CPQ Medicine (2022) 13:2

Petrova, N. G.

Professor, MD, I.P.Pavlov First St. Petersburg State Medical University of the Ministry of Health of the Russian Federation, Russia

*Correspondence to: Professor, MD, I.P.Pavlov First St. Petersburg State Medical University of the Ministry of Health of the Russian Federation, Russia

Copyright © 2021 Dr. Petrova, N. G. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The economic development of any country, the level of well-being, its security and defense capability are largely determined by the state of “human capital” - the number and level of health of the population. The population size depends on internal (the ratio of fertility and mortality) and external (the level of emigration and immigration) components. Thus, in order to prevent depopulation, any state should take care of people’s regenerations, to maintain a sufficient birth rate. Expanded reproduction is provided when the total fertility rate exceeds 2.1 children per woman. However, in 2020, the average European figure was only 1.49, which does not even ensure simple reproduction. Therefore, the problem of birth rate growth is relevant for all developed countries.

In order to outline ways to solve a particular problem, it is necessary to know its causes and factors. The birth rate in each country is determined by their complex. All these factors can be divided into biological and social. Biological factors include the age and health status of parents, which, in turn, are determined by such social aspects as: the financial condition of the family, stability in the country (absence of unemployment, military conflicts, social cataclysms, etc.), the environmental situation, the presence and severity of state support for families with children, the prevailing stereotype of behavior in society / lifestyle (including bad habits, commitment to sexual behavior, choice of priorities - family and children or career and personal freedom), legislation (for example, regulating the permission or prohibition of abortions), accessibility and quality of medical care (ranging from issues of rational family planning and ending with the possibility of using modern effective assisted reproductive technologies).

Let’s focus on some of these listed aspects in details. In all developed countries of the world, there is a general trend to increasing the age of first and subsequent childbearing. Many young people after graduation from educational institutions can’t find a job, they haven’t a permanent income, their own housing, profession or sufficient qualifications. Accordingly, the birth of a child cannot be financially secured and is postponed “until better times”. At the same time, it is clear that the older parents have the higher risk of congenital mutations (i.e. the birth of a disabled child, whose upbringing can become an unbearable burden for parents and a factor preventing the birth of subsequent children), as well as they have the higher risk of appearance (increasing) such changes in the state of health that can be an obstacle to childbearing (decreasing the “quality” of spermatozoa in men and chronization of gynecological pathology in women).

Various emergencies (COVID-19 pandemic, military conflicts) not only worsen the financial condition of states and families, but also adversely affect the socio-psychological state of society and can cause or contribute to the exacerbation of various diseases.

Sexual freedom (which turning into promiscuity), among other things, leads to a wide spread of sexually transmitted infections, including HIV, which can lead to the development of many diseases ending in infertility, the frequency of which is constantly increasing in the world, as well as to abortions, the consequence of which can also be a reason of infertility. Today, 7-8 million women and 3-4 million men are infertile. The infertility rate in marriage is on average 16%, which exceeds the critical level of 15%. Medical examinations and social studies have shown that more than 90% of infertile women are feeling discomfort, the frequency of divorces among them is increasing, and professional activity is decreasing. To date, infertility is a difficult task for solving even in highly developed countries, the using of assisted reproductive technologies is not available to everyone, primarily due to their high cost.

The fashion for single-childedness (and in recent years - for the absence of children at all free child ideology) also has an economic basis. In the XVIII century Adam Smith established the “feedback paradox” - the higher social status of a mother leads to the fewer children she has. Promotion on the social ladder often puts before the mother (family) alternative: either personal achievements and the possibility of self-development, or orientation to childbearing (with the inevitable predominance at one stage or another of the interests of the child over the interests of the mother or parents).

Among the “medical” problems, we can note the presence of various kinds of complications during pregnancy and childbirth which are determined, again, by the level of women’s health, including the presence of somatic pathology, and the quality of medical care, which, among other things, may depend on the material wellbeing of the family. To date, the rate of miscarriage is 10-25% of all pregnancies

Thus, fertility is a complex problem, the solution of which requires active actions simultaneously in the economic, social, biological and psychological spheres of life of the population of the country. It is necessary to actualize the problem of depopulation in society and change the value orientations of a significant part of the population. The State should provide financial and social support to citizens in connection with the birth and upbringing of children, implement a set of measures to combine parental and family responsibilities with professional activities for women, as well as form medical care accessible to all segments of the population aimed at preserving reproductive potential and the birth of a healthy generation.