INTRODUCTION
During the COVID-19 pandemic, fertility care in the USA was put on hold temporarily to minimize transmission of infections.1 Prior to the pandemic, physicians were more likely than non-physicians to experience fertility challenges.2 The impact of the pandemic on family building among physicians is unknown. As part of a larger study on fertility, we examined family building challenges posed by the pandemic for physicians and trainees.
METHODS
A cross-sectional study design was used to administer a fertility questionnaire between April and May 2021 to physicians and physicians-in-training. A non-probabilistic sample of participants was recruited using an infographic advertisement leveraging social media (Twitter, Instagram, Facebook, and LinkedIn networks of the authors and AMWA (American Medical Women’s Association) including Facebook groups (e.g., Physician Moms Group, Gay Men Physicians Group)). Survey participants provided socio-demographic and work-related characteristics. Using an open-ended question, survey participants were asked, “How has COVID-19 affected your family planning?” An inductive thematic analysis was conducted.3 A group of three independent coders developed the codebook by coding responses until thematic saturation was reached (n = 200), two coded all responses, and differences were resolved by discussion. Quantitative analyses were conducted using SPSS Version 25 (IBM Corp). The study was approved by the University of Miami IRB.
RESULTS
Out of 3116 (90.6% women, n = 2824) survey participants, 1885 responses physicians and trainees (60.5%; see Table 1) responded to the free-response item about how COVID-19 affected their family planning. Of these participants, 37.3% (n = 703) said their family planning was impacted by COVID-19.
Our analysis identified seven major themes: delay, mental health, pregnancy experience, childcare, partnership, social support and isolation, and benefits (Table 2). Reasons stated for the most prominent theme, delaying family building, included fertility treatment challenges, inability to see their partner, delays in weddings, deliberate pauses in childbearing, COVID-19 vaccination, adoption delays, financial stressors, and change in desire to have children. Fertility treatment access challenges included scheduling appointments, fear of COVID-19 exposure, and lack of work coverage. Describing access to in vitro fertilization, one participant said: “I had a lot of frustration as someone who was putting themselves on the line every day to help people during a pandemic and who was then denied access to my own care.”
Participants voiced mental health concerns associated with adding a child to their family or being pregnant during the pandemic (i.e., COVID-19 exposure, isolation, and miscarriages). Pregnancy-related difficulties included fear and anxiety related to miscarriages, absence of support at appointments and delivery, and getting COVID-19 while pregnant. Participants had difficulties obtaining childcare and/or provided childcare themselves while working from home which was stressful and prohibitive for having additional children during the pandemic.
While most comments were made by women (91.6%), our themes did not vary across gender identities, nor did they vary by race or ethnicity.
DISCUSSION
It is critical to address the impact of the COVID-19 pandemic on the well-being of physicians, including the ability to build a family. In this first large-scale survey of physicians and trainees, the family planning of almost one-quarter of all respondents to the survey (and over one-third of those responding to the item analyzed here) was impacted by COVID-19. This finding is consistent with a national survey of the general population which showed many delayed milestones such as parenthood and marriage due to the pandemic.4 While our study is limited due to gender imbalance among participants and potential sampling bias that may slightly overestimate the impact of the pandemic, the data remain informative.
It is worth emphasizing that prior to the pandemic, physicians faced a higher rate of infertility and delayed childbearing compared to the general population.2 For some, additional delay due to the pandemic could be the difference between having a child and not. Our findings suggest healthcare employers should take active measures such as encouraging fertility check-ups, providing insurance coverage for fertility treatment, and educating leaders about the importance of supporting family building financially and with flexible schedules for physicians and trainees.5 Institutions that want to reverse the negative impact of the pandemic on women physicians must be intentional about incorporating these recommendations alongside other efforts such as addressing bias and harassment, improving childcare and parental leave, and providing additional research funds for women researchers.6
References
Schirmer D, Kawass JF, Adashi EY. Fertility care amidst the COVID19 pandemic: the American experience. J of Ovarian Res. 2021;14:34.
Stentz NC, Griffith KA, Perkins E, Jones RD, Jagsi R. Fertility and Childbearing Among American Female Physicians. J Womens Health (Larchmt). 2016 Oct;25(10):1059-1065. doi: https://doi.org/10.1089/jwh.2015.5638.
Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int J Qual Methods. 2017;16(1):1-13. doi:https://doi.org/10.1177/1609406917733847
Goda GS, Streeter JL. The Impact of the Covid-19 Pandemic on the Trajectories of Key Life Milestones. Stanford Cent Longev. 2021:1-10.
Marshall AL, Arora VM, Salles A. Physician Fertility: A Call to Action. Acad Med. 2020;95(5):679-681. doi: https://doi.org/10.1097/ACM.0000000000003079
Salles A, Jagsi R. Institutional imperatives for the advancement of women in medicine and science through the COVID-19 pandemic. The Lancet. 2021; 398(10304): 937-939. https://doi.org/10.1016/S0140-6736(21)01912-7
Acknowledgements
The authors thank the American Medical Women’s Association Physician Fertility Initiative for supporting the dissemination of this survey.
Funding
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number P30CA240139. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. (Caban-Martinez)
There was no funder/sponsor role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Levy and Salles had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Levy, Kelly, Brown, Arora, and Salles. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: Levy, Arora, Caban-Martinez, and Salles. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Levy, Kelly, Arora, Caban-Martinez, and Salles. Administrative, technical, or material support: Caban-Martinez, Arora, and Salles. Supervision: Caban-Martinez, Arora, and Salles.
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The study protocol was reviewed and approved by the University of Miami, IRB (#20210222).
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Levy, M.S., Kelly, A.G., Brown, A.D. et al. The Impact of COVID-19 on Family Building Among Physicians and Trainees. J GEN INTERN MED 37, 1582–1584 (2022). https://doi.org/10.1007/s11606-022-07442-3
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DOI: https://doi.org/10.1007/s11606-022-07442-3