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What you need to know about COVID-19: September 18, 2020
Catherine Lebel’s team launched their online survey of pregnant women in April, in the early and uncertain days of these exceptional times. Lebel and her colleagues wanted to know, how were pregnant women holding up? How much did they fear their own lives were in danger? Were they feeling more alone than usual? How much were they worried that exposure to the COVID-19 virus will harm “your unborn baby”?
The initial target was 1,200 women. Two thousand signed on within two weeks. To date, more than 6,000 have responded. An early analysis based on 1,987 women surveyed across Canada has been released in a pre-print article. The researchers found high rates of anxiety and depression, three to four times what they would normally see in pregnancy. Many women were “quite a bit,” or very much worried about what the virus might do to the fetus, though the data at this point suggest pregnant women aren’t more susceptible to serious COVID-19 infections, and there is no evidence, nor any signal, that it causes birth defects. Many women worried they weren’t getting the prenatal care they needed. Many weren’t getting adequate sleep, and the less sleep, the worse the anxiety and depression.
The pandemic, Lebel and her co-authors wrote, is presenting “serious psychological challenges” that could have consequences for both mom and baby. “We do see changes in brain structure and brain function in kids whose mothers were more depressed or more anxious during pregnancy,” said Lebel, Canada Research Chair in pediatric neuroimaging at the University of Calgary.
The survey was about reaching out to women already pregnant, to better understand what might help buffer anxiety and depression when faced with a unique stressor — answer: strong support from partners, family and friends, and longer sleep —“so we’re not asking any questions about decisions to conceive or have children,” Lebel said.
However, the same anxiety and uncertainty has some wondering whether they should even get pregnant. Some American economists are already forecasting a coming COVID-19 “baby bust” that could see up to half a million fewer children born in the U.S. alone.
It remains to be seen how long people are wiling to wait
When the pandemic hit, when millions were urged to shelter in place, some “playfully speculated” there would be a spike in births, nine months out, the authors of a report by Washington, DC-based Brookings Institution , a nonprofit public policy organization, wrote. But the pandemic is a large-scale disaster, and studies have shown that, all else equal, each one percentage increase in unemployment is associated with a similar decrease in birth rates. An analysis of the Great Recession and the 1918 Spanish Flu, both of which generated large declines in U.S. births, suggest the U.S. could see a drop on the order of 300,00 to 500,000 births next year, according to the Brookings paper. “We expect that many of these births will not just be delayed — but will never happen,” the authors wrote. “There will be a COVID-19 baby bust,” they said.
The Canadian economy is also grappling with a staggering recession and record high unemployment. Daycares are cautiously beginning to reopen. People are cut off from their extended families. “Homeschooling makes it difficult and stressful to take care of kids right now, and most likely stressful to contemplate expanding a family,” said Roberta Begignski, a postdoctoral fellow at Western University’s Exercise and Pregnancy Lab.
But it’s also true that some people worry their reproductive window is closing, “that ‘life is short, and we’re not getting any younger,’” Begignski said, and if not now, then when?
“Many of the conversations we’ve had in gynecology clinics is patients feeling that, now is not a good time,” said Dr. Dustin Costescu, a family planning specialist at McMaster University in Hamilton.
“But it remains to be seen how long people are wiling to wait.”
Compared with the U.S., Canada’s social safety net softens the blow, at least somewhat, of the expenses of pregnancy and raising a child, Costescu said. With no national statutory paid maternity leave, a lack of access to prescription drugs for children, “there are different cost pressures on American families”. He thinks it’s unlikely we’ll see huge variations in the birth rate, and that any reduction in children in the short term would be made up as the pandemic progresses, or passes.
“We don’t think this will change the total number of children, or the decision to have children in the long run.”
COVID-19 shut down fertility clinics, and as those clinics reopen, as it becomes more apparent that the pandemic is going to linger for a year or longer, “I think more people are thinking now, ‘there’s never going to be a good time.’ And for that reason they’re reverting back to their original plans,” Costescu said.
Most fertility clinics are functioning at reduced volumes, to adhere to public health safety measures. “Purposefully reduced volumes aside, from what I understand, we are all very busy and in fact have patients on waiting lists wanting to start their cycles,” said Eileen McMahon, president of the Canadian Fertility and Andrology Society. So, no obvious reduction in demand.
Still, it’s a complicated picture. One of the first signals to try to estimate future baby booms or busts is complications related to early pregnancy, like ectopic pregnancies, where a fertilized egg implants and grows outside the uterus. Anecdotally, gynaecologists across Canada and the U.S. are reporting fewer ectopics, “which would suggest there are fewer people having pregnancies,” Costescu said.
Another signal is abortion volume. Initially, it was thought there would be an uptick in demand. Instead, demand has dropped off somewhat. “We are seeing a slight reduction in accessing abortion,” said Laura Neidhart, of Action Canada for Sexual Health & Rights. “We actually think it’s a bit more reflective of people making different choices with regards to their sexual behaviour — potentially having less sex, basically, because of the pandemic.”
Teenagers and university students have been isolated at home with parents. With re-openings, they’re likely to become more sexually active, Costescu said.
Obstetrical clinics are now getting referrals for pregnant women due in December and January. Nobody is really noticing the volumes to be much more, or much less, he said.
The truth is to be seen
Baby bust, or boom? “The truth is to be seen,” Costescu said. “But economics is never part of the conversation when I talk with patients.” Instead, they focus is on more existential issues, “like raising their child to be a good person, raising a child that may have a lower quality of life than what we’re used to. The balancing act for a lot of people is the effect of delayed childbearing and fertility, and missing a window of opportunity, versus the uncertainty of raising a child during the middle of a pandemic.”
In Canada, the average number of children per woman was 3.7 during the baby boom. In 2011, the total fertility rate was 1.6 children per woman, up slightly from the record low of 1.5 about a decade earlier, but still below the replacement level, the level of fertility at which a population exactly replaces itself. In Canada, that’s an average of 2.1 children per woman.
The total fertility rate has been below the replacement level for more than 40 years, according to Statistics Canada.
Copyright Postmedia Network Inc., 2020