Japan, South Korea, Singapore, Taiwan, Italy, Spain, Greece, Poland, Ukraine And Additional Countries Struggle With Fertility Declines as Japan Sets Example with 2026 Childbirth Fee Coverage Reform : New Update

Japan, South Korea, Singapore, Taiwan, Italy, Spain, Greece, Poland, Ukraine, and several other countries are grappling with alarming declines in fertility rates, posing serious challenges to their demographic stability and economic sustainability. These nations face a complex combination of factors including rising living costs, career pressures, shifting social values, and limited family support systems that deter many from having children or lead to delayed parenthood. In response to this growing crisis, Japan is taking a bold step by introducing a groundbreaking reform in 2026 that will cover hospital fees for childbirth under its national health insurance system. This pioneering move aims to alleviate the financial burden of childbearing, encouraging families to have more children and offering a potential blueprint for other countries confronting similar fertility challenges.

Currently, childbirth expenses in Japan are largely not covered by national health insurance except for certain procedures such as Caesarean sections. The cost of a standard delivery has steadily risen, reaching an average of 518,000 yen in the first half of 2024 — a 24 percent increase compared to 2012. Although the government provides subsidies of up to 500,000 yen per birth, recent evaluations reveal that nearly forty-five percent of births incur out-of-pocket costs exceeding this subsidy, underscoring the inadequacy of current support.

Japan’s birth rate reached a historic low in 2024, with only 720,988 births recorded—the smallest number since the country began keeping such records over 125 years ago. Compounding the problem, approximately thirty percent of Japan’s population is aged sixty-five or older, creating an urgent need for policies that can reverse demographic decline and support a more balanced age distribution.

This demographic issue is not isolated to Japan. Numerous developed countries in Asia and Europe are grappling with similar declines in fertility rates. Contributing factors include modern lifestyles that prioritize career and personal freedom, economic challenges such as rising living costs and housing shortages, and changing social values that affect decisions around marriage and childbearing. These trends collectively complicate and delay family formation and child-rearing.

Countries with the Lowest Fertility Rates in 2024

Data from Statista highlights several countries with the lowest fertility rates worldwide, measured as the average number of children born per woman of childbearing age. The following list identifies countries where fertility rates are notably below the replacement level of 2.1 children per woman, the minimum needed to sustain a stable population:

Taiwan – 1.11
South Korea – 1.12
Singapore – 1.17
Ukraine – 1.22
Hong Kong – 1.24
Macau – 1.24
Moldova – 1.26
Puerto Rico – 1.26
Italy – 1.26
Spain – 1.3
Poland – 1.32
Montserrat – 1.33
Mauritius – 1.36
Bosnia and Herzegovina – 1.38
British Virgin Islands – 1.38
Japan – 1.4
Greece – 1.41
Costa Rica – 1.43
Bahamas – 1.44
Belarus – 1.44

These figures illustrate a widespread demographic trend in many parts of the world where populations are shrinking or aging rapidly.

Implications of Declining Birth Rates

The consequences of sustained low birth rates extend far beyond population numbers, affecting economic growth, social structures, and political stability. With fewer young people entering the workforce, countries face labor shortages that hinder productivity and innovation. The reduced domestic consumer base also impacts demand for goods and services, slowing economic expansion.

Moreover, an aging population increases the burden on pension systems and social welfare programs, as fewer working-age individuals contribute taxes that support retirees. This imbalance threatens the long-term sustainability of public finances and social services.

Economic experts attribute declining birth rates to several interconnected factors: rising costs of living, especially housing; the difficulty of balancing work and family life; and evolving cultural attitudes that value personal freedom and career development over traditional family roles. Without intervention, these trends can result in population decline, weakening a country’s global economic competitiveness.

For instance, Japan and South Korea are already experiencing acute labor shortages and are turning increasingly to automation technologies to fill gaps in productivity. Both countries are also considering more open immigration policies to supplement their shrinking workforces.

Policy Approaches for the Future

Addressing low birth rates requires comprehensive strategies that support families holistically. Financial assistance for childbirth and child-rearing, improved access to affordable housing, enhanced childcare services, and flexible work arrangements are critical components. Policies that promote gender equality and support work-life balance can also encourage higher fertility rates by reducing the burden on parents.

Additionally, governments need to adapt to changing societal norms and expectations around family life, ensuring that young people feel empowered and supported in their decisions to have children.

Japan’s decision to cover childbirth hospital fees through national health insurance reflects an important step in this direction. By lowering one of the key financial barriers to having children, the policy aims to alleviate economic pressures and help stabilize the nation’s population for future generations.

Japan, South Korea, Singapore, Taiwan, Italy, Spain, Greece, Poland, Ukraine, and others face steep fertility declines due to economic and social pressures, while Japan leads by example with its groundbreaking 2026 policy to cover childbirth hospital fees, aiming to ease financial burdens and boost birth rates.

Sustaining a balanced and vibrant population will remain a complex challenge for many countries in the coming decades, demanding innovative and responsive policy solutions that address economic realities and social values alike.

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