Baby Boom, or Bust?

After a major power blackout left New York City in the dark in 1965, the New York Times suggested it led to a citywide baby boom, citing a surge in births at local hospitals. After Boston was hit with a blizzard in 1978, the Boston Globe predicted it would result in a baby boom. In 2012, the New York Times reported the possibility of an uptick in births following Hurricane Sandy, calling it the “Sandy Syndrome.” And after a federal government shutdown led to mass layoffs in 2013, the Washington Post wondered, “Is Washington in the midst of a post-shutdown baby boom?”

The logic behind those forecasts goes: When couples are cooped up, they turn to each other. And babies are made. As it turned out, however, none of those events resulted in a baby boom nine months later.

But social restrictions put in place to slow the COVID-19 virus have kept Americans more homebound for a much longer time than any blackout, hurricane or blizzard. The virus has led to recession and job loss. And after nearly one year of pandemic living, speculation of an uptick in births has resurfaced.

U.S. population growth had slowed to a crawl prior to the pandemic, in part because there have been fewer births in recent years. The fertility rate—the estimated number of births a woman has in her lifetime—sat at 1.7 at the beginning of 2020, the lowest in 40 years, according to the Centers for Disease Control and Prevention.

Could pandemic pregnancies reach numbers high enough to reverse the declining U.S. fertility rate and give the nation’s population a boost?

If history has the final word, the answer is no. Economic and health crises most often lead to fewer births, not more. But some hospitals, including Pittsburgh’s UPMC Magee-Womens Hospital, say they’re seeing an increase and expecting to deliver more babies.

High hopes in Pittsburgh

Whether or not the COVID pandemic’s impact on fertility rates is following historic trends is expected to become more clear when 2020 data are tabulated later this year. But certain characteristics of the pandemic, such as the way health and economic impacts have been unevenly felt across races, income levels and job sectors could influence birth trends in at least some places.

Southwestern Pennsylvania may be one of them. “What’s interesting is that in Pittsburgh, we seem to be seeing an increase in expected births,” said Dr. Susan Lareau, division director of obstetrical specialties at UPMC Magee-Womens Hospital. “We have seen a steady increase in expected deliveries throughout the pandemic.”

Typically Magee-Womens would see a flat to a 1 percent increase in birth rate. Now, however, the hospital reports a 3 percent increase in deliveries that were expected to begin in December 2020 compared to a year earlier.

History: No baby boom

“The intuition behind why there would be a baby boom is rooted in historical stories about what happens after a blizzard,” said Philip Levine, professor of economics at Wellesley College. “Everyone is stuck inside and has nothing to do and one thing leads to another and there’s more babies. That’s cute and romantic and all that, but that’s not where we are right now.”

Levine co-authored a recent Brookings Institution report estimating the national public health crisis and recession will result in about 300,000 fewer U.S. births this year. “The economic crisis that we’ve been through and the stress and anxiety and health implications that result from the pandemic itself—neither of those things are good for fertility.”

Economic conditions matter when it comes to having babies, according to the report which found that, historically, a one percentage-point increase in the unemployment rate is associated with a 1.4 percent decrease in birth rates in U.S. metropolitan areas. Similar trends are also seen outside metro areas, studies of statewide data suggest.

And that could have a long-term impact on population. Fertility rates after the 2007–09 Great Recession suggest that when women have fewer babies in the short term, they have fewer children over their lifetime. “The Great Recession had a significant impact on births leading to a declining birthrate,” Levine said. “Even after the recession, births continued to fall.”

Other circumstances contribute to the drop in U.S. birth rates. Access to more effective forms of contraception has played a key role, for example, particularly access to intrauterine devices, or IUDs, which are effective for years.

Women with the highest levels of education are the least likely to give birth during their lifetime. But over the past 20 years, the share of highly educated women who become mothers has grown in the United States. In 2014, 80 percent of women aged 40 to 44 with a Ph.D. or professional degree had given birth at some point during their lifetime—more than 10 years earlier, when 65 percent of women with similar levels of education had given birth, according to a Pew Research Center report. Women with bachelor’s or master’s degrees also were increasingly likely to become mothers during this period.

More recently, the decline in U.S. births has been driven by a sharp decline among young mothers with less education. In 2018, the teen birth rate in the U.S. dropped below 18 births per 1,000 women aged 15 to 19 for the first time since 1940, according to an analysis of the 2018 data, the most recent available, from the National Center for Health Statistics. The teen birth rate of 17.4 births per 1,000 women in 2018 was less than half of the 41.5 births per 1,000 women for this age group in 2008.

The last great pandemic resulted in fewer babies born in its wake. Each spike in mortality during the Spanish Flu epidemic early in the 20th century led the birth rate to drop about 21 births per 1,000 population. Similar “death spikes” and subsequent drops in fertility also occurred after Hurricane Katrina and the 2015 Ebola outbreaks in West Africa, according to a March 2020 report from the Institute of Family Studies, a conservative think tank focused on marriage and family issues.

While 2020 birth data are still being gathered, some researchers are already pointing to evidence that suggests a continued baby bust in the United States. An estimated 34 percent of American women have either delayed their plans to have a child or reduced the number of children they expect to have as a result of the pandemic, according to survey by the Guttmacher Institute, a reproductive health research nonprofit.

And a study published by the German economic research institute, IZA Institute of Labor Economics, predicts a 15 percent drop in U.S. monthly births between November 2020 and February 2021. The forecast is based an analysis of Google Trends data that weighed the trend in searches for pregnancy-related terms, which could reflect higher birth rates, with the trend in searches related to unemployment, which researchers associated with lower birth rates.

Pregnant in a pandemic

Alysia Davis began 2020 with big plans and high expectations. “We planned on starting a family,” said the 32-year-old public health worker from Homewood. “It was something we had talked a lot about and had started prepping for.” It wasn’t long after the pandemic arrived in March that Davis learned she was pregnant with her first child. By then, her expectations had already been tempered by the global health crisis.

“When I told my mom, she wanted to give me a hug,” Davis said. “I had to tell her, ‘no,’ because she’s in the population that’s high risk. I had to tell her through a screen door. It was devastating.”

One thing seems clear about the pandemic: It’s a difficult time to be pregnant and it is forcing women and health care providers to adapt their pregnancies, care and expectations to extraordinary circumstances.

COVID-19 has led pregnant and postpartum women to experience greater uncertainty and anxiety related to factors ranging from having to change birth plans and doctor’s visits to worrying about how the coronavirus might affect their babies, according to the American College of Obstetricians and Gynecologists.

Researchers are still learning how COVID-19 affects pregnant women. But some early studies suggest they are at greater risk to experience a severe case of COVID compared to women who are not pregnant. And pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes, such as pre-term birth, according to the CDC.

“First-time moms are stressed in general with what’s happening with their bodies and their child,” said Megan Rinard, a home-visiting nurse in Allegheny County with Nurse-Family Partnership, a community health program that serves low-income, first-time mothers. “Is this feeling normal? Or, is the baby doing OK? The general stressors are still there and then there’s the extra piece of the coronavirus to think about.”

There also is concern that the pandemic poses risks to women’s health in general. “One thing we saw in the beginning, and I worry about, is women not getting their routine care—not getting mammograms, not getting their colonoscopies,” Dr. Lareau said. “That’s how we pick things up early and I worry we’re going to [later] find more advanced stage breast cancer, colon cancer.”

Holly Pisanelli counts herself as one of the fortunate ones. “It has been a long journey,” said the 42-year-old, who is an attorney with Highmark. “We were going to attempt another round of IVF [invitro fertilization] in the spring. Then COVID hit. Once everything started opening up, we wanted to jump on the next round. Given my age, we didn’t have the luxury to wait until the pandemic was over.”

Still, the pandemic brought worries she couldn’t have anticipated. “The procedure is in a hospital and there were concerns about the elevated risk. They weren’t sure about how COVID would affect pregnant women—if it would carry over to the child. The concern was there, but the risk was worth it for us.”

Pisanelli found out she was pregnant this summer. After years of waiting, she was ready to celebrate. “When you imagine having a baby—the celebrations, the parties—it won’t be the same. We’ll just have to rethink things and be creative.”