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PITTSBURGH What will our new reality look TODAY & TOMORROW TODAY like? 2021 Adobe Stock Adobe photos throughout this section: Daniel Marsula; Marsula; Daniel illustration: illustration: 64 pittsburgh quarterly | spring 2021 Pittsburgh Post-COVID Baby Boom, or Bust? HIGH HOPES IN PITTSBURGH Whether or not the COVID pandemic’s impact on fertility written by julia fraser rates is following historic trends is expected to become more clear when 2020 data are tabulated later this year. But certain fter a major power blackout left characteristics of the pandemic, such as the way health and New York City in the dark in 1965, the New York economic impacts have been unevenly felt across races, income Times suggested it led to a citywide baby boom, levels and job sectors could influence birth trends in at least citing a surge in births at local hospitals. After some places. Boston was hit with a blizzard in 1978, the Southwestern Pennsylvania may be one of them. “What’s Boston Globe predicted it would result in a interesting is that in Pittsburgh, we seem to be seeing an increase Ababy boom. In 2012, the New York Times reported the possibility in expected births,” said Dr. Susan Lareau, division director of of an uptick in births following Hurricane Sandy, calling it the obstetrical specialties at UPMC Magee-Womens Hospital. “We “Sandy Syndrome.” And after a federal government shutdown have seen a steady increase in expected deliveries throughout the led to mass layoffs in 2013, the Washington Post wondered, “Is pandemic.” Washington in the midst of a post-shutdown baby boom?” Typically Magee-Womens would see a flat to a 1 percent The logic behind those forecasts goes: When couples are increase in birth rate. Now, however, the hospital reports a 3 cooped up, they turn to each other. And babies are made. As it percent increase in deliveries that were expected to begin in turned out, however, none of those events resulted in a baby boom December 2020 compared to a year earlier. nine months later. But social restrictions put in place to slow the COVID-19 virus have kept Americans more homebound for a much longer HISTORY: NO BABY BOOM time than any blackout, hurricane or blizzard. The virus has led “The intuition behind why there would be a baby boom is to recession and job loss. And after nearly one year of pandemic rooted in historical stories about what happens after a blizzard,” living, speculation of an uptick in births has resurfaced. said Philip Levine, professor of economics at Wellesley College. U.S. population growth had slowed to a crawl prior to the “Everyone is stuck inside and has nothing to do and one thing leads pandemic, in part because there have been fewer births in recent to another and there’s more babies. That’s cute and romantic and years. The fertility rate—the estimated number of births a woman all that, but that’s not where we are right now.” has in her lifetime—sat at 1.7 at the beginning of 2020, the lowest Levine co-authored a recent in 40 years, according to the Centers for Disease Control and Brookings Institution report Prevention. estimating the national Could pandemic pregnancies reach numbers high enough public health crisis and to reverse the declining U.S. fertility rate and give the nation’s recession will result population a boost? in about 300,000 If history has the final word, the answer is no. Economic fewer U.S. births and health crises most often lead to fewer births, not more. But this year. “The some hospitals, including Pittsburgh’s UPMC Magee-Womens economic crisis Hospital, say they’re seeing an increase and expecting to deliver that we’ve more babies. << pittsburghquarterly.com 65 Health: Adults With Diabetes denver 6.7% austin 8.0% seattle 8.1% benchmark avg 10.1% pittsburgh 10.2% philadelphia 11.6% 15 cleveland 12.5% indianapolis 13.4% 0% 3 6 9 12 Percentage of MSA population with diabetes; Pittsburgh with highest and lowest among Pittsburgh Today benchmark regions. source: Centers for Disease Control and Prevention, 2019 Behavioral Risk Factor Surveillance System << also were increasingly likely to become mothers during this period. been through and the stress and anxiety and health implications More recently, the decline in U.S. births has been driven by a that result from the pandemic itself—neither of those things are sharp decline among young mothers with less education. In 2018, good for fertility.” the teen birth rate in the U.S. dropped below 18 births per 1,000 Economic conditions matter when it comes to having babies, women aged 15 to 19 for the first time since 1940, according to according to the report which found that, historically, a one per- an analysis of the 2018 data, the most recent available, from the centage-point increase in the unemployment rate is associated National Center for Health Statistics. The teen birth rate of 17.4 with a 1.4 percent decrease in birth rates in U.S. metropolitan births per 1,000 women in 2018 was less than half of the 41.5 births areas. Similar trends are also seen outside metro areas, studies of per 1,000 women for this age group in 2008. statewide data suggest. The last great pandemic resulted in fewer babies born in its And that could have a long-term impact on population. wake. Each spike in mortality during the Spanish Flu epidemic Fertility rates after the 2007–09 Great Recession suggest that early in the 20th century led the birth rate to drop about 21 births when women have fewer babies in the short term, they have fewer per 1,000 population. Similar “death spikes” and subsequent drops children over their lifetime. “The Great Recession had a signifi- in fertility also occurred after Hurricane Katrina and the 2015 cant impact on births leading to a declining birthrate,” Levine said. Ebola outbreaks in West Africa, according to a March 2020 report “Even after the recession, births continued to fall.” from the Institute of Family Studies, a conservative think tank Other circumstances contribute to the drop in U.S. birth rates. focused on marriage and family issues. Access to more effective forms of contraception has played a key While 2020 birth data are still being gathered, some research- role, for example, particularly access to intrauterine devices, or ers are already pointing to evidence that suggests a continued baby IUDs, which are effective for years. bust in the United States. An estimated 34 percent of American Women with the highest levels of education are the least likely women have either delayed their plans to have a child or reduced to give birth during their lifetime. But over the past 20 years, the the number of children they expect to have as a result of the share of highly educated women who become mothers has grown in pandemic, according to survey by the Guttmacher Institute, a the United States. In 2014, 80 percent of women aged 40 to 44 with reproductive health research nonprofit. a Ph.D. or professional degree had given birth at some point during And a study published by the German economic research insti- their lifetime—more than 10 years earlier, when 65 percent of women tute, IZA Institute of Labor Economics, predicts a 15 percent drop with similar levels of education had given birth, according to a Pew in U.S. monthly births between November 2020 and February 2021. Research Center report. Women with bachelor’s or master’s degrees >> 66 pittsburgh quarterly | spring 2021 Health: Adults With Obesity << The forecast is based an analysis of Google Trends data boston 22.5% that weighed the trend in searches for pregnancy-relat- denver 23.3% ed terms, which could reflect higher birth rates, with seattle 24.4% austin 24.9% the trend in searches related to unemployment, which benchmark avg 30.3% researchers associated with lower birth rates. st. louis 33.6% pittsburgh 34.6% PREGNANT IN A PANDEMIC nashville 34.8% milwaukee 36.2% Alysia Davis began 2020 with big plans and high 15 expectations. “We planned on starting a family,” said the 0% 5 10 15 20 25 30 35 32-year-old public health worker from Homewood. “It Percentage of MSA population with obesity; Pittsburgh with highest and lowest was something we had talked a lot about and had started among Pittsburgh Today benchmark regions. source: Centers for Disease Control and prepping for.” It wasn’t long after the pandemic arrived Prevention, 2019 Behavioral Risk Factor Surveillance System 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 >> images throughout this section: Shutterstock << 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.

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