The global decline in fertility rates is a defining demographic trend of this era. Globally, governments are developing policies to address this decline with the goal of encouraging people to have more children. However, by focusing on raising fertility without a rights-based approach, policies are overlooking, and potentially dismantling, the rights and choices of women.
One key question that emerges in today’s global context: are women truly free to make their own reproductive choices?
Published last month, UNFPA’s 2025 State of the World Population report found that millions of people are unable to have the number of children they want. YouGov and UNFPA surveyed 14 countries across national income levels, representing almost 40% of the global population. The findings were striking – nearly 1 in 4 respondents felt unable to fulfil their desire for a child at their preferred time.
The report highlights a severe lack of reproductive agency felt among many people around the world, whether due to health issues, economic concerns, concerns over the future, lack of a suitable partnership, or other factors. Almost 40% of respondents reported that financial limitations were the largest deterrent to fulfilling their fertility aspirations and limited their ability to have the number of children they wanted.
As declared by many national governments at the International Conference on Population and Development (ICPD) 30 years ago, family planning policies should focus on rights, autonomy, and women’s empowerment. However, national responses to declining fertility rates do not always prioritize women’s agency in practice.
Declining fertility versus the reproductive choice
Like in many other countries, demographic trends in India mirror the global decline in fertility and there exists a disconnect between demographic goals and reproductive autonomy. While India increased access to family planning services and achieved near-universal institutional childbirth in public and private healthcare facilities—leading to a substantial reduction in maternal mortality – critical gaps remain. For many Indians, intended fertility versus their fertility aspirations are not aligned.
Of the many issues, secondary infertility – the inability to conceive or carry a pregnancy to term after having given birth before – has nearly doubled in 30 years and can in part explain the disconnect. Additionally, the unintended outcomes of reproductive health program interventions may also be playing a role, including the high rates of caesarean sections, hysterectomies, and female sterilization. The increase in women’s health challenges with non-communicable diseases, premature menopause, and cancer becoming more common is in part explaining the lower fertility in recent times.
Policies across countries that aim to address fertility trends must generate much needed evidence, take a person-centered approach, and support the choices of women without coercion or constraint. To address low fertility in countries with rapid demographic transition, governments must implement evidence-based structural reforms and a rights-based program model that centers women’s autonomy. Ensuring respectful, non-invasive reproductive care and reducing unnecessary medical interventions will help build trust in the health system and positive birthing experiences which are critical to balancing fertility.
It is more important than ever before that we work with governments worldwide to achieve the ICPD goal that every woman has the right to decide when, whether, and how to become a mother. The key to balanced fertility is to have supportive policies and create positive birthing experiences.