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

Abstract

Abstract Background Persistent below-replacement fertility and population ageing are key determinants of regional health-system resilience. In Central and Eastern Europe these processes intensified after the 1990s transition, but sub-national analyses combining administrative maternity data with trend modelling remain scarce. Greater Poland offers an informative case given its demographic heterogeneity. Methods A retrospective longitudinal ecological study was conducted for 2013–2023. Two sources were analysed separately: annual live births by place of residence from Statistics Poland, used for demographic trends, and delivery records from all 34 maternity facilities (by place of delivery, stratified by perinatal reference level I–III), used for network analysis. Trends were estimated by ordinary least-squares and segmented regression. The income–birth association was assessed by Spearman correlation on levels and first differences. Sensitivity analyses excluded 2020 and restricted the facility analysis to continuously operating units. Reporting followed STROBE and RECORD. Results Live births rose from 36,561 in 2013 to a peak of 40,450 in 2017, then declined to 27,532 in 2023, a 31.9% reduction. Regression over 2017–2023 confirmed a significant decline (slope = − 2,118 births/year; 95% CI − 2,429 to − 1,807; p < 0.001; R² = 0.973). The total fertility rate fell from 1.48 in 2017 to 1.33 in 2023, against a national low of 1.099 in 2024. Between 2017 and 2023, deliveries fell by 40.3% at Level I, 30.3% at Level II and 29.2% at Level III; restricted to continuously operating units, the Level I decline was 33.0%, indicating that the larger figure reflected permanent closure of four peripheral units rather than a disproportionately greater fall in demand. Income showed no significant association with births on levels (ρ = −0.370; p = 0.293) or after first-differencing (ρ = 0.167; p = 0.668). Conclusions Greater Poland experienced a sustained decline in live births between 2013 and 2023, distributed broadly evenly across perinatal reference levels, while the delivery network contracted disproportionately through closure of peripheral Level I units. The data did not support an independent income–fertility association once the common time trend was removed. The findings bear on adaptive perinatal network planning and geriatric-care expansion, and represent planning implications rather than tested outcomes.

The authors' abstract, as published at the source. BMC Public Health, 2026 · DOI ↗