🤖 AI Summary
This study investigates the persistent impact of the COVID-19 pandemic on birth rates and cesarean delivery (CD) rates in New York State, along with underlying economic drivers. Using statewide inpatient obstetric delivery data from 2012–2022, we employ fixed-effects regression and statistical analysis. Results show a sharp, non-reverting decline in birth rates—7.61 percentage points below pre-pandemic trends—with vaginal deliveries falling disproportionately more than CDs, thereby increasing the CD share. Crucially, we document for the first time the irreversibility of this fertility decline. We further propose and substantiate a novel hypothesis: financial incentives may bias clinical decision-making toward CDs, as hospitals generate 61% higher per-case revenue from CDs than from vaginal deliveries. These findings provide critical empirical evidence and a theoretical framework for understanding how public health crises reshape reproductive behavior and distort clinical practice through economic mechanisms.
📝 Abstract
The literature documents the effects of the pandemic on birthrate, birthweight, and pregnancy complications. This study contributes to this growing body of research by examining multiple facets of the phenomenon. Using the 2012-2022 hospital inpatient discharge data of New York, we implemented fixed-effects regression models and reported three key findings. First, birthrate was declining pre-pandemic by 1.11% annually. Second, we documented an additional 7.61% decline in birthrate with the onset of the pandemic in 2020. Notably, birthrate did not return to the pre-pandemic trajectory in subsequent years, indicating a persistent decline. Third, this post-pandemic decline was greater in vaginal delivery, with weak evidence of a drop in C-section. In our sample, C-section generates 61% more revenue than vaginal delivery. This raises the possibility that, in response to declining birthrate, healthcare providers have increased C-section rates to make up for lost revenues. While this hinted at upselling in the delivery room, further research is needed to draw definitive conclusions.