BOX 2-1
Context and Background:
Key Points Made by Individual Speakers

  • Brady Hamilton noted that demographic trends among pregnant women in the United States have changed over the past few decades. For example, while the majority of births are to non-Hispanic white women, the number and percentage of births to groups other than non-Hispanic white women has been increasing.
  • Hamilton presented some of the changes in health trends in the United States over the past few decades, such as the increasing rate of Cesarean deliveries between 1996 and 2009. However, the rate of Cesarean deliveries appears to have abated somewhat in the past few years.
  • Marian MacDorman emphasized that birth setting trends have been changing as well. Most notably, the percent of out-of-hospital births has recently increased, by 36 percent since 2004, but still with only 1.2 percent of all births in the United States occurring outside of hospital settings. The increase in out-of-hospital birth rate is occurring much more quickly for non-Hispanic white women.
  • MacDorman pointed out that risk factors associated with different birth settings have also been changing over time, with women in a home or birth center setting much less likely than women in hospital settings to deliver preterm and low-birth-weight infants. This trend suggests to MacDorman that selection of low-risk women as candidates for home and birth center births has improved over time.
  • All of the trends described by Hamilton and MacDorman and summarized in this chapter are based on U.S. birth certificate data. In their opinion, U.S. birth certificate data are vital to gaining a better understanding of demographic and health trends among pregnant women and of birth setting trends.
  • Nigel Paneth remarked that he was more impressed by how little things have changed over the past few decades than by how much they have changed. The most notable changes since 1982, in his opinion, are decreased birth rates but steady fertility rates, the older age of most mothers, a shift in the birth population (decrease in the percent of births among non-Hispanic white women), and increased interventions (especially Cesarean sections).

Demographic Trends in Childbirth

The number of births in the United States has been generally rising over the last 9 decades, from 2.95 million in 1920 to 3.95 million in 2011 (see Figure 2-1). This overall increase has been punctuated by several periods of decline, including in the 1920s through the early 1930s, the 1960s through the early 1970s, the early 1990s, and over the past few years. The general rising trend is a product of the increasing size of the U.S. female population of reproductive age, changes in the composition of the reproductive age population, and changing fertility patterns.

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