US Birth Rate Hits Another Record Low during Pandemic: What Will This Mean for Maternal Care?

In May 2021, the Centers for Disease Control and Prevention (CDC) announced that the US birth rate dropped by 4% in 2020, the sixth consecutive year that that number has declined (see figure 1). 2020 saw only 3,605,201 births, the fewest since 1979, surprising those who had speculated that pandemic-related stay-at-home orders could lead to a rise in births. That appears not to be the case, as births declined more precipitously at the end of the year, when babies conceived at the start of the COVID-19 outbreak would have been born (see figure 2).

This data is alarming for inpatient facilities that consider maternal and children’s health to be core community service offerings, and for community obstetric (OB) and pediatric providers facing decreasing demand for their services.

While overall births are decreasing, the average age of first-time mothers is increasing. From 2000 to 2014, the proportion of first-time mothers aged 30–34 rose 28% (from 16.5% to 21.1%), and first births to women aged 35 and over rose 23% (from 7.4% to 9.1%) (see figure 3). Within that 14-year period, the most pronounced increases in maternal age occurred more recently, from 2009 to 2014.

Maternal Care Implications

The combination of lower demand for services, projected continuation of the decreasing birth rate, and increasing maternal age has numerous implications:

• Labor and delivery (L&D) units will be competing for fewer deliveries.
• A higher proportion of births will continue to tip into the high-risk category, which has implications for cesarean section rates and low-birthweight babies.
• Demand for maternal-fetal medicine specialists and neonatologists will increase.
• Consumer preference will be king. Hospitals and physician groups will no longer be able to rely on organic growth; instead, they will need to offer patient services and experiences that are superior to those of their competitors.
• Even with vaccines readily available, COVID-19 will continue to be top of mind for all expectant mothers, and hospitals will need to demonstrate that they can provide safe L&D services. More broadly, patients have a heightened awareness of cleanliness and recognition that hospitals care for sick people (whereas maternity patients are not ill).
• Digital, virtual, and telehealth care will be in high demand. Temporary pivots for virtual care developed during the pandemic will now be permanent, and patients will expect more digital applications to support maternity and postpartum care.
• Legislative funding to expand postpartum care for Medicaid from 60 days to 12 months creates an opportunity for systems to expand postpartum coverage (pelvic floor, urogynecology) and wraparound services (breast screening, behavioral health) to maternity patients.

With the US birth rate likely to continue trending downward, competition in the maternal care space is likely to intensify. Hospital administrators, service line administrators, and physicians should be actively considering strategies to maintain market position and develop differentiators or risk being left behind.

Published May 19, 2021