Why everyone has fewer children today than ever before

Child survival. The dramatic improvement in child survival globally has brought babies per woman to as low as 2.2 in Bangladesh; 2.3 in India and 3.97 in Ethiopia. These are not anomalies. This is the norm. Furthermore, in cities, such as the Ethiopian capital of Addis Ababa, the number of babies per woman is less than 2. This too, is the norm in urban areas and cities globally.

I have discussed population growth in the past superficially; and intend to write a more extensive piece on this topic. However, it is important to realise that the world one once knew is no more. The world of our parents and grandparents is no more. And the pace of change in what we still refer to as the developing world, is particularly rapid.

Exponential ‘population growth’ is not a phenomenon that anyone should be actively worried about. Fertility rates have fallen significantly with improved healthcare access and outcomes – meaning that parents are sure that all their children will survive. Additionally, access to contraception and changing views as well as experiences of life quality have played an enormous role. Not only is the likelihood of child survival increased – but in many cases, governments have gone beyond legislating and are subsiding and/or incentivising families to send their female children to school. This is particularly the case in low income, and peri-urban settings – an example of this is Bangladesh.

This serves two important goals – as there is a large body of evidence to support the fact that more educated mothers have fewer children and that the health outcomes for those children born to educated mothers surpasses that of uneducated mothers.


Understanding the world is often about keeping up with the times and applying context based in realities to buttress perceptions. Cultural contexts make up a big part of this particular understanding. Without the cultural context of varied – specific regional and intra-national comprehension of the role and value of children within different societies it is difficult to understand why demographic changes occur in family planning.

In societies where children are expected to one day care for their ageing parents – having surviving children who can work and earn becomes more important. In the same vein – when these adult children are tasked with supporting their own elderly parents – given the choice – they will have fewer children to ensure that the available resources are sufficient to feed, educate and enrich the lives of those children as well as meet societal commitments of caring for family and even extended family.

Nonetheless, on the whole, parents wish for their children to thrive, be in health, earn and work in adulthood – almost regardless of cultural, religious or socio-economic setting. Our grandparents knew a world where women in Western Europe and North America had approximately 5 children who they could support and who survived – very much unlike the generation of their parents and grandparents – as we are reminded. However, in the days of their grandchildren, the likelihood of child survival was lower, thus having large families became the norm. Our grandparents and parents also knew a world where countries viewed to be steeped in poverty had many more children – the global south. An often perplexing reality when it was not understood that as in Europe in the 1800s; many poor countries of the global south would tragically lose as many as 40%, by some estimates, of their children before reaching adulthood.

Here is a link to a past article where I went into more depth statistically about the current state of babies per woman globally and global health outcomes associated with fertility rates in response to an interview by the global press with Emmanuel Macron.

It is my aim here to contribute to the global discourse on healthcare and development. Whilst this is a basic piece – I felt it was important for me to address this again. As, being an international and having lived in different counties, developed and developing, that someone points out flaws in reasoning with facts. And perhaps, in some way, not that it is my place, to defend the choices of families that are not understood by those who accuse developing nations of stifling their own growth by accommodating populations who don’t have the mental capacity to simply have fewer children. This disturbing trope is one that I have come across frequently. And it needs to be dispelled by fact. The reasons for slower growth in many nations are multiple, multifactorial, multifaceted and very much historical.

A topic, perhaps, for another day.

I write this from an adorable cafe on a sunny winters day in Lausanne – suitcase in tow having arrived back from London. As I take in the refreshingly cloudless sky – I wish you, as always, a banging Friday.


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