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 (pnc@umd.edu).

Conflict of Interest Disclosures: None reported.

References

  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. https://www.cdc.gov/nchs/covid19/technical-notes-outcomes.htm
  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/osf.io/qwxz3
  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

Chasing Life podcast on making babies, or not

CNN’s Dr. Sanjay Gupta has a podcast called Chasing Life about coming out of the pandemic. Associate producer Grace Walker interviewed me for an episode titled, “Let’s Talk About Making Babies (Or Deciding Not To).” In it reporter Chloe Melas starts with the story of a Black couple (two women, one of them trans) seeking to have children. At about minute 21, she turns to the fertility decline in the US. The transcript of that part is below. This episode would be good for teaching.


Chloe Melas: But we can’t forget – not everyone wants to have children. And that’s OK. According to the CDC, the number of births in the United States fell by 4% last year – the largest annual decline since 1973. Given the global pandemic, for demographers like Philip Cohen of the University of Maryland, this isn’t too surprising.

Philip Cohen: What we’ve learned in the last century or so is that when there are crises birth rates go down. It’s partly deliberate, that is, people decide to hold off on having children, or decide against having children, because they’re unsure about the future, they’re unsure they’ll be able to care for them, they think they might lose their job, they think their mother might lose her job – all the things that go into the calculations of when and whether to have children.

CM: 2020 is not an outlier. Cohen says birthrates have been on a downward trend for quite a while.

PNC: We were sort of focusing on issues like work-family balance, childcare, healthcare, housing, the expenses of raising children, and the difficulty of raising children, which had been putting pressure on people to reduce their number of children. That’s the main reason. At the same time, when people have more opportunities to do other things in their lives, they’re also inclined to have fewer children, or delay having children. So especially for women, when opportunities improve, the number of children they have tends to go down, because on average they’re more likely to choose something else.

CM: Hispanic women in particular are seeing some of the largest declines. From 2007 to 2017 birth rates fell by 31%. Experts attribute this drop to more Hispanic women joining the workforce, and waiting longer to start families than previous generations. Overall, the data doesn’t lie. Fewer people are having kids. That could lead to smaller kindergarten classrooms, as well as larger demands on Social Security, given the aging population. But Cohen and others think there could be positives, too. For example, fewer people means less of an environmental impact on the planet. So it’s really a glass half empty, glass half full kind of situation. The point is, I think this pandemic has really made many of us reflect on what we want our future to look like, including our future families. Some have been inspired to freeze their eggs, some to seek out help for infertility, and some have decided against having kids while others have been inspired to do so.

New paper: Baby Bust analysis of 124 counties in 2 states through February 2021

Having spent a few months collecting data on birth rates over the last year, and a few months pouring over pandemic data, I took the time to bring the two together and assess the relationship between some basic pandemic indicators and the latest fertility outcomes. The result is a short paper I titled, “Baby Bust: Falling Fertility in US Counties Is Associated with COVID-19 Prevalence and Mobility Reductions,” now available on SocArXiv, with links to the data and Stata code for replication. 

Here’s the abstract:

The United States experienced a 3.8 percent decline in births for 2020 compared with 2019, but the rate of decline was much faster at the end of the year (8 percent in December), suggesting dramatic early effects of the COVID-19 pandemic, which began affecting social life in late March 2020. Using birth data from Florida and Ohio counties through February 2021, this analysis examines whether and how much falling birth rates were associated with local pandemic conditions, specifically infection rates and reductions in geographic mobility. Results show that the vast majority of counties experienced declining births, suggestive of a general influence of the pandemic, but also that declines were steeper in places with greater prevalence of COVID-19 infections and more extensive reductions in mobility. The latter result is consistent with more direct influences of the pandemic on family planning or sexual behavior. The idea that social isolation would cause an increase in subsequent births receives no support.

Here’s the main result in graphic form, showing that births fell more in January/February in those counties with more COVID-19 cases, and those with more mobility limitation (as measured by Google), through the end of last May:

However, note also that births fell almost everywhere (87% of the population lives in a fertility-falling county), so it didn’t take a high case count or shutdown to produce the effect.

There will be a lot more research on all this to come, I just wanted to get this out to help establish a few basic findings and motivate more research. I’d love your feedback or suggestions.

Earlier updates and media reports are here.

Pandemic Baby Bust situation update

[Update: California released revised birth numbers, which added a trivial number to previous months, except December, where they added a few thousand, so now the state has a 10% decline for the month, relative to 2019. I hadn’t seen a revision that large before.]

Lots of people are talking about falling birth rates — even more than they were before. First a data snapshot, then a link roundup.

For US states, we have numbers through December for Arizona, California, Florida, Hawaii, and Ohio. They are all showing substantial declines in birth rates from previous years. Most dramatically, California just posted December numbers, and revised the numbers from earlier months, now showing a 19% 10% drop in December. After adding about 500 births to November and a few to October, the drop in those two months is now 9%. The state’s overall drop for the year is now 6.2%. These are, to put it mildly, very larges declines in historical terms. Even if California adds 500 to December later, it will still be down 18%. Yikes. One thing we don’t yet know is how much of this is driven by people moving around, rather than just changes in birth rates. California in 2019 had more people leaving the state (before the pandemic) than before, and presumably there have been essentially no international immigrants in 2020. Hawaii also has some “birth tourism”, which probably didn’t happen in 2020, and has had a bad year for tourism generally. So much remains to be learned.

Here are the state trends (figure updated Feb 18):

births 18-20 state small multiple by month

From the few non-US places that I’m getting monthly data so far, the trend is not so dramatic. Although British Columbia posted a steep drop in December. I don’t know why I keep hoping Scotland will settle down their numbers… (updated Feb 18):

births countries 18-20 small multiple by month

Here are some recent items from elsewhere on this topic:

  • That led to some local TV, including this from KARE11 in Minneapolis:

Good news / bad news clarification

There’s an unfortunate piece of editing in the NBCLX piece, where I’m quoted like this: “Well, this is a bad situation. [cut] The declines we’re seeing now are pretty substantial.” To clarify — and I said this in the interview, but accidents happen — I am not saying the decline in births is a bad situation, I’m saying the pandemic is a bad situation, which is causing a decline in births. Unfortunately, this has slipped. As when the Independent quoted the piece (without talking to me) and said, “Speaking to the outlet, Philip Cohen, a sociologist and demographer at the University of Maryland, called the decline a ‘bad situation’.”


The data for this project is available here: osf.io/pvz3g/. You’re free to use it.


For more on fertility decline, including whether it’s good or bad, and where it might be going, follow the fertility tag.


Acknowledgement: We have lots of good conversation about this on Twitter, where there is great demography going on. Also, Lisa Carlson, a graduate student at Bowling Green State University, who works in the National Center for Family and Marriage Research, pointed me toward some of this state data, which I appreciate.

Host, parasite, and failure at the colony level: COVID-19 and the US information ecosystem

Trump campaign attempts to remove satirical cartoon from online retailer | Comics and graphic novels | The Guardian

This cartoon is offensive. And yet.


A few months ago I did some reading about viruses and other parasites, inspired by the obvious, but also those ants that get commandeered by cordyceps fungi, as seen in this awesome Richard Attenborough video:

Besides the incredible feat of programming ants to disseminate fungus spores, the video reveals two other astounding facts about this system. First, worker ants from afflicted colonies selflessly identify and remove infected ants and dump their bodies far away, reflecting intergenerational genetic training as well as the ability to gather and process the information necessary to make the diagnosis and act on it. And second, there are many, many cordyceps species, each evolved to prey upon only one species, reflecting a pattern of co-evolution between host and parasite.

This led me to reading about colony defenses in general, including not just ants but things like wasps and termites that leave chemical protection for future generations, and bees getting together to make hive fevers to ward off parasitic infections. I don’t find a video of exactly a hive fever, but this one is similar: It’s bees using their collective body temperature to cook a predatory hornet to death:

Incredible. That got me thinking about how information management and dissemination is vital to colony-level defenses against parasites. They need to process and transmit information to work together in the arms race against parasites (especially viruses) that usually evolve much more rapidly than they do.

And you may know where this is going: How the US failed against SARS-CoV-2. In an information arms-race, life and death struggle against a parasitic virus that mutates exponentially faster than we can react — who knows how many experimental trials it took to design SARS-CoV-2? — this kind of efficient information system is what we need. And it worked in some ways, as humanity identified the virus and shared the data and code necessary to take action against it. But clearly we failed in other ways — communicating with our fellow citizens, dislodging the disinformation and misinformation that clouded their understanding and led so many to sacrifice themselves at the behest of a corrupt political organization and its demented leader.

Is this social evolution, I asked (despairingly), in which the Chinese system of government proves its superiority for survival at the colony level, while the US democratic system chokes on its own infected lungs. Worse, is the virus programming us to exacerbate our own weaknesses — yanking our social media chains and our slavery-era political institutions, like the rabies virus, which infects the brain and then explodes out through the salivary glands of a zombified attack animal. Colonies of ants rise or fall based on how they respond to parasites, which themselves are evolving to control ant behavior, as they evolve together. How exceptional are humans? Maybe we just do it faster, in social evolutionary time, rather than across many generations of breeding. Fascinating, but kind of dark. lol.

Anyway, naturally my concern is with information systems and scholarly communication. How human success against the virus has come from the rapid generation and dissemination of science and public health information (including preprints and data sharing). And failure came from disinformation and information corruption. Dr. Birx in the role the rabid raccoon, watching herself lose her grip on scientific reality as the authoritarian leader douses the public health information system with bleach and sets it on fire with an ultraviolet ray gun “inside the body.”

So I wrote a short paper titled, “Host, parasite, and failure at the colony level: COVID-19 and the US information ecosystem,” and posted it on SocArXiv: socarxiv.org/4hgam.* It includes this table:

hpit2


* I barely took high school biology. In college I took “Climate and Man,” and “Biology of Human Affairs.” That’s pretty much it for my life sciences training, so don’t take my word for it. Comments welcome.

COVID-19 mortality rates by race/ethnicity and age

Why are there such great disparities in COVID-19 deaths across race/ethnic groups in the U.S.? Here’s a recent review from New York City:

The racial/ethnic disparities in COVID-related mortality may be explained by increased risk of disease because of difficulty engaging in social distancing because of crowding and occupation, and increased disease severity because of reduced access to health care, delay in seeking care, or receipt of care in low-resourced settings. Another explanation may be the higher rates of hypertension, diabetes, obesity, and chronic kidney disease among Black and Hispanic populations, all of which worsen outcomes. The role of comorbidity in explaining racial/ethnic disparities in hospitalization and mortality has been investigated in only 1 study, which did not include Hispanic patients. Although poverty, low educational attainment, and residence in areas with high densities of Black and Hispanic populations are associated with higher hospitalizations and COVID-19–related deaths in NYC, the effect of neighborhood socioeconomic status on likelihood of hospitalization, severity of illness, and death is unknown. COVID-19–related outcomes in Asian patients have also been incompletely explored.

The analysis, interestingly, found that Black and Hispanic patients in New York City, once hospitalized, were less likely to die than White patients were. Lots of complicated issues here, but some combination of exposure through conditions of work, transportation, and residence; existing health conditions; and access to and quality of care. My question is more basic, though: What are the age-specific mortality rates by race/ethnicity?

Start tangent on why age-specific comparisons are important. In demography, breaking things down by age is a basic first-pass statistical control. Age isn’t inherently the most important variable, but (1) so many things are so strongly affected by age, (2) so many groups differ greatly in their age compositions, and (3) age is so straightforward to measure, that it’s often the most reasonable first cut when comparison groups. Very frequently we find that a simple comparison is reversed when age is controlled. Consider a classic example: mortality in a richer country (USA) versus a poorer country (Jordan). People in the USA live four years longer, on average, but Americans are more than twice as likely to die each year (9 per 1,000 versus 4 per 1000). The difference is age: 23% of Americans are over age 60, compared with 6% of Jordanians. More old people means more total deaths, but compare within age groups and Americans are less likely to die. A simple separation by age facilitates more meaningful comparison for most purposes. So that’s how I want to compare COVID-19 mortality across race/ethnic groups in the USA. End tangent.

Age-specific mortality rates

It seems like this should be easier, but I can’t find anyone who is publishing them on an ongoing basis. The Centers for Disease Control posts a weekly data file of COVID-19 deaths by age and race/ethnicity, but they do not include the population denominators that you need to calculate mortality rates. So, for example, it tells you that as of December 5 there have been 2,937 COVID-19 deaths among non-Hispanic Blacks in the age range 30-49, compared with 2,186 deaths among non-Hispanic Whites of the same age. So, a higher count of Black deaths. But it doesn’t tell you there are 4.3-times as many Whites as Blacks in that category. So a much higher mortality rate.

On a different page, they report the percentage of all deaths in each age range that have occurred in each race/ethnic group, don’t include their percentage in the population. So, for example, 36% of the people ages 30-39 who have died from COVID-19 were Hispanic, and 24% were non-Hispanic White, but that’s not enough information to calculate mortality rates either. I have no reason to think this is nefarious, but it’s clearly not adequate.

So I went to the 2019 American Community Survey (ACS) data distributed by IPUMS.org to get some denominators. These are a little messy for two main reasons. First, ACS is a survey that asks people what their race and ethnicity are, while death counts are based on death certificates, for which the person who has died is not available to ask. So some people will be identified with a different group when they die than they would if they were surveyed. Second, the ACS and other surveys allow people to specify multiple races (in addition to being Hispanic or not), whereas death certificate data generally does not. So if someone who identifies as Black-and-White on a survey dies, how will the death certificate read? (If you’re very interested, here’s a report on the accuracy of death certificates, and here are the “bridges” they use to try to mash up multiple-race and single-race categories.)

My solution to this is make denominators more or less the way race/ethnicity was defined before multiple race identification was allowed. I put all Hispanic people, regardless of race, into the Hispanic group. Then I put people who are White, non-Hispanic, and no other race into the White category. And then for the Black, Asian, and American Indian categories, I include people who were multiple race (and not Hispanic). So, for example, a Black-White non-Hispanic person is counted as Black. A Black-Asian non-Hispanic person is counted as both Black and Asian. Note I did also do the calculations for Native Hawaiian and Other Pacific Islanders, but those numbers are very small so I’m not showing them on the graph; they’re on the spreadsheet. Note also I say “American Indian” to include all those who are “non-Hispanic American Indian or Alaska Native.”

This is admittedly crude, but I suggest that you trust me that it’s probably OK. (Probably OK, that is, especially for Whites, Blacks, and Hispanics. American Indians and Asians have higher rates of multiple-race identification among the living, so I expect there would be more slippage there.)

Anyway, here’s the absolutely egregious result:

This figure allows race/ethnicity comparisons within the five age groups (under 30 isn’t shown). It reveals that the greatest age-specific disparities are actually at the younger ages. In the range 30-49, Blacks are 5.6-times more likely to die, and Hispanics are 6.6-times more likely to die, than non-Hispanic Whites are. In the oldest age group, over 85, where death rates for everyone are highest, the disparities are only 1.5- and 1.4-to-1 respectively.

Whatever the cause of these disparities, this is just the bottom line, which matters. Please note how very high these rates are at old ages. These are deaths per 100,000, which means that over age 85, 1.8% of all African Americans have died of COVID-19 this year (and 1.7% for Hispanics and 1.2% for Whites). That is — I keep trying to find words to convey the power of these numbers — one out of every 56 African Americans over age 85.

Please stay home if you can.

A spreadsheet file with the data, calculations, and figure, is here: https://osf.io/ewrms/.

COVID-19 Baby Bust update and data

Joe Pinsker at the Atlantic has a piece out on the coming (probable) baby bust. In it he reviews existing evidence for a coming decline in births as a result of the pandemic, especially including historical comparisons and Google search data. Could we see this already?

Pinsker writes:

The baby bust isn’t expected to begin in earnest until December. And it could take a bit longer than that, Sarah Hayford, a sociologist at Ohio State University, told me, if parents-to-be didn’t adjust their plans in response to the pandemic immediately back in March, when its duration wasn’t widely apparent.

If people immediately changed their plans in February, we might see a decline in births in October, but Hayford is right that’s early. And what about September, for which I’ve already observed declining births in Florida and California? If people who were pregnant already in January had miscarriages or abortions because of the pandemic, that would result in fewer births in September, but how big could that effect be? So maybe the Florida and California data are flukes, or data errors, or lots of pregnant people left those states and gave birth elsewhere (or pregnant people who normally come didn’t arrive). Perhaps more likely is that 2020 was already going to be a down year. As I told Pinsker:

“It might actually be that we were already heading for a record drop in births this year … If that’s the case, then birth rates in 2021 are probably going to be even more shockingly low.”

Anyway, we’ll find out soon enough. And to that end I’ve started assembling a dataset of monthly births where I can find them, which so far includes Florida, California, Oregon, Arizona, North Carolina, Ohio, Hawaii, Sweden, Finland, Scotland, and the Netherlands, to varying degrees of timeliness. As of today we have October data for some of them:

As of now Florida and California remain the strongest cases for a pandemic effect. But they are also both likely to add some more births to October (in November’s report, California increased the September number by 3%).

Anyway, lots of speculation while we’re killing time. You can get the little dataset here on the Open Science Framework: https://osf.io/pvz3g/. Check the date on the .csv or .xlsx file to see what I last updated it. I’ll add more countries or states if I find out about them.

New COVID-19 and Health Disparities lecture

I recorded a new version of the lecture I created last spring: COVID-19 and Health Disparities. It defines health disparities, introduces the theory of fundamental causes, and then describes COVID-19 disparities by race/ethnicity and age with reference to education and occupational inequality. For intro sociology students.

Using data from Bureau of Labor Statistics (inspired by this piece from Justin Fox), I showed the percentage of workers working at home according to the median wage in their occupations, illustrating how people in lower-paid occupations aren’t working at home, while professionals and managers are:

And, using age- and race/ethnic-specific mortality rates from CDC, with population denominators from the 2018 ACS (I don’t know why I can’t find the denominators CDC uses), I made this:

The greatest race/ethnic disparities are in the working ages, which suggests they are driven at least partly by occupational inequality.

The lecture 23 minutes, slides with references and links are here.

Are pandemic effects on birth rates already detectable?

As birth data approaches, maybe we can get beyond analyses like Google searches for pregnancy-related terms to see what’s happening with birth rates.

At this writing we are a few days shy of 35 weeks from February 1st. If I read this right, 10% of US births occur at 36 weeks of gestation or less. But the most recent complete data I see is from August, so it’s early. However, most fertilized human eggs do not come to term, being lost either before (30%) or after (30-40%) implantation. That’s from a paper by Jenna Nobles and Amar Hamoudi, who write:

Evidence suggests that multiple mechanisms may be involved in pregnancy survival, including those that affect placental development and function, fetal oxidative stress, fetal neurological development, and likely many others. These, in turn, are shaped by more distal processes that affect maternal nutrition, maternal exposure to biological and psychosocial stress, maternal exposure to infection, and management of chronic conditions. Pregnancy survival varies with women’s body mass index, consumption of folic acid, and in some studies, reports of stressful life events (citations removed).

The pandemic might reasonably have contributed to a higher rate of pregnancy loss from these factors. And then there are abortions, which people have probably needed more even though they had less access to them (see this report from Guttmacher). So the net effect is unclear.

Setting aside how the pandemic might have affected fertility intentions and planning (I assume this is negative, as reported by Guttmacher), there might already be fewer births, from loss and abortion.

I haven’t looked at every state, but Florida and California report births by month. In Florida, there were 9.5% fewer babies born in August 2020 than in the previous year (they revise these as they go, but the August number has been stable for a little while, so probably won’t increase much). In California there were 9.6% fewer births in August of this year compared with last year. Here are the monthly trends, including the last three years (I included Florida’s September number as of today, but that will certainly rise):

This is going to be tricky because birth rates were already falling in many places. But the average decline in the last three years was 2.9% in California and 0.7% in Florida, so these numbers clearly outpace that naïve expectation. Also, what about spring? Maybe the pandemic was already causing a decline in live births in California in March (from immigrants not coming or staying in Mexico or other countries?), but if the decline in March was unrelated, then it’s not clear how to interpret the drop in August. So it will be complicated. But this is a bona fide blip in the expected direction, so I’m posting it with a question mark.

I assume other people will be way ahead of me on this, though I haven’t seen anything. Feel free to post other analyses in the comments.