Most women want children – but half are unsure if they will
Ohio State University
COLUMBUS, Ohio – As concern grows about America’s falling birth rate, new research suggests that about half of women who want children are unsure if they will follow through – and many won’t be that bothered if they don’t.
The results show that the intention to have a baby is not just a “yes” or “no” question for many women today, said Sarah Hayford, co-author of the study and professor of sociology at The Ohio State University.
There’s also a question of how certain they are in their goal to have a child and the intensity of that desire.
“People’s feelings about having children are complicated, and we found there are a lot of nuances,” said Hayford, who is also director of Ohio State’s Institute for Population Research.
“It suggests that there is no simple answer to the declining birth rate in the United States.”
The U.S fertility rate was stable at about 2.0 children per woman in the 1990s and early 2000s, reaching a peak of 2.12 in 2007, statistics show. But the fertility rate steadily declined in the aftermath of the Great Recession, falling to 1.62 in 2023.
The study, published recently in the journal Genus, was led by Luca Badolato, an Ohio State PhD student in sociology. Co-authors were Hayford and Karen Benjamin Guzzo, professor of sociology at the University of North Carolina at Chapel Hill and director of the Carolina Population Center.
The researchers used data from the National Survey of Family Growth, a federally funded survey conducted by the National Center for Health Statistics, from 2002 to 2019. This included surveys of a nationally representative group of 41,492 women aged 15 to 44 about a broad range of fertility-related indicators.
Findings showed that there was little change during that time in the proportion of women who said they intended to have children. On average, 62% of women said they intended to have a child and 35% did not intend to, with only a small percentage saying they didn’t know.
But up to 50% of the women who intended to have children said they were only “somewhat sure” or “not at all sure” that they would actually realize their intention to have a child.
Women who had higher levels of income and education were slightly more likely to say they were “very sure” they would have a child than those with less education and income. But even those with a bachelor’s degree who said they were “very sure” they will have more children declined from 65% in 2014 to 54% in 2018.
And it is not just the certainty that may be affecting the fertility rate. The intensity of the desire mattered, too.
The study found that up to 25% of childless women who intended to have children also said they would not be bothered if they ended up not having a child.
“This not being bothered was especially high among younger women, and it increased over time among those who were younger,” Hayford said.
“They are open to different pathways and different kinds of lives. If they don’t become parents for whatever reason, it doesn’t seem that upsetting to many of them.”
One possibility often discussed for the declining birth rate is that young people today are unsure about the future of the country and the world, and that is keeping them from having children.
Hayford and Guzzo considered that possibility in a separate study, published recently as a chapter in the book The Retreat from Marriage and Parenthood: Examining the Causes and Consequences of Declining Rates.
In this study they used survey data from the American Trends Panel, which surveyed 3,696 people.
That study found that as people’s dissatisfaction with their own lives increased, they were less likely to think they would have a child. But concerns about the difficulty of life for today’s young people and evaluations about problems in the community were not related to their goals to have children.
“It was a bit of a surprise to us, but it was only their personal situation that mattered to whether they expected to have children,” Hayford said.
“It wasn’t so much what was going on in society that predicted their fertility goals.”
Overall, the studies suggest it is very difficult to predict what will happen with birth rates in the United States and other developed countries.
“On the one hand there is a lot of latent desire and intentions to have children. But people have a lot of uncertainty about whether they will meet those goals, and many don’t seem to worry that much if they do or don’t have children,” she said.
“It is hard to predict what will happen next.”
Journal
Genus
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Multiple dimensions of uncertainty in fertility goals: recent trends and patterns in the United States
Illuminating gaps in perinatal palliative care evidence amidst abortion restrictions
University of Pennsylvania School of Nursing
PHILADELPHIA (June 18, 2025) – A new review published in Health Affairs Scholar highlights significant limitations in the existing evidence base for perinatal palliative care (PPC) in the United States, raising concerns about its capacity to adequately support a growing, vulnerable patient population increasingly directed towards it due to abortion restrictions.
The review, titled "Dobbs-driven expansion of perinatal palliative care: a scoping review of the evidence and its limits," was conducted by a team of researchers led by Abigail B. Wilpers, PhD, WHNP-BC, Assistant Professor, in Penn Nursing’s Department of Family and Community Health. PPC is an interdisciplinary approach that provides comprehensive support from prenatal diagnosis through labor, birth, neonatal care, and end-of-life support for families facing pregnancies complicated by life-limiting fetal conditions (LLFCs). This care integrates medical management with psychosocial and bereavement support, aiming to facilitate values-driven decision-making for families.
"Our review reveals a significant and concerning gap in the evidence for PPC in the United States, especially at a time when more families are being directed to this care due to abortion restrictions," said Wilpers. "We urgently need robust, U.S.-based research to truly understand if PPC can effectively and equitably meet the needs of all vulnerable patients, ensuring their safety, comfort, and well-being in an increasingly complex landscape of reproductive health.
Key Findings and Identified Gaps:
- Understudied Area: The review of 13 U.S.-based studies found that PPC programs are largely understudied, with limited evidence on crucial outcomes such as maternal health and neonatal comfort.
- Limited Data on Uptake and Diversity: Studies lacked comprehensive data on PPC use rates for all eligible individuals, hindering a full assessment of overall uptake. Furthermore, existing studies showed a lack of diversity in their samples, making it difficult to determine if PPC adequately serves diverse populations.
- Patient Satisfaction vs. Policy Impact: While most PPC patients reported high satisfaction, often citing compassionate care, emotional support, and parental validation, none of the reviewed studies examined the specific experience of receiving PPC due to abortion restrictions.
- Insufficient Evidence for Policy Shifts: The review concludes that the current evidence is insufficient to determine whether PPC can adequately support the escalating number of patients now being directed to this care by policy rather than personal choice.
The authors underscore that existing PPC evidence is limited, leaving critical gaps in understanding its safety, effectiveness, acceptability, and equity—factors essential for assessing if PPC meets its intended goals and serves diverse populations. This comprehensive review serves as a crucial call to action for more rigorous research to inform policy and ensure appropriate care for vulnerable families.
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About the University of Pennsylvania School of Nursing
The University of Pennsylvania School of Nursing (Penn Nursing) is one of the world’s leading nursing schools. It has been ranked the #1 nursing school in the U.S. by QS University for a decade. Our Bachelor of Science in Nursing (BSN) is among the top-ranked programs in the nation, according to the 2025 U.S. News & World Report’s Best Colleges rankings. Penn Nursing also consistently earns high rankings in U.S. News & World Report’s annual list of best graduate schools and is a top recipient of National Institutes of Health (NIH) funding for nursing research. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: Facebook, X, LinkedIn, YouTube, & Instagram.
Journal
Health Affairs Scholar
Article Title
Dobbs-driven expansion of perinatal palliative care: a scoping review of the evidence and its limits
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