Fighting low fertility rates

Tinley Nangai

The Ministry of Health and the World Health Organization believe that reversing the country’s low fertility rate will require more than just government intervention.

Currently, Bhutan faces potential demographic challenges with a significant decline in fertility rates.

Although globally no country has managed to maintain replacement-level fertility rates after its population began to decline, despite numerous initiatives, health ministry officials hope that patriotism and awareness of the issue can turn the tide in a few years.

Bhutan’s fertility rate is currently just 2.0 children per woman, down from 6.6 in 1971. This is below the replacement level of 2.1 needed to maintain a stable population. However, a recent slight increase in the fertility rate, to around 1.2, offers some hope.

Health experts recommend that in order for Bhutan to sustain its population, each couple should ideally have two to three children.

The falling fertility rate has also raised questions about the 1990s family planning push that health officials say was effective in reducing maternal and infant mortality. The campaign, which provided options such as salpingectomies, vasectomies and copper T insertions, also led to a sharp drop in fertility rates to about three children per woman in the early 2000s.

The contraceptive use rate among Bhutanese women increased from 18.8% in 1994 to 58.7% in 2023.While some have suggested stopping the use of birth control pills, WHO and health ministry officials clarified that the government cannot stop using the pills as it would violate human rights. Instead, they suggested campaigning and raising awareness about the importance of having children and their role in nation building.

There are many reasons for Bhutan’s declining fertility rate. Economic challenges such as slow economic growth and rising inflation have led many people to be reluctant to have children due to the high cost of living.

Although the overall unemployment rate fell from 5.9% in 2022 to 3.5% in 2023, and the youth unemployment rate also fell sharply, many young people delayed having children in order to complete their education and build a career.

The best age for childbearing is between 20 and 30 years old, but there are also risks in getting pregnant at an older age.

Health issues also play a role. According to a 2023 report from the World Health Organization, approximately 17.5% of the global adult population (about one in six) experiences infertility. This statistic highlights the urgent need for accessible, high-quality fertility care.

Furthermore, rural-urban migration has disrupted traditional family planning practices, while migration for education and employment has led young Bhutanese to settle abroad and start families there.

The global average fertility rate has dropped from around 5 in the 1960s to around 2.4 in 2021. South Korea, Singapore, Japan, and several European countries report population growth rates well below replacement levels, largely due to high living costs, stressful work cultures, and expensive housing. Japan’s population, for example, is expected to decline by about 30% by 2070.

With support from the World Health Organization, the government plans to introduce in vitro fertilization (IVF) in Thimphu as part of a broad effort to boost fertility rates. The government has also pledged to provide 10,000 Ngultrum per month for every three-year-old child and is rolling out a comprehensive mother-and-child care program.

In addition, the 150-bed Gyaltsuen Jetsun Pema Wangchuck Mother and Child Hospital in Thimphu aims to encourage childbirth, and a clinic specifically for mothers and children is being built in Mongar.

From June 2023, the Ministry of Labor began allowing the entry of foreign child caregivers to ease the burden on working parents and encourage the birth of more children.