Poland’s Greater Poland Region Sees Births Plummet Nearly a Third in a Decade

A comprehensive longitudinal analysis of one of Poland’s largest regions has documented a demographic downturn so steep and so rapid that it is forcing health planners to rethink the very shape of the local maternity network. Between 2013 and 2023, the number of live births in the Greater Poland Voivodeship first climbed to a peak and then collapsed by almost a third, while the network of maternity units contracted even faster, driven not by falling demand alone but by the permanent closure of small peripheral hospitals. The study, published in BMC Public Health by a team from Kalisz University and Charité Universitätsmedizin Berlin, offers one of the most detailed sub-national pictures yet of the fertility crisis sweeping Central and Eastern Europe.

The research team, led by Andrzej Ciborek, combined two complementary data sources that are rarely analysed together. The first came from Statistics Poland: annual counts of live births recorded by the mother’s place of residence, which capture the true demographic behaviour of the regional population. The second consisted of delivery records from all 34 maternity facilities in the voivodeship, stratified by perinatal reference level from Level I, the smallest units offering basic obstetric care, up to Level III, the tertiary centres equipped for the most complex and high-risk pregnancies. Separating these two streams of data allowed the authors to distinguish demographic change in the population from structural change in the healthcare network itself, a distinction that many regional analyses conflate.

The numbers tell a striking story. Live births in Greater Poland rose from 36,561 in 2013 to a high point of 40,450 in 2017, a brief echo of the so-called mini-baby boom that followed pro-family policy announcements and a favourable age structure among women of reproductive age. Then the reversal began. By 2023, births had fallen to 27,532, a reduction of 31.9 percent from the 2017 peak. Ordinary least-squares regression over the period 2017 to 2023 confirmed that the decline was statistically robust and remarkably consistent, with a fitted slope of minus 2,118 births per year, a 95 percent confidence interval running from minus 2,429 to minus 1,807, a p-value below 0.001 and an R-squared of 0.973. In practical terms, more than 97 percent of the year-to-year variation in the region’s birth count is captured by a simple linear downward trend, indicating a steady erosion rather than a series of random shocks.

The total fertility rate in the voivodeship followed the same trajectory, sliding from 1.48 children per woman in 2017 to 1.33 in 2023. Both values sit well below the replacement level of roughly 2.1, the rate at which each generation exactly replaces the previous one in the absence of migration. The regional picture, grim as it is, still looks marginally better than the national one: Poland’s national total fertility rate fell to just 1.099 in 2024, among the lowest figures ever recorded for the country. This gap illustrates an important nuance in European demography. Greater Poland, with its mix of the Poznań metropolitan area, mid-sized cities and a broad agricultural hinterland, has historically been more demographically resilient than eastern regions of Poland, yet even this comparatively advantaged region is now aging and shrinking in its childbearing population.

The delivery network data revealed a second, equally consequential finding. Between 2017 and 2023, the number of deliveries fell by 40.3 percent at Level I facilities, by 30.3 percent at Level II units and by 29.2 percent at Level III centres. At first glance, the numbers suggest that small rural hospitals lost business far faster than the large referral centres. But the sensitivity analysis tells a subtler story. When the researchers restricted the facility analysis to units that had operated continuously throughout the study period, the Level I decline shrank to 33.0 percent, a figure much closer to the losses at higher levels of care. The gap between the raw and adjusted figures was explained by the permanent closure of four peripheral Level I units. In other words, the apparent collapse of the smallest maternity hospitals reflected not a disproportionately greater fall in demand in rural areas but the deliberate consolidation of the network, as struggling units were shuttered and their catchment populations redirected elsewhere.

This distinction matters enormously for planning. If the decline in deliveries had been genuinely steeper in peripheral areas, planners might have concluded that rural obstetric services were becoming redundant and could safely be allowed to wither. The corrected picture suggests instead that demand fell broadly evenly across the region, and that the closure of small units was a structural response to falling volumes and the economics of running low-throughput maternity wards. Each closure, however, increases the distance that a pregnant woman must travel to reach care, raising questions about access to emergency obstetric services in sparsely populated areas, particularly for time-critical complications where minutes matter for both maternal and neonatal outcomes.

The study also tested a hypothesis that dominates public debate about fertility: that economic conditions drive birth rates. Using regional income data, the researchers computed Spearman rank correlations between income and the number of births, both on the raw levels and after first-differencing, a statistical technique that removes the common time trend and asks whether the two series still move together. The answer was a clear no. On levels, the correlation was negative and statistically insignificant, with rho equal to minus 0.370 and a p-value of 0.293. After differencing, rho fell to 0.167 with a p-value of 0.668. The data, in short, did not support an independent income-fertility association once the shared downward drift was taken out. That does not mean income is irrelevant to childbearing decisions at the individual level, but it cautions against the simplistic expectation that regional prosperity alone can reverse a fertility decline shaped by deep structural forces, including the shrinking cohort of women of reproductive age, changed life-course preferences and the postponement of parenthood.

Methodologically, the paper is a model of transparency for an ecological study. The authors followed the STROBE and RECORD reporting guidelines, which govern observational studies using routinely collected health data, and ran sensitivity analyses that excluded the year 2020, when the COVID-19 pandemic disrupted both healthcare utilisation and conception patterns, and restricted the facility analysis to continuously operating units. Because the study relied exclusively on aggregated administrative and publicly available statistical data, with no individual-level records, the authors note that ethics committee approval was not required under Polish law. The correspondence between the demographic series, based on place of residence, and the facility series, based on place of delivery, provides an unusually coherent picture: the population series tracked the region’s demographic reality, while the facility series tracked how that reality was absorbed by the hospital network.

The implications reach well beyond obstetrics. A region whose births have fallen by nearly a third in six years is a region whose population is aging rapidly, and the study frames its findings explicitly around the dual challenge of adaptive perinatal network planning and geriatric-care expansion. Fewer children mean fewer paediatric wards, fewer school places and, eventually, fewer young workers; more elderly residents mean rising demand for long-term care, geriatric medicine, chronic-disease management and social services. The authors are careful to characterise these as planning implications rather than tested outcomes, a scientifically honest framing, but the direction of the demographic arithmetic is not in doubt. Healthcare systems built around a growing or stable young population cannot simply be repurposed overnight, and the closures of maternity units already underway show how difficult and politically sensitive the transition can be.

For other regions of Central and Eastern Europe, Greater Poland may function as a leading indicator. The post-1990 transition intensified below-replacement fertility across the region, and Poland’s national fertility rate of 1.099 in 2024 is among the lowest in the European Union. The Greater Poland analysis demonstrates that sub-national data, properly modelled, can reveal dynamics that national statistics conceal: the uneven geography of facility closures, the timing of turning points and the degree to which economic variables do or do not track birth trends. As the authors’ collaboration between Kalisz University and Charité underscores, the questions raised here are European in scope, and the answers will shape how health systems across the continent adapt to a future in which the cradle is quieter but the ranks of the elderly grow with every passing year.

Subject of Research: Fertility decline, population ageing and perinatal care network contraction in the Greater Poland Voivodeship, 2013–2023

Article Title: Fertility decline and population ageing in the Greater Poland Voivodeship, 2013–2024: a longitudinal analysis of implications for regional health and social services planning

Article References: Ciborek, A., Chęcińska-Maciejewska, Z., Bogdański, A., & Krauss, H. (2026). Fertility decline and population ageing in the Greater Poland Voivodeship, 2013–2024: a longitudinal analysis of implications for regional health and social services planning. BMC Public Health. https://doi.org/10.1186/s12889-026-29263-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29263-3

Keywords: fertility decline, population ageing, total fertility rate, Greater Poland Voivodeship, perinatal care network, live births, health services planning, Poland, demographic change, longitudinal analysis, maternity facility closures, public health