The demographic crisis affecting Greece is deepening on its islands, with Lemnos and Agios Efstratios emerging as stark examples of shrinking populations, aging residents, and dwindling birth rates — trends that threaten the long-term viability of local communities.
On Lemnos, an island of approximately 16,000 residents, just 100 births are registered annually. Of these, only 20 occur at the local hospital; the rest take place in major cities like Athens and Thessaloniki. At the same time, the number of deaths on the island is double that of births. According to Eleni Farmaki, pediatrician and president of the Lemnos Medical Association, “We are a society that is aging without being renewed. For us here on the islands, this means something even more serious: the sustainability of our local society is at risk.”
Once home to kindergartens and primary schools in nearly every village, Lemnos now operates only 10 of each due to school mergers driven by the population decline.
This troubling picture was presented during a scientific conference titled “Prevention in Reproductive Health and Fertility”, held on July 5 on Lemnos and Agios Efstratios. The event was organized by the Hellenic Intermunicipal Network of Healthy Cities (EDDYPPY) in collaboration with the Hellenic Society of Reproductive Medicine, under the auspices of the Lemnos Medical Association and the Region of North Aegean.
Apostolos Koutsogiannis, the regional governor of Lemnos, added: “The demographic problem is not just statistics. It’s empty schools, fewer families, deserted villages.”
The island’s hospital, like many remote healthcare facilities, struggles with chronic staff shortages — particularly anesthesiologists. Of the 70 registered doctors on Lemnos, only about 50 are actively practicing. The treatment of serious medical cases remains difficult.
If the situation in Lemnos is bleak, the reality on Agios Efstratios, a smaller island with only about 180 residents, is even more dire. The majority of the population is over 60 years old. There are just 16 children on the island, and very few women under 35. The kindergarten has been closed for three years, only two children attend primary school, and the rest go to the island’s secondary school.
Medical care is provided solely by two young rural doctors whose service will end in the coming months. Despite having modern equipment for telemedicine, the system remains inactive due to a lack of interest and institutional support — a failure that does not fall on the local doctors.
Raising Awareness About Fertility
The cases of Lemnos and Agios Efstratios illustrate a broader demographic crisis unfolding across Greece. Experts stress the importance of preventive measures, including education about reproductive health. One major issue is a lack of awareness among women about their fertility windows.
According to Konstantinos Pantos, Secretary General of the Hellenic Society of Reproductive Medicine, only one in ten women knows that fertility begins to decline after the age of 35, with a sharper drop after 40. “We need urgent education so that women understand their real reproductive potential and can plan their lives without illusions,” he said.
One proposed solution is the measurement of Anti-Müllerian Hormone (AMH), a key fertility indicator that reveals the number of eggs a woman has at a given time. EDDYPPY has launched initiatives to inform the public about the importance of AMH testing. As noted by Giorgos Patoulis, president of EDDYPPY and the Athens Medical Association, “The value of AMH lies in its ability to predict future ovarian reserve before problems occur, allowing women to make informed reproductive choices.”
In collaboration with the Hellenic Society of Reproductive Medicine, a fertility information and support hotline will soon be launched nationwide. Additionally, 50 free AMH tests will be provided to women on Lemnos.
Pantos also referenced a successful case study from Portugal, where AMH testing was implemented as part of a national screening program for women aged 25–30. The results were eye-opening: 83% of women with low AMH levels said they would reconsider their reproductive plans. Nearly 36% planned to accelerate their first pregnancy, and 27.5% considered egg freezing.
The program not only influenced personal decisions but also saved the Portuguese national health system an estimated €9.4 million by reducing the need to fund in vitro fertilization treatments.
In Greece, infertility affects an estimated 18% of couples trying to conceive.
