Decline in US birth rates shouldn't be viewed as a doomsday prophecy

Decline in US birth rates shouldn't be viewed as a doomsday prophecy
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According to a recent report released by the CDC, fertility rates are down and the age of first-time mother’s has increased. As a high-risk pregnancy doctor who works at one of the busiest labor and delivery units in the country, these facts mirror my daily reality. But contrary to the alarming headlines that are invoking panic in reproductive-aged women across the country, the report’s findings are not necessarily bad news.

In fact, I think they highlight an opposite truth. While there are many factors likely contributing to why the demographics of childbearing are shifting, the most noteworthy — particularly in a period when reproductive autonomy is being threatened — is that women are taking more control over the timing and circumstances of their pregnancies.

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In order to interpret the findings, we have to gauge the magnitude of the changes we are talking about. Specifically, what is an increase in the mean age at first birth? For large metro areas this translates to a change in mean age from 25.9 years to 27.7 years and a change in the fertility rate from 2096 births per 1000 women to 1712 births per 1000 women.

These patterns were consistent across levels of urbanization. However, women in rural areas had higher fertility rates and lower mean age at first birth than those in urban areas. Similarly, there were declines in fertility rate and increases in mean age at first birth for each race and Hispanic origin group. 

Now, lets get to why this report may offer some cause for celebration. An increasing number of women are using more effective contraceptive methods. According to the Guttmacher Institute, the number of women using long-acting reversible contraception has increased from 2002-2012.

This is exciting because the ability to make choices about reproduction has consistently been associated with greater economic empowerment. Additionally, unintended pregnancies are associated with huge toll on society, both in terms of dollars and in terms of public health with increased rates of adverse maternal and child health outcomes. 

Additionally, the report shows that in 2007, 50 percent of non-Hispanic black women in rural areas were having their first child younger than 21. In the decade since then, this average age has increased by nearly two years. This is because there have been dramatic reductions in the teen pregnancy rate and correspondingly, in the teen abortion rate. 

In 2015, the pregnancy rate among 15 to 19-year-olds was at its lowest rate in 80 years. While the reasons for this are not fully elucidated, there is data to indicate that much of the decline can be attributed to increased contraceptive use in this age group. These rates remain higher than other industrialized nations, but the consistent trend is encouraging.

Continued progress in this area is important to pursue because teenage pregnancies are associated with higher rates of growing up in poverty, lower levels of education achievement in both mothers and offspring, and a host of other socioeconomic costs.

Some may worry that an increased age of first motherhood means more dangerous pregnancies. It is important to remember that the statistic describes the average age of first birth, meaning that the majority of births are still occurring in women who are not of advanced maternal age. Furthermore, many women older than 35, have healthy successful pregnancies. While there has been an alarming rise in maternal mortality in the United States, there are many contributing factors including more women with high-risk conditions are becoming pregnant across all age categories. 

The CDC’s report offers another piece of evidence that the investments that have been made in increasing access to and education about reproductive health services to women of all ages have resulted in positive changes. Rather than view it as a doomsday prophecy, the optimistic take is that progress in public health can be achieved with innovative programs and sensible funding.

Priya Rajan, MD is an associate professor in the division of maternal-fetal medicine at Northwestern University.