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Recovery of Fertility through Family Creation Subsidy – ReBirth Greece

23/06/21

The replacement rate for parents is 2.1 children per woman. Fertility in Greece, with a fertility rate of 1.38, is among the lowest in the world, and there are consistently fewer than 100,000 births per year, which many consider to be the most concerning issue in our country (source: Eurostat).

Not only because it leads to a steady decline in the population (since 2011, for the first time in peacetime, the population of Greece has been decreasing), with all that this entails – demographic aging, loss of the labor force, loss of scientists, a decline in entrepreneurship, and progressive ethnological alteration – but also because it will be impossible in 30 years from now (2050) to maintain a healthy social security system that is contributory and provides security to those entering the workforce. There is a projection for 5 million economically active population by 2050 compared to 7 million in 2015 (source: DiaNesis 2019). Other countries have already implemented provisions and favorable legislation to help maintain the birth rate above 2, if not to increase their population. Proposals should be directed towards three Pillars of Action, two with government financial support and one with administrative facilitations. First, how to financially assist those who are preparing to have more than one child or already have one child and are considering having a second or even a third child. Second, how to assist couples who are struggling with infertility, where the birth of even one child can be costly. And third, how to facilitate the upbringing of children, especially in the first few years of family life.

The main proposal consists of providing a family allowance for 17 years, which is renewed every 5 years only if the family expands by having 2 or 3 children. Let’s break it down in more detail: we propose supporting the establishment of a family with a family allowance of €250 per month, initially starting with the birth of the first child. This is intended to help cover rent, housing loans, or basic child-rearing needs for a new couple starting their life. The allowance remains constant for 5 years, and only if the couple has a second child, it is renewed for another 5 years with an additional €200 per month (as we hypothetically improve our product position professionally) and for another 7 years with €150 per month if they proceed to have a third child.

In summary, for a maximum duration of 17 years, if within a five-year period, a couple has a second child, the family allowance is renewed at €200, and if they have a third child during the decade, it is maintained for 17 years with €150. What will be the burden on the Greek state: referring to ELSTAT data from 2020, families with at least one child under 18 are estimated to be 1,160,000. If we assume in the long run that 25% will have one child (€72,500,000 monthly), 50% will have two children (€116,000,000 monthly), and 25% will have three children or more (€43,500,000 monthly), the annual cost for the Greek budget will be around €2,784,000,000. In other words, as much as the ENFIA property tax! Which will gain meaning for those who pay it conscientiously, as they will know it will be returned to new families, either themselves or their children, if they are property-owning retirees. Further details of this measure will follow in a separate intervention to analyze what will happen in the case of divorce, a nomadic lifestyle, and non-attendance of children in school, as well as economic interventions for saving money (e.g., discontinuation of child allowances, which are already ridiculously low and do not serve as a real incentive for workers, cessation of childbirth allowances that end up in private maternity clinics and whose benefit is lost).

2nd Pillar: Compensation for Assisted Reproduction Procedures

If we consider that, in Greece, 16% of Greek women born in 1965 did not have any children, while those born a decade earlier, only 8.3% remained childless, and when the percentage in neighboring Turkey is below 5%, we can imagine the extent of our subfertility issue as a nation. To better understand the problem of subfertility, we must mention that Greek women have their first child at the age of 30.3 years, while European women give birth at 28 years. The age group of 35-39 contributes one out of four births in Greece, and Greece has one of the highest rates of births by mothers over 40 (5.3%). Every year in our country, around 12,000 in vitro fertilization procedures are performed (not including those related to medical tourism).

While the majority of European countries subsidize both the procedure (€4,500-€6,000) and medications (approximately €1,000), with a significant number of attempts, ranging from 3 (Denmark) to 6 (Belgium), Greece is lagging behind, providing only the cost of medications. Even our neighboring North Macedonia, with its limited budget, subsidizes 3 attempts at in vitro fertilization. So, what does our state subsidize: (a) Medical treatment, about €1,000, which is consistent with other European countries, but through a highly outdated regional committee made up of non-experts in the field of reproduction, causing delays of 2-4 months for assessment. This is unnecessary, as simply the definition of subfertility should be enough, a condition that cannot be certified by marriage alone since people are free to have children outside of marriage. Also, (b) our Greek state, which is expected to have around 8,500,000 Greeks in 2050, offers as compensation a gift of €350 to the couple when the cost in our country does not exceed €3,000, a sum much lower than the cost in other European countries. Our proposal here is radical but entirely feasible. Compensation for assisted reproduction expenses (medical, nursing, and medication) up to €2,000-€3,000, only with the submission of receipts, up to the birth of two children (at least). If the couple desires a third child, they can use public hospital facilities for free, just like they can now. The removal of the committee and the purchase by the couple with a 25% contribution for medications, as with other drugs (a cost of €250-€400 only for aspiring parents). No participation in any diagnostic tests required for investigating subfertility. Finally, private health insurers should be required to cover fertility treatments, something that is, apparently, not in the public interest in Greece. The cost for the Greek state will be minimal, as only the removal of zero participation and the elimination of committee bureaucracy will balance the cost of 75% of the 12,000 annual in vitro fertilization procedures, amounting to €18,000,000-€27,000,000.

3rd Pillar: Facilitation of Child Rearing – Administrative Measures

Here, smaller steps are needed, as we can consistently commend the Greek state, as all governments have made regulations. However, it is essential to overlook that we should first provide incentives for having children, and then facilitate their upbringing. Specifically, we propose: (1) the establishment of a Ministry of Family Care, (2) longer parental leave if a second child is born within three years, e.g., 360 days with full compensation equal to the pre-parental leave salary, (3) immediate job transfers for those who have a second child, (4) bonus points for parents with a sufficient number of points for job transfers or promotions (e.g., double the points for obtaining a doctoral degree for the second child), (5) immediate institutionalization of the neighborhood babysitter with already unemployed mothers who can offer their services, relieving childcare facilities simultaneously, (6) subsidies for housing loans for families with three or more children, (7) a 3% reduction in taxes for families with three or more children, (8) reduced social security contributions for employers with parents of two children and no contributions for parents of three children, and many other similar measures that will arise from social dialogue. In conclusion, Greece is not only hemorrhaging due to the loss of its youth abroad but is also committing slow suicide by failing to replace those who pass away. Urgent measures are needed today, free from any political arrogance or bureaucracy. I believe that politicians from all parties are ready, provided they seek the assistance of experts.

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* Evangelos G. Papanikolaou MD, PhD is an Assistant Professor of Human Reproduction and Gynecology at the Aristotle University of Thessaloniki (AUTh) – Visiting Lecturer at Yale University in the USA.

Source: www.protothema.gr


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