Social policy responses to COVID-19: New issues, old solutions?

et al. 2022

PeerJ

Background The sex ratio at birth (defined as male/(male+female) live births) is anticipated to approximate 0.510 with a slight male excess. This ratio has been observed to decrease transiently around 3–5 months following sudden unexpected stressful events. We hypothesised that stress engendered by the onset of the COVID-19 pandemic may have caused such a decrease in South Africa 3–5 months after March 2020 since in this month, South Africa reported its first COVID-19 case, death and nationwide lockdown restrictions were instituted. Methods We used publicly available, recorded monthly live birth data from Statistics South Africa. The most recent month for which data was available publicly was December 2020. We analysed live births for a 100-month period from September 2012 to December 2020, taking seasonality into account. Chi-squared tests were applied. Results Over this 100-month period, there were 8,151,364 live births. The lowest recorded monthly sex ratio at birth of 0.499 was in June 2020, 3 months after March 2020. This June was the only month during this period where the sex ratio inverted i.e., fewer male live births occurred. The predicted June 2020 ratio was 0.504. The observed June 2020 decrease was statistically significant p = 0.045. Conclusions The sex ratio at birth decreased and inverted in South Africa in June 2020, for the first time, during the most recent 100-month period. This decline occurred 3 months after the March 2020 onset of COVID-19 in South Africa. As June 2020 is within the critical window when population stressors are known to impact the sex ratio at birth, these findings suggest that the onset of the COVID-19 pandemic engendered population stress with notable effects on pregnancy and public health in South Africa. These findings have implications for future pandemic preparedness and social policy.

Section: Discussionmentioning

confidence: 89%

COVID-19 onset reduced the sex ratio at birth in South Africa

Masukume¹,

et al. 2022

PeerJ

“…The finding of a higher sex ratio at birth in December 2020, 9 months after COVID-19 was declared a pandemic, indicates that lockdown regulations initially encouraged more partnered sexual activity in a small portion of the population. Future pandemic preparedness (Marston et al 2017) and social policy (Cook & Ulriksen 2021) can be influenced by our findings. Examples of how this knowledge could be applied to prevent a potential SRB reduction include targeted increases in resources for maternal health services, including improved fetal surveillance, particularly during and in the lead up to 3-5 months after the start of a future pandemic.…”

Section: Discussionmentioning

confidence: 89%

“…) and social policy(Cook & Ulriksen 2021) can be influenced by our findings. Examples of how this knowledge could be applied to prevent a potential SRB reduction include targeted increases in resources for maternal health services, including improved fetal surveillance, particularly during and in the lead up to 3-5 months after the start of a future pandemic.…”

mentioning

confidence: 76%

COVID-19 induced birth sex ratio changes in England and Wales

et al. 2022

Preprint

Background The sex ratio at birth (male live births divided by total live births) may be a sentinel health indicator. Stressful events reduce this ratio 3-5 months later by increasing male fetal loss. This ratio can also change 9 months after major population events that are linked to an increase or decrease in the frequency of sexual intercourse at the population level, with the ratio either rising or falling respectively after the event. We postulated that stress caused by the COVID-19 pandemic may have affected the ratio in England and Wales. Methods Publicly available, monthly live birth data for England and Wales was obtained from the Office for National Statistics up to December 2020. The sex ratio at birth for 2020 (global COVID-19 onset) was predicted using data from 2012-2019. Observed and predicted values were compared. Results Three months after COVID-19 was declared pandemic (March 2020), there was a significant fall in the sex ratio at birth to 0.5100 in June 2020 which was below the 95% prediction interval of 0.5102-0.5179. Nine months after the pandemic declaration, (December 2020), there was a significant rise to 0.5171 (95% prediction interval 0.5085-0.5162). However, December 2020 had the lowest number of live births of any month from 2012 to 2020. Conclusions Given that June 2020 falls within the crucial window when population stressors are known to affect the sex ratio at birth, these findings imply that the start of the COVID-19 pandemic caused population stress with notable effects on those who were already pregnant by causing a disproportionate loss of male fetuses. The finding of a higher sex ratio at birth in December 2020, i.e., 9 months after COVID-19 was declared a pandemic, suggests that lockdown restrictions initially spurred more sexual activity in a subset of the population in March 2020.

“…As June 2020 is within the critical window when population stressors are known to impact the sex ratio at birth, via elevated risk of fetal death among males, these findings suggest that the onset of the COVID-19 pandemic engendered population stress with notable effects on pregnancy and public health in South Africa. Our findings can help inform future pandemic preparedness [32] and social policy [33]. Whether other countries experienced a decline in the SRB, following the onset of COVID-19 is an area for future research.…”

Section: Discussionmentioning

confidence: 93%

COVID-19 onset reduced the sex ratio at birth in South Africa

et al. 2022

Preprint

Background The sex ratio at birth [defined as male/(male+female) live births] is anticipated to approximate 0.510 with a slight male excess. Following sudden unexpected stressful events, this ratio has been observed to decrease transiently around 3-5 months following such events. We hypothesised that stress engendered by the onset of the COVID-19 pandemic may have caused such a decrease in South Africa 3-5 months after March 2020 since in this month, South Africa reported its first COVID-19 case, death and nationwide lockdown restrictions were instituted. Methods We used publicly available recorded monthly live birth data from Statistics South Africa. The most recent month for which data was available publicly was December 2020. We analysed live births for a 100-month period from September 2012 to December 2020, taking seasonality into account. Chi-squared tests were applied. Results Over this 100-month period, there were 8,151,364 live births. The lowest recorded monthly sex ratio at birth of 0.499 was in June 2020, 3 months after March 2020. This June was the only month during this period where the sex ratio inverted i.e., fewer male live births occurred. The predicted June 2020 ratio was 0.504. The observed June 2020 decrease was statistically significant p = 0.045. Conclusions The sex ratio at birth decreased and inverted in South Africa in June 2020, for the first time, during the most recent 100-month period. This decline occurred 3 months after the March 2020 onset of COVID-19 in South Africa. As June 2020 is within the critical window when population stressors are known to impact the sex ratio at birth, these findings suggest that the onset of the COVID-19 pandemic engendered population stress with notable effects on pregnancy and public health in South Africa. These findings have implications for future pandemic preparedness and social policy.