Covid-19 threatens to speed up a decades-old trend towards smaller families in rich countries. In Singapore the fertility rate (ie, the number of children that a woman can expect to have during her lifetime) was 1.14 (far below the replacement rate of 2.1), even before the pandemic. When New York City went into lockdown, many people stopped fertility treatment. Some hospitals did not allow partners into delivery rooms. The prospect of going through birth alone put some women off starting a family, according to Brian Levine, founder and director in New York of ccrm Fertility, a network of fertility clinics in America and Canada. “You’re not going to see a bunch of people being born in December and January because [people] were home and bored and having sex,” he says. “They were home and bored and scared.”
Women are worried about catching covid-19 while pregnant, since medics say it is possible to pass the virus on to an unborn child. Others have found themselves taking on a disproportionate share of housework during the lockdown and can’t face looking after a newborn, too. “It’s not people saying they don’t want kids—it’s them saying they can not and should not,” says Karen Benjamin Guzzo at Bowling Green State University in Ohio.
At Planned Parenthood, the country’s largest provider of abortions and reproductive services, the number of medical abortions has gone up. Gillian Dean, who works in obstetrics and gynaecology for the group in New York, says patients are terminating pregnancies they would have continued in other circumstances. “I’ve had patients who are frontline workers, who are the only people in their homes who are employed, and they feel like they need to do everything they can to not step away from the workforce right now,” Dr Dean says.
Evidence from an outbreak in 2015-16 of Zika, a disease that causes birth defects, suggests covid-19 won’t have a uniform impact across the developing world either. In Brazil, a middle-income country where half of all pregnancies are unintended in normal times, the number of births dropped after Zika hit. This is a sign that many women managed to obtain contraception (or illegal abortions). Births fell furthest in the north-east, where the Zika epidemic struck first and hardest, according to research led by Letícia Marteleto at the University of Texas at Austin. This year, with covid-19, it is black women and other minorities in Brazil who find it hardest to access health care, even after taking account of their poverty.