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

Questions for Danielle Ely, Health Statistician and Lead Author of “Trends in Fertility and Mother’s Age at First Birth Among Rural and Metropolitan Counties: United States, 2007–2017

Q: Why did you decide to look at fertility rates and mother’s age at first birth among rural and metropolitan U.S. counties?

DE: Rural and metropolitan counties have a variety of differences related to general health, birth outcomes, and mortality rates. However, we noticed that recent research did not focus on the overall fertility differences in these areas or maternal age, which can affect birth outcomes. Looking at these items can help us understand why we might see differences between rural and metro counties in births and birth outcomes.


Q: How did the findings vary by race?

DE: Patterns for total fertility rates were similar by race and Hispanic origin. There were higher total fertility rates in rural counties than in metropolitan counties among the three race and Hispanic origin groups in 2007. In 2017, this pattern was the same for non-Hispanic white and Hispanic women, but non-Hispanic black women had higher total fertility rates in small or medium metro counties compared with rural and large metro counties. Hispanic women had the highest total fertility rates for each urbanization level in both 2007 and 2017

Non-Hispanic white, non-Hispanic black and Hispanic women had lower ages at first birth in rural counties compared with both metro county types. This was true in both 2007 and 2017, and differences between county types widened over this time.


Q: How did the findings vary by mean age of mothers at first birth?

DE: Mean age at first birth was lower in rural counties than small or medium metro counties and large metro counties from 2007-2017. Each of the three race and Hispanic origin groups had lower mean age at first birth in rural counties compared with metropolitan counties.


Q: Is there any comparable trend data prior to 2007?

DE: We have not computed trend data on total fertility rates or mean age at first birth by urbanization level prior to 2007.


Q: What is the take home message in this report?

DE: The important message in this report is that there are differences in the fertility rates and mean age at first birth between rural and metro areas, and these differences have gotten larger over time. These trends are generally the same by race and Hispanic origin. Information on differences in birth rates and maternal age by urbanization level can inform decisions on resource allocation and ultimately lead to improvement in infant and maternal health.

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