Recently engaged, Tracy Leong, 31, and her fiancé hoped 2020 or 2021 might be the year to start their family. A lifelong New Yorker, she felt sure that with lots of support from her parents, a sister and cousins who still live nearby, she could also keep her job in communications.
But when the coronavirus, lockdown measures and social distancing came to New York, her plans changed. Pregnancy was put on hold.
"The pandemic has totally thrown off what we've envisioned our family to be like," Leong said in a telephone interview with CBS News. "This isn't it."
Leong isn't alone. About a third of women say they're delaying pregnancy or want fewer children because of the pandemic, according to a recent study published by the Guttmacher Institute. It's a shift in sentiment that could trigger a staggering 500,000 fewer births in the U.S. as soon as next year, a potential 13% decline, according to a recent Brookings Institution study.
Pregnancy timing preferences varied dramatically between White women and those of color. Nearly half of Hispanic women and 44% of Black women said they planned to have children later or have fewer children, while just 28% of White women expressed the same preference.
CBS News spoke to 17 women, including Leong, all of whom said the pandemic had upended their plans to start or increase their family. Some cited economic uncertainty and job losses, while others feared the medical issues surrounding pregnancy during an outbreak of a virus where so much is unknown.
At the onset of the coronavirus's arrival in the U.S., little was known about how the disease uniquely impacted pregnant people, Dr. Denise Jamieson, a professor in the Department of Gynecology and Obstetrics at Emory Medical School, said. In March, while New York City was the epicenter of the outbreak, hospitals briefly mandated that those going into labor must deliver alone, without a partner or support person, a situation one woman described to CBS News as "an absolute, hellish, nightmare."
By June, the CDC issued guidance indicating that pregnant people "might be at an increased risk for severe COVID-19 illness." In the report, researchers noted that "pregnancy was associated with hospitalization and increased risk for intensive care unit admission, and receipt of mechanical ventilation, but not with death." Additionally, pregnant Black and Latina people "appear to be disproportionately affected" by COVID-19 infection, according to the CDC.
New reports on how the virus impacts those who are pregnant and their babies continue to emerge. A research note published by JAMA in July noted higher instances of preterm labor and cesarean sections among those who were infected, and noted that instances of stillbirths were "significantly higher" during the pandemic. Last week, a paper in the journal Endocrinology found that patients infected with COVID-19 during pregnancy, as well as those on certain kinds of birth control pills, may be vulnerable to deadly blood clots.
"We're learning more every day, but there's still a lot of questions that remain," Jamieson said in a telephone interview.
Economic uncertainty and coronavirus-related job losses, which have disproportionately impacted women, have also caused many to rethink pregnancy timing. Between February and April, 12.1 million women lost their employment, accounting for 55% of job losses since the onset of the pandemic, according to calculations made by the National Women's Law Center using data from the Bureau of Labor Statistics.
As the economy has begun to inch back and communities reopen, women accounted for two-thirds of the jobs added in July, according to NWLC. But 44.2% of those jobs were in leisure/hospitality and retail — work that often requires in-person contact with guests and clients, placing employees at a higher risk of exposure to the lethal virus. It's also work vulnerable to being shut down again as coronavirus cases have surged, signaling "that women may soon be at risk of losing their jobs all over again," the NWLC wrote in a press release published Friday.
Job losses have been particularly high among women of color. As of July, the unemployment rate among Black women was 13.5% and for Hispanic women it was 14%, according to data from the NWLC. That compares to 11.2% for White women, and 9.8% for men of all races.
In the U.S., unemployment poses another problem: health insurance coverage. A recent Guttmacher study found that assuming a 20% unemployment rate, more than 6 million women of reproductive age could find themselves uninsured — an increase of 22%, and a situation that would pose particular hardships in the 14 states that haven't expanded Medicaid eligibility.
"If you're pregnant, unemployed and uninsured? Oh, my God, that is a terrifying prospect," said Adam Sonfield, the author of the report, in a telephone interview with CBS News.
Sarah and her husband had been trying to conceive in the months leading up to the pandemic. But as the country went into lockdown, Sarah lost her job as a security guard, and consequently, her health insurance. She hasn't found a steady job since.
"The next day I called my doctor to find the cheapest birth control option," said Sarah, who asked her real name not be used, in a telephone interview in July. "We can barely afford medical bills even with insurance. A pregnancy? No way."
A recent study published in Health Affairs found that the average hospital delivery in the U.S. cost an average of $4,500, and that's with insurance. Without coverage, a non-complicated birth clocks in around $30,000. When complications occur, the cost skyrockets "easily into six figures and in some cases, seven."
"It could easily bankrupt you," Sonfield said.
Delivery is only part of the cost. For many, a pregnancy will be the most contact they have with the health care system in their lives, Sonfield said. Between testing, ultrasounds, vaccinations and counseling, patients can expect at least 15 prenatal doctors appointments before their delivery, more if the pregnancy is deemed high-risk, according to guidance from the American College of Obstetrics and Gynecology.
For Leong and her fiancé, a future pregnancy is indefinitely on hold until the virus is under control and things, she says, have "calmed down." When that happens is anyone's guess.
"I'm 31 and I know there's theoretically time, but what if by the time we decide to do it we can't?"