Falling birthrate and rising C-section: Post-pandemic evidence from New York

Background

The literature documents the effects of the pandemic on birthrate, birthweight, and pregnancy complications. However, the evidence is mixed on the persistence of these effects post-pandemic.

Objective

This study examined whether birthrate has decline with the onset of the pandemic, if the effects subsided post-pandemic, and whether there are discrepancies by race and ethnicity, or between vaginal delivery and C-section.

Methods

Using the 2012–2022 hospital inpatient discharge data of New York, we implemented fixed-effects regression models to estimate changes in birthrate and delivery method composition. The study was conducted at the Zip-Code level, and eliminated the effect of time-invariant characteristics such as geographic and demo- graphic discrepancies.

Results

Birthrate was declining pre-pandemic by 1.11% annually. The onset of the pandemic in 2020 led to an additional 7.61% decline in birthrate, which did not revert to the pre-pandemic trajectory in subsequent years, indicating a persistent decline. The post-pandemic decline was more pronounced in vaginal deliveries, with weak evidence of a drop in C-sections. In our sample, C-sections generate 61% more revenue than vaginal deliveries, suggesting that healthcare providers may have increased C-section rates to offset revenue losses from declining birthrates.

Conclusions

The pandemic accelerated an ongoing decline in birthrate, and this decline has persisted post-pandemic. The shift in delivery method composition raises concerns about potential financial incentives influencing clinical decisions. Further research is needed to confirm whether hospitals are upselling C-sections in response to declining births.