The Ministry of Health (MoH) and the World Health Organization (WHO) have asserted that addressing Bhutan’s low fertility rates will necessitate efforts beyond government interventions.
Bhutan is currently grappling with a significant demographic challenge as its fertility rate has plummeted to concerning levels.
Globally, no nation has managed to sustain a replacement-level fertility rate once it begins to decline, despite numerous initiatives. However, MoH officials remain optimistic that a combination of patriotic spirit and increased awareness can reverse this trend within a few years.
Bhutan’s current fertility rate stands at 2.0 births per woman, a stark decrease from 6.6 in 1971. This figure is below the replacement level of 2.1 births per woman needed to maintain a stable population. Nonetheless, a recent slight increase to around 1.2 births per woman offers a glimmer of hope.
Health experts recommend that each Bhutanese couple should ideally have two to three children to sustain the population.
The drop in fertility also calls into question the effectiveness of family planning initiatives launched in the 1990s. These programs successfully reduced maternal and infant mortality rates, but they also contributed to a significant decrease in the fertility rate, which dropped to around three children per woman by the early 2000s.
Contraceptive use among Bhutanese women has risen from 18.8 percent in 1994 to 58.7 percent in 2023. While some have suggested discontinuing contraceptives, WHO and MoH officials emphasize that doing so would violate human rights. Instead, they advocate for increased awareness about the importance of childbearing and its role in nation-building.
Several factors are contributing to the declining fertility rate in Bhutan. Economic challenges, such as slow growth and rising inflation, deter many from starting families due to high living costs.
Despite a decrease in the overall unemployment rate from 5.9 percent in 2022 to 3.5 percent in 2023, and a significant drop in youth unemployment, many young people are postponing childbearing to complete their education and establish their careers.
The optimal age for childbearing is between 20 and 30, but there are risks associated with later pregnancies.
Health issues are also a factor. According to a 2023 WHO report, approximately 17.5 percent of the global adult population—roughly one in six—experience infertility. This underscores the urgent need for accessible, high-quality fertility care.
Moreover, rural-to-urban migration disrupts traditional family planning practices, while emigration for education and employment leads many young Bhutanese to settle abroad and start families there.
Globally, the average fertility rate has declined from around 5 in the 1960s to about 2.4 in 2021. Countries such as South Korea, Singapore, Japan, and several European nations report fertility rates well below the replacement level, primarily due to high living costs, intense work culture, and expensive housing. Japan, for example, is projected to see its population decrease by about 30 percent by 2070.
In response, the Bhutanese government, supported by WHO, plans to introduce in vitro fertilization (IVF) in Thimphu as part of broader efforts to boost fertility rates. Additionally, the government has committed to providing Nu 10,000 per month per child until the age of three and is promoting comprehensive mother and childcare programs.
The Gyaltsuen Jetsun Pema Wangchuck Mother and Child Hospital, a 150-bed facility in Thimphu, aims to encourage childbearing. A dedicated health clinic for mothers and children is also being developed in Mongar.
Since June 2023, the Department of Labour has allowed the entry of foreign child caregivers, easing the burden on working parents and encouraging larger families.
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