Comment on pandemic family plans

After reviewing a paper for JAMA Network Open I was invited to write a comment about it. The paper is here, reporting a large drop in the percentage of mothers who are planning or thinking about having another child in a sample from New York City in mid-2020. After summarizing the results, I wrote this:

Before the COVID-19 pandemic, the US was in a period of declining fertility following the 2008 financial crisis and subsequent recession—a decline that was linked to economic precarity and hardship [2]. Then, in 2020, the total number of US births decreased 3.8%, which was the largest annual decline on a percentage basis since the early 1970s. The decreases were steeper at the end of the year, −6% in November and −8% in December, compared with 2019 [3]. In some large states with public monthly reports (California, Florida, and Ohio), it appears that January and February 2021 had fewer births still, with some recovery in the months that followed [4]. This timing suggests a direct association with the onset of the pandemic and closures that began in the spring of 2020. The evidence presented by Kahn and colleagues [1] supports this interpretation and suggests that when people faced the uncertainty and hardships associated with the pandemic, one common response was to pull back from plans to add children to their families. Future research will examine whether family decision-making in more advantaged families was similarly affected.

The current evidence concerns shifts in pregnancy planning. However, in the US, a substantial portion of births results from unintended or mistimed pregnancies, and these are concentrated among disadvantaged women [5]. The inability to predict, much less control, the trajectory of their lives leads many women to postpone the lifelong commitments implied by intentional births, but also makes unintentional pregnancy more likely. How the pandemic may have affected such births is not yet known. If mobility restrictions, unemployment, illness, care work burdens, and social distancing all reduced social interaction, coupled with increased motivation to prevent pregnancy, we may suspect unintended births will have declined as well.

The impacts of the pandemic within and between families points to the complex interrelationships among family structure, health disparities, and social inequality in the US [6]. The COVID-19 pandemic has been an inequality-exacerbating event on a large scale, widening existing health disparities, especially along the lines of socioeconomic status, race, and ethnicity. Excess mortality among Black and Hispanic populations in 2020, directly and indirectly related to the pandemic, far outstripped that seen among non-Hispanic White populations and contributed to the decrease in overall US life expectancy that exceeded that seen in peer countries [7]. In light of disparate impacts of COVID-19 itself and the social and economic fallout of the pandemic, research should concentrate on widening inequalities in fertility and family well-being, and their relationship to health disparities.

Published: September 15, 2021. doi:10.1001/jamanetworkopen.2021.24399

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Cohen PN. JAMA Network Open.

Corresponding Author: Philip N. Cohen, PhD, Maryland Population Research Center, Department of Sociology, University of Maryland, Parren J. Mitchell Art Sociology Building, College Park, MD 20742 (

Conflict of Interest Disclosures: None reported.


  1. Kahn  LG, Trasande  L, Liu  M, Mehta-Lee  SS, Brubaker  SG, Jacobson  MH.  Factors associated with changes in pregnancy intention among women who were mothers of young children in New York City following the COVID-19 outbreak.   JAMA Netw Open. 2021;4(9):e2124273. doi:10.1001/jamanetworkopen.2021.24273
  2. Seltzer  N.  Beyond the great recession: labor market polarization and ongoing fertility decline in the United States.   Demography. 2019;56(4):1463-1493. doi:10.1007/s13524-019-00790-6
  3. National Center for Health Statistics. Provisional estimates for selected maternal and infant outcomes by month, 2018-2020. Accessed July 1, 2021.
  4. Cohen  PN.  Baby bust: falling fertility in US counties is associated with COVID-19 prevalence and mobility reductions.   SocArXiv, March 17, 2021. doi:10.31235/
  5. Hartnett  CS, Gemmill  A.  Recent trends in US childbearing intentions.   Demography. 2020;57(6):2035-2045. doi:10.1007/s13524-020-00929-w
  6. Thomeer  MB, Yahirun  J, Colón-López  A.  How families matter for health inequality during the COVID-19 pandemic.   J Fam Theory Rev. 2020;12(4):448-463. doi:10.1111/jftr.12398
  7. Woolf  SH, Masters  RK, Aron  LY.  Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data.   BMJ. 2021;373(n1343):n1343. doi:10.1136/bmj.n1343

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