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White PapersWhite PapersGlobal fertility conversations often miss the real crisis: the growing inability of people to achieve their reproductive choices. This white paper, informed by a United Nations Population Fund report, explores how economic strain, gender inequality, and limited healthcare access restrict reproductive agency and deepen the divide between desired and achieved fertility worldwide.
The global demographic landscape is undergoing tectonic shifts, characterized by declining fertility rates and population aging, leading to widespread anxiety about topics like workforce shortages and economic stability. However, the 2025 State of World Population report, titled The Real Fertility Crisis: The pursuit of reproductive agency in a changing world, argues that public discourse often overlooks the central human rights challenge: the pervasive inability of individuals to realize their reproductive desires. This gap between desired and achieved fertility is the real fertility crisis confronting populations worldwide, regardless of whether a country is experiencing high or low total fertility rates.
The fundamental issue is a widespread crisis in reproductive agency, defined as a person’s ability to make free and informed choices about sex, contraception, and starting a family without being subjected to legal, political, economic, or normative constraints. When people cannot exercise their reproductive rights and choices, they are unable to realize their desired family goals—be that avoiding an unintended pregnancy or successfully becoming a parent.
New research conducted by the United Nations Population Fund (UNFPA) and the international polling firm YouGov across 14 diverse countries confirms the severity and universality of this crisis. The findings demonstrate that barriers to preventing pregnancy and barriers to starting a family are often rooted in the same systemic failures, including economic instability, gender discrimination, inadequate healthcare access, and widespread pessimism about the future. Addressing this requires a fundamental shift in policy focus, moving away from manipulating fertility rates to serve the state or economy and prioritizing instead the creation of enabling environments that support individuals’ reproductive autonomy and security.
The real fertility crisis stems from policy choices and environments misaligned with individual desires, rather than individual decisions that fail to meet national demographic targets. Policymakers must focus on supporting the full range of sexual and reproductive health services, providing stable, long-term support to families, and tackling gender-based violence and discriminatory norms that undermine people’s ambitions. This comprehensive, rights-based approach rooted in reproductive agency is essential to effectively navigate the demographic changes reshaping the world. Ignoring this core issue risks repeating historical mistakes where coercive policies led to harmful consequences and rights violations. The real fertility crisis demands immediate and comprehensive action that ensures rights and choices for all people.
A rights-based fertility policy framework ensures individuals can decide when, whether, and how many children to have. Removing medical and social barriers, expanding access to care, and rejecting demographic pressure are essential to creating conditions that allow people to pursue their reproductive intentions freely and without discrimination
This policy framework explores how inclusive fertility care policy can eliminate barriers rooted in legal, financial, and social inequities. It calls for data-driven governance, culturally competent care providers, and equitable access frameworks that empower every individual, regardless of background, to pursue parenthood with dignity and equal opportunity.
FastTraCS’ white paper probes the most significant unmet needs in REI, from daily injection burdens and clinic workflows to data systems and patient access, underscoring innovation’s role in fertility care’s next chapter.
The Fertility Futures Pulse Report uncovers widespread silence around reproductive health in Britain, highlighting male stigma, poor school education, and media misinformation. With the UK fertility rate at 1.41, the report urges earlier conversations and stronger fertility literacy to prevent delayed parenthood and demographic decline.
The Australian Guidelines for Male Infertility offer clinicians a unified evidence-based framework to improve diagnosis, management, and counseling for male fertility issues.
