New York—The COVID-19 pandemic and its health, financial and social disruptions continue to impact whether and when people want to have children in the United States, according to a new Guttmacher Institute study released today.

The study—based on a survey conducted in summer 2021—finds that although COVID-19’s impact on people’s childbearing plans has lessened since the beginning of the pandemic, 15% of respondents said they wanted fewer children or have children later because of the pandemic. The top three reasons respondents cited for this change were:

• "I’m concerned about money."  
• "It didn’t seem like a good time to bring kids into the world." 
• "I was scared to be pregnant or give birth during the pandemic." 

This new study is a follow-up to a June 2020 Guttmacher report documenting that at the beginning of the pandemic, 34% of respondents said they wanted to get pregnant later or wanted fewer children because of COVID-19.

Furthermore, 19% of respondents in the new study had trouble getting their contraception or other sexual and reproductive care during the previous 12 months of the pandemic. The earlier report found that 33% of respondents faced delays or were unable to get contraception or other care because of COVID-19.

"The COVID-19 crisis and its unprecedented economic and social upheaval have changed when people want to get pregnant, how many children they want, and if they are able to get the contraception and other care they need to make these fundamental choices," says Guttmacher Institute Principal Research Scientist Laura Lindberg. "But the impacts of COVID-19 appear to be diminishing as the pandemic stretches on, with 15% of respondents in our new study saying they want fewer children or to have children later. This indicates that COVID-19’s impact may not result in a long-term baby bust but has been more of a short-term fertility shock."

COVID-19 is making health disparities worse

The study also finds that the COVID-19 pandemic continues to have a disproportionate impact on those already marginalized because of their race, income or sexual orientation.

For instance, substantial proportions of the following groups experienced COVID-19–related barriers to contraceptive and other sexual and reproductive health care:

• Black respondents (25%)
• Hispanic respondents (26%)
• Asian and Pacific Islander respondents (21%)
• LGB+ respondents (24%)
• Transgender and other gender-diverse respondents (28%)
• Lower-income respondents (21%)
• Respondents who had financial and employment difficulties in the past year (21%)

This compares with White (14%), straight (18%), cisgender (18%), and financially better-off (16%) or employed (17%) respondents.

"The impacts of COVID-19 are not occurring equally in many ways. The pandemic is having a much greater effect on the sexual and reproductive health of people of color and those who are LGB+, transgender or nonbinary, lower-income, or those with financial and employment difficulties," says Dr. Lindberg. "Addressing these inequities is a key component of ensuring that all people can decide when, whether and how to become parents, and have the support they need to take care of their families."

Telehealth is helping contraceptive access

Finally, the study shows that telehealth is helping to bridge gaps in sexual and reproductive care caused by COVID-19. Among those who received contraceptive care in the last six months, at their last visit:

• 17% used telehealth or online services.
• 49% received care in-person.
• 34% received care from a pharmacy, drugstore or some other place.
• 44% of those using telehealth or online services were new users during the pandemic.

Telehealth was a more common source of care for respondents who conventionally face barriers. Respondents of color (21–22%) were more likely to use telehealth or online services than White respondents (13%), and lower-income respondents (20%) were more likely to use them than higher-income respondents (15%). However, respondents who used telehealth or online services for contraceptive care were less likely than those obtaining in-person care to rate the overall quality of care as excellent (47% vs. 55%), indicating that work remains to be done to ensure that telehealth services are consistently high quality and equitable.

"Telehealth has played a key role in making birth control and other care available to people during the pandemic. But we have to ensure the quality of telehealth meets the same high standards as in-person care," says Dr. Lindberg. "Given that our study found respondents of color and lower-income respondents were more likely to use telehealth, providers and policymakers must ensure equitable and high-quality telehealth care, in addition to ensuring that patients have the option of getting care via telehealth or in-person based on their individual needs and preferences."