Managing ever-rising ages at childbearing in low fertility Asia

Abstract

Alarm bells are sounding across East Asia as the long-expected post-pandemic baby bust has become more apparent from national statistics under the shadow of a slowing world economy. Part of the challenge for low-fertility Asia is high and rising ages at childbearing, coupled with relatively small tempo effects that fail to make up for declining birth rates among younger women at older ages. In response, governments in China, Japan, Korea and Singapore have all recently pledged to step up support for parents-to-be, ranging from increased monthly allowances to enhanced paternity leave and more flexible working arrangements. Yet growing evidence of underlying causes, including economic-related pressures and gendered divisions of household labour (Lee et al., 2021; McDonald, 2000), leaves a sense that these issues are simply so wide in scoop and deeply rooted in social and economic institutions that any upticks in fertility will not come at the pace and scale required to avoid demographic crisis. Beyond the implications for workforce numbers, labour productivity and social dynamics, rising ages at childbearing also result in serious negative biomedical consequences. Singapore provides a useful example. In 2021, the city state reached a littlenoticed milestone: for the first time, birth rates among women aged 35–39 exceeded those of women aged 25–29; just two decades ago in 2001, the proportions were around one to 2.5. This statistical crossover is not only striking because of the compressed timespan but also because of the specific age thresholds, since births above age 35 are widely categorised as high-risk in clinical settings, due to negative associations with maternal and child outcomes, including pre-eclampsia, gestational diabetes, low birth weight, chromosomal disorders, miscarriage and stillbirth, and hence elevated risks of involuntary childlessness and secondary infertility. Hence, delayed childbearing is a public health problem, in addition to being a demographic challenge. In light of the twin policy imperatives and the seemingly intractable and urgent nature of extremely low fertility rates, assisted reproductive technologies (ART) will likely play an increasingly important role. In vitro fertilisation, together with social egg freezing and embryo transfer, addresses both sides of the issue: it offers the opportunity of boosting reproductive longevity, which helps to reduce the costs of the tension between family formation and career success for women, and simultaneously, mitigates some of the biomedical risks, including chromosomal disorders. Although conceptions from medically assisted technological procedures still account for well under ten percent of births in developed countries, the numbers are projected to go up over successive cohorts. In