The National Consultative Ethics Committee (CCNE) recently released a report titled “Decline in Birth Rates and Fertility: Different Responses, Shared Ethical Issues.” This report follows a request from the former health minister, Frédéric Valletoux, who asked the CCNE to provide insight into the ethical issues surrounding infertility on June 20, 2024. However, the report does not directly respond to that request and does not offer clear ethical recommendations either. Instead, the CCNE provides “perspectives,” which may confuse the issues at hand.
The request was focused on infertility, but the CCNE chooses to first discuss birth rates. This can be misleading because the solutions to infertility challenges and declining birth rates differ significantly, and their ethical considerations are often in conflict. The report emphasizes the importance of considering the child’s well-being in society, which contrasts with infertility issues that focus on the couple’s desires. The CCNE states that the interests of the child do not always align with the goals of parents wishing for a child. Therefore, combining these subjects in one report creates confusion about the issues and the possible solutions.
In discussing the decline in birth rates, the CCNE details various cultural, economic, and social reasons why fewer people want children. For instance, a recent survey found that 13% of women do not want children, a significant rise from 2.6% in 2006. The reasons given include personal fulfillment (91%), climate and political concerns (81%), and financial or family issues (63%). The age at which women are having children has also risen, contributing to the decline in births. From 1973 to 2023, the number of births dropped from 888,000 to 678,000, and in 2024, it continued to decline, with only 663,000 births.
The report questions whether medically assisted procreation (MAP) could be a solution to reverse the decline in birth rates. However, it appears that this is not the case, as the birth rate continues to fall despite an increase in the use of MAP. The CCNE acknowledges that while improving the success rates of MAP might help, it would only have a limited impact on overall birth rates. MAP mainly addresses individual desires rather than providing a long-term solution to declining fertility.
Additionally, the CCNE points out the risks associated with MAP for both couples and children. It mentions potential health issues that can arise from MAP procedures, which makes it surprising that the CCNE seems to position MAP as the primary solution for infertility. This approach does not empower couples but rather puts them at the mercy of medical professionals and procedures.
After discussing the causes of declining birth rates and the limited role of MAP, the CCNE presents some “perspectives” for future legislation on bioethics. However, it remains cautious and does not provide strong recommendations. Despite this, the report hints at certain ideas that might influence upcoming reforms in bioethics, such as promoting the preservation of gametes (sperm and egg freezing) and potentially opening access to foreign gamete banks, which could require changes to current French laws.
Furthermore, the CCNE suggests that improving genetic diagnostics related to infertility could lead to more discussions on the topic. It recognizes the need for more debate about infertility rather than merely addressing birth rates.
The report also touches upon two specific issues regarding MAP: post-mortem MAP and ROPA (the reception of oocytes from a partner). The CCNE notes that healthcare professionals and patient associations are generally supportive of these practices. It questions why it is acceptable to allow a child to be born to a single mother through MAP but not to allow post-mortem MAP.
In conclusion, the CCNE’s report sheds light on the complex relationship between declining birth rates and infertility but stops short of making definitive recommendations. As future bioethics discussions unfold, particularly those anticipated to begin in 2026, there may be more clarity on issues like post-mortem MAP and ROPA, as well as other evolving technologies in reproduction.
This article has been translated and simplified by artificial intelligence from a French article “Baisse de la natalité et de la fertilité : un avis timide du CCNE”
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