A new report from the United Nations Population Fund (UNFPA) has highlighted that falling birth rates worldwide are increasingly linked to economic hardships, gender inequality, and social pressures, rather than a lack of desire to have children.

The 2025 State of World Population Report , titled “The Real Fertility Crisis: The Pursuit of Reproductive Agency in a Changing World,” warns that millions of people globally are unable to form the families they want because of financial burdens, job insecurity, unaffordable housing, and cultural expectations.

Drawing on surveys across 14 countries representing over one-third of the global population, the report reveals that one in five people expect not to have the number of children they desire. It further notes that coercive or simplistic measures, such as cash incentives to boost birth rates, have largely proven ineffective. Instead, the report urges governments to empower individuals by providing affordable healthcare, housing, child care, paid leave, and broader reproductive rights. “Vast numbers of people are unable to create the families they want,” said UNFPA Executive Director Dr Natalia Kanem. “The issue is lack of choice, not lack of desire.”

Among the key findings, more than half of respondents cited economic barriers to having more children. One-third of adults reported experiencing unintended pregnancies. One in five people felt pressured to have children against their will, while gender inequality in caregiving and workforce participation was found to be a significant barrier to forming desired families.

Against this global backdrop, Nepal released its first-ever national report on sexual dysfunction on June 16, offering important insights into another under-recognized aspect of sexual and reproductive health.

The Nepal Sexual Dysfunction Study 2024 (NSDS-2024) was conducted by SOLID Nepal with support from UNFPA and the Family Welfare Division under the Government of Nepal. Covering over 3,300 married, literate men and women aged 30 and above across all provinces and regions, the study found that nearly seven in ten Nepali adults (68%) over age 30 experience some form of sexual dysfunction — a critical but often overlooked factor influencing reproductive choices, health, and well-being.

The prevalence was found to be slightly higher among men (72.2%) than women (67%). The most commonly reported issues included low sexual desire (reported by 91.9% of participants), orgasmic dysfunction (75.3% of men and 73.5% of women), and arousal difficulties (reported by 94.3% of affected women). Key risk factors identified include early marriage (before age 18), chronic illnesses such as diabetes and hypertension, and unhealthy lifestyle habits such as tobacco use and obesity. Geographically, the highest rates of dysfunction were recorded among males in Karnali Province (82.4%) and females in Madhesh Province (73.3%), with the lowest among females in Lumbini Province (40.8%).

Experts warn that sexual dysfunction affects not only physical health but also emotional intimacy, mental well-being, and overall quality of life. Yet the issue remains heavily stigmatized in Nepal, with little public discussion and limited access to care. The report calls for integrating sexual health — including sexual dysfunction — into Nepal’s national health policies and programs on sexual and reproductive health and rights (SRHR). It also recommends expanding education and awareness through comprehensive sexuality education in schools and community outreach programs, establishing specialized sexual health clinics in major hospitals, and training healthcare professionals in psychosexual therapy and counseling. Additionally, it highlights the need to strengthen data collection and integrate sexual health indicators into Nepal’s non-communicable disease (NCD) monitoring systems.

“Sexual health is an essential component of well-being and family life, but too often goes unaddressed,” said UNFPA Nepal representatives during the report launch. “Evidence-based policy, greater public awareness, and improved access to care are urgently needed.”