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Low-Fertility - the Future of Europe?

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Low-Fertility - the Future of Europe? LOW-FERTILITY - THE FUTURE OF EUROPE? THE EUROPEAN MAGAZINE FOR SEXUAL AND REPRODUCTIVE HEALTH No.63 - 2006 The European Magazine for Sexual and Reproductive Health CONTENTS Entre Nous is published by: Reproductive Health and Research Programme WHO Regional Office forE urope Scherfigsvej 8 DK-2100 Copenhagen Ø Denmark Tel: (+45) 3917 1602 Fax: (+45) 3917 1818 Editorial E-mail: [email protected] By Gunta Lazdane, Jacqueline Bryld 3 www.euro.who.int/entrenous Chief editor Is Europe trapped in/by low fertility? Dr Gunta Lazdane By Nikolai Botev 4 Editor Human rights considerations in addressing low fertility Jacqueline Bryld By Jane Gauthier 8 Editorial assistant Dominique Gundelach Current trends of fertility – and infertility-in Europe Layout By Karl Nygren, Gunta Lazdane 10 Sputnik Reklame Aps, Denmark. www.sputnikreklame.dk The determinants of low fertility in Europe Print By Hans-Peter Kohler 12 Central tryk Hobro a/s Europe’s looming population bust Entre Nous is funded by the United Nations By David E. Bloom, David Canning 14 Population Fund (UNFPA), New York, with the assistance of the World Health Organization Low fertility, low modern contraceptive prevalence and Regional Office for Europe, Copenhagen, the high number of abortions – the case of Serbia Denmark. By Mirjana Ra˘sevic´, Katarina Sedlecki 16 It is published three times a year. Present Defending the family – the Latvian experience distribution figures stand at: 3,000 English, By Linda Anderson 18 2,000 Spanish, 2,000 Portuguese, 1,000 Bul- garian, 1,500 Russian and 500 Hungarian. Sexual and reproductive health in low fertility countries By Radosveta Stamenkova, Todor Chernev 20 Entre Nous is produced in: Bulgarian by the Ministry of Health in Bul- Between policy-maker awareness and policy responses: garia as a part of a UNFPA-funded project; lowest-low fertility in Italy Hungarian by the Department of Obstetrics By Francesco C. Billari 24 and Gynaecology, University Medial School of Debrecen, PO Box 37, Debrecen, Hungary; Behind the surprising stability of romanian fertility Portuguese by the General Directorate for By Vasile Ghetau, Laurian Arghisan 18 Health, Alameda Afonso Henriques 45, P-1056 Lisbon, Portugal; Recent changes in family policies in Austria and Germany Russian by the WHO Information Centre for – A response to very low fertility Health for the Central Asian Republics; By Alexia Prskawetz, Isabella Buber, Tomas Sobotka, Henriette Engelhardt 27 Spanish by the Instituto de la Mujer, Minis- Resources terio de Trabajo y Asuntos Sociales, Almagro By Jacqueline Bryld 30 36, ES-28010 Madrid, Spain. The Portuguese and Spanish issues are dis- tributed directly through UNFPA representa- tives and WHO regional offices toP ortuguese and Spanish speaking countries in Africa and South America. THE ENTRE NOUS EDITORIAL ADVISORY BOARD Material from Entre Nous may be freely trans- 2 lated into any national language and reprinted Dr Assia Brandrup- Dr Evert Ketting Dr Peer Sieben in journals, magazines and newspapers or Lukanow Netherlands School of Public UNFPA Representative and placed on the Web provided due acknowl- Senior Adviser, Division for and Occupational Health Country Director, Romania edgement is made to Entre Nous, UNFPA and Health, Education and Social Utrecht, The Netherlands Ms Vicky Claeys the WHO Regional Office forE urope. Protection Dr Malika Ladjali Regional Director Articles appearing in Entre Nous do not German Agency for Technical Senior Programme Specialist International Planned Parent- necessarily reflect the views of UNFPA Co-operation (GTZ) UNESCO/Headquarters, Paris hood Federation, European or WHO. Please address enquiries to Mr Bjarne B. Christensen Ms Adriane Martin Hilber Network (IPPF-EN), Brussels the authors of the signed articles. Head of secretariat, Sex & Technical Officer, Department Dr Robert Thomson For information on WHO-supported activi- Samfund, the Danish Member of Reproductive Health and Adviser on Sexuality, Repro- ties and WHO documents, please contact the Association of IPPF Research, WHO Headquarters, ductive Health & Advocacy, Family and Community Health unit at the Dr Helle Karro Geneva UNFPA Country Technical address given above. Head, Department of Obstet- Ms Nell Rasmussen LLM Services Team for Europe, Please order WHO publications directly from rics and Gynaecology, Medical Director, PRO-Centre, Bratislava the WHO sales agent in each country or from Faculty, University of Tartu, Copenhagen Marketing and Dissemination, WHO, Estonia CH-1211, Geneva 27, Switzerland ISSN: 1014-8485 Jacqueline Gunta EDITORIAL Bryld Lazdane More than half of the coun- (POA ICPD, 1994). The 57th World are trying to respond to what by some is Health Assembly in 2004 approved the discussed as the ‘fertility crises’ through tries that make up the WHO World Health Organization’s first Global support to couples with children and to European Region have fertil- Reproductive Health Strategy to acceler- create family friendly environments. We ate progress towards the attainment of have invited authors, specialist in this field ity levels, which are defined international development goals and from academic institutions, professional as low or lowest-low. This targets. Since then many countries have associations and UN agencies to discuss analyzed the reproductive health of their the role of the health care services in in- significant population fea- population and developed their national creasing the birth rates. The role of social ture of the European region strategies for the further improvement factors is emphasized in many articles, and of reproductive health. Parallel to this the national experts in the field present is in some countries causing process the question has been asked: examples of the policies in countries from concern, due to changes in “How important are these international different parts of the European region. agreements as well as the goal to achieve It is beyond any doubt that all efforts the structures of the la- universal access to reproductive health should be made to ensure that health and bour market and national services for the countries in the European sexuality education is combined with Region of WHO, where more than half of analysis of human values and respon- economy, or might do so in the Member States have low fertility rates sibilities for every single adolescent. the future. This issue of Entre and a negative population growth?” Information and knowledge increases the Let us make it clear – these agreements possibilities of making informed choices Nous illustrates that the pol- are still of high importance, some might and preventing mistakes in reproductive icy solutions to the ‘demo- argue now more than ever. Since the behaviour that may have long lasting con- ICPD in 1994 and the World Summit in sequences. Reproductive health services graphic crises’ are complex 2000 there have been several attempts to are to meet the needs of all women and and context specific. undermine the global commitments to men to fulfil their goals in family plan- ensure reproductive rights and access to ning. The global community is trying to The Museum of Contraception presents sexual and reproductive health services. achieve universal access to reproductive the history of humankind in trying to As can be read from several of the articles health by 2015, in less than 10 years. We plan a family and prevent unwanted preg- in this issue of Entre Nous, upholding are to ensure that reproductive health nancies. Since the discovery of hormonal the reproductive rights of women and services are accessible and of high quality contraception in the middle of the last men, also in a European context, can be a in all countries, including those with low century, the research in this field has re- challenge and several governments have fertility rates. sulted in providing a significant diversity led pro-natalist policies, which in some We hope that you will find this issue of of choices to couples in order to ensure cases have been in conflict with ensuring Entre Nous helpful for your future activi- “ability to have a satisfying and safe sex reproductive rights. ties in the area of sexual and reproductive life and capability to reproduce and the The fact that many policy makers in health and rights and beyond. freedom to decide if, when and how often Europe are following the development of to do so” (Programme of Action (POA) the fertility trends closely is signified by Gunta Lazdane adopted at the International Conference the fact that several countries have estab- [[email protected]] 3 on Population and Development (ICPD), lished high-level national committees to Chief Editor 1994). evaluate the possibilities of changing the During the last 20-30 years the interna- present demographic trends. For example Jaqueline Bryld tional community has changed the focus President Vladimir Putin highlighted the [[email protected]] of the development goals from reducing demographic crisis of the Russian Federa- Editor the global population growth to ensuring tion in his state-of-the-nation address this sexual and reproductive health and rights. year and has made it one of the countries Several international agreements have highest priorities: ”First a lower death rate; set the scene and recommended the way second, an efficient migration policy; and to achieve “a state of complete physical, third, a higher birth rate”. mental and social well-being and not This edition of Entre Nous is planned merely the absence of disease or infirmity, to assist policy makers to learn more in all matters relating to the reproductive about the general trends of fertility rates system and to its functions and processes” in Europe and the ways some countries No.63 - 2006 IS EUROPE TRAPPED IN/BY LOW FERTILITY? The “Low Fertility Trap” Birth rates throughout Moreover, in a number of these countries years, and the latest data suggests that TFR is even below 1.3, a level that Kohler, in 2002 its TFR was already 1.48 (3).
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