Effects of the Pandemic on Births in New York City: Interview with Elizabeth Gregory

HOST:  Elizabeth Gregory is a health scientist with the CDC’s National Center for Health Statistics.  Elizabeth has authored a new study examining the effects of the pandemic on births in New York City, one of the hardest-hit areas by COVID-19.  The study looked at changes in the percentage of births to women who are residents of New York City but who gave birth outside the city.  The data covered the period between 2018-2019 and 2019-2020.

HOST:  So this is a different study than what we usually get from NCHS.  Can you explain why you chose this topic?

ELIZABETH GREGORY:  Sure.  Early on during the height of the pandemic in New York City in 2020 there were a lot of news stories about residents leaving the city and busy hospitals with a brief ban on support persons during labor and delivery at some hospitals.  So we decided to take a look at what are these things resulted in women going out of the city to give birth.

HOST: Now a lot of people are anxiously awaiting new data from 2021 to see if there were any major changes in fertility due to the pandemic, but your report is showing really that the pandemic did impact births in New York, at least from a health care utilization, from a delivery perspective, is that correct?

ELIZABETH GREGORY:  So we found that from 2019 to 2020 the percentage of New York City residents giving birth outside the city increased overall for all months from March through November, peaking in April and May.  And the timing of these increases in these out-of-city births correspond with the height of the early pandemic in New York City.

HOST:  is there any indication that these patterns were also true for other cities that were hard hit that in the early stages of the pandemic?

ELIZABETH GREGORY:   We didn’t look at any other cities – but this would be something that would be really interesting to look at.

HOST:  Is there any indication whether these New York City residents were just going across the state line and into New Jersey or Connecticut to have their babies or were they actually traveling further than that? Do you have any information on that?

ELIZABETH GREGORY:   So this is also another thing that be really interesting to look at but for this report we didn’t specifically look at where the out-of-city births were occurring.

HOST:  NCHS of course is also releasing their annual births report on Wednesday and there will be state data and also data for New York City available soon.  Now what happens data-wise in the situation your study focuses on – so for example if a New York City woman goes to New Jersey to give birth does that count as a New Jersey birth or is it still a New York birth?

ELIZABETH GREGORY:  So birth certificates are filed in the state where the birth occurred but are usually looked at by the mother’s state of residence for NCHS reports.  So in this report, a birth to a mother that lived in New York City occurring outside of the city will be considered a birth to a New York City resident.  And in this report it would just be classified as an out-of-city birth.

HOST:   Did we see a surge in births in these neighboring states like New Jersey or Connecticut for 2020?

ELIZABETH GREGORY:  So we didn’t specifically look at where the out-of-city births were occurring but maybe that’s something that could be looked at in the future.

HOST:  So what are some of the conclusions that you’ve drawn from this research?

ELIZABETH GREGORY:  Well from 2019 to 2020 the percent of New York City residents giving birth outside the city increased overall from March through November, peaking in April and May, with the timing of the increases in these out-of-city births corresponding with the height of the early pandemic in New York City.  And additionally, the overall rise in out-of-city births is largely the result of increases among non-Hispanic white women while increases were less pronounced for births to non-Hispanic black and Hispanic residents.

HOST:   Are you planning any other similar geographic studies based on the 2020 data?

ELIZABETH GREGORY:  We currently have a report in the works that will be looking at whether there were any changes between 2019 and 2020 in the percentage of births by whether the mother was born inside or outside the U.S.  I just wanted to mention that we are also working on another report about home births, just to see whether there was a change in the percentage of home births that were occurring in the U.S. from 2019 to 2020.

HOST:  Elizabeth Gregory’s new study was released on the same day that the full-year 2020 birth statistics for the U.S. were released.  These new data were based on over 99% of birth certificates issued in the U.S. during the year, and were featured in a new report that had a number of noteworthy findings:

The nation’s general fertility rate, which is the number of births per 1,000 women age 15-44, reached another record low in 2020, dropping 4% from 2019.  The total number of births in 2020 also fell 4%, to 3,605,201 – the sixth straight year the number of births declined.

The new report also revealed that births in the U.S. continue to be at below replacement levels, based on another decline in the total fertility rate.  Birth rates declined for females of all age groups except two:  adolescents age 10-14 and women age 45-49.

The birth rate for teenagers age 15–19 declined by 8% in 2020 to 15.3 births per 1,000 women in that age group.  The teen birth rate has declined every year going all the way back to 1991 except for two – 2006 and 2007.  The rates in 2020 declined for both younger teens age 15–17 and older teens age 18–19.

Nearly one-third of all births in 2020 were by cesarean delivery, and over one-fourth of births were low-risk cesarean deliveries.  Also, the preterm birth rate in the U.S. declined in 2020 for the first time since 2014, to just over 10% of all births in 2020.