1 in 6 women worldwide experience infertility, according to the World Health Organisation (WHO). In most countries, women are blamed and shamed for not being able to conceive a child. Infertility is treated as a medical condition, rather than a social problem, stemming from the stigma of childlessness. The concept of fertility is disproportionately attached to women, which reinforces the idea of biological essentialism by reducing women’s worth to their reproductive capability, while simultaneously overlooking men’s experience of infertility. Even though the state blames the women for fertility declines, men, too, play a significant role in reproduction. The state’s concern often oscillates between overpopulation and underpopulation, without realising the barriers that prevent individuals from fulfilling their fertility aspirations.
Recently, the United Nations Population Fund (UNFPA) published its State of World Population 2025 Report, titled “The Real Fertility Crisis: The Pursuit of Reproductive Agency in a Changing World.” The report highlights the singular realities of individuals who are unable to create their families. The report highlights 14 countries, which cover nearly one-third of the global population. The report primarily focuses on what people themselves want from their fertility. However, to contextualise the report findings, a brief explanation of the UNFPA is necessary.
UNFPA: An Overview
Established in 1969 as the “United Nations Fund for Population Activities”, the UNFPA is a subsidiary organ of the United Nations General Assembly. In the same year, the United Nations General Assembly declared that “parents have the exclusive right to determine freely and responsibly the number and gap between children”. The goal was to ensure reproductive rights and autonomy for all.
In 1987, the name of the organisation was changed to the United Nations Population Fund; however, the original acronym remains the same. The organisation’s mission “promotes gender equality, empowers girls and women to take control of their bodies and futures, meets the need for family planning, ends gender-based or intimate partner violence, and works to prevent maternal death and spacing of their children”. (About Us, UNFPA)
Barriers to reproductive autonomy: a glimpse from the report
The State of World Population 2025 report brings a significant shift in the global perspective on fertility. While the state is primarily concerned about the ageing, decline in workforce, and fertility, the report brings a paradigm shift. It explores the barriers behind people’s lack of performing their free and informed choices. It redirects attention towards the structural and social barriers. The report identifies the following barriers:
- Health – includes the lack of access to infertility clinics, pregnancy-related medical care, and medical access to general or chronic illnesses;
- Economic barriers – it includes the financial limitations, unemployment or job insecurity, housing limitations (e.g., lack of space, high rents, etc.) and lack of quality childcare options;
- Gender inequality – lack of partner and family support in caregiving or housework, and infrastructure at the workplace, such as creches;
- Relational barriers – includes the lack of a suitable partner or a supportive partner;
- Fear about the future – includes the concern about climate change, political instability, wars, or pandemics.
While there are wide-ranging reasons why people don’t desire a family, the most important and greatest barrier is economic. The most important aspect it highlighted was that the real fertility crisis is to provide an environment where people can practice reproductive rights freely.
Policy limitations
The assumption in policy is that fertility and human sexuality should be subject to the dictates of leaders, and people should obey the policies they implement. The report criticises the “anti-nationalist” and “pro-nationalist” policies. The categorisation of family-friendly policies, such as Hum do Hamare do and China’s One-Child Policy, is considered “pro-nationalist”, while policies related to abortion and contraception are “anti-nationalist”. This represents the perspective of the state rather than individual autonomy. Research has shown that supportive childbearing practices have negative lasting impacts on fertility rates.
The measurement of policies is based on the increase or decrease rate of fertility, which overshadowed the lived experiences of women. Policies should be designed inclusively, one that gives individuals autonomy to decide when, how, and with whom they wish to have a child. More than 150 countries indicate that half of the pregnancies are unintended. This is an outcome of ill-suited policy interventions.
Over time, global health policies improved. 60 countries improved their abortion laws. Neither policies nor their impacts are linear. Millions of women who live in poverty and belong to marginalised communities never exercise their reproductive rights and choices. The quality of care is also related to unmet demands for fertility. Although fertility care exists, it is not accessible to everyone. For example, eligibility is often based on heterosexual norms, which overlook the needs of non-binary individuals. Even clinics lack certain areas of clinical expertise in some cases.
Conclusion
The report offers a new perspective that encourages moving beyond demographic anxieties and focusing more on an individual-centred approach. It reminds policymakers that reproductive choice is not just about access to contraception, however deeply connected with political, legal, educational, and economic conditions of an individual.
Written by – Khushboo Dandona
Edited by – Shiv Talesara
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