Many mothers may have delayed or abandoned plans for additional children because of COVID-19 pandemic

Led by researchers at NYU Grossman School of Medicine, the survey of 1,179 mothers in New York City also found that one-third of women who had been thinking about becoming pregnant before the pandemic but had not yet begun trying, said they were no longer considering it.

"Our findings show that the initial COVID-19 outbreak appears to have made women think twice about expanding their families and, in some cases, reduce the number of children they ultimately intend to have," says study lead author and epidemiologist Linda Kahn, PhD, MPH. "This is yet another example of the potential long-lasting consequences of the pandemic beyond the more obvious health and economic effects."

Pregnancy becomes riskier and more difficult to achieve as women age, so the delays prompted by the pandemic may lead to increased health risks for both mother and child, as well as the need for costly fertility treatments, she adds.

Kahn, an assistant professor in the Departments of Pediatrics and Population Health at NYU Langone Health, notes that all of the women in the study already had at least one child age 3 or younger. As a result, it is possible that the challenges of caring for a young child during the peak of New York City's outbreak and subsequent lockdown may have played a role in their hesitancy to have another baby.

Early evidence has already identified a birthrate decline in the United States during the coronavirus pandemic. Recent data showed that the country saw roughly 300,000 fewer births in 2020 than experts had expected based on annual fertility trends, with a particular drop in the last two months of the year, which corresponds with fewer conceptions at the beginning of the outbreak in March. However, until now, few investigations have explored the root causes behind individual parents' decisions to delay pregnancy.

The new study, publishing online Sept. 15 in the JAMA Network Open, is the first to examine pregnancy plans among mothers during the first wave of COVID-19 in New York City.

For the investigation, the researchers analyzed data from an ongoing pregnancy and child health study. In the survey, which collected data beginning in mid-April 2020, the mothers were asked to recall their pregnancy plans before the pandemic as well as whether they were still going forward with their plans at the time of the survey.

Among the findings, the study revealed that fewer than half of mothers who had stopped trying to become pregnant were certain they would resume trying to become pregnant once the pandemic ended, suggesting that they may abandon rather than just delay their plans to expand their families, Kahn says.

In addition, those with higher stress levels and greater financial insecurity were especially likely to postpone or end their plans for an additional child. According to the study authors, this finding highlights the importance of financial health in parents' decisions around pregnancy and suggests that additional financial support for families may be needed to address the nation's ongoing fertility decline, which began in 2008.

"These results emphasize the toll the coronavirus has taken not only on individual parents, but perhaps on fertility rates overall," says study senior author epidemiologist Melanie Jacobson, PhD, MPH.

Jacobson, a research scientist in the Division of Environmental Pediatrics at NYU Langone, cautions that the investigation only included women who were planning to have children and did not account for unplanned pregnancies.

She says the study authors next plan to repeat the survey with the same group of mothers and explore the potential impact of vaccination, an option not available at the time of the survey.

Funding for the study was provided by National Institutes of Health grants UH3 0D023305 and K99 ES030403.

In addition to Kahn and Jacobson, other NYU Langone researchers included Leonardo Trasande, MD, MPP; Mengling Liu, PhD; Shilpi Mehta-Lee, MD; and Sara Brubakerf, MD.