
‘Rethink what we expect from parents': Norway's grapple with falling birthrate
Although falling birthrates are a global trend, such is the concern in Oslo the government has commissioned a birthrate committee to investigate the causes and possible consequences and devise strategies to reverse the population's current trajectory.
Over the last two decades, Norway's fertility rate plummeted from 1.98 children for each woman in 2009 to 1.40 in 2023, a historic low. This is despite a parental leave policy that entitles parents to 12 months of shared paid leave for the birth, plus an additional year each afterwards.
If current fertility trends continue, the sparsely populated country of nearly 5.5 million people could face wide-ranging consequences ranging from problems caring for the elderly to a reduced labour force.
Factors contributing to the decline include housing costs, postponing having children until ones 30s, fewer people having more than two children, and an increase in those not having children at all.
'It is uncertain what the cohort fertility of the younger generations will be, but the trend is downward,' said the Norwegian minister for children and families, Lene Vågslid. 'Norway is among the countries where birthrates have dropped the most over the past 10 to 15 years,' she said.
As well as leading to 'long-term societal changes', low birthrates could, she said, 'eventually weaken the social model and the intergenerational contract'.
The birthrate committee's chair, Rannveig Kaldager Hart, said there had been a 'tempo shift' among Norwegians in their 20s and 30s, leading to a fall in overall births.
'There is a really marked fall among young adults in their 20s, both in their early and their late 20s,' she said from her office at the University of Oslo. 'And then there was a long-term increase [in births] among adults in their 30s, but now that has stalled or even reversed.'
Kaldager Hart, an associate professor at the university's department of health economics and health management and a fertility researcher at the Norwegian Institute of Public Health, said the changes among both age groups were important.
'If you just look at the baseline, it's very easy to just focus on the 20s picture,' Kaldager Hart said. 'If Norwegians have a child, they often have one more. But then there also used to be a fair share that had three kids and that's become less common.' A lack of time and more women working full-time are both factors, but another is the rise of 'intensive parenting'.
This is a shift away from informal family-based responsibility for raising children, where parents followed their intuition, to a more child-centred, expert-informed approach, where parents pour in more time, emotion and financial investment to ensure the success of their children for which they feel personally responsible.
'If you want to follow each child very closely and take them to their activities and all these things that you're supposed to do, then maybe it's just easier to have two children than to have three,' said Kaldager Hart.
Raquel Herrero-Arias, an associate professor specialising in parenting at the University of Bergen, said there had been 'a clear intensification of parenting' in recent years. 'Raising children has become more demanding, more complex and more expansive, involving tasks and responsibilities that were not traditionally associated with the parental role.'
Intensive parenting, she added, 'promotes the idea of parental determinism – that parents are the primary architects of their children's future' – rather than structural issues such as poverty, employment, discrimination or housing.
Despite Norway's family-friendly policies, this cultural expectation could make parenthood seem less appealing.
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'These policies aim to support work-family balance, but if the cultural expectations of parenting remain so demanding, then no amount of policy support may feel sufficient,' said Herrero-Arias.
'In other words, unless we rethink what we expect from parents, even the best policies may fall short,' she said.
The birthrate committee is the first of its kind since the 1980s, when fertility was also very low in Norway and efforts were made to better combine work and family and gender equality, which led to the 'Nordic model' of family-friendly policies and an increase in the country's birthrate.
The committee has just published its interim findings, where it recommends additional child allowance for parents under 30 and extra support and partial student loan forgiveness for students under 30 who have children, and will publish a full report in February. Next it will look at the impact of rising housing costs and what interventions could be made there.
Unlike the cost of childcare, which is falling in Norway, the rising cost of owning a home is thought to be a barrier to having children because many aspiring parents see it as a prerequisite.
Twenty-two-year-old Marita Løkken, a special needs education student at Oslo University, said she wanted to have two or three children in the future, and was not surprised that birthrates were falling because of the length of time it took to get on the career ladder.
'To have a bachelors [degree] is just not worth anything when you're looking for a job, then you have to study for even longer and then people wait even longer [to have children]. So it isn't surprising at all,' said Løkken.
'If the circumstances were different, I think more people would have had kids,' said Løkken. 'Money is tight for a lot of people, especially as inflation now is crazy. It's a lot of things coming together. It's difficult.'
A society with fewer children was not only bad for a country's future prospects, but aslo had a marked impact on society, said Kaldager Hart.
It can shift resources from schools to care homes, for example, meaning children might have to travel a long way to go to school. 'A society with very few children can also be a society where it's harder to be a child. Children contribute something to the lives of their parents but also to the life of society,' she said.

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The Independent
7 hours ago
- The Independent
New NHS plan will ‘fundamentally rewire' health service
A new 10-year NHS plan will 'fundamentally rewire' the health service and put care on people's doorsteps, the Prime Minister has said. Sir Keir Starmer will use a speech in London on Thursday to unveil his vision for the NHS, which will focus on 'three big shifts' in the way the health service operates. The new plan, which will be published by the Government on Thursday, sets out how the NHS will move from analogue to digital, treatment to prevention, and from hospital to more community care. The 'status quo of hospital by default will end', according to the Government, with care shifted into neighbourhoods and people's homes. By 2035, the intention is that the majority of outpatient care will happen outside of hospitals, with less need for hospital-based appointments for things like eye care, cardiology, respiratory medicine and mental health. New neighbourhood health services will be rolled out across the country to bring tests, post-op care, nursing and mental health teams closer to people's homes. The aim is to give people access to a full range of services, leaving hospitals to focus on the sickest, with neighbourhood health centres opening at evenings and weekends. These will be staffed by teams including nurses, doctors, social care workers, pharmacists, health visitors, palliative care staff and paramedics. New services will also include debt advice, employment support and stop smoking or obesity services – all of which affect people's health. Community outreach, with people going door to door, could also reduce pressure on GPs and A&E, the Government said. The plans also outline training for thousands more GPs, as the Government pledges to 'bring back the family doctor' and end the '8am scramble' to get an appointment. Sir Keir said: 'The NHS should be there for everyone, whenever they need it. 'But we inherited a health system in crisis, addicted to a sticking plaster approach, and unable to face up to the challenges we face now, let alone in the future. 'That ends now. Because it's reform or die. Our 10-year health plan will fundamentally rewire and future-proof our NHS so that it puts care on people's doorsteps, harnesses game-changing tech and prevents illness in the first place. 'That means giving everyone access to GPs, nurses and wider support all under one roof in their neighbourhood – rebalancing our health system so that it fits around patients' lives, not the other way round. 'This is not an overnight fix, but our Plan for Change is already turning the tide on years of decline with over four million extra appointments, 1,900 more GPs, and waiting lists at their lowest level for two years. 'But there's more to come. This Government is giving patients easier, quicker and more convenient care, wherever they live.' Health and Social Care Secretary Wes Streeting said the plan would deliver 'one of the most fundamental changes in the way we receive our healthcare in history'. He added: 'By shifting from hospital to community, we will finally bring down devastating hospital waiting lists and stop patients going from pillar to post to get treated. 'This Government's Plan for Change is creating an NHS truly fit for the future, keeping patients healthy and out of hospital, with care closer to home and in the home.' In a bid to free up time, GPs will be encouraged to use artificial intelligence to take notes, while technology will be used to speed up the answering of calls to surgeries. Dental therapists, who tend to carry out some of the straightforward work of dentists, could undertake check-ups, treatment and referrals, according to the plan. And there will be a new requirement for newly-qualified dentists to practise in the NHS for a minimum period, intended to be three years, according to the Government. Ministers also want to improve access to dental care for children, such as by allowing dental nurses to give fluoride varnish to children in between check-ups. Royal College of Nursing (RCN) general secretary, Professor Nicola Ranger, said: ''A neighbourhood health service is a bold vision and it needs nursing staff in the driving seat. 'The Prime Minister must back up his plan with a clear one to turn around the shortage of nurses in all local communities. 'Moving care away from overcrowded hospitals is urgent and necessary but it will prove impossible whilst this part of the healthcare workforce is so depleted and undervalued. 'Crucial teams of district nursing and health visiting staff, who keep patients well and safe at home, have fallen by thousands in the last decade or more.' Thea Stein, chief executive of the Nuffield Trust, said: 'Top quality community services, like district nursing, end of life care and rehabilitation, are, in pockets of the country, already working around the clock to fit care around patients' needs, working closely with GPs, charities and council staff. 'This approach is essential if we want to end the disjointed ways of working that too often leave patients to do the time-consuming and often bewildering job of joining up their own care.' She said, however, that a lack of detail on how it will all work 'casts doubt on whether it will stick'. She added: 'What's more, care closer to home doesn't mean care on the cheap. 'While ministers are always keen to cite examples of community services saving money, often this kind of care costs more, not less… let's be under no illusion, this is not a money-saving measure.' Sarah Woolnough, chief executive of the King's Fund, said: 'As the Government publishes its 10-year plan for health today, what patients, the public and those working in the NHS will want to know is, why it will be different this time, and how soon it will lead to improvements? 'When will it mean people can see a GP more easily, or get mental health support for their child, or not wait hours in A&E? 'There is plenty to welcome in the details we've seen so far, with the biggest changes outlined being about how people access NHS services, with the rollout of new neighbourhood health centres and a much greater role for the NHS app. 'At the King's Fund our call for a fundamental shift of care from hospital to community and a more people-first approach has been echoed by successive governments, so, whilst welcome, the vision itself is not new, the radical change would be delivering the vision.' The Government's political opponents were sceptical about the plan, with Conservative shadow health secretary Edward Argar insisting that it must provide reform and 'that reform must be real, it needs to be deliverable, and crucially it must deliver results for patients'. He added: 'But after the collapse of their Welfare Bill, the government's tough talk seems meaningless. This Government has proven they cannot stand up to their own MPs or take tough decisions in the national interest.' Liberal Democrat Leader Sir Ed Davey said the plan 'will be a castle built on sand until ministers finally tackle the crisis in social care'. He added: 'Years of Conservative neglect pushed the NHS to breaking point, with overcrowded A&Es, people waiting weeks to see a GP and parents unable to find a dentist for their children. 'But the current Government's failure to fix social care is leading to more of the same, as vulnerable people are stuck in hospital beds while their families are left in anguish.'


The Herald Scotland
8 hours ago
- The Herald Scotland
New NHS plan will ‘fundamentally rewire' health service
The new plan, which will be published by the Government on Thursday, sets out how the NHS will move from analogue to digital, treatment to prevention, and from hospital to more community care. The 'status quo of hospital by default will end', according to the Government, with care shifted into neighbourhoods and people's homes. By 2035, the intention is that the majority of outpatient care will happen outside of hospitals, with less need for hospital-based appointments for things like eye care, cardiology, respiratory medicine and mental health. New neighbourhood health services will be rolled out across the country to bring tests, post-op care, nursing and mental health teams closer to people's homes. The aim is to give people access to a full range of services, leaving hospitals to focus on the sickest, with neighbourhood health centres opening at evenings and weekends. These will be staffed by teams including nurses, doctors, social care workers, pharmacists, health visitors, palliative care staff and paramedics. New services will also include debt advice, employment support and stop smoking or obesity services – all of which affect people's health. Community outreach, with people going door to door, could also reduce pressure on GPs and A&E, the Government said. The plans also outline training for thousands more GPs, as the Government pledges to 'bring back the family doctor' and end the '8am scramble' to get an appointment. Sir Keir said: 'The NHS should be there for everyone, whenever they need it. 'But we inherited a health system in crisis, addicted to a sticking plaster approach, and unable to face up to the challenges we face now, let alone in the future. 'That ends now. Because it's reform or die. Our 10-year health plan will fundamentally rewire and future-proof our NHS so that it puts care on people's doorsteps, harnesses game-changing tech and prevents illness in the first place. 'That means giving everyone access to GPs, nurses and wider support all under one roof in their neighbourhood – rebalancing our health system so that it fits around patients' lives, not the other way round. 'This is not an overnight fix, but our Plan for Change is already turning the tide on years of decline with over four million extra appointments, 1,900 more GPs, and waiting lists at their lowest level for two years. 'But there's more to come. This Government is giving patients easier, quicker and more convenient care, wherever they live.' Health and Social Care Secretary Wes Streeting said the plan would deliver 'one of the most fundamental changes in the way we receive our healthcare in history'. He added: 'By shifting from hospital to community, we will finally bring down devastating hospital waiting lists and stop patients going from pillar to post to get treated. 'This Government's Plan for Change is creating an NHS truly fit for the future, keeping patients healthy and out of hospital, with care closer to home and in the home.' In a bid to free up time, GPs will be encouraged to use artificial intelligence to take notes, while technology will be used to speed up the answering of calls to surgeries. Dental therapists, who tend to carry out some of the straightforward work of dentists, could undertake check-ups, treatment and referrals, according to the plan. And there will be a new requirement for newly-qualified dentists to practise in the NHS for a minimum period, intended to be three years, according to the Government. Ministers also want to improve access to dental care for children, such as by allowing dental nurses to give fluoride varnish to children in between check-ups. Royal College of Nursing (RCN) general secretary, Professor Nicola Ranger, said: ''A neighbourhood health service is a bold vision and it needs nursing staff in the driving seat. 'The Prime Minister must back up his plan with a clear one to turn around the shortage of nurses in all local communities. 'Moving care away from overcrowded hospitals is urgent and necessary but it will prove impossible whilst this part of the healthcare workforce is so depleted and undervalued. 'Crucial teams of district nursing and health visiting staff, who keep patients well and safe at home, have fallen by thousands in the last decade or more.' Thea Stein, chief executive of the Nuffield Trust, said: 'Top quality community services, like district nursing, end of life care and rehabilitation, are, in pockets of the country, already working around the clock to fit care around patients' needs, working closely with GPs, charities and council staff. 'This approach is essential if we want to end the disjointed ways of working that too often leave patients to do the time-consuming and often bewildering job of joining up their own care.' She said, however, that a lack of detail on how it will all work 'casts doubt on whether it will stick'. She added: 'What's more, care closer to home doesn't mean care on the cheap. 'While ministers are always keen to cite examples of community services saving money, often this kind of care costs more, not less… let's be under no illusion, this is not a money-saving measure.' Sarah Woolnough, chief executive of the King's Fund, said: 'As the Government publishes its 10-year plan for health today, what patients, the public and those working in the NHS will want to know is, why it will be different this time, and how soon it will lead to improvements? 'When will it mean people can see a GP more easily, or get mental health support for their child, or not wait hours in A&E? 'There is plenty to welcome in the details we've seen so far, with the biggest changes outlined being about how people access NHS services, with the rollout of new neighbourhood health centres and a much greater role for the NHS app. 'At the King's Fund our call for a fundamental shift of care from hospital to community and a more people-first approach has been echoed by successive governments, so, whilst welcome, the vision itself is not new, the radical change would be delivering the vision.' The Government's political opponents were sceptical about the plan, with Conservative shadow health secretary Edward Argar insisting that it must provide reform and 'that reform must be real, it needs to be deliverable, and crucially it must deliver results for patients'. He added: 'But after the collapse of their Welfare Bill, the government's tough talk seems meaningless. This Government has proven they cannot stand up to their own MPs or take tough decisions in the national interest.' Liberal Democrat Leader Sir Ed Davey said the plan 'will be a castle built on sand until ministers finally tackle the crisis in social care'. He added: 'Years of Conservative neglect pushed the NHS to breaking point, with overcrowded A&Es, people waiting weeks to see a GP and parents unable to find a dentist for their children. 'But the current Government's failure to fix social care is leading to more of the same, as vulnerable people are stuck in hospital beds while their families are left in anguish.'

Leader Live
16 hours ago
- Leader Live
Hancock: Moving patients from hospitals to care homes was least-worst decision
Bereaved people whose loved ones died in care homes have urged truth and accountability from those appearing before the UK Covid-19 Inquiry, as its focus for the next month falls on the care sector. The inquiry has previously heard there were more than 43,000 deaths involving the virus in care homes across the UK between March 2020 and July 2022, and a civil servant was quoted earlier this week describing the toll as a 'generational slaughter within care homes'. Appearing before the inquiry on Wednesday, Mr Hancock acknowledged the discharge policy was an 'incredibly contentious issue', but he added: 'Nobody has yet provided me with an alternative that was available at the time that would have saved more lives.' When the pandemic hit in early 2020, hospital patients were rapidly discharged into care homes in a bid to free up beds and prevent the NHS from becoming overwhelmed. However, there was no policy in place requiring patients to be tested before admission, or for asymptomatic patients to isolate, until mid-April. This was despite growing awareness of the risks of people without Covid-19 symptoms being able to spread the virus. Mr Hancock, who resigned from government in 2021 after admitting breaking social distancing guidance by having an affair with a colleague, has given evidence to the inquiry multiple times. Returning for a full-day session to face questions specifically about the care sector, he said the hospital discharge policy had been a government decision but had been 'driven' by then-NHS chief executive Sir Simon Stevens, now Lord Stevens. Mr Hancock said: 'It was formally a government decision. It was signed off by the prime minister. It was really driven by Simon Stevens, the chief executive of the NHS, but it was widely discussed.' The inquiry heard Mr Hancock said in his witness statement that NHS England had 'insisted' on the policy, and while he did not take the decision himself, he took responsibility for it as then-health secretary. He said it was an 'incredibly contentious issue' but added that 'nobody has yet provided me with an alternative that was available at the time that would have saved more lives'. He said there were no good options, adding: 'It's the least-worst decision that could have been taken at the time.' Pressed further, he said he had both agreed with and defended the decision at the time. The High Court ruled in 2022 that Government policies on discharging hospital patients into care homes at the start of the pandemic were 'unlawful'. While the judges said it was necessary to discharge patients 'to preserve the capacity of the NHS', they found it was 'irrational' for the Government not to have advised that asymptomatic patients should isolate from existing residents for 14 days after admission. Asked about March 17, 2020 when NHS bosses were instructed to begin the discharge process, Mr Hancock said officials were 'pushing very hard' to get more PPE into care homes. He said not advising care homes to isolate returning residents without symptoms was a 'mistake', but it was in line with clinical guidance at the time. In 2023, appearing for a separate module of the inquiry, Mr Hancock admitted the so-called protective ring he said had been put around care homes early in the pandemic was not an unbroken one, and said he understood the strength of feeling people have on the issue. At a Downing Street press conference on May 15 2020, Mr Hancock said: 'Right from the start, we've tried to throw a protective ring around our care homes.' Mr Hancock told the inquiry: 'I would stress in that piece of rhetoric, what I said is that we had 'tried' – it was not possible to protect as much as I would have wanted.' He added: 'The protection, what at the time, was clearly not as much as we would have liked, but the alternatives were even worse. 'We were trying to put as much protection in place as possible. 'All I can do is take you back to the actual decisions and the resources that we had at that moment. He went on: 'We were trying to do everything that we possibly could, we were in bleak circumstances.' Counsel to the inquiry Jacqueline Carey KC highlighted anonymous evidence given to the inquiry, saying: 'One person in particular said he (Mr Hancock) blatantly lied about the situation with care homes, there was no blanket of protection. We were left to sail our own ships. He wasn't heartfelt. He had no understanding or appreciation of the challenges care homes face, pandemic or not, it felt like we were the sacrifice, a cull of older people who could no longer contribute to the society.' Mr Hancock said it was 'not helpful' for the inquiry to 'exchange brickbats', but went on: 'I've been through everything that we did as a Department, a big team effort, and we were all pulling as hard as we possibly could to save lives – that's what I meant by saying that we tried to throw a protective ring around. 'Of course, it wasn't perfect. It was impossible – it was an unprecedented pandemic, and the context was exceptionally difficult. 'What I care about is the substance of what we did, the protections that we put in place, and most importantly, what we can do in the future to ensure that the options available are better than they were last time.' Bereaved families have previously called this 'protective ring' phrase a 'sickening lie' and a 'joke'. Nicola Brook, a solicitor representing more than 7,000 families from Covid-19 Bereaved Families for Justice UK (CBFFJ), said Mr Hancock's claim that the discharge policy had been the least-worst decision available was 'an insult to the memory of each and every person who died'. She added: 'He knew at the time that many care homes did not have the ability to isolate the people who would be discharged from hospital and that Covid was airborne. 'It's frankly ridiculous and insulting that he says they tried to throw a protective ring around care homes when his department's policies caused Covid to spread like wildfire amongst society's most vulnerable loved ones. 'Mr Hancock claims the decision to discharge people into care homes was driven by Simon Stevens, the chief executive of the NHS, yet the inquiry is not calling him. We would call for this decision to be urgently reviewed.' The CBFFJ group had already written to inquiry chairwoman Baroness Heather Hallett, to express their concern at some 'key decision-makers' not expected to be called in this module, including former prime minister Boris Johnson. Outlining the state of the adult social care sector at the outbreak of the pandemic, Mr Hancock said it 'was badly in need of, and remains badly in need of, reform', but rejected the suggestion of it being a 'Cinderella service to the NHS'. He said pandemic contingency plans, prepared by local authorities for adult social care, had been 'as good as useless' at the time, and described a 'hodge podge of accountability' between local councils and Government departments. He claimed the situation has 'got worse not better' for care homes in the event of another pandemic hitting, and suggested a series of recommendations, including having isolation facilities in care homes and ensuring a stockpile of personal protective equipment (PPE). Module six of the inquiry is focused on the effect the pandemic had on both the publicly and privately funded adult social care sector across the UK. Public hearings for the care sector module are expected to run until the end of July.