces and our schools.

Young people are told how to prevent pregnancies but not how to maintain their fertility or take care of their reproductive health. I have long advocated introducing fertility education in schools; young people need to understand the impact of lifestyle, age and other factors on natural fertility, empowering them to make informed decisions later in life.

As young adults, they need to understand that egg freezing can be an option they can consider – for example, giving them the opportunity to freeze younger, healthier eggs in their twenties and early thirties for use in treatments later. Egg freezing can give them greater reproductive choice if they are not ready to start a family, but it is not a guarantee.

We need a long-term perspective; this is not a quick fix. Birth rates have been declining across Europe for more than 50 years and the total fertility rate in the EU has halved since 1960, so this is not simply a UK problem. A radical policy re-think is required, and we can learn from family-friendly solutions that other countries are adopting.

Professor Geeta Nargund is Lead Consultant in Reproductive Medicine at St George’s Hospital and Founder of Create Health Foundation