Enter the Coronials

By Insight.

“When we die, our bodies become the grass, and the antelope eat the grass. And so we are all connected in the great Circle of Life.” – Mufasa

In the time since the pandemic started, while most of us were distracted by the end stages of the great Circle of Life – mortality, morbidity, hospitalisation, fatality rates, excess deaths, etc., etc., ad infinitum – a whole new generation sprung to life.

“Coronials” has become a popular label for the babies conceived or born during the COVID-19 pandemic.  A generation whose fathers weren’t allowed in the delivery room, who are growing up believing that masks are items of clothing as essential as underwear, and who will regard The Lion King (released almost 30 years ago!) as a relic from the olden days.

There is an element of intrigue around these children.  At a philosophical level, who are the babies born during these (forgive the cliché) unprecedented times and who are their intrepid parents?  At a statistical level, are they part of a boom (perhaps between loadshedding and lockdowns there wasn’t much else to do at home)?  Or was there a bust (did sky-high levels of anxiety and uncertainty, as well as the extra time spent at home with existing children wither the urge to procreate)?

There is surprisingly little published research on the impact of COVID-19 on fertility, and what does exist is not relevant to South Africa and/or is out of date.  We therefore decided, after looking at studies done elsewhere, to analyse medical scheme data on South African births to uncover whether there was any detectable baby boom or bust and what that might mean for the coronials.

Aassve, Cavalli et al. (2021)[1] conducted a study of live birth rate data of 22 high-income countries for the period January 2016 to March 2021.  They found a decrease in monthly crude birth rates (CBRs) in all countries except for Denmark, Finland, Germany, and The Netherlands.  Statistically significant decreases ranged from 5.2% in Austria to 11.2% in Portugal and Spain.

A separate study on birth rates in the United States by Kearney and Levine (2021)[2] estimated approximately 60 000 “missing births” between October 2020 and February 2021 attributable to the COVID-19 pandemic.  Missing births were calculated as the shortfall between actual births and the number of births predicted based on pre-pandemic trends.  Births returned to pre-pandemic trend levels in March 2021, corresponding to June 2020 conceptions.

Their main observations about the nature of the birth rate reduction of the early months of the pandemic were:

1. States with larger spikes in unemployment rates and higher numbers of COVID-19 cases tended to have larger reductions in birth rates nine months later; and
2. Birth rate reductions were largest among highly educated women, women in their late 30s and early 40s, and those who already had at least one child. The authors noted that these were not the groups most affected by job or income losses, suggesting that pandemic-related factors beyond economic challenges were important drivers of the observed reduction in births.

A study by Berrington and Ellison (2022)[3] on the effect of lockdowns on birth rates in the UK revealed a temporary decline in babies conceived during the first three months of the first lockdown in 2020, but then the fertility rate rebounded to levels above those seen in previous years.

The authors suggest that the recovery might be explained by births taking place where conception had been postponed during the first lockdown.  This hypothesis is supported by the fact that birth rates bounced back most strongly for women in their 30s, who might have been reluctant to postpone conception much longer than necessary.

The United Nations Population Fund (UNFPA) collected data from 15 countries up until the third quarter of 2021. Overall, changes in births associated with COVID-19 appeared to be temporary. Apparently declining birth rates could, at least to some extent, be explained by delays in birth registrations during imposed lockdowns.

Across Africa, there were numerous reports of family planning service disruptions due to COVID-19. Data in many African countries, however, remains too incomplete to definitively assess impacts on births.

To determine the impact of the COVID-19 pandemic on South African birth rates, we analysed the data of a representative subset of the Insight medical scheme data universe.

The data

We used monthly live birth data from January 2016 to February 2022, which corresponds to conceptions (carried to term) from April 2015 to May 2021. The schemes under consideration covered, on average, around 1.3 million female lives per month over this period.  Monthly CBRs per 1000 female lives per month were computed as: Monthly Live Births/Total Active Female Lives.

We analysed the dataset as a whole, and then split by province, age bands and low-cost, mid-range and top-end scheme options (as a proxy for income[4]).

The declining trend in birth rates of the entire dataset, as illustrated by Figure 1, seems to reflect the pattern of South Africa as a whole[5].

Figure 1: Number of births per 1000 female lives from January 2016 to February 2022 (Source: Insight medical scheme database). With no obvious trends visible over the pandemic period, we conducted statistical analysis to identify any significant deviations from the mean.

We define the pandemic as having started in February 2020, when the World Health Organization declared the COVID-19 outbreak an international public health emergency. We thus expect to observe effects nine months later, i.e., from November 2020.

Analysis of the pandemic period as a whole

To isolate the impact of the pandemic on birth rates – and remove confounding factors such as long-term trends and seasonality – we calculated coefficients for each population segment from a set of ordinary least squares models. CBRs were regressed from 2016 to 2022 on a dummy variable which took a value of one starting November 2020. Figure 2 below shows the pandemic indicator coefficient within a 95% confidence level for each population segment.

Figure 2: Changes in CBRs by population segment. Shown are point estimates and 95% CIs for segment models. The confidence intervals of all of the segments overlap 0, suggesting that the pandemic had no significant effect on birth rates for the period.

Month-by-month analysis

To assess whether the pandemic had any temporary impacts on birth rates during the pandemic, we compared CBRs each month from November 2020 onwards to the mean CBR of that month for the years from 2016 to the last instance of that month before November 2020.  For example, January 2021 birth rates were compared to the mean of the January CBRs from 2016 to 2020.  We assumed that each set of monthly birth rates was distributed normally.

At the 95% confidence level, a handful of significant differences emerged, summarised in Table 1.

Table 1: Months showing significant CBR differences from the birth month mean by population segment

Discussion

More thorough analysis would be required to draw conclusions with a high degree of certainty and causality, but at face level, the following patterns are observed:

Early 2021 and 2022 saw dips in birth rates

For the population as a whole and for several population segments, birth rates were significantly lower than usual in January and February of both 2021 and 2022. 

2021

At the corresponding time of conception – April/May 2020 – South Africa was at the tail-end of its hard lockdowns (level 5 ended on 30 April, with level 4 being applicable throughout May).  High levels of anxiety about the future, as the impacts of retrenchment and social isolation were being strongly felt, might have contributed to fewer conceptions.  The lack of alcohol probably didn’t help either…

2022

The decrease in birth rates observed in early 2022 are less straightforward to explain, given that the country was in lockdown level 1 during the corresponding time of conception.  It will be worth monitoring birth rates in the coming months to see if these last data points are the beginning of a longer-term baby bust.

Boom months in the lower-income and Western Cape segments

The segment on low-cost medical aid options (representing the lower-income portion of the medical scheme population) experienced significant increases in birth rates towards the ends of both 2020 and 2021, corresponding to conception in February/March of those years.

The Western Cape saw sporadic booms from November 2020 to September 2021.

Given the lack of obvious connection to the trajectory of the pandemic, further analysis would be required to better understand these results.

What it all means

Mirroring findings elsewhere in the world, it seems that significant deviations from the mean of South African birth rates due to COVID-19 have been temporary, indicating that, to quote another 90s classic “life finds a way”.  It will be of interest to monitor whether the decreased birth rates observed in early 2022 will continue, reflecting a more cautious post-COVID lifestyle…and, in the long-term, what the coronials will make of this new world, however many or few of them there may be.

 insight.co.za | lifesolutions@insight.co.za

[1] Early assessment of the relationship between the COVID-19 pandemic and births in high-income countries
[2] Early evidence of missing births from the COVID-19 baby bust
[3] Effect of lockdowns on birth rates in the UK
[4] It should be noted that medical scheme membership is representative of higher income South Africans, not the population overall, which may have had different experience.
[5] Simple correlation analysis between the Insight data and data obtained from Statistics South Africa and macrotrends.net shows that the Insight data birth rate trends are moderately to highly representative to those of the South African population at a monthly and annual level respectively.