The goal of this thesis was to better understand the lived experiences of an ethnically and linguistically diverse sample of mothers who gave birth during the COVID-19 pandemic. Pregnant women experience higher risk for severe COVID-19 outcomes compared to non-pregnant women. Yet the impact on women’s psychosocial wellbeing may be just as problematic, given new mothers’ increased risk for depression postpartum coupled with the loss of multiple forms of support so critical during the postpartum period and new stressors created by the pandemic. A universal testing strategy at a Labor & Delivery Unit at a hospital in the Southwestern U.S early in the pandemic identified that Communities of Color – particularly resettled refugee women - experienced COVID-19 infection at higher rates compared to White women. Therefore, this study investigates stressors and coping strategies specific to the pregnancy, birth, and postpartum periods in a linguistically diverse sample of 140 women (Swahili n=18 , Kinyarwanda n=18 , Burmese n=13, Arabic=11, Spanish n=35, English n=45) who gave birth between May and December 2020. Across groups, the most severe health stressor was fear of self or infant contracting COVID-19, leading to strict adherence to prevention measures among women, and feelings of social isolation. This was followed by anxiety for lack of social support at birth, and, in some women, management of other health concerns related to increased risk for adverse pregnancy or severe COVID-19 outcomes. Coping strategies included looking to religion or spirituality for comfort, as well as spending more time with family. This analysis of how the pandemic affected women’s psychosocial wellbeing from pregnancy to postpartum informs adaptation of care for linguistically and ethnically minoritized groups and their infants.

Background: Recent studies have shown a decline in birth rates in large metropolitan areas (after accounting for population), which can be possibly explained by barriers to reproduction associated with the COVID-19 pandemic and related lockdowns. Objective: This study’s objective was to investigate the impact of the COVID-19 pandemic and related lockdowns on the fertility rates of women in reproductive ages living in Greater Phoenix. Methods: The total number of inpatient births and people in both Maricopa and Pinal Counties during pre-COVID-19 years (2017-2019) were compared with those during the COVID-19 years (2021) among women in reproductive ages (15-49 years). To make age-specific comparisons, women in reproductive years were divided into eight distinct age group categories (15-17, 18-20, and then five year age group categories to age 49) from which age-specific, general, and total fertility rates were calculated. Results: Using a two-sample z-test for difference in proportions, findings revealed that the general fertility rate in Greater Phoenix had significantly declined from 48 to 46 per 1,000 population from the pre-COVID-19 period to COVID-19 period (P<0.001). Two sample z-tests were also used to compare age-specific fertility rates, which revealed a significant decline in the fertility rate in women ages 15-17 (from 8.0/1000 to 5.0/1000) (P<0.001), 18-20 (from 43.0/1000 to 35.0/1000) (P<0.001), and 21-24 (from 79.0/1000 to 68.0/1000) (P<0.001) from the pre-COVID-19 period to COVID-19 period, while no significant change was observed in the fertility rate in women ages 25-49. Conclusions: The observed general fertility decline in Greater Phoenix as a result of the COVID-19 pandemic poses significant implications for further research on barriers to reproduction brought upon by the COVID-19 pandemic and related lockdown measures. Another direction for further research involves possibly continuing this study to include years 2022 and 2023 in the COVID-19 period, as well as calculating age-specific fertility rates by race.