Infertile ground: time to up our game on fertility education

A planned national curriculum 'refresh' of relationships and sexuality education will be an opportunity for New Zealand to finally align with global initiatives, writes Rhonda Shaw.

Doctor looking at ultrasound image
Photo: via Pexels

Comment: Global fertility rates are declining. New Zealand’s fertility rates reflect international trends, particularly those in middle- to high-income countries. In 2023, the total fertility rate in New Zealand, which has been below 2.1 since 2013, dropped to a record-low of 1.56 births per person.

Demographers and social scientists attribute the decline in fertility rates and involuntary childlessness to multiple factors. These include medical conditions, health determinants, economic pressures and job precarity, higher education and career pursuits, lack of a suitable partner, being in a gender-diverse or same-sex relationship, absence of supportive family policies, environmental costs, and climate anxiety concerns.

Insufficient fertility knowledge has also been identified as a key factor in the failure to achieve desires to be (or not be) a parent. To address this deficit, the World Health OrganizationUNESCO, and other bodies suggest improving fertility awareness through relationships and sexuality education (RSE) programmes. They argue that informed decision-making relating to preventing or avoiding pregnancy and to family-building (conception knowledge, pregnancy planning, and childbearing) is crucial in supporting young people’s reproductive and sexual health in later life.

In our research with fertility experts and people accessing assisted reproduction, those we interviewed thought RSE emphasised contraception, reducing unplanned pregnancies and sexually transmitted infections, and that fertility awareness was often overlooked. Experts pointed to a lack of information given to young people about the optimal time to start a family, challenges to getting pregnant, fertility risk factors such as prolonged exercise, and how to manage and avoid early onset infertility.

As one fertility clinic counsellor in our study put it: “No one tells you what to do when you can’t [have children] or the optimum time to be starting a family. No one talks to you about this stuff, you just find yourself sitting in a fertility clinic talking to a counsellor and it’s like, I just thought I’m young, I go to the gym five times a week, I’m healthy, but your body doesn’t say the same thing.”

A women’s health doctor we interviewed reckoned: “Half the problem is that the media and women’s magazines publish articles of celebrities having babies well into their 40s, saying they did IVF [in vitro fertilisation]. And people believe, oh, if I can’t have a baby naturally, I’ll just do IVF, and this belief that IVF will guarantee you a baby is wrong. A lot of people go through IVF and aren’t successful. Everything about sex education in schools is about telling kids how not to have babies.”

Evidence from international studies with college-level students concurs, showing a low-to-moderate range of fertility awareness among university students. In New Zealand, recent school leavers taking university classes with modules on family, whānau, and intimate relationships draw a blank when asked to pinpoint men’s and women’s peak reproductive years and guesstimate the beginning of fertility decline, showing a lack of awareness about the limitations of their own fertility.

One study indicates that university graduates may be “unrealistically optimistic” about the chances of becoming pregnant. The study, which involved survey research with 5,157 students aged 20 to 34 at New Zealand universities, suggests these young adults believe biological fertility declines much later than it does and overestimate the success rate of fertility treatment.

While gender and sexuality norms are shifting and families are more diverse than ever, there is no published evidence that fertility preservation or access to assisted reproduction is discussed with gender- and sexuality-diverse youth at secondary school level.

The recent government announcement to introduce a national curriculum “refresh” of RSE, designed to replace guidelines introduced by the Ministry of Education, provides an opportunity to align with global initiatives around the promotion of fertility education.

The aim of this initiative is to better incorporate fertility awareness in RSE, not to advocate pronatalism or encourage certain young people to procreate. What is proposed is the introduction of well-timed modules on reproductive and sexual health that reflect a comprehensive range of topics applicable to all young people, including holistic modules on bodies and identities, consent, relationship diversity and intimacies, infertility risk factors and treatments, fertility choices, assisted reproduction options, and parenting aspirations. Reading the findings and recommendations of the recently published Education Review Office RSE report, this could be achieved from Year 10 and up.

This article was originally published on Newsroom.

Rhonda Shaw is an associate professor in the School of Social and Cultural Studies at Te Herenga Waka—Victoria University of Wellington.


Health and wellbeingOpinion