Will Covid-19 Cause a Baby Boom — or Bust?
By: Juno Demelo
Tags: Covid 19, Health, Pandemic, Parenting, Pregnancy

Will Covid-19 Cause a Baby Boom — or Bust?

Photo: Noam Galai/Getty Images

In late winter of 2020, when quarantine still seemed like it would last just long enough to binge The Crown, Americans busied themselves with making masks, sourdough, and — many joked — babies.

Fast-forward to summer, however, and the bloom was off the rose. In June, digital health clinic Nurx told USA Today they’d seen a 50% increase in requests for birth control from patients. That same month, the Brookings Institute estimated that there could be between 300,000 and 500,000 fewer births in 2021. Also in June, a survey by the Guttmacher Institute reported that because of the Covid-19 pandemic, more than 40% of women are changing their plans about when to have children or how many children to have; 34% of women are planning to get pregnant later or have fewer children. (Women belonging to groups experiencing systemic inequalities long before the pandemic were even likelier to report wanting to delay pregnancy or shrink the size of their brood.)

What gives?

Pre-Covid-19, birth rates were already declining in the United States, from 60.2 births per 1,000 women aged 15 to 44 in 2017 — the lowest number in 30 years — to 59.1 in 2018 and 58.3 in 2019. Now, some women fear that if they were to get Covid-19 while pregnant, it could negatively affect their prenatal care, the health of their fetus, or even their birth. (While pregnant women who developed severe Covid-19 well into their third trimester were more likely to deliver prematurely, a recent study found that the vast majority of pregnant women who test positive will not develop health complications, and it’s unlikely that their babies will become infected.)

This isn’t the first time a public health scare would lead to a drop in births. According to a study in the American Journal of Epidemiology, birth rates fell by 10% in the nine to 10 months following the peak in deaths caused by the Spanish flu of 1918. Weak economic conditions have also driven declines; the Great Recession led to a 9% drop in births between 2007 and 2012. This time around, not only is the economy badly damaged, but job losses are disproportionately affecting mothers. In fact, a Harvard Business Review analysis found that women’s jobs are nearly twice as vulnerable to the pandemic as men’s are. On top of that, school closures have further shifted the burden of unpaid care to women, so even if they haven’t lost their jobs, many are dropping out of the workforce. When the school year began in September, 865,000 women had dropped out of the labor force, compared with 216,000 men.

This isn’t the first time a public health scare would lead to a drop in births.

And what was already an isolating experience for some parents has become even more siloed now that mommy-and-me yoga is off the table. Laura Lobosco, 36, a special education administrator and mother of a 15-month-old, was just beginning to bond with other new parents in New Orleans when the pandemic started. “We’re not from here, we don’t have family here, and none of our friends have children,” she says. “We were just starting to form some relationships that would have made us feel more connected to a helpful community — and then they got cut off. I think I would have wanted to start trying for a second after Mardi Gras. But now the idea of being pregnant and not having help or community sounds tough on me and our marriage. What would we do with our daughter during labor and delivery? How would we do it all without anyone to help?”

For Molly Cooper, 30, a compliance and operations manager at a financial firm in Colorado and the mother of a 4-year-old, “the pandemic has reintroduced all those elements of fear and panic I remember feeling for the first time when I gave birth.” She and her husband have good jobs and health insurance and own their own home. “He wants more kids, but this summer I finally reached the conclusion — with the help of a therapist — that this is just how our family is going to look going forward,” she says. “The introduction of yet another element that we can’t control in our lives is simply one too many things for me to deal with and live a healthy life.”

On the other (heavily sanitized) hand, Covid-19 has fast-tracked some people’s plans to get pregnant. Sarah R.,* 33, an editor at an independent publisher in Chicago, says that the pandemic has made having a career seem more compatible with raising an infant. “Significant factors in deciding whether to get pregnant were the sudden ability to work from home full-time, and the idea that having worked from home successfully for months might make it possible to negotiate full-time work from home for the foreseeable future,” she says.

Karen B.,* 38, a professional dancer in New York City, had always planned to continue performing until she was 40, then get pregnant, be a stay-at-home parent for a few years, and figure out her next steps. “But now that would mean me spending the last two years of my career dancing in my bedroom and not performing,” she says. So she’s switched up her plans and is trying to conceive pronto. “If I’m lucky and I can get pregnant before the end of this year, I could be back in the studio in 2022, which hopefully looks more like 2019 did. As long as I stay healthy physically, it opens up the possibility for me to dance for five more years rather than the two that I was going to squeeze in.”

For people who already live with socioeconomic risk, Covid-19 doesn’t change the equation much either way. “Early in the HIV epidemic, when it was recognized that there were high rates of perinatal transmission and women and their babies did very poorly before the advent of treatment, there were public health recommendations that women avoid pregnancy,” says Anne Drapkin Lyerly, MD, a professor of social medicine and the associate director of the Center for Bioethics at the University of North Carolina, Chapel Hill. “In the 1990s, a working group took a very hard look at whether that was appropriate, and what they found is that many women were giving birth in circumstances where they or their children already faced poverty, lack of access to health care, and drug use. This risk that seemed so scary to many public health officials or doctors was familiar to these women.”

“A lot of women are looking at which is going to make me feel more out of control or anxious: delaying either starting or expanding a family, or being pregnant during this pandemic and having my prenatal care or delivery preferences or postpartum impacted?”

According to a recent paper in The New England Journal of Medicine that Lyerly co-authored, Covid-19 doesn’t present enough of public health risk to recommend not getting pregnant. (Though the authors do recommend access to effective contraception and information from providers that clearly outlines the risks — and benefits — of becoming pregnant during a public health emergency versus waiting to conceive until it’s over). But what about the mental health risks? Those are harder to quantify.

“A lot of women are looking at which is going to make me feel more out of control or anxious: delaying either starting or expanding a family, or being pregnant during this pandemic and having my prenatal care or delivery preferences or postpartum impacted?” says Pooja Lakshmin, MD, a clinical assistant professor of psychiatry at the George Washington University School of Medicine and psychiatrist who specializes in women’s mental health. “So much of what has made this pandemic so traumatic is the uncertainty. There are very few clear answers, so it’s not surprising we want something happy that we can look forward to,” says Lakshmin.

“I think the most accurate answer to how Covid-19 will affect people’s decisions around conception is, ‘it depends.’ Different people will make different decisions about how they think pregnancy will impact their mental health,” says Lyerly. “There are women I know that gave birth in 2020, and their baby is the shining star of this dark year.” In other words, the data suggests a bust, but there are plenty of parents-to-be bucking the trend.

Karen, the dancer, certainly sees having a baby in 2021 that way, though she admits it’s a different vision than the one she’s held onto through most of her thirties. “It might mean bringing a baby on tour,” she says. “It might look like me buying extra plane tickets and extra hotel rooms and bringing my parents, my husband, one of my husband’s parents. It’s completely reimagining the scenario.”

Which is not uncommon for bringing a baby into the world even outside of a pandemic, says Lyerly. “I wrote a book called A Good Birth, which talks about the profound complexities of giving birth. What I found is that even when people’s births didn’t go as planned, oftentimes they found things in them that they value and hold onto as important pieces of the experience, even if it just went off the rails.”

Like Karen’s path to parenthood, Sarah’s has also taken an unexpected but affirming turn. She got engaged last winter and planned to get married in the spring of 2021. “But when it became clear that wouldn’t be happening in the way we’d envisioned, any pressure to ‘do things right’ went out the window,” she says. She made the decision in March to try to conceive, and by summer, she was pregnant. “Being pregnant now has been a source of hope and joy when both are in extremely short supply.”

*names changed for privacy