“China is facing a population crisis but some women continue to say ‘no’ to having babies.” — CNBC
“It’s ‘now or never’ to reverse Japan’s population crisis, prime minister says.” — CNN
“South Korea in demographic crisis as many stop having babies.” — Associated Press
“Population collapse imminent? Italy’s birth rate drops to historic low in 2022.” — World Is One News
“Russia’s existential challenge is not just war but demography.” — Mercator Net
“U.S. birth rates at record lows.” — The Conversation
Around the world, some countries (although not all) are starting to grapple with what some see as an existential crisis: Their birth rates have fallen so low that they are below what demographers call the “replacement rate,” meaning those countries are destined to see their populations decline.
That “replacement rate” is calculated at 2.1 babies per woman. Why isn’t it 2.0? Because demographers factor in that some children will die. This is a grim actuarial business.
The United States fell below that replacement rate in 1974 and has never been back above it. In the 1990s and early 2000s, we topped 2.0 but never got to 2.1. Now we’re back down to 1.784, not quite a record low (that was 1.778 in 1978) but close to it.
The only reasons that the United States isn’t losing population are that a) people are living longer but mostly because of b) immigration. Countries that aren’t so open to immigration (such as Japan) or aren’t so desirable (such as China) are seeing their populations decline. This is why efforts to decrease immigration are economically short-sighted: Many of our entitlement programs (such as Social Security) are based on the notion that we have a large pool of younger workers paying taxes to benefit a smaller pool of retirees. If we have a small pool of workers paying to support a larger pool of retirees, the system doesn’t work. We need more younger adults — to fill the jobs coming vacant as baby boomers retire, and to pay taxes to support those baby boomers in their retirement. If we’re not producing those young adults naturally, then immigration (something the United States has embraced through much of its history as a key component of the American identity) is the only recourse. Otherwise, we have to reconcile ourselves to a declining population and to the structural challenges that would bring to our society, which has been built on the assumption that our population will always either grow or, at least, stay stable. But that’s a conversation for another day.
Today we will examine this issue not through the big picture lens but through a local one, because many localities in rural Virginia have fertility rates that are much lower than the ones that China, Italy, Japan, Russia and South Korea are agonizing over.
Let’s look at some baseline numbers. According to World Population Review, South Korea has the world’s lowest fertility rate, at 1.0 births per woman. If that continued long enough, South Korea’s population would be cut in half. Italy, it’s 1.3. In Russia, 1.6. In China, 1.7, about the same as the United States, just without the aforementioned benefit of immigration. And those are just the countries whose public lamentations have made the news recently. The figures in Western countries are all below the replacement rate — from 1.3 in Spain to 1.8 in Ireland and Sweden to a relatively fecund 2.0 in New Zealand. And not just Western countries. Brazil’s fertility rate is 1.7, Chile’s is 1.6, Singapore’s is 1.1. The countries driving population growth are all in Africa; 25 of the 26 highest fertility rates in the world are there, with Niger topping the list at 6.9 births per woman. If you’re looking at the global big picture, then these explosive population growth rates in Africa could either lead to large-scale unrest and migration in search of better opportunities — or to fantastic economic growth on the continent. Africa’s not a place that takes up a lot of our foreign policy; perhaps it should.
In any case, I promised a local look so let’s place more attention on Norton and Nottoway County than Niger.
Hamilton Lombard, a demographer with the Weldon Cooper Center for Public Service at the University of Virginia, has supplied me with the fertility rates for each locality in the state, based on the Census Bureau’s American Community Survey. The first caveat: In small communities, these rates are often misleading. The layman’s term would be “whacked.” Fewer people, fewer women, so the percentages can often look out of line, high or low, based on a relatively small numerical change. We’ll just set those aside so we don’t get distracted by statistical oddballs. For instance, they show the fertility rate in Williamsburg to be just 0.65 births per woman. However, Williamsburg is a college town and so its numbers are distorted by a lot of young women who are in school and not the maternity ward. Likewise, the highest fertility rate in the state is supposedly in Highland County — 3.64 births per woman — but Highland is also the smallest county in the state, so it doesn’t take much to send those figures up or down wildly. Best to look at larger communities. By that measure, the highest birth rate is in Tazewell County, at 3.35 births per woman.
Most of Virginia, as you’ll see from the map above, has birth rates below the replacement rate. To examine this further, let’s look at two communities that are very much not college towns and where the fertility rate is unusually low. In Covington, the fertility rate is 0.5 births per woman; in Alleghany County, the rate is 0.9 births per woman.
This makes much more sense. In Covington, the median age is 41.4, in Alleghany it’s 49.1. These are simply older communities, with relatively few women in their child-bearing years. We can also see the consequences of an older population. In both communities, deaths outnumber births. Since 2020, the Census Bureau says Alleghany County has seen 344 more deaths than births while Covington has seen 98 more deaths than births. That’s not surprising: With an older population, neither community can expect to see many births. Both communities have seen a small amount of net in-migration — more people moving in than moving out. But that net balance of new residents is dwarfed by all those deaths in an aging population. The result: Both Alleghany County and Covington are losing population.
Here’s a real-life consequence of all that: This is the last year for Covington High School. After this school year, it will be merged into Alleghany County High School. That’s a painful thing for the community. Our readers in more urban areas may not be able to appreciate just how central a school is to a small community’s identity. But the numbers are what they are. In 1960, there were 225 babies born in Covington. In 2021, just 56. Some of that is due to population decline, but just as big a change has been dropping fertility rates. In 1960, the nation’s fertility rate was 3.4 births per woman, now it’s about half that.
From a policy perspective, if Covington and Alleghany County want to keep their populations stable — let’s not even talk about growing, let’s just talk about breaking even — then they really just have one recourse. They need to attract new residents, ideally new, young residents who will then let nature take its course. That’s easy prose to write, but much harder policy to enact. In the meantime, Covington High School is still closing.
Now let’s look at two other places where we’ve seen falling birth rates, combined with a falling population, reverberate with economic consequences. Last year, the Sovah Health hospital in Martinsville closed its labor and delivery unit. A few weeks ago, Sentara announced that its hospital in Halifax County would likewise close its labor and delivery unit. In both cases, the reason was the same: not enough births to justify those units’ existence. Sentara said that in 2018, it delivered 363 babies in Halifax — almost one a day. By 2022, there were just 244 deliveries, which meant that one-third of the time there were no deliveries taking place. From a business perspective, it’s hard to maintain a service that’s only used two-thirds of the time — and given demographic trends, likely to be used even less in the future.
Local officials aren’t happy about Sentara’s decision; they see it as bad for economic development. They’re right, of course. This is a vicious cycle: Halifax, like all rural localities, wants to attract new and younger residents, but what young couple is likely to move to Halifax if they know they’ll have to go out of town for any future labor and delivery services? I can understand the frustration that Del. Jim Edmunds, R-Halifax County, expressed to the South Boston News & Record: “We’ve gone to great lengths to get broadband here, get young professionals here, and by the way, you’ve got to drive out of town to have a baby. We’ve got a new high school but you have to go out of town for a baby. It’s crazy,” he said. On the other hand, I can’t fault Sentara for making a bottom-line business decision: Why should the hospital pay — literally — to maintain a service that it says is losing money? That raises a different question: Should somebody subsidize those hospital labor and delivery services because that’s necessary for economic development, just as we subsidize some of that broadband installation that the private sector either couldn’t or wouldn’t pay for on its own? Edmunds has raised that prospect: “If they can prove to me they’re losing money and they need another million to make it at least break even, maybe the state can give them another million to keep labor and delivery in the rural area.”
I can’t help with such policy questions, but I can help with the demographics that have been cited in these closures. In Halifax County, the fertility rate is 1.23. If it were a country, it would be one of the lowest in the world, just ahead of South Korea and Singapore. Like Alleghany County and Covington, it’s an older community, with a median age of 46.6, so it has a population that’s not likely to produce many babies, no matter what the fertility rate is. Like Alleghany County and Covington, Halifax County has also seen deaths outnumber births. Unlike those communities, it’s also seen more people move out than move in, so it faces a demographic double whammy. Its population is going down two ways. In 1950, there were 1,176 babies born in Halifax County. In 2021, just 332. (That figure is higher than what the hospital cited because the hospital counted how many babies were born at its facility; some were apparently born elsewhere but the mother listed Halifax County as her home.)
Halifax, even more than Alleghany and Covington, needs an influx of new, younger residents who can engage in some community-building and some baby-making, but the absence of a labor and delivery unit may make that harder.
Finally, let’s look at Martinsville and Henry County, where the labor and delivery unit shut down last year. Lo! What have we here? Henry County’s fertility rate is 2.08, just barely under the replacement rate — and would be exactly 2.1 if we believed in rounding. Martinsville, though, is one of the relatively small number of localities in the state where the fertility rate is above the replacement rate. It’s 2.37 — and yet that apparently wasn’t high enough for the hospital to justify a labor and delivery unit. I’m not privy to those economics but it’s safe to assume that if the hospital felt it could make money on those services, it would. That’s how businesses work.
These closures in Martinsville and Halifax County aren’t unusual, either. A recent report found that since 2011, some 217 rural hospitals across the country have shut down their labor and delivery units. They say that demography is destiny; demography also helps explain (and drive) the economy.
So now we must fully engage the question raised above: Localities are doing lots of things to attract new (and younger) residents. They’re investing in various quality of life initiatives — parks, greenways and so forth. Should they also be spending money to help support labor and delivery units at for-profit hospitals? Or should there be some sort of tax incentive created to encourage hospitals to keep those units open? We’re in an election year. It would be interesting to hear General Assembly candidates, especially those in rural districts, address these questions. There are some candidates around the country — all the examples I’ve found have been Republicans — who have proposed various tax breaks to encourage couples to have more children. How practical is that, though, in communities where labor and delivery units are being shuttered?
In any case, the math is the math: We’re having a lot fewer babies. The decision to have — or not have — a child is a very personal decision. But, collectively, there are community consequences. We’re seeing some of those in Covington, Martinsville and Halifax.