Op-Ed: Worried about a ‘baby bust’? Then prevent pregnancy ‘wastage’ 

SHER ON INTERCONCEPTION/PRECONCEPTION HEALTH, EDUCATION AND CARE Worried about a ‘baby bust’? Then prevent pregnancy ‘wastage’ 

Dr Jonathan Sher – is an IJBPE Contributing Editor and Founding Partner of Scotland’s Coalition for Healthier  Pregnancies, Better Lives while the former Deputy Director of the Queen’s Nursing Institute Scotland. 

REFERENCES 

British Medical Journal  Feature (2023) Folic acid:  The case to rethink the  UK’s food fortification  plans. British Medical  Journal, 381:1335.  

Ehrlich, P. &  

Ehrlich, A. (1968) The  Population Bomb. United  States: Sierra Club/ 

Ballantine Books

Hardly a day goes by now without  anxiety-laden news about falling  birth rates across the globe. These  are routinely accompanied by dire  warnings about the anticipated long 

term economic and societal consequences of too  few babies. The main worries are a depleted work  force, reduced consumer spending, inadequate  care for the elderly, and declining tax revenues. 

Even nations at odds with each other are  united in decrying this current trend. South Korea  has a plan to avoid population collapse and  North Korea may issue punishments to reverse  its falling birthrate. While Asia is a particular  focal point for this panic, it is echoed across  Europe and the other OECD countries, too.  

For instance, the Prime Minister in Greece  has called the baby bust a national threat and a  ‘ticking time bomb’ and is offering tax breaks,  

repatriation incentives and cash benefits to  address the problem. The Greek Government is  far from alone in emphasising economic measures  to deal with this demographic dilemma.  And yet.  

And yet, there are two essential realities  largely missing from the leading analyses and  proposed solutions. The first is a disconnect  between pregnancies and babies. The remedies  intended to reverse declining birth rates – from  more affordable housing to better pay & leave  policies – are built on the assumption that  people of childbearing potential are increasingly  choosing not to become parents. There are, of  course, some people whose priorities mitigate  against having children. And, for some of  them, the remedies being proposed might make  a difference in their attitudes and actions. 

However, the ‘choice’ assumption blithely  ignores the contradictory fact that at least one  out of every four pregnancies has an ‘unhappy  ending’. These are pregnancies intended to  be full term and produce healthy babies  who will grow up to become net assets to  their economies and societies. An ‘unhappy  ending’ includes miscarriages, stillbirths,  therapeutic terminations, very premature  deliveries, harm to the mother’s health and/ or her future reproductive life, as well as babies  born with lifelong, life-limiting birth defects. 

Turning all ‘unhappy endings’ into happy  ones is well beyond our collective capacity.  Still, many of these unwelcome outcomes  could, and should, have been prevented through  robust, universal, effective policies and  practices under the umbrella of preconception  

and interconception health, education and care. To cite only one of many examples, 80% of  the babies currently born with, and burdened  by, Neural Tube Defects could have been  prevented from ever developing NTDs by  implementing fully effective fortification  of staple foods with Vitamin B9 (folic acid)  (British Medical Journal Feature, 2023). Think  about the implications of the rate of ‘unhappy  endings’ dropping from one in 4 to one in 14 or  eventually to only one in 40. That alone would  eliminate the panic over lower birth rates.  The second flaw in the current remedies is a  disregard for the quality versus the quantity of  births. Everyone wants a healthy, productive and  thriving citizenry. But we all know this is not  what has been true. Thus, the panic over falling  birth rates is predicated, in part, on the belief  that the current proportion of any birth cohort  who will not become successful net contributors  to the economy and society will remain stable.  However, there is no natural law dictating  the inevitability of this pessimistic prediction.  What if a significantly higher percentage  of babies in each birth cohort are just fine?  Think about the implications of preventing  (before and during pregnancy) most of the  large number of children born with – and  hampered for life by – Fetal Alcohol Spectrum  Disorders. Actually preventing preventable  harm to babies – from FASD and dozens of other  conditions – would neutralize many negative  impacts of declining birth rates. Moreover,  it would do so far less expensively than the  economic measures being considered today. On a more personal note, I am writing this  column from the perspective of a ‘Boomer’  (someone born between the mid-1940s and mid 1960s). During my life, I have witnessed the rise  and fall of numerous, diametrically opposed,  demographic trends predicted to have disastrous  impacts. The first was the Malthusian, society shaking book, ‘The Population Bomb’ (1968), by  Paul and Anne Ehrlich. To them, rapidly falling  birth rates across the globe would have been an  undiluted Godsend and a dream come true.  In my view, choosing to prevent harm by  preparing well for pregnancy – in other words,  preconception and interconception health,  education and care – could become the silver  lining in the present population panic. In fact,  this silver lining offers us a golden opportunity.  But only if we have the precious ‘mettle’ to finally  accord priority in thought, word and deed to  promoting healthier pregnancies and better lives. 

36 Sher, IJBPE, vol 12, issue 2, 2025