AT a public event recently, a government minister urged women to have more babies to save schools from closing due to low enrolment. This suggests that Jamaica has reached an important demographic crossroads.

For years, our reproductive health policies understandably concentrated on reducing unplanned pregnancies, adolescent pregnancy and high fertility rates; however, it is time for the national conversation to broaden. Recent statistics from the Ministry of Health and Wellness (MOHW) have shown that Jamaica’s total fertility rate has fallen to approximately 1.3 children per woman, which is below the replacement level of approximately 2.1 and among the lowest fertility rates recorded in the country’s history.

According to the United Nations Population Fund, at the Jamaican launch of the State of World Population 2025 report, Jamaica’s total fertility rate was reported at 1.9 children per woman, also below the replacement level of 2.1. While this differs from the MOHW rate of 1.3, the rates are based on different data sources and reference periods. Regardless of the estimate used, Jamaica’s fertility rate is below replacement level and reflects a sustained decline.

Jamaica is not alone in confronting declining fertility rates. The United States recorded a total fertility rate of approximately 1.63 children per woman in 2024, remaining well below the replacement level of 2.1. Approximately 3.63 million births were registered in the United States that year. Similarly, New Zealand recorded an even lower total fertility rate of 1.56 children per woman in 2024, with 58,341 live births registered. China is also confronting an extremely low fertility rate of approximately 1.01 children per woman, despite recording 9.54 million live births in 2024, as well as population decline. This has prompted national concern about its ageing population and shrinking future workforce.

These international experiences demonstrate that declining fertility is complex and not simply a reproductive health issue. Sustained low fertility can have far-reaching implications for population growth, school enrolment, the size of future workforce, economic productivity, pension systems, healthcare services and the capacity of a smaller working-age population to support an increasing elderly population.

The dilemma

The decline has been substantial and could easily be described as a dilemma. According to the MOHW, Jamaica’s total fertility rate was approximately 3.0 children per woman in 1993, declining to 1.9 in 2021, with the Ministry reporting a fertility rate of 1.3 in 2022. The country’s 2026 Voluntary National Review further reports that fertility rate was approximately 4.5 children per woman during the period 1973-1975. Jamaica’s population is currently approximately 2.7 million, with a median age of 33.3 years, increasing from 17 years in 1970. This reflects a progressively ageing population. Please note that these demographic data may vary depending on the source, methodology and reference year.

A point to note is that the decline in the fertility rate is occurring alongside migration and population ageing. This decline should compel us to examine not only how many children Jamaican women are having, but whether women and families are adequately supported during the childbearing and childrearing periods. Central to this discussion must be a health professional whose contribution is sometimes underestimated — the midwife.

Midwife defined

The International Confederation of Midwives defines the midwife as an educated, regulated and accountable health professional who works in partnership with women across pregnancy, childbirth and the postnatal period, while also contributing to reproductive and sexual health, health education and care of the newborn. It is also widely accepted that midwives offer support to families and communities. It should be noted that midwives are not registered nurses unless they are licensed in both fields.

Why invest in midwifery?

Investment in midwifery should not simply mean training and employing more midwives to deliver babies. It requires a deliberate strengthening and repositioning of midwifery across the continuum of reproductive healthcare.

Midwives can provide preconception care, including reproductive life planning, health assessment, nutrition counselling, family planning and identification of high-risk pregnancies. They can help women and couples understand fertility and the implications of postponing childbearing, while respecting their right to determine if, when and how many children they wish to have.

This is important because of the changing fertility pattern in Jamaica. The 2021 Reproductive Health Survey found declining age-specific fertility across most age groups. Likewise, the National Family Planning Board highlighted this phenomenon across age groups, with women aged 25–29 being the notable exception. This data suggest possible postponement of childbearing.

Greater investment in midwives should, therefore, include midwife-led preconception clinics, more community reproductive health programmes and stronger referral pathways for women and couples experiencing fertility anomalies.

Supporting choice, not prescribing childbirth

There is an important caution because, in my humble opinion, a fertility rate of 1.3 should not be the justification for encouraging Jamaican women to have children or to have more children. UNFPA’s State of World Population 2025 makes an important distinction, pointing out that the real fertility crisis is not simply that fertility rates are rising or falling, but that many people cannot achieve the number of children they desire because of financial insecurity, inadequate services and insufficient social support.

Investment in midwifery must, therefore, be accompanied by broader policies addressing childcare, housing, employment security, parental leave, workplace flexibility and the economic realities of raising children. Midwives cannot solve these problems, neither can they reverse Jamaica’s declining fertility rate. They can, however, ensure that women and families considering parenthood receive expert information, that pregnancies are supported, that mothers receive safe and respectful care, that childbirth becomes a more positive experience for the family, and that women receive continuity of care after delivery.

In concluding, Jamaica’s falling fertility rate should prompt more than concern about numbers. It should stimulate serious discussion about the systems surrounding women, pregnancy, childbirth and family life. Investing in the next generation means greater investment in midwives who care for women as that generation begins. This is a great place to start.

Professor Adella Campbell is a lecturer in the College of Health Sciences, University of Technology, Jamaica.