The U.S. fertility rate has fallen steadily since reaching a recent peak in 2007, and hospitals are responding to the decrease by cutting their obstetrician units, according to recent research.

Fertility rate declines

A new report from CDC's National Center for Health Statistics (NCHS) finds that from 2007 to 2017 fertility rates declined by 9% in rural counties, while rates in small or medium metropolitan counties fell by 16% and rates in large metro counties fell by 18%. 

The researchers found the fertility rate in rural counties in 2007 was 5% higher than the fertility rate in small or medium metro counties and large metro counties. The data show that gap widened by 2017, when the fertility rate for rural counties was 14% higher than the rate for large metro counties, and 10% higher than reported for small or medium metro counties.

The researchers also found total fertility rates for non-Hispanic white and Hispanic women in 2007 and 2017 were higher in rural counties when compared with the total fertility rates for non-Hispanic white and Hispanic women in small or medium metro counties and large metro counties.

The researchers found total fertility rate for non-Hispanic black women was higher in rural counties when compared with the total fertility rates for non-Hispanic black women in small or medium metro counties and large metro counties in 2007. However, the total fertility rate for non-Hispanic black women in small or medium metro countries was higher when compared with the total fertility rates for non-Hispanic women in rural counties and large metro counties in 2017.

In addition, the researchers found women in 2017 waited longer to have their first child than they did in 2007. The data show the average age women gave birth for the first time increased from 2007 through 2017 by:

• 1.8 years in large metro counties;
• 1.5 years in small metro counties; and
• 1.3 years in rural counties.

When broken down by rate, the researchers found non-Hispanic black women had the largest increase in the average age of their first birth when compared with non-Hispanic white women and Hispanic women.

Danielle Ely, a health statistician at NCHS, said, "Back to the 1950s and 1960s, there were these differences between rural and urban areas, but there was also this expectation that at some point, these differences would disappear." However, she said, "What we're seeing (instead) is that even as patterns are the same in (urban and rural) areas, there still is this difference. It's indicating that there might be different needs in rural counties than large metro counties in some ways … in terms of medical care for mothers and for infants."

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Fewer US hospitals delivering babies

The decline in U.S. fertility rates has lowered demand in hospital birthing centers—and according to a new study from the University of Minnesota published in Health Affairs, fewer U.S. hospitals are delivering babies.

The study comes as hospitals across the United States have announced maternity unit closures.

For example, LRGHealthcare announced the health system would close the maternity unit at Lakes Region General Hospital in New Hampshire, but the hospital's prenatal, postnatal, women's health and pediatric units would remain open. Alice Peck Day Memorial Hospital in February also announced it would close its maternity unit and would transfer those services to Dartmouth-Hitchcock Medical Center. Mesa View Regional Hospital in September announced the hospital would no longer offer labor and delivery services beginning Oct. 1.

For the study, researchers examined national data on recent obstetric unit closures from 2004 to 2014. The study, which focused on obstetric unit closures from 2004 to 2014, found 45% of U.S. rural counties did not have access obstetrician services from 2004 to 2014. The researchers found 9% of U.S. rural counties lost access to obstetrician services during that time period. According to the study, the decline in rural access to obstetrician services led to more women giving birth prematurely or in emergency departments.

Jeffrey Johnson, chair of the OB-GYN department at Wentworth-Douglass Hospital, said the findings are "definitely a big deal because it's a loss of critical access for patients. Patients wind up having to travel farther not only for prenatal care, but for delivery."

Timothy Fisher, an OB-GYN at Dartmouth-Hitchcock Medical Center, said, "One could argue this is an appropriate re-setting of supply and demand, but I think it's a little more complicated than that." He noted, "While emergency [department] physicians and emergency medicine practitioners have to be sort of ready for anything, they're not a group of health care practitioners who have expertise in the management of labor and delivery" (Galvin, U.S. News & World Report, 10/16; Colliver, "Pulse," Politico, 10/17; Gooch, Becker's Hospital Review, 10/16; Feathers, New Hampshire Union Leader, 10/14).

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