The Emptying Planet: The Global Impact of Declining Fertility Rates, A Virtual Roundtable

Most countries outside of sub-Saharan Africa are projected to enter a period of sustained low fertility and a decline in the working age populations. Speakers Drs. Natalia Kanem and Christopher Murray discuss the drivers of declining fertility rates in many regions of the world as well as their social, economic, fiscal, and national security implications.

BOLLYKY: Great. Well, welcome. My name is Tom Bollyky. I’m the director of the Global Health Program. And it is my great pleasure to welcome you to this roundtable, entitled “Emptying Planet: The Global Impact of Declining Fertility Rates.”

The phrase “demography is destiny” has been around at least for decades, but its rationale is alive and well here in the discussion that we’ll have today at the Council. The idea may seem to many as an exaggeration, but there’s no question that the aging of populations, fertility, the size of working-age population have significant implications nationally and globally. It affects the drivers of climate change, stresses on the environment, food production, everything from the size of the labor force, military might, to economic growth, to the viability of health-care and welfare systems.

For the last seventy years our understanding of how demography will shape the future has largely been driven by U.N. population forecasts. That forecast has been, the last years at least, that fertility rates would decline, but that there would be significant population momentum in South Asia, and they would be slow to decline in sub-Saharan Africa, and that would lead us to a population of close to eleven billion by the end of this century as opposed to where we are—eight billion—today.

A new study published in the Lancet on Tuesday challenges that forecast, asserting that fertility rates will be considerably lower than the U.N. projections and decline much sooner in sub-Saharan Africa. That will have major social and economic implications globally as well as for nations that are going to experience the deepest declines.

We have two fantastic speakers today to help us think through this debate and this paper that I referenced, which you should all have the link to and I assure you is well worth your time to read. You have their very impressive biographies, these speakers, so I am going to grossly truncate them and just rely on their titles so that we can get to the discussion.

Dr. Natalia Kanem is the executive director of the U.N. Population Fund, a role in which she has served since 2017.

My good friend Chris Murray is the institute director of the Institute for Health Metrics and Evaluation. He’s also a professor and chair of metric science at the University of Washington. He is the corresponding author of the paper that I referenced.

We’re going to start with ten minutes of opening remarks, first from Chris about the paper and how it is a departure from previous analyses and its implications, after that from Natalia. And then I will ask a few questions to get the conversation started, and then turn it over to all of you.

A couple of items to note. This meeting will be on the record, so it is for attribution. We will be posting the video and the transcript, so you’ve been warned. In terms of your questions and your remarks, when we get close to the end of my questions I will call on you in the order that I see you. So you can raise your hands and I will proceed in that manner.

And with that, I would like to turn it over to Chris.

MURRAY: Thank you very much, Tom. And thank you, Natalia, for being on this as well. I’m honored to be on this platform with you.

So a little bit of context as to why we did this study. At IHME we have been making forecasts for a few years now of health outcomes. We run the Global Burden of Disease and we look back in the past and in the present at a huge array of health outcomes at the country level and increasingly at the subnational level as a guide to resource allocation.

And then many decisions require a longer-term view, and so even back twenty-five years ago in the earlier days of the GBD we did make forecasts, very simplistic forecasts, and we ended up with a more sophisticated way of forecasting causes of death, life expectancy, and put that out. And as we were showing this to various governments and others, the question came from the climate community, the adolescent health community, and the research, you know, investors, what would be our forecast running farther out into the future. So we started to run our models much farther out than we had been. We’d been running for about twenty-five years. So we started running the health models out to the end of the century.

And then we realized that to do that well, we also needed to understand how a difference about mortality would change population from what, for example, the U.N. had been forecasting. And as we got into that topic, we started to evaluate using our usual standards of investigation the fertility part and the migration part of the U.N. forecasts, and we recognized that the U.N. forecasts—which had been enormously helpful to the world to date—had a fundamental assumption which was at odds with how we think about the future of health. The U.N. forecasts, the determinant of future fertility is time itself, namely calendar—(audio break)—cause women to choose to have fewer or more children. It is simply a proxy for all the other determinants of fertility.

And so we then wanted to figure out what were the actual determinants of fertility. And it turns out that two variables explain 85 percent, or just under, of all the variation in fertility in the last seventy years across all countries, which is in our business an extraordinary thing that two variables can explain that much. And that’s women’s educational attainment and access to reproductive health services. Those two really explain the vast majority of all fertility patterns. There’s no mystery here. I mean, there’s a—there’s a much smaller component that is cultural, but fundamentally the trajectory of fertility is driven by what happens in the circumstances for women.

Once you have that recognition, then the second insight came, which is: Where is fertility going as women get access to education and get access to reproductive health services? Well, it turns out that on average women have 1.4 or 1.5 children when you get to that higher level of education and access. And the sort of belief in the demographic community has long been that somehow women would, you know, increase their fertility to make sure their society would stay in demographic balance, and that somehow fertility would come back up to replacement. But once you look at fertility in cohorts of women, we see no evidence of that.

So then we took that basic observation, we took the observation that fortunately education for women is getting better, access to reproductive health services is getting better. You put those two together, and that’s where you end up with our new population forecasts; namely, that we see the global population would peak in the 2060s and then decline. And perhaps more profoundly, the rapid drop in fertility in places like, you know, already seen in Iran, in China, happening in India, the speed of that decline is really quite extraordinary, so that these transitions start to happen really quickly. We see the population pyramid in pretty much everywhere outside of Africa going from a—you know, what we all learnt in school about a population pyramid to an inverted pyramid.

And the consequences on societies of moving to an inverted population pyramid are really quite extraordinary, and it’s things that we’ve never really grappled with as a development community. When you switch—which is happening rapidly in a place like China—to the inverted pyramid, you end up with, you know, more people to take care of at older age, a smaller tax base, and then the argument that goes back to John Maynard Keynes in the 1930s of the perils of economic—of declining population, namely that the idea that somehow we would, like, sort of sustain economic growth even though this is happening may be unlikely. And there’s a new generation of economists, for example, at Stanford writing about this; that, you know, younger people are often the engine of innovation. They’re the people who buy consumer durables. They’re often the people borrowing money and increasing consumer spending. And people later in life are not doing those things. So there’s a lot of factors that may factor into sort of adverse effects of this inverted population pyramid.

And then there’s the geopolitical part, which we try to trace out in the paper by taking other forecasts of GDP per working-age adult and then say, well, given this transition, a country like China where the working-age population will go down by 50 percent or more this century, that’s really going to put the brakes on their economic growth, and that also changes the ordering of sizes of economies at the global level. So, you know, one argument might be that China’s sort of at or near its peak in terms of geopolitical power, and that these demographic forces might be really leading to a decline. And a country like Nigeria may be very much expanding its geopolitical position in the course of this century.

Now, the last observations are, what do you do about this problem? Because it is quite profound. We’re not the first at all to recognize how big a challenge this is. In Russia, Central Asia, Eastern Europe, this is this concept of demographic security. It’s really quite well—you know, there’s a lot of thought about this—and I’m sure Natalia can reflect on that, that she probably gets asked by governments in those places—where they’re worried already very much about the geopolitical consequences, the security consequences of declining population. And you know, now that we see this sort of writ large, what are the options that governments will pursue?

Well, first, everybody will try—and hopefully it has many other benefits as well—to make—give more support to women who want to have children so they can pursue careers, have children, maternity leave, paternity leave, childcare, employers who are friendly to women who want to have children, that package of interventions, which in Sweden increased fertility by about 0.2 children per woman, which is a good bump—not enough to deal with fertility rates of 1.4, 1.5. Unfortunately, that package in Singapore and Taiwan and Japan hasn’t done as much. It’s done very little. But clearly, that’s one strategy.

The second strategy is migration. Countries like Australia, New Zealand, Canada, the U.S. have avoided some o the deleterious effects of low fertility to date by having liberal migration policy, and that’s clearly going to be part of the strategy for those societies that are able to welcome migrants and not have a political backlash. Those societies that don’t feel like they can welcome migrants will be much more challenged by these transitions.

And then there’s the third—I won’t call it a strategy—factor that we’re very concerned about—we think it’s a real threat to women’s reproductive rights—is those countries who will try to put pressure on women to have more children, reduce their rights to choose, and even go as far as restricting access to some reproductive health services. Now, we think that’s a real threat, and we think that it’s going to be incumbent on people like Natalia and the global community to be vigilant to make sure that that’s not an option that’s on the table to deal with this really profound challenge going forward.

I’ll stop there and pass it back to you, Tom.

BOLLYKY: Great. Thank you for that, Chris. I do appreciate that you have shifted from the controversial territory of making COVID-19 projections to the safe ground of projecting the geopolitical and migration-related implications of low fertility. So good on you.

Let me switch to Dr. Kanem for her remarks. I do want to acknowledge that your program, or the department that you run, put out a report this week, too, that of course has a much more pessimistic view of the current circumstances facing women around the world. So I was wondering if you, in addition to commenting on this paper and Chris’ remarks, might want to weave in some of your own perspective of where we sit on those issues.

KANEM: Well, thank you so much, Tom, and it’s great to be with you and Chris. I want to thank the Council for inviting UNFPA to what is really a very important discussion.

UNFPA, which I understand may not be a household word, is the United Nations Population Fund, and we work on sexual and reproductive health in over 150 countries all around the world. And we’ve evolved over the fifty years of our existence from being a small population fund actually based in UNDP, and initially working just on census and family planning, to today, where we’re over a billion dollars, on the ground, and a major provider of contraception as well as safe-birth services for maternal health. And we’re a big advocate against gender-based violence. And I’ll say a couple words about our report in a minute.

We actually have a pretty active and fruitful partnership with the institute. IHME and your Global Burden of Disease studies, for example, Chris, as you well know, we’ve used in our UNFPA Strategic Frameworks. I happen to be an epidemiologist myself. I trained at the University of Washington, which is where Chris’ institute sprang up. And so I’ve really appreciated IHME’s contributions to what needs to be a much livelier debate over whither goest the world’s demographic trajectory. And I love your opening on that, Tom.

Our United Nations secretary-general, Antonio Guterres, has actually identified demographic change, along with climate change and other things, as one of five megatrends that are going to shape the common future. In our report just this week on the state of world population, titled Against My Will, we describe the effects of choice and reproductive health and women’s ability to be able to be protected from gender-based violence, harmful practices, child marriage, and a number of things that are very germane to our discussion today.

The United Nations happens to be seventy-five years old this year. Happy birthday to the U.N. And in this milestone year, these demographic shifts and the implications that Chris has put on the table have rightly been highlighted in the discussions of U.N. at seventy-five, and we are working directly with countries. The aim is to promote peace, of course, and sustainable development, of course, but also to respond to population shifts, which are relevant for the current humanitarian situation in which the world finds itself, health crisis—a pandemic—and of course, the economic crisis that follows from that.

So guess what? In the time of COVID, this discussion on fertility is even more germane. And there are way fewer babies in certain countries. And what’s behind that? We say what’s behind this megatrend of fertility decline may be complex, et cetera, but it does boil down to women’s choices and what influences women’s decisions.

In the thirty years since 1990, seventeen countries experienced population decline and five of them actually lost up to a third of their population. I’m talking about Latvia, Bosnia and Herzegovina, Lithuania, Georgia, and Bulgaria—major. And we do foresee that trend in more countries in years to come.

And as these countries are experiencing population decline, it isn’t all because of fertility. High net emigration, out-migration, that’s a big worry for many of these countries in Eastern Europe and elsewhere. But the effects of fertility decline on population numbers, of course, are important. And East Asia and Eastern Europe are sort of up against that right now.

The fertility replacement rate, if we were going to be in steady state, would be two children per couple, quote-unquote, per woman. And for a variety of reasons, that average woman is not choosing to have those two children, or even one, and many are choosing to have none at all.

So the social issues which Chris started to allude to, we’ve got to pay attention to. There’s pretty good convergence, actually, in the near term of the population projections between the three major sources—United Nations, IHME, and then there’s also in Australia the Institute of—the International Institute for Applied Systems Analysis.

In the short term, the projections are pretty convergent, right? But they start to differ substantially. And that was the point Chris was making as you try to go out to the end of the century. And that kind of makes sense, because the further out you go, the harder it is. But as much as our U.N. populations differ from what Chris is presenting today, it’s debate that’s going to sharpen our ability to anticipate and to prepare. And there are a variety of future scenarios, and I would venture to say we’re very woefully ill-prepared for any of them.

As UNFPA, we’re encouraging governments to pay attention to these debates and not just leave them in the hands of the statisticians and demographers. Better understanding these trajectories is really important in terms of shaping that path, that destiny that Tom was alluding to, if you will.

And I think, no matter where you sit, the trend seems clear that world fertility will fall. And as it decelerates, more and more countries are going to experience population decline. So, yes, they do turn to UNFPA for advice as to how low fertility and migration and population aging, how this is going to affect their economy, their social-security system, which, by the way, it wasn’t the woman who had the pension typically. She doesn’t have the job. She doesn’t hold the property in her name; and things like vital infrastructure to prepare for the type of services that you need, and, of course, your relationship with the country next door that you’re worried your population is falling while theirs are growing, right.

So some of the things that we’ve been doing are innovations in our Eastern Europe-Central Asia office. We have launched an advisory service, which is turning out to be quite popular. This is because we studied the European Demographic Data Sheet 2020. It notes that what we call pro-natalist policies, encouraging women to give birth, be patriotic, have that third, fourth, fifth child, in places like Belarus, Russia, Ukraine, for example, did initially increase the total fertility rate when coupled with incentives—$500 to have a second child, whatever it would be for the second, et cetera. But that only lasted for a few years, and then immediately afterwards it declines again.

So our policy reviews do confirm that pro-natalist incentives may encourage people to maybe have your child earlier. But that’s because of the cash payment and the in-kind benefit. It doesn’t change your idea about ideal family size.

And the last thing that I’d like to mention is that historically there has been fear and trembling in the hearts of some that greater participation of women—education, in the workplace, business, politics, et cetera—would negatively affect women’s interest in childbearing.

Well, there is some truth to this. The days of some of our grandmothers of having ten, twelve, even twenty children are well past. And the issue of reproductive choice and the rights of women is what the fundamental discussion of fertility centers on. Women’s greater access to education and the workplace did coincide with them choosing to have lower fertility. The advent of modern contraception did play its role.

And now it’s up to us to intelligently use some of these decades of research and try to predict what will make a difference in order for people—women, couples, families, new types of families—to be able to enjoy the satisfaction that theoretically childrearing could bring were it affordable and were you able to be safe and secure.

So I’ll leave it there, and happy to expand on anything else that you’d like to know. Thank you.

BOLLYKY: Great. Thank you both for really terrific opening remarks.

I’m going to start with you, Chris. As you would not be surprised, there’s already some commentary that has been coming out about the article. In the New York Times press report on the article today, there was a quote by the director of the Population Division at the U.N. responding to the study. You may have seen it.

He argued the paper had extreme assumptions around fertility and the idea that governments would not be able to think their way out of that particular problem for the next eighty years was unduly pessimistic.

Whether it’s unduly pessimistic or optimistic to think that these trends that you identify on women’s education or access to reproductive services will continue, I’m not so sure. But I did want to give you an opportunity to respond.

The second piece that I wanted to pull in is in connection to a conversation that I had with regard to the book I wrote on the decline of infectious diseases and how it’s affected societies. And one economist argued to me that the adaptation countries to low-fertility and longer-lives would make would be automation. And you’re starting to see that around issues like elder care. So I wanted to draw you out a little bit about whether there are any other alternative solutions other than migration or oppression of women for societies to adapt to this.

MURRAY: Yeah. Well, that was a lot of comments and questions rolled into that.

So I don’t—first on the John Wilmoth comments, which I haven’t seen yet—I’ve been too busy with COVID and other things this morning—but, you know, I don’t think there’s anything extreme.

The difference here is traditionally the Pop Division, many demographers, have just sort of assumed or structured their analysis that somehow fertility will come back, that women, in the interest of the greater good, will choose to have more children. And when you look at cohorts of women, this idea that fertility bounces back, which you do see when you look at fertility, this sort of hypothetical measure of taking the fertility rate in fifteen-year-olds and twenty-year-olds at a moment in time, in a place like Italy it went down and came back up, but when you look at completed fertility of, you know, groups of actual women, we don’t see that. We don’t see it bouncing back.

So I think there’s really nothing extreme at all in our assumption. We’re just following the data and we’re following what is clearly a profound driver of fertility, namely, education and access to contraception and other reproductive health services.

What do you do about it? Look, I think there are many possibilities out there. The one that we’ve—you know, people who work in developmental biology have brought to our attention is the idea that technology is not that far away from having, you know, babies grown in the lab. And while that sounds sort of, you know, science fictiony, they assure me that within ten years that’s going to be quite feasible.

Whether societies choose to do that and whether the issue on fertility is about, you know, pregnancy, I doubt that’s the real issue. I think the issue is raising a child and all the time it takes for a family, and particularly a woman, to invest in that. And they may choose to spend more time on their careers or other things that interest them.

So I don’t think the sort of technological solution of, you know, lab babies will do much; so on the fertility side, not sure about that. On the economic consequences, definitely automation may make a difference there. You may be able to mitigate some of these adverse effects.

At the end of the day, though, if we don’t find a way to transition to a replacement level of fertility over a generation or two, then you are in this cycle of inevitable decline. Just like population momentum drives population up, if fertility rates stay low, you have the reverse population momentum and it just drives population down.

So eventually as a species we will have to solve this problem. Now, whether that happens in 200 years or in this century, I don’t know.

BOLLYKY: Natalia, did you want to build on any of those comments?

KANEM: Well, absolutely. And thanks for offering.

Look, population is not an instrumentality for women to do or not do. Women have individual human rights and they will choose, hopefully with the support of all of us, to do what they think is best for them, for their situation, for their family. I think the impetus for a lot of the concern can be shrinking population, meaning loss of economic productivity. And that is a fallacy that we need to hit head on.

When I do the flip side of declining fertility, for example, in countries that have a youth boom and high fertility, I hasten to assure them that when we talk about the demographic dividend for young people, we’re talking about investing in their education so that they can be productive. Because you have huge numbers of young people doesn’t automatically mean that you’re going to be a prosperous society. If that were true, then a lot of the issues that we’re facing would be solved.

So I think Chris is absolutely right to hasten to the predicament of how countries look through that lens. And what I would say is what’s really interesting—and we’ve talked to women directly; that’s why I feel very confident in telling you that many women, and men for that matter, too, believe that the ideal family is that family of four—mom, dad, and the two kids. But they’re not willing to have those two kids precisely because of the amount of investment of time, money, and everything else that it takes to successfully child-raise in the current world of today.

And I think our research suggests that for those couples who would want to have that family of four, the two children that would stabilize population, there are things that make a difference to them. And first and foremost is the more equitable sharing of responsibility. Here’s the diaper. Here’s the bottle. (Laughs.) Here’s the next 18 years of your life. And typically that’s a gendered discussion, right, so more shared housework among couples and more fatherly responsibilities, which men actually tend to enjoy.

But I find it very telling that even in a very progressive environment, many men will not take their paternity leave fully off. They don’t want to be seen as the person who’s sliding off the achievement scale, if you will. And women now are also caught in there as well. But things like flexible working hours and policy and affordable childcare that’s high quality, all of this influences women in their decisions as to how to balance, you know.

I also believe that in a way the natural experiment is already being done, because countries that have failed to address the gender dimensions of child-rearing are not having the success, if you will, in reversing this trend. Chris put Sweden on the table, where you have your years of maternity leave. The midwife is there to help you. The father of the child is very respectfully expected to enjoy those years, which are so precious, you know, as a pediatrician, I’ll say, for the cementing of the wellbeing of the baby.

So I think the surveys that we do and the information that we have has to be translated from a perspective of women’s rights. And right now surveys that the gender teams at the U.N. and U.N. Women and U.N. DESA, the Statistics Division, lead on this, say that everywhere you turn it’s working mothers who suffer the baby penalty, not the dad, and that they also have what we refer to as time poverty—how many hours of sleep you get a night, leisure, et cetera. It’s working mothers that have the least hours of anyone.

OK, thank you.

BOLLYKY: Great.

All right, one last set of questions and then I will turn it over to the audience. So please start thinking of yours, and I will call on you in the order in which I see you.

Chris, we are at the Council on Foreign Relations. Obviously, this is a body deeply concerned about geopolitics and foreign policy. And I hope to draw you out a bit on that score. What is the foreign-policy community missing right now about these demographic trends? Or what can we learn from this report that should influence how we think about geopolitical shifts that may occur as a result of this and the effects on U.S. interests? Can I convince you to put your foreign-policy-analyst hat on?

MURRAY: I will stray there, even though I’m probably not qualified. But nevertheless, I will give it a go.

You know, I think there’s some pretty obvious effects. You look at a country like Russia. And while it is still very much in people’s mind on the geopolitical landscape, the trajectory seems clear. They are already struggling demographically, and there’s very little prospect that they will solve their demographic issues. They are compounded—although they benefited from the in-migration of ethnic Russians from some of the outlying republics for a period. That seems to have ended. And so they are going to—less likely that they will be by mid-century a sort of major rival to the United States, as an example of that.

China—I think, you know, any sort of geopolitical analysis of world power has to take into effect that the working-age population is already shrinking there. That’s going to have all sorts of consequences. China will be, I think, as we’ve seen so far, rather reluctant to use migration to solve that problem. So there’s no easy out for them.

And then you have the, you know, likely rise geopolitically of Nigeria and perhaps other countries in the south that, both for economic growth and demography, will likely become, you know, much more important geopolitically in the future.

My sense is that people are so caught up in the 1960s view of—still, in the way they think and speak—about the, you know, population explosion, you know, the threat of unbridled population growth, that I have found in the last couple of years, in talking to people, other than those countries like China, who are grappling with it today, or Estonia or places, Croatia, wherever you name, many others just laugh this off. It couldn’t possibly be true, because they’ve been taught and educated that they should be worried about the population explosion.

And so I think it’s one of these classic problems that probably, on the foreign-policy side, people are not, you know, internalizing what these trends mean for relative power, because it just sort of seems sort of, you know, far from their lived experience so far that decline in population numbers will actually be sustained. And I think it’s almost part of the sort of response that you were describing from the U.N. Pop Division that they’re really still heavily invested in the population-explosion type narrative and not really coming to grips with how profound this may be.

BOLLYKY: Natalia, I wanted to give you an opportunity there. When you hear gender issues discussed as a matter of foreign policy, they’re generally discussed as a component of human rights. But the vision or the implications that Chris is drawing out suggest that perhaps we really should think about these issues more as a matter of national security than we do currently. I wanted to get a sense of whether you’re seeing a greater appreciation for that perspective through the work that you and your colleagues are doing.

KANEM: Well, you know, these are good points, and as we said, both of us, actually, in our introductions, it’s a field that’s evolving, and even though it’s dynamic, it’s complex, you can glean trend and you, certainly, can appreciate what it is that governments are doing, reactively or not, whether we criticize it or not. Our only plea is for women’s human rights to be at the center.

But earlier I mentioned our regional office for Eastern Europe and Central Asia, and the pioneering work that they’ve been doing under Alanna Armitage’s leadership with a demographic resilience program, and this was actually at the invitation and some of it is actually supported by Russia and others as Eastern Europe is looking at low fertility and thinking about how to respond to demographic change.

So our advice is always to strengthen your human capital, and as alluded to before, low fertility and aging societies go together. So what you do to have a healthy adolescence is going to feature for your bone structure and Lord knows what else by the time you’re sixty, seventy, eighty, and as the population pyramid goes from very few elderly to what China is looking at and predicting in thirty years where it’s going to be a lot of elderly, less working-age population, right, the issues on policy become more and more important.

Our other aspect of this, which I think is interesting for the Council, is that cultural tolerance also changes. You can think back not so many generations ago where a single woman would never have a child on her own. I mean, it was unheard of. It was a shame to the family, et cetera. And now this is rather mainstream.

So if we’re talking about the fulfillment of the human being, they’re not married, different types of diverse families—it’s not always male/female, and then male and female/child. You know, there are so many different varieties. But as we look across the spectrum, in places like East Asia that’s not the case. In parts of Africa, that will not be the case.

But where you do have tolerance for different types of family structure, it can be very encouraging and it widens the circle of that social support that a woman has.

BOLLYKY: Great answer.

Let me turn it over to the audience now. Again, happy to take questions. I’m sure many of you have participated in more Zoom calls than you would like at this point. But at the bottom of your screen there is the participant function and a raise hand function. If you do that, I can see you and call on you in the order that occurs.

When I call on you, I’d be grateful if you would say your full name and your affiliation for the speakers. I had seen someone just now, Joel Cohen. I’m not sure if you meant to do so. You had raised your hand and declined it. If you’d like to speak I’ll pause for a minute to allow you to do so.

(Pause.)

BOLLYKY: OK, Great. Any other questions from the group? Yes, I see now we have Judith Bruce. Please go ahead.

Q: Thank you, first of all, and greetings.

My question is really nomenclature that helps people understand this better. Natalia especially has spoken about the dependency burden—you know, who cares for the kids, because the demographic division was really sold as, you know, a solution without, you know, I think a pretty catastrophic continuing maldistribution of dependencies. I’m particularly focused on adolescent girls. Tracking just what’s happening under COVID, there are real distortions in this now. And so I prefer the word “dependency burden” because—both with reference to the environment and with regard to human caring and financial support. So just thought—just a thought there in repositioning the discussion, and thank you.

BOLLYKY: Great. Do one of you want to start with that?

KANEM: Well, hi, Judith. I absolutely just have to underscore what you’ve said, and I think one of the things which maybe I haven’t brought out and you’re spurring me to do so is that when we’re looking at fertility very often we’re talking about adolescents, right. Thirty-three thousand girls under the age of seventeen are going to get married today, they got married yesterday, and they will be married tomorrow.

So, again, this aspect of against her will is very, very important, and I think from the ignorance that many adolescent girls have subjected upon them we’re not really giving them the wherewithal to understand the path of fertility and how it’s going to fit with their aspirations in life.

The converse of the dependency burden, and Judith knows this better than anyone—I mean, she’s been at this, and successfully, for quite a while—the adolescent girl is also expected to do things. Go and fetch the water. Be the one who’s going to prepare the cooking, and on and on.

So, again, when we’re talking about declining fertility and we’re talking about how we apportion what happens in society, they are in this nether world where when we think of who’s getting pregnant—well, many do—you think of an adult who absolutely has made her own decisions, et cetera, et cetera. But that’s actually not the case, and we have a lot of child marriage in this world and that needs to end so that adolescents can really fulfill their potential.

Thank you.

BOLLYKY: Great. Not seeing Chris weighing in further on that, which is fine. Let me get to the next question.

Emmanuel?

Q: Thank you. Emmanuel D’Harcourt from Helen Keller International.

So my question primarily to Dr. Kanem but to both of you is if we look at contraception access programs, which, per what Dr. Murray said earlier, was, you know, our kind of no-brainer and also, like, shooting an elephant in a corridor in terms of massive response and very satisfying, like, clearly, there’s huge unmet demand and if you provide—if you meet that demand, you get immediate uptake and change people’s lives.

But in light of the kind of longer-term consequences, would you say that we should be thoughtful in anticipating the consequences of those programs and, you know, I don’t know, for example, just thinking off the top of my head but, like, balancing them out with gender equality work so that while you’re offering the choice to women to have less kids, you’re also not completely taking away the incentive for families to grow, so that if you have a program like the one in Nigeria you’re not also undercutting the country?

KANEM: Well, Tom, if I may.

Emmanuel, that’s actually a great question and it really cuts to the heart of the question, which is full panoply of information so that a woman can make up her own mind. If she chooses to have 1.4 children, we’ve got to back her a hundred percent. But as I said, many women actually would like to have more children. They actually would like to have two or three children, right. On average, it’s two. But they’re not willing to do it.

So I believe that the perspective is that a woman should have contraception of her choice, noncoerced, offered to her, and for infertility, for example, UNFPA has worked very closely with midwives because it’s a tragedy for many families when you can’t conceive. And by the way, it can also be a harsh judgment of other family members if you don’t conceive the right type of child, a.k.a., a son.

So we’re really talking about things that are embedded in maybe millennia of human practice and culture but that can and must and need to change, and rather rapidly, I would say. So I find that a woman and even, you know, a girl, as I said, because some of the women that we’re talking about are adolescents who’ve been married off by their families very young—COVID is worrying me because of this.

People see solutions for economic crisis in the culture of, you know, marrying your girls. Sometimes it comes with financial gain for the family but at other times it, basically, removes a set of responsibilities.

Looking at this question which you’ve raised, which is at the heart of things, brings us back to women are individuals. Their human rights are enshrined in every device that we have in terms of the charter of the United Nations, in terms of everything that we’re saying this year, Beijing+25. So let her choose to do what she finds is going to work for her in her circumstances. I think that’s always the answer.

Thanks. Thanks for posing the question.

BOLLYKY: Chris?

MURRAY: Yeah. I think the idea there that in addition to, as Natalia was saying, you know, giving women the access to reproductive health services that they deserve and it’s their right to have, but thinking in advance and being more proactive about, you know, looking ahead a decade so that women have more support who choose to work and more support in terms of having children and working, makes a lot of sense, because I think what happens is those programs come to the fore when the problem is really quite far along, that fertility is very low, and they might be—that sort of cultural transformation might be—first of all, it’s a good thing to do and, second of all, it might be more successful if it happens sooner. I think that’s a very interesting idea for the future.

BOLLYKY: Great. Next in the queue we have Anita.

Q: Hi. This is Anita Zaidi from Gates Foundation.

I have a question for both Natalie and Chris. So in thinking about demographic change, how do you factor in the impact on climate change? These are two mega trends, as we talked about, and one can imagine that one mega trend of the decline in population could help mitigate the other mega trend of climate change.

So would like your thoughts on that, please. Thank you.

BOLLYKY: Chris, do you want to start?

MURRAY: I’ll start. And so, absolutely. You know, we have probably, Anita, as you know, for the Goalkeepers’ analyses we’ve—we started to look at the implications for climate change, and, you know, if there’s 8.8 billion or 8.9 billion people at the end of the century compared to eleven (billion) or twelve (billion), you know, that has a very direct effect on carbon emissions.

So there’s, clearly, an effect. It plays out more in the latter third of the century. But, you know, carbon intensity—that is, the amount of carbon per unit GDP—is a bigger factor. So you—you know, they’re both important. There’s a benefit there on terms of climate. But at least in the next fifty years anything that’s done to reduce carbon intensity probably is a bigger driver.

KANEM: Well, thanks. And, you know, we appreciate this question, too, because the dots do connect and from the standpoint of food security, for example, and other aspects of the fight against extreme poverty. The climate issues, compounded by populations that are moving—and neither Chris nor I actually had a chance to talk about the humanitarian crisis superimposed on every other horror that the world is seeing at the moment.

But imagine if you’re in East Africa and COVID is arriving. You’re in Kenya. There are locusts that are ravaging the crops and those locusts, unfortunately, are going to have a second generation now and spread further afield. The dynamics of climate action and what it portends in terms of financing and the cooperation among states is something that civil society and, as you know, young people in particular are very seized with at the moment.

In our discussion as we think about declining fertility, we should not assume that less people also means more resources per capita either. Do you see what I mean? So I don’t want to be too glib in saying that when you have declining population, oh, well, that’s great because we’re just going to invest more per person. And the consideration of climate and gender is one which UNFPA has lately started to partner together with others to study, because I already mentioned the girl child and she’s the one who’s going to go fetch the water.

But as the—whatever the ravages of climate may be, you’re in the Pacific and the ocean is rising, et cetera, et cetera, sadly, it tends to be women and girls who are not at the decision-making table who get the short end of the stick. So we do need to understand how these climactic impacts, which are huge, are also going to factor into our topic on fertility today.

Thanks.

BOLLYKY: Great. So I think this question around climate gets at the heart of what Chris was talking about, which is whether people will view these latest projections as positive or negative as it folds into whether they’re thinking that this will reduce environmental effects and then, therefore, is positive. It is certainly true that many of the countries experiencing fertility decline are carbon-intensive economies.

In that context, I wanted to give Chris—we have three people in the queue so forgive me to all of you—but I want to give Chris a moment to talk about India, because you talked a lot about China and you’ve talked a lot about Europe and the United States and other high-income countries that are currently carbon-intensive.

What does your study show for India, which, of course, a major driver of climate-related concerns, but is a topic that you didn’t have a chance to discuss in your opening remarks.

MURRAY: Yeah. Thanks, Tom.

India is interesting because, as you probably all know, the fertility rate has been plummeting and it’s gone down faster than we would have expected based on women’s education and access to contraception. So what—you know, and while women’s education, access to contraception, explains 85 percent of everything that happens, there is this, you know, variation above and beyond that.

India is on the low side of that. So that suggests that as education continues to expand, access to reproductive health services continues to expand, fertility rates drop—continue to drop. Then that translates into India peaking around about 1.6 billion mid-century, around about 2050, maybe slightly before, and then, because of that low fertility, it starts to look like China after that and goes into a rather profound decline.

And, you know, the countries that have had the extremely fast declines in fertility to date also turn out to be the countries that when they hit peak population tend to have the very fast decline. So pretty big changes. I think, obviously, varied by state within India, but overall profound. I think in our discussion with colleagues in India there’s not much discussion in the government so far of that sort of, you know, looking out to mid-century and thinking about how—what India might do to manage that demographic transition, going forward.

BOLLYKY: Thank you for indulging me on that. Let me turn to the queue.

Ann Starrs?

(No response.)

BOLLYKY: Ann, can you hear us? I think you’re still on mute.

Q: Sorry. Took me a minute to figure that out. Can you hear me now?

BOLLYKY: Yeah.

Q: Great. Thanks. Hi, Natalia, and hi, Chris. A really fascinating presentation, fascinating discussion.

I just want to make one quick comment on what Chris just said about India, which is, Chris, you talked about contraception. You also talked about reproductive health services. Of course, we know that a significant factor in the fertility decline in India is actually use of abortion, not contraception. So just to clarify that the broader scope of reproductive health services includes that.

My question—you’ve commented, and this is both to Chris and to Natalia, that 80 percent, 85 percent, of the decline in fertility is due to female education and access to reproductive health services.

I’m wondering if there is a risk—and if you’d be willing to comment on this—on a risk of countries that haven’t yet reached that point of their fertility transition of looking at your paper and your conclusions and saying, oh boy, well, we need to restrict female education and restrict access to reproductive health services because we don’t want these outcomes, and, you know, would love to hear your thoughts on what the risks of that are and how, potentially, to mitigate that. Thanks.

BOLLYKY: Great. Chris, will your study have the opposite effect of the Population Bomb? Please, go ahead.

MURRAY: Yeah, I think the risk is there. You know, I think that’s why I started at the beginning with the critical role for Natalia and UNFPA and other parts of the global community in being the watchdog about women’s reproductive rights not being affected. I think, however, that many of the countries that are, you know, with a TFR of four or three or two and a half are not thinking that far ahead and that often there’s a bit of a lag.

I think so far we’ve seen that people really or governments only really start to worry about this when they go into a natural rate of decline, namely, the death rate’s higher than the birth rate, and that’s when suddenly, you know, you get this huge engagement in the topic.

So I suspect the threat to women’s rights is greatest in those settings, not in those that are really forward thinking and saying, oh, we’re going to manage that future threat now by putting the brakes on women’s education. But I do think vigilance, collective vigilance, is going to be really important.

BOLLYKY: And I will say for people who haven’t read the paper, the paper really does make those qualifications quite clear and raise the importance of looking at other solutions than restricting women’s access to reproductive services. So it’s well worth looking at the framing of the paper.

Natalia, did you want to add anything there?

KANEM: Absolutely, and Ann, you know, thanks for making the comment.

The first thing I think we need to do is to absolutely reject the heavy-handed family planning programs of the past, for example, and to absolutely reject any type of coercion of women to have or not have children. And so, ultimately, the danger is a danger that we’re living. The phrasing of the policy is not going to be let’s not educate the girl. But, objectively, when we think of who is prioritized in terms of education world over, she’s at risk. The policy may not stay refuse to offer contraception, et cetera, et cetera.

But I’ve toured so many hospital wards, so many clinics, so many health posts, and in certain countries the minister is very happy to tell me, this woman is having her fourth child. How wonderful. She’s a hero of the nation. I’m quoting practically verbatim.

So I think the expectation and the shaping of even the role of the girl who is growing up—what do we expect of you, do we expect you to be the brainy head of IHME or are we happy for you to be advertising, you know, for fill in the blanks where the female body is going to be utilized—these are all pieces of a bigger picture, and I think what we are advising, and we are speaking with governments who are now in that youth boom to understand these youth are going to age out. They’re going to become the elderly of tomorrow. So the time to think about that policy is now, and I think there’s a lot of appetite.

The African Union, I would like to cite, has focused on population issues both in terms of getting a hold of what they would see too rapid fertility and population growth, but also with the understanding that without education you’re going to have a liability on your hands. So I think we have to tease out all these different aspects and make sure women get to decide it’s their rights and choices that UNFPA defends every day.

And I just have to add, Tom, that the politicization of women’s bodies and reproductive health and whatever does not ever go to sleep. This is something which we face in every country, in every U.N. convening. The World Health Assembly is supposed to be talking about health, but sexual and reproductive health is used as a wedge to divide. You thought you were talking about education. Well, the ability to tell a girl about her natural biological processes is being politicized day by day. So we all need to pay attention to this.

Thanks.

BOLLYKY: Great. Very powerfully said, so thank you for adding that.

Kathleen Hunt?

(No response.)

BOLLYKY: Kathleen?

(No response.)

BOLLYKY: You’re not muted so I’m not sure. But we can’t hear you. So I’m going to go to Patrick and, hopefully, we can get that sorted out and you can go subsequently.

Patrick Fine?

Q: Hi. This is Patrick Fine from FHI 360.

First, I just want to pick up on what Ann just said about the risks of backlash against women’s rights. I think we are seeing that. Tanzania is an example of that. You’re hearing some, or I’ve read about some actions along those lines in Iran.

So, Chris, in your opening comments you sort of said we want to—we hope to guard against that kind of reaction. I think that we’re seeing it right now and that that calls for action on the parts of our institutions to figure out what are the policy strategies to counter that.

And I want to ask about policy strategies. Chris, in your presentation—I’m sorry, I haven’t read your paper—and I just want to say we’ve all been in, you know, multiple Zoom discussions. This is one of the most interesting I’ve been in. So thank you very much, Tom, for putting it together, and Natalia and Chris, for your presentations because it’s—this is terrific.

Now, my question. I haven’t read your paper. I’m embarrassed that this will sound naïve. But it sounds, Chris, like you’re saying that these demographic transitions are inevitable. We’re going to see them happen and they’re going to lead to economic decline in the countries where they occur and there’s sort of nothing we can do to stop that.

If that’s the case, doesn’t that make it important for us to be thinking about envisioning some sort of economic order that is not dependent on economic growth as the only mechanism for satisfying lives, for meaningful lives, and for reasonable living standards?

In other words, if what you’re saying is inevitable, should we be trying to envision a different kind of economic future that is not so dependent on economic growth, and if that’s the case, then where do we start? What are the policies/strategies that we should start advocating for and formulating now?

Thank you.

BOLLYKY: Really great provocative question. Let me turn it to Chris.

MURRAY: Very interesting.

So, you know, I think for any of us who are involved in projecting, you know, making forecasts or producing scenarios, whether for population, health, or COVID, our hope is to be wrong, right, and it’s an interesting thing when there’s so much discussion about, you know, predictive validity. But there’d be no point making a forecast if we really thought you can’t change the future, and the hope is by putting these issues much more clearly on the table we will, actually, end up with better solutions.

And I sort of think that there are phases to this discussion, right. There’s a phase in the next twenty-five years where, you know, people will try, we hope, to think about how to support what Natalia was saying, those families—those women who want to have two children and to make that as practical and seamless with career aspirations as possible, and get people to recognize the benefits of a diverse society and embrace migration because that’s also very good for the planet, right.

It’s good for redistributing income. It’s good for solving this, you know, really challenging problem—the inverted population pyramid—at so many levels. And then how do you, you know, manage the political discourse? How do you reframe that migrants are an aid to society and not a threat, and a whole series of discussions that go with that?

At some point, however, once we’re through that part of trying to change our forecasts, you’re at either end of the century or slightly beyond; we must find a way as the world to what I think of as the demographic soft landing. We have to get to the point where we are in equilibrium and are close to replacement fertility. Otherwise the species disappears eventually, right?

And so that’s the part where I think there will be innovation that we don’t understand. There will be—as Tom was talking about—automation. We may have a very—wait, wait, we will have a very different set of societies at the end of the century. But I think that’s the part that’s really hard to get your head around, about how that will be managed.

But this first set of issues I think we push hard on the—you know, the two ones that are not going to abrogate women’s rights and may provide at least a partial solution or a full solution, at least for a while.

BOLLYKY: Yeah, I had actually wondered the same thing on the migration. Of course, what we find with migrants is that when they move into societies with lower fertility rate, it tends, at least within the next generation, that the descendants of the migrants adopt the background fertility rate of that society. So to some extent, on a global population level, migration accelerates the process to low-fertility. Obviously, it redistributes people, which has all the benefits you’ve described, but on a global level it’s likely to accelerate the process you’re describing.

Great. Natalia, did you—do you have a response to that?

KANEM: Well, you know, this is so great, and I think it’s wonderful that the Council is doing this type of future casting, and hats off to you, Chris, and your team for having the courage to at least give some data to be debated.

And I will say that, as we think about trajectory—and it might have been Emmanuel (sp) or maybe Anita (sp) who made the point that we also have to rethink our economies. We have to stop the simplistic notion that more people means XYZ and declining population numbers mean XYZ because, you know, take Germany, for example, or Japan; aging societies with lower fertility who are innovating and doing things that have higher quality of life. So I think the same way a couple may have an ideal family size, a country may have an ideal population size, but it’s a nonsense if you have the type of inequality that the world is up against today.

I’d like to emphasize that the IHME model, Chris, says that with universal secondary education, right, and with zero unmet need for contraception—which happens to be one of the three zeros that my UNFPA agency espouses—the global population, instead of being the, you know, eight billion—8.7 billion, would be instead 6.2 (billion). So what does that tell you now? What does that tell you about perhaps endorsing those sustainable development goals that say better quality of life, but it also tells you that women are not able to make optimal choices, and that if they did, rather than arguing with them about thou ought—you should—we should really make the world a safer and more welcoming place for them to be able to raise their children if they want, or no children if they don’t want.

So I think there is no optimal total fertility rate. What’s good for your family is not going to work for mine, and I will be very proud and happy to have the opportunity to not have any type of judgment placed on me because I either have ten children or I have none.

And then the last thing I just have to also add is that, for the Japan and the Germany—and there are other examples, as well—some of the Nordic countries—the innovation that allows that grandparent to invest in their grandchild—which they would love to do—but because of how we’re set up that’s unlikely to happen. And of course with COVID, now we even have more strictures, right? But I’m saying good quality of life for that second demographic dividend generation, some of whom policy encourages to either retire too early, or they can’t afford to live close to their grandchild, or whatever it is, these are the types of dynamics that actually bring human satisfaction, that speak to the intimacy of a family, the quality of life that I’m imagining for that ten-year-old girl who today is strapping on her little flip-flops and going to lug the water, or the firewood, or whatever she is doing. So how is she going to turn out to be the next Nelson Mandela? I don’t know.

So for me it’s not women, again, as womb, being asked to do for others. What would you like to do? How would you like to fulfill—(laughs)—your God-given potential? That’s what the fertility discussion in general is about, and I think today it’s great that the Council is discussing demography. These are things that shape attitude and shape futures—hopefully a more equitable future. Thanks, Tom.

BOLLYKY: Great. Well, it’s my pleasure. I actually love demography. My last book was largely about it, so I am a fan of this topic and certainly am a fan of the work that both of your institutions are doing.

We have fifteen minutes left. I have a lot of questions, but you may have some, too, so if you’ve been shy about raising your hand, you should do so. I will start with a question now to give you a little time to work up the courage to ask one, and I will call you in the order that I see you.

But Chris, how about Natalia’s reference to Japan? You talk about it in the paper. You said in the opening that it’s inevitable that countries will need to deal with this. Has Japan dealt with it? Are they the soft demographic landing that Natalia just referenced? Or, is there a different model we might look to as a softer demographic landing?

Now we’re talked about how we have short-term solutions for the next twenty-five years. Hopefully countries will adopt them, but we’re heading towards this low-fertility future anyway. So to where should we look for models.

MURRAY: Yeah, Japan is interesting. As you know, population in Japan is declining already, so it’s quite far along in this process. On current trajectory, they drop from, you know, just coming—now dropping below 130 million down to sixty million at the end of the century, and the age structure, if that happens, if that goes without, you know, a big change, is such that there will be something like three times as many people turning 80 as being born each year, so a really extreme inverted population pyramid—huge, huge transformation there.

Now the Japanese government does not see this as a good thing, and have been trying to—many pronatalist policies, and in the case of Japan, they have quite abjectly failed. And that may have something to do with this, you know, associated challenge that Natalia has been talking about, which is the sort of culture around the status of women and, you know, how is that going to work if women don’t really want to be—you know, educated women, as they are in Japan, want to be, you know, having to do most of the work at home, and take care of a child, and work.

But so far, pronatalist policy is not working, and I think five years ago everybody said Japan was in that category of never going to shift on letting in migrants, but we’re seeing that soften as the consequences just get more and more severe from their perspective. And so now they’ve got a much more lenient temporary visa policy, as you know, and I suspect that’s the trend we’ll see there as they’re essentially the vanguard of this, you know, issue, and they will eventually find mechanisms to bring in, you know, migrants under various types of restrictions given what they’ve shown so far. But as they run out of pronatalist options, that seems to be the direction they’ll be going to.

BOLLYKY: Do you want to say anything about whether there is a more positive example of a softer demographic landing that you’ve seen from this research? Japan obviously sounds like not the right one. Is it the Nordic countries? Is there a more positive story to adjusting to a lower fertility reality?

MURRAY: Well, you know, I think the Australia-New Zealand-Canada examples, where they are not—you know, there is a little bit of pronatalism, but it’s mostly about liberal migration and assimilation. And I think those are rather successful stories in terms of managing. There’s all sorts of challenges. People can always do—you know, welcome migrants better. But they’ve fared better. They’ve sustained migration, and that seems to have worked for those countries.

So I think it’s sort of back to the original dichotomy, and I suspect most countries will want to try both and should try both to manage this process, at least for the next fifty years; that is, making it easier for women to, you know, be supported in their careers, and having a family if they so choose, and, you know, liberal migration and welcoming of migrants.

BOLLYKY: I will ask Chris one more question then I will turn it to both of the speakers to sum up unless there are additional questions out there.

So the question I had is, of course this is not our first experience globally with population decline. One thinks of the Black Death. Many people associate it with the invention of the printing press, rising incomes, a dramatic change in the fortunes of Europe. If we have this future of a dramatic decline in population, are there historical models we should draw from for what that will mean for societies? Or, is the reality today just fundamentally different now and those historical precedents are of limited utility?

MURRAY: You know, I think—we’ll start with the Black Death—I think an exogenous mortality shock of enormous magnitude but nevertheless something that nobody asked for—it wasn’t a choice of anybody, and it was a relatively short period of time with huge consequence—is not a great analogy here. This is something that’s coming about because of the aggregation of choices of millions of women around the world, and that’s a very different thing than a shock from a pandemic, or an earthquake, or a war, that have historically brought population down.

And if you go back in time, you know, there’s always been sort of excess—you know, the crude birth rate has historically been higher than the crude death rate, but it looked like it was in balance until about the beginning of the 18^th century because that historic excess was always countermanded by wars, and plagues, and other events that brought the population down. And then in the nineteenth century, you know, there is this literature out there that suggests that an awful lot of colonialism was about managing the fact that the death rate came down much faster than the birth rate, and there was this huge excess population in Britain and then in France and Germany. And then that was used as a strategy to, you know, move them abroad, and that became part of the sort of colonial expansion and empire building. So I don’t think there is an analogy here, and I think the other reason that this is really quite unique historically is that, to get to this point has been, you know, two generations of decline that themselves would be pretty hard to reverse, and it’s just continuing that into the future.

The closest period that I think is interesting is the sub-replacement fertility in the 1930s in the U.K. where, for some of the same reasons, fertility rates dropped rather low. And that’s how John Maynard Keynes wrote that essay about the perils of population decline economically. And then what happened was World War—you know, the Depression, World War II, and then the baby boom. And so it sort of, for about thirty or forty years, took that—for the high-income world took that sort of imminent collapse of fertility off the table for a while. So fertility rates have been malleable, and so there’s something to be learned, I think, about that experience back in time.

BOLLYKY: Yes, although hard to recommend that particular sequence of solutions to this problem. (Laughs.)

Let me turn it over—Natalia, I wanted to move to where we go from here. We are of course in the midst of the pandemic. I would like to think we will learn from this experience and look at the broader societal issues that have been highlighted. There are many elections coming up, lots of potential upheaval. How do we take into account the work that you are doing, Chris is doing, in the short term and start to move our societies towards a better version of the futures that Chris’ demographic forecast laid out for us?

KANEM: Well, thanks, Tom.

Just before addressing that, I would like to chime in on what history is telling us, and I think we have an immediate past history of what happens when women are forced to limit their family size, and son preference—which sits alongside everything we’re discussing—comes into being. So some of the issues which UNFPA is dealing with right now is trying to assist countries—and India is one of the ones on this list—where you have excess men and missing girls—the 140 million missing women and girls where natural, you know, sex selection did not occur.

So where you have son preference, I think a lot of the issues as to the spur and the technology that goes with it we have to revisit as well.

Earlier, Chris gave an example of things like IVF, for example—you know, assisted fertility. He was using it in another instance, but I’m just saying that technology has played a role in helping women who otherwise wouldn’t be able to have children to do so. But if you are poor, if you on the wrong side of the tracks, and whatever, good luck to you affording it. So we never need to stray very far before we see that the gender equation and how we differentially value people—you know, by gender, by race, take it however you want—means that we lack important voices at the table.

Personally speaking for me, looking to the end of the century, in a time of COVID, so much can happen. Again, I do appreciate the difficulty of predictive value when you are looking so far out, and I’m glad that IHME has taken it upon themselves to do this, but I think there are many grains of salt in many different directions.

But as it happens now, low fertility tends to be a Nordic, developing country, East Asian—many countries that have succeeded along the development axis. But now we see that, when we look at human development, it’s not just economic money that counts. People are choosing—you know, they are voting with their feet, if you will. And so I would hate to get away from respecting and protecting women’s ability to fulfill what it is that they want to do on a policy basis.

I think as we advise governments, we do want them to prepare, and scenario building is part of that because these demographic shifts do effect how resources are planned for. We are glad the governments are requesting this advice; that statisticians are starting to walk over next door to the minister of planning and finance and have these discussions. But reproductive rights and choices are at issue because, really, women still don’t have enough of a say. A lot of these discussions are not necessarily centering women, and that’s what Cairo was about twenty-five years ago. That’s what the Beijing discussion that continues is about.

So I look forward with interest to how we piece together this puzzle, and I think IHME has really done a big service by looking at this particular issue, which can fall below the radar very often. So thank you for the opportunity to debate and discuss it today.

BOLLYKY: Great. Thank you so much, Natalia.

Chris, you get the last set of comments. You have two minutes.

MURRAY: Thanks, Tom.

I think that the surest way for there to be, you know, loss of women’s reproductive health rights is going to be if we don’t publicly debate and discuss this issue of low fertility. There is a segment—won’t name names—but there’s a segment of people in the development community who think talking about low fertility will undermine efforts to reduce fertility in high fertility countries that have, you know, rapid population growth. And so there is a natural resistance. The idea is that you can’t simultaneously discuss high fertility and low fertility in a policy space, and that people can’t handle the nuance of that. But I think there is remarkable risk in that, and I think the most important thing that we should be doing is just being super transparent about this discussion; that it’s relevant for actually most countries, you know, that are not in the high-fertility category, which is the majority of countries, and that it can only help if we discuss the options and understand, you know, what are the, you know, positive things we can to do support women in choosing the number of children they want, and pursing the careers they want, and their other life aspirations, and also promote liberal migration.

So I’ll just end there—that I think silence on this topic is not a good strategy.

BOLLKY: Great. Well, first, let me thank both of our terrific speakers for being here today.

 

I had joked earlier that Chris has moved from the controversial topic of COVID to these more non-controversial topics. I really have admired the work that Chris and IMHE have been doing throughout this. They have been absolutely fearless in taking on difficult, controversial issues, including what they’ve done on the pandemic, and done so in a rigorous way. I admire them for that, and their research has been a really good resource. I’m grateful for them for pressing this issue today and giving us the opportunity to have this discussion.

I want to say a word of thanks to Sam Kiernan, Caroline Kantis, Yousof Omeish, who organized this roundtable and made it such a terrific event. So thank you all for joining. If you haven’t read the paper, please do so. And I look forward to more discussions in the future.

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