How can modern medicine counter Germany's low birth rates?
Of all the world's countries, Germany numbers among those with the fewest children. For some time, the government has pursued family-related policies designed to change this. A new study from the Berlin Institute investigates whether reproductive medicine can help.
Some 12.8 million people in Germany aged between 25 and 59 either want – or wished they had already had – children. Of these, 1.4 million failed in their attempts to procreate, despite "trying" for more than one year. Until recently, the problem of involuntary childlessness for medical reasons was rarely discussed in public. This could change in the light of falling birth rates: on average the number of babies born during the past 10 years (1997 to 2006) declined by 14,000 annually. This decrease would have been even more drastic had some 95,000 children not been born as a result of artificial insemination between 1997 and 2005 – an average of about 10,000 per year.
Conducted by the Berlin Institute for Population and Development in conjunction with the Allensbach Institute for Public Opinion Research, a new study entitled "Unwanted Childlessness" investigates how reproductive medicine can help mitigate the demographic crisis in Germany. The study concludes that ¬– in addition to modern family policies and improved treatments for medical conditions that cause infertility – the country's medical services could help couples who long for families. In doing so they could increase birth rates to a limited degree. If artificial insemination (in-vitro fertilisation or IVF) were used to the same extent as in Denmark – the country with the highest number of IVF procedures per inhabitant – medicine could even make a significant contribution.
In 2002, the proportion of children born to IVF procedures in Germany was 1.9 percent. The figure peaked at 2.6 percent in 2003, only to drop to 1.4 percent a year later and 1 percent in 2005. The sharp increase and subsequent decrease can be partly explained by government policy: after the German Health Care Reform took effect on 1 January 2004, the statutory health insurance companies have only paid 50 percent of the cost for a maximum of three treatments. Before this, they had been obliged to pay the full cost of four treatments. For this reason, many couples who would have otherwise waited underwent treatment in 2003. The average rate of IVF children for the years 2000 to 2005 was 1.65 percent.
In Denmark however, where couples wanting children are entitled to three fully paid treatments (provided they are conducted at a public health clinic), IVF procedures make a far higher contribution. In 2002 they comprised 4.2 percent of all newborns, with the average between 2000 and 2005 being 3.96 percent, almost 2.5 times higher than in Germany.
Calculations performed as part of the new study by the Berlin Institute show that even if the proportion of IVF newborns remained at the average level of recent years ("German model"), this would already have a noticeable impact on Germany’s demographic evolution through 2050. There would be a discernible difference if this proportion increased to Denmark’s level immediately (i.e. from 2007 onwards) and was then sustained until 2050 ("Danish model").
Given the German model, IVF children, their children and their grandchildren would make up 3 percent of all 0- to 4-year-olds by 2500. According to this calculation, a total of about 750,000 children in Germany would directly or indirectly owe their lives to reproductive medicine.
Given the Danish model, IVF children (including their offspring into the second generation) would make up 7.2 percent of 0- to 4-year-olds by mid-century. This proportion would be almost 2.5 times as high as in the first scenario. With the Danish model, some 1.6 million of the children born in Germany by 2050 would owe their existences directly or indirectly to artificial insemination.
Click here (PDF, 1.5 MB) to view the full German version of the study.
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