Thinley Namgay
The Ministry of Health (MoH) and the World Health Organisation (WHO) believe that reversing the country’s low fertility would require more than just government interventions.
Currently, Bhutan faces a potential demographic challenge as its fertility rate has significantly dropped.
While, globally, no country has successfully maintained a replacement-level fertility rate once their population began to decline despite numerous initiatives, MoH officials are hopeful that the patriotic spirit and awareness of the issue can help turn the tide in a few years.
Bhutan’s fertility rate stands at just 2.0 births per woman, down from 6.6 in 1971. This figure is below the replacement level of 2.1 needed to maintain a stable population. However, a slight recent uptick of around 1.2 offers some hope.
Health experts suggest that for Bhutan to sustain its population, every couple should ideally have two to three children.
The decline in fertility also raises questions about the family planning initiatives in the 1990s. These measures effectively reduced maternal and infant mortality rates, health officials said. The campaign, which provided options like tubectomy, vasectomy, and copper-T insertion, also led to a significant drop in the fertility rate to around three children per woman by the early 2000s.
The contraceptive prevalence rate among Bhutanese women has risen from 18.8 percent in 1994 to 58.7 percent in 2023.While some suggest discontinuing contraceptives, WHO and MoH officials clarified that the government cannot stop contraceptives as it would violate human rights. Instead, they suggested advocacy and raising awareness about the importance of having children and their role in nation-building.
Several factors contribute to the declining fertility rate in Bhutan. Economic challenges, including slow growth and rising inflation, deter many from starting families due to high living costs.
Although the overall unemployment rate dropped from 5.9 percent in 2022 to 3.5 percent in 2023, and youth unemployment fell significantly, many young people delay childbearing to complete their education and establish careers.
The optimal age for childbearing is between 20 and 30, but there are risks associated with later pregnancies.
Health issues also play a role. According to a 2023 WHO report, approximately 17.5 percent of the adult population globally—roughly one in six—experience infertility. This statistic highlights the urgent need for accessible, high-quality fertility care.
In addition, rural-to-urban migration disrupts traditional family planning practices, while emigration for education and employment leads to young Bhutanese settling abroad and starting families there.
The global average fertility rate has reduced from around 5 in the 1960s to around 2.4 in 2021. Countries like South Korea, Singapore, Japan, and several European nations report rates well below the replacement level, primarily due to high living costs, intense work culture, and expensive housing. Japan’s population, for example, is expected to decrease by about 30 percent by 2070.
The government, supported by WHO, plans to introduce in vitro fertilisation (IVF) in Thimphu as part of a broader effort to improve fertility rates. The government has also committed to providing Nu 10,000 per month per child until the age of three and is promoting comprehensive mother and childcare programmes.
In addition, 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.
From June 2023, the Department of Labour began allowing the entry of foreign child caregivers, easing the burden on working parents and encouraging larger families.