Continued Declines in Teen Births in the United States, 2015

•The teen birth rate declined to another historic low for the United States in 2015, down 8% from 2014 to 22.3 births per 1,000 females aged 15-19. •The birth rates for teenagers aged 15-17 and 18-19 declined in 2015 to 9.9 and 40.7, respectively, which are record lows for both groups. •In 2015, birth rates declined to 6.9 for Asian or Pacific Islander, 16.0 for non-Hispanic white, 25.7 for American Indian or Alaska Native, 31.8 for non-Hispanic black, and 34.9 for Hispanic female teenagers aged 15-19. •Birth rates fell to record lows for nearly all race and Hispanic-origin groups of females aged 15-19, 15-17, and 18-19 in 2015. The birth rate for teenagers aged 15-19 has fallen almost continuously since 1991, reaching historic lows for the nation every year since 2009 (1-4). Despite declines in all racial and ethnic groups, teen birth rates continue to vary considerably by race and ethnicity. Moreover, the U.S. teen birth rate remains higher than in other industrialized countries (5). Childbearing by teenagers continues to be a matter of public concern. This report presents the recent and long-term trends and disparity in teen childbearing by race and Hispanic origin.

Explaining the 2001–2002 Infant Mortality Increase in the United States: Data from the Linked Birth/Infant Death Data Set

The U.S. infant mortality rate (IMR) increased from 6.8 infant deaths per 1,000 live births in 2001 to 7.0 in 2002, the first increase in more than 40 years. From 2001 to 2002, IMR increased for very low birthweight infants as well as for preterm and very preterm infants. Although IMR for very low birthweight infants increased, most of the increase in IMR from 2001 to 2002 was due to a change in the distribution of births by birthweight and, more specifically, to an increase in infants born weighing less than 750 grams. The majority of infants born at less than 750 grams die within the first year of life; thus, these births contribute disproportionately to overall IMR. Increases in births at less than 750 grams occurred for non-Hispanic white, non-Hispanic black, and Hispanic women. Most of the increase occurred among mothers 20 to 34 years of age. Although multiple births contributed disproportionately, most of the increase in births at less than 750 grams occurred among singletons. Three hypotheses were evaluated to assess their possible impact on the increase in less than 750-gram births: possible changes in (1) the reporting of births or fetal deaths, (2) the risk profile of births, and (3) medical management of pregnancy. Although each of these factors may have contributed to the increase, the relative effects of these and other factors remain unclear. More detailed studies are needed to further explain the 2001–2002 infant mortality increase.

Births: Preliminary Data for 2015

Objectives-This report presents preliminary 2015 data on U.S. births. Births are shown by age and race and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthweight are also presented.

Can Community Health Workers Report Accurately on Births and Deaths? Results of Field Assessments in Ethiopia, Malawi and Mali

Introduction

Most low-income countries lack complete and accurate vital registration systems. As a result, measures of under-five mortality rates rely mostly on household surveys. In collaboration with partners in Ethiopia, Ghana, Malawi, and Mali, we assessed the completeness and accuracy of reporting of births and deaths by community-based health workers, and the accuracy of annualized under-five mortality rate estimates derived from these data. Here we report on results from Ethiopia, Malawi and Mali.

Method

In all three countries, community health workers (CHWs) were trained, equipped and supported to report pregnancies, births and deaths within defined geographic areas over a period of at least fifteen months. In-country institutions collected these data every month. At each study site, we administered a full birth history (FBH) or full pregnancy history (FPH), to women of reproductive age via a census of households in Mali and via household surveys in Ethiopia and Malawi. Using these FBHs/FPHs as a validation data source, we assessed the completeness of the counts of births and deaths and the accuracy of under-five, infant, and neonatal mortality rates from the community-based method against the retrospective FBH/FPH for rolling twelve-month periods. For each method we calculated total cost, average annual cost per 1,000 population, and average cost per vital event reported.

Results

On average, CHWs submitted monthly vital event reports for over 95 percent of catchment areas in Ethiopia and Malawi, and for 100 percent of catchment areas in Mali. The completeness of vital events reporting by CHWs varied: we estimated that 30%-90% of annualized expected births (i.e. the number of births estimated using a FPH) were documented by CHWs and 22%-91% of annualized expected under-five deaths were documented by CHWs. Resulting annualized under-five mortality rates based on the CHW vital events reporting were, on average, under-estimated by 28% in Ethiopia, 32% in Malawi, and 9% in Mali relative to comparable FPHs. Costs per vital event reported ranged from $21 in Malawi to $149 in Mali.

Discussion

Our findings in Mali suggest that CHWs can collect complete and high-quality vital events data useful for monitoring annual changes in under-five mortality rates. Both the supervision of CHWs in Mali and the rigor of the associated field-based data quality checks were of a high standard, and the size of the pilot area in Mali was small (comprising of approximately 53,205 residents in 4,200 households). Hence, there are remaining questions about whether this level of vital events reporting completeness and data quality could be maintained if the approach was implemented at scale. Our experience in Malawi and Ethiopia suggests that, in some settings, establishing and maintaining the completeness and quality of vital events reporting by CHWs over time is challenging. In this sense, our evaluation in Mali falls closer to that of an efficacy study, whereas our evaluations in Ethiopia and Malawi are more akin to an effectiveness study. Our overall findings suggest that no one-size-fits-all approach will be successful in guaranteeing complete and accurate reporting of vital events by CHWs.

Births in the United States, 2014

For the first year since 2007, childbearing rose in the United States in 2014, albeit slightly. Trends differed by race and Hispanic origin, with the GFR up among non-Hispanic white and API women but down or unchanged among other groups for 2013–2014. Historical lows in teen childbearing were seen in the U.S. overall in 2014, and for each of the race and Hispanic origin groups. Following years of steady increases that totaled nearly 60% (3), the U.S. cesarean delivery rate declined for the second straight year. Cesarean delivery rates had been on the decline for several years for non-Hispanic white and API women, but 2014 marks the first year of decline in cesarean deliveries among non-Hispanic black and Hispanic women. Preterm birth rates continued to trend downward in 2014 (2), overall and among most race and Hispanic origin groups, but large differences among groups in the risk of preterm birth were observed. The forthcoming report, "Births: Final data for 2014" (4), will present more information on the topics addressed in this report and selected others.

Births: final data for 2013

OBJECTIVES

This report presents 2013 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birthweight, and plurality. Birth and fertility rates are presented by age, live-birth order, race and Hispanic origin, and marital status. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

METHODS

Descriptive tabulations of data reported on the birth certificates of the 3.93 million U.S. births that occurred in 2013 are presented.

RESULTS

A total of 3,932,181 births were registered in the United States in 2013, down less than 1% from 2012. The general fertility rate declined to 62.5 per 1,000 women aged 15-44. The teen birth rate fell 10%, to 26.5 per 1,000 women aged 15-19. Birth rates declined for women in their 20s and increased for most age groups of women aged 30 and over. The total fertility rate (estimated number of births over a woman's lifetime) declined 1% to 1,857.5 per 1,000 women. Measures of unmarried childbearing were down in 2013 from 2012. The cesarean delivery rate declined to 32.7%. The preterm birth rate declined for the seventh straight year to 11.39%, but the low birthweight rate was essentially unchanged at 8.02%. The twin birth rate rose 2% to 33.7 per 1,000 births; the triplet and higher-order multiple birth rate dropped 4% to 119.5 per 100,000 total births.

Births in the United States, 2013

Childbearing is on the decline in the United States overall and among women under age 30 and women in each of the largest race and Hispanic origin groups. Childbearing continues to rise among older women, however, with rates for women aged 35 and over at the highest levels seen in approximately 50 years. After more than a decade of steady rises, cesarean delivery rates are trending slightly downward; a recent report revealed larger declines for 2009-2013 among women at low risk for cesarean delivery than for all women with cesareans. Following several years of relative stability, twinning rates were up for 2013; a recent report based on 2012 data revealed that triplet and higher-order multiple births have been trending sharply downward. Declines in the incidence of preterm deliveries, especially in conjunction with reductions in low birthweight (albeit modest) and in perinatal mortality, suggest some recent progress in improving pregnancy outcome in the United States. The forthcoming report "Births: Final Data for 2013" will present more information on the topics addressed in this report and selected others.

Evolutionary demography of agricultural expansion in preindustrial northern Finland

A shift from nomadic foraging to sedentary agriculture was a major turning point in human evolutionary history, increasing our population size and eventually leading to the development of modern societies. We however lack understanding of the changes in life histories that contributed to the increased population growth rate of agriculturalists, because comparable individual-based reproductive records of sympatric populations of agriculturalists and foragers are rarely found. Here, we compared key life-history traits and population growth rate using comprehensive data from the seventieth to nineteenth century Northern Finland: indigenous Sami were nomadic hunter-fishers and reindeer herders, whereas sympatric agricultural Finns relied predominantly on animal husbandry. We found that agriculture-based families had higher lifetime fecundity, faster birth spacing and lower maternal mortality. Furthermore, agricultural Finns had 6.2% higher annual population growth rate than traditional Sami, which was accounted by differences between the subsistence modes in age-specific fecundity but not in mortality. Our results provide, to our knowledge, the most detailed demonstration yet of the demographic changes and evolutionary benefits that resulted from agricultural revolution.

Provision of no-cost, long-acting contraception and teenage pregnancy

BACKGROUND

The rate of teenage pregnancy in the United States is higher than in other developed nations. Teenage births result in substantial costs, including public assistance, health care costs, and income losses due to lower educational attainment and reduced earning potential.

METHODS

The Contraceptive CHOICE Project was a large prospective cohort study designed to promote the use of long-acting, reversible contraceptive (LARC) methods to reduce unintended pregnancy in the St. Louis region. Participants were educated about reversible contraception, with an emphasis on the benefits of LARC methods, were provided with their choice of reversible contraception at no cost, and were followed for 2 to 3 years. We analyzed pregnancy, birth, and induced-abortion rates among teenage girls and women 15 to 19 years of age in this cohort and compared them with those observed nationally among U.S. teens in the same age group.

RESULTS

Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008-2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively.

CONCLUSIONS

Teenage girls and women who were provided contraception at no cost and educated about reversible contraception and the benefits of LARC methods had rates of pregnancy, birth, and abortion that were much lower than the national rates for sexually experienced teens. (Funded by the Susan Thompson Buffett Foundation and others.).

National and state patterns of teen births in the United States, 1940-2013

OBJECTIVES

This report presents trends from 1940 through 2013 in national birth rates for teenagers, with particular focus on the period since 1991. The percent changes in rates for 1991-2012 and for 2007-2012 are presented for the United States and for states. Preliminary data for 2013 are shown where available.

METHODS

Tabular and graphical descriptions of the trends in teen birth rates for the United States and each state, by age group, race, and Hispanic origin, are presented and discussed. Data are shown for the U.S. territories.

RESULTS

Birth rates for U.S. teenagers have generally fallen in the United States since peaking in 1957. The rate fell 57% between 1991 and 2013. The 2013 preliminary rate (26.6 per 1,000 aged 15-19) is less than one-third of the historically highest rate (96.3 in 1957). During 1991-2012, rates fell for all race and Hispanic ethnicity groups, with the largest declines measured for non-Hispanic black teenagers. In the more recent period, 2007-2012, the declines have been steepest for Hispanic teenagers. Birth rates declined significantly for teenagers in all states during 1991-2012; during 2007-2012, rates fell for all but two states. The drop in teen birth rates translates into an estimated 4 million fewer births to teenagers from 1992 through 2012. The declines in teen birth rates reflect a number of behavioral changes, including decreased sexual activity, increases in the use of contraception at first sex and at most recent sex, and the adoption and increased use of hormonal contraception, injectables, and intrauterine devices.

Cumulative teen birth rates among girls in foster care at age 17: an analysis of linked birth and child protection records from California

This study used linked foster care and birth records to provide a longitudinal, population-level examination of the incidence of first and repeat births among girls who were in foster care at age 17. Girls in a foster care placement in California at the age of 17 between 2003 and 2007 were identified from statewide child protection records. These records were probabilistically matched to vital birth records spanning the period from 2001 to 2010. Linked data were used to estimate the cumulative percentage of girls who had given birth before age 20. Birth rates and unadjusted risk ratios were generated to characterize foster care experiences correlated with heightened teen birth rates. Between 2003 and 2007 in California, there were 20,222 girls in foster care at age 17. Overall, 11.4% had a first birth before age 18. The cumulative percentage who gave birth before age 20 was 28.1%. Among girls who had a first birth before age 18, 41.2% had a repeat teen birth. Significant variations by race/ethnicity and placement-related characteristics emerged. Expanded data and rigorous research are needed to evaluate prevention efforts and ensure parenting teens are provided with the needed services and supports.

Prenatal care through the eyes of Canadian Aboriginal women

The Aboriginal Prenatal Wellness Program (APWP) in Canada represents a culturally safe approach to prenatal care. By understanding the history of colonization and residential schools and how this history has contributed to health disparities, a multidisciplinary team provides culturally competent and integrated prenatal care to Aboriginal women and their families. This article describes the APWP and discusses how increased participation in health care by historically marginalized populations can lead to better maternal and neonatal health outcomes.

Effect of ethnicity on live birth rates after in vitro fertilisation or intracytoplasmic sperm injection treatment

OBJECTIVE

To assess the relationship between the ethnicity of women and the clinical success of in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment.

DESIGN

Observational cohort study.

SETTING

Nottingham University Research and Treatment Unit in Reproduction (NURTURE), UK.

SAMPLE

A total of 1517 women, of which 1291 were white Europeans and 226 belonged to an ethnic minority group. All the women were undergoing their first cycle of assisted reproductive technology (ART) between 2006 and 2011.

METHODS

All of the women underwent their first cycle of ART between 2006 and 2011.

MAIN OUTCOME MEASURES

Live birth rates following IVF or ICSI treatment.

RESULTS

Although pre-treatment ovarian reserve variables [mean age, basal follicle stimulating hormone (FSH), and total antral follicle count] were significantly favourable in the ethnic group, the live birth rates were significantly lower in this group (35%) compared with the white European group (43.8%) (relative risk 0.8; 95% CI 0.66-0.97). On logistic regression analysis, ethnicity was an independent predictor of live birth rate (OR 0.688; 95% CI 0.513-0.924). After controlling for the other independent variables (age and FSH), the significant association between ethnicity and live birth rate remained strong (OR 0.591; 95% CI 0.425-0.822) on multivariate logistic regression analysis.

CONCLUSIONS

Live birth rates following IVF or ICSI treatment were significantly lower in the ethnic minority group compared with white European women, which suggests that ethnicity is a major determinant of live birth following IVF treatment.

Mapping for maternal and newborn health: the distributions of women of childbearing age, pregnancies and births

BACKGROUND

The health and survival of women and their new-born babies in low income countries has been a key priority in public health since the 1990s. However, basic planning data, such as numbers of pregnancies and births, remain difficult to obtain and information is also lacking on geographic access to key services, such as facilities with skilled health workers. For maternal and newborn health and survival, planning for safer births and healthier newborns could be improved by more accurate estimations of the distributions of women of childbearing age. Moreover, subnational estimates of projected future numbers of pregnancies are needed for more effective strategies on human resources and infrastructure, while there is a need to link information on pregnancies to better information on health facilities in districts and regions so that coverage of services can be assessed.

METHODS

This paper outlines demographic mapping methods based on freely available data for the production of high resolution datasets depicting estimates of numbers of people, women of childbearing age, live births and pregnancies, and distribution of comprehensive EmONC facilities in four large high burden countries: Afghanistan, Bangladesh, Ethiopia and Tanzania. Satellite derived maps of settlements and land cover were constructed and used to redistribute areal census counts to produce detailed maps of the distributions of women of childbearing age. Household survey data, UN statistics and other sources on growth rates, age specific fertility rates, live births, stillbirths and abortions were then integrated to convert the population distribution datasets to gridded estimates of births and pregnancies.

RESULTS AND CONCLUSIONS

These estimates, which can be produced for current, past or future years based on standard demographic projections, can provide the basis for strategic intelligence, planning services, and provide denominators for subnational indicators to track progress. The datasets produced are part of national midwifery workforce assessments conducted in collaboration with the respective Ministries of Health and the United Nations Population Fund (UNFPA) to identify disparities between population needs, health infrastructure and workforce supply. The datasets are available to the respective Ministries as part of the UNFPA programme to inform midwifery workforce planning and also publicly available through the WorldPop population mapping project.

Contribution of immigration to adolescent fertility in Spain considering the reproductive pattern in the country of origin

Adolescent fertility displays a trend that does not follow-and even runs contrary to-the general temporal fertility pattern. Multiple factors determine this trend, including socioeconomic conditions and cultural patterns at both immigrants' place of origin of and their destination. This article analyzes adolescent fertility in Spain with regard to country of maternal origin using records of deliveries (1980-2008) and information from countries with high immigration rates to Spain. After 1980, deliveries to adolescents diminished; after 1996, only Spanish-born adolescents continued this downward trend, but not immigrants. The factors responsible for these differences are diverse and related to the characteristics of the immigrants themselves, in addition to the situation of immigrants in the Spanish context.

Benefits of meeting the contraceptive needs of Cameroonian women

(1) In 2013, an estimated 40% of pregnancies in Cameroon were unintended. (2) More than six in 10 women who want to avoid pregnancy either do not practice contraception or use a relatively ineffective traditional method. These women can be said to have an unmet need for modern contraception. (3) Meeting just half of this unmet need would prevent 187,000 unplanned pregnancies each year, resulting in 65,000 fewer unsafe abortions and 600 fewer maternal deaths annually. (4) If all unmet need for modern methods were satisfied, maternal mortality would drop by more than one-fifth, and unintended births and unsafe abortions would decline by 75%. (5) Investing in contraceptive commodities and services to fulfill all unmet need among women who want to avoid pregnancy would result in a net annual savings of US$5.4 million (2.7 billion CFA francs) over what would otherwise be spent on medical costs associated with unintended pregnancies and their consequences. (6) Expanding contraceptive services confers substantial benefits to women, their families and society. All stakeholders, including the Cameroon government and the private sector, should increase their investment in modern contraceptive services.

Births: final data for 2012

OBJECTIVES

This report presents 2012 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birthweight, and plurality. Birth and fertility rates are presented by age, live-birth order, race and Hispanic origin, and marital status. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

METHODS

Descriptive tabulations of data reported on the birth certificates of the 3.95 million births that occurred in 2012 are presented.

RESULTS

A total of 3,952,841 births were registered in the United States in 2012. The general fertility rate declined to 63.0 per 1,000 women aged 15-44. The teen birth rate fell 6%, to 29.4 per 1,000 women. Birth rates declined for women in their twenties and increased for women aged 30-44. The total fertility rate (estimated number of births over a woman's lifetime) declined 1% to 1,880.5 per 1,000 women. The rate of births to unmarried women declined; the percentage of births to unmarried women was essentially stable at 40.7%, but the number of births to unmarried women increased slightly. The cesarean delivery rate was unchanged at 32.8%. The preterm birth rate declined for the sixth straight year to 11.55%; the low birthweight rate declined slightly to 7.99%. The twin birth rate was stable at 33.1 per 1,000 births; the rate of triplet and higher-order multiple births dropped 9% to 124.4 per 100,000 total births.

Clustering in Northern Territory perinatal data for 2003-2005: implications for analysis and interpretation

Clustering in perinatal data can violate assumptions of independence, an important consideration for data analysis. Few published studies report on the extent of repeat births in routinely collected Australian perinatal data and the implications thereof for analysis and interpretation. This paper reports on a case study that examined the extent and implications of clustering in the Northern Territory Midwives Collection (NTMC) for the period 2003-2005. Data were obtained on 7,741 individual mothers giving birth to 8,707 babies in public hospitals during 2003-2005. Clusters of multiple pregnancies and repeat births were identified and the design effects for birth weight of Aboriginal and non-Aboriginal newborns were calculated. Of the mothers, 46.1% were Aboriginal. Of these, 13.2% had repeat singleton births; 0.4% had multiple pregnancies, and 0.3% had both. Of non-Aboriginal mothers, 8.7% had repeat singleton births; 1.2% had multiple pregnancies; and 0.3% had both. The design effect was 1.07 for Aboriginal newborns and 1.04 for non-Aboriginal newborns. The design effects indicate that the correct variance accounting for clustering is 4-7% larger than the incorrect variance ignoring clustering when three consecutive years of NT data are considered and an intracluster correlation coefficient of 0.48 is assumed for birth weight between twin and non-twin siblings. Depending on the outcome of interest, the impact of clustering should be considered in multivariate analysis of perinatal data, especially when such analyses involve more than one year’s data, include large proportions of Aboriginal mothers and newborns, and groups with different rates of repeat births.

Pregnancy rates for U.S. women continue to drop

The pregnancy rate for U.S. women in 2009 was 102.1 per 1,000 women aged 15-44, the lowest level in 12 years; only the 1997 rate of 101.6 has been lower in the last 30 years. Rates for women under age 30 fell during 1990-2009, while rates for women aged 30 and over increased. Rates for teenagers reached historic lows in 2009, including rates for the three major race and Hispanic origin groups. Pregnancy rates have declined about 10% each for married and unmarried women since 1990. The birth rate for married women was 72% higher than the rate for unmarried women; the abortion rate for unmarried women was almost five times higher than the rate for married women. Pregnancy rates for women in the United States continued to decline in 2009, reaching the lowest level in 12 years (102.1 per 1,000 women aged 15-44). This level is 12% below the 1990 peak (115.8). The estimated number of pregnancies dropped to 6,369,000 (4,131,000 live births, 1,152,000 induced abortions, and 1,087,000 fetal losses). The drop in birth rates since 2007 has been well documented. However, it is important to examine the other outcomes of pregnancy to understand the full scope of current reproductive trends. The data in this report provide a comprehensive picture of pregnancies and pregnancy outcomes. Data on pregnancy outcomes by age, race and Hispanic origin, and marital status are presented using data from the National Vital Statistics System, the Abortion Surveillance System and Guttmacher Institute, and the National Survey of Family Growth (NSFG).

Pregnancy and childbirth among females aged 10-19 years - United States, 2007-2010

Pregnancy and childbirth among females aged <20 years have been the subject of long-standing concern among the public, the public health community, and policy makers. Teenagers who give birth are much more likely than older women to deliver a low birthweight or preterm infant, and their babies are at higher risk for dying in infancy. The annual public costs associated with births among teenage girls are an estimated $10.9 billion. According to the 2006-2010 National Survey of Family Growth (NSFG), an estimated 77% of births to teenagers aged 15-19 years were unintended.

A binational overview of reproductive health outcomes among US Hispanic and Mexican women in the border region

INTRODUCTION

The US-Mexico border region has 15 million residents and 300,000 births annually. Reproductive health concerns have been identified on both sides of the border, but comparable information about reproductive health is not available. The objective of this study was to compare reproductive health indicators among populations in this region.

METHODS

We used 2009 US Hispanic and Mexican birth certificate data to compare births inside the border region, elsewhere within the border states, and in the United States and Mexico overall. We examined trends in total fertility and birth rates using birth data from 2000 through 2009 and intercensal population estimates.

RESULTS

Among women in the border region, US women had more lifetime births than Mexican women in 2009 (2.69 births vs 2.15 births) and throughout the decade. Birth rates in the group aged 15 to 19 years were high in both the US (73.8/1,000) and Mexican (86.7/1,000) border regions. Late or no prenatal care was nearly twice as prevalent in the border regions as in the nonborder regions of border states. Low birth weight and preterm and early-term birth were more prevalent in the US border than in the Mexican border region; US border rates were higher and Mexican rates were lower than their corresponding nonborder and national rates. We found some variations within border states.

CONCLUSION

These findings constitute the first population-based information on the reproductive health of the entire Hispanic US-Mexico border population. Evidence of disparities warrants exploration at state and local levels. Teen pregnancy and inadequate prenatal care are shared problems in US-Mexico border communities and suggest an area for binational cooperation.

Births: final data for 2011

OBJECTIVES

This report presents 2011 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics, including age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, and infant characteristics (e.g., period of gestation, birthweight, and plurality). Birth and fertility rates are presented by age, live-birth order, race and Hispanic origin, and marital status. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

METHODS

Descriptive tabulations of data reported on the birth certificates of the 3.95 million births that occurred in 2011 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2010 census. Birth and fertility rates for 2001-2009 are based on revised intercensal population estimates. Denominators for 2011 and 2010 rates for the specific Hispanic groups are derived from the American Community Survey; denominators for earlier years are derived from the Current Population Survey.

RESULTS

The number of births declined 1% in 2011 to 3,953,590. The general fertility rate also declined 1%, to 63.2 per 1,000 women aged 15-44. The teen birth rate fell 8%, to 31.3 per 1,000 women. Birth rates declined for women in their 20s, were unchanged for women aged 30-34, and rose for women aged 35-44. The total fertility rate (estimated number of births over a woman's lifetime) declined 2% to 1,894 per 1,000 women. The number and rate of births to unmarried women declined; the percentage of births to unmarried women was essentially stable at 40.7%. The cesarean delivery rate was unchanged from 2010 at 32.8%. The preterm birth rate declined for the fifth straight year to 11.73%; the low birthweight rate declined slightly to 8.10%. The twin birth rate was not significantly changed at 33.2 per 1,000 births; the rate of triplet and higher-order multiple births also was essentially stable at 137.0 per 100,000.

Declines in state teen birth rates by race and Hispanic origin

Teen birth rates fell steeply in the United States from 2007 through 2011, resuming a decline that began in 1991 but was briefly interrupted in 2006 and 2007. The overall rate declined 25% from 41.5 per 1,000 teenagers aged 15-19 in 2007 to 31.3 in 2011--a record low. The number of births to teenagers aged 15-19 also fell from 2007 to 2011, by 26% to 329,797 in 2011. Births to teenagers are at elevated risk of low birthweight, preterm birth, and of dying in infancy compared with infants born to women aged 20 and over, and they are associated with significant public costs, estimated at $10.9 billion annually. Recent trends by state and race and Hispanic origin are illustrated using the most current available data from the National Vital Statistics System.