Arkansas marriage certificate

Two new reports from the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) examine trends in birth patterns in the United States and document an improvement in prenatal care utilization and a growing tendency for women to have their first and subsequent babies at later ages. Newly released data from the National Health and Nutrition Examination Survey (NHANES) show that obesity is still on the rise among Americans of all ages.

USE OF PRENATAL CARE INCREASES OVER PAST DECADE

The percentage of pregnant women in the U.S. who do not receive prenatal care has been reduced by nearly 50% since 1990, and the proportion of women beginning care in the first trimester of pregnancy has risen 10%. Increases in prenatal care have occurred among all race and ethnic groups, but are particularly evident among Hispanic and non-Hispanic black women. The report, Births: Final Data for 2001, shows that slightly over 1% of women received no prenatal care in 2001, down from 2% in 1990. (1) From 1990 to 2001, the percent of Hispanic women who received no care fell from 4% to 1.6%, and the percent of non-Hispanic black women with no care fell from 4.7% to 2.3%.

The report, based on birth certificates filed in state vital statistics offices and reported to the CDC, tracked many important indicators of maternal and infant health and contained other positive findings. Cigarette smoking during pregnancy continued to decline to 12% in 2001, a drop of 38% from 1989 (when smoking was first reported on the birth certificate). The teen birth rate declined for the 10th consecutive year in 2001, as first reported in preliminary data released earlier this year. However, the report also documented less positive trends in two important areas. The percent of infants born prematurely (at less than 37 completed weeks of gestation) rose to nearly 12% (11.9%), its highest level in at least two decades. The rate of low birthweight has climbed to 7.7% in 2001, up 13% from the mid 1980s.

Other significant findings from the report include:

* There were 4,025,933 babies born in 2001, 1% fewer than the year before. The birth rate declined from 14.7% to 14.5% over the same period.

* The twin birth rate rose in 2001. For the first time, twin births exceeded 3% of all births in the U.S. Triplets and other higher-order multiple births rose 3% from 2000 to 2001.

* The number of births to unmarried mothers increased to a record high of more than 1.3 million in 2001, accounting for 33.5% of all births in 2001. However, the birth rate among unmarried women of childbearing age (15-44) actually declined between 2000 and 2001, from 45.2 per 1,000 in 2000 to 45 per 1,000 in 2001.

* The proportion of births with induced labor has more than doubled since 1989. More than one out of five births were induced in 2001.

* Cesarean deliveries increased for the fifth consecutive year in 2001 to the highest level reported since at least 1989. The primary cesarean rote jumped 5% and the rote of vaginal birth after previous cesarean delivery fell 20%.

Births: Final Data for 2001 can be found on the CDC/NCHS website at http://www.cdc.gov/nchs.

AMERICAN WOMEN ARE WAITING TO BEGIN FAMILIES

In 2000, the average American woman having her first baby was almost 25 years old. In 1970, the average age was 21.4 years for a first birth, according to a new NCHS report, Mean Age of Mother, 1970-2000. (2) The report showed that the average (or mean) age of mothers for all births rose from 24.6 years to 27.2 years over the past three decades. Over half of all births still occur to women in their 20s--the peak childbearing years--but the average age in this group has shifted steadily upward since 1970. The increase in the average age of women having a baby also reflects the relatively recent downturn in the teen birth rate and the rising birth rates for women in their 30s and 40s. The report is based on birth certificates filed in state vital statistics offices and reported to NCHS through the National Vital Statistics System (NVSS).

The trend in delayed childbirth is universal--observed nationwide and among all groups in the population. Yet, the actual age at first or subsequent births varies greatly by state and by race and Hispanic origin. In 2000, the average age of women at birth ranged from a high of 27.8 in Massachusetts to a low of 22.5 in Mississippi. The difference between the state with the highest and lowest average age has increased over the past 30 years. In 1970, Arkansas had the lowest average age for first birth at 20.2 years and the highest age was reported by Massachusetts, Connecticut and New York (22.5 years).

Differences were even more pronounced when patterns were examined by race and Hispanic origin from 1989 (the first year detailed data are available) to 2000. American Indian women had the lowest average age at first birth (21.6 years) in 2000, up only slightly from their 21.3 average in 1989. In 2000, Japanese and Chinese women had the highest average age at first birth, just over 30 years; in 1989 women in these two groups were older than other women at first birth, with an average age of about 29. The average age for non-Hispanic white women for a first birth in 2000 was 25.9 years; the average for non-Hispanic black women was 22.3 years; and the average ranged considerably for Hispanic women, from about 22 years of age for Puerto Rican and Mexican women to 27 years for Cuban mothers.

Comparing international patterns, the report points to an increase in the average age at first birth in most of the developed countries; averages in 2000 ranged from 24 in the Slovak Republic to 29 in Switzerland.

Several factors may account for the delay in childbearing, most importantly educational opportunities and career choices for women. From 1970 to 2000, the number of women completing college has nearly doubled and the number in the labor force has gone up almost 40%. Changes in contraception use, economic cycles, social support, and marriage patterns should also be considered. This report is on the CDC website at http://www.cdc.gov/nchs.

NEW DATA SHOW OBESITY STILL ON THE RISE

Obesity continued to increase dramatically during the late 1990s for Americans of all ages, with nearly one-third of all adults now classified as obese, according to new data from the 1999-2000 NHANES, available in Internet-only releases on the CDC website. (3) The data show that 31% of adults 20 years of age and over--nearly 59 million people--have a Body Mass Index (BMI) of 30 or greater, compared with 23% in 1994. The findings show more adult women are obese (33%) than men (28%), with the problem greatest among non-Hispanic black women (50%) compared with Mexican American women (40%) and non-Hispanic white women (30%). There was practically no difference in obesity levels among men based on race/ ethnicity.

Meanwhile, the percent of children who are overweight (defined as BMI-for-age at or above the 95th percentile of the CDC Growth Charts) also continues to increase. (4) Among children and teens ages 6-19, 15% (almost 9 million) are overweight according to the 1999-2000 data, or triple what the proportion was in 1980.

The data on children also show:

* Non-Hispanic black and Mexican American adolescents ages 12-19 were more likely to be overweight (24%) than non-Hispanic white adolescents (13%).

* Mexican American children ages 6--11 were more likely to be overweight (24%) than non-Hispanic black children (20%) and non-Hispanic white children (12%).

* Preschool-aged non-Hispanic black children were less likely (8%) than younger Mexican American children (11%) and non-Hispanic white children (10%) to be overweight.

NCHS Dataline is prepared by Sandra Smith, MPH, Public Affairs Officer, National Center for Health Statistics, Centers for Disease Control and Prevention.

REFERENCES

(1.) Martin JA, Hamilton BE, Ventura SJ. Births: final data for 2001. Natl Vital Stat Rep 2002;51 (2):1-104.

(2.) Mathews TJ, Hamilton BE. Mean age of mother, 1970-2000. Natl Vital Stat Rep 2002;51(1):1-16.

(3.) National Center for Health Statistics (US). Prevalence of overweight and obesity among adults: United States, 1999-2000. Health E-Stats. Hyattsville (MD): National Center for Health Statistics; 2002 [cited 2002 Nov 27]. Available from: URL: http://www.cdc.gov/nchs/products /pubs/pubd/hestats/obese/obse99.htm

(4.) National Center for Health Statistics (US). Prevalence of overweight among children and adolescents: United States, 1999-2000. Health E-Stats. Hyattsville (MD): National Center for Health Statistics; 2002 [cited 2002 Nov 27]. Available from: URL: http://www.cdc.gov/nchs /products/pubs/pubd/hestats/overwght99.htm