Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysisResearch in context
Summary: Background: Several high-income countries, including Japan, have adopted pro-natalist policy to counteract declining fertility rates. However, the effectiveness of these policies varied across different studies and countries. This study aims to conduct an initial systematic review to ident...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-06-01
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| Series: | The Lancet Regional Health. Western Pacific |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606525001336 |
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| author | Md Mizanur Rahman Haruka Sakamoto Sabera Sultana Miho Sassa Md Ashraful Alam Kenji Shibuya |
| author_facet | Md Mizanur Rahman Haruka Sakamoto Sabera Sultana Miho Sassa Md Ashraful Alam Kenji Shibuya |
| author_sort | Md Mizanur Rahman |
| collection | DOAJ |
| description | Summary: Background: Several high-income countries, including Japan, have adopted pro-natalist policy to counteract declining fertility rates. However, the effectiveness of these policies varied across different studies and countries. This study aims to conduct an initial systematic review to identify effective policies that have reversed declining fertility rates. Subsequently, it will apply them to Japan’s context through scenario-based secondary analysis. The goals are to project Japan’s total fertility rate (TFR) up to the year 2035. Methods: We conducted searches in major electronic databases from their inception until March 27 2025 to investigate the impact of fertility policies. We also extracted a variety demographic and public expenditure data from the OECD, World Bank, and IMF databases for the years 1990–2022. A Bayesian hierarchical regression model was used to estimate and project Japan’s TFR trends up to 2035 in Japan, analyzing the effects of significant fertility policies on these trends. Findings: Our analysis included a total of 61 studies focusing on pro-natalist policies, identifying cash benefit policies—such as payment at birth, allowances, paid maternity and paternal leave, childcare coverage, and tax exemptions—as the most influential. Unpaid maternity leaves, universal two-child policy, and Assisted Reproductive Technology health insurance coverage also showed potential to boost fertility, although further research is needed. Countries like Australia, Greece, Hungary, France, and the UK allocate over 1.3% of their GDP to family cash benefits, contrasting Japan and Korea, where the allocation is less than 1%. Our findings indicate that Japan’s current cash benefit policies are unlikely to significantly reverse the fertility decline by 2030 (12% likelihood) and 2035 (29% likelihood). However, should Japan enhance its cash benefits to levels observed in Australia, Hungary, and France by 2030, the probability of reversing Japan’s fertility decline could rise significantly to 79%, 70%, and 69%, respectively. Even if cash benefit policies are scaled up by 2035, the probability of reversing the decline fertility rate is projected to be around 60 or more. Interpretation: Cash benefits emerged as the most effective fertility policy in high-income countries, although such benefits in Japan were notably modest. Elevating Japan’s cash benefit scheme could potentially lead to higher TFR. Funding: HIAS Health, Hitotsubashi University; Tokyo Foundation for Policy Research, Japan. |
| format | Article |
| id | doaj-art-416481eba7ac48c1b01039cfedb0a633 |
| institution | OA Journals |
| issn | 2666-6065 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj-art-416481eba7ac48c1b01039cfedb0a6332025-08-20T02:06:57ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652025-06-015910159610.1016/j.lanwpc.2025.101596Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysisResearch in contextMd Mizanur Rahman0Haruka Sakamoto1Sabera Sultana2Miho Sassa3Md Ashraful Alam4Kenji Shibuya5Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan; Corresponding author. Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo 186-8601, Japan.Tokyo Foundation for Policy Research, Tokyo, Japan; Department of International Health and Tropical Diseases, Tokyo Women’s Medical University, JapanTokyo Foundation for Policy Research, Tokyo, JapanDepartment of Global Health Policy, Graduate School of Medicine, The University of Tokyo, JapanDepartment of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, JapanMedical Excellence JAPAN, Tokyo, 103-0023, JapanSummary: Background: Several high-income countries, including Japan, have adopted pro-natalist policy to counteract declining fertility rates. However, the effectiveness of these policies varied across different studies and countries. This study aims to conduct an initial systematic review to identify effective policies that have reversed declining fertility rates. Subsequently, it will apply them to Japan’s context through scenario-based secondary analysis. The goals are to project Japan’s total fertility rate (TFR) up to the year 2035. Methods: We conducted searches in major electronic databases from their inception until March 27 2025 to investigate the impact of fertility policies. We also extracted a variety demographic and public expenditure data from the OECD, World Bank, and IMF databases for the years 1990–2022. A Bayesian hierarchical regression model was used to estimate and project Japan’s TFR trends up to 2035 in Japan, analyzing the effects of significant fertility policies on these trends. Findings: Our analysis included a total of 61 studies focusing on pro-natalist policies, identifying cash benefit policies—such as payment at birth, allowances, paid maternity and paternal leave, childcare coverage, and tax exemptions—as the most influential. Unpaid maternity leaves, universal two-child policy, and Assisted Reproductive Technology health insurance coverage also showed potential to boost fertility, although further research is needed. Countries like Australia, Greece, Hungary, France, and the UK allocate over 1.3% of their GDP to family cash benefits, contrasting Japan and Korea, where the allocation is less than 1%. Our findings indicate that Japan’s current cash benefit policies are unlikely to significantly reverse the fertility decline by 2030 (12% likelihood) and 2035 (29% likelihood). However, should Japan enhance its cash benefits to levels observed in Australia, Hungary, and France by 2030, the probability of reversing Japan’s fertility decline could rise significantly to 79%, 70%, and 69%, respectively. Even if cash benefit policies are scaled up by 2035, the probability of reversing the decline fertility rate is projected to be around 60 or more. Interpretation: Cash benefits emerged as the most effective fertility policy in high-income countries, although such benefits in Japan were notably modest. Elevating Japan’s cash benefit scheme could potentially lead to higher TFR. Funding: HIAS Health, Hitotsubashi University; Tokyo Foundation for Policy Research, Japan.http://www.sciencedirect.com/science/article/pii/S2666606525001336Total fertility rateBirth rateFertility policyCash incentiveParental leaveScenario-based analysis |
| spellingShingle | Md Mizanur Rahman Haruka Sakamoto Sabera Sultana Miho Sassa Md Ashraful Alam Kenji Shibuya Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysisResearch in context The Lancet Regional Health. Western Pacific Total fertility rate Birth rate Fertility policy Cash incentive Parental leave Scenario-based analysis |
| title | Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysisResearch in context |
| title_full | Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysisResearch in context |
| title_fullStr | Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysisResearch in context |
| title_full_unstemmed | Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysisResearch in context |
| title_short | Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysisResearch in context |
| title_sort | reversing fertility decline in japan with foreign pro natalist policies 1990 2035 a systematic review and secondary data analysisresearch in context |
| topic | Total fertility rate Birth rate Fertility policy Cash incentive Parental leave Scenario-based analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2666606525001336 |
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