CDC: Birth rates falling, with fewer women receiving prenatal care
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Key takeaways:
- The overall number of births in the U.S. declined 2% from 2022 to 2023.
- The percentage of women receiving no prenatal care increased by 5% during the same period.
In the U.S., birth and general fertility rates dropped while the percentage of women receiving no prenatal care rose from 2022 to 2023, according to a recent CDC birth trends report.
Joyce A. Martin, MPH, epidemiologist at the CDC, and colleagues evaluated U.S. birth certificate data for 2022 and 2023 to compare birth rates, general fertility rates and teenage birth rates. The report also analyzed prenatal care initiation by trimester and birth distributions by gestational age.
From 2022 to 2023, the number of births in the U.S. decreased by 2% and the general fertility rate declined by 3%, according to the report. The overall teen birth rate also fell by 6% since 2021.
“The decreasing fertility and birth rates over the past few years is not surprising in the context of the economy and the socioeconomic implications of having children,” Malini Nijagal, MD, MPH, an obstetrician and gynecologist with UCSF Health and Zuckerberg San Francisco General Hospital and Trauma Center, told Healio. “The lack of supportive family-leave policies and high cost of child care can lead people to avoid or delay childbearing until it is financially feasible. In addition, the steady increase in maternity care deserts — areas with no OB/GYNs, midwives or birthing facilities — is undoubtedly also a factor. People will want to avoid pregnancy if they cannot access the care they need to make it safe. In 2022, 36% of U.S. counties were maternity care deserts, a trend being driven mainly by loss of maternity care providers in each area.”
The preterm birth rate did not change from 2022 to 2023; however, the percentage of infants born early term increased by 4% in 2023.
The percentage of women receiving no prenatal care rose by 5%, from 2.2% in 2022 to 2.3% in 2023, consistent with the 5% increase observed from 2021 to 2022.
The percentage of women receiving delayed prenatal care also rose year over year. Prenatal care during the first trimester declined for the second year in a row in 2023, according to the report, falling from 78.3% in 2021 to 76.1% in 2023.
Prenatal care initiation during the second and third trimesters rose by 4% and 2%, respectively. Second trimester prenatal care initiation rose from 16.3% in 2022 to 16.9% in 2023, consistent with the previous 6% increase observed from 2021 to 2022. Third trimester initiation rose from 4.6% in 2022 to 4.7% in 2023, consistent with the previous 10% increase observed from 2021 to 2022.
“The decline in prenatal care access can certainly be explained with the steady increase in maternity care deserts, but I also think is reflective of the overall reduced access to reproductive health care services,” Nijagal told Healio. “This reduced access has undoubtedly increased as a result of Dobbs and will continue to increase if states implement the restrictive abortion bans that we have seen over the past year. The lower birth rates do show that people are able to access the care they need to prevent and manage unintended pregnancy; this is largely because of the expansion of telehealth services, which have allowed people to access abortion and other reproductive health care despite geographical barriers.”
Perspective
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Veronica Gillispie-Bell, MD, MAS
As an obstetrician, I noted the decrease in birth rate before the article was published. We are seeing it in the hospital. I think it is still unclear why the birth rate has decreased. There are some things to consider: The decrease in rates based on these data is among the younger population, those aged 15 to 19 years. This could also be due to increased access to contraception, increased use of long-acting reversible contraception, and/or loss of reproductive options.
The trend in decreased access to prenatal care is concerning. Again, it is unclear why we are seeing this trend, but we are seeing an increase in maternity care deserts — a term defined by the March of Dimes as a county with no obstetrician, no midwife and no obstetric care hospital per 10,000 births. This could be contributing to decreased access to care. Further analysis is needed to determine if these trends are consistent across the entire population or driven by certain geographic areas.
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