Around half of the world’s countries now report fertility rates below the level required to sustain their populations, sparking mounting concerns among policymakers and demographers. Without significant migration, projections suggest that dozens of countries could see their populations more than halve by the end of this century,a demographic shift poised to reshape societies, economies, and labour markets worldwide.

Decades of family planning focused on contraception have been central to this trend, but the official response to declining birth rates has remained inconsistent. In wealthier nations, assisted reproductive technologies are becoming increasingly common, with up to one in ten children now born through such interventions.Yet the high costs of these treatments mean that many families, particularly in lower and middle-income regions, cannot access the fertility care they need.

Support for families also varies sharply from country to country. While some governments offer generous child benefits, cash incentives, and publicly funded fertility treatments, others lag behind, resulting in stark disparities in access and outcomes. Experts are now calling for a fundamental rethink of how societies approach family building, arguing that support for having children must be placed on an equal footing with contraception.

They urge targeted education campaigns for young adults and more robust research to address gaps in knowledge. As the world confronts unprecedented demographic change, governments face a critical choice: adapt to support family growth, or accept the consequences of shrinking, ageing populations.