Marked decline in European birth rate: a concern for midwives; Penny Held, European representative on the IM Editorial Advisory Group, highlights demographic changes in the region that will impact on midwifery.

• Auteur: Held, Penny

No major industrialised country in the world has a total fertility rate (that is, the average number of children a woman has) above 2.1. The average fertility rate in Europe is 1.45. France, with a total fertility rate of 1.9 per woman and England with a rate of 1.64, have rates above the European average. In Germany, the rate is 1.4 children per woman and in Italy it is as low as 1.2. Even in Scandinavia, where the countries are well known for 'family-friendly,' politics, the fertility rate is 1.7 in Denmark and Finland and in Sweden only 1.54. The Eastern European countries are most negatively affected by declining birth rates where close to only 1.2 children per woman are born.

Current trends in the socio-demographic development in Europe must be of interest and concern to midwives as well as to demographers and economists. European society is changing in a way that has never been seen before. Researchers writing in the journal Science in 2003 (1) said that European population growth reached a turning point in the year 2000. At that time the number of children dropped to a level that statistically assured there will be fewer parents in the next generation than there are in the current generation.

If the current fertility rate of around 1.45 births per woman persists until 2020, the negative momentum will result in a fall of 88 million people in Europe by 2100, if one assumes constant mortality and no net migration. The greatest numbers will be lost in Eastern European countries such as Bulgaria, Estonia, Georgia, Latvia, Russia and Ukraine according to Joseph Chamie, Director of the UN Population Division. Up to half these countries could be wiped out by the year 2050.

Factors in the choice to have children

In the longer term, can we expect the total fertility rate to return to the replacement rate or even higher? The revolution in the second half of the 20th century gave women the chance of easy access to family planning. Now that reliable contraception is available, the fertility of women depends largely on how many children they and their partners want. Assuming that the biological impulse to reproduce is constant, the decision to have children will depend on the costs and benefits of having them.

In developed countries the economic motive of having children in order to put them to work for contribution to the family income, or to support their parents in old age, is no longer relevant. The economic factors that do apply are therefore...