The decline in fertility rates in Germany is at an all time low. This is becoming a serious health issue in Germany because low birth rates result in a declining population, which will eventually lead to a lack of people to run the country and fill important positions such as health care providers and health researchers. Social, political, and economic determinants have a major effect on Germany’s declining birth rate. The main social determinants include an increase in women furthering education and entering the work force. Political determinants such as the merge between East and West Germany, and government not providing enough public day care facilities and maternity leave benefits also effect women’s decision to have fewer children. When couples or single women do not have an ideal economic situation, they are also less likely to start a family. Economic factors that stem from social and political issues in Germany also play a role in low fertility rates. While examining low birth rates in Germany, I used the critical medical anthropological theory to help explain the causes and effects of this health issue.
The Critical medical anthropology is defined as “…understanding and responding to pressing health issues and problems around the world as they are influenced and shaped by human social organization, culture, and context” (Singer 2004). Merrill Singer also claims that medical anthropology is more concentrated on “the micro level and involved explaining health-related beliefs and behaviors at the local level in terms of specific ecological conditions, cultural configurations, or psychological factors” (Singer 2004). The critical medical anthropology theory does provide some insight into ecological, cultural and psychological factors, but it tends to “ignore the wider causes and determinants of human decision-making and action” (Singer 2004). This, however, does not effect the examination of low birth rates in Germany because social, political, and economic factors are what the critical medical anthropological theory focuses on. An excellent example of this was given in our class lecture on critical medical anthropological theory. It leads to the idea that biomedicine focuses mostly on “biological and chemical processes” related to health issues, but it does not factor in social, economic, and political factors as much because these factors are not as much of an issue compared to other countries. So people in other parts of the world who have less power, money, fewer health resources and health care are more aware of social, economic, and political determinants because it directly affects their health. In other words, the social, political, and economic issues in Germany are different compared to other countries, and more directly affect health issues such as birth rates opposed to a country that does not have the social, political, and economic issues that Germany does. These social, political, and economic issues are the basis for the critical medical anthropological theory, and are exactly why it is the best theory to use for examining low birth rates in Germany.
The crude birth rate as of 2012 was 8,400,000 and the total fertility rate was only 1,400,000. The population annual growth rate from 2012-2013 was only 0.2% compared to 0.7% in the United States. The crude birth rate of the United States in 2012 was 13,300,000 (UNICEF 2013). Also, the crude death rate in 2012 in Germany was 10,800,000. With the crude death rate being higher than the crude birth rate in Germany, the birth rate is now below what it needs to be for “generational replacement”. (Sleebos 2003). Generational replacement is when there are enough people being born and populating the country so they can replace the older generations that will eventually die. Without generational replacement, the population in Germany will eventually cease to exist.
Before explaining the effects of social, political, and economic determinants on birth rates, it is important to understand why fertility is so important. A low birth rate creates a chain reaction that will eventually affect the economic and health status of Germany. When the birth rate is low, this reduction in growth results in the reduction in the size of population compared to developing countries. This could then lead to changes in government and shifts in political power compared to other countries. If there is a lack of generational replacement, then there will be a deficit of people who are able to join the work force. Currently, pensions are financed by today’s workers paychecks, but if there are fewer workers then there will be less money for pensions (Sleebos 2003). With less money for pensions from worker’s paychecks, the government will have to support the high number of retirees. This could then result in major debt for the country. Not only does a low birth rate affect Germany economically, but most importantly from a health perspective. If there is a lower population, and no generational replacement, then there will not be enough workers to fill positions of health care providers and health researchers. A lack of health care will be detrimental to the future population (Sleebos 2003).
Now that the effects of low birth rates in Germany have been established, it is important to comprehend how these low birth rates came to be. Social determinants are a major factor in women’s decision to have children or not. According to the World Health Organization, social determinants of health are, “the conditions in which people are born, grow, live, work, and age” that “are mostly responsible for health inequities- the unfair and avoidable differences in health status seen within and between countries” (WHO 2015). These determinants of health give us a better idea of what social factors most directly affect the health, or lack of health for all people. In Germany, work is the main social determinant in women deciding to not have children. In German society today, more women are deciding to further their education and enter the workforce. Hank & Kreyenfeld (2003), state, “women’s emancipation and career orientation are part of an irreversible progress of social, demographic, and ideational change…” This means that women’s new economic goals are now leading to adjustments in family planning. With a higher skill demand for many careers these days, women are now staying in school longer. Women who are in school, or finish their education later than other women are less likely to have children (Hank & Kreyenfeld 2003). In the past, women would often have children before they finished their education, but today education has become a priority.
Women also have difficulties balancing work, providing childcare, and fulfilling other household duties. Since women have started preferring their own careers, difficulties balancing time for work and home life are changing their decisions to have children. Full time workingmen spend on average 9 hours working each day. Out of these 9.8 hours, about 6 hours is spent on paid work, 1 hour is spent on childcare, and about 2.2 hours is spent on other unpaid work. Full time workingwomen spend about 10.3 hours working each day. Four hours is usually spent on paid work, 2 hours is spent on childcare, and about 4.3 hours is spent on other unpaid work such as household duties (Sleebos 2003). In conclusion, women who work fulltime spend about 2 hours more working each day compared to a workingman. Since it is extremely difficult for women to balance all of these responsibilities, they are sometimes forced to choose between a career and having a family.
While the social determinant of work significantly effects women’s decisions to have children, economic situations also play a major role. Because it is very difficult for women to balance fulltime work, children, and other household duties, they are sometimes forced to choose work over a family in order to financially support themselves. According to Witte & Wagner (1995), “women who expressed concerns about personal economic situations were far less likely to have a child in coming months” compared to those who didn’t face economic problems.
Some of these economic problems stem from political factors. After the unification of East and West Germany in 1990, many people’s economic stability faltered. Combining two different economies into one economy resulted in many people struggling to find a balance between the two. A study was implemented to find a link between declining fertility rates and the unification of Germany. Statistics show that there was a 40% decline in fertility between 1990 and 1991 (Witte & Wagner 1995). Also, the average predicted number of children per woman declined from 1.5 to 0.9% (Witte & Wagner 1995). Probabilities of East German women giving birth between April 1991 and March 1992 according to their current worries and future expectations were computed based on the question: “Are you currently concerned about your personal economic situation?” Results show that all women who said yes to this question have a probability of .04 for all births and .07 for first births. Women who responded no had a probability of .17 for all births and .31 for first births. The justification behind these responses was all directly related to couple’s current economic status. Couples that know unemployment is high, there are less generous maternity benefits, and few childcare choices “respond rationally by limiting fertility” (Witte & Wagner 1995). The political changes in government and economies have drastically effected women’s decisions to have children because they do not want to bring a child into the world under unstable economic situations.
Other reasons for decreases in fertility after the unification of East and West Germany were the introduction of abortion and birth control. Abortion and birth control were introduced before the unification of Germany, but it became more prevalent and widely used after the unification. In April 1974, the government passed a law “allowing for legal pregnancy termination up to the third month…” (Glatzer et. al 1992). Glatzer, et. al (1992) also states that low birth rates started with “the introduction of reliable contraceptive devices, especially the pill, which enabled women to take a more active part in family planning,” The introduction and legalization of contraceptives can be viewed as a political and social issue. The government legalized contraceptives, however, women still had a choice in using them depending on their current situation.
Another political factor that is keeping fertility rates low in Germany is the lack of public health care. The provision of childcare in Germany is considered a “municipal responsibility” (Hank & Kreyenfeld 2003). The government does not provide enough public childcare to help women balance work, children, and other duties, so they often choose not to have children, or have less children. Schools in Germany often get out around 1 p.m., which is the middle of the workday for most. It would not be possible to leave work early every single day to pick up kids from school and then return to work. Another deterring political element for women deciding to have children is maternity leave benefits. Germany is regarded as one of the most generous countries when it comes maternity benefits, yet the birth rate is still so low. This could be due to a lack of paternal leave for fathers. Many fathers need to take time off initially to help their wives take care of the new baby. When fathers are not given enough time to help with the care of a newborn, mothers become more hesitant to have children. Studies reveal, “the contrast between mothers’ maximum entitlements and fathers’ minimum entitlements is stark” (Ray et. al 2010). Some countries, such as Germany, offer “use it or lose it” job protected leave for fathers, but some countries do not offer paternal leave at all. The German government gives only about 8 weeks of paternity leave for fathers (Ray et. al 2010). Compared to other countries such as France (156 weeks) and Sweden (78 weeks), these 8 weeks seems very unsubstantial. Due to cultural norms, many fathers are not willing to take time off either. German cultural norms almost always place the mother as the childcare provider and the father as the “breadwinner”. A study in 2014 showed that only 17% of men and 23% of women stated that they could imagine the man staying at home taking care of the children and the woman becoming the main provider (Economist 2014). The cultural norms of Germany once again place many German women in a situation where they have to once again choose between children and work.
From a critical medical anthropological perspective, it is evident that a negative correlation exists between a mother’s job status or education and her lifetime fertility. As Low (1993) states, “this implies a conflict: what is invested in work cannot be invested in childcare.” Other social and economic determinants such as the German cultural norm of placing the man as breadwinner and the woman as childcare provider result in low birth rates as well. Many women, however, have less than idea economic situations and cannot afford to stay at home to take care of children without working, so they decide not to have any children. These economic and social factors stem from political changes and policies in Germany The unification of East and West Germany caused many people to fall into poor economic situations, resulting in many women’s decision to not have children. German government also lacks the provision of public childcare, which is one more reason that women cannot work. If women cannot work and support themselves, they respond rationally by limiting their fertility. Lastly is the issue of maternity benefits. German government provides generous maternity benefits for women who have children, but they provide very limited paternity leave benefits for fathers. With a lack of childcare provision and a small window of time for the father to help take care of a newborn, many women decide they do not want to have children. The low birth rates in Germany ultimately create a ripple effect that will eventually create a major health issue for the country of Germany. Low birth rates mean a lower population every year. Low populations will soon mean a deficit of people joining the workforce. With less people working, pensions will no longer be supplemented by worker’s paychecks and the German government will have to start using their own funds for the greater retiring population. This could potentially place Germany in debt. Debt and a low population can also cause shifts in political power compared to other countries. Health issues will start when the retiring generations no longer receive health care because of a lack of money from younger generations and a lack of people to fill health care provider and researcher positions. A shift in political power could also mean less overall health resources for the entire population. A weaker country means less health knowledge and health care to prevent and fight disease and illness for the population.
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