Why Are Fertility Rates Dropping Globally—But Infertility Is Rising Unequally?
By Dr. Chelsea Dakers, ND; Assisted by AI
There’s a quiet shift happening across the globe. While many headlines point to falling birth rates and aging populations, a deeper conversation is emerging—one that asks who is struggling to conceive, why, and what systems are at play beneath the surface?
This blog post explores the paradox of declining global fertility rates alongside rising infertility, with a special focus on the racial and geographic disparities that shape who gets access to reproductive vitality—and who gets left behind.
📉 The Global Fertility Freefall: A Quick Look
Across nearly every continent, the average number of children born per woman has declined dramatically. In 1950, the global fertility rate was around 5.0. Today, it's hovering near 2.3—and expected to fall below 2.1 (the "replacement level") by mid-century (United Nations, 2022).
Many high- and middle-income countries are seeing the steepest drops. South Korea now reports the lowest fertility rate in the world at just 0.72, followed by countries like Japan, Italy, and China.
These shifts are not just statistical—they reflect powerful transformations in how people relate to work, parenthood, health, and environmental stability. Women are delaying childbirth or choosing not to have children at all. Economic pressures, environmental toxins, hormonal disruption, and cultural shifts are reshaping reproductive patterns.
But Fertility Decline ≠ Infertility
What often gets missed in these discussions is that declining fertility rates are not always by choice. Many individuals, couples, and communities are facing unexplained or preventable infertility—and not all are receiving the support or care they need.
Infertility is defined as the inability to conceive after 12 months of regular unprotected intercourse (World Health Organization, 2023). Globally, it's estimated to affect 1 in 6 people—but the experience and causes vary drastically by geography, race, and healthcare access.
The Case of Black American Women: A Crisis Hidden in Plain Sight
In the United States, Black women are nearly twice as likely as white women to experience infertility, yet they are less likely to access or complete fertility treatments like IVF (Farland et al., 2016; Dieke et al., 2020).
Why? It’s not biology—it’s inequity.
Delayed diagnosis of reproductive conditions (e.g., fibroids, PCOS)
Environmental exposures, like endocrine disruptors in hair and skin products
Medical racism and implicit bias in clinical care
Lower access to fertility benefits, insurance, and culturally competent care
Chronic toxic stress from racism and systemic inequity, which affects ovulatory and hormonal rhythms
This is not a new issue. It is the cumulative effect of structural racism and medical exclusion, layered over generations. It’s also a call to action for practitioners to deconstruct biases and expand access to fertility care for all.
But Wait—Aren’t Fertility Rates High in Africa?
Yes—and that’s exactly why this contrast is so often misunderstood.
Countries like Niger, Somalia, Chad, and the DRC report fertility rates of 4.5 to 6.7 children per woman. On the surface, it may appear that infertility is not a concern. But these averages mask deep disparities.
In reality, secondary infertility—inability to conceive after a previous birth—is alarmingly common in many sub-Saharan African countries. Factors include:
Untreated STIs and pelvic infections
Unsafe abortion and postpartum care
Limited access to OB-GYN or fertility specialists
Cultural stigma around infertility that prevents open care-seeking
In these settings, fertility is highly valued, yet infertility is often hidden, stigmatized, and unaddressed. And unlike in high-income nations, ART (assisted reproductive technologies) are scarce and unaffordable.
Race Is Not Biology—It's Environment and Systems
It’s important to dismantle the false assumption that race is a cause of infertility. Race is not a biological variable—it’s a sociopolitical one. What we are witnessing is the epigenetic and physiological impact of lived environments: from environmental toxins to trauma, diet, housing, stress, and healthcare systems.
For example:
A Black woman in Harlem and a woman of African descent in rural Nigeria may share ancestry, but their reproductive outcomes are shaped by entirely different realities—pollution, medical access, racism, and stress being among the most critical.
Understanding this helps us build more equitable, compassionate, and effective reproductive care—one that’s rooted in lived experience, not statistics alone.
Indigenous Women: Healing After Generations of Reproductive Injustice
Any conversation about infertility and access to reproductive care must include the voices of Indigenous women, whose experiences have been shaped by centuries of colonial violence, systemic racism, and reproductive injustice. In Canada, up to 25% of Indigenous women of reproductive age report difficulties conceiving or carrying pregnancies to term (Jenkins & Ranjit, 2020). Historically, forced sterilization programs persisted into the 1970s—and reports of coerced sterilizations have continued into the 21st century, with at least 117 cases documented between 2006 and 2017 (Stote, 2012; Senate of Canada, 2021).
Indigenous communities also face higher rates of pelvic inflammatory disease, STIs, and endometriosis, all of which contribute to secondary infertility. Many live in rural or remote areas with limited or no access to OB-GYNs, fertility specialists, or midwifery services. In some regions, pregnant women are evacuated weeks before birth, removing them from land, community, and traditional practices (Lawford et al., 2018). The compounded effects of environmental degradation, food insecurity, and intergenerational trauma continue to shape hormonal rhythms, metabolic health, and fertility.
True healing must go beyond access—it must include restoring cultural birth practices, land-based healing, midwifery autonomy, and supporting Indigenous-led reproductive care initiatives that prioritize sovereignty, consent, and the sacredness of creation.
What Can We Do Differently?
As practitioners and educators, we need to:
Name and challenge racial disparities in access to fertility education and care
Offer early, proactive care to those disproportionately affected by infertility
Explore holistic root-cause frameworks, including endocrine disruption, trauma healing, and metabolic repair
Ensure research and clinical protocols reflect racial and cultural diversity
Listen deeply to the stories of those who feel silenced or dismissed by the system
This is about restoring sovereignty over fertility and reproductive choice, not just raising birth rates.
Closing Reflection
Fertility isn’t just a number—it’s a mirror of how well we are caring for bodies, communities, and ecosystems. When we see fertility struggles rising, especially among marginalized populations, it's a signal to look deeper—not just at hormones and lab tests, but at the whole terrain of life that shapes reproductive health.
Let us reclaim this conversation from fear and control—and instead offer a path of clarity, choice, and holistic support.
References
Dieke, A. C., Zhang, Y., Chen, L., & Zhang, Y. (2020). Racial and ethnic disparities in the use of and success of fertility treatments: Analysis of data from a national ART registry. Fertility and Sterility, 114(6), 1231–1239. https://doi.org/10.1016/j.fertnstert.2020.06.041
Farland, L. V., Missmer, S. A., Rich-Edwards, J., Chavarro, J. E., Barbieri, R. L., & Grodstein, F. (2016). Use of fertility treatment among women with a history of infertility. Fertility and Sterility, 105(6), 1505–1513. https://doi.org/10.1016/j.fertnstert.2016.02.015
United Nations, Department of Economic and Social Affairs, Population Division. (2022). World Population Prospects 2022: Summary of Results. https://population.un.org/wpp
World Health Organization. (2023). Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility
Browne, A. J., Varcoe, C., Lavoie, J., Smye, V., Wong, S. T., Krause, M., ... & Fridkin, A. (2016). Enhancing health care equity with Indigenous populations: Evidence-based strategies from an ethnographic study. BMC Health Services Research, 16, 544. https://doi.org/10.1186/s12913-016-1707-9
Lawford, K. M., Giles, A. R., & Bourgeault, I. L. (2018). Canada's evacuation policy for pregnant First Nations women: Restructuring midwifery services in remote communities. Canadian Public Administration, 61(3), 371–392. https://doi.org/10.1111/capa.12280
Stote, K. (2012). The coercive sterilization of Aboriginal women in Canada. American Indian Culture and Research Journal, 36(3), 117–150. https://doi.org/10.17953/aicr.36.3.2077n5m173274657
Jenkins, A. L., & Ranjit, N. (2020). Environmental injustice, health disparities, and reproductive health in Indigenous communities. Environmental Justice, 13(5), 169–178. https://doi.org/10.1089/env.2020.0019
Van Wagner, V., Epoo, B., Nastapoka, J., & Harney, E. (2007). Reclaiming birth, health, and community: Midwifery in the Inuit villages of Nunavik, Canada. Journal of Midwifery & Women's Health, 52(4), 384–391. https://doi.org/10.1016/j.jmwh.2007.03.004