While the world’s population continues to grow, in many countries fertility rates have fallen. Women are putting off having children, or not having any

Infertility is also on the rise, and in Asia there’s still a stigma about it, but attitudes are changing as more couples take fertility tests

Sarah Fung is often told she would make a great mother, a comment that usually comes just after she tells people she is not having children.

“We never thought we needed children to complete us,” says British-born Fung, 45, who has been married for five years to her Austrian-born husband, Phillip. “My business and lifestyle give me purpose in life.”

Fung, who has called Hong Kong home for 13 years and is founder of Hula, an online platform for pre-owned designer clothes, says the decision whether to have children is always very personal. “It might be easier in a conversation to say that I couldn’t have children to avoid having to explain why I didn’t want them,” she says.

“The world’s population is way too big and some people have children for the wrong reasons,” Fung says. “In Asia, cultural pressure is also felt on children to look after their parents in old age and this is the reason many people bear children. This is great if it happens, but it should not be expected.”

Fung says some people are shocked when she tells them that she and her husband have decided not to have children. But the couple are not alone.

Birth and fertility rates are falling globally, whether through choice or out of necessity. In the United States, the number of babies born in 2018 fell to the lowest level in 31 years. A UK government report found the birth rate in England and Wales for the same year also hit a record low.

The birth rate continues to decline in the European Union, according to Eurostat data. In 2017, 5.1 million babies were born in the EU, 90,000 fewer than the year before.

East Asian countries are struggling with falling birth and fertility rates; in several nations they have dropped to record lows. In Singapore, the number of babies born in 2018 was the lowest in eight years, with women delaying childbirth until they are older, according to government statistics. The decline in South Korea’s fertility rate continued, to fewer than 1.2 children per woman of child-bearing age.

In China, a government study found that births in 2018 fell to their lowest since it relaxed its one-child policy in 2014, and Japan recorded its lowest birth rate since records began.

Figures from the Department of Health show Hong Kong’s birth rate fell 78 per cent between 1961 and 2017. The city’s fertility rate has been consistently below the replacement rate of 2.1 children per woman of child-bearing age for the past 36 years, and stood at 1.1 in 2017.

Paul Yip Siu-fai, chair professor of population health in the department of social work and social administration at the University of Hong Kong, says the number of children Hong Kong women have is not so much a choice but rather a compromise based on factors including work and availability of childcare support.

“To a certain extent, Hong Kong women are pragmatic and try to make a decision despite the many constraints,” says Yip.

The reasons for the trend of falling fertility rates are varied. More women are delaying having children, instead seeking higher education and fulfilling career paths.

Others are having no children or fewer children for social and economic reasons, deterred by the high cost of living and of raising children, job instability and lack of parental leave. And a growing number of couples are infertile.

Some people are choosing not to have children for environmental reasons, spawning campaigns such as BirthStrike, a group comprising people who are not having children because of climate change. Then there’s the #NoFutureNoChildren campaign that kicked off before last month’s United Nations Climate Change Summit in New York.

While most agree family size is a personal choice, the bigger picture has some governments concerned about the negative impact low birth rates can have on their country’s economy, the dwindling numbers adding to the pressure on those facing problems such as a shrinking labour pool and an ageing population.

On the one hand, a high birth rate can be a drain on resources. On the other hand, if birth rates are too low, countries may not have enough young workers to maintain productivity. Some countries have introduced incentives to raise birth rates. In Hungary, women with four children or more will be exempt from paying income tax for life, while Japan this year made preschool education free.

The global fertility rate has declined, but still stands at 2.4, meaning the world’s population continues to grow, according to the 2019 World Population Data Sheet, released by Population Reference Bureau (PRB), a non-profit that uses data to assist policymaking.

According to the PRB, the places with the lowest fertility rates are in South Korea (1.0), Singapore (1.1) and Taiwan (1.1).

Dr Ann Tan is medical director of the Virtus Fertility Centre in Singapore, which helps couples who are struggling to conceive.

“Asia is generally more conservative, and infertility is often not talked about openly – stigma still exists,” says Tan.

“However, we are seeing more of an open dialogue in recent years. More couples are willing to get tested, especially after a year of trying for a baby in vain, a general benchmark indicating possible fertility issues.”

Compared with the past, when women traditionally bore the stigma of infertility and childlessness, couples are now “more equal” in their approach, she says. “Culturally, this has been a difficult challenge to overcome – for the wider public perception to change that infertility can affect both males and females,” she says.

“It is heartening that there is more education and conversation around fertility as well as financial and emotional support for those having difficulties. This will go a long way to improving pregnancy and take-home baby rates in Singapore.”

She adds: “In Singapore, most newlyweds aim to have children within the first three years of marriage, but most are blissfully unaware of potential fertility issues. This is especially significant given the trend that people are marrying later here.”

Tan’s centre has seen increased demand from patients over 40 years old for assisted reproductive technology (ART) treatments. The average age of women attending the centre for ART was 37 in 2016; in 2018, there was a 65 per cent increase in the number of women aged 40 to 45 seeking ART treatments from Virtus.

In August, Singapore announced measures to increase the accessibility and affordability of fertility treatments for couples, including removing the upper age limit of 45 years.

Tan says while the regulatory changes are a step in the right direction, more can be done to improve fertility in Singapore – specifically egg freezing, which is allowed only on medical grounds.