U.S. fertility rate drops, as does prenatal care

The number of births in the U.S. and the fertility rate both declined from 2022 to 2023. And for the second year in a row, so did prenatal care in the first trimester of pregnancy, including a growing share of mothers who got no prenatal care at all.
That’s according to the final count for 2023 from the National Center on Health Statistics within the Centers for Disease Control and Prevention, released Tuesday.
The fertility rate is the number of births per 1,000 females of childbearing age, 15 to 44.
The report also noted that the preterm birth rate (before 37 completed weeks of gestation) didn’t change, but 3 in 10 babies were born at 37 to 38 weeks gestation.
According to the report, 3,596,017 births were recorded in the United States, down 2% from 2022 and 2021. The general fertility rate dropped 3% to 54.5 births per 1,000 females ages 15-44, which is considered child-bearing age.
The birth rate for teens ages 15-19 continued to fall, this time by 4% from 2022 to 13.1 births per 1,000 females. That number was down 6% compared to 2021. The biggest change (a 5% drop) was among teens 18-19. Among those 15-17, the birth rate declined 2%.
Compared to the most recent highest number of births, in 2007, that’s a 17% decrease in births and a 21% drop in the fertility rate.
Just over three-fourths of pregnancies involved prenatal care in the first trimester, but the share was 1% lower than in 2022, which itself was 2% lower than in 2021. Care starting in the second trimester increased 4% in 2023 to 16.9%.
The report said that 5.7% of prenatal care began in the third trimester. And 2.3% of pregnancies included no prenatal care at all.
According to the report, 10.41% of babies were born preterm, delivered before 37 weeks, which was essentially unchanged from 2022. The share born early term — at 37-38 weeks gestation — rose 2% to 29.85% from 2022 to 2023, after a 4% increase from 2021. Meanwhile, the share born late or post-term (after 40 weeks gestation) was 4.82% in 2023, down from 4.99% in 2022.
Birth rates are dropping in most countries, including the United States, where the total fertility rate is now 1.62 births per woman, using 2023 data. The replacement rate, which is the rate at which the population size is stable, is 2.1. Some countries, including Hong Kong and South Korea, are now well below 1. Others, including Italy and Japan, hover around 1.2 children per woman.
As Deseret Magazine reported recently, “Demographers are now projecting that nearly every country outside of sub-Saharan Africa will soon be failing to replace their people. This will, in turn, leave them struggling with an inverted pyramid of care as fewer working people will pay into public programs that support aging populations who are living longer.”
The journal The Lancet predicts the global fertility rate will drop from 2.2 in 2021 to 1.6 in the year 2100.
In the 2021 report “More Work, Fewer Babies: What Does Workism Have to Do with Falling Fertility,” Institute for Family Studies senior fellow Laurie DeRose and research fellow Lyman Stone argued that work-focused personal values could put what they call “workism” and “familism” at odds. The two words indicate whether a person derives their sense of identity primarily from their career or from their family roles.
The two said that for policymakers concerned about the economic and other future impacts of stalled fertility, programs that support work are less helpful than “policies that help families function regardless of whether, for example, both partners work or one parent stays home with the children,” per Deseret News coverage of the report.
“The ramifications of letting fertility slide could be dire, experts have said, from too few skilled workers for a robust economy to more people needing help than workers to support the programs designed to provide the help. Predictions include everything from reduced Social Security payments to school closures and a housing market where nothing moves,” the article said.