4% drop in U.S. birth rate is largest in 3 decades

Birth rates nationwide declined by 4% on average between 2007 and 2009, reaching 66.7 births per 1,000 women age 15 to 44, according to a federal report. This is the biggest decrease in more than 30 years.

Rates dropped most sharply in the West and Southeast, and among Hispanic women and younger women, according to the report. Birth rates decreased by 9% for Hispanic women and 9% for women age 20 to 24. The study was released March 29 by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention.

Although the CDC report does not link the decline to the most recent economic recession, other studies have. For example, the Pew Research Center concluded in an April 2010 analysis that there was a strong correlation between the decline in birth rates between 2007 and 2008 and the economic downturn in states.

Older women bucked the national trend. Birth rates for women 40 to 44 increased 6% between 2007 and 2009 to reach 10.1 per 1,000 women. Improved in vitro fertilization techniques could be giving these women more options, said George Macones, MD, chair of the Dept. of Obstetrics and Gynecology at Washington University in St. Louis.

The relatively sharp decline in birth rates in some states is deeply affecting hospitals and ob-gyns. In Arizona, for instance, the rate declined by 12%, the largest decrease of any state.

That drop was steep enough to force John C. Lincoln Health Network to close its North Mountain Hospital's birthing center in Phoenix in February, according to the health network. The birthing center consistently lost money, most recently $5.4 million in 2010, Rhonda Forsyth, the network's president and CEO, said in a statement. Administrators also cited relatively low Medicaid payment rates as a factor in the closing, which affected nearly 100 jobs. More than two-thirds of John C. Lincoln's obstetrics patients are on Medicaid.

Forsyth expected the roughly 1,350 OB patients who would have gone to North Mountain Hospital to be picked up by the five larger, more comprehensive programs in the immediate area.

Some of Arizona's birth rate drop could be due to Hispanic families and others moving out of the state because of the decline in the construction industry, said Dean Coonrod, MD, MPH, chair of the Dept. of Obstetrics and Gynecology at Maricopa Integrated Health System in Phoenix. He estimated that births at nearby hospitals have declined by 20% or more.

Decreased patient loads at Arizona ob-gyn practices have had an impact, Dr. Coonrod said. "Practices aren't expanding. They're kind of waiting things out," he said.

Robert J. Marotz, DO, past chair of the Arizona section of the American Congress of Obstetricians and Gynecologists, said some Phoenix-area practices have merged as a result.

The CDC report is available online (link).