Rahul Gupta is the chief medical and health officer for the March of Dimes.

In the United States alone, at least 1 million children who would have been born over the next three years will never giggle, take their first steps or grow up to contribute to the great American experiment.

The covid-19 pandemic will be remembered for its death toll and the shock it inflicted on the world. Its other indelible imprint will be the lives that never began because of it.

Though one might expect that stay-at-home orders would create a baby boom, scientific evidence and our own history point in the opposite direction. In the global influenza pandemic of 1918, for instance, U.S. birthrates dropped by 10 percent over the nine to 10 months following the peak in deaths. If even this single trend holds true with today’s pandemic, the United States will have 379,000 fewer births each year until 2022.

Even before the novel coronavirus reached our shores, Americans were having fewer babies. Just recently, the Centers for Disease Control and Prevention reported that the U.S. birthrate dropped to its lowest level in 35 years. In 2019, the total fertility rate — the expected number of births that a woman would have over her lifetime — had fallen to a meek 1.71. A rate of 2.1 is needed to sustain a nation’s population.

The overall trend is troubling enough. Yet a confluence of three factors — fear of the unknown, economic instability and shuttered fertility services — will likely drive the country’s already-declining fertility rate even beyond today’s historic lows. These changes stand to dramatically impact our population, workforce, economy and even our culture over the next generation unless actions are taken to mitigate the impact of the pandemic.

We know from decades of research that stress and fear are the enemies of healthy pregnancies. We also know, according to the American College of Obstetricians and Gynecologists, that pregnant and postpartum women today are undergoing a significant degree of stress, fear, uncertainty and anxiety because of covid-19, from changing prenatal visits to wondering about the impact of the virus on their baby.

While researchers are still learning how covid-19 affects pregnant women, I’ve seen in my own work that women are wondering whether they should even get pregnant, especially with warnings that a brutal second wave of the virus awaits in the fall. At a charity clinic where I see patients in West Virginia, more women than ever are requesting birth control. The patients I’m seeing are taxed as they manage their children at home and face fresh economic hardships.

Times of grave instability naturally force people to postpone big life decisions, whether buying a home, moving or changing jobs. There is not a much weightier decision than whether to introduce a life into the world. Sufficient research has clearly demonstrated that women delay parenthood over economic insecurity, financial stress and job uncertainty. With 40 million Americans filing jobless claims since the pandemic began and an unemployment rate that has exploded to about 15 percent, we know that families coast to coast are feeling the fiscal strains of this moment and adapting their lives accordingly.

For women who still want to get pregnant, there are new obstacles. In many states, governors moved quickly to restrict fertility clinics and even imposed fines and penalties for health-care providers who violated their guidelines. Though some clinics have reopened amid unclear guidelines for doing so, the return to normal is months and perhaps years away. According to the CDC, 81,478 infants were born in 2018 as a result of fertility technologies, and these numbers will surely wane in the next few years.

For national, state and local planning, fertility rates matter. Not only do births today help plan for the future — how many schools or houses should be built — but a stable population trend line ensures an adequate workforce and a robust tax base. Today’s birth numbers have future implications for Social Security and Medicare solvency, and for our immigration policies.

Demographic stability is critical to achieving balance and progress across communities. This has been the formula, in fact, for U.S. prosperity. Though current economic stimulus measures will help Americans in the short term, no single policy intervention will reverse long-term fertility declines. Labor-market discrimination, an uneven health-care system, education inequality and inadequate parental leave and child care have paved our nation’s path.

This pandemic will end one day. But the pause should force us to see and address the barriers our society has placed before American women and their families.

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