The Star
Rising costs and growing infertility
By FATIMAH ZAINAL | Focus | 26 Nov 2023

Having fewer children: An increase in the number of women participating in the labour force can influence women’s decision to marry or increase the number of children they have. — Posed photo/123rf.com

COST of living pressures, the country’s socioeconomic progress, and infertility are among the major reasons for the nation’s steadily declining Total Fertility Rate (TFR), say experts.

To reverse this worrying trend, fundamental shifts and pro-natalist policies are needed.

According to Universiti Sains Malaysia’s population and development expert Dr Suziana Mat Yasin, in general, Malaysia’s rapid socioeconomic development progress has caused a consistent TFR decline.

Specifically, the decline can be attributed to an increased cost of living and an increase in the age at first marriage, she says.

Suziana says the Value of Children (VOC) influences behaviour towards women’s fertility as the cost of raising a child nowadays is higher, especially for couples in urban areas.

Other than bearing the cost of basic needs such as housing, transportation, food and utilities, parents must also consider other costs of child support such as providing educational needs including smartphones, Internet facilities and computers.

The age of a woman at first marriage also impacts the TFR as it is pertinent to the number of years available for her to have children during her reproductive age, which is between 15 and 49 years old.

Suziana cites a report from the Statistics Department of Malaysia which showed that the median age of women getting married has increased to 27 in 2022 from 26 in 2021.

“This data implies that the number of years for women to bear children becomes short and limited,” says the senior lecturer at USM’s School of Social Sciences.

Suziana adds that an increase in the number of women participating in the labour force can influence women’s decision to marry or increase the number of children they have.

“The woman playing the dual role of a mother and a worker has burdens and challenges which are higher than men to balance time between family and work.

“In addition, the increase in the number of women in the labour force also causes childcare costs to increase because children need to be sent to a childcare centre or childminder to enable the mother to work.

“Indirectly, this has influenced the decision to have a smaller number of children, further affecting the TFR,” she says.

Empowerment crucial

The decline in TFR meanwhile further accelerates the ageing process of the country’s population, with Malaysia estimated to reach the status of an ageing country in 2030 when the population aged 65 and over reaches 15%.

An ageing population has a big impact on the country’s coffers in bearing the cost of healthcare expenses, the welfare of the elderly, and public pension expenses that are increasing while, concurrently, the working age population is shrinking, says Suziana.

“This can cause a fiscal deficit,” she says.

The lecturer says efforts to achieve the status of a developed country will be more challenging when the population ages and if the TFR fall is uncontrolled, as it will lead to a decline in the supply of human resources, the vital movers of the economy.

“The TFR needs to be increased back to replacement level [2.1], to ensure that the population and development process goes smoothly.

“If examined, the main issue of the declining TFR is related to women and parents’ anxiety over increasing the number of children due to the high cost of living,” she says.

In balancing the goal of increasing female labour force participation and increasing the TFR to at least replacement level, the framework of efforts to empower women must be more comprehensive.

“For example, improving policies and programmes related to maternity protection such as off days or leave for taking children to health centres or taking care of sick children, and expanding this facility to the father as well.

“Family leave policies like this are important to help parents meet the demands of work and family.

“In addition, support such as the provision of childcare centres by employers and flexible working hours, are needed,” she says.

Financial incentives can also be provided such as in the form of family facilities, tax exemptions, and incentives for second and third births.

“Generally, pro-natalist policies should be considered to stabilise the TFR,” she says.

She adds that most developed countries, however, do not only rely on policies or strategies to increase the TFR alone, because in reality it is quite difficult to return TFR to the replacement level of 2.1 which has long gone.

“Immigration is one way to balance the effect of the TFR decline on the population and it has been carried out by most developed countries,” she says.

She notes that such policies and programmes have successfully attracted the labour force to immigrate, work and indirectly maintain the economic viability of the countries.

Natural decrease

Dr Wan Ibrahim Wan Ahmad, of Kolej Dar al-Hikmah, says the decrease in TFR is natural and parallel to the increase in the level and quality of life of individuals.

“As the level and quality of life of individuals increases, the importance of children to old age security will decrease because when someone feels that life in their old age is secure, they will no longer feel the need to have many children.

“Many married couples choose not to have many children due to the costs.

“Even if they need children, they only need one or two children, just for psychological satisfaction and to avoid loneliness in old age.

“This scenario is the reason why TFR decreases,” he says.

Wan Ibrahim agrees that educational opportunities affect age at first marriage in that it delays the age at first marriage for women, which in turn reduces their total possible number of child-bearing years.

“Education also affects female labour-force participation in formal jobs, social mobility, husband-wife communication, exposure to contraceptive use, family income, and many more variables that could ultimately lower the TFR,” he says.

Infertility issue

Wan Ibrahim also notes that medical issues such as infertility, are important in this regard.

According to the World Health Organisation (WHO), around 17.5% of the world’s adult population, or roughly one in six people, worldwide experience infertility, showing the urgent need to increase access to affordable, high-quality fertility care for those in need.

Wan Ibrahim notes that infertility treatment is often expensive, which makes poor couples unable to afford it.

“For the poor, they need many children as children are important for their old age security,” he says.

Wan Ibrahim adds that the consequences of a decreasing TFR is that the country will experience population decline, and it can even lead to negative population growth, whereby the number of births in a country is less than the number of deaths.

“The consequences of such a negative population growth are various but the most important is the country will become an aged or super-aged nation.

“It is a nation where more people are aged 60 or 65 compared with the young working ages within the whole population age structure,” he says, adding that the negative effect of this is the shrinking of the productive labour-force for the country.

This will cause the country to have a shortage of productive workers which can lead to the country’s dependence on foreign workers.

“Countries experiencing this situation right now are increasingly turning to international immigration to expand the size of their labour force, and in many European countries, the participation rate of the elderly in the workforce has also increased significantly.

“Some of these countries have also increased mandatory retirement ages,” he adds.

Wan Ibrahim says measures that can be taken by the government to overcome this scenario is to give incentives to married couples to have more children, or at least more than two children in the family.

Facilities such as adequate maternity leave, childcare incentives, childcare support for working women, or at least providing flexibility in working time for working mothers are among other measures that can be taken to prevent the TFR from falling significantly, he says.

Facilities such as adequate maternity leave and childcare support for working women are among other measures that can be taken to prevent the TFR from falling significantly. — Posed photo/123rf.com

“A high cost of living, cost of caring for, and raising children, ultimately forces married couples living in cities to choose to reduce the number of children they can have.

“To help couples overcome their financial problems, couples who want to have children need to be helped financially,” he says.

Wan Ibrahim adds that couples living in rural areas do not have many problems having many children as the economic value of children to rural families is generally still high, and the majority of those who live in rural areas tend to have a large number of children in their marriage.

He adds that couples facing infertility problems must be made aware of the need to get medical advice.

Wan Ibrahim also says the TFR is expected to continue to decline further.

“Looking at past scenarios, and demographic history in various developed and developing countries, the national TFR will continue to decline, and it may even reach a negative rate in the future, unless some effective measures are taken.

“This is because, there is a negative relationship between the level of a nation’s socioeconomic development and the level of TFR, that is, the more developed the nation, the lower the TFR,” he says.

Meanwhile, Women, Family and Community Development Minister Datuk Seri Nancy Shukri says that a National Subfertility Centre – which will be the first in Malaysia – will be built in Shah Alam next year, as part of the effort to deal with the country’s declining TFR.

The centre, to be built at a cost of RM171mil, is expected to be operational in 2029.

She says the current subfertility treatment services offered at the subfertility clinic of the National Population and Family Development Board can no longer meet demand.

“If the fertility rate continues to decrease at the current rate and no intervention is taken to deal with this situation, the country’s population is expected to reach a maximum number of 46 million people in 2071 before experiencing population shrinkage the following year,” she was quoted as saying on Nov 22.