When suspicions turn to real evidenceBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1704 (Published 11 April 2019) Cite this as: BMJ 2019;365:l1704
All rapid responses
Another suspicion become fact is the enormous decline in western world fertility. For more than 40 years the birth rates in industrialised countries have been below 2.1 children per woman - the replacement level. Germany and Japan already have 50% declines in children and youth. Ireland has the highest non-national workforce in the OECD and Germany must import 240,000 foreign workers annually to keep pace with needs. The Lancet article 10th Nov 2018: "Population and fertility by age and sex for 197 countries 1950-2017..." paints the full picture.1 The discussion of the research focused on economic and social factors as being the causes. However a Danish correspondent in today's Lancet suggests that exposure to environmental chemicals detrimental to fertility is a major culprit. There is no doubt that there is and has been a major demographic change for the worse in these countries, but this correspondent suggests it may reverse "because social and economic trends often change."2
Here we have the worst demographic shift on record (apart from epidemics and famines and wars that reduced populations) with the difference that this is happening before our very eyes and people are doing it to themselves. The social science is basic. If you ask a cohort of 20 year olds when will they get married and how many children they will have - the average answer to question 1 is "when I'm over 30, and the answer to question 2 is 1 or 2, maybe 3. There is nothing wrong with their fertility it's their view of the family and children that determines their fertility. This will not change, and red herrings like widespread insecticide induced infertility as a major cause of this epidemic (which antedated widespread insecticide use) is not serious. Unfortunately human behaviours do not change without a serious stimulus and the best indicator of future behaviour is past behaviour. Europe and USA etc will therefore continue to reproduce at less than replacement levels unless there is a resurgence of interest in larger families and the economic supports are enacted to enable this. This is the biggest health issue in industrialised countries and an enormous increase in support for larger families has to be the best investment the government can make. The alternative is to see dwindling populations of British, French, Americans ...
Competing interests: No competing interests