According to the Centers for Disease Control and Prevention (CDC), the fertility rate of women aged 15 to 44 years in the United States in 2015 was 62.5 live births per 1000 women (Martin, 2017). This rate began slowly trending downward in 1990 and has now dropped below that for replacement births. This indicates a population decline (Hamilton, 2012). There were 3.98 million births in 2015, and this constituted the lowest birth rate ever recorded for the United States-12.3 per 1000 population. The birth rate decreased for all major ethnic and racial groups, for adolescents and unmarried women, and for those aged 20 to 24 years. For women older than 30 years, the birth rate rose slightly. Almost half of newborns in 2010 in the United States were minorities: Hispanic-25 percent, AfricanAmerican-14 percent, and Asian-4 percent (Frey, 2011).
he total number of pregnancies and their outcomes in 2015 are shown in Table 1-2. According to the Guttmacher Institute (2016b), 45 percent of births in the United States are unintended at the time of conception. Importantly, the overall proportion of aExciudes spontaneous abortions and ectopic pregnancies. Data from Martin, 201l7.
unintended births has declined only slightly since 2001. Unmarried women, black women, and women with less education or income are more likely to have unplanned pregnancies.
In Table 1-2, induced abortion information derives from CDC abortion surveillance data from 45 states combined with Guttmacher Institute data on induced abortion. hese data have been collected beginning in 1976. Since Roe v. Wade legalization of abortion, more than 46 million American women have chosen legalized abortions. As discussed later, this provides a compelling argument for easily accessible family planning.
Several indices are used to assess obstetrical and perinatal outcomes as measures of medical care quality. As noted, the perinatal mortality rate includes the numbers of stillbirths and neonatal deaths per 1000 total births. In 2013, the perinatal mortality rate was 9.98 per 1000 births (Fig. 1-1) (MacDorman, 2015). There were 25,972 fetal deaths at gestational ages of 20 weeks or older. Fetal deaths at 28 weeks or more have been declining since 1990, whereas rates for those between 20 and 27 weeks are static (Fig. 1-2). By way of comparison, there were a total of 19,041 neonatal deaths in 2006-meaning that nearly 60 percent of the perinatal deaths in the United States were fetal.
here were 6.1 infant deaths per 1000 live births in 2013 compared with 6.8 in 2001 (MacDorman, 2015). The three leading causes of infant death-congenital malformations, low birthweight, and sudden infant death syndrome-accounted for almost half of all deaths (Heron, 2015). Infants born at the lowest gestational ages and birthweights add substantively to these mortality rates. For example, more than half of all infant deaths in 2005 were in the 2 percent of infants born before
FIGURE ,A-, Perinatal mortality rates: United States, 2000-2013.
(Reproduced with permission from MacDorman MF, Gregory EC:
Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep. 2015 Jul 23;64(8):1-24.) 0..C ::l� 0
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