Unpacking the post-COVID association between unexpected births and excess deaths.

Abstract

Objective: Global fertility has halved since its 1960s peak to be little above the replacement rate, and lower in many developed countries. In addition it has been suggested that excess deaths since the onset of the COVID pandemic may have influenced fertility. Given the economic and social interest in declining fertility, this study seeks an explanation.

Methods: We developed a sample for 18 mid-large industrialized countries of 30 variables covering vital statistics and health, social and economic data, and determined excess deaths during 2020-2022 and unexpected births during 2022-2024. Analysis estimated the link between COVID excess deaths and subsequent unexpected births; and estimated links between excess deaths and unexpected births and national parameters.

Results: Countries' average birth rate during 2022-2023 was 5-6% below that expected from their trend and mean prior to the spread of COVID-19 in 2020. Birth rates were higher than expected after 2022 in countries which had high excess deaths during 2020-2022. Regression against national parameters traced reductions in post-COVID births to countries' strong economic measures (low unemployment, high GDP per capita), indicators of women's high economic capacity (years at school, female workforce participation), and weak religiosity. Similar analysis identified higher excess deaths in less wealthy countries, and those with weaker social measures and women's opportunities, and poor pre-existing health outcomes (high infant mortality, low life expectancy, fewer physicians).

Conclusion: The association between unexpected births and excess deaths this decade is largely spurious because lower wealth and poor previous health outcomes drove excess deaths, while the opportunity cost of childbearing has accelerated declining births in wealthier countries post-COVID. Better understanding population effects of the pandemic is of broad social and economic interest given declining fertility rates; and change in trajectory of births could prove the pandemic's most serious socio-economic consequences.