California sees COVID-19 baby bust what causes it

California is poised to ditch its mask mandate for a vaccine-filled summer of lust — but when it comes to protection, Angelenos like Jahkara Smith won’t rely solely on antibodies.

“A lot of my friends have been getting IUDs lately,” said the 24-year-old Air Force veteran, a YouTube icon-turned-TV star. “Even if you lose your health care, it’s already in. They will not come and take it out.”

The humble IUD, short for intrauterine device, is just one of many reasons California is projected to see nearly 50,000 fewer births in 2021, the nadir of a national COVID-19 “baby bust” that has sparked political backlash and young families left and would be – parents drowning in demographic quicksand. While Californians are delaying pregnancy in many other ways — including over-the-counter pills, self-injected hormones, and higher rates of abstinence and abortion — experts say the tiny T-shaped device has helped an unprecedented number haunt the stork in recent months.

“Because I have my IUD, I have time to plan,” Smith said. “A lot of my friends talk about wanting babies — I want babies — but when you think about the tools you get versus the tools you need, it feels really grim.”

Economists, demographers and reproductive health experts agree: The COVID-19 crisis capped a decade in which basic costs far exceeded wages, while at the same time the Affordable Care Act made birth control virtually free for most Americans. This is especially true in California, where market rent costs as much as a Tesla, preschool costs as much as UC Berkeley, and an IUD averages $0 on both public and private insurance.

“People imagine a ‘Children of Men’ situation when in reality the pandemic freaked people out,” said Ponta Abadi, a reproductive health expert, referring to the 2006 apocalyptic thriller in which a pandemic killed the makes mankind sterile. “It caused a lot of people to lose their jobs and affected whether they wanted to have children.”

Historical data backs this up, said Melissa Kearney, an economics professor at the University of Maryland. The 1918 Spanish flu pandemic resulted in significant baby busts, even though contraception was both rudimentary and almost entirely illegal at the time. During the Great Recession, the birth rate fell by about 1% for every 1% of unemployment.

New survey data from the Guttmacher Institute, a think tank that campaigns for reproductive rights, suggests the effect could be even larger this time. More than a third of those surveyed said they plan to either postpone or have fewer children due to the pandemic, which has been devastating for women of childbearing age, although far more deadly for older men. About half of the 5 million women who lost their jobs last spring had young children, and another million mothers were displaced by the pressure of distance learning this fall and winter. Others delayed or terminated pregnancies amid news that COVID-19 could be more serious and fatal in pregnant women.

The impact has been seismic: Local abortion providers saw a surge in demand as early as April 2020, and clinicians across the country said they have since helped frontline health workers, newly unemployed parents and working mothers-turned-teachers terminating pregnancies, any other year, would have ended up in the delivery room.

“When things switched to virtual schools, we had to completely overhaul our schedule,” said Dr. Diane Horvath, an abortion provider in Maryland. “[Many] People told us that if we hadn’t been in the pandemic they would have continued with the pregnancy.”

But abortion remains at an all-time low, and there’s little evidence it was greater in California than in other states. Nor do Millennials in the Golden State differ significantly in terms of educational attainment or family structure from their peers in other populous states, where the decline has been more modest. Instead, experts say, a sharper rise in pandemic unemployment here has put severe downward pressure on parents and prospective parents, who have already suffered from stagnant wages, rising rents and other economic stresses that have depressed fertility rates for years.

These pressures are particularly acute in Los Angeles, where rents have risen almost twice as fast as wages over the past 10 years. Sending a preschooler to home daycare now costs significantly more than sending a freshman to Cal State Long Beach; Infant care exceeds tuition at UCLA, where fees have increased 30% over the past decade. Yet only 1 in 4 children whose parents can afford day care in Los Angeles find a place. For those who depend on government subsidies, that number is 1 in 9.

“[Child care] is not only unaffordable, but also unavailable,” said Jessica Chang, executive director of WeeCare, the nation’s largest home childcare network. “It’s a big factor in why people [here] have fewer children.”

Childcare is now more expensive than housing in California, and housing is more expensive here than in any state except Hawaii.

“Real estate prices went up after 2014, and that weighed heavily on people,” said Dowell Myers, professor of urban planning and demography at USC.

This is also the year that IUDs became one of the most popular forms of birth control in America, after decades languishing in the shadow of a failed early model that was phased out before most modern users were conceived.

“IUDs are super popular with younger people,” who until now have only known about safe, free models, Abadi said.

In 2007, the last peak for American fertility, about 6% of women trying to prevent pregnancy used long-acting, reversible contraceptives such as IUDs — already a significant increase from 2000, when about 2% did . By 2014, just three years after they became free for most patients under Obamacare, that number was nearly 15%. And when access was threatened after the 2016 election, insertions spiked again.

Here is the long in long-acting reversible contraceptives becomes important. A copper IUD like Smith’s can prevent pregnancy for up to 12 years—about a third of a woman’s average reproductive lifespan. But just 12 years ago, before the Affordable Care Act, most doctors didn’t prescribe them to women who didn’t have children, and a pad could cost more than a first-trimester abortion. Three of the four IUDs currently on the market –– and in millions of Americans — have not yet been approved by the Food and Drug Administration.

This makes them more attractive to many women, since even after the law, access to contraception is still limited by politics and insurance coverage.

“The day before my 26th birthday, I got an IUD while I was still covered by my parents’ insurance,” said writer Steph Cha, who had to rely on her for seven years. “When my IUD was removed, I asked the doctor if I could take it home. I have it in my wallet – it’s a little talisman.”

Like Smith, Cha said the device allowed her and her husband to establish themselves professionally before starting a family.

“We’ve always wanted kids, we just put it off,” she said while feeding the couple’s 13-month-old son Leo at their Mid City home recently in the morning. “Now seemed like a good time.”

Steph Cha feeds her 13-month-old son Leo while the family dog ​​looks on.

(Christina House/Los Angeles Times)

Ironically, Cha gave birth to Leo in April 2020 just weeks after California’s stay-at-home order. She was among the first Angelenos to go into labor wearing a face mask amid tough new restrictions on who was allowed to attend the delivery. Back then, mothers who tested positive for the coronavirus in hospital were forcibly separated from their newborns, and the rare inflammatory syndrome that affects children had just been identified.

It is now clear how frightening these conditions were for California families. In December, when babies expected to be born between mid-March and early April, the state saw a 10% decline in births, compared with the 2% year-over-year decline typical of about the last decade. In January, when most of the babies conceived in April and early May were born, births fell by a staggering 23%.

“There was so much anxiety and confusion – ‘What if I get pregnant, how will the infection affect the pregnancy?'” said Dr. Aparna Sridhar, professor of obstetrics and gynecology at UCLA. “When the pandemic was really at its peak, we also offered pregnant women “postplacental IUDs,” where the device is inserted by hand just minutes after a baby is born. “We tried to prevent them from having to come back in.”

Still, in many ways, the pandemic has been an ideal time for Cha as a new mom.

“Having both parents work at home for a year, I feel like we’ve benefited in a weird way,” she explained as Leo stumbled around some wooden Montessori-style toys. “If you’re the kind of person who has…resources, now is probably a good time. On the other hand, if you don’t know what your job situation is or how much you’ll have to spend on healthcare over the next year, it’s a terrifying time to get pregnant.”

For reproductive health professionals, the ability of individuals to have children when they want and not to have children when they don’t want is the ultimate goal. But tens of thousands more people choosing not to conceive at the same time are worrying economists and demographers, who say it could put enormous pressure on the economy for years to come.

Some believe the American Families Plan, announced in April, and the universal transitional kindergarten program unveiled by Gov. Gavin Newsom this month, will help restore the shine to pregnancy. But others fear it won’t be enough to offset the sharp drop in immigration — which has been the main source of the state’s population growth for years — or the ongoing economic pressures that make childbearing unsustainable for so many young people.

“I wish we had bigger discussions about what’s causing people’s fears outside of the pandemic,” Abadi said. “People might not want to have kids right now because it sucks.”