Health, Social Security, and Declining Fertility
At CDC, Danielle M. Ely, and Brady E. Hamilton report on data from data from the National Vital Statistics System
- During 2007–2017, total fertility rates in the United States fell for rural and metropolitan counties: 12% in rural, 16% in small or medium metro, and 18% in large metro counties.
- Rural counties had higher total fertility rates for each year from 2007 through 2017 compared with small or medium and large metro counties.
- During 2007–2017, the mean age of mothers at first birth rose by 1.3 (rural), 1.5 (small or medium metro), and 1.8 years (large metro).
- For all years, the mean age of mothers at first birth was lower in rural counties compared with metro counties.
- Downward trends in total fertility rates and increases in mean maternal age over time occurred in rural and metro counties for each selected race and Hispanic-origin group.
- Since the most recent peak in the total fertility rate (the estimated number of lifetime births expected per 1,000 women) in 2007, the United States has experienced a decreasing total fertility rate and an increasing mean, or average, age of mothers at first birth (1–4). Previous research shows rural areas have persistently higher fertility and worse birth outcomes compared with metropolitan (metro) areas (2,5–8). This report describes trends and differences in total fertility rates and mean maternal age at first birth overall, and by race and Hispanic origin, between rural and small or medium metro, and rural and large metro counties, from 2007 through 2017.
Overall birth rates continue to fall in the United States, but higher birth numbers in rural areas could mean insufficient pre-natal care as obstetricians retire and hospital coverage areas shrink.
Falling birth rates also matter when it comes to the sustainability of the Social Security system, per Forbes. A 2017 Social Security Administration actuary report considered two scenarios, one in which fertility rises to 2.20 children per woman and one in which it stays low, at 1.8. Expenditures would exceed income by 5.97 percent by 2091 in the low-fertility scenario.
