The Centers for Disease Control and Prevention released two important reports last year: the national births report for 2022 and the provisional births report for 2023. Both reflect a concerning trend: a decline in the general fertility rate among women aged 15-44 and a corresponding drop in the annual number of live births in the United States.
The numbers are stark. The numbers are stark. In 2022, the U.S. recorded 3,667,758 births, a figure nearly identical to the previous year's 3,664,292 births. These numbers are the nadir of a sustained decline in the national birth rate that began in 2007.
Between 2007 and 2013, the annual number of U.S. births decreased by an average of 2% per year. From 2014 to 2019, this decline moderated to 1% annually. Buried within these statistics is a sobering reality: These numbers remain below the replacement level needed for population sustainability. The provisional data for 2023 suggest a continuation of this trend, with a further 2% reduction in births from 2022. In 2023, the general fertility rate also hit a historic low. Teenage birth rates, a key demographic indicator, likewise reached a record low.
Such declines are not unique to the U.S. Many developed nations are grappling with fertility rates below replacement levels. According to the Global Burden of Disease study, global fertility rates are projected to decline further, and by 2100, only six countries are expected to maintain fertility rates above replacement levels. These shifts are expected to have far-reaching economic and societal consequences, especially as aging populations and declining workforces become more pronounced in higher-income countries.
Although a smaller population may seem manageable or even beneficial in a world with limited resources, the transition to lower fertility rates presents significant challenges. The long-term implications are especially concerning: A declining working-age population means reduced income tax revenue, making it harder to support an aging population. This is particularly critical as longevity continues to increase, leading to higher healthcare costs and a growing mismatch between public spending and revenue.
The situation is exacerbated by trends toward earlier retirement and the increasing proportion of elderly people requiring support. Even U.S. states reliant on sales taxes rather than income taxes will feel the economic strain, albeit to a lesser extent.
Policymakers have two broad approaches available to address declining fertility rates: encouraging immigration or designing social programs to support larger families. Immigrants often have higher fertility rates, but political gridlock and a hostile climate toward immigration reform in the U.S. have prevented the encouragement of more immigration. Without significant policy changes, relying on immigration to offset declining fertility may prove untenable.
The second option involves creating incentives for family growth. Congress could lower barriers to larger families by addressing issues such as high housing costs, limited parental leave, and inadequate child care support. Investments in maternal health and reproductive technologies could also make a significant difference.
However, even in countries with robust family support systems, reversing fertility declines has proven difficult. By 2100, the populations of 34 countries, including China, are projected to shrink by a whopping 25% to 50%. An additional 23 nations, including Japan, Spain, and Ukraine, could experience population declines exceeding 50%. In contrast, the poorest regions of the world are expected to account for an increasing share of global births, further deepening the divide between developed
and developing nations.
The U.S. has faced declining fertility for nearly five decades, with the natural replacement rate of 2.1 offspring per woman consistently unmet. By 2100, the U.S. fertility rate is projected to drop to 1.53. This trajectory underscores the urgency for comprehensive measures to address the issue.
The challenge of decreasing birth rates demands coordinated action from Congress and the executive branch. Sweeping reforms are needed to enable people to support families while addressing the economic and social implications of an aging population. Failure to act will only accelerate the demographic and economic challenges already underway. For the U.S. and other developed nations, the time to act is now.
Henry I. Miller, a physician and molecular biologist, is the Glenn Swogger distinguished fellow at the American Council on Science and Health. He was the founding director of the FDA's Office of Biotechnology.