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Each Bhutanese couple should have 3 children to increase the Total Fertility Rate from 1.9% to 2.1%: MoH

Aim to increase fertility rate in 13th Plan

TFR to increase by 2034

The declining trend of the fertility rate in the country has become the highest concern, whereby the Ministry of Health (MoH) has prioritized increasing the Total Fertility Rate (TFR) from 1.9 percent to 2.1 percent by 2034 in the 13th Five-Year-Plan.

The Prime Minister shared that the current fertility rate is a concern in the country, as the trend is the biggest threat to the country due to the reduction in the birth rate.

A MoH official shared that, globally, there is a general trend in reduction in fertility rate, and in Bhutan the downward trend is seen. However, no scientific study has been done on what is causing the decline in the fertility rate. But from the anecdotal evidence, the cost of childcare is becoming expensive, and so the couples are choosing to have fewer children, and also the sperm quality is going down.

The ministry is venturing into specifically targeting the total fertility rate in those who have infertility issues, and those infertile couples to institute fertility clinic services and provide all the necessary interventions. There are Intrauterine insemination (IUI) services in JDWNRH and in the upcoming plan, the health ministry is planning to have In Vitro Fertilization. (IVF).

“We already have fertility services, but the health ministry is working on improving the existing services. For this, we have work together with the medical service group,” said the official.

Currently, the health ministry is focusing on quality care by ensuring that infant and maternal mortality with essential care and encouraging mothers with a quality pregnancy. Therefore, there is a preconception care program intervention, such as good check-up, vitamin supplementations and counselling for the couple.

MoH has been propagating on accelerating mother and child policy. However, it has faced financial issues, but the ministry is still trying to find the budget.

To increase total fertility, MoH, alone, cannot make it happen, it requires support from the multi-sectoral organization. Anecdotally, raising a child has become very expensive; therefore, there is a need to have childcare facilities where somebody can look after the kids unlike in the past when grandparents and parents used to look after the kids.

For instance, to achieve TFR in the 13th FYP, there is a need to bring in more recent technologies in infertility management and treatment. Other sectors could also provide affordable housing and could also come up with ideas to help the couple that have three or four children or the higher number of children, by giving them preference when accessing public facilities and transportation, such as free movement passes which can be some of the ways to accelerate the TFR in the country.

There is an assessment needed to look at the infertility burden, needs of the couple, someone who is career-focused, then individuals who are delaying their marriage and factors determining the reduction of the fertility rate in the country.

Some questioned the family planning services leading to population control. Family planning is just for birth spacing and ensuring a healthy pregnancy, it does not mean reducing the family size.

The number of deliveries in 2021 was 11,600, 11,139 in 2020, 10,156 in 2019 and 11,658 in 2018.

Meanwhile, the MoH official also shared that pregnant women do not compulsorily have to reflect the name of the spouse; instead they can have the emergency contact number. Reflecting the name of the spouse has always been an issue, due to which, many pregnant mothers do not come to avail themselves of the services.

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