Mapping the General Fertility Rate in Greece: A Time-Trend Nationwide Analysis (1956-2024)

Abstract

Background: Accurate assessment of fertility rates and their long-term trends is essential for understanding reproductive dynamics, anticipating the healthcare and socioeconomic consequences of demographic change, and informing family planning and population policies. The aim of this study was to investigate long-term trends in the general fertility rate (GFR) in Greece using nationwide population data. Materials and methods: Official national data on annual live births and the female population aged 15-44 years were obtained from the Hellenic Statistical Authority for the period 1956-2024. The GFR was calculated as the annual number of live births per 1,000 women of reproductive age (WRA). An age-standardized GFR (ASGFR) was also calculated for each study year using the 2013 European Standard Population. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs) and corresponding 95% confidence intervals (95% CIs). Results: The GFR declined during 1956-1980 (APC = -0.3, 95% CI: -0.4 to -0.2), with two historic peaks recorded in 1959 and 1967, when it reached 81.6 and 80.7 births per 1,000 women aged 15-44 years, respectively. Over the subsequent two decades, the GFR declined further (1980-1989: APC = -4.7, 95% CI: -5.5 to -4.2; 1989-1999: APC = -1.2, 95% CI: -1.6 to -0.7). From 1999 to 2009, the GFR increased (APC = 2.1, 95% CI: 1.7 to 2.6). Thereafter, it entered a renewed period of decline, reaching a historic low of 39.4 births per 1,000 women aged 15-44 years in 2024, representing a 25% decrease compared with 2009. This decline was characterized by two periods of significant reduction, during 2009-2013 (APC = -3.7, 95% CI: -5.4 to -2.0) and 2021-2024 (APC = -5.0, 95% CI: -8.1 to -3.0), with a period of relative stability between 2013 and 2021. Following a period of stability during 1956-1963, the ASGFR increased during 1963-1967 (APC = 2.6, 95% CI: 1.3 to 4.1) and subsequently declined during 1967-1999. The rate increased again during 1999-2009 (APC = 2.3, 95% CI: 1.9 to 2.7), declined during 2009-2013 (APC = -3.4, 95% CI: -5.9 to -0.7) and 2021-2024 (APC = -4.4, 95% CI: -6.9 to -1.8), whereas it showed a modest upward trend during 2013-2021 (APC = 0.9, 95% CI: 0.2 to 1.7). During 2009-2024, approximately 70% of the overall decline in the GFR was attributable to declining fertility rates and 30% to changes in the age composition of women of reproductive age. However, the contribution of these factors shifted over time: alterations in the age distribution of women of reproductive age accounted for most of the decline during 2009-2021, whereas fertility decline became the predominant driver during 2021-2024. Conclusions: This nationwide study demonstrates a sustained long-term decrease in the GFR in Greece over nearly seven decades, culminating in a historic low in 2024, despite a temporary recovery between 1999 and 2009. The recent GFR downward trend observed from 2009 to 2024 was the result of fertility decline, exacerbated by unfavorable shifts in the age structure of women of reproductive age.