Wagga obstetrician Dr Carl Henman has identified a range of medical, cultural and financial reasons for why the city's fertility rate has been struggling to rise.
According to the latest Australian Bureau of Statistics, the number of births recorded within Wagga City Council is at its highest point in at least six years with more than 1000 new babies in 2018.
Despite a 20 per cent jump in births, Wagga's overall fertility rate of births per woman remains below the estimated 2.1 ratio needed to sustain the current population without outside migration.
"It's a steady trend; the fertility rate has been falling for the best part of a decade really," Dr Henman, who works as a GP and obstetrician at Riverina Family Medicine, told The Daily Advertiser.
"The total fertility rate generally refers to births per mother but that's not necessarily the definition of fertility; the ability to fall pregnant is the definition of fertility.
"Access to termination services and more antenatal screening [for genetic disorders in the foetus] and that sort of stuff plays a role but I doubt that's the largest contribution."
Dr Henman said societal changes like people marrying later or forming long-term relationships later in life, choosing careers or struggling with finances were bigger influences on people's fertility.
"We are probably not as healthy - overall we are living longer - but to get pregnant and to take a pregnancy to term you generally need to be a pretty well woman," he said.
"Things like obesity, diabetes, endometriosis [when the type of cells that line the uterus form in other parts of the body] and a range of chronic health factors including mental health will negatively contribute to getting pregnant and staying pregnant.
"Maybe even the desire to be pregnant; if you know you have a chronic health issue you might not want to put that burden on yourself."
Wagga's fertility rate has lifted from 1.85 to 1.93 in the past two years but remains below the 2.05 NSW average.
Most council areas in the Riverina had a higher fertility rate than Wagga but also had fewer births and smaller populations.
Dr Henman said Wagga was a "fairly well-off area" in the economic sense and that corresponded with people having children later in life.
"Working women tend to have children later and that makes a differences, and big families are probably less desired.
"I have got a few families under my care who have four or five children but they are the standouts.
"Couples are getting together later, which means they have children later and they have fewer children."