The UK fertility crisis: what the data shows & how employers can help

A new consensus paper from Merck, Understanding the Decline in Live Birth Rate in the UK: Barriers, Beliefs and Opportunities to Support Future Families, makes for sobering reading. Developed by a group of leading clinicians, charities, health economists and patient advocates, it paints a clear picture of a country facing a fertility crisis that goes far beyond individual choice and one that demands urgent action from policymakers, healthcare providers and employers alike.

At Peppy, much of what this report highlights resonates deeply with what we hear every day from the people we support. Here's what caught our attention and why it matters for HR and benefits leaders.

The scale of the problem

The UK's total fertility rate dropped to just 1.41 children per woman in 2024 - well below the 2.1 replacement rate needed to sustain a stable population. This is the largest decline seen across any G7 nation, with profound long-term implications for the economy, public services and the workforce.

This isn't simply a story about people choosing not to have children. It's a story about people who want to have families being let down by a system that isn't designed to support them.

Poor patient experience is a driving factor

One of the report's most striking findings is how significantly poor patient experience contributes to the fertility crisis. According to the HFEA's own patient survey data cited in the report:

• 53% of patients said NHS waiting lists delayed their treatment
• 43% of patients who spoke to their GP about fertility options were not satisfied with their experience
• 15% of patients reported delays in starting treatment due to administrative errors at their GP practice
• Only 35% of NHS-funded patients start treatment within a year of referral

These represent real people losing precious time during what is already one of the most emotionally and physically demanding journeys of their lives. As the report notes, delays don't just cause distress; they actively reduce the chances of treatment success because fertility declines while people wait.

We hear this directly from the people using Peppy's fertility support. The uncertainty, the long silences between appointments, the feeling of not knowing who to ask or what comes next - these are the gaps that specialist support can help to fill.

The knowledge gap is bigger than we think

The report highlights a significant and often overlooked contributor to the crisis: a widespread lack of fertility literacy. Studies show that most young people leave school without adequate understanding of how fertility changes with age, or how conditions like PMOS and endometriosis can affect their reproductive health.

Crucially, this knowledge gap doesn't close in adulthood. Without reliable, accessible sources of information, many people turn to social media, where only 11% of fertility-related content has been found to be credible, and nearly half of content creators have no relevant qualifications.

The report recommends that healthcare providers should "make every contact count" using touchpoints like contraception counselling and chronic disease management as opportunities to proactively share fertility guidance. It also calls for national public health campaigns to improve fertility literacy, covering lifestyle, environmental and health factors that affect fertility.

This is exactly the kind of proactive, ongoing support that Peppy was built to deliver. Our specialist clinicians don't wait for people to come to them in crisis, they provide regular check-ins, evidence-based guidance and personalised support that helps people understand their own health before issues escalate.

The workplace has a real role to play

While the report is primarily aimed at policymakers, its implications for employers are significant. The report notes that 88% of people would change jobs for better fertility support and that fertility challenges affect not just physical health but mental health too, with 90% of people struggling with fertility reporting feelings of depression.

The financial and workplace pressures driving delayed parenthood are also well documented. High childcare costs, insufficient parental leave and limited flexible working are pushing people to delay starting families until later in their reproductive years, a decision that carries real biological consequences that are, again, poorly understood.

Employers who provide meaningful fertility support are addressing a genuine gap in the care system that is costing them in retention, productivity and absence.

What Peppy does differently

The Merck report calls for a system that provides timely, personalised, stigma-free support across the fertility journey - from preconception health and fertility literacy, through treatment and beyond. It's a vision we share entirely.

Through Peppy, employees get:

• Unlimited one-to-one access to specialist fertility clinicians - no waiting lists, no gatekeeping
• Proactive check-ins so people aren't left in silence between appointments
• Evidence-based guidance on fertility, lifestyle, preconception health and treatment options
• Mental health support woven into the care pathway, because the emotional toll of fertility challenges is real and often underserved
• Support that continues through pregnancy, parenthood and beyond

The report makes clear that the UK's fertility crisis will not be solved by the NHS alone. Employers, and the benefits they offer, are part of the solution. The question is whether your organisation is ready to play its part.

Peppy provides specialist fertility support as part of a broader employee healthcare benefit covering women's health, men's health, menopause, pregnancy and parenthood. To find out how Peppy can support your workforce, book a call with our team.