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Joanna Kraus' second pregnancy, during the worst wave of the COVID-19 pandemic, was lonely.

Her husband couldn't attend clinic or ultrasound appointments when she was allowed to see her doctor in person rather than on Zoom. And she spent most of the nine months at home, trying to avoid an infection that could threaten her health and pregnancy. The only saving grace was that she had done it already.

"If I was like a first-time mom? If this was my first child? I definitely would have delayed," she said.

Turns out, many moms did exactly that. Births dropped by historic numbers nine months after Minnesota's first COVID-19 wave in the spring of 2020. The 4,653 births in January 2021 was the lowest monthly total since at least 2003, according to federal and state data. Monthly birth records prior to 2003 weren't immediately available for comparison.

Birth numbers rebounded in March 2021, but the dip revealed the stranglehold that COVID-19 had on Minnesota's psyche at the start of the pandemic along with the statewide stay-at-home orders issued in response.

"All parts of all of our lives were so uncertain at first," said Dr. LeeAnn Hubbard, medical director of the family birthing center at Regions Hospital in St. Paul. In addition to financial and other losses, "parents had other kids they were home-schooling while working from home and maybe they were overwhelmed even thinking about adding to their family — if they even wanted to."

National crises have suppressed births before; Minnesota saw a 7% decline in 1919 at the end of the Spanish Flu epidemic, according to data from the Minnesota Historical Society. However, a decline following COVID-19 was not a certainty. Some experts predicted a baby boom on the supposition that locked-down couples would have more sex and less ready access to birth control.

Surveys quickly doused those theories. Job losses and other pandemic fallout prompted 40% of U.S. women 18 to 49 to change their plans regarding the timing of pregnancy or the number of children they wanted, according to the Guttmacher Institute, a New York-based reproductive health research organization. Bar closures and other restrictions simultaneously reduced opportunities for sexual encounters and unplanned pregnancies.

"If you didn't have a partner at home, it wasn't very easy to find one. And for couples at home, the stress of the pandemic may not have been the aphrodisiac that people had thought," said Laura Lindberg, co-author of the Guttmacher report and a reproductive health researcher at the Rutgers School of Public Health.

Births had already been declining in Minnesota — from more than 73,000 in 2006 to 65,490 in 2020 — as the large Baby Boomer generation aged out of child-bearing and Millennials showed less eagerness to become parents.

Today's young adults either are less interested in having kids, or as many kids, or are delaying their plans, said Susan Brower, Minnesota's state demographer: "You don't really know until they're out of their child-bearing years. They could just be having them later."

A suspension of in vitro fertilization and other forms of assisted reproduction at the start of the pandemic accelerated the decline in births. There were 44 births involving assisted reproduction in Minnesota in December 2020, compared to 117 a year earlier, according to the Centers for Disease Control and Prevention.

Age also was a factor in choices to refrain from pregnancy at the outset of the pandemic. Monthly demographic data in Minnesota was only available for 2020, but in November and December, births declined sharply among women older than 40 whose pregnancies could have been put at greater risk by COVID-19.

Births also declined among women younger than 24 who had more time and flexibility to start or add to their families, Hubbard said.

In the middle were women like Kraus, 31. The Shakopee mother and her husband talked about delaying through the pandemic, but decided they wanted a second child close in age to their first-born daughter. Their pregnancy in August 2020 resulted in a newborn son in May 2021.

Carly Jakubowski, 30, didn't have a chance to plan. The Maple Grove woman discovered she was pregnant with her second child one week before COVID-19 was declared a pandemic, and gave birth during the most severe wave in November 2020.

"I remember cases were at like 50, 60, 70,000 a day," she said, recalling how she couldn't leave her room after her delivery. "That was a scary feeling."

Births to Minnesota residents increased from 63,470 in 2020 to 64,360 in 2021, when there was less uncertainty over the pandemic and vaccines became available. Birth totals for the first five months of 2022 are slightly below the pace of 2021, though, suggesting a return to pre-pandemic trends, according to preliminary state health data.

Lindberg said the COVID-related dip in births might have ended quickly, but the pandemic will have a lasting impact.

A follow-up Guttmacher survey last year showed shifting family planning. Parents seeking large families had reigned in plans after the pandemic caused income and job losses. Others seeking small families started thinking bigger after spending more time at home together.

"It makes a lot of sense when you think about how different people's experiences with the pandemic have been," Lindberg said.

Family planning decisions also varied by race for several reasons, she said. Minorities were more likely to have jobs in the service industry, for example, that prevented working from home and increased their COVID-19 exposure risks and child care expenses.

A report released Tuesday by the National Center for Health Statistics showed that U.S. births declined 5% among non-Hispanic Black women in the first six months of 2021 and didn't increase in the next six months. Births among white non-Hispanic women didn't decline in the first six months but increased 4% in the next six months.

Mothers are more confident at this point in the pandemic, but early on some were asking for long-term contraception before they left the hospital with their newborns, said Fernanda Honebrink, a nurse-midwife with Hennepin Healthcare. "Everybody was afraid about what was going to happen to them."