背景:计划生育政策侧重于避孕方法,以避免意外怀孕,推迟,或终止妊娠,减缓人口增长。这些政策导致世界人口增长大幅放缓。目前,全球有一半国家的生育率低于更替水平。不包括移民的影响,预计从2017年到2100年,许多国家的人口将下降>50%,从而导致具有深远社会影响的人口变化。在需要时优化生育机会的政策会提高生育率,并作为一种家庭建设方法而引起人们的兴趣。越来越多,各国实施了有利于儿童的政策(主要是财政激励措施,除了在少数国家为生育治疗提供公共资金外),以减轻国家人口的减少。然而,儿童福利的公共支出范围因国家而异。据我们所知,这份国际生育协会联合会(IFFS)共识文件是首次尝试描述在世界人口增长下降的全球趋势下获得生育保健的主要差距,基于对现有文献的叙事回顾。
目的:家庭建设的概念,个人或夫妇建立或扩大家庭的过程,在计划生育模式中被大大忽视了。家庭建设包括希望生孩子的个人或夫妇的各种方法和选择。它可能涉及生物手段,比如自然概念,和艺术一样,代孕,收养,和寄养。家庭建设承认个人或夫妇可以创造他们想要的家庭的不同方式,并反映了这样一种理解,即没有一种放之四海而皆准的家庭建设方法。迫切需要为年轻人制定教育计划,以提高家庭建设意识并防止不孕。提供了建议,并确定了重要的知识差距,以提供专业人员,公众,政策制定者全面了解爱幼政策的作用。
方法:由受邀的全球领导者对现有文献进行叙述性回顾,他们自己对这一研究领域做出了重大贡献。审查的每个部分都由两到三名专家编写,每个人都在已发表的文献(PubMed)中检索了同行评审的完整论文和综述.所有作者每月讨论各节,每季度由审查委员会讨论。最后文件是在所有团队成员在一次混合邀请赛中进行讨论后编写的,会上达成了充分共识。
结果:自1990年代以来,生育保健方面的重大进展极大地改善了家庭建设的机会。尽管在一些富裕国家,所有儿童中有多达10%是由于生育保健而出生的,获得护理的机会差异很大。不孕症治疗患者的高成本使大多数人负担不起。初步研究表明,生育保健对全球人口的贡献越来越大,并为社会带来相关的经济利益。
结论:在世界人口增长迅速减少的背景下,很少讨论生育保健。很快,大多数国家的平均每名妇女生育数量将远远低于替代水平。虽然这可能会对环境产生有益的影响,在许多国家,人口不足是一个令人严重关切的问题。尽管各国政府实施了爱幼政策,在获得生育保健方面仍然存在明显差异。
BACKGROUND: Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS)
consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature.
OBJECTIVE: The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies.
METHODS: A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full
consensus was reached.
RESULTS: Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society.
CONCLUSIONS: Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain.