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COVID-19: Lockdown, collateral birth and impact on population

June 23, 2020
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COVID-19 Lockdown, collateral birth and impact on population

Health Workers in say they are worried about the vulnerability of women and girls under curfew (Lockdown) due to the Covid 19 pandemic. Ongoing lockdowns and major disruptions to health services during the COVID-19 pandemic could result in seven million unintended pregnancies in the coming months, according to data released on in April by the UN Population Fund (UNFPA) and partners.

They estimate that the number of women unable to access family planning or facing unintended pregnancies, gender-based violence and other harmful practices, could “skyrocket” by millions due to the crisis.

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In line with the Sustainable Development Goals (SDGs), UNFPA works to serve the unmet need for family planning, and to stamp out gender-based violence and harmful practices such as female genital mutilation (FGM) and child marriage. It also focuses on ending all preventable maternal deaths.

Limited access to services
The research was conducted by UNFPA, in collaboration with Avenir Health, Johns Hopkins University in the United States, and Victoria University in Australia.

COVID-19 is having an enormous impact on women and girls as health systems become overloaded and facilities close, or provide a limited set of services which they need. At the same time, many women and girls also are skipping important medical check-ups for fear of contracting the virus.

Disruptions to global supply chains could lead to significant shortages of contraceptives, the partners said, while gender-based violence – already on the increase due to the pandemic, as UN News reported earlier this month – is expected to rise still further as women are trapped at home for prolonged periods.

Unable to plan families
Globally, around 450 million women across 114 low and middle-income countries use contraceptives, according to UNFPA and partners.

They project that if health services remain disrupted and lockdowns continue for six months, some 47 million in these countries may not be able to access modern contraceptives, resulting in around seven million unintended pregnancies.

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COVID-19, has sickened over 113,000 people around the world and killed over 4,000 (at the time this report was written). Normal people from Italy, to Iran, to China, to Korea, and even now in the United States have rushed to stores to buy food, hand sanitizer, masks—all in preparation for what is now taken for granted by many, that containment of COVID-19 will fail. At this point, most public health experts concede that COVID-19 will infect a very large number of people, and as a result, may cause a considerable number of deaths. One epidemiologist claimed that COVID could infect between 40-70% of the world’s adult population. Given that COVID is estimated to be fatal in somewhere between 0.5% and 5% of cases, this projection would mean anywhere from 15 to 200 million deaths around the world, and somewhere between 500,000 and 10 million deaths in the United States.

In all likelihood, actual death tolls will be far lower. Vaccines are already in development, treatment options are improving, and governments are aggressively responding to the threat, imposing quarantines and other measures to reduce the spread of the disease. But still, a major pandemic is likely.

But when we think about the effect of pandemics on demography, it’s important to look at not only deaths but also births. Illness, quarantine, and death can all have a major impact on conception, pregnancy, and birth. In this research brief, I will lay out what we know about how epidemic diseases, and governmental responses to them, influence birth rates, and what that may tell us about how COVID-19 will shape the ongoing decline in global birth rates.

COVID is very likely to reduce births in the near term, and perhaps by a quite considerable amount. But after the epidemic has passed, fertility in countries other than China is likely to rebound, especially if death tolls have been significant or if governments take action to replace lost wages, like expanding paid sick leave or extending unemployment insurance benefits. But thanks to China’s uniquely anti-natalist policy stance, no large fertility rebound is expected there.

Disasters Impact Fertility

The relationship between high-mortality events and future fertility patterns is well-established in the academic literature. Previous academic literature has shown that high-mortality events as diverse as famines, earthquakes, heatwaves, and disease all have very predictable effects on reducing births nine months later.

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Estimating the Effect of COVID

In the short run, some predictions can be ventured. If 10% of the population of America is infected, and they experience a 0.5% mortality rate, then a very simple model would suggest that this would have virtually no impact on fertility whatsoever. If, on the other hand, 30% of the population is infected, and mortality is near the World Health Organization’s current estimates of 3.5%, effects could be larger: births 9 months from now could fall by half.

Estimating birth recoveries is even more uncertain, but the academic papers cited above suggest that mortality replacement fertility ranges from 0.25 births added for each epidemic casualty (or birth loss) in the 1-5 years after an epidemic, to as high as 2 births added. Using the infection spread and fatality rate estimates as above, and the mortality-replacement estimates mentioned, estimates of medium-term fertility recuperation are very wide: COVID could boost births over four years after the epidemic runs its course by anywhere from 0.3% to 40%.

If COVID infections and deaths rise to epidemic levels (that is, rise to hundreds of thousands of cases in America), then any positive quarantine effect would almost certainly be mitigated by mortality and collateral survivorship, as well as economic effects. But if Americans take proactive measures to stay home together more and avoid going out, and in so doing also succeed in preventing COVID from spreading widely, and if policymakers take measures to keep the economy humming, then U.S. birth rates could actually rise slightly in the next year as a result of COVID.

The key factors to watch are:

How many people live in households where someone was infected, or in communities that had significant levels of local transmission (collateral survivorship)?
Is mortality from all causes rising, or are COVID deaths being offset by fewer deaths from other causes like influenza (mortality replacement)?
To the extent mortality from COVID occurs, is it large enough among reproductive-age people to meaningfully alter the marital status distribution of the population? Are weddings being postponed to a significant degree? (marriage market effects)
Are people actually staying home with their significant others more frequently as a result of quarantine or social distancing measures (possible quarantine baby bumps)?
Has COVID led to significant, negative economic disruptions, especially boosting unemployment (economic effects)?

Right now, in America , very few people have experienced any kind of collateral survivorship, and there have been only a few confirmed deaths. Certainly, there have been no documentable marriage market effects yet, and social distancing has also not occurred to a very appreciable degree, although this is changing rapidly. Some negative economic effects may have begun, but they are very mild. Thus, if COVID gets no worse than it is now, then no birth rate impact would be expected.

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On the other hand, in Wuhan, virtually the entire population can be considered a “collateral survivor,” and mortality has been significant enough that it seems unlikely that all COVID deaths would have been due to influenza or other respiratory deaths (COVID probably increased Wuhan’s mortality rate in January and February by about 2 to 7%, by my calculations). Mortality in Wuhan has been heavily concentrated among older people, however, so probably has not impacted marriage markets. That said, China’s continuing anti-natal restrictions and norms, and stigmas against non-marital childbearing, limit the potential for mortality-replacement fertility after COVID has passed. The entire population of Wuhan has been quarantined, which should produce some baby bump, except that China’s economic output has collapsed, suggesting that economic losses are large. Furthermore, anecdotal evidence suggests that quarantines may have led to more divorces than babies. Thus, in Wuhan, we can expect a considerable drop in births over the next 10 months with only very modest potential for mortality-replacement-style recoveries later on.

Every country is different, and so different countries will have different experiences. As more information becomes available, possible fertility impacts will become clearer. For now, we should all be washing our hands frequently, enforcing good hygiene for everyone in our household and place of business, and making plans for how to protect our communities in the event of a major outbreak.

In Conclusion:

The COVID-19 pandemic could have serious consequences for women’s health, according to the UN Population Fund.
The pandemic has disrupted access to sexual and reproductive health and gender-based violence services.
It could also exacerbate existing financial inequality between men and women.
Global health authorities are battling to prevent the COVID-19 pandemic from having severe consequences for women’s health, with spikes in domestic violence and maternal mortality predicted as women lose access to vital health services and social support.

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