[Big read] Taiwan is running out of babies — and obstetricians

(Edited and refined by Candice Chan, with the assistance of AI translation.)

Lo Giok-ting (罗玉婷), 32, and her husband married at the end of last year. With help from both sets of parents, they managed to scrape together the NT$5 million (US$158,000) down payment on a resale home in New Taipei City. The property, which is more than 40 years old, cost over NT$18 million.

For the past six months or so, the couple have been busy overseeing renovations, but labour shortages mean they are unlikely to move into their new home before the end of the year. Lo told Lianhe Zaobao (LHZB) that without financial help from their parents, they might even have had to postpone their marriage. For now, the newlyweds continue to live separately with their respective families.

However, not everyone is as fortunate as Lo. Mr Ko, 38, has lost both his parents. Although he lives with his girlfriend, the couple have no plans to marry, much less have children.

He said: “We can barely afford to keep a dog, let alone raise a child for 18 years. These are hardly boom times. You have children because you want to give them a good life, not bring them into the world to suffer.”

This is typical of many young Taiwanese. With wages generally low and homes routinely costing more than NT$10 million, buying a property is little more than a pipe dream without parental help. The traditional belief that “having no descendants is the worst of the three types of unfilial conduct” has long since lost its grip.

According to Taiwan’s Ministry of the Interior, the island’s population stood at 23,235,002 at the end of July this year. It has now declined for 31 consecutive months, with no sign of the trend reversing.

Fertility rate plunges from top five to world’s lowest

Dr Huang Jian-pei, secretary-general of the Taiwan Association of Obstetrics and Gynaecology, offered even more startling figures from the medical front line: just 54,000 babies were born across Taiwan between January and July this year, putting the projected full-year total at between 90,000 and 95,000.

“Last year there were 108,000 births. That was already very low, but the number is falling. If it drops below 95,000, that would be another decline of about 15%.”

Taiwan’s total fertility rate (TFR) fell to 0.695 in 2025, meaning that a woman of childbearing age would have fewer than 0.7 children on average over her lifetime, making Taiwan the place with the lowest fertility rate in the world.

James Hsueh Cherng-tay, a former minister without portfolio in the Executive Yuan, noted that in 1951, women in Taiwan had an average of seven children over their lifetime, putting the island among the five highest-fertility places in the world. By 2004, however, the fertility rate had fallen to 1.3, the threshold used in Western countries to define “lowest-low fertility”.

In just over 70 years, Taiwan’s total fertility rate has plunged from 7 to 0.695, taking it from among the world’s top five to the very bottom. Such speed and scale of change is extremely rare in global demographics.

At a forum organised by the Fair Winds Foundation in May, Kuomintang (KMT) legislator and reproductive medicine specialist Chen Ching-hui recalled foreign lawmakers exclaiming in disbelief when told of Taiwan’s low fertility rate: “That’s even lower than Ukraine!”

Between 2018 and 2025, the Taiwanese government allocated nearly NT$600 billion to support measures aimed at tackling the falling birth rate, with little to show for it.

Hsueh said a decline in the total fertility rate was an inevitable part of the transition from an agricultural to an industrial society, a process African countries are also undergoing. Yet Europe’s average fertility rate is around 1.5 and Japan’s about 1.2 — both still well above Taiwan’s.

Hsueh also sounded a warning: “There are now fewer than three million people aged between 25 and 34, and fewer than 25% of them are married.”

At the same time, Taiwan’s twin problems of a falling birth rate and an ageing population are becoming increasingly acute. Statistics released by the Ministry of the Interior on 10 August showed that just 54,250 babies were born in the first seven months of this year, 10,064 fewer than in the same period last year, a decline of 15.65%. Over the same period, 115,628 people died — more than twice the number of births.

Taiwan’s population projected to halve by 2075

A report issued by Taiwan’s National Development Council (NDC) at the end of 2024 had already warned that births would continue to fall short of deaths and that the natural decline in the population was expected to accelerate. Although the government has been actively opening up more avenues for immigration, this will not be enough to offset the natural decrease, making the downward trend in the overall population difficult to reverse.

On 28 August, the NDC released its population projections for 2026 to 2075, warning further that the declining birth-rate trend was irreversible. Taiwan’s population is projected to fall below 20 million by 2045 and, by 2075, to roughly half its current level, at just 12.15 million.

The NDC said Taiwan’s low fertility rate marked the end of an era of abundant labour, with population ageing and decline set to accelerate over the next half-century. In response, the Executive Yuan has formed an inter-ministerial task force to strengthen regulations and social support.

In September 2025, the Executive Yuan approved measures to encourage childbirth, including raising the birth subsidy to NT$100,000 per newborn. Couples under 39 undergoing in-vitro fertilisation can also receive up to NT$150,000 per treatment cycle.

President Lai Ching-te has said the government wants to give young people greater confidence to marry and start families. In May, the Executive Yuan unveiled a broader package providing parents with NT$5,000 a month for each child up to age six and NT$2,500 a month from six to 18, for a total of NT$720,000. A further NT$2,500 a month would go into a “children and youth growth account”, bringing total support to NT$1.08 million. Local governments have also introduced measures to encourage marriage and parenthood.

The opposition KMT and Taiwan People’s Party also announced last year that they would emulate the US by introducing Taiwan Future Accounts. On 24 July this year, they used their legislative majority to push through the Act Governing Taiwan Children’s and Youth Growth and Future Accounts, under which every newborn would be entitled to a cumulative NT$1.14 million by the age of 18.

However, the ruling and opposition camps remain divided over how the more than NT$1 million in subsidies should be structured and distributed. The Executive Yuan has refused to countersign legislation passed by the legislature, leaving the measures in limbo.

High housing prices, low wages and the heavy burden of childcare have long made “no marriage, no children, a happy life” a lifestyle choice for many young people. The proposals put forward by both the government and opposition may ease some of the burden on families that already have children, but they are unlikely to be enough to change the minds of most young people.

“Even if it passes, what can NT$1 million really do? Doesn’t it cost NT$7 million or NT$8 million to raise a child to 18?” said Mr Ko.

He and his girlfriend earn more than NT$90,000 a month combined. After NT$25,000 in rent and NT$5,000 in utilities, a third of their income is already gone. A child would also require a nanny from birth, with nappies, formula and other necessities costing more than NT$20,000 a month, followed by after-school care, tuition and other expenses once the child starts school.

“And there are so many other things to worry about. You’d have no quality of life at all.”

Experts frequently point to South Korea as an example. Its fertility rate fell to 0.72 in 2023, the lowest in the world then. The government began treating the problem seriously as a matter of national security, rolling out measures including allowing families with one child to live rent-free in public housing for 20 years, while those with a second child could effectively live there rent-free for life. It has also sought to ease the broader pressures of raising children.

Not just a ‘national security crisis’

Huang said: “The situation in South Korea has indeed improved markedly over the past two years. The number of marriages rose from 300,000 to 380,000, an increase of about 25%, while the fertility rate has recovered from 0.72 to above 0.8. Taiwan, meanwhile, continues to plumb new lows.”

Huang, who is also a member of the Presidential Office’s Healthy Taiwan Promotion Committee, suggested that the government could start by waiving mortgage interest for parents of newborns to ease their financial burden.

He worked out the sums from the government’s perspective. On a NT$20 million mortgage at an interest rate of just over 2%, a household would pay roughly NT$500,000 in interest a year. If parents with three children were exempted from paying mortgage interest, this would effectively amount to a subsidy of nearly NT$200,000 per child per year, or just NT$3.6 million over 18 years.

“Young people can do the math. It costs NT$7 million or NT$8 million to raise a child, and if you receive only NT$1 million in subsidies, you’re still millions out of pocket. Who would want to have children?

Experts say encouraging people to have children also requires more family-friendly workplaces and better childcare. Pregnant women can face resentment from colleagues who fear heavier workloads, while many worry that having children will hurt their pay and promotion prospects. Subsidising companies with pregnant employees or rewarding exemplary employers with a quality mark could, experts say, gradually shift workplace culture.

The falling birth rate has long ceased to be merely a “national security crisis”. A report commissioned by Taiwan’s Ministry of Finance found that, as the demographic dividend disappears, central government revenue will fall from NT$2.9 trillion in 2024 to NT$1.6 trillion in 2070, a decline of 45%. By 2041, labour insurance, national health insurance and long-term care schemes are all expected to face serious funding shortfalls.

Cross-strait tensions pushing fertility rate even lower?

Apart from economic pressures and high housing prices, James Hsueh raised another factor that may have been overlooked in explaining the unusually rapid decline in Taiwan’s fertility rate since 2000: geopolitical tensions.

In an interview with LHZB, Hsueh noted that Europe and the US regard a total fertility rate of 1.3 as the threshold for “lowest-low fertility”. Once the rate falls below that level, he said, young people’s reproductive behaviour and consumption patterns tend to become entrenched, making them extremely difficult to reverse through policy.

“Taiwan fell below that threshold as early as 2004. It has now dropped further to 0.695, far beyond anything seen in Western experience.”

Hsueh pointed to the timeline in support of his argument. Taiwan’s total fertility rate fell sharply from 1.68 to below 1.3 between 2000 and 2010, and then declined steadily from 1.17 in 2016 to 0.695 in 2025. He believes both periods coincided with major shifts in cross-strait relations after the Democratic Progressive Party came to power in 2000 and again in 2016.

By contrast, during the KMT’s Ma Ying-jeou presidency from 2008 to 2016, cross-strait relations eased and Taiwan’s fertility rate registered a rare, modest rebound between 2011 and 2015 — a period Hsueh sees as a useful counterpoint to his argument.

He also cited South Korea. After North Korea significantly improved the accuracy of its missiles in 2017, South Korea’s fertility and marriage rates both began falling sharply from 2018. Its total fertility rate hit a record low of 0.72 in 2023, even lower than Taiwan’s at the time.

Hsueh believes this was no coincidence. “The threat of war directly affects young people’s expectations for the future, which in turn affects their willingness to marry and have children,” he said.

Other academics, however, point out that the rebound in Taiwan’s fertility rate between 2011 and 2015 coincided with government initiatives such as parental leave allowances and schemes to help young people set up homes, suggesting that economic and policy factors may have been intertwined with political ones. Similarly, the decline after 2016 coincided with the house-price-to-income ratio reaching record highs and, later, the Covid-19 pandemic.

He added that Taiwan’s decision in 1998 to allow foreign spouses from Southeast Asia to settle on the island had temporarily helped shore up its fertility rate; without them, the decline after 2000 would have been even steeper.

Hsueh’s observation offers another perspective on the issue. Whether changes in cross-strait relations really have a significant bearing on Taiwan’s fertility rate, however, will require more rigorous long-term research to establish.

Older mothers

Lo finally tied the knot at the end of last year with her parents’ encouragement and help. But when asked whether she planned to have a child before reaching Taiwan’s threshold of 34 for advanced maternal age, she laughed.

“We haven’t even moved into the house yet, and work is pretty busy too. Maybe in a few years.”

The average age at marriage in Taiwan has risen to between 32 and 33. Statistics from the Ministry of Health and Welfare show that women of advanced maternal age accounted for more than one in every three expectant mothers in 2024. Such pregnancies carry significantly higher risks, including premature birth, chromosomal abnormalities and Down’s syndrome.

Huang Jian-pei said bluntly: “For women in their 30s, becoming pregnant and giving birth are both more difficult and riskier than for women in their 20s, let alone the women we now regularly see in their 40s or even 50s.

“Twenty or 30 years ago, perhaps 2% to 3% needed assisted reproductive technology to become pregnant. Now the figure is above 10%, probably the highest in the world.”

At the same time, Taiwan faces another harsh reality: as more older mothers require specialised care, falling birth rates are driving obstetrics and gynaecology clinics into the red and forcing many to close, while more obstetricians leave the field.

Taiwan also has a relatively high proportion of high-risk pregnancies, including those involving older mothers and pregnancies achieved through assisted reproduction. Its maternal mortality rate last year was about 14 deaths per 100,000 live births, compared with three per 100,000 in Japan and four per 100,000 in South Korea. When something goes wrong, medical staff also face the prospect of litigation, further deterring young doctors from entering the speciality.

Huang said: “In the past, you had to be among the top students to get into obstetrics and gynaecology. Now, we’re just grateful if you’re willing to join us.”

He warned that young doctors increasingly see little future in the speciality and are even less willing to work in delivery rooms.

“In ten years, Taiwan will face a generational gap in its obstetric workforce.”

This article was first published in Lianhe Zaobao as “台湾生育率滑至全球最低 养儿太重本年轻人拒买单”.

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