News Maternity and Birthing

Birthrates Stabilize Overall, but Teen Births Reach Yet Another Record Low

Martha Kempner

Good news from the preliminary birthrate data for 2012: Teen births are down to yet another historic low, births to women in their early 20s also fell to an all-time low, the rate of cesarean sections is stabilizing after years of increasing, and fewer babies were born preterm or at low birth weight.

The National Center for Health Statistics released preliminary data for 2012 on births in the United States. While the overall birthrate did not change from the year before, the report found that the rates are stabilizing after years of decline. The report has a lot of other good news: Teen births are down to yet another historic low, births to women in their early 20s also fell to an all-time low, the rate of cesarean sections is stabilizing after years of increasing, and fewer babies were born preterm or at low birth weight. Specifically, the report, which is based on birth certificates filed in 2012, found:

Overall Births

  • There were 3,952,937 babies born in the United States in 2012. This is similar to the number of births in 2011, but marks a change from previous years, as the number of births declined steadily between 2007 and 2010.
  • The number of births to non-Hispanic Black women as well as American-Indian or Alaska Native women was unchanged, while births to non-Hispanic white and Hispanic women were down slightly at 1 percent. In contrast, births to Asian or Pacific Islander women rose by 7 percent.
  • The general fertility rate was down slightly (1 percent) from the previous year, dropping to a record low of 63 births per 1,000 women ages 15 to 44.

Births to Teenagers

  • The birthrate to teenagers fell 6 percent from 2011, reaching a new historic low of 29.4 births per 1,000 teenage women ages 15 to 19. Overall, the rate has dropped more than half since its high of 61.8 per 1,000 teenage women in 1991 and by a third since 2007 when it was at 41.5 per 1,000 teenage women.
  • In 2012, there were 305,420 births to teenage women ages 15 to 19; this is the fewest births to this age group since the end of World War II.
  • Births to younger teens fell 8 percent to just 14.1 births per 1,000 teen women ages 15 to 17. This represents a 63 percent decline since 1991. Rates for older teens fell by 5 percent to 51.4 births per 1,000 teen women ages 18 and 19. This represents a 45 percent decline since 1991.
  • Birthrates fell among teenage women ages 15 to 19 in all ethnic and racial groups between 2011 and 2012.
  • The birthrate among Hispanic teenagers has dropped the most since 2007 (39 percent), to 46.3 births per 1,000 in 2012.
  • The birthrate for women ages 20 to 24 has been falling by about 5 percent each year since 2007. Between 2011 and 2012, the birthrate to women in their early 20s dropped 3 percent, to 83.1 births per 1,000 young women, which represents another historic low for the nation.

Health Outcomes

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  • In 2012, 32.8 percent of newborns were delivered via c-section. This rate is unchanged since 2010, but follows more than a decade of steady increase—the c-section rate rose nearly 60 percent between 1996 and 2009.
  • The rate of cesarean delivery, however, was not the same across racial and ethnic groups. While it declined for the third consecutive year among non-Hispanic white women, the rates among non-Hispanic Black and Hispanic women were at the highest levels reported since 1989 (the first year for which data on this was collected).
  • In 2012, 11.54 percent of births were considered preterm, meaning that the infant was delivered at less than 37 weeks’ gestation. This represents a 2 percent decline from 2011 and a 10 percent decline form 2006. Before that—between 1981 and 2006—the percent of babies born preterm rose by more than a third.
  • Though the preterm birthrates differs by ethnic and racial groups, no groups experienced a rise between 2011 and 2012. Rates were “essentially stable” for Hispanic and American-Indian/Alaska Native infants and fell for non-Hispanic white, non-Hispanic Black, Black, and Asian or Pacific Islander infants.
  • The rate of preterm births among Black infants is higher than in other ethnic groups, at 16.53 percent in 2012, but still represents an all-time low since this data began being collected in 1981.
  • In 2002, 7.99 percent of babies were considered low birthweight (born at less than 5 pounds, 8 ounces). This represents a 1 percent decline from 2011 and 3 percent decline from the 2006 peak of 8.26 percent.

The data cannot explain why birthrates are dropping in general or among particular groups, but public health experts, demographers, and economists have suggested numerous possible reasons. Public health experts point to increased use of birth control and, in particular, increased use of better methods of contraception such as intrauterine devices (IUDs) and contraceptive implants, which have very low failure rates. Economists add that financial struggles and joblessness have also played a role in individual’s decisions about starting or increasing the size of their families.

John Santelli, a professor at Columbia University‘s school of public health told NBC News that a combination of factors likely affected these numbers. “People are starting families later and later, and these are historical changes and happening worldwide,” he said. “The last downturn in the economy has accelerated the trend.”

Some demographers, however, think that the birthrates have bottomed out and will climb again soon. Sam Sturgeon, president of Demographic Intelligence, said in a statement, “We think that this fertility decline is now over. As the economy rebounds and women have the children they postponed immediately after the Great Recession, we are seeing an uptick in U.S fertility.” And, Kenneth Johnson, a demographer at the University of New Hampshire, told CNN Money, “In the 2012 data, you’re seeing what women were thinking about in 2011. If the economy were to be picking up now, you’re not seeing that in the birth patterns yet. It will be another year until you’ll see the effect of that.”      

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.

Commentary Maternity and Birthing

What My First Pregnancy Taught Me About Birth Justice

Ruth Jeannoel

The medical community needs to do more to support women of color, particularly Black women, who must confront a number of hurdles in order to have a vaginal birth after cesarean.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

After discovering I was pregnant for a second time, I had concerns that my previous cesarean section would keep me from having a vaginal birth. But what I learned after speaking with medical professionals and reading up on vaginal birth after cesarean (VBAC) is that it is possible, with the appropriate resources. I also came to realize that the medical community needs to do more to support women of color, particularly Black women, who must confront a number of hurdles in order to have a VBAC.

All across the country there has been an injection of #BlackLivesMatter in our decades-long Black liberation movement, and reproductive justice, including birth justice, is a critical part of those efforts. Birth justice includes making sure Black moms have full control of their own health and birth process through proper childbirth education and community resources.

It was around 9:30 p.m. on October 22, 2008, when I began to have contractions and I went to the hospital. I was about 32 weeks into my first pregnancy, which was well before my “safe period” of 37 weeks, which in 2008 was described as the stage when the fetus has fully developed. (The “safe period” has since changed to 39 weeks.) Within six hours of labor I developed preeclampsia, which is a pregnancy condition affecting as many as 8 percent of all pregnancies and can be deadly for Black women.

At about 10:30 p.m., the doctors explained I would need an emergency cesarean or else I could lose the little one I had been carrying.

I was scared: At the age of 21, I had to have major surgery.

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The nurses quickly changed my gown, gave me an epidural, and moved me from my hospital room to surgery. I kept thinking about how I didn’t want any of this, because I wanted to give birth naturally and without any pain relief medication, but it sounded so urgent. It sounded like I needed to really have a cesarean for both my safety and the health of my baby. And so on October 22 at 11:59 p.m. I had a c-section.

C-section rates are declining in the United States, but Black women continue to have them more frequently than their white counterparts. According to 2014 data from the Centers for Disease Control and Prevention, the cesarean delivery rate “declined for non-Hispanic white women for the fifth consecutive year, down 2% from 32.0% in 2013 to 31.4% in 2014 and 4% from the 2009 peak. Rates declined 1% for both non-Hispanic black (from 35.8% to 35.6%) and Hispanic women (32.3% to 31.9%). For the second year in a row, non-Hispanic white women had the lowest cesarean delivery rate; non-Hispanic black women continued to have the highest rate.”

Throughout my pregnancy I saw a midwife at a birth center, who ultimately was not with me when I developed preeclampsia and had to go under the knife. I felt disempowered because everything happened so fast and it seemed as if all of the decisions were made for me.

After the surgery, my family and close friends were glad that the baby and I were both safe. But beneath their concern for our safety I could see there was an underlying stigma around having a cesarean birth. Even though the c-section was not planned, I would get looked down on as if I wasn’t “woman enough” because I didn’t have a vaginal birth. I felt ashamed and didn’t know how to share my birth story because in a way I had lost decision-making control over it. I was unprepared to deal with the stigma that was attached with having a c-section.

A couple years after having my first child, I began to have a different understanding of what reproductive justice is and began to reflect more on what it would look like in my own life. SisterSong Women of Color Reproductive Justice Collective describes reproductive justice as, “the human right to have children, not have children, and parent the children we have in safe and healthy environments.”

During that period between my two pregnancies, after having more conversations with other mothers and hearing different birth stories, I began to understand that what I was attempting to deal with wasn’t about vaginal birth vs. cesarean birth; it was about women having the bodily autonomy to make their own decisions. I told myself that if I ever got pregnant again, I would make sure that I had all the necessary information to ultimately decide how my birth went: I would do everything in my power to have a vaginal birth. For example, had I known in advance that I may be susceptible to preeclampsia, I would have looked into methods to lower the risks of complications.

While telling everyone who asked (or didn’t) that I would have a vaginal birth, I ran into several myths. The main one was that you can’t have a vaginal birth after c-section. It just didn’t make sense to me because I knew that birthing was a natural process, meaning that I needed to trust my body and know that every pregnancy was different and that my body could handle a vaginal birth.

At that point I had a lot more questions than answers.

I began reading and asking my OB-GYN about vaginal births and she described the risks and benefits of having a VBAC and emphasized that it was very possible. And she, of course, was right.

As research from the National Institutes of Health explains, “VBAC is a reasonable and safe choice for the majority of women with prior cesarean.” The American College of Obstetricians & Gynecologists (ACOG) agrees, adding that “most” women with one prior cesarean and “some” women with two prior cesareans are candidates for VBAC.

The main problem a woman seeking to have a VBAC might encounter, I found during my research, was a potential uterine rupture. However, a report published in the Obstetrics & Gynecology medical journal found:

Despite increased rates of VBAC attempt and VBAC failure among black women as compared with other racial groups, black women are significantly less likely to experience a uterine rupture. It is unclear whether this discrepancy in magnitudes of risks and benefits across race associated with VBAC trials is attributable to selection bias or inherent racial differences.

My research helped me to better understand that the risks associated with a VBAC weren’t as high as I thought.

When I found out that I was pregnant five years later, I moved forward with my plan to have a VBAC. By that time I had moved to another state, and VBACs were not as common or accessible in Florida as they were in Massachusetts.

I quickly learned that not every OB-GYN I encountered performs VBACs. In South Florida, I had only three doctors to choose from. With help from my doula, I was able to find the right one and a hospital where VBAC was an option.

Unfortunately, in Black communities, not everyone may have access to doctors who do VBAC. Because of the higher risk of uterine rupture, many hospitals, especially in low-income communities of color, are not able to make this accommodation. Also, I found that doctors often do not promote VBACs; therefore, many women who may want to have one may not know that such an option exists.

In 2014, at 37 weeks, I was able to have a successful VBAC and give birth to my second born. I was proud of myself that I was able to have a vaginal birth under my own terms in a hospital room with an amazing team of doctors.

It’s important to dispel the myth that you can’t have a vaginal birth after a previous c-section. Doctors and the medical community have a responsibility to make sure that all women have the appropriate information to make an informed decision over their body. It will always be a woman’s right to choose how she wants to have her child, and where she wants to have her child if her local hospital doesn’t offer the services she requires.