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 AND RATIONALE 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. SEARCH 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. OUTCOMES 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. WIDER IMPLICATIONS 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.

中文翻译：

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全球生育率下降及其对计划生育和家庭建设的影响：基于文献叙述性回顾的 IFFS 共识文件。


背景技术 计划生育政策的重点是避孕方法，以避免意外怀孕、推迟或终止怀孕以及减缓人口增长。这些政策导致世界人口增长大幅放缓。目前，全世界有一半国家的生育率低于更替水平。不包括移民的影响，预计许多国家的人口从 2017 年到 2100 年将减少 50% 以上，从而造成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可以提高生育率，并且作为一种家庭建设方法正在引起人们的兴趣。越来越多的国家实施了儿童友好政策（在少数国家，除了公共资助生育治疗之外，主要是财政激励措施），以缓解国民人口减少的趋势。然而，各国在儿童福利方面的公共支出程度差异很大。据我们所知，这份国际生育协会联合会 (IFFS) 共识文件是在世界人口增长放缓的全球趋势背景下首次尝试描述获得生育保健方面的主要差异。现有文献。目标和基本原理 家庭建设的概念，即个人或夫妇创建或扩大家庭的过程，在计划生育范式中很大程度上被忽视了。家庭建设包括为想要孩子的个人或夫妇提供的各种方法和选择。它可以涉及生物学手段，例如自然受孕，以及辅助生殖技术、代孕、收养和寄养。 家庭建设承认个人或夫妇可以通过多种方式创建他们想要的家庭，并反映了这样的理解：建立家庭没有一刀切的方法。迫切需要为年轻人制定教育计划，以提高家庭建设意识并预防不孕不育。提出建议并确定重要的知识差距，以使专业人士、公众和政策制定者全面了解儿童友好政策的作用。检索方法 受邀的全球领导人对现有文献进行了叙述性回顾，他们本人也对该研究领域做出了重大贡献。综述的每个部分均由两到三名专家准备，每个专家都检索已发表的文献（PubMed）以获取同行评审的完整论文和评论。所有作者每月讨论各部分，审查委员会每季度讨论一次。最终文件是在混合邀请会议上所有团队成员进行讨论后编写的，并达成了充分共识。结果 自 20 世纪 90 年代以来，生育保健方面的重大进步极大地改善了家庭建设机会。尽管在一些富裕国家，高达 10% 的儿童是通过生育护理出生的，但获得护理的情况却存在很大差异。不孕不育治疗的高昂费用使大多数患者难以承受。初步研究表明，生育护理对全球人口的贡献以及相关的社会经济效益日益增加。更广泛的影响 在世界人口增长迅速下降的背景下，生育保健很少被讨论。 很快，大多数国家的平均每名妇女生育的孩子数量将远远低于更替水平。虽然这可能对环境产生有益的影响，但人口不足是许多国家非常关注的问题。尽管各国政府实施了儿童友好政策，但在获得生育护理方面仍存在明显差异。