COVID-19 Linked to Baby Bust in High-Income Countries

Diana Swift

August 30, 2021

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If COVID-19 has caused millions of deaths, it may also have prevented or at least led to a postponement of many births.

In an assessment of the pandemic's early effects, Arnstein Aassve, PhD, and colleagues found a significant COVID-19-related decline in crude birth rates (CBRs) in 7 of 22 high-income countries, particularly in Southwestern Europe.

Dr Arnstein Aassve

Aassve, an economist at the Carlo F. Dondena Center for Research on Social Dynamics and Public Policy at the Università Commerciale Luigi Bocconi, Milan, Italy, and colleagues report the results in an article published online today in the Proceedings of the National Academy of Sciences.

Defining the start of the COVID-19 pandemic as February 2020, the study identifies strong declines in Italy (-9.1%), Hungary (-8.5%), Spain (-8.4%), and Portugal (-6.6%) beyond those predicted by past trends. In the United States, CBRs fell by 7.1% relative to 2019 for births occurring in November and December 2020 following conceptions in February and March of that year.

Significant declines in CBR also occurred in Belgium, Austria, and Singapore.

A year-to-year comparison of the mean for monthly CBRs per 1000 population before and during the pandemic suggests a negative difference for all countries studied except for Denmark, Finland, Germany, and the Netherlands, Aassve and colleagues write. These findings may have policy implications for childcare, housing, and the labor market.

The Milan researchers compared monthly vital statistics data on live births from the international Human Fertility Database for the period January 2016 to March 2021. These figures reflect conceptions carried to term between April 2015 and June 2020. The 22 countries in the analysis represent 37% of the total reported COVID-19 cases and 34% of deaths worldwide.

The study findings align with surveys on "fertility intentions" collected early in the first COVID-19 wave in Germany, France, Spain, and the United Kingdom. These surveys indicated that 73% of people who were planning pregnancies in 2020 either decided to delay the pregnancy or they abandoned their plans.

"The popular media speculated that the lockdown would lead to a baby boom, as couples spent more time together," Aassve told Medscape Medical News. "There's very little evidence of this when you look to previous disasters and shocks, and the first data suggest more of an immediate collapse than a boom. But as you also see from the paper, the collapse is not seen everywhere." Other current studies suggest the fertility drop is immediate but temporary, says Aassve, who is also a professor of demography.

Interestingly, Aassve and colleagues found that CBRs were relatively stable in Northern Europe. The authors point to supportive social and family policies in that region that might have reduced the effect of the pandemic on births. "These factors are likely to affect CBRs in the subsequent pandemic waves," they write. They call for future studies to assess the full population implications of the pandemic, the moderating impact of policy interventions, and the nexus between short- and long-run effects in relation to the various waves of the COVID-19 pandemic.


Some regions have already reported a rebound from the COVID-19 fertility trough. Molly J. Stout, MD, director of maternal fetal medicine at the University of Michigan, in Ann Arbor, Michigan, and colleagues used electronic medical records to predict a surge in births after the initial decline.

"The surge we've seen at the end of this summer is exceeding the usual annual birth rate, as predicted," she told Medscape Medical News. "But I think there'll be a return to normal after this transient escalation. I don't think birth rates will stay elevated above the normal because the birth surge is a temporary response to an event, although there will likely be regional differences."

Looking ahead, Stout, who was not involved in Aassve's analysis, is not certain how a fourth pandemic wave might ultimately modify a couple's overall family size. But the toll the health crisis has taken on working women who have been forced to withdraw from the economy because of a lack of childcare points to a societal need that should be addressed.

Dr Philip Cohen

According to Philip N. Cohen, PhD, a professor of sociology at the University of Maryland, in College Park, Maryland, who's been tracking fertility trends since the onset of the COVID-19 emergency, the pandemic has combined a health crisis with an economic crisis, along with "the additional factor of social distancing and isolation, which all contributed to the decline in birth rates. Some people changed their plans to hold off on having children, while others didn't get pregnant because they weren't socializing and meeting people as much."

Cohen, who was not involved in the study by Aassve and associates, said his provisional data show that although in many places, birth rates have rebounded more or less to prepandemic levels after a nadir around January 2021, some areas of the United States still show substantially lower rates, including California, Hawaii, and Oregon.

As to the duration of the pandemic effect, Aassve cautions that his group's estimates refer to the first wave only. "We then have the second, third, and currently the fourth wave. We can't be sure about the impact of these waves on fertility since the data are not there yet, but I'd be surprised if they didn't continue to have an impact on fertility rates," he said.

Cohen agreed: "Some people who delayed childbearing will make up the delay. However, whenever there's a delay, there's inevitably some portion of the decline that's not recouped."

As for the wider effect across the world, Aassve said his team's figures derive from high-income countries where data are readily available. For middle- and low-income countries, fewer data exist, and the quality of those data is not as good.

The lessons from this and other upheavals teach us that unforeseen shocks almost always have a negative impact on fertility, says Aassve. "[B]ut these effects may be separate from existing declining trends. The issue here is that those overall declining trends may be driven by other factors. In contrast, the shock of the pandemic is short-lived, and we may return to normal rather quickly. But if the pandemic also impacts other societal structures, such as the occupational and industrial sectors, then the pandemic might exacerbate the negative trend."

The study was supported by funding from the European Research Council for funding under the European Union's Horizon 2020 Research and Innovation Programme. The study authors, Stout, and Cohen have disclosed no relevant financial relationships.

Proc Natl Acad Sci. Published online August 30, 3021.

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