By Karen Sternheimer

During a trip to Milan, one of the first places I visited was the Cimitero Monumentale, a cemetery famous for its ornate sculptures. We noticed a lot of funeral homes on our walk to this famous landmark, and flowers for sale for visitors to place on graves. This wasn’t surprising. But what was surprising were the many ads for funeral services on street signs in other parts of town.

The signs caught me a bit off guard, but they shouldn’t have. Italy’s population is aging; nearly a quarter of Italians are 65 or older (by contrast, only about 17 percent of the U.S. population is 65 or older). Funerals are a growing business.

Italy is amid a demographic crisis of sorts, which has been in the news for several years. Just months before my visit, reports of Italy’s lowest recorded birth rate made international news. In 2023, the most recent year for which data are available, Italy recorded about 281,000 more deaths than births, leading to continued population decline. As I wrote about in 2017, when births fall below a particular level, there can be reason for concern.

During the previous decade, Italy’s population has shrunk by nearly 2 million, about the size of the city of Milan itself. The fertility rate has fallen to a low of 1.18 per woman, well below the 2.1 replacement rate. (This replacement rate presumes an addition of two people in a population “replacing” a child’s two parents. The .1 accounts for deaths in infancy and childhood.) Other countries, like Taiwan and South Korea, have even lower birth rates, closer to 1.1. The birth rate in the U.S. is higher at 1.6, but still below replacement rate.

People are having fewer children for several reasons, including economic factors. In agrarian societies when having more farm labor is necessary, having more children is an economic plus, but in industrialized societies having children is economically costly. In wealthier countries where more opportunities exist for women, having children might just be one of many life choices people opt into or out of, thanks to the availability of reproductive technologies, including birth control.

Why does this matter? Isn’t deciding to have children an intensely personal and private choice?

Yes, but there are larger consequences to declines in birth rates below “replacement level.” On the one hand, it’s generally good news when a lower income country with a high birth rate sees their birth rate fall closer to replacement levels. This means that people will have fewer children to feed and care for and might also reflect an increase in educational opportunities in that country.

In the U.S., for instance, fewer people under 25 are having children, with the biggest decline seen in births to teens 15-19; down 79 percent since 1991. This is arguably good news, as it affords people time for more education and training to participate in the labor force.

Source: https://www.cdc.gov/nchs/data/nvsr/nvsr74/nvsr74-1.pdf

But here’s the concern, which has grown to crisis levels in places like Italy and Japan. When a population has far more elderly residents than young people, it is considered an aging population and a number of complications can occur:

• There aren’t enough people to care for the elderly; this could be literal, hands-on care.
• There aren’t enough workers earning wages to pay into programs that serve the elderly, which in the U.S. are Social Security and Medicare. These programs provide monthly income based on one’s lifetime earnings, enabling many people to retire, and access to healthcare (although Medicare is not free and not all health care providers accept Medicare).
• Fewer children mean fewer jobs for teachers and a declining number of students in universities (but getting into selective universities could become easier).

There are several things countries can do to stave off a demographic emergency. One is to enable and promote healthy aging, decreasing dependency on caregivers and extending the amount of time people are able to work. We already have seen extended retirement ages for receiving Social Security, which gradually increased from 65 to 67 based on birth year. Another is to enable immigration to bring in more workers to pay into the senior support systems.

As I wrote in 2017:

Countries with declining populations have created policies to nudge their fertility rates higher. From providing childcare and other financial incentives to using popular culture to promote marriage and procreation, many countries facing demographic dilemmas have tried a number of fertility-promoting policies, with mixed success.

Countries like Japan have tried to use public policy to encourage people to have more children, but it hasn’t been successful. As Thoại Ngô, Chair of the Department of Population and Family Health at Columbia University told CBS News:

I think the global evidence is very clear: we can’t buy fertility…. Japan [has] invested so much in the last 40 years, and their fertility [rate] is still at 1.2…South Korea [has] invested $200 billion into boosting up fertility, and it hasn’t worked. Their total fertility rate is at 0.7.

As this NPR story explains, researchers who study this issue have varying perspectives, with some noting that falling birthrates are indicative of positive changes, such as the increase in economic opportunities for women, and fertility rates are unlikely to reverse course. Others note that improved economic conditions, family-friendly workplace policies, access to high quality, and affordable childcare might tip fertility rates up.

But young couples interviewed about their parenting future seemed uncomfortable with government policy geared towards higher fertility. One woman told NPR “I think it’s gross…I feel very icked out, I guess, when I hear people…talk about their family values and, like, incentivizing having a child.”

In a society that highlights individualism, personal choice, and privacy, policies promoting having more children are likely to face resistance from their targeted audience, particularly young women. What ideas do you have to address a possible demographic shift?

Photos courtesy of the author