The number of children in the U.S. is declining, and the drop is sharpest in the country’s largest cities, The Wall Street Journal reported July 26. Where does that leave hospitals and health systems?
The number of children under 18 living in the country’s 38 cities with more than 500,000 residents as of 2024 has fallen 6% since 2015, compared to a 1% drop nationwide, according to the Journal’s analysis of Census Bureau data. The number of children under 5 has declined 15.4%, compared to a 7.2% decline nationwide.
Of the 38 largest cities, only 13 saw the number of children grow, mostly in the South. Eight of the largest cities saw declines of children under 18 of more than 10%: San Jose, Calif.; Los Angeles; Albuquerque, N.M.; Portland, Ore.; San Diego; Chicago; Boston; and Milwaukee.
Cities held onto families in the years right after the 2008-09 financial crisis, when job stability often mattered more than other considerations, Connor O’Brien, a fellow the Institute for Progress, told the Journal. As economic opportunity spread beyond major metros later in the 2010s, families gained more freedom to relocate, and the number of children in big cities began declining in 2017. That trend accelerated during the pandemic, when remote work let many families reconsider where they lived — with plenty choosing the suburbs or farther out.
One source of the drop is that more people without children are choosing to stay that way. The number of births across the country has dropped 9% in the past decade, mostly driven by fewer women having children in their teens and 20s, according to the Journal.
Residents with children pointed to concerns about costs, safety and quality of life as reasons for leaving big cities. Still, the pattern held across cities of every income level, the Journal found.
Declining birthrates have significant healthcare implications and remain a key driver of maternity service closures, along with persistent financial pressures and staffing shortages. Becker’s has reported on 18 hospitals that ended maternity care so far in 2026, compared to 29 closures in all of 2025. Rochester (N.Y.) Regional Health, for example, pointed to national and local birth rate decline as a reason for ending inpatient labor and delivery, newborn nursery and postpartum services at its Newark (N.Y.)-Wayne Community Hospital.
Several hospitals have also ended inpatient pediatric services in 2026, citing declining birthrates and declining patient volumes, including Providence Santa Rosa (Calif.) Memorial Hospital, which closed its eight-bed inpatient children’s unit and is converting the space for adult inpatient care.
Notably, big cities tend to have the most access to maternity and pediatric healthcare services, often connected to large academic health systems or large regional hospitals with more offerings. Of the 47 hospitals that have closed departments or ended services so far in 2026, only one (non-pediatric and non-maternity) closure was in the 25 largest cities with declining children populations.
Children leaving big cities also brings economic implications. Families anchor a city’s tax base, and their spending on everyday goods, like groceries, ripples out to benefit residents without kids too, according to the Journal. Further, fewer kids lead to less support for public schools, which are often one of the largest employers in cities. One school district in El Paso, Texas, is closing elementary schools to save money amid a 30% drop in children under 5, the Journal reported.
Fewer children in big cities mean fewer opportunities for workforce pipeline efforts that often start in high school. Several health systems across the country — from small rural communities to the largest cities — have implemented programs to introduce students to healthcare careers in hopes of developing a long-term workforce pipeline.
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