projections by an international team of scientists published last year in The Lancet, 183 countries and territories — out of 195 — will have fertility rates below replacement level by 2100.

municipalities have been consolidated as towns age and shrink. In Sweden, some cities have shifted resources from schools to elder care. And almost everywhere, older people are being asked to keep working. Germany, which previously raised its retirement age to 67, is now considering a bump to 69.

Going further than many other nations, Germany has also worked through a program of urban contraction: Demolitions have removed around 330,000 units from the housing stock since 2002.

recently increased to 1.54, up from 1.3 in 2006. Leipzig, which once was shrinking, is now growing again after reducing its housing stock and making itself more attractive with its smaller scale.

“Growth is a challenge, as is decline,” said Mr. Swiaczny, who is now a senior research fellow at the Federal Institute for Population Research in Germany.

Demographers warn against seeing population decline as simply a cause for alarm. Many women are having fewer children because that’s what they want. Smaller populations could lead to higher wages, more equal societies, lower carbon emissions and a higher quality of life for the smaller numbers of children who are born.

But, said Professor Gietel Basten, quoting Casanova: “There is no such thing as destiny. We ourselves shape our lives.”

The challenges ahead are still a cul-de-sac — no country with a serious slowdown in population growth has managed to increase its fertility rate much beyond the minor uptick that Germany accomplished. There is little sign of wage growth in shrinking countries, and there is no guarantee that a smaller population means less stress on the environment.

Many demographers argue that the current moment may look to future historians like a period of transition or gestation, when humans either did or did not figure out how to make the world more hospitable — enough for people to build the families that they want.

Surveys in many countries show that young people would like to be having more children, but face too many obstacles.

Anna Parolini tells a common story. She left her small hometown in northern Italy to find better job opportunities. Now 37, she lives with her boyfriend in Milan and has put her desire to have children on hold.

She is afraid her salary of less than 2,000 euros a month would not be enough for a family, and her parents still live where she grew up.

“I don’t have anyone here who could help me,” she said. “Thinking of having a child now would make me gasp.”

Elsie Chen, Christopher Schuetze and Benjamin Novak contributed reporting.

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Healthcare Start-Up Ro to Acquire Modern Fertility

Ro, the parent company of Roman, the brand that is best known for delivering erectile dysfunction and hair loss medication to consumers, announced on Wednesday that it would acquire Modern Fertility, a start-up that offers at-home fertility tests for women.

The deal is priced at more than $225 million, according to people with knowledge of the acquisition who spoke on condition of anonymity because the information was not public. It is one of the largest investments in the women’s health care technology space, known as femtech, which attracted $592 million in venture capital in 2019, according to an analysis by PitchBook.

Modern Fertility was founded in 2017 with its flagship product: a $159 finger prick test that can estimate how many eggs a woman may have left, which can help determine which fertility method might be best.

“We essentially took the same laboratory tests that women would take in an infertility clinic and made them available to women at a fraction of the cost,” said Afton Vechery, a founder and chief executive of Modern Fertility, noting that her own test at a clinic set her back $1,500.

valued in March at about $5 billion, has in recent years expanded into telehealth, including delivering generic drugs by mail. In December, Ro acquired Workpath, which connects patients with in-home care providers, like nurses.

The global digital health market, which includes telemedicine, online pharmacies and wearable devices, could reach $600 billion by 2024, according to the consulting firm McKinsey & Company. And yet, by one estimate, only 1.4 percent of the money that flows into health care goes to the femtech industry, mirroring a pattern in the medical industry, which has historically overlooked women’s health research.

“Gender bias in health care research methods and funding has really contributed to sexism in medicine and health care,” said Sonya Borrero, director of the Center for Women’s Health Research and Innovation at the University of Pittsburgh. “I think we’re seeing again — gender bias in the venture capital sector is going to exactly shape what gets developed.”

That underinvestment was part of the reasoning behind the acquisition, said Zachariah Reitano, Ro’s chief executive. The company developed a female-focused online service in 2019 called Rory.

“We’re going to continue to invest hundreds of millions of dollars over the next five years into women’s health,” Mr. Reitano said, “because ultimately I think women’s health has the potential to be much larger than men’s health.”

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