he Asia Pacific region is grappling with a profound challenge: declining birth rates. This region is home to countries with the lowest total fertility rate (TFR) in the world, including Taiwan, South Korea, Singapore, Australia, Thailand, and Vietnam, where birth rates are well below the replacement level of 2.1 children per woman, leading to population decline and substantial economic consequences. In fact, South Korea's total fertility rate is at 0.78, one of the lowest in the region. This demographic shift is further complicated by inconsistent access to infertility treatment and information, including options like egg freezing.
Infertility affects one in six people globally but is often overlooked in policy discussions, despite its profound impact on individuals and societies. In many Asia Pacific countries, infertility is not recognized as a medical condition, resulting in a lack of targeted policies and support.
Public awareness about infertility and its treatments remains low, particularly in rural areas, where misconceptions and stigma are prevalent. This leads to delayed diagnosis and treatment, reducing the chances of successful outcomes. For example, women in South Korea experiencing infertility tend to wait over two years on average before seeking medical advice.
Additionally, access to fertility treatments such as in vitro fertilization (IVF) and egg freezing varies greatly across the region. While countries like Australia perform around 3,630 ART cycles per million individuals per year, other countries, such as Vietnam, report only 25 ART cycles per million individuals per year. Investing in infertility treatment and ensuring wider access to affordable screening has shown a positive return on investment, yielding a threefold return in future revenue for every $1 invested.
Addressing these challenges necessitates a coordinated approach. The "Improving Access to Fertility Treatment in Asia Pacific" policy paper, presented at the 14th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE), highlights the best practices through literature reviews, interviews with fertility experts, and a Policy Roundtable.
Firstly, infertility must be recognized as a disease and comprehensive national strategies are needed to improve access to treatment. Public awareness campaigns are crucial to educate individuals about infertility, its causes, and available treatments. These campaigns should reach both urban and rural populations to ensure equitable access to information.
Secondly, improving access to fertility treatments. This involves increasing the number of fertility centers, particularly in underserved rural areas, subsidizing and reimbursing treatments like IVF and egg freezing, to make them affordable and accessible for all individuals, regardless of their socioeconomic status. For instance, in Vietnam, poorer patients may pay over 100% of their annual income for one ART cycle. Additionally, policies should support both medical and social egg freezing, allowing women to preserve their fertility for future use. Offering fertility testing can inform women about their reproductive potential and the optimal time for egg freezing.
Thirdly, psychosocial support—a critical component of infertility management. Infertility can lead to significant emotional distress, and integrating psychosocial care into the treatment pathway can improve patient outcomes. People with infertility in China are at least seven times more likely to experience depressive symptoms compared to the general population. Training healthcare professionals in providing psychosocial support and ensuring these services are publicly funded will help patients navigate the emotional challenges of infertility and decrease dropout rates from treatment.
The time for action is now. It took 23 years between reaching a total fertility rate of 2.1 in South Korea and providing reimbursement for ART. By then, the total fertility rate had dropped to 1.13 and continued to decline quickly. Countries like the Philippines and Thailand, who currently have a replacement rate of 1.9 and 1.44 respectively, need to act now before it’s too late.
Access to ART is not enough. A holistic approach to create a family friendly society is critical to ensuring that people are supported when building their families. This demands a coordinated effort across government sectors, including education, labor, finance, and health to support demographic resilience in the region.
By implementing these measures, we can create an effective and intentional approach to managing infertility in the Asia Pacific region and achieve demographic resilience. This will address the declining birth rates and improve the quality of life for individuals experiencing infertility. The future of our societies depends on our ability to support and empower those who wish to build families. No one sector can do this alone. It will require the entire community—governments, the medical community and the private sector—to partner to realize a brighter future for all.
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Asia Pacific’s declining birth rate demands unified action
Photo by kian zhang on Unsplash
June 25, 2025
Across the Asia Pacific, birth rates are declining faster than anywhere else in the world—but this can be countered with fertility treatment. Overcoming low public awareness, misconceptions, and lack of access to fertility treatments is possible, writes Noha Salem.
T
he Asia Pacific region is grappling with a profound challenge: declining birth rates. This region is home to countries with the lowest total fertility rate (TFR) in the world, including Taiwan, South Korea, Singapore, Australia, Thailand, and Vietnam, where birth rates are well below the replacement level of 2.1 children per woman, leading to population decline and substantial economic consequences. In fact, South Korea's total fertility rate is at 0.78, one of the lowest in the region. This demographic shift is further complicated by inconsistent access to infertility treatment and information, including options like egg freezing.
Infertility affects one in six people globally but is often overlooked in policy discussions, despite its profound impact on individuals and societies. In many Asia Pacific countries, infertility is not recognized as a medical condition, resulting in a lack of targeted policies and support.
Public awareness about infertility and its treatments remains low, particularly in rural areas, where misconceptions and stigma are prevalent. This leads to delayed diagnosis and treatment, reducing the chances of successful outcomes. For example, women in South Korea experiencing infertility tend to wait over two years on average before seeking medical advice.
Additionally, access to fertility treatments such as in vitro fertilization (IVF) and egg freezing varies greatly across the region. While countries like Australia perform around 3,630 ART cycles per million individuals per year, other countries, such as Vietnam, report only 25 ART cycles per million individuals per year. Investing in infertility treatment and ensuring wider access to affordable screening has shown a positive return on investment, yielding a threefold return in future revenue for every $1 invested.
Addressing these challenges necessitates a coordinated approach. The "Improving Access to Fertility Treatment in Asia Pacific" policy paper, presented at the 14th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE), highlights the best practices through literature reviews, interviews with fertility experts, and a Policy Roundtable.
Firstly, infertility must be recognized as a disease and comprehensive national strategies are needed to improve access to treatment. Public awareness campaigns are crucial to educate individuals about infertility, its causes, and available treatments. These campaigns should reach both urban and rural populations to ensure equitable access to information.
Secondly, improving access to fertility treatments. This involves increasing the number of fertility centers, particularly in underserved rural areas, subsidizing and reimbursing treatments like IVF and egg freezing, to make them affordable and accessible for all individuals, regardless of their socioeconomic status. For instance, in Vietnam, poorer patients may pay over 100% of their annual income for one ART cycle. Additionally, policies should support both medical and social egg freezing, allowing women to preserve their fertility for future use. Offering fertility testing can inform women about their reproductive potential and the optimal time for egg freezing.
Thirdly, psychosocial support—a critical component of infertility management. Infertility can lead to significant emotional distress, and integrating psychosocial care into the treatment pathway can improve patient outcomes. People with infertility in China are at least seven times more likely to experience depressive symptoms compared to the general population. Training healthcare professionals in providing psychosocial support and ensuring these services are publicly funded will help patients navigate the emotional challenges of infertility and decrease dropout rates from treatment.
The time for action is now. It took 23 years between reaching a total fertility rate of 2.1 in South Korea and providing reimbursement for ART. By then, the total fertility rate had dropped to 1.13 and continued to decline quickly. Countries like the Philippines and Thailand, who currently have a replacement rate of 1.9 and 1.44 respectively, need to act now before it’s too late.
Access to ART is not enough. A holistic approach to create a family friendly society is critical to ensuring that people are supported when building their families. This demands a coordinated effort across government sectors, including education, labor, finance, and health to support demographic resilience in the region.
By implementing these measures, we can create an effective and intentional approach to managing infertility in the Asia Pacific region and achieve demographic resilience. This will address the declining birth rates and improve the quality of life for individuals experiencing infertility. The future of our societies depends on our ability to support and empower those who wish to build families. No one sector can do this alone. It will require the entire community—governments, the medical community and the private sector—to partner to realize a brighter future for all.
