By Dato’ Dr Amar-Singh HSS, Senior Consultant Paediatrician
The long-term impacts of the COVID-19 pandemic are only just being felt. In the past 10-11 months we have largely experienced the short-term effects. But as the pandemic drags on we can begin to recognise some long-term impacts.
We are beginning to realise that this pandemic will be with us for another 1-2 years. While there are promising developments with a vaccine, we must not forget the issues of mutations, limited antibody durations, proven re-infections by COVID-19, the logistics of any vaccine that requires a minus 700C cold chain, and finally the enormous challenges in rolling out a vaccine that has a worldwide demand. So recovery in 2 years may even be optimistic.
I would like to highlight one long-term impact on our population growth. While much of our focus has, rightly so, been on economic recovery and poverty reduction, it is also important to consider what this pandemic will do to our future generations.
If you look at our annual births (see Table 1) you will note that our birth volume (number of births each year) has been gradually coming down. There is about a 1.5-2.5% reduction in birth for each subsequent year.
Table 1: Live Births 2014-2019, Malaysia
|Change from Previous Year
Source: Department of Statistics Malaysia (DOS)
* 2019 data summated from DOS quarterly reports
If we look more closely at data for 2020 (see Table 2) we will see a steeper reduction in births beginning to appear in July-September for the same period last year. There was an initial expectation of a ‘baby boom’ due to lockdowns and more sexual activity between couples. However as the pandemic has dragged, with significant economic impacts on a sizable proportion of the public, we expect that many will choose not to have children for a while. There are also parental fears about the virus’ impact on children.
Table 2: Live Births 2020, Malaysia
|Live Births 2020
|Live Births 2019
|Change from Same Period Previous Year
p < 0.0001
Source: Department of Statistics Malaysia (DOS) quarterly reports
What we are experiencing now is akin to the impact on populations during a major, protracted war. In many countries, the loss in births during a major war exceeded the numbers killed in action [See Caldwell (2004). Social Upheaval and Fertility Decline. Journal of Family History].
A pandemic that has uncertainty as to when it will end, with enormous economic consequences for the average person, is anticipated to have the following impact on births of children:
- Many will defer having children (reduction in planned births).
- Many will delay getting married (reduction in pool of prospective parents).
- Possibility of increased terminations of early pregnancies.
From the data shared above, we are beginning to see this change, but the major decline will only be seen in 2021. How much birth rates will drop is uncertain; during wars they have declined from between 15 to 30%. Note that this effect may last much longer, even after the COVID-19 pandemic is over, due to increased poverty and the need to rebuild economic livelihood.
Hence we may end up with a ‘lost generation’ – a generational scar or gap in our society. There may be many ramifications for such a birth-gap in society, especially if protracted. These include impacts to the education system (reduction in students/classes), long-term manpower needs and health considerations (increased later age pregnancies).
Note that birth rates have been dropping for years in almost all nations, including ours. This pandemic may further accelerate this decline, not just during the pandemic but permanently. We may expect a small ‘baby boom’ after the pandemic but, in the long term, experience an even steeper decline in birth rates. Different segments of society may also respond differently to the threat posed by this pandemic, and we may see greater birth rate disparities in society.
Hence the loss in births we experience as a nation may far, far exceed the numbers killed by the COVID-19 pandemic. While there may be no solution to what I have highlighted, it is important that the authorities begin to become aware of this, track the changes and plan accordingly.