One of Jaquelyn Yeh’s patients ran out of birth control when the coronavirus pandemic hit.

She ended up going a week without the medication and having an unplanned pregnancy. Thanks to the economic crisis that has come along with the pandemic, she and her partner are both facing furloughs from their jobs. Yeh, a family medicine physician in Seattle and a fellow with the group Physicians for Reproductive Health, recently met with them via telemedicine to talk about whether they wanted to continue the pregnancy.

“Talking to them about options counseling has been very different,” Yeh said. “They definitely had to weigh their financial strains, which is something they didn’t have to think about a few months ago.”

Yeh is due to follow up with the patient and her partner this week to find out their decision. But whatever happens, they are just two of the countless many around the country whose reproductive lives have already been impacted by the spread of Covid-19.

Initially, shelter-in-place orders around the country gave rise to jokes about a “coronavirus baby boom” — based in part on research showing that births can spike nine months after certain disasters, especially those that require people to stay inside. But already, just weeks after many Americans were told to stay home, it’s clear that the effect of the pandemic on people’s decisions about children — and their ability to make those decisions — is going to be more complicated than that.

Some say the worldwide crisis has inspired them to try for a child. Victoria Insley, for example, told Vox that she and her husband had been trying to conceive but decided to put things on hold after she became unemployed last year. But in March, after about two weeks of social distancing, they decided to start trying again. In part, the pandemic made them realize that “life is short,” Insley told Vox. “We’re not getting any younger.”

But others are making the opposite decision. Clinics are reporting an increase in requests for birth control prescriptions, and providers of abortion medication are seeing increased demand as well, according to Nourbese Flint, policy director and manager of reproductive justice programming for the group Black Women for Wellness.

A lot of the reason may be economic. With millions of Americans newly unemployed and many industries all but shuttered, many families are deeply uncertain about their financial future — if they can even provide for the present. The fact that many child care facilities are currently closed and many people are cut off from their extended families may also discourage some people from planning for kids right now. “People make long-term decisions when they feel certain about the future, and they put off long-term decisions when they don’t,” Philip Cohen, a sociology professor at the University of Maryland who studies families, told Vox.

But the ability to make reproductive choices also isn’t so simple in the pandemic. Several states, such as Texas, have moved to restrict abortion, categorizing it as nonessential during this time. Meanwhile, some are having difficulty getting birth control because they’ve lost their employer-provided health insurance or because shelter-in-place orders mean they can no longer make a trip to the pharmacy without family members finding out, Flint said. And for people who do get pregnant and deliver during this time, the pandemic could exacerbate racial disparities already found in maternal health care.

Overall, when it comes to health care, the pandemic “has really shown our gaps and where we need to be better,” Yeh said.

The pandemic — and the economic crisis that comes with it — could change a lot of people’s thinking on having kids

It’s long been a popular assumption that when people are stuck at home with little to do, there’s a spike in pregnancies as a result. But evidence for that is somewhat limited, according to the New York Times. One study did find that low-severity storm advisories were associated with a slight uptick in birth rates, but more severe advisories were actually associated with a downturn. “If you’re running for your life, you’re not making babies,” Richard W. Evans, one of the study’s authors, told the Times.

And the pandemic is unlike any storm. While some people may be sheltering at home with their partners, some health care workers are actually self-isolating away from their families to avoid infecting them. And thanks to closures of restaurants, bars, and other businesses to slow the spread of the virus, 22 million people have filed for unemployment since March and the jobless rate is likely the highest it’s been since the Great Depression.

With millions of Americans newly unemployed and many industries all but shuttered, many families are deeply uncertain about their financial future

Unemployment tends to lower birth rates in the short term, Cohen said, and that’s likely to be the case with the current crisis as well. When it comes to having kids, “people who are unemployed or unstably employed or worried that they might lose their jobs are just likely to put it off,” he explained.

Some people may also be concerned about what being pregnant and giving birth in the coming year will look like. A lot of questions remain about the risks of the coronavirus during pregnancy — while it’s possible that the virus can pass to a fetus during pregnancy, for example, the effect on newborns appears to be mild. Meanwhile, circumstances for birthing parents have changed significantly, with hospitals around the country limiting visitors in the delivery room in recent months. It’s hard to predict what the picture will look like for parents-to-be nine months from now, but questions around medical care only add to the uncertainty people are facing when they think about expanding their families right now.

Concerns about the future of child care and school could also have an effect, especially for people who already have at least one child and see how the pandemic has upended their routines. With schools in all 50 states closed and many day care facilities shuttered as well, parents are in the position of taking care of their children at home and supervising online schooling, all while continuing to work if they’re still employed and potentially looking for work if they are not. That makes it difficult and stressful to take care of kids right now, and most likely stressful to contemplate expanding a family. “It’s hard to imagine people making the decision to have more children in the middle of this,” Cohen said.

There’s already evidence that some people are changing their plans in response to the pandemic. Black Women for Wellness has been hearing from clinics about an uptick in requests for birth control, Flint said. Meanwhile, Plan C, a website that offers information about getting abortion pills online, saw traffic double in March when many shelter-in-place orders were issued, Amy Merrill, the site’s digital director, told Vox. Traffic has dropped somewhat since then, but remains elevated above its pre-pandemic level.

And some abortion providers are reporting an increase in demand for the procedure, with some patients citing fears of giving birth during a pandemic. Some patients are saying “having a child right now isn’t best for them,” Meera Shah, chief medical officer of Planned Parenthood Hudson Peconic, told the Associated Press.

Overall, when it comes to having children, “a lot of people are rethinking their lives right now,” Flint said. “The world has changed very dramatically.”

Still, despite those changes, the pandemic has some people wanting to expand their families, even if now may not be the best time. Amy Klein, for instance, wrote recently at Insider that living under a shelter-in-place order made her wish her daughter had a sibling. “When I’m stuck inside, coloring or monitoring princess outfit change No. 537, or playing ‘hide and seek’ (mostly just ‘hide’ because sometimes I’m working and forget to look for her), my heart goes out most to my daughter,” Klein wrote. “At times like these, I feel we’re not enough.”

Insley, meanwhile, says she’s wrestled with the uncertainties of getting pregnant during this time. “I really feel for the moms who are in labor and delivery right now who are only able to have one person with them,” she says. However, she and her husband agreed that especially because they had already put off trying for so long, “now is the time.”

People are facing barriers to making reproductive decisions right now, whether it’s an abortion or IVF

Whether they want to conceive or prevent pregnancy, however, Americans are facing additional barriers thanks to the pandemic.

Hormonal birth control, for instance, may be more difficult to access right now for a variety of reasons. Though employer-based health insurance is required to cover contraception with no copay, many of those who lost their jobs in recent weeks lost their insurance as well, Flint said.

“It’s hard to imagine people making the decision to have more children in the middle of this”

And shelter-in-place orders bring with them new privacy concerns. Some people may not feel safe or comfortable telling parents, partners, or other family members that they are on birth control. And under normal circumstances, they were able to pick up their prescriptions without other family members finding out, Flint said — on the way home from work, for example. But now, with many people staying at home due to the pandemic, “if you’re stepping out of your house, there has to be a reason.” And people may have difficulty filling their prescriptions due to the added scrutiny.

Others may not want to go to a pharmacy to pick up a prescription for fear of being exposed to the coronavirus. Perhaps because of such fears, Pill Club, an online birth control delivery service, reported a 30 percent increase in requests to transfer prescriptions from outside pharmacies during one week in March.

Meanwhile, abortion has become more difficult to access in some parts of the country as states restrict the procedure during the pandemic. Texas Gov. Greg Abbott, for example, announced in March that abortions did not qualify as essential medical procedures and ordered them postponed unless the life of the pregnant person was threatened. Last week, Abbott announced that other medical procedures could resume on April 22 but that the ban on abortions would continue. As a result of the ban, clinics in Colorado, New Mexico, and Nevada saw a 706 percent increase in patients from Texas after the pandemic began, according to NPR.

But not everyone is able to travel out of state, especially now. When it comes to abortion, it’s likely that “there are a ton of people who need access who literally just can’t get it,” Flint said.

And those who do want to have a child right now face barriers as well. Fertility clinics around the country have been postponing in-vitro fertilization and other procedures during the pandemic, both to slow the spread of the virus and to conserve medical resources for the fight against it, Katherine Harmon Courage reported for Vox. That means many people dealing with infertility, as well as many LGBTQ couples who can’t conceive a child on their own, have had to put their plans on hold.

Meanwhile, those who want to visit an OB-GYN for preconception testing or to talk about trying to get pregnant may have a hard time doing so, since many such medical services have been postponed due to the pandemic. “If you’re trying to get a regular OB-GYN appointment” to discuss trying to conceive, Flint said, “it’s really hard to get that appointment, if not impossible.”

Prenatal care is also changing, with ultrasounds spaced out in some cases, and other services provided by telemedicine, according to the New York Times. And once babies are born, it can be hard for parents to get support from family or friends during a time of social distancing, which some fear could increase the risk of postpartum depression.

For people who do get pregnant and give birth in the months ahead, advocates are concerned that the pandemic could widen existing inequities. Black women already die in childbirth at three to four times the rate of white women — likely due to a combination of factors including discrimination by providers and chronic health conditions exacerbated by poverty — and the current crisis could exacerbate the racism women of color experience in the medical system, Flint said. Black Women for Wellness is starting to hear increased reports of pregnant people’s birth plans being ignored, she added. “In such a time where health professionals are not questioned,” Flint said, “there is even more space for abuse.”

Now and in the future, people are going to need support to build the families they want to have

The coronavirus pandemic came at a time when many Americans’ reproductive lives were already tightly constrained by outside forces. Preventing pregnancy has become more difficult for many low-income Americans in recent years as states and the federal government strip funding from Planned Parenthood and other providers of contraceptive care. Recent restrictions on federal family planning funds under the Title X program, for example, have led to a 46 percent reduction in that program’s ability to provide contraception to low-income and other underserved patients around the country, according to a study by the Guttmacher Institute.

Abortion, meanwhile, has become increasingly difficult and expensive across much of the South and Midwest in the last 10 years as states have instituted waiting period laws and clinic restrictions. Eighty-nine percent of Americans currently live in counties with no abortion clinic, according to Guttmacher.

Those who do want to have children have also run up against difficult economic realities and policies that make it hard to parent. Birth rates in the United States have been falling since the Great Recession, and many young people cite economic anxieties as the reason they may have fewer children than they would otherwise like to have. In 2018, Morning Consult and the New York Times surveyed young adults who had or expected to have fewer kids than they considered ideal: 64 percent cited the expense of child care as the reason, 49 percent cited worries about the economy, and 39 percent mentioned a lack of paid family leave.

Having the family you want to have, when you want to have it, is already a luxury in America, and the pandemic stands to make that even more true. The threat of the coronavirus has produced worry and uncertainty for everyone, but “that instability and insecurity that people feel is very inequitably distributed,” Cohen said. “The professionals who are staying home and working from home and the working-class people who are in front-line jobs of various kinds are just having a very different experience right now.”

As a result, low-income Americans may be even more likely than wealthier people to feel that they can’t afford to think about having kids right now. Yet they are also more likely to have a hard time accessing birth control due to job loss or reductions in federal funding.

To help people maintain contraceptive access during this time, some providers — and a number of online services — are offering birth control prescriptions by telemedicine. States are also asking the Trump administration to lift FDA restrictions so that medication abortions can be prescribed by telemedicine as well. According to Merrill of Plan C, “people all across this landscape are trying to understand, what can abortion access look like in the time of Covid and beyond?”

But telemedicine is another area where the gap between low-income Americans and wealthier people is painfully evident. “Not everyone has a smartphone” or internet access, Yeh said. “What we really need to do is be cognizant about those gaps and try to fill them.”

When it comes to feeling financially secure enough to have a child, meanwhile, policies that provide a safety net for parents — from an increased minimum wage to affordable child care — could be more necessary than ever during and after the pandemic, Cohen said. “Those things have always been good policy ideas,” he said. But assuring people that “there’s a floor below which you won’t fall,” he said, “that seems just really crucial right now more than ever.”

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