What do high birth rates and high fertility rates show in terms of a country's health care system?

There is a concern about declining birth rates in both the developing and developed world (www.rand.org). Fertility rates tend to be higher in poorly resourced countries but due to high maternal and perinatal mortality, there is a reduction in birth rates. In developing countries children are needed as a labour force and to provide care for their parents in old age. In these countries, fertility rates are higher due to the lack of access to contraceptives and generally lower levels of female education. The social structure, religious beliefs, economic prosperity and urbanisation within each country are likely to affect birth rates as well as abortion rates, Developed countries tend to have a lower fertility rate due to lifestyle choices associated with economic affluence where mortality rates are low, birth control is easily accessible and children often can become an economic drain caused by housing, education cost and other cost involved in bringing up children. Higher education and professional careers often mean that women have children late in life. This can result in a demographic economic paradox.