After the shock, time for announcements. During his press conference organized on Tuesday January 16, Emmanuel Macron focused part of his speech on something new: a “demographic rearmament” to revive the birth rate. A position which echoes the INSEE figures published a few hours earlier showing a drastic drop of 6.6% in the number of births in France in 2023 compared to the year 2022. With 680,000 babies who have seen day over the last twelve months, our country has thus reached the lowest level ever recorded since 1946. The Head of State therefore decided to react, and announced the creation of “birth leave” as well as the launch of a “major plan” to fight the scourge of “infertility”. But is it really relevant to link falling birth rates and the inability to procreate?
A multitude of factors can explain the fall in the birth rate: the uncertain economic situation, marked by high inflation, the context of war in Ukraine and the Middle East, or even the challenges of reconciling family and professional life. All this creates a “climate of uncertainty” which can slow down or delay the desire to have a child. When we look closely at INSEE statistics, we see a decline in the fertility rate, which stood at 1.68 children per woman last year, compared to 1.79 in 2022. It had decreased each year between 2015 and 2020, after having oscillated around two children per woman between 2006 and 2014. In 2023, this fertility rate declines for women of all ages, including those aged 30 or over. However, France is faced, like Western countries, with an aging of the average age of motherhood, which stands at 31 years today – compared to 26 and a half 50 years ago. Another data: women give birth to their first born on average at 29 years old in 2023, compared to 24 years old half a century ago.
This is where the problem of infertility can come into play. Because this gradually decreases from the age of 30, so-called “late” motherhood mechanically increases the risk of infertility. In addition to societal and economic problems, “the ignorance of many couples about the reality of the decline of their fertility with age, and excessive confidence in the performance of medically assisted procreation techniques” play a certain role, writes Professor Samir Hamamah in a report submitted to the government in February 2022. “Even if a certain number of couples have difficulties after the thirties, the vast majority manage to do so. We should not be overly alarmed,” says Gilles Pison, professor emeritus at the National Museum of Natural History and advisor to the management of the National Institute of Demographic Studies (INED).
The fact remains that requests for medical support to conceive a child are on the rise and concern increasingly older couples. At the head of the obstetrics and gynecology department at Foch Hospital in Suresnes, Professor Jean-Marc Ayoubi assures that “one in four couples would have recourse, during their life, to a consultation for infertility”. In France, 40,000 to 50,000 births using medically assisted procreation are recorded each year. But 40% of couples who enter the process fail to achieve pregnancy. And this for several reasons, notably the average age of the first child per PMA is 33 years (older than in natural pregnancies).
Infertility on the rise
If infertility is not the only cause of the fall in the birth rate, it is nevertheless constantly increasing and could, in the long term, become a global problem. According to the WHO, one in six people is affected worldwide, with a prevalence that varies little from one region to another. In 2046, one in two couples will have difficulty conceiving, according to the WHO. In France, one in four couples wanting to have a child are currently affected by infertility problems, according to INED. In his report, Professor Samir Hamamah indicates that 3.3 million people would be affected in France. If the oldest are the most affected, since fertility declines with age, couples who are barely in their thirties are not spared. However, it is still difficult to determine whether the phenomenon has worsened massively among young people because parental plans are being postponed later and later and the younger generation is showing less and less desire to be parents.
At the same time, other scientific factors explain the increase in infertility. According to a meta-analysis carried out in 2017, there was a 50% decline in sperm concentration among men in industrialized countries between 1973 and 2011. A curve which, according to this study, has probably continued at the same pace since that date. This phenomenon would be linked in particular to regular exposure to endocrine disruptors, but also to tobacco or cannabis consumption, obesity, or even eating disorders. “We are quite worried, naturally, because this fall is constant and global, assures Professor Jean-Marc Ayoubi. But we must still be reasonable, because we remain at levels which remain largely sufficient to conceive a child. Afterwards, it “We will need to monitor this indicator closely in the coming decades.” In women, the role of endometriosis, a widespread but still poorly understood pathology, should not be underestimated, as should polycystic ovarian syndrome (PCOS), which could be the most common cause of menstrual cycle disorders and absence of ovulation.
Another fact should be highlighted: the number of women of childbearing age who do not have children stands at 14-15% in France today, a figure that is increasing. This rate is, on the other hand, almost 25% in Germany and more than 30% in South Korea or Taiwan. Spain and Italy, where the fertility rate is 1.2 children per woman, tend to move closer to these Asian countries. Are we at the dawn of a new demographic situation where the “zero child” model would progress? “We still lack perspective to say that women want fewer children today than at the time. Perhaps once prices start to fall, for example, we will experience a new peak in prices. births as was the case at the beginning of the 2000s after a sharp decline between 1980 and 1993. Perhaps, on the contrary, the trend of a life with one child will prevail to the detriment of the old model of two children per child. woman”, judge Gilles Pison.
Fighting against infertility can therefore prove useful in countering the decline in the birth rate. It now remains to be seen what the “grand plan” mentioned by Emmanuel Macron will contain. “Effective public policies are those which make life easier for parents. But also those which aim to encourage women’s work, and to reduce inequalities between the sexes. This is in countries where inequalities are less, and where women work the most, they have the most children”, adds Gilles Pison. Professor Jean-Marc Ayoubi, for his part, calls for more information for young people on the risks of infertility, strengthening the training of caregivers, the establishment of targeted consultations for young men and women in order to identify potential factors affecting their fertility, and a structuring of research in the field of human reproduction. “Now we are waiting for action,” he concludes.
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