This article [1] claims that it's actually still quite higher than replacement, to make people around ancient Mediterranean have to resort to various kinds of birth control (be it violent or non violent). Medicinal revolution do lowers death rate significantly but I guess the reason why we haven't normalized late/late marriage pattern as birth control until recently is because of abundance of resource resulted by industrial and agricultural revolution.

1. https://acoup.blog/2025/08/08/collections-life-work-death-an...