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.