Timing and Adequacy of Prenatal Care in the United States, 2016

May 30, 2018

Questions for Michelle Osterman, Statistician, and Lead Author of “Timing and Adequacy of Prenatal Care in the United States, 2016

Q: What do you feel was the most significant finding in your analysis?

MO: Overall more than 3 out of 4 women are receiving prenatal care in the first trimester of pregnancy, but this varies by race and Hispanic origin.

Q: Did you find anything surprising about the findings?

MO: The wide variation in first trimester prenatal care between race and Hispanic origin groups among different sources of payment for the delivery (Supplemental Tables 1 and 2).

Q: How has the percentage of mothers who received adequate prenatal care changed over the years?

MO: Trends were not analyzed in this report because 2016 is the first year for which national data on prenatal care is available. Provisional 2017 data show that the percentage of women receiving prenatal care in the first trimester increased to 77.3%

Q: Do you have any insight as to why some groups of women seem to be less likely to have at least adequate prenatal care and/or start their care in the first trimester?

MO: Differences in utilization and initiation may be due to differences in access and resources.

Q: What is the take-home message from your report?

MO: Healthy People 2020, a set of national health objectives for the country, includes a goal for prenatal care.  The goal for 2020 is for 77.9% of pregnant women to receive prenatal care in the first trimester of pregnancy, a target only about 1% higher than the national level of 77.1% we are reporting in this analysis. This target may be achievable for the United States as a whole, but may be less achievable for certain subgroups.

Births: Provisional Data for 2017

May 17, 2018

Questions for Brady E. Hamilton, Ph.D., Demographer, Statistician, and Lead Author of “Births: Provisional Data for 2017

Q: What did you think was the most interesting finding in your new analysis?

BH: The report includes a number of very interesting findings. The general fertility rate, 60.2 births per 1,000 women aged 15–44, declining 3% in 2017 and reaching a record low is certainly noteworthy. In addition, the continued decline in the birth rate for teens, down 7% from 2016 to in 2017, and reaching another record low, is very significant. The increase in the cesarean delivery rate following several years of decline is noteworthy as are the recent increase in rates of preterm and low birthweight births.

Q: Why does fertility keep going down in the U.S.?

BH: In general, there are a number of factors associated with fertility. The data on which the report is based comes from the birth certificates registered for births in the U.S. While the scope of this data is essentially all births in the country, and provides detailed information about rare events, small areas, or small population groups, the data does not provide information about the parent’s decision to have (or not have) a child. And so, accordingly, we cannot examine the “why” of the changes and trends in births.

Q: Does the decline in the Total Fertility Rate essentially mean fertility is down below “replacement” levels?  Could you explain this in general terms?

BH: “Replacement” refers to a minimum rate of reproduction necessary for generation to exactly replace itself, that is, enough children born to replace a group of 1,000 women and their partners. For the total fertility rate, this rate is generally considered to be 2,100 births per 1,000 women. In 2017, the total fertility rate, 1,764.5 births per 1,000 women, was below replacement.

Q: Do the increases among women over 40 suggest a “new norm” in people waiting till much later to have children?

BH: Birth rates for women aged 40-44 and 45-49 years have increased generally over the last 3 decades. Given this, it reasonable to expect this trend to continue.

Q: Are the annual declines in teen pregnancy something that we are in danger of taking for granted?

BH: The birth rate for females aged 15-19 has decreased 8% per year from 2007 through 2017. For comparison, the decline in the birth rates for women aged 20-24 and 25-29 was 4% and 2% from 2007 through 2017. The decline in teen births is very noteworthy.

Q: Can you explain how the increases in preterm births and low birthweight are connected?

BH: Infants born preterm are also often, but not exclusively, born low birthweight and vice-versa.  The causes of the recent upward shift in these rates are not well understood.

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

April 25, 2018

TJ Mathews, NCHS Demographer

Questions for T.J. Mathews, M.S., Demographer, Statistician, and Lead Author of “Declines in Births to Females Aged 10–14 in the United States, 2000–2016

Q: Why did you decide to examine trends in births to females aged 10-14 in the U.S.?

TM: We have published data on births to females aged 10-14 for decades but only once before have we published data specific to this group. We decided this significant decline was noteworthy and needed publishing.

Q: How have U.S. birth rates to females ages 10-14 changed since 2000?

TM: The birth rate to females aged 10-14 in the U.S. has declined 78% from 0.9 per 1,000 in 2000 to 0.2 in 2016.

Q: What differences or similarities did you see among race and Hispanic origins in this analysis?

TM: From 2000 to 2016, all groups observed declines in the birth rate for this age group. The largest decline was seen for non-Hispanic black females, a decline of 79%. This group had the highest rate in both time periods.

Q: Is there any comparable trend data on U.S. births to females aged 10-14 older than 2000?

TM: While we didn’t study trends in birth rates to 15-19 year olds in this publication we have been reporting significant declines for this age group over this time period.

Q: Were there any surprises in the findings from this report?

TM: First is the wide range of birth rates for this age by state. Using 2014 to 2016 combined the highest rate was seen in Mississippi, 0.7 per 1,000 while a handful of states had rates as low as 0.1. A second interesting observation is that the majority,  81%, of births to 10-14 years old occurred to those 14 years old.

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

TM: Birth and birth rates to females aged 10-14 in the U.S. have declined significantly since 2000.  Disparities by race and Hispanic origin and by state persist.

Fact or Fiction: Are Asian mothers are less likely to be unmarried at the time they give birth than mothers of other race/ethnicities in the U.S.?

April 18, 2018

Source: National Vital Statistics Reports, Volume 67, Nos. 1 and 2



Asian American Mothers: Maternal Characteristics by Maternal Place of Birth and Asian Subgroup, United States, 2016

April 18, 2018

Questions for Anne K. Driscoll, Ph.D., Statistician and Lead Author of “Asian American Mothers: Maternal Characteristics by Maternal Place of Birth and Asian Subgroup, United States, 2016

Q: What do you feel was the most interesting finding in your report?

AD: Although Asian mothers as a groups differ from other mothers on the characteristics analyzed, they are a heterogeneous group; birthplace and Asian subgroup are key sources of that heterogeneity.

Q: What countries of origin do Asian-Indian mothers come from?

AD: Asian Indian refers to people from India (i.e., to distinguish between people from India and Native Americans/ American Indians).

Q: How do we explain the significant difference between unmarried childbearing among Asian women vs. the rest of the U.S.?

ADIt is likely that the difference is related to differences in educational attainment and maternal age between Asian women and other women, as well as to other factors not measured here.

Q: How do the high education levels among Asian mothers compare to U.S. mothers of other races?

ADAsian mothers have the highest education levels of any race/Hispanic origin group; the percent with at least a bachelor’s degree is roughly 50% higher than that of non-Hispanic white mothers, the group with the second highest education level.

Q: Any other significant findings you’d like to mention about your study?

ADAsian mothers, both those born in and outside the US, were more likely to be age 30 and over and less likely to be teen mothers than other groups.

Cigarette Smoking During Pregnancy: United States, 2016

February 28, 2018

Questions for Patrick Drake, Health Statistician and Lead Author of “Cigarette Smoking During Pregnancy: United States, 2016.”

Q: Why did you decide to examine smoking during pregnancy?

PD: Questions on tobacco use during pregnancy were first introduced on the US certificate of live birth in 2003, but not all states reported that information until 2016. NCHS’s 2016 natality file provides the first look at nationally representative rates of smoking during pregnancy in the United States from vital statistics data.

Q: Has the National Vital Statistics System ever examined cigarette smoking during pregnancy in the past?

PD: NCHS produced a report on the topic using data from the National Vital Statistics System in 2016. That report presents levels of smoking during pregnancy as well as smoking cessation rates in 46 states and the District of Columbia for 2014.

Q: What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

PD: Smoking rates varied widely by state, maternal age, race and Hispanic origin, and by maternal education:

  • Women in West Virginia smoked during pregnancy about five times as often as women in the States with the lowest smoking rates.
  • Non-Hispanic white women smoked during pregnancy nearly six times as often as Hispanic women, and nearly twice as often as non-Hispanic black women.
  • While less than 1.0% of women with a bachelor’s degree or higher smoked during pregnancy, 12.2% of women with a high school diploma or GED smoked during pregnancy.

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

PD: It has been well established that maternal tobacco use during pregnancy is linked to a host of negative infant and child outcomes.  Despite the well-understood risk to mother and child, still about one of every 14 women in the United States smoked during pregnancy. These levels do vary widely by state, maternal age, race and Hispanic origin, and education, but any amount of smoking during pregnancy is too much. These data can be used to better identify which women might be at greater risk of smoking during pregnancy and better inform future preventative strategies.

Births: Final Data for 2016

January 31, 2018

Questions for Joyce A. Martin, M.P.H., Demographer, Statistician, and Lead Author on, “Births: Final Data for 2016.”

Q: Are there any data that are new in this report compared with previous annual final birth reports?

JM: Yes!  This report includes new national data on a number of items including prenatal care utilization in the US, whether the mother received WIC food during pregnancy, cigarette smoking before and during pregnancy, maternal body mass index of overweight or obese, primary cesarean and vaginal birth after previous cesarean delivery and source of payment for the delivery.

Q: Is the U.S. birth rate going up or down in 2016?

JM: Both the number of births and the general fertility rate (births per 1,000 women aged 15-44) declined in the US from 2015 to 2016.

Q: Are teen births in the U.S. continuing to decline?

JM: Yes, the teen birth rate declined 9% from 2015 to another record low.

Q: What did the findings show for the mean age of U.S. mothers at first birth?

JM: The 2016 mean or average age of mothers having a first birth was a record high in 2016, at 26.6 years.

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

JM: Births are down overall and among women 15 to 29 years of age.  The cesarean delivery rate continued to decline but rates of preterm birth and low birthweight are on the rise.  Birth certificate data are a rich source for important information on mothers and their newborns.