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. 2022 Jan 25;37(4):629–638. doi: 10.1093/humrep/deac011

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© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Figure 3. — Determinants of total fertility rate (TFR) decline. (A) A powerful negative correlation between adult female literacy rate and TFR across the world (P < 0.001). (B) Plot of TFR against marriage rate in the Netherlands, as an exemplar of a consistent trend seen in many developed countries. Note that as TFR declines to below replacement levels, marriage rates collapse (arrowed). Data on x-axis plotted in descending order. (C) The number of children born out of wedlock is increasing rapidly with time, again using the Netherlands as the exemplar. (D) A plot of testicular cancer rates against gross domestic product (GDP) per capita (measured in current $US) demonstrates a highly significant correlation (P < 0.001), indicating that the more prosperous a country becomes, the higher the incidence of testicular cancer. (E) When TFR falls to around replacement levels there is a sudden exponential increase in the incidence of testicular cancer, even though it remains a relatively rare condition. Data of x-axis plotted in descending order. (F) Increase in the uptake of ART in Australia (1991–2018). Arrow indicates a sudden, 13% reduction in ART uptake in 2010 when the Australian Government changed its Medicare rebate scheme. Source of data for panel (A): UNICEF (https://data.unicef.org/topic/gender/gender-disparities-in-education). CC BY-4.0 (03 October 2021, date last accessed). Sources of data for panels (B) and (C) from Our World in Data (http://ourworldindata.org/fertility-rate). CC-BY (28 September 2021, date last accessed). Sources of data for panels (D) and (E): Testicular cancers rates by country from GLOBOCAN database accessible at http://gco.iarc.fr/, as part of IARC’s Global Cancer Observatory. Fertility rates from World Bank Open data retrieved from https://data.worldbank.org/ (16 February 2021, date last accessed). Source of data for panel (F): The National Perinatal Epidemiology and Statistics Unit, the University of New South Wales Sydney. https://npesu.unsw.edu.au/ (5 September 2021, date last accessed).