Fertility, particularly at its current low level in many developed countries and high level in some less developed countries, is a key factor driving demographic, economic, and societal changes at local, national, and global levels. Population ageing due to low fertility and increasing longevity represents one of the most significant global megatrends and risks. Many countries are already experiencing population decline and rapid growth of their elderly populations, with implications for workforce size, economic development, health and pension schemes, and social security arrangements. Actuaries are well known for their work on mortality and morbidity, but they have rarely considered fertility and its proximate determinants, despite their demographic and economic effects. This paper explores key explanations and outcomes of past and projected future fertility trends, and the implications for actuaries and for political and economic decision-makers.