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New York Times, November 18, 2004 Empty Maternity
Wards Imperil a Dwindling Germany FRANKFURT -- It is a typical night in the maternity ward of this city's second biggest hospital and the loneliest place is the nursery. Empty baby beds are lined up against a wall like rental cars in an airport parking lot. A colorful mobile hangs hopefully over the still room. With more than 1,000 beds, a team of doctors and midwives but only a few births a day, the Frankfurt-Höchst hospital has an abundance of everything except babies. Germany's falling birthrate, like that in much of Western Europe, is entering its second generation. This means not only that mothers continue to have one or at most two children - too few to reproduce the population - but also that the number of potential mothers has dwindled. The reunification with eastern Germany, where the birthrate is even lower than in the west, has made matters worse. Dresden, the capital of depopulated Saxony, closed 43 schools this summer because of a lack of children. Elsewhere in the country, there are too many hospitals and even too many roads. Germany, like several of its neighbors, is running out of the people it needs to sustain its advanced social systems and public infrastructure. "There will be 10 million fewer young people in my lifetime," observed Frank Schirrmacher, an editor at the daily Frankfurter Allgemeine Zeitung, who has written a best-selling book about population trends in Germany. "Our whole infrastructure is designed for a bigger population." Mr. Schirrmacher and other commentators conjure up a sort of reverse Malthusian nightmare: Germany as a land of predominantly geriatric towns and cities set in a deserted, creeping countryside. While such a bleak vision strikes some as far-fetched, the low birthrate is rippling through society in unlikely ways. The dearth of babies, for example, has ignited a fierce competition among Frankfurt's hospitals. The other evening, half a dozen German couples gathered over fresh fruit and sparkling water at the Höchst hospital to listen to the chief of the obstetrics and gynecology department, Dr. Volker Möbus, try to persuade them to deliver their babies there. He promoted the hospital's well-regarded neonatal intensive care unit and dangled extra services like acupuncture and massage therapy for the mothers. Höchst no longer resists performing Caesarean sections for nonmedical reasons. The number of deliveries at the hospital has been declining since 1995, when refugees from the war-torn Balkans swelled the numbers. This year, it will barely reach 1,800, or slightly less than five a day. By comparison, Mount Sinai Hospital in New York City, with only 119 more beds than Höchst, had 4,617 births in 2002. "In every German city, you could close 20 percent of the hospitals and no one would notice," said Dr. Möbus, as he made the rounds. "We have too many beds and too many hospitals." Höchst is fighting an ingrained social prejudice against large families. Even Turkish and other immigrants, who constitute half the patients at the hospital, tend to adapt to Germany's birthrate of 1.3 children per couple within a generation, according to population experts. Slobodanka Jovanovic, a Bosnian who came to Germany 13 years ago, just gave birth to a girl, her second child. Recovering in the maternity ward, Ms. Jovanovic said she would not contemplate having a third child. "The biggest reason is financial," she said. "We don't get enough support from the state." A blunt-spoken woman who works as a hairdresser, Ms. Jovanovic, 32, said she also felt that children were neither particularly welcome nor prized in German society. Her neighbors, she said, complained more when her child cried at night than if she threw a party or played music. "They want their houses, they want their cars, they want their peace," she said, apologizing to her German roommate, Simone Schönhoff, and her husband, Thorsten, who were preparing for the birth of twins. "It is partly selfishness," Mr. Schönhoff agreed. "They want a Mercedes, and it costs so much that they can't afford a child." Mrs. Schönhoff noted, however, that women were motivated by something else: a fear that they will cramp their professional options if they stay at home too long. While German family leave laws are generous, allowing either parent to take three years off and return to their jobs, Mrs. Schönhoff, a secretary, says she plans to stay at home no longer than six months. "They would give me a secretarial job when I get back, but I'm not sure it would be the same one," she said. Such angst is not new. The watershed decline in the birthrate occurred from 1967 to 1972, when female contraceptives became widely available. After dropping from 2.5 children per couple to 1.5, the rate has drifted downward only modestly since then. The reason hospitals are feeling an added pinch is that the children born in the early 1970's are now in their childbearing years. "It's simple arithmetic, but even the hospitals don't realize it," said Reiner Klingholz, director of the Berlin Institute for Population and Development. Dr. Klingholz drew attention here last spring when he calculated that without new immigrants, Germany's population would wither from 82 million to 24 million by 2100. If the country maintained its current rate of 230,000 immigrants a year, it would still shrink by 700,000 over the next 15 years. Along with the shrinking comes aging. At current birthrates, the number of schoolchildren will fall nearly 12 percent by 2050. One in every three Germans will be over 65, double the ratio today. For those who believe demography is destiny, those numbers add up to a slow-motion calamity. Some problems, like the financial burden of the elderly on a smaller working-age population, are easy to predict. Others, like the political drift of an aging society, are open for debate. "Rumsfeld was right: this is 'old Europe,' " Mr. Schirrmacher said. "With the loss of young people and the growth of old people, this country will become more timid and angst-ridden." Other European countries, notably Sweden, have nudged up their birthrates by offering incentives to families to have extra children. But the German government, already battling a tide of red ink, does not have the resources to embark on an ambitious family policy. Even if it did, Mr. Schirrmacher noted, demographic trends take generations to reverse. Immigration is only a temporary solution, he said, because the new arrivals so swiftly adopt the German lifestyle. Germany's birthrate is roughly equivalent to that of Spain or Italy, but lower than that of France, which has been encouraging larger families since the 1930's. France also has a stronger tradition of working mothers. "Spain, Italy and Germany will be the first societies in human history with more older people than children," said Mr. Schirrmacher, whose book, "The Methuselah Conspiracy," has sold 400,000 copies here. "What will it mean for popular culture? How will they vote?" In a report last June, Deutsche Bank warned that Germany would have to curtail its public services, because tax revenue from a declining population would not be enough to support them. Höchst, which is owned by the city of Frankfurt, hit a financial wall five years ago, when the local government said it could no longer afford to cover the hospital's operating losses. While it is not in danger of being shut down, it has no money to make new investments. Dr. Möbus's remark about the color of the walls was not offhand. He said he had been handicapped in the competition with other hospitals because he could not upgrade the rooms in the maternity ward. The recent health care changes passed by the government of Chancellor Gerhard Schröder may add to the pressure. Health insurers are changing the formula by which they cover treatment, moving toward the American-style system that pays a flat fee based on the diagnosis. Manfred Haubrock, an expert in health care finance at the University of Applied Science in Osnabrück, estimates that the number of hospitals in Germany will shrink to 600 from 2,200 in the next decade. "We'll be lucky to maintain the quality levels we have now," he said. "With less money, many good doctors and nurses will leave." For those expectant mothers who choose the hospital at Höchst, the treatment is first-rate and the doctors and nurses are attentive, especially if one has the good fortune to deliver on a slow day. Saskia Schenck, a 35-year-old business strategist who worked for Mercedes-Benz, could afford to have her baby anywhere. Ms. Schenck, a Dutch woman who is married to a German, chose to deliver her son, Mick, at Höchst because of its neonatal clinic. Mick is her second child, and as she swaddled him in the empty nursery, Ms. Schenck said she was seriously thinking about striking a blow for population growth in Europe by having another child. "In our generation of Europeans, there are far too many families with one child," she said. << New York Times -- 11/18/04 >>
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