The UK has a fertility crisis – here's how we solve it

Fertility rates are falling faster in the UK than in any other G7 nation and have declined by 25% since 2010. The birthrate fell to an all-time low of 1.44 in 2023, which will make it increasingly difficult to support our ageing population in the decades ahead.

New research by Ipsos provides an insight into the reasons behind our fertility crisis. Nearly half of adults, aged 18-50, say they are putting off or deciding against having children; financial worries are the main factor, principally the cost of raising children, including food, clothing and education. Nearly one in three cite the cost of childcare, nearly one in five are concerned about the cost of adapting their current home or moving house.

The Ipsos survey of 1,000 adults found that tackling affordable housing is the single most popular policy to encourage more people to have children, favoured by 42% of respondents.

Read more:

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• 6 in 10 women say the cost of childcare was a reason they had an abortion

Make housing affordable

We should not be surprised that the cost of housing is a barrier to starting or growing a family. The average house price in the UK is £268,400, according to Zoopla’s July index, with the average London property selling for £669,234 over the last 12 months. Meanwhile, rents have reached new record highs at £1,365 per month, according to Rightmove, rising to £2,712 per month in London.

We cannot solve our fertility crisis unless we address the underlying causes. I use the term “political infertility” to describe policy decisions that create socio-economic conditions which deter women and couples from starting a family.

We need to adopt a collaborative approach, involving every arm of government and employers too. Policies that support family time, such as flexible work options, are important because parenthood requires more than just cash; career protection must be part of the offer.

This is not solely a UK problem. Birth rates have been declining in Europe for more than 50 years and the total fertility rate in the EU has halved since 1960. According to UN forecasts, China’s population will halve by 2100, with almost half aged over 65.

Make childcare available and parental leave more generous

We can learn from other countries – what works and what doesn’t. The Chinese government is promising to pay 3,600 yuan (£375) per year, per child, up to the age of three. Hungary is spending 5% of GDP on pro-natal policies, such as subsidised housing loans and tax exemptions for parents. Austria has increased paid maternal leave from one to two years, which has persuaded more couples to have a second child.

An Economist Impact review of global research, to which I contributed, found that family-friendly policies, which promote gender parity, most effectively encourage larger families. The availability of childcare is the single most effective mechanism to improve the fertility rate, alongside longer and higher-paid maternity leave.

The UK is the fourth most expensive country in the world for childcare, with costs accounting for 19% of income. Our statutory paternity leave offers only two weeks paid leave – the least generous in Europe. Only 1% of eligible mothers and 5% of eligible fathers or partners have taken up shared parental leave – largely due to financial reasons.

Introduce a national IVF tariff and end the postcode lottery

Infertility is classified as a disease by the World Health Organization and access to treatment should be a medical right. We need to make IVF accessible and affordable to all, including same-sex couples. Currently, more than half of Integrated Care Boards (ICBs) require same-sex couples to self-fund between six and 12 cycles of artificial insemination before being eligible for IVF.

There is no justification for the health inequalities that exist within fertility treatment, whether they relate to accessibility for minority communities, LGBTQ+ couples and single women, or the IVF postcode lottery, which goes against the founding principles of our NHS to offer fair and equal access to healthcare.

One in seven British couples have difficulty conceiving and a national IVF tariff would end the postcode lottery. Price caps exist on other medical treatments and a tariff on the upper limit ICBs pay for a single IVF cycle would help the NHS budget go much further and reduce the disparity of access across the UK.

We need to combine this with better education; let’s introduce fertility education in secondary schools, to empower our young people with knowledge about the impact of age and lifestyle on their fertility.

The long-term impact of a declining population will be profound. PwC’s consulting arm, Strategy&, forecasts that ageing populations and falling birth rates will reduce UK GDP by £429 billion by the end of the century.

For the sake of generations to come, and to protect our nation’s economic prosperity, we cannot duck this issue; we need to act now.

Professor Geeta Nargund is a senior NHS consultant in reproductive medicine and director of the Create Health Foundation.

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