Expected reduction in the number of births due to the COVID-19 pandemic and proposal for countermeasures

To the Editor: In recent years, Japan has faced a rapidly and continuously declining birth rate similar to or even worse than those of other developed countries. The global COVID-19 pandemic in 2020 has further exacerbated this. Our purpose for writing this letter is to raise awareness on the relationship between the COVID-19 pandemic and declining birth rate in Japan. The COVID-19 pandemic in Japan noticeably worsened at the end of March 2020, and with the government’s declaration of a state of emergency, people voluntarily refrained from going outside unless urgently needed until June. If women became pregnant during this period, their estimated due dates would be in the first three months of 2021. Thus, we investigated the number of delivery appointments for these three months. The number of births in 2019 was 865,239, which amounts to a 5.8% decrease compared to the year before.1) If this decreasing trend continues this year, then the number of delivery appointments at delivery facilities should decrease by about 5%. However, in reality, the decrease is even greater (Figure). The difference of approximately 10–25% is not the result of a spontaneous decrease in the number of births, but likely due to another factor. Part of this difference might be explained by the temporary postponing of assisted reproductive technology in view of the statement set forth by the Japan Society for Reproductive Medicine (April 1, 2020).2) However, the entire difference cannot be solely pinned on this. Hospitals which provided data for this study are tertiary hospitals, as well as perinatal medical centers that take on cases of maternal transport or fetal congenital anomalies, which might be included in delivery appointments. However, given the magnitude of the difference, we view the avoidance of becoming pregnant due to fears of COVID-19 to be a major contributing factor. We propose the following three measures. First, a national survey of birth appointments should be conducted. Second, trends of decreasing birth appointments should be closely and continuously monitored. Lastly, the public should be provided with accurate information regarding the relationship between maternal and neonatal COVID19 infection. For the first measure, the use of data limited to tertiary hospitals and urban areas paints the picture that the COVID-19 situation is worse compared to rural areas. Thus, data from rural areas and local clinics should also be examined to determine whether similar trends are observed. For the second measure, the postponement of assisted reproductive technology was temporary and has now returned to normal after another announcement from Ch an ge s o f b irt h ap po in tm en ts (% )