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As already noted, fertility rates in developed countries are significantly lower than in developing countries. Judging by this indicator, Russia can be safely attributed to developed countries: the birth rate in our country is very close to similar indicators of the EU countries. It is also characteristic that in most developed countries the total fertility rate fell below the simple reproduction rate of 2.2 children per woman in the late 1960s – early 1970s, and at the beginning of the 20th century this level exceeded 5 children per woman. This decline in fertility is known in demography as the first demographic transition. The main reason for this transition is considered to be the development of medicine, leading to a sharp decrease in infant mortality, which allows you to save the lives of almost all born and desired children. In Russia, this transition began at the beginning of the last century and ended with reaching the level of simple reproduction of 2.7 children per woman by the second half of the 1950s. The instruments for reducing fertility were different in different countries, but the consequences were similar. Condoms and other mechanical contraceptives of moderate reliability were widely used in Western Europe, and in the USSR, the main way to prevent unwanted labor was through abortion, whose role has declined only today.

The next stage in the decline in the birth rate below the level of simple reproduction is known as the second demographic transition. It is explained by the fact that in the conditions of a steady growth of well-being and personal well-being, the birth of children begins to be compared with other values: career, self-realization, consumption - and the choice is often made not in favor of having children. This becomes characteristic of the broad masses of men and women, while previously such an approach was peculiar only to representatives of individual (for example, creative) professions. The ability to make reproductive choices is reinforced by the “contraceptive revolution,” that is, the emergence and widespread dissemination of reliable and less harmful contraceptives. In Russia, this transition began in the 1960–1970s and finally ended at the end of the 20th century, when the average number of children per woman born in a lifetime fell from an already low indicator of 1.6 to 1.25.

However, one should not think that these trends are characteristic exclusively for Russia. Most modern demographers share the view that the first and second demographic transitions are a universal path that all countries gradually follow; even the countries of the Third World, which frighten many with their extremely high natural growth, are also already at the very initial stage of the first stage. If this is so, then sooner or later the decline in fertility will also occur in those countries where they are giving birth to a lot, and the Earth’s population should stabilize in the long run and even, most likely, will begin to decrease.

With regard to mortality, there are concepts for the first and second epidemiological transitions. The first is associated with a significant reduction in mortality from "external" causes - infectious diseases, malnutrition, unsanitary conditions, mainly due to a reduction in the enormous infant mortality rate.
This transition occurred in most developed countries in the 1900–1920s as a result of the widespread introduction of basic sanitary standards, especially with regard to the care of infants. In the 1940-1950s, mortality from “external” causes was further reduced with the widespread use of sulfa drugs and antibiotics that prevent death from illness even if sanitary standards were violated and the disease arose. In Russia, mortality also decreased significantly in the 1920s, however, in the middle of the century, due to hunger, war, and mass repressions, the population fluctuated significantly before the first epidemiological transition more or less ended by the 1950s and 1960s. It was then that Russia finally resolved as a whole (or minimized) the problems associated with low hygiene culture, unsanitary conditions, malnutrition, and the lack of basic medical care, which are associated with the spread of tuberculosis and other infectious diseases.

The second epidemiological transition occurred in developed countries after the 1960s. It is associated both with the success of medicine, which allows overcoming diseases of an “internal” nature (or at least prolonging the years of life even in the presence of cardiovascular, oncological, diabetes, etc. diseases), and (primarily) with activity the population itself in matters of maintaining their health, disseminating knowledge and practices of a “healthy lifestyle” (smoking cessation, moderate alcohol consumption, healthy eating, the desire to protect the environment).

Our country has not even come close to this transition, despite the fact that we have certain successes in medicine. But, firstly, they are distributed only to a very insignificant, well-off and active population group regarding their use. Secondly, the success of medicine alone does not lead to anything: they must be supported by lifestyle changes, state programs in support of health and sports (in 8 million Sweden, for example, 26,000 voluntary sports clubs are constantly functioning!), And also the formation of a system of values ​​that contribute to the growth of life expectancy and quality.

Fertility policy is also associated with these values. And although one cannot speak clearly about cause and effect relationships, the fact that European countries have the highest birth rate in the countries of Scandinavia and France, where the most active pro-natalistic (stimulating birth rate) social policy is being carried out: high benefits for births of children, a powerful system of kindergartens, benefits for large families (for example, free travel by public transport), etc. The lowest birth rates are observed in Italy, Spain, Germany, as well as a number of East Asian countries, primarily in Japan, Hong Kong, Singapore and South Korea, where this is not least connected with traditional values. Most of the burden in the event of the birth of a child rests with a woman there, despite the fact that the sphere of life of a mother is limited to her family and her status is relatively low, while the labor market provides women with much more attractive prospects.
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