"Since 1996, graduates of U.S. medical schools who enter training programs in obstetrics and gynecology have dropped 23 percent - from 968 to 743.

...But this year, just two-thirds of new residencies in obstetrics and gynecology nationwide were filled by graduates of U.S. medical schools - down from 86 percent eight years earlier."

(Source: Jonathon Bor, "Obstetrics is failing to draw new doctors," The Baltimore Sun, July 11, 2004; http://www.baltimoresun.com/news/health/bal-te.obstetrics11jul11,1,1356982.story.)

"'People don't want to be in the delivery room - that's where the malpractice is,' said Dr. Jack Gladstein, associate dean of students at the University of Maryland School of Medicine. 'Any time a baby comes out bad, the gynecologist gets sued.'

...'Nationally, we certainly are concerned about quality,' said Dr. Jessica Bienstock, who runs the OB/GYN training program at Johns Hopkins Hospital. 'If we're seeing fewer people going into the specialty, then we do need to start worrying about the quality of people who do go into the field.'"

(Source: Jonathon Bor, "Obstetrics is failing to draw new doctors," The Baltimore Sun, July 11, 2004; http://www.baltimoresun.com/news/health/bal-te.obstetrics11jul11,1,1356982.story .)

In a much-discussed book published in 1987, social commentator Ben Wattenberg warned of the consequences of the sub-replacement fertility-the "Birth Dearth"-observed in the United States since the early 1970s.  "The Birth Dearth," he then wrote, "hurts us in every geopolitical way: militarily, economically, politically, and culturally." The American birth dearth, however, looks relatively mild compared to that experienced by Western Europe in recent decades.

Indeed, in a recent issue of Population and Development Review a team of concerned demographers ponder the "negative population momentum" now evident in the European Union.  Extrapolating current trends into the future, the researchers develop three different demographic projections, all of which show the population of the EU-now close to 400 million-dropping to less than 100 million by 2400.  The researchers concede the implausibility of their statistical assumptions of "a closed population with no further mortality changes and constant fertility after 2021."  Yet they insist that their projections are still "useful for illustrating some important points."

The point the authors of the new study want most to illuminate is that "ending the increase in the average age of childbearing in Europe would have a substantial effect on population dynamics by slowing population decline and aging."  Although they acknowledge that "further declining population size" is "the dream of many ecologists," the researchers worry about the difficulty of providing income and health care for a disproportionately aged population.  Hence, they regard as desirable policies that would bring "an end to further postponement of childbearing population."  Such policies, they suggest, would have "significant positive effects both on population size and on reducing the burden of population again over the coming decades."

But having demonstrated the great social benefits of ending the retreat from childbearing, the researchers leave to other minds "the difficult question of what kinds of policy intervention might end further delays in childbearing."  They themselves have no answers to that question. 

Indeed, as if to emphasize the challenge of answering that question, the editors of Population and Development Review append to the new study comments published decades ago by two prominent scholars who could already discern the downward trajectory of European and American fertility.  One of these scholars-American sociologist Edward Alsworth Ross-celebrated the downward turn of fertility as "a colossal secular phenomenon" achieved by a civilization that is "democratic, individualistic, feminist, secular, and enlightened."  Though he conceded that low fertility brought "undoubted evils in its train," Ross dismissed these evils as "minor, or transient, or self-limiting, or curable" when compared to the "famine, war, saber-tooth competition, class antagonism, the degradation of the masses, the wasting of children, the dwarfing of women, and the cheapening of men" he viewed as inextricably linked to population growth.  

But readers encounter a very different perspective in the commentary of the second scholar whose remarks the PDR editors have chosen to reprint with Ross's as context for the new study of European population trends.  In this commentary, initially published in 1907 alongside Ross's, demographer Walter F. Wilcox expresses concerns that the PDR editors label "prescient" about how a society's fertility rate may decline "too far" because of "individual interests diverging from the interests of society."   "In the decrease of the birth-rate," Wilcox wrote, "...there may always be, and doubtless often is, a conflict between the apparent or real interests of the individual or [individual nuclear] family and the real interest of society, the former often indicating a balance of individual or family advantage in favor of a small family, the latter always indicating that it is for the welfare of man, as of any other form of life, to continue the species."  Because of this "conflict of interests," Wilcox feared that "the decrease of the birth-rate... may be more rapid, either in the entire community or in parts of it, than the welfare of the society as a whole or of humanity justifies."  Prescient indeed.