Births: Final Data for 2022.

Objectives- This report presents 2022 data on U.S. births by selected characteristics. Trends in fertility patterns and maternal and infant characteristics are described. Methods-Descriptive tabulations based on birth certificates of the 3.67 million births registered in 2022 are shown by maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates also are shown. Trends for 2010 to 2022 are presented for selected items, and by race and Hispanic origin for 2016-2022. Results-A total of 3,667,758 births occurred in the United States in 2022, essentially unchanged from 2021. The general fertility rate declined 1% from 2021 to 56.0 births per 1,000 females ages 15-44 in 2022. The birth rate for females ages 15-19 declined 2% from 2021 to 2022; birth rates fell 7% for women ages 20-24, rose 1% to 5% for women ages 25-29 and 35-44, and rose 12% for women ages 45-49 (the first increase since 2016). The total fertility rate declined less than 1% to 1,656.5 births per 1,000 women in 2022. Birth rates declined for unmarried women but increased for married women from 2021 to 2022. Prenatal care beginning in the first trimester declined to 77.0% in 2022; the percentage of women who smoked during pregnancy declined to 3.7%. The cesarean delivery rate was unchanged in 2022 (32.1%); Medicaid was the source of payment for 41.3% of births. The preterm birth rate declined 1% to 10.38%; the low birthweight rate rose 1% to 8.60%. The twin birth rate was unchanged in 2022 (31.2 per 1,000 births); the 2% decrease in the triplet and higher-order multiple birth rate.

Births in the United States, 2022.

This report presents selected highlights from 2022 final birth data on key demographic, healthcare utilization, and infant health indicators. The number of births, general fertility rates (GFRs) (births per 1,000 females aged 15-44), age-specific birth rates (births per 1,000 women in specified age group), and cesarean delivery and preterm (less than 37 weeks of gestation) birth rates are presented. Results for 2020, 2021, and 2022 are shown for all births to describe changes in birth patterns during the COVID-19 pandemic years (1,2). Cesarean and preterm birth rates are shown for select race and Hispanic-origin groups.

Births: Final Data for 2021.

Objectives-This report presents 2021 data on U.S. births according to a variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

Births in the United States, 2021.

This report presents selected highlights from 2021 final birth data on key demographic, healthcare use, and infant health indicators. The number of births, general fertility rates (GFRs) (births per 1,000 females aged 15-44), age-specific birth rates (births per 1,000 females in specified age group), vaginal birth after cesarean (VBAC) delivery rates, and preterm (less than 37 weeks of gestation) birth rates are presented. Results for 2019, 2020, and 2021 are shown for all births to provide context for changes in birth patterns noted during 2020, the first year of the COVID-19 pandemic (1,2). VBAC and preterm birth rates are shown for the three largest race and Hispanic-origin groups: non-Hispanic White, non-Hispanic Black, and Hispanic.

Births in the United States, 2020.

This report presents selected highlights from 2020 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (births per 1,000 women aged 15-44), age-specific birth rates (births per 1,000 women in specified age group), low-risk (nulliparous, term, singleton, cephalic births) cesarean delivery, and preterm (less than 37 weeks of gestation) birth rates are presented. All indicators are compared between 2019 and 2020 and shown for all births. General fertility rates (GFRs), lowrisk cesarean and preterm birth rates are shown for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic. Fertility rates are shown by age of mother.

2021Total Fertility Rates, by Maternal Educational Attainment and Race and Hispanic Origin: United States, 2019.

Objective-This report presents 2019 total fertility rates for the United States, by educational attainment and race and Hispanic origin of mother. Methods-Descriptive tabulations of the total fertility rate by educational attainment of mother for the United States are presented and described. The total fertility rate is the average number of children a group of women would expect to have at the end of their reproductive lifetimes. Data are based on the 2003 revision of the U.S. Standard Certificate of Live Birth. Results-In 2019, the U.S. total fertility rate (TFR) for all women aged 15-49 was 1,705 expected births per 1,000 women. TFRs decreased as level of education increased from women with a 12th grade education or less through an associate's and bachelor's degree, and then rose from bachelor's degree through a doctorate or professional degree. Among the race and Hispanic-origin groups, TFRs were highest for Hispanic women (1,939), followed by non-Hispanic black (1,774) and non-Hispanic white (1,610) women. Rates generally declined from the lowest educational level through a bachelor's degree for non-Hispanic white women, and through an associate's degree for Hispanic women, and then generally rose for both groups for women with advanced degrees. TFRs for non-Hispanic black women declined by educational level through a master's degree. Across the race and Hispanic-origin groups, the lowest TFR by educational level was for non-Hispanic black women with a master's degree (1,038), and the highest was for Hispanic women with a 12th grade education or less (3,025). TFRs for non-Hispanic black and Hispanic women with some college credit or less were generally higher than the rates for non-Hispanic white women, but TFRs for non-Hispanic black and Hispanic women with a master's degree or more were generally lower than the rates for non-Hispanic white women.

Births: Final Data for 2019.

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. 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 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.

Births in the United States, 2019.

This report presents selected highlights from 2019 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 women aged 15-44), prenatal care timing (the percentage of mothers with first trimester care), source of payment for the delivery (the percentage of births covered by Medicaid), and preterm birth rates are presented. All indicators are compared between 2018 and 2019 and are presented for all births and for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic.

State Teen Birth Rates by Race and Hispanic Origin: United States, 2017-2018.

Objectives-This report presents changes in state-specific birth rates for teenagers between 2017 and 2018 by race and Hispanic origin of mother. Methods-Data are from birth certificates of the 50 states and the District of Columbia (D.C.). Teen birth rates, the number of births to females aged 15-19 per 1,000 females aged 15-19, are shown by state for all births and for non-Hispanic single-race white, non-Hispanic single-race black, and Hispanic females for 2017 and 2018. Results-Birth rates for females aged 15-19 declined in 38 states between 2017 and 2018; nonsignificant declines were reported in eight additional states and D.C. Among non-Hispanic white teenagers, rates declined in 29 states between 2017 and 2018; nonsignificant declines were reported in 16 additional states. Teen birth rates for non-Hispanic black females declined in 10 states between 2017 and 2018; nonsignificant declines were seen in 21 additional states and D.C. For Hispanic teenagers, birth rates declined in 10 states between 2017 and 2018; nonsignificant declines were reported in 30 additional states and D.C. The magnitude of change between 2017 and 2018 varied by state for each race and Hispanic-origin group.

Births in the United States, 2018.

This report presents selected highlights from 2018 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 women aged 15-44) and teen birth rates are presented. Also shown are the distribution of births with a previous cesarean delivery (vaginal births after previous cesarean [VBAC] and repeat cesarean delivery) and the distribution of births by gestational age. All indicators are compared between 2017 and 2018 and are presented for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic.

Educational Attainment of Mothers Aged 25 and Over: United States, 2017.

Maternal education has been shown to be associated with the number of children a woman has during her childbearing years, as well as maternal and infant health (1-5). Using 2017 national birth certificate data, this report describes educational attainment of mothers aged 25 and over, overall and by race and Hispanic origin and state, and the mean numbers of live births by mothers' educational attainment.

Total Fertility Rates by State and Race and Hispanic Origin: United States, 2017.

Objectives-This report presents 2017 total fertility rates by state of residence and race and Hispanic origin of mother for the United States. Methods-Data are from birth certificates of the 50 states and the District of Columbia. Total fertility rates, the expected number of lifetime births per 1,000 women given current birth rates by age, are shown by state for all births, and for non-Hispanic single-race white, non-Hispanic single-race black, and Hispanic women for 2017. Results-Total fertility rates varied by state for each race and Hispanic-origin group. In 2017, South Dakota (2,227.5) had the highest total fertility rate of the 50 states and the District of Columbia; the District of Columbia had the lowest (1,421.0). For non-Hispanic white women, the highest total fertility rate was in Utah (2,099.5) and the lowest in the District of Columbia (1,012.0). Among non-Hispanic black women, the highest total fertility rate was in Maine (4,003.5) and the lowest in Wyoming (1,146.0) along with California (1,503.5), Connecticut (1,575.5), Montana (1,641.0), New Mexico (1,651.0), New York (1,574.5), Rhode Island (1,594.0), and West Virginia (1,579.5). For Hispanic women, the highest total fertility rate was in Alabama (3,085.0) and the lowest in Vermont (1,200.5) and Maine (1,281.5).

Births: Final Data for 2018.

Objectives-This report presents 2018 data on U.S. births according to a wide variety of characteristics. 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 3.79 million births that occurred in 2018 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010 through 2018 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2018. Results-3,791,712 births were registered in the United States in 2018, down 2% from 2017. Compared with rates in 2017, the general fertility rate declined to 59.1 births per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 7% in 2018. Birth rates declined for women aged 20-34 and increased for women aged 35-44. The total fertility rate declined to 1,729.5 births per 1,000 women in 2018. Birth rates for both married and unmarried women declined from 2017 to 2018. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.5% in 2018; the percentage of all women who smoked during pregnancy declined to 6.5%. The cesarean delivery rate decreased to 31.9% in 2018 following an increase in 2017. Medicaid was the source of payment for 42.3% of all 2018 births, down 2% from 2017. The preterm birth rate rose for the fourth straight year to 10.02% in 2018; the rate of low birthweight was unchanged at 8.28%. Twin and triplet and higher-order multiple birth rates declined in 2018 (Figure 1).

Trends in Fertility and Mother's Age at First Birth Among Rural and Metropolitan Counties: United States, 2007-2017.

Since the most recent peak in the total fertility rate (the estimated number of lifetime births expected per 1,000 women) in 2007, the United States has experienced a decreasing total fertility rate and an increasing mean, or average, age of mothers at first birth (1-4). Previous research shows rural areas have persistently higher fertility and worse birth outcomes compared with metropolitan (metro) areas (2,5-8). This report describes trends and differences in total fertility rates and mean maternal age at first birth overall, and by race and Hispanic origin, between rural and small or medium metro, and rural and large metro counties, from 2007 through 2017.

Births in the United States, 2017.

This report presents selected highlights from 2017 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 females aged 15-44 years) and teen birth rates are presented by race and Hispanic origin. The use of Medicaid as the source of payment for the delivery and preterm birth rates are presented by the age of the mother. Data for 2017 are compared with 2016 for each indicator.

Declines in Births to Females Aged 10-14 in the United States, 2000-2016.

The birth rate for teen mothers aged 15-19 declined 57% from 2000 through 2016. During this time, the rate for young adolescent mothers aged 10-14 also declined. Childbearing by very young mothers is a matter of public concern because of the elevated health risks for these mothers and their infants and the socioeconomic consequences. This report describes recent trends and variations in births to young mothers aged 10-14 by race and Hispanic origin and state.

Births: Final Data for 2016.

This report presents 2016 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 3.95 million births that occurred in 2016 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010-2016 are presented for selected items. A total of 3,945,875 births were registered in the United States in 2016, down 1% from 2015. Compared with rates in 2015, the general fertility rate declined to 62.0 per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 9% in 2016. Birth rates declined for women in their 20s but increased for women intheir 30s and early 40s. The total fertility rate declined to 1,820.5 births per 1,000 women in 2016. The birth rate for unmarried women declined, while the rate for married women increased. More than three-quarters of women began prenatal care in the firsttrimester of pregnancy (77.1%) in 2016, while 7.2% of all women smoked during pregnancy. The cesarean delivery rate declined for the fourth year in a row. Medicaid was the source of payment for 42.6% of all 2016 births. The preterm birth rate rose for the second straight year, and the rate of low birthweight increased 1%. Twin and triplet and higher-order multiple birth rates declined, although the changes were not statistically significant.

National Center for Health Statistics Guidelines for Analysis of Trends.

Many reports present analyses of trends over time based on multiple years of data from National Center for Health Statistics (NCHS) surveys and the National Vital Statistics System (NVSS). Trend analyses of NCHS data involve analytic choices that can lead to different conclusions about the trends. This report discusses issues that should be considered when conducting a time trend analysis using NCHS data and presents guidelines for making trend analysis choices. Trend analysis issues discussed include: choosing the observed time points to include in the analysis, considerations for survey data and vital records data (record level and aggregated), a general approach for conducting trend analyses, assorted other analytic issues, and joinpoint regression. This report provides 12 guidelines for trend analyses, examples of analyses using NCHS survey and vital records data, statistical details for some analysis issues, and SAS and SUDAAN code for specification of joinpoint regression models. Several an lytic choices must be made during the course of a trend analysis, and the choices made can affect the results. This report highlights the strengths and limitations of different choices and presents guidelines for making some of these choices. While this report focuses on time trend analyses, the issues discussed and guidelines presented are applicable to trend analyses involving other ordinal and interval variables.

Births: Final Data for 2017.

Objectives-This report presents 2017 data on U.S. births according to a wide variety of characteristics. 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 3.86 million births that occurred in 2017 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010 to 2017 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016 and 2017. Results- A total of 3,855,500 births were registered in the United States in 2017, down 2% from 2016. Compared with rates in 2016, the general fertility rate declined to 60.3 births per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 7% in 2017. Birth rates declined for women in their 20s and 30s but increased for women in their early 40s. The total fertility rate declined to 1,765.5 births per 1,000 women in 2017. Birth rates for both married and unmarried women declined from 2016 to 2017. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.3% in 2017; the percentage of all women who smoked during pregnancy declined to 6.9%. The cesarean delivery rate increased to 32.0% following 4 years of declines. Medicaid was the source of payment for 43.0% of all births in 2017, up 1% from 2016. The preterm birth rate rose for the third straight year, as did the rate of low birthweight. Twin and triplet and higher-order multiple birth rates were essentially stable in 2017.

Births in the United States, 2016.

This report presents several key demographic and maternal and infant health indicators using 2016 final birth data. Trends in the general fertility rate (the number of births per 1,000 women aged 15­44), age-specific birth rates, cesarean delivery, preterm, and triplet and higher-order multiple birth rates are presented by age of mother. For each indicator, data for 2016 are compared with 2015, and also with a year representing a recent high or low rate.