How declines in fertility rates are informing responses within health systems: a protocol for a scoping review

INTRODUCTION: Global total fertility rates (TFR) are declining by approximately 1% annually due to factors such as increasing use of contraceptives, urbanisation, a shift in social norms, educational and socioeconomic changes among others. The result is a growing proportion of the world population not meeting their family-building intentions, a shift in global demographic profiles, an ageing population with different social and health system needs and a reduced workforce and taxpayer base to support economic demands. How health systems across the globe are responding to this ‘fertility transition’ has not yet been systematically mapped. METHODS AND ANALYSIS: The proposed scoping review will follow the Arksey and O’Malley framework and will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data will be obtained through a comprehensive search of academic databases and grey literature. All documents describing health systems’ responses to fertility decline will be considered. Responses will be coded using Braun and Clarke’s inductive and deductive analysis approach and the types of responses will be mapped within the WHO Building Blocks of Health Systems. Analysis will determine how health system responses vary across regions, cultures and TFR levels, and how they intersect with policies outside the health system, including pronatalist family policies. ETHICS AND DISSEMINATION: This review is being commissioned by the WHO’s Department of Sexual Reproductive, Maternal, Child, Adolescent and Ageing Health as part of WHO’s efforts to enable the promotion and protection of people’s health as it relates to sexuality and reproduction, as well as the implementation of sound public health strategies. Results will be disseminated through submission to a peer-reviewed scientific article, the WHO website and will be used by the WHO to inform and promote further public health adaptations to declines in TFR. Ethical approval is not required.