An ageing Bulgaria must make some big choices

Elitsa Dimitrova is Research fellow at the Bulgarian Academy of Sciences’ Institute for Population and Human Studies

Europe’s demographic landscape shows a cluster of “fertility champions” – the north-western countries that have birth rates close to or slightly above population replacement level (and which also have some of the highest life expectancies in the world). But the post-communist countries to the east are enduring an unprecedented demographic collapse. These countries must critically re-think
their traditions of communist demographic policies, which are inadequate in modern times.

In the 1990s, eastern Europe went through a period of “lowest-low fertility” – below 1.3 children per woman. Countries in the region are gradually recovering, but the “demographic problem” persists in each of them. An ageing population, very low fertility, extensive emigration among young people, and emerging ethnic tensions related to the higher reproduction rates of minorities raise concerns in the media, among policymakers and in civil society.

Bulgaria is one of the countries in which the transition to democracy and a market economy has had some of the most negative implications for demographic development. As a country that was, until 1990, an example for an almost ideal two-child society, and that in the mid-1960s had one of the lowest mortality rates in the world, Bulgaria has turned into one of the poorest countries in the EU, with an extremely worrying demographic situation. Bulgaria has the worst population growth rate in the EU. When combined with a persistent trend of huge emigration, population decline becomes steep and irreversible in the short term. And while Bulgaria’s population not only shrinks with unprecedented speed, it is “greying” very quickly.

Since 2000, Bulgaria has escaped from the “lowest-low fertility” group. In recent years, birth rates have approached the EU average of 1.58 children per woman, reaching 1.53 in 2014. But a one-child model prevails for 64% of families, with many couples also deliberately postponing marriage and childbirth. Half of young people surveyed in 2011 expressed a strong desire to emigrate, their values and preferences regarding family, marriage and children being more liberal and non-conformist. Life expectancy for men and women, although increasing, is one of the lowest in the EU. Crucially, infant mortality – especially among ethnic minorities (the Roma population) – is double the EU average, at 7.6 per thousand live births (although it has fallen from 17.5 in 1997).

These demographic tendencies provoke the question: why does the country show so little improvement in this area, given that the last decade has seen economic stability and significant increases
in living standards? One of the explanations – though not the only one – relates to the specific character of Bulgaria’s demographic policy, which is strongly biased towards fertility and reproduction,
and underestimates the importance of effective state intervention in public health and mortality.

This bias dates back to communist times, when coercive pronatalism was seen as the main tool for optimising the country’s demographic development. But health and survival reflect socioeconomic conditions far better than fertility. Several prosperous societies – Germany and Austria, for instance – have very low birth rates.

In recent times, Bulgaria has struggled with chaotic healthcare reforms. Healthcare organisation has been decentralised. Private healthcare has been introduced along with the general practitioner model of primary care, clinical pathways, co-payments and rationing of care. The resulting huge inequalities in access to high-quality medical services turned healthcare from universally accessible
under communism into a luxurious commodity affordable mostly by upper echelons of society. Guaranteed access for the most vulnerable social groups to adequate medical care and treatment is a must if Bulgaria is to have an effective demographic policy.

In 2007, Bulgaria’s EU membership was celebrated as an important milestone that would bring additional stability to the political and economic life of the country. But it also meant accepting many European states’ common vision of social policies and protections. The country’s financial resources, though, were insufficient to maintain the legacies of the quasi-communist welfare system and invest in social protection for vulnerable groups or high-quality welfare infrastructure like nurseries and homes for the elderly. The extremely low financial support for families and children – currently, family benefits are less than €20 per month distributed on a means-tested principle – meant that EU social policy principles were accepted only on paper.

Very recently, Bulgaria has experienced a new challenge. The current refugee crisis, with its transient migration, found formerly “closed to immigration” countries like Bulgaria completely unprepared and unable to provide adequate facilities or financial help for refugees. The same Bulgaria that still experiences the huge emigration of ethnic Bulgarians today faces becoming a country of immigration – something for which the country is politically,socially and financially unqualified. In public discussions, the role of the EU is seen as supporting the protection of national security, since illegal migration is considered not only an economic burden for the “poorest state in EU” but also a demographic threat to “the most quickly depopulating country in Europe”.

One of the messages we can draw from these short reflections on Bulgaria’s demographic situation, which could be valid for the majority of the post-communist countries, is that recent policy interventions concerning demographic development should be critically re-evaluated. The persistent overlooking of health and mortality should be replaced by a multi-dimensional, comprehensive and sustainable demographic policy that takes into account the complexity of population development, and incorporates effective measures in all domains of social life relevant to people’s health, survival and reproduction.