In parts of Asia, and especially Africa, the population is still growing rapidly – it is projected to rise from 1.4 billion today to 3.4 billion in 2100 according to UN’s latest World Population Prospects – and fertility remains high, at 4.1 births per woman (4.3 in sub-Saharan Africa).

Undernourishment has increased globally according to FAO and the State of Food Security and Nutrition. In Africa, for instance, 298 million people were undernourished in 2023, and 847 million were food insecure. Rapid population growth contributes to poverty, climate change and poor health services.

The perils of population growth

Rising global and African populations, and increasing per capita consumption in high- and middle-income countries, are major threats to food production, ecosystem functions and biodiversity (Dasgupta & Dasgupta 2024). In IPCC’s Sixth Assessment Report in 2022, the two strongest identified drivers of CO₂ emissions were economic growth (GDP per capita) and population increase. Consumption in rich countries must decrease, and countries with high birth rates need to reduce their fertility.

Contraception, family planning programs, and social norms

From about 1960, global population growth and poverty motivated many family planning (FP) programs that improved life for women and children, helping to raise contraceptive use from 10 to 60 percent and reduce fertility from about 6 to 3 births per woman (Cleland et al. 2006, World Bank 2007, TOP 2024). Recent evidence from Brazil, Ecuador, Egypt, Ethiopia and Rwanda show that these countries successfully increased family planning coverage between 1950 and 2023 (Hellwig et al. 2024). In short, excepting cases where violation of human rights occurred, such as China’s earlier one-child policy (started in 1979), India’s vasectomy campaign of 1975-76, and Peru’s sterilizations in 1996-97, such programs have a history of success.  

FP programs have played an important role in reducing fertility rates in developing countries (Figure 1), and they are still needed today, in Africa and some other regions.

In sub-Saharan Africa, contraceptive use has increased where longer education is combined with FP programs (Bongaarts & Hardee 2019, see Figure 2), two factors that are also major determinants of fertility decline (Bongaarts 2020).

Contraceptive use and family size also depend on culture, and what others are doing (Dasgupta & Dasgupta 2024). Africa seems partly trapped in unfortunate social norms of high fertility,and efforts to lower these norms are essential for reducing unsustainably high population growth. Policies should consider people’s overall situation, not only human rights, but also human responsibilities.

The UN reported that unmet female need for FP was as high as 37% in sub-Saharan Africa in 2022. A UN/UNFPA Summit in Nairobi 2019 celebrated 25 years since Cairo with a laudable goal of no unmet need for FP. Yet, review and revision of the Cairo program is needed, given the high fertility and population growth in sub-Saharan Africa and other regions.

Family planning programs can improve maternal health and reduce unintended pregnancies. FP services should promote longer female education, school teaching of safe contraceptive use, easy access to free contraceptives, and information about the need to slow population growth. Social legitimation of contraception lets individuals re-assess how many children they want. Improved status and empowerment of women as well as FP education of men are also crucial.

Smaller families improve living conditions and may also produce economic benefits at country level. According to government reports, FP programs are strongly needed in Africa. In 2015, 42 of 54 African nations reported to the UN a policy of “lower population growth”, and in 2017, 45 of these 54 nations reported the need for a “lower fertility level”, important information that was omitted in UNFPA (2023).

The role of the United Nation’s Population Fund

In a recent publication (Götmark et al. 2026) we evaluated the policy of the United Nations Population Fund (UNFPA). Since 1973, UNFPA has been mandated to promote awareness of population problems and to devise strategies to deal with them. But according to its current website, the goal since the 1994 UN population conference in Cairo has been to “ensure reproductive rights for all”. Its Executive Director regards concerns about population growth as “population alarmism” and has criticized focus on numbers (The Guardian, 18 October, 2022).

After the Cairo conference, FP programs were largely replaced by a focus on sexual and reproductive health and rights (SRHR), with reduced financial and other support for FP. With the exception of the FP2020 (now FP2030), supported by the Gates Foundation and partners, concerns about population growth waned. The Cairo program of action emphasized the rights of people “to be informed and to have access to safe, effective, affordable and acceptable methods of family planning”, and the need for countries to “contribute to the stabilization of the world population”. Yet, 10 years after Cairo, the global population had increased by almost one billion.

Current concerns about low fertility overshadow the worrying prospect of a 2 billion population increase by the end of this century, mainly in sub-Saharan Africa. Despite much scientific evidence (e.g., Cleland et al. 2006, World Bank 2007, Hellwig et al. 2024), UNFPA underrates the negative human effects of continued rapid population growth and the need for FP programs. In its State of the World Report (UNFPA 2023) it says that “population sizes are neither good nor bad”, which is of little help to policymakers. According to Bajaj et al. (2024), UNFPA’s “extreme reluctance to address the population factor has resulted in messaging that excludes the impact of demographic realities on women, girls, ecosystems and vulnerable human communities”. Such policy contrasts with insightful evaluation of population growth and FP by the UN in World Population Prospects 2024 (see, e.g. Summary in ch. IV).

According to its website, UNFPA is the world’s largest public-sector procurer of contraceptives. With insightful UNFPA leadership, SRHR and improved contraceptive use should be an integral part of complete FP programs where the positive humanitarian roles of fertility decline and population stabilization in Africa and elsewhere are emphasized. Strong commitment by political leaders is essential, and outreach and communication through the media can improve FP programs. Policies should also highlight the environmental benefits: saving more forests, savannahs, freshwater habitats and the Earth’s last populations of mega-fauna, which still remain viable in some African and other countries.

For many years, the United States were a major supporter of family planning. Unfortunately, many health programs supported by USAID were ended by President Trump in 2025, and their closure has also reduced FP services. African commentators point to opportunities for countries to reconsider aid programs, increase self-reliance, and reduce dependency on uncertain foreign donors. But international aid has, for instance, helped lower adolescent fertility rates in low-income countries, and it is still much needed. 

Conclusions

Voluntary family planning programs help increase contraceptive use, slow population growth, promote economic development and improve the lives of children, women and men, thereby facilitating several of the UN’s Sustainable Development Goals. The leadership of UNFPA should therefore emphasize and support FP programs and return to its historic mandate of improving human welfare through slower population growth. This is especially important for countries in Africa and elsewhere that are seeking to invest in such programs.

References

Bajaj, N., Crist, E. & Stade, K. (2024). Confronting the United Nations pro-growth agenda: A call to reverse overshoot. The Journal of Population and Sustainability 8, 15-44.

Bongaarts, J. (2020). Trends in fertility and fertility preferences in sub-Saharan Africa: the roles of education and family planning programs. Genus 76, 32.

Bongaarts, J. & Hardee, K. (2019). Trends in Contraceptive Prevalence in Sub-Saharan Africa: The Roles of Family Planning Programs and Education. African Journal of Reproductive Health 23, 96-105.

Cleland, J., Bernstein, S., Ezeh, A. et al (2006). Family planning: the unfinished agenda. Lancet, 368, 1810-27.

Dasgupta, A. & Dasgupta, P. (2024). Human population and the biosphere. Population and Development Review 51, 41-61.

Götmark F, AjaeroC, IslamMM, MundiR, Ugwu NH & Andersson M (2026). Downplaying reality: Is the UN Population Fund forgetting population growth and family planning? Reproductive Health, 23, 77.

Hellwig F, Moreira LR, Silviera, MF, et al. (2024) Impacts of policies for expanding family planning coverage: lessons from five successful countries. Front. Public Health 12, 1339725.

The World Bank (2007). The Global Family Planning Revolution (pdf). Robinson WC, Ross JA., Eds. Washington D.C.

TOP, The Overpopulation Project (2024). Responsible parenthood, family planning, and the United Nations. An interview with Carl Wahren – pioneer of family planning (video). Film, 2024.

UNFPA, State of the World Report 2023.

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Brothers and sisters teach us to share secrets, negotiate for the last slice of cake and slam doors. Such childhood tussles may do more than shape our childhood lives. Until recently, scholars had mostly considered sibship size for educational attainment, showing how each extra child dilutes parental time and resources (Blake 1985). Extending to a life course perspective, in a recent study (Li 2026), using historical Census records of Americans born in the 1920s and 1930s, I find evidence that the number, spacing, and sex of our childhood companions leave a lasting imprint on our health as we age.

Siblings and the long shadow of childhood

Two competing ideas attempt to explain why siblings might matter. Resource dilution theory argues that each additional child reduces the money, time, and emotional support that parents can devote to each offspring (Downey 1995). Confluence theory counters that older siblings may act as tutors and role models, enriching the developmental environment for younger brothers and sisters (Zajonc 1976). Gender also matters: sisters are often more emotionally supportive but may shoulder heavier caregiving responsibilities later in life (Grigoryeva 2017).

In a recent study (Li 2026), using data from the American health and Retirement study (HRS), I compared adults aged 51 and over who had grown up as only children with those who shared their childhood homes with one to several siblings, with attention to how close in age siblings were and whether they were boys or girls. Adults from very large families were more likely to come from disadvantaged socioeconomic backgrounds. To minimize such selection effects, I adjusted for an extensive range of time-invariant demographic, socioeconomic, and contextual characteristics in childhood alongside time-varying health conditions in later life.  The main result is that, everything else (more or less) equal, adults growing up with more siblings had markedly faster cognitive decline in later life.

Big families and cognitive aging

Americans who shared their childhood homes with siblings do not simply remember more squabbles; they also lose cognitive sharpness more quickly than those who grew up alone. Even having one or two siblings speeds up cognitive decline by roughly one-fifth relative to only children (Figure 1). Among people who grew up with three or four siblings, decline was around 30% faster.. The descent into cognitive frailty is even more pronounced for those with five or more siblings: by their mid-80s, adults from such large families had lost about a third more cognitive capacity than their peers who grew up alone.

Large sibships often go hand in hand with fewer resources per child (Downey 1995). People from big families completed about half a year less schooling than only children, even after adjusting for an extensive range of family and contextual socioeconomic characteristics. Each additional year of education raises baseline cognitive function and slows decline a little, but it does not fully make up for the long-term effects of resource dilution. This suggests that the real damage is done in childhood, when a parent’s time and attention must be divided among many mouths and minds.

Policy should focus on levelling the playing field rather than discouraging big families. Programs that provide scholarships, tutoring, and childcare subsidies can help children from large sibships secure the education and stimulation that only children take for granted. Evidence from other studies suggests that investing in the eldest child’s schooling benefits younger siblings too. Such targeted support need not dictate family size, but it can ensure that families with many children do not face a cognitive penalty that manifests decades later (Zang, Tan, and Cook 2023).

Spacing and gender: hidden traps in sibships

Numbers are not the only factor; configurations matter too. When brothers and sisters are born within two years of each other, the competition for parental attention intensifies. Adults from such closely spaced sibships experienced almost as rapid cognitive declines as those from large families. It seems that having several children at once, rather than across a wider span, strains a household’s capacity to nurture each child’s brain.

Women generally experience higher cognitive functioning at baseline than men (Levine 2021). Yet the gender composition of the siblings matters for men and women. Men who grew up with only brothers entered adulthood with the lowest cognitive scores (brother-brother siblings, red line), whereas women raised with only sisters (sister-sister siblings, purple line) fared best (Figure 2). Over time, however, compared to women with only sisters (sister-sister siblings, purple line), women with at least one brother (sister-brother siblings, blue line) descended slightly faster into cognitive decline. Without sisters, earlier studies show that the daughters often shoulder more care for aging parents, leaving less time for paid work and cognitive stimulation, while sons reap the benefits of their sisters’ support (Grigoryeva 2017). Such asymmetric caregiving burdens may explain why women with brothers pay a steeper cognitive price.

Policies that help parents to space births and that relieve daughters of disproportionate caregiving responsibilities could mitigate these hidden traps. Access to family planning allows couples to space births and reduce intense competition for attention. More generous parental leave and elder-care services, along with incentives for men to share care work, would support daughters’ cognitive health and, by extension, that of their brothers. Encouraging equitable sharing of family responsibilities may be just as important for cognitive aging as encouraging further years of schooling.

References

Blake, Judith. 1985. “Number of Siblings and Educational Mobility.” American Sociological Review 50(1):84–94. doi:10.2307/2095342.

Downey, Douglas B. 1995. “When Bigger Is Not Better: Family Size, Parental Resources, and Children’s Educational Performance.” American Sociological Review 60(5):746–61. doi:10.2307/2096320.

Grigoryeva, Angelina. 2017. “Own Gender, Sibling’s Gender, Parent’s Gender: The Division of Elderly Parent Care among Adult Children.” American Sociological Review 82(1):116–46. doi:10.1177/0003122416686521.

Levine, Deborah A., Alden L. Gross, Emily M. Briceño, Nicholas Tilton, Bruno J. Giordani, Jeremy B. Sussman, Rodney A. Hayward, James F. Burke, Stephanie Hingtgen, Mitchell S. V. Elkind, Jennifer J. Manly, Rebecca F. Gottesman, Darrell J. Gaskin, Stephen Sidney, Ralph L. Sacco, Sarah E. Tom, Clinton B. Wright, Kristine Yaffe, and Andrzej T. Galecki. 2021. “Sex Differences in Cognitive Decline among US Adults.” JAMA Network Open 4(2):e210169. doi:10.1001/jamanetworkopen.2021.0169.

Li, Yiang. 2026. “Brothers, Sisters, and the Legacy of Sibship: Childhood Coresiding Siblings and Late-Life Cognitive Decline in the United States.” Demographic Research 54(8):215–60. doi:10.4054/DemRes.2026.54.8.

Zajonc, R. B. 1976. “Family Configuration and Intelligence: Variations in Scholastic Aptitude Scores Parallel Trends in Family Size and the Spacing of Children.” Science 192(4236):227–36. doi:10.1126/science.192.4236.227.

Zang, Emma, Poh Lin Tan, and Philip J. Cook. 2023. “Sibling Spillovers: Having an Academically Successful Older Sibling May Be More Important for Children in Disadvantaged Families.” American Journal of Sociology 128(5):1529–71. doi:10.1086/724723

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Observed gains in life expectancy have sparked debates about the life quality of these additional years. Healthy life expectancy (HLE) measures have contributed to this debate by focusing on the average years that individuals are expected to live in good health, without chronic conditions or limitations. However, to obtain HLE, researchers usually focus on a unique measure of health, leaving aside the complex relationship between unhealthy states – such as living with chronic conditions – and disability or limitations. By observing more than one measure of health, research can be more informative on healthcare and social care needs. 

In a recent paper (Calderón-Jaramillo et al. 2026), we introduced a more comprehensive indicator for estimating the years of life that individuals are expected to live with care needs by combining healthcare needs, measured through multimorbidity, with social care needs, operationalised as limitations in performing basic and instrumental activities of daily living (ADL and IADL, respectively). The comparative use of this measure in different Ibero-American countries provides insights into how specific ageing processes shape care needs after age 60 at country-level. 

A comprehensive perspective of healthcare and social care needs

Research on healthy life expectancy has creatively expanded the notions of good and bad health by incorporating different measures such as multimorbidity, self-rated health, disability and limitations (Saito et al. 2014). These indicators are usually based on certain physical or mental health functions (Beltrán-Sánchez et al., 2015), and are used to understand future healthcare demand by measuring the consequences of longevity on the time spent in healthy and unhealthy states at population level. However, they rarely consider interactions between different ways of measuring health problems and the implications for individual autonomy. Some studies have therefore proposed broader approaches to estimate healthy life expectancy, accounting simultaneously for chronic conditions and limitations in performing ADL (Lam et al., 2023; Shen & Payne, 2023). Along these lines, we propose an additional layer by using the experience of multiple chronic conditions, as well as limitations in ADL and IADL, as proxies of healthcare and social care needs. The synthetic indicator that we derive measures years of life expectancy with care needs, or YLCN.

There are two main benefits of combining measures of healthcare and social care needs when estimating YLCN. First, we can determine how increasing life expectancy is accompanied, or not, by the presence of chronic conditions and their potential repercussions on individual needs. Second, we can understand how social care needs may vary due to the prevalence of specific chronic conditions and their relationship with diverse epidemiological trends, including the different ways in which healthcare systems approach symptoms and outcomes. 

Differences in care needs across Ibero-American countries

Cross-country differences in HLE have usually been explained in terms of the demographic and epidemiological transition, with declining mortality across specific age groups attributed to a shift in causes of death from infectious to non-communicable and chronic diseases. This is a good theoretical model, but in practice, not all populations experienced these transitions in the same way or at the same pace. While European countries seem to generally align with this process, Latin American countries have faced a heterogeneous scenario (Alvarez et al., 2020; Calazans & Queiroz, 2020), with overlapping phases in many cases due to the persistence of infectious disease risks. This has implications for healthcare needs, as chronic conditions might be experienced alongside other acute conditions, and it also has consequences for individual dependency and disability associated with social care needs. 

The analysis of Brazil, Colombia, Mexico, Portugal and Spain provided some insights into these differences. Using 2015 data from surveys on ageing populations (respectively ELSI, SABE, MHAS and SHARE) and mortality registers from the Human Mortality Database, we estimated the years of life expectancy with care needs for men and women after age 60. 

Life expectancy at age 60 is higher in Europe than in Latin America, with women outliving men, as expected (Figure 1). However, women’s health is worse: they frequently have more than two chronic conditions (with healthcare needs) and spend more years with social care needs.

In general, longer life expectancy also means that individuals are expected to live, on average, more years with care needs. However, the composition of these years with care needs varies by countries (see Table 1). Individuals from Brazil and Colombia spend more years with multimorbidity but without chronic conditions. Meanwhile, Mexicans, Spaniards and Portuguese spend more years with one chronic condition without care needs. This emphasises that healthcare needs and (multi)morbidity are not necessarily related to increasing social care needs.

Between healthcare and social care: the challenges ahead

Individuals from Portugal and Spain, especially women, are expected to live longer with healthcare and social care needs. This reflects their longer life expectancy, but also the fact that men in the Latin American countries under scrutiny tend to have shorter lives, probably due to the impact of amenable causes.

Comparing countries that have experienced demographic and epidemiological transitions in heterogeneous ways helps to highlight the differing consequences of population ageing in different contexts. Moreover, by studying the relationship between healthcare and social care needs, debates on healthy life expectancies can be expanded to consider how the experience of (multi)morbidity and other unhealthy states affects individuals’ lives. 

References

Alvarez, J.-A., Aburto, J. M., & Canudas-Romo, V. (2020). Latin American convergence and divergence towards the mortality profiles of developed countries. Population Studies, 74(1), 75–92. https://doi.org/10.1080/00324728.2019.1614651

Beltrán-Sánchez, H., Soneji, S., & Crimmins, E. (2015). Past, Present, and Future of Healthy Life Expectancy. Cold Spring Harb Perspect Med., 11.

Calazans, J. A., & Queiroz, B. L. (2020). The adult mortality profile by cause of death in 10 Latin American countries (2000–2016). In Revista Panamericana de Salud Publica/Pan American Journal of Public Health (Vol. 44). Pan American Health Organization. https://doi.org/10.26633/RPSP.2020.1

Calderón-Jaramillo, M., Spijker, J., Rentería, E., & Correia Alves, L. (2026). Between curing and caring: years of life expectancy with care needs (YLCN) in Ibero-American countries. Genus, 82(1), 1. https://doi.org/10.1186/s41118-025-00279-8

Lam, A., Keenan, K., Cezard, G., Kulu, H., & Myrskylä, M. (2023). Inequalities in disability-free and disabling multimorbid life expectancy in Costa Rica, Mexico, and the United States. https://doi.org/10.4054/MPIDR-WP-2023-002

Saito, Y., Robine, J.-M., & Crimmins, E. M. (2014). The methods and materials of health expectancy. Statistical Journal of the IAOS, 30, 209–223. https://doi.org/10.3233/SJI-140840

Shen, T., & Payne, C. F. (2023). Disability and morbidity among US birth cohorts, 1998–2018: A multidimensional test of dynamic equilibrium theory. SSM – Population Health, 24, 101528. https://doi.org/10.1016/j.ssmph.2023.101528

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Over the past several decades, the United States has witnessed an extraordinary widening of policy divides across its states (Grumbach, 2019). And because where you live is increasingly tied to how you live, as state policy contexts within the country pull father apart, so too do the patterns of American longevity (Montez et al, 2020). While the former geographic divides of the 20th century, especially those separating Black and White life chances, have not disappeared, they have begun to reorganize themselves along a new axis, that of states’ policy orientations.

Mapping 60 years of policy polarization

In a recent study (Luck, 2025) I show how polarized state policy regimes translate into longevity inequalities. By pairing 60 years of historical policy orientation data with three decades of vital statistics records, my research tracks longevity among non-Hispanic Black and White men and women across clusters of states that share similar long-term trajectories of policy liberalism. 

Figure 1 illustrates this changing policy landscape within the United States. Policy liberalism increases progressively from Group 6, representing the most conservative policy environments, to Group 1, the most liberal, but over the 60 years of study, these divides widen considerably. The spatial pattern of these shifts is also recognizable: the most conservative-shifting clusters lie mostly in the South, the most liberal in the West and Northeast, and more moderate contexts across parts of the Midwest. Importantly, because Black and White populations are unevenly distributed across these regions, they are also unevenly distributed across policy regimes, a key demographic underpinning of today’s policy-linked health divides.

Varied growth in the liberal longevity advantage

Figure 2 shows how Black and White life expectancy has changed between 1990 and 2019 across these state policy clusters. Across all race-sex groups, more liberal states achieved far larger gains in life expectancy between 1990 and 2019 than their conservative counterparts. In the most liberal states, life expectancy rose by 3.4 years for White women and an extraordinary 10.7 years for Black men. Meanwhile, the most conservative states registered modest improvements at best, and for White women, there was essentially no progress at all.

Yet the most striking finding is not just the widening gap, but the reordering of long-standing racial patterns when looking across policy environments. By 2019, Black residents in liberal states had life expectancies equal to or exceeding those of White residents in certain conservative states. Black women in these liberal states outlived White women in the most conservative states by more than a year, a dramatic break from patterns that defined the late twentieth century.

Among White men and women, the relationship between policy and longevity resembles a smooth gradient: each step toward more liberal policy regimes corresponds with higher life expectancy. But for Black populations, patterns are more complex. Life expectancy advantage for Black men, in particular, is concentrated in the most liberal policy cluster. Notably, the lowest life expectancies for Black residents are not in the most conservative Southern states but in certain more moderate policy Midwestern groups, states identified to have particularly troubling trends for Black mortality in recent decades (Elo et al, 2025). 

What’s driving the divides?

My study also takes a deeper look at which age groups and causes of death contributed to the growing divide (Figure 3). For Black men, the liberal advantage is rooted in improvements below age 50. Declines in HIV/AIDS and homicide mortality were especially powerful, adding about 2.5 extra years of life expectancy in liberal compared with conservative states. Black women also saw meaningful gains at younger ages, though less pronounced. For White residents, the story shifts to midlife and older adulthood. Improvements between ages 50 and 74, driven by reductions in circulatory disease, cancer, and respiratory illness, account for most of the growing liberal advantage among both White men and women. Among women of both races, gains at ages 75+ and reductions in deaths linked to mental and nervous system disorders, including dementias, also played a meaningful role.

One countervailing pattern cuts across every population group: drug-related deaths narrowed the liberal advantage. Across every race-sex group, drug mortality contributed negatively to the growth of the liberal advantage, meaning the gaps would have been even larger were it not for the opioid epidemic.

Looking forward

Taken together, these findings highlight a profound shift in the U.S. population health landscape. State policy environments have become a powerful upstream determinant of mortality and crucially, not all populations are affected equally (Luck, 2025a; Luck, 2025b). Findings show that the greatest gains in liberal states accrue to Black populations, who have historically faced the steepest mortality risks, but also reveal a troubling stagnation of White life expectancy, particularly among women, in conservative states.

These divides are unlikely to narrow. As states continue to drift apart along partisan and policy lines, the health consequences of these divergent contexts will grow even sharper, especially if conservative states continue to lag in areas such as chronic disease prevention, social welfare provision, health care access, and violence and injury prevention.

In a polarized era, the ideological path of a state’s policy context is increasingly intertwined with the length and quality of the lives of its residents, reshaping both the racial and geographic contours of longevity in America.

References 

Elo, I.T., Luck, A.N., & Tuder, S. (2025). Pre‐COVID‐19 Geographic Inequalities in Non‐Hispanic Black US Life Expectancy, 1990–2019. Population and Development Review, 51(3), 1075-1113.

Grumbach, J.M. (2018). From Backwaters to Major Policymakers: Policy Polarization in the States, 1970–2014. Perspectives on Politics, 16(2), 416–435. https://doi.org/10.1017/S153759271700425X

Luck, A.N. (2025a) Variation in Black and White Life Expectancy Across State Policy Groups, 1990–2019: A Research Note. Demography , 62(5):1483–1496. https://doi.org/10.1215/00703370-12260835

Luck, A.N. (2025b) The political landscape of death: state policy polarization and mortality among Black and White Americans, Social Forces, 2025; soaf177, https://doi.org/10.1093/sf/soaf177

Montez, J.K., Beckfield, J., Cooney, J.K., Grumbach, J.M., Hayward, M.D., Koytak, H.Z., Woolf, S.H., & Zajacova, A. (2020). US State Policies, Politics, and Life Expectancy. The Milbank Quarterly, 98(3), 668–699. https://doi.org/10.1111/1468-0009.12469

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America is struggling with continuing its birthright citizenship, which was established by the 14th Amendment to the US Constitution in 1868. Section 1 of the 14th Amendment declares: “All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside”. 

The struggle

Shortly after taking office on 20 January, President Trump issued an executive order restricting birthright citizenship, insisting that the 14th Amendment does not apply to the births of unauthorized migrants. Many have raised objections, pointing out that America has upheld birthright citizenship for more than 150 years and as US laws apply to unauthorized migrants, so the Constitution’s 14th Amendment should apply to them too.

The American Civil Liberties Union and several states have filed federal legal challenges to Trump’s executive order restricting birthright citizenship. The American Bar Association described it as an attack on a “constitutionally protected” right. Also, no less than four federal judges and a growing number of courts have blocked the order. How the US Supreme Court, where conservative justices form a supermajority, would interpret the 14th Amendment is not clear. The litigation over Trump’s executive order is likely to focus on what it means for someone to be “subject to the jurisdiction” of the United States.

Shortly after becoming president on January 20, Trump falsely claimed that “We are the only country in the world that does this with the birthright, as you know, and it’s just absolutely ridiculous.” Actually, at least 33 countries provide automatic citizenship to anyone born within their borders. Those countries, located mostly in the Western hemisphere, include America’s neighboring countries of Canada and Mexico.

Foreign-born population

The number and proportion of foreign-born residents in America have varied considerably over the past several centuries (Table 1). In 1890, for example, they totaled nearly ten million and their proportion reached a high of 14.8%. Following World War II, their number declined to below 10 million and their proportion fell to a record low of 4.7% in 1970. The early 21st century saw a marked increase and their number rose to 31 million (11% of the total population). In 2024, the estimated 51.6 million foreign-born residents accounted for a record-breaking 15.6% of America’s population.

Births to foreign-born mothers

Over the period 2014-2024, the average number of births to foreign-born mothers in the US was 850,000, varying from a high of 910,000 in 2016 to a low of 780,000 in 2021. Their share of total births remained relatively stable at approximately 23% (Table 2) – greater than the proportion of foreign-born population in the same period (about 14%).

The exact number of births to unauthorized foreign-born mothers is unknown. However, with a few reasonable assumptions (detailed in the footnotes to Table 2), an annual average total of around 213,000 can be estimated over the period, possibly ranging between 180,000 births in 2021 and a high of 245,000 in 2016.  

Those annual estimates also provide an indication of the distribution of births among native-born and foreign-born mothers. Over the past 11-year period, approximately 77% of the births in America were to native-born women and 23% were to foreign-born mothers, 17% to authorized foreign-born mothers and 6% to unauthorized foreign-born mothers (Figure 1).

Conclusions

As a result of President Trump’s recent executive order, birthright citizenship has developed into a major political and legal struggle for America. The outcome of that struggle is now playing out in US courts. While the legal outcome is currently uncertain, its major demographic consequence is already clear. 

If birthright citizenship is restricted, as President Trump has ordered, up to 225,000 children born to unauthorized foreign-born mothers each year – around 6% of America’s annual births – will not be granted US citizenship. 

References

American Civil Liberties Union (2025) “Immigrants’ Rights Advocates Sue Trump Administration Over Birthright Citizenship Executive Order”. January 20, ACLU, Washington, D.C.

Baker, Bryan and Robert Warren (2024) “Estimates of the Unauthorized Immigrant Population Residing in the United States: January 2018-January 2022”. April, US Office of Homeland Statistics, Washington, D.C. 

Bay, William (2025) “The ABA supports the rule of law”. February 10, American Bar Association (ABA), Chicago, Illinois.

Camarota, Steven and Karen Zeigler  (2021) “Fertility Among Immigrants and Native-Born Americans”. February 16, Center for Immigration Studies, Washington, D.C.

Hussein, Mohamed A. (2025) “Which countries, other than the US, offer birthright citizenship”. February 6, Aljazeera, Doha, Qatar.

Jeyaretnam, Miranda (2025) “How Does Birthright Citizenship in the U.S. Compare to the Rest of the World?”. January 23, Time, Washington, D.C.

Moslimani, Mohamad and Jeffery S, Passel (2024) “What the data says about immigrants in the U.S.” September 24, Pew Research Center, Washington, D.C.

Neufeld, Dorothy (2024) “Charted: The Foreign-Born Share of the U.S. Population: (1850-2024)”. October 30, Visual Capitalist, Vancouver, Canada.

Putterman, Samantha (2025) “Donald Trump’s False claim that the US is the ‘only’ country with birthright citizenship”. January 21, PolitiFact, The Poynter Institute, Washington, D.C.

Richwine, Jasion and Steven Camarota (2025) “Births to Illegal Immigrants and Long-Term Temporary Visitors”. February 14, Center for Immigration Studies, Washington, D.C.

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Who counts as white in the U.S.? This has been a demographic puzzle since the 1790 Naturalization Act, when U.S. citizenship was first legally determined to be available only to “free white persons”. Over time, immigrants from different world regions began to comprise the white population, creating the numerical majority and widely-used reference category for measuring racial inequality. But what are the implications of diversity within the white category for social scientific research? In a recent study (Read & Fairfax 2025), we leveraged nationally representative data to disaggregate white adults by their global region of birth and found considerable health variation that is hidden by the broad, white category. 

Changes in the white immigrant population, 1960s to present

Up until the 1960s, the ethnic origins of white immigrants – and thus their 2nd and 3rd generation offspring – were almost exclusively from western and northern Europe. Several changes in immigration policy since then have increased the number of white immigrants arriving from eastern Europe and the Middle East/North Africa, complicating who is classified as white. We explored immigration patterns over the past several decades to show the growing ethnic diversity of white immigrants to the U.S. and the differences in health outcomes for groups categorized as white.

In our deep dive into immigration trends, we analyzed data from the 1986-2022 Yearbook of Immigration Statistics alongside the 1960-2023 decennial census and the American Community Survey (ACS). Our findings reveal a shift in the demographics of white immigrants over the decades (Figure 1). In 1960, northern and western Europeans dominated the scene, constituting over half of the white immigrant population. In stark contrast, eastern Europeans and Middle Easterners together made up less than a third. Fast forward to 2023, and the landscape has changed considerably: eastern Europeans now account for about a third of white immigrants, surpassing their northern and western counterparts, while those from the Middle East have grown to represent a quarter of the white immigrant population.

The shifting global origins of white immigrants reflect pivotal events and conflicts over the past several decades, from the Fall of the Soviet Union to the 9/11 terrorist attacks, the Arab Spring, and Russia’s invasion of Ukraine. These events have reshaped migration patterns, leading to growth in the number of white immigrants arriving as refugees and through family reunification, often with diverse socio-demographic backgrounds. The evolving profile of white immigrants has far-reaching implications for their lives in the U.S., particularly in terms of their health and well-being. 

Health of white immigrants

Immigrants to the U.S. often appear healthier than U.S-born peers in the same racial group, a phenomenon known as the “healthy immigrant effect” (Ro et al. 2016). While this has been explored granularly for many racial groups, less attention has been paid to the health of white immigrants – a group that makes up one in six of the U.S. foreign-born population (Vespa et al. 2020). We address this gap using nationally representative data from the National Health Interview Survey (NHIS) from 2000-2018. Using logistic regression modeling, we show differences in self-rated health and hypertension (high blood pressure) between U.S.-born whites and foreign-born whites. We further disaggregate foreign-born whites by region of birth – Europe, Former Soviet Union, and the Middle East. This allows us to paint a more detailed picture of their health outcomes and compare these groups against each other to understand their relative health statuses.

We find that white immigrants from Europe and the Middle East have health outcomes that are on par with, or better than, those of U.S.-born whites. In contrast, white immigrants from the Former Soviet Union report significantly poorer health (Figure 2). A similar pattern exists when we focus exclusively on white immigrant groups: European and Middle Eastern immigrants exhibit similar health profiles, whereas those from the Former Soviet Union are in poorer health. Importantly, these disparities persist after controlling for differences in healthcare access, education, income, and citizenship status – factors typically used to explain health variation between groups (fully adjusted model in Figure 2).

Implications for racial inequality

Our findings of within-group heterogeneity resonate with earlier work on diversity among U.S. whites (Read et. al 2020; Read 2024). While this body of work is small compared to the literature on Black, Asian, and Hispanic populations, it is similar in its critique of using broad, pre-defined U.S. Census categories to identify inequality. Previous research and advocacy to re-classify those from the Middle East and North Africa to reflect their different lived experience in the U.S. highlight the importance of disaggregating these preexisting racial categories (Abboud et al. 2019). In our study, we uncovered particularly poor health outcomes for immigrants from the former Soviet Union. This insight holds profound implications for healthcare professionals as they adapt to treat an increasing number of immigrants from these regions, driven by ongoing conflicts in Ukraine and Russia.

Beyond missing within-group disparities, the aggregate white category may also produce biased or misleading estimates of racial inequality between whites and other populations, especially when comparing trends over time. Trends assume relative stability in the composition of populations, which, as we have shown, is not the case for whites.

Moving forward, we must pay more attention to the composition of the white category. While there has been considerable discussion and debate about the size of the white population, the question of who is in that category is equally important, especially if we continue to use it as a measuring stick to gauge racial gaps in health, wealth, and other social mobility outcomes. 

References

Abboud, S., Chebli, P., & Rabelais, E. (2019). The contested Whiteness of Arab identity in the United States: Implications for health disparities research. American Journal of Public Health, 109, 1580–1583. Budiman, A., Tamir, C., Mora, L., & Noe-Bustamante, L. (2020). Facts on U.S. immigrants, 2018: Statistical portrait of the foreign-born population in the United States. Pew Research Center. https://www.pewresearch.org/race-and-ethnicity/2020/08/20/facts-on-u-s-immigrants-current-data/

Read, J. G. (2024). Does an immigrant health advantage exist among U.S. Whites? Evidence from a nationally-representative examination of mental and physical well-being. Journal of Immigrant and Minority Health, 26, 878–886.

Read, J.G., and F. Fairfax. (2025). Hidden Heterogeneity: How the White Racial Category Masks Interethnic Health Inequality. Demography, DOI 10.1215/00703370-11790429.

Read, J. G., Lynch, S. M., & West, J. S. (2021). Disaggregating heterogeneity among non-Hispanic Whites: Evidence and implications for U.S. racial/ethnic health disparities. Population Research and Policy Review, 40, 9–31.

Ro, A., Fleischer, N. L., & Blebu, B. (2016). An examination of health selection among U.S. immigrants using multi-national data. Social Science & Medicine, 158, 114–121.

Vespa, J., Medina, L., & Armstrong, D. M. (2020). Demographic turning points for the United States: Population projections for 2020 to 2060 (Current Population Reports, No. P25-1144). Washington, DC: U.S. Census Bureau.

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The context: COVID-19 in Latin America 

Latin America was one of the world regions most affected by the COVID-19 pandemic, accounting for 8.5% of the global population but 27% of all COVID-19 deaths by mid-2022 (Larrain et al. 2023). With a dramatic increase in the number of deaths, especially in Brazil, the region was declared the epicenter of the pandemic in May 2020 by the World Health Organization. The rapid spread of the virus throughout the region resulted in some of the highest levels of excess mortality worldwide in the year 2020. For example, in Peru, Ecuador, and Mexico, the numbers of observed deaths were 153%, 80% and 61% above the expected levels for the year 2020, respectively (Karlinsky and Kobak 2021). This metric, known as P-score, measures the relative change in total mortality by comparing the observed number of deaths against the expected number under “normal” conditions. Lima et al. (2021) estimate that in 2020, 10.9 years of life were lost to the pandemic in Peru, 7.9 years in Ecuador and 5.5 years in Mexico, despite a younger (but rapidly ageing) population age structure than in most other world regions. Social inequalities have been pointed up as important determinants of the severe impact of the COVID-19 pandemic in Latin America (Cid and Marinho 2022). 

While the death toll increased massively in most Latin American countries during 2020, the first year of the pandemic, it declined instead in Uruguay, as well as in a handful of other countries around the world (Australia, New Zealand and Norway; Karlinsky and Kobak 2021). Yet, mandatory lockdown was not decreed in Uruguay; instead, the authorities called upon citizens to adhere to social distancing, which they called “responsible freedom”. In addition, several non-pharmaceutical measures were implemented by the government, guided by a group of scientific experts.

Mortality changes in Uruguay in 2020-2022

In a recently published study (Torres et al. 2024), we showed that, in comparison with the year 2019, life expectancy increased in Uruguay in 2020, for both sexes, by almost 10 months. The relatively few COVID-19 fatalities of that year, concentrated mainly in the month of December (Figure 1), were not enough to offset the general survival improvements of the country, mainly driven by mortality reductions among people of ages 65+, possibly benefiting from the battery of preventive measures implemented in the first year of the pandemic. 

Conversely, 2021 and 2022 showed large peaks in the estimated number of excess deaths as well as COVID-19 deaths. The annual P-scores for those years rose to almost 19% and 13% respectively. These figures, although much less dramatic than those of countries like Peru, Ecuador and Mexico in 2020, as mentioned above, were unprecedented in Uruguay. With respect to the year 2019, Uruguayan life expectancy declined by about 2 years in 2021, dropping from 81.14 to 79.21 years for females and from 73.43 to 71.37 years for males. The 2022 losses were smaller but still substantial, especially for females (–1.34 years compared to 2019, vs. –0.66 years for males). 

The worst months were April and May of 2021 (autumn in the southern hemisphere), when most excess deaths can be attributed to COVID-19. The following, milder mortality peak is observed in January and February of 2022 (summer), which contrasts with the experience of other countries where COVID-19 mortality was lowest in summer and highest in winter (Torres et al. 2023). This result could be related to the relaxation of mobility restrictions in Uruguay during the summer holidays. A third, smaller peak is observed in June 2022 (winter), when most excess deaths were related to causes other than COVID-19. 

In comparison with other selected countries, Uruguay’s monthly excess mortality profile during the first pandemic year more closely resembles the paths followed by countries like Australia and New Zealand, which also had a deficit of deaths in 2020 (Karlinski and Kobak 2021). However, 2021 tells a different story, with a pattern more similar to that of its neighbors, Argentina and Brazil. 

Why the shift from a deficit to an excess of deaths in Uruguay?

The success of Uruguay during the first pandemic year has been attributed, in part, to the joint efforts of the scientific community and the authorities. The latter were receptive and rapidly implemented the recommendations of the former, especially in 2020 (Taylor 2021). Furthermore, the testing, tracing and isolating strategy was particularly effective in 2020, when most people took social distancing and other official recommendations very seriously, even though lockdown was never mandatory in the country. 

Starting in May 2021, however, due in part to the increase in vaccination coverage and in part to the general fatigue with the restrictions that was beginning to surface in society, the battery of preventive measures was progressively relaxed. Too early, maybe, considering that the new “Gamma variant” – which originated in Brazil – was in circulation in the first months of that year. Furthermore, the “pool” of vulnerable people may have been larger than usual in 2021, thanks to the lives saved in 2020, mainly among people of advanced age.

References

Karlinsky, A., Kobak, D. (2021). Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset. elife, 10, e69336.

Cid C., Marinho M.L. (2022). Dos años de pandemia de COVID-19 en América Latina y el Caribe: reflexiones para avanzar hacia sistemas de salud y de protección social universales, integrales, sostenibles y resilientes. Documentos de Proyectos (LC/TS.2022/63), Santiago, Comisión Económica para América Latina y el Caribe (CEPAL).

Larrain, N., Di Paolantonio, G., Raitzik Zonenschein, T., Naik, R., Guanais, F. (2023), “The impact of the COVID-19 pandemic on Latin American and Caribbean healthcare systems”, in Health at a Glance: Latin America and the Caribbean 2023, OECD Publishing, Paris, https://doi.org/10.1787/1dd81269-en.

Lima, E. E., Vilela, E. A., Peralta, A., Rocha, M., Queiroz, B. L., Gonzaga, M. R., Piscoya-Díaz, M., Martinez-Folgar, K., García-Guerrero, V., Freire, F. H. (2021). Investigating regional excess mortality during 2020 COVID-19 pandemic in selected Latin American countries. Genus, 77(30).

Taylor L. Why Uruguay lost control of COVID. Nature 2021; 595(7865): 21.

Torres, C., García, J., Meslé, F., Barbieri, M., Bonnet, F., Camarda, C. G., … & Robine, J. M. (2023). Identifying age-and sex-specific COVID-19 mortality trends over time in six countries. International Journal of Infectious Diseases, 128, 32-40.

Torres, C., Prieto Rosas, V., De Armas, G., Paredes, M. (2024). The impact of the COVID-19 pandemic on mortality in Uruguay from 2020 to 2022. Demographic Research, 51, 911-926.

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Family life is changing rapidly around the world, and Colombia is no exception. Over the past few decades, marriage has become less common, with more mothers raising their children within cohabiting relationships (living with a partner and not married) or on their own. This shift reflects deeper social transformations and has sparked interest in understanding how different family forms influence the lives of mothers and their children.

Unmarried mothers often face greater social and economic challenges than their married counterparts. These include limited access to resources, fewer opportunities for support, and increased stress, all of which can negatively affect maternal well-being and the development of their children. Studies suggest that such factors play a key role in poorer health outcomes for children (Brown, 2010), including low birth weight (LBW, below 2,500 grams), an important indicator of infant health.

Another factor shaping this dynamic is intimate partner violence (IPV), which is common during pregnancy in many parts of the world, including Colombia. IPV during pregnancy not only endangers the mother but may also harm the unborn child through increased stress, trauma, or reduced access to prenatal care. Furthermore, IPV levels are not evenly distributed across family forms. Women in less stable or non-marital partnerships are often at greater risk (Friedemann-Sanchez and Lovatón, 2012), raising important questions about how family dynamics influence experiences of IPV and the health of both mothers and their children.

In a recent study (Molina, 2025), I investigated the implications of Colombia’s shifting family forms for infant health, focusing on IPV and its relationship to maternal partnership status. The study draws on data from the Colombian Demographic and Health Surveys (DHS) conducted in 2000, 2005, 2010, and 2015.

Cohabitation: the norm for mothers in Colombia

Unmarried motherhood is rising globally, but Colombia offers a unique case. In 2015, 65.8% of mothers with children aged 0-1 were cohabiting, while only 22.3% were married (Figure 1). This trend reflects Colombia’s history, where consensual unions have long been a significant part of family life due to cultural and historical influences (De Vos, 2000). Today, cohabitation has become the leading family form, extending beyond less advantaged groups to include highly educated mothers.

Intimate partner violence during pregnancy

IPV during pregnancy remains a severe public health problem with widespread consequences for maternal and child well-being (Garcia-Moreno et al., 2006). In my study, I found that separated and cohabiting mothers report notably higher IPV levels than married mothers. 

From 2000, reported levels of IPV among cohabiting mothers declined over time, while separated mothers continued to report high levels. This decline could be attributed to changes in the composition of cohabiting mothers, as this family form includes women from increasingly diverse social and educational backgrounds. By 2015, however, 17.5% of separated mothers and 5.8% of cohabiting mothers with children aged 0–1 were still reporting experience of IPV during pregnancy, compared to just 3.7% of married mothers (Figure 2).

Additionally, IPV itself might influence family transitions, with violence potentially contributing to separation. As societal acceptance of separation following IPV grows, the higher IPV levels among separated mothers may reflect this evolving social norm.

Intimate partner violence and infant health 

The relationship between IPV and infant health is complex and multifaceted. While unmarried mothers are more likely to have infants with LBW, much of this disparity stems from differences in maternal characteristics, such as education and age, and inequities in antenatal care. For example, compared to cohabiting or separated mothers, married mothers are significantly more likely to attend the recommended eight or more antenatal visits, which have a considerable impact on reducing LBW risks.

Surprisingly, IPV during pregnancy was not found to have a direct association with LBW. This could reflect the complexity of examining LBW – which is influenced by multiple factors beyond IPV – as a health outcome. Moreover, the relatively low prevalence of LBW in the data adds to the challenge of detecting such relationships. Additional analysis revealed that IPV during pregnancy is closely linked to an increased likelihood of pregnancy loss, suggesting that its most profound effects might actually occur before birth.

Conclusions

These findings reveal a complex interaction between changing family forms, intimate partner violence, and maternal and child health in Colombia. The increase in cohabitation and separation reflects shifting social norms, but these changes also highlight enduring gender inequalities. Mothers who are separated or in cohabiting unions face unique challenges, including higher rates of IPV and reduced access to healthcare, which affect child health outcomes such as LBW.

To improve maternal and child health outcomes, Colombia must strengthen healthcare services for unmarried mothers, ensuring equitable access to antenatal care. At the same time, addressing IPV requires a multifaceted approach that considers the varying risks across different partnership statuses. Finally, tackling the broader social and economic inequalities that exacerbate IPV and family instability will be critical to fostering healthier outcomes for mothers and their children. 

References

Brown, S. (2010). Marriage and child well-being: Research and policy perspectives. Journal of Marriage and Family 72(5): 1059–1077. 

De Vos, S. (2000). Nuptiality in Latin America: The view of a sociologist and family demographer. In: Browning, S.L. and Miller, R.R. (eds.). Till death do us part: A multicultural anthology on marriage. Stanford: JAI Press: 219–243.

Friedemann-Sanchez, G., and Lovatón, R. (2012). Intimate partner violence in Colombia: Who is at risk? Social Forces 91(2): 663–688. 

Garcia-Moreno, C., Jansen, H.A., Ellsberg, M., Heise, L., and Watts, C.H. (2006). Prevalence of intimate partner violence: Findings from the WHO multi-country study on women’s health and domestic violence. The Lancet 368(9543): 1260–1269. 

Molina, S. (2025). Unmarried motherhood and infant health: The role of intimate partner violence in Colombia. Demographic Research, 52(6), 141–178.

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In 2023, nearly one in four children in America aged 0‒17 years, totaling about 19 million, were living in a household without their biological, step, or adoptive father, mostly with their mother (85% of cases). In fact, living in a single-parent households with a father absent is the second most common U.S. living arrangement, and the proportion of these households has doubled since 1970 (US Census Bureau, 2023). 
Single-parent households in the US are the result of various factors, including declining marriage rates, divorces, widowhood, non-married parents who split up and parents who are single by choice.

Levels 

According to a global survey of 130 countries conducted in 2019 (Kramer 2019), the US had the highest rate of children living in single-parent households of any nation in the world, at about 23%, or more than three times the worldwide level of 7% (Figure 1).

The prevalence of these cases was markedly lower in neighboring Canada and Mexico (15% and 7%, respectively), and much lower in developing countries, all below 5%.

Trends

For decades, the share of U.S. children living with a single parent has been rising, accompanied by a decline in marriage rates and a rise in births outside marriage (Livingston 2018). The percentage of US children living in single-parent households nearly tripled between 1960 and 2023, increasing from 9% to 25% (US Census Bureau 2023). In the same period, the share of households with fathers missing more than doubled, increasing from 11% to 25% (Figure 2). 

The proportions of children living in a father-absent household varies considerably among America’s three major social groups: in 2023, the shares were 20%, 29% and 50% among Whites Hispanics and Blacks, respectively, and in all three groups they are substantially higher than 50 years before (Figure 3). 

The rise in births to unmarried mothers has contributed strongly to the increase in households with missing fathers. While many unmarried women cohabit with a partner at the time of giving birth, these relationships fail at twice the rate of marriages (Brewer 2023). In 2022, 40% of all births in the US were to unmarried women, a four-fold increase since 1970. Again, there is notable variability across the major US social groups: 16% for Asians, 22% for Whites, 42% for Hispanics and 69% for Blacks (Osterman 2024).

Consequences and perspectives

Children who grow up in a household with only one biological parent are worse off, on average, than children who grow up with both of their biological parents, regardless of the parents’ race or educational background (McLanahan and Sandefur 1996). For instance, they are nearly four times more likely to live in poverty (Brewer 2023), have more trouble academically, scoring poorly on tests of reading and mathematics, and are more likely to drop out of school. 

Boys living in these conditions are more likely to engage in negative social behaviors (Kearney 2023) and girls often experience lack of confidence and struggle with decision-making (Rothwell 2023). 

Nearly half of US adults in a 2021 national survey – men especially (59% of men versus 37% of women; Hurst 2022) – said that raising children in a single-mother household is generally a bad thing for society. However, despite these widespread negative opinions, current trends in marriage, cohabitation and divorce, and social norms concerning non-marital births and family type, suggest that the situation is unlikely to change any time soon. The same holds for the resulting inequalities that will affect the future lives of these children. 

References

Brewer, Jack (2023)  “Fatherlessness and its effects on American society”. May 15, America First Policy Institute, Washington, D.C.

Hurst, Kiley (2022) “Rising share of Americans see women raising children on their own, cohabitation as bad for society”. March 11, Pew Research Center, Washington D.C.

Kearney, Melissa (2023) The Two-Parent Privilege. University of Chicago Press, Chicago, Illinois. 

Kramer, Stephanie (2019) “U.S. has world’s highest rate of children living in single-parent households”. December 12, Pew Research Center, Washington D.C.

Livingston, Gretchen (2018) “About one-third of U.S. children are living with an unmarried parent”. April 27, Pew Research Center, Washington D.C.

McLanahan, Sara and Gary Sandefur (1997) Growing Up with A Single Parent: What Hurts and What Helps. Harvard University Press, Cambridge, Massachusetts.

Osterman, Michelle J. et al. (2024)  “Births: Final Data for 2022”.  April 4, National Vital Statistics Reports, CDC, Washington, D.C.

Rothwell, Jonathan (2023) “Parenting Is the Key to Adolescent Mental Health”. November 30, Gallup and The Institute for Family Studies, Charlottesville, Virginia.

US Census Bureau (2023) “Living Arrangements of Children Under 18 Years Old: 1960 to Present”. November, Washington, D.C.

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Child care in the the U.S. is both costly and scarce, and fails to meet the needs of children and parents. The country’s child care system is dominated by the private sector which receives very limited financial support: as a result, child care costs across America are untenable for most families (Landivar 2024). The U.S. Treasury Secretary has described child care in America as “a broken market”.

Costs

While the U.S. Department of Health considers that 7% of household income as an affordable benchmark for child care, in 2023, two-thirds of U.S. parents with young children spent 20% or more of their household income on child care, up from about half in 2022 (Solá 2023).  The average cost of child care for two children is higher than the average rent in all 50 states and the average mortgage payment in 45 states (Luhby 2024). Likewise, in about 40 states, the average annual price of infant care in a child care center exceeds annual, in-state university tuition costs. 

Child care expenses for parents are often more than $1,000 per month. In 2021, for example, preschool, infant care and day care cost between $14,000 and $24,000 annually for couples in the ten U.S. states with the highest annual child care expense (Figure 1). In addition to their high cost, child care services are often difficult to find. Approximately 75% of families report difficulties, and about 32% of children under the age of five cannot access a child care slot (Editorial Staff 2024). Moreover, since 2019, there has been a 12% decline in licensed family child care homes.

Child care providers are also struggling with limited space and staffing shortages, in part because wages in this sector are low, with a median hourly wage of $14.60 in May 2023 (US Bureau of Labor Statistics 2024). Due to the national shortage of workers and facilities, the costs of day care and preschool are rising at nearly twice the pace of inflation: the national average annual price of child care increased by 23% between 2017 and 2023 (Luhby 2024).

Consequences

The price tag for having two children in child care while working full-time is significantly higher in the U.S. than in most OECD countries (Figure 2). 

Many parents with young children in America are thus forced to choose between spending a significant portion of their income on child care, finding a cheaper, less desirable option, or leaving the workforce altogether to become full-time caregivers.  Child care issues are more likely to impact a mother’s than a father’s career. About half of mothers with young children are considering leaving the workforce due to inadequate childcare. The US has gone from leading its peers in women’s workforce participation rates in the 1990s to lagging dramatically behind them today. About one-fifth of mothers who do not currently work would look for a job if they had better access to quality child care, and about one-third of mothers unable to find affordable child care have already dropped out of the labor force. In 2023, 25% of  mothers were economically inactive, up from just 15% in 2022. Subsidized child care and preschool increase the likelihood that mothers will remain in work and pursue a career. Besides, child care helps children develop physically, mentally, socially and emotionally, thereby increasing their chances for lifelong success. Numerous studies about child care in the U.S. have indicated the benefits of early-childhood education (Wise 2024). 

Policies 

One of the major reasons why child care is more expensive in the US than in the rest of the developed world is that other countries devote a larger share of government spending to child care provision (Buchholz 2024).  America’s two major political parties have different views on the role of the federal government in this area. While Democratic elected officials have proposed more federal spending on child care, many Congressional Republicans argue against federal intervention and are opposed to federal tax increases for this purpose. The vast majority of U.S. voters feel a sense of urgency concerning the need for affordable, quality child care. Nearly 80% of voters support increased federal funding for states to expand their child care and early learning programs. That view among voters is evident across party lines and is felt strongly by parents and non-parents alike (Patrick 2024).

Conclusions 

Those opposed to subsidized child care tend to ignore the economic realities of modern America. In many households both parents want to work, and for a growing share of parents, being employed is simply not a choice. The U.S. Department of Labor has highlighted the need for greater federal investments in child care services. Businesses and policymakers are also paying close attention to America’s child care crisis because a good child care system that accommodates the needs of working parents contributes to a healthy workforce and economy.   In sum, child care in America is in crisis largely because it is costly and scarce. Increased federal support and funding would contribute significantly to improving child care affordability and availability .

References

Buchholz, Katharina (2024) “U.S. Childcare Cost Higher than In Other Developed Countries”. 10 September, Forbes.

Editorial Staff (2024) “This is how much child care costs in 2024” January 17, Care.Com. 

Grundy, Adam (2024) “Rising Cost of Child Care Services a Challenge for Working Parents”. January 9, U.S. Census Bureau, Washington, D.C.

Landivar, Christin (2023) “New Childcare Data Shows Prices Are Untenable for Families”. January 24, U.S. Department of Labor, Washington, D.C.

Luhby, Tami (2024) “Here’s where child care costs at least twice as much as rent”. May 15, CNN. 

Patrick, Stephen W. (2024) “Voter Support for Policies Associated With Child Health as National Campaign Priorities”. September 27,  JAMA Health Forum.

Shine, Ian (2023) “These countries have the highest childcare costs in the world”. July 19, World Economic Forum, Switzerland. 

Solá, Ana Teresa (2023) “Majority of parents spend 20% or more of household income on child care, report finds”. August 7, CNBC. 

U.S. Bureau of Labor Statistics (2024) “Occupational Outlook Handbook: Childcare Workers”. August 29, Washington, D.C. Wise, Jessica N. Wise,

Katarina Reyes, Sandra McKay (2024) “The Case for Early Childhood Education as Health and Economic Policy”. September 6, Baker Institute, Rice University, Houston, Texas, U.S.

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