On the 21st of March the Danish national newspaper published the opinion piece with the Professors Søren Ziebe and Lone Schmidt who are also part of ReproUnion’s Challenge 5 – Fertility Awareness
By Søren Ziebe, Head of Department, the Fertility Department at Rigshospitalet, ReproUnion
Lone Schmidt, Professor with Special Responsibilities, National Institute of Public Health, University of Copenhagen, ReproUnion
Sophie Hæstorp Andersen, Chairman of the Regional Council, Capital Region of Denmark, (Social Democratic Party)
Prior to many of life’s great choices, we seek advice and guidance from family, friends and experts to ensure that we have the best platform for decision making. But this is only rarely the case with one of the biggest and most difficult decisions we have to make in our own lives – the decision whether to have children.
This can be difficult to address in a relationship. Which one of us is ready to make the big decision first – and who will be first to express it? It can be awkward to talk about, even among friends. Who will be the first couple to give priority to a life with children, thereby putting it above social cohesion? Are you letting your friends down – or will you be de-selected when you are the first to have a child?
Pregnancy and children are not only difficult for the young people to talk about. We all know how parents beat about the bush when adolescents reach a certain age. Dreams are dreamt and there is talk of grandchildren. But not in dialogue with the young couple. It can quickly become an explosive subject and create divisions, while young people may experience that their parents are pushing them.
It is also not the first topic of discussion in the workplace. The aspiration for more exciting assignments or a job a little further up the ladder means that many people see it as rash, should they divulge their plans to start a family.
And should you make it through all these obstacles and finally make the big decision to have children, only to discover that you are having problems getting pregnant, then it will truly be very difficult to talk about. If everyone else is successful, why not us?
It is a delicate and sensitive topic and therefore difficult to talk about. But we must have the discussion, also in the public, because the decision to have children – or not to have children – will have consequences, not just for the life of the individual but for all of society.
A shared challenge
We want to bring a different focal point to the heart of the debate, namely the consequences our reproductive challenges have for what we see as the Scandinavian welfare model. The unpleasant truth is that the demographic, and thereby also the economic precondition for our current welfare model, is slipping very slowly. The reason is that not enough children are born and far too many are not able to have the children they want! This is a challenge we share with most other Western countries, which was also mentioned by the Norwegian Prime Minister in her 2019 New Year’s address. Overall, the number of children born throughout the world has been cut in half during the past 60 years.
When the birth rate is a particularly significant challenge for Denmark and the other Nordic countries, the somewhat simplified reason is that our welfare models are based on a generational contract, where the scope of a generation’s access to e.g. healthcare and welfare services, depends on the prosperity created by subsequent generations. We do not fund our own old age, but that of our parents, and we assume that our children will finance ours. All things being equal, if we have fewer children, the result will be self-evident. The fact that we maintain sufficient numbers is a prerequisite for maintaining the current model, including a high level of public service, free education, a social safety net as well as free and equal access to the healthcare system.
First I must have my education
The development of fertility research and treatment has made a significant contribution to keeping the problem of declining birth rates somewhat in check. The truth is that today, more than 1 in 10 newborns is the result of fertility treatment. Without access to fertility treatment, we would have 6000 fewer children each year, and we would soon face a huge challenge.
The most important single factor for our declining fertility is age. We have arranged ourselves in ways where the combination of individual and joint choices made by men and women as well as the norms and incentive structures of society mean that we often start having children later than our biology dictates. There are many good reasons for this, but our biology does not give in to even the best of arguments.
It still takes two to have children
The situation is not sustainable. We have too many elderly people – and there are not enough to support them. We must therefore have this discussion, even if it is difficult and can be experienced as uncomfortable and taboo-breaking. We have to say goodbye to the fear of offending.
The discussion concerning reproductive sustainability is complex and concerns, among other things, the work force, equality, maternity rules, rules relating to assisted reproductive technology, educational policy, private and family economies as well as the fundamental question of whether we as a community can help each other to motivate future generations to have more children – without it being misinterpreted as “interfering” with the individual’s right to make a free choice.
We should face up to the challenge and discuss solutions with at least the same level of seriousness and intensity that we discuss e.g. unemployment, climate challenges, integration and retirement age.
In order for us to create a society with sustainable reproduction levels, we need to ensure that everyone has a better understanding of the limitations and importance of fertility, thereby reducing ignorance in this area. It is about education and information precisely at the time when this knowledge makes sense. Seen in isolation, this should be a surmountable task!
It’s also about what each one of us can do
An equally important, but perhaps more difficult part of the debate, is about the standards and framework conditions that are necessary to start building a family a bit sooner. How do we set up an educational system and a labour market in which having children in our mid-20s is not experienced as a barrier and a trip-wire, but as a natural phase in our lives. How do we create changes to the standards that govern the Danish television program “The Young Mothers”, so that the very young women in it who have actually gotten it right in a purely biological sense, are not portrayed as actors in a horror story about the more or less chaotic struggle young impoverished females have with children, authorities, failed relationships and their own inner demons? How do we create the framework for a credible storyline that discusses the inherent qualities of having our children at the very time when our biology prompts us to do so, and which in addition will help us solve a number of the structural socio-economic and political challenges facing our welfare society?
We can and must have that debate with each other. We cannot continue to excuse ourselves because it is difficult to talk about. We must be able to talk about it without being accusing and reproachful. Without provocation or being provoked. We need to be aware that some people will feel backed into a corner, and there must be room for that. But there will be generations after us. And if we do not equip future generations with the knowledge and standards that will ensure that they can have all the children they want, we will only have passed the problem on – our shared problem – and that is not the decent thing to do.
The desire and willingness to have children when our biology prompts us to do so, is an important marker for the way a society prioritizes and recognizes basic qualities of life. Let’s talk about the elephant in the room. Right now!