Published 12 December 2022
Analysis of birth rates in 24 European countries shows that birth rates declined by an average of 14.1% during the nine months after the first wave of Covid-19 lockdowns. The decline in birth rates seemed dependent on indirect effects, and notably relative to the duration of lockdown and the strain experienced by national healthcare services.
Although some governments – and not a few journalists – speculated that the first Covid-19 lockdown in 2020 would prompt an upturn in birth rates nine months later, national statistics have now shown the opposite. Indeed, a new analysis of birth rates in 24 European countries has found an overall decline of 14.1% in January 2021, nine months after the first lockdown peaks.(1) And only after then did birth rates begin to slowly recover over time. Lockdowns may have locked more couples together for longer, but procreation seemed less on their minds than ever.
The findings were derived from an analysis of monthly national birth rates as recorded by the Human Fertility Database.(2) Inclusion in the study required data on LBRs per month for at least two years pre-pandemic (2018–2019) and up to March 2021 (deemed one year after the lockdown peak), with 24 countries included.
Building up to the pandemic, a generalised analysis showed – as expected - an average but progressive decline in live births of -2.9% per year between 2015 and 2019. However, by January 2021 LBR was 14.1% less than recorded in January 2018 or 2019. This drop, explain the authors, ‘occurred 9–10 months after the epidemic peaks’ and after the lockdowns of the first wave of Covid-19 in Europe. The declines were fairly consistent in most of the 24 countries studied: -12.2% Belgium; -14.4% France; -17.2% Italy; -23.5% Spain; -13% UK. However, by March 2021 LBRs (in most but not all countries) were slowly moving back towards their pre-pandemic levels.
Why the lockdown droop in LBRs? First, the analysis suggests that the overall decline may be explained by a substantial decrease in just 13 of the 24 countries, where declines of between 12% and 28% were recorded. However, the authors dismiss an effect of ‘direct exposure’ in pregnant women to the Covid-19 virus, with evidence of low case fatality and stillbirth rates. Other reasons, they suggest, such as an overwhelmed healthcare system or a longer lockdown duration, offer more plausible explanations, with the caveat that Sweden, which did not introduce a lockdown, had more adult deaths than most European countries but no decline in LBR.
The most likely explanation, however, is a pandemic-exaggeration of those reasons already associated with this century’s decline in fertility rates – what the authors describe as ‘indirect factors’, related to ‘social distancing measures, fears related to the pathogen and the social/economic crisis’, for postponing pregnancy.
One interesting component of this study, which is extended in an accompanying editorial commentary, is the pattern of birth rates during previous pandemics of the 21st and 20th centuries. The outbreak of Spanish influenza in 1918, and the 2013 Ebola and 2016 Zika virus outbreaks were all associated with a decline in birth rates nine months after their peaks. In his commentary, Christian De Geyter, a former Chair of ESHRE’s EIM Consortium, takes such examples further by proposing – with good evidence in support - that LBRs change ‘during dramatic events, epidemics and global crises’.(3) De Geyter cites the examples of the two World Wars, the great depression of the 1930s, and the financial crises of 2008/09, which were all followed by ‘undulations in live birth numbers in many countries’. However, while the explanations for some of these declines may lie with direct effects (death rates, even ‘stressor’ effects on pregnancy), indirect effects prompting individual decisions to postpone pregnancy seem more plausible during the Covid-19 lockdowns – especially in countries where medical services were under heavy strain. Indeed, it was evident that the reasons for both ESHRE and the ASRM’s advice to suspend the activities of IVF clinics were to free resources for elsewhere in the healthcare system.
There is, the authors suggest, a certain pattern here of LBRs following the chronology of crises and epidemics. A better understanding of the consequences of their various waves on fertility, they add, may help shape future public health policies and a better explanation of trends in birth rates.
1. Pomar L, Favre G, de Labrusse C, et al. Impact of the first wave of the COVID-19 pandemic on birth rates in Europe: a time series analysis in 24 countries. Hum Reprod 2022; 37: 2921-2931.
3. De Geyter C. Live birth numbers undulate as crises come and go. Hum Reprod 2022; 37: 2728-2729.
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