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Invited Commentary
Obstetrics and Gynecology
September 15, 2021

Disrupted Family Plans and Exacerbated Inequalities Associated With COVID-19 Pandemic

Author Affiliations
  • 1Department of Sociology, University of Maryland, College Park
  • 2Maryland Population Research Center, University of Maryland, College Park
JAMA Netw Open. 2021;4(9):e2124399. doi:10.1001/jamanetworkopen.2021.24399

Kahn and colleagues1 report an apparent disruption in family plans in New York City in the first months of the city’s COVID-19 outbreak. Using an existing hospital-based cohort, they obtained survey responses over the spring and summer of 2020 from 1179 women with at least 1 young child. In this group, 252 women (21.4%) reported that they were previously thinking about becoming pregnant (191 [16.2%]) or trying to become pregnant (61 [5.2%]) before the pandemic. However, at the time of the survey, 71 women reported they had given up thinking about another child (37.2% of that group), and 30 had stopped trying to get pregnant (49.2%). Only 42 (4.5%) of those who reported that they were not planning to become pregnant before the pandemic said they now were thinking about it. In sum, there was a substantial shift away from intentions to have another child during the first months of the pandemic in New York City. Responses to other questions on the survey noted that this shift was concentrated among women in economically precarious circumstances, including those who had experienced recent job loss in their households.

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 colleagues1 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.

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Article Information

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.2021.24273Google Scholar
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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
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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/qwxz3Google Scholar
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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 PubMedGoogle ScholarCrossref
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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 PubMedGoogle Scholar
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