Future‐Proofing the ICPD PoA: Reproductive Rights in a Low‐Fertility World

Abstract

This commentary discusses the issue of low and declining fertility and the enduring relevance of the 1994 International Conference on Population and Development (ICPD) Programme of Action (PoA) in this new demographic context. We explore low‐fertility trends, patterns, and determinants; fertility in the context of the ICPD PoA; and the recent pushback against sexual and reproductive health, rights, and gender equality. We conclude with various actions that can be taken to future‐proof the ICPD PoA in low‐fertility contexts looking forward to the next 30 years.

INTRODUCTION

Over the past few decades, we have seen a substantial increase in both the number and geographical diversity of countries with low fertility. Two‐thirds of the world's population currently lives in a country or area with a total fertility rate (TFR) below the approximate replacement level of 2.1 births per woman, while almost one‐third lives in a country or area with a TFR below very low levels of 1.5 (UNDESA ²⁰²⁴). This commentary discusses the issue of low and declining fertility and the enduring relevance of the International Conference on Population and Development (ICPD) Programme of Action (PoA), agreed in Cairo in 1994, in this demographic context. Structured in four parts, we examine (1) low‐fertility trends, patterns, and determinants, (2) fertility in the context of the ICPD PoA, (3) the recent pushback against sexual and reproductive health, rights, and gender equality, and (4) the actions that can be taken to future‐proof the ICPD PoA in low‐fertility contexts looking forward to the next 30 years.

LOW FERTILITY TRENDS, PATTERNS, AND DETERMINANTS

Back in 1994 when 179 countries adopted the ICPD PoA, 45 percent of the world's population lived in a country or area with a TFR below 2.1, 11 percent in a country or area with a TFR below 1.5, and just 3 percent in a country or area with a TFR below 1.3 (UNDESA ²⁰²⁴). Today, 30 years later, the respective figures are 67 percent, 29 percent, and 24 percent (UNDESA ²⁰²⁴). Many middle‐income countries in Asia, Latin America, and the Caribbean, as well as island states in sub‐Saharan Africa, have experienced rapid fertility transitions and now have TFRs (well) below 2.1 children per woman (UNDESA ²⁰²⁴). Meanwhile, several high‐income societies such as the Nordic countries—with high gender equality, some of the most family‐friendly policies in the world, and previously relatively high fertility rates—have witnessed recent unexpected fertility declines (Campisi et al. 2023).

Various factors drive this decline to low and particularly very low fertility levels (Balbo, Billari, and Mills ²⁰¹³; Sobotka ²⁰¹⁷; Mills et al. ²⁰¹¹; Wilkins ²⁰¹⁹). Economic and labor market uncertainty is one key factor. The past decades have seen rapid transformations of labor markets (Matysiak and Vignoli 2024) with increased deregulation, digitalization, and a rise in labor market dualism in some countries (meaning that the economy is divided into one sector characterized by higher salaries, job security, and good conditions, and another sector characterized by lower wages, lack of job security, and poor conditions). Linked with this, we have seen stagnating and declining real wages, job losses, and increased precarity and uncertainty (Matysiak and Vignoli 2024), particularly for low‐ and middle‐educated young people (Matysiak and Vignoli 2024; Rahman and Tomlinson ²⁰¹⁸). Such insecurity (and also perceived uncertainty about the future (Vignoli, Bazzani, et al. ²⁰²⁰; Vignoli, Guetto, et al. ²⁰²⁰; Vignoli et al. ²⁰²²) makes it difficult to start a family and leads to fertility postponement (Matysiak and Vignoli 2024). At the same time, having children is expensive, with housing and education costs particularly important (Thévenon 2015).

Challenges combining paid work and family present another barrier to childbearing in many countries. Long and rigid working hours in East Asia (Kim 2018; Lee and Choi ²⁰¹⁵; Tsuya ²⁰¹⁵), childcare opening and closing times that are not aligned with parents’ working hours, and the limited availability of part‐time and flexible working options (Rindfuss and Choe 2016) (although these have increased in many jobs since the COVID‐19 pandemic) all play a part. Meanwhile, opportunities for women have expanded in education and paid employment. Yet in the home, traditional gender norms persist in many countries with women shouldering the load of childcare, housework, and care for older relatives, in addition to their work outside the home (McDonald ^{2000, 2013}). This “incomplete” gender revolution (Esping‐Andersen ²⁰⁰⁹; Goldscheider, Bernhardt, Lappegård ²⁰¹⁵) creates a double (and even triple) burden for women who want—and often need—to do paid work but are expected to take responsibility for domestic duties too. In response, we see the rejection of marriage by some women and the decision to have fewer or no children. Difficulty finding a suitable partner also seems to be significant (Skirbekk 2022), and there is also some evidence of lifestyle preferences (i.e., a desire not to change one's current lifestyle and/or to do other things in life than childbearing) influencing people's decisions to postpone or not have (more) children (Savelieva, Jokela, and Rotkirch ²⁰²²). At the same time, infertility (associated with the rising age at parenthood as well as various environmental factors) is important, with one in six people globally having experienced infertility during their lives (WHO ²⁰²³). Finally, a suite of newer factors such as intensive parenting (Sobotka, Matysiak, and Brzozowska ²⁰¹⁹), use of technology and social media (Tanskanen 2018; Savelieva, Jokela, and Rotkirch ²⁰²²), conflict, and climate change concerns (Berrington, Kuang, and Perelli‐Harris ²⁰²⁴; Frageri et al. ²⁰²⁴) may also play a part and are ripe for further investigation.

FERTILITY AND THE ICPD PROGRAMME OF ACTION

In 1994, the ICPD was a turning point in global thinking on population and development issues. Among the many issues addressed, it affirmed a rights‐based and person‐centered approach to sustainable development and emphasized sexual and reproductive health and reproductive rights and gender equality as key preconditions to achieve this (UNFPA ¹⁹⁹⁴). In the ICPD PoA, it was agreed that “all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so.”

At the time of the ICPD and in the years since attention has often focused on the gap that exists for women and men who want or intend to have a certain number of children but end up having more. We talk about an “unmet need” for contraception (which still exists today) and the importance of access to sexual and reproductive health and empowerment of women and girls as a means to reduce this unmet need. But there is also a gap between fertility aspirations and actual fertility for many women, men, and couples who end up having fewer children than they want or intend to have. In most low‐fertility countries, people on average aspire to have two children but the actual completed family size is lower (Beaujouan and Berghammer 2019)—often as a result of the various barriers to childbearing discussed above. The gap between fertility aspirations and the reality has been termed an “unmet demand for children” (Chesnais 2000; Harknett and Hartnett ²⁰¹⁴) and suggests a shortfall in the realization of individual reproductive rights (UNFPA ^2018a) in much the same way as for people with an unmet need for contraception. The inability of people to realize their reproductive aspirations—whether those aspirations are overachieved or underachieved—thus remains a key issue today.

THE PUSHBACK AGAINST SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS

A growing number of governments have become deeply anxious about (very) low fertility and the consequences of population aging and, in some cases, population decline (which in many countries is driven largely by emigration). They worry about the sustainability of healthcare and pension systems, about the economic consequences of a smaller and aging workforce, about a reduction in the number of potential consumers, and even about a decreasing number of young adults to serve in the military (Rindfuss and Choe 2016; Gietel‐Basten, Rotkirch, and Sobotka ²⁰²²). These concerns are further fueled by the media, with recent exaggerated news articles highlighting a “jaw‐dropping” “crash” (Gallagher 2020) in birth rates and a resultant “economic catastrophe” (Cumming 2024).

Some governments in low‐fertility contexts have developed policies that provide family‐friendly environments and support the equal rights and opportunities of men and women, often with the aim of increasing well‐being rather than fertility per se. France, Germany, and the Nordic countries, among others, represent examples of countries with generous, supportive, and rights‐based family policies today. UNFPA has also supported governments such as the Republic of Moldova in developing and implementing rights‐based family‐friendly policies. These policies aim to address the challenges that prevent people from having the children they desire.

Other countries have responded by adopting pronatalist approaches with the goal to stabilize or reverse fertility trends to reach numerical fertility and population targets (Sobotka, Matysiak, and Brzozowska ²⁰¹⁹; UNFPA ²⁰²³). Such targets have, in the past two decades, been introduced by various governments including Belarus, Iran, Japan, Poland, the Republic of Korea, and Russia, among others (Sobotka, Matysiak, and Brzozowska ²⁰¹⁹; UNFPA 2023). Often, pronatalist policies involve financial incentives, including cash bonuses for families that have another child, tax advantages for larger families, and/or loans and subsidies for housing (UNFPA 2023). Sometimes they also include other less conventional incentives such as awards or medals for achieving a certain number of children (UNFPA 2023). And, in many cases, these policies are accompanied by political rhetoric emphasizing the purported value of having large(r) families.

In more extreme cases, policies are being introduced that curb women and girls' sexual and reproductive health and rights, and bodily autonomy. These include restrictions on access to contraception, comprehensive sexuality education, and abortion care (UNFPA 2023; Gietel‐Basten, Rotkirch, and Sobotka ²⁰²²), rolling back many of the hard‐won rights and progress made over the past 30 years. In Iran, academics point out that the new Family Law of 2021 includes, alongside a series of “positive” incentives for childbearing, various restrictions on access to sexual and reproductive healthcare. These measures encompass, among others, the prohibition of the free distribution or financing of contraception; the prohibition of contraceptive implants; and the prohibition of the encouragement to utilize such devices (Asadisarvestani and Sobotka 2023). In Türkiye, researchers note that even though abortion was legalized in 1983, political rhetoric encouraging women to have a minimum of three children has occurred at the same time as reduced access to contraception in the public sector (MacFarlane et al. ²⁰¹⁶, cited in UNFPA 2023). Moreover, in several countries, restrictions on access to sexual and reproductive health and rights are targeted at specific groups (UNFPA 2023). These contemporary policies have echoes of the coercive measures implemented from the 1960s in many high‐fertility countries to reduce birth rates.

Evidence to date, however, shows that introducing pronatalist policies to meet numerical population targets does not tend to work. While a focus on the TFR might suggest a positive impact, a closer look at the actual number of births per year, and completed cohort fertility indicate slight, no, or tempo effects only (Lutz, Sobotka, and Zeman ²⁰²⁴). Moreover, most of the countries with specific fertility targets often continue to show fertility rates far lower than the stated goal in the target year (Sobotka, Matysiak, and Brzozowska ²⁰¹⁹). Cash‐based incentives may have a short‐term effect in encouraging people to have children sooner but rarely have longer‐term effects on completed family size. They can also encourage women to leave the labor market, which can have knock‐on effects of reducing tax revenues (UNFPA ^2018b) as well as reinforcing stereotypical unequal gender roles. Meanwhile, policies that restrict access to contraception, while harming women and girls’ right to choose, often result in increased abortions and maternal mortality (Rotkirch 2024), reducing agency, bodily autonomy, and the empowerment of the individual, directly contradicting the principles of the ICPD PoA.

RECOMMENDATIONS FOR THE NEXT 30 YEARS

Looking forward to the next 30 years, how can we future‐proof the ICPD agenda to better address the challenges being faced in the context of low and declining fertility?

First, among the global sexual and reproductive health and rights (SRHR) community, we need a broader use of the term “family planning” that reflects today's demographically diverse reality. UNFPA defines family planning as “the information, means and methods that allow individuals to decide if and when to have children” (UNFPA ^2024a). This definition is broad and encompasses enabling individuals to realize their aspirations to have both fewer or more children. However, while the definition is inclusive, in practice “family planning” is often used only to refer to contraception and other methods and information that help people to have fewer children.

Second, to reflect this reframed use of the term “family planning,” global policymakers and programmers, in collaboration with the academic community, need to develop and promote measures that allow us to capture individual underachieved fertility aspirations, and use these systematically across countries. This could mean including measures of women and men's fertility desires and intentions in nationally representative longitudinal surveys and following up to the end of their reproductive lifespan to assess the extent to which these desires are achieved. At the same time, systematic survey measurement of the barriers that prevent people who want to have (more) children from doing so can inform our understanding of low‐fertility determinants and provide pointers for policy action to close the fertility aspirations–reality gap. The Generations and Gender Survey Round II is already collecting such data for 24 countries in Europe, East Asia, and Latin America and could be expanded (Generations and Gender Programme ²⁰²⁵). UNFPA will also be launching a large cross‐national survey focusing specifically on young people's reproductive choices and partnership aspirations and the barriers and enablers to their fulfillment.

Third, national governments are encouraged to recommit to the ICPD PoA principles in the context of low fertility. This means being vigilant in stopping and reversing the current pushback against sexual and reproductive health and the rights of women and girls. It also means concentrating on rights‐based, person‐centered, and inclusive approaches to help all people achieve the number and spacing of children they desire. A constellation of policies that address the root causes of low fertility is required and may include affordable and accessible formal childcare; well‐paid parental leave that is flexible, including “use it or lose it” schemes that incentivize fathers to take leave; financial support for families as part of a broader policy package; policies to provide affordable housing and good‐quality, stable jobs especially for young people; policies that increase opportunities for flexible and part‐time employment; inclusive access to medically assisted reproduction; as well as normative societal change to address issues such as long working hours and harmful gender norms (Sobotka, Matysiak, and Brzozowska ²⁰¹⁹; UNFPA ^2018b). Such interventions should be tailored to the individual country context. In addition, further research is required to assess the effectiveness of specific policies in reducing the unmet demand for children.

Crucially, developing and implementing evidence‐ and rights‐based measures in national settings to enable people to realize their fertility aspirations will require multisectoral engagement, bringing together a range of government departments along with the private sector and civil society (including a strong representation of women‐led and feminist organizations), in much the same way as an integrated, multisectoral approach was advocated for and established in Cairo in 1994. At the same time, this reaffirmed human rights‐based, person‐centered approach needs to focus on supporting all individuals to achieve their fertility aspirations whether for more or fewer children. As such, we must continue to support those women and men who do not want to have (more) children to realize their aspirations too.

Fourth, efforts to enable women and men to achieve desired family sizes must be complemented by much greater national government efforts to anticipate and plan for their demographic futures by adapting social policies, social protection systems, service delivery, and infrastructures (Gietel‐Basten, Rotkirch, and Sobotka ²⁰²²). A growing number of countries in Eastern Europe, for instance, are developing “demographic resilience” programs supported by UNFPA, which aim to promote rights‐based policy responses to help countries build resilience to and take advantage of unfolding demographic change (UNFPA ^2024b). Adopting these recommendations can help national governments address their demographic challenges while protecting people's reproductive rights.

Finally, we call for the establishment of an Independent Expert Panel on Population and Development that can, along with other functions, provide thought leadership on the implementation of the ICPD PoA including in a low‐fertility world; contribute to and enhance interdisciplinary analysis and research on demographic trends; project future scenarios and assess sectoral impacts on social services and the economy; provide rights‐based policy recommendations for closing the “fertility aspirations–reality gap”; monitor and evaluate policy responses; and lead the mobilization of funds and stewardship to support countries in designing, implementing, and monitoring policies. Such a panel could be established by UNFPA and other stakeholders and would play a technical role, complementing the political role of the United Nations Commission on Population and Development in monitoring, reviewing, and assessing the implementation of the ICPD PoA at national, regional, and global levels.

CONCLUSION

In the 30 years since the ICPD PoA, low fertility has become a global phenomenon. A number of low and middle‐income countries have experienced rapid fertility transitions, and, in other countries, fertility rates have declined to unprecedentedly low levels. Back in Cairo in 1994, it was agreed that “all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so,” with the main focus on supporting women and men who wanted to have fewer children to realize this goal. Today, individuals experiencing a range of economic, social, and institutional barriers, are often having fewer children than they would like (while others continue to have more than they would like). At the same time, we are seeing some countries adopt misguided policies that restrict reproductive rights in a largely ineffectual effort to sustain or increase their population size. The principles of the ICPD PoA must be at the heart of pushing back against these restrictive approaches. Looking forward to the next 30 years, we call on governments to recommit to the rights‐based principles of the ICPD PoA in all contexts, including in the increasingly prevalent context of low fertility.