Total U.S. fertility fell in last decade, but less in rural areas

Centers for Disease Control and Prevention chart

The U.S. fertility rate fell during the last decade, but less in rural counties than in large metropolitan counties, according to the Centers for Disease Control and Prevention. "Total fertility rates – representing the estimated number of lifetime births expected per 1,000 women – fell 18 percent in large metro counties and 16 percent in small or medium metro counties between 2007 and 2017," Gaby Galvin reports for U.S. News and World Report. "Yet while the rate in rural counties fell 12 percent in that time frame, the decline slowed after 2011, resulting in a 14 percent gap between total fertility rates in rural counties and large metro counties last year. The gap was just 5 percent in 2007."

The age at which women became mothers also rose in the past 10 years, the study found, but rural women still tend to have their first births earlier. In 2017 the average age of first birth was 24.5 in rural counties, 25.8 in small and medium metro counties, and 27.7 in large metro counties.

The rural-urban age gap isn't new. "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," CDC health statistician Danielle Ely told Galvin. The pattern's persistence indicates "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."

The higher rural birth rate is concerning in light of the fact that rural counties are increasingly losing access to prenatal, obstetrical and maternal health care. "The share of rural counties with hospital obstetric services fell from 54 percent in 2004 to 46 percent in 2014," Galvin reports.