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A National Strategy to
Prevent Teen Pregnancy
ANNUAL REPORT 1998-99
HUMAN SERVICES USA
&
HEALTH
OF
DEPARTMENT
U.S. Department of Health and Human Services
June 1999
Table of Contents
Introduction
3
Trends in Teen Births & Pregnancies
4
Building Partnerships
6
Supporting Promising Approaches
10
Research & Evaluation Activities
17
Appendix I
Declines in Teenage Birth Rates, 1991-1997:
National and State Patterns
Appendix II
Measuring the Proportion of Communities With Teen Pregnancy Prevention
Programs
Appendix III
HHS Activities
Appendix IV
HHS Funded Data Sets
Introduction
At the end of the second year of its National Strategy to Prevent Teen Pregnancy, the U.S.
Department of Health and Human Services (HHS) is pleased to report that teen pregnancy rates
continue to decline. The on-going decrease in teen pregnancy rates is encouraging and suggests
that the Department's Strategy to prevent teen pregnancy is having a positive impact.
The President and Congress called on HHS to develop a National Strategy to address this serious
challenge and to assure that at least 25 percent of communities in this country have teen
pregnancy prevention programs in place - as mandated under the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996. The Department responded to this call by
releasing a National Strategy to Prevent Teen Pregnancy in January of 1997. This Strategy
presented a comprehensive plan to prevent teen pregnancies in the United States by
strengthening, integrating, and supporting teen pregnancy prevention and other youth-related
activities in communities across the country.
More Good News. Encouraging trends in teen pregnancy rates continue:
Teen birth rates declined for white, black, American Indian, Asian or Pacific Islander and
Hispanic women ages 15-19, from 1991 through 1997.
The birth rate for black teens reached the lowest rate ever reported for blacks in 1997, and
also declined more than any group between 1991 and 1997.
Teen birth rates have decreased in every state.
Key Principles. The National Strategy is guided by five key principles which shape and guide
our prevention efforts. Based on ideas that are essential to all community efforts, as indicated by
research and experience, the key principles are the cornerstone of the Department's Strategy.
1. Parents and other adult mentors must play key roles in encouraging young adults to
avoid early pregnancy and to stay in school.
2. Abstinence and personal responsibility must be the primary messages of prevention
programs.
3. Young people must be given clear connections and pathways to college or jobs that give
them hope and a reason to stay in school and avoid pregnancy.
4. Public and private-sector partners throughout communities - including parents, schools,
business, media, health and human service providers, and religious organizations - must
work together to develop comprehensive strategies.
5. Real success requires a sustained commitment to the young person over a long period of
time.
TRENDS IN TEEN BIRTHS AND PREGNANCIES
The Department is pleased to report that, according to the latest data compiled from HHS'
National Center for Health Statistics (NCHS) (through 1997), teen birth rates continue to decline
steadily. Notably, these declines cut across ages (younger and older adolescents) and race and
Hispanic origin. Further, fewer teenagers are having second children.
Teen Birth Rates Declining Steadily. Both national and state-level teenage birth rates have
fallen since 1991. The overall rate for teenagers declined by 16 percent from 1991-1997 (62.1
births per 1,000 females aged 15-19 in 1991 to 52.3 in 1997). Between 1991 and 1997:
Teen birth rates have fallen in all states (the decline is not statistically significant for Rhode
Island).¹
Rates fell by 20 percent or more in 10 states and the District of Columbia.
The U.S. rate fell more for younger than for older teenagers. Birth rates dropped 21 percent
for girls 10-14 years old, 17 percent for 15-17 year olds and 11 percent for 18-19 year olds.¹
Teen Birth Rates by Age. Birth rates for teenagers differ substantially by age. In 1997, 83.6 of
every 1,000 older teens had a baby, more than 2.5 times the rate for teens aged 15-17, which was
32.1 per 1,000. The declines in rates since 1991 experienced by older and younger teens partly
reverse the 20 to 27 percent increase found during the late 1980s.²
The U.S. birth rate for teenagers declined 4 percent from 1996 (54.4 per 1,000 aged 15-19)
to 1997, and 16 percent from 1991 to 1997.
The rate for teens aged 15-17 years fell 5 percent between 1996 (33.8 per 1,000) and 1997,
and 17 percent between 1991 (38.7 per 1,000) and 1997.
The rate for older teens aged 18-19 declined 11 percent since 1991 (94.4 per 1,000).
Trends by Race and Hispanic Origin. Birth rates for black teenagers have dropped steeply in
the 1990s. Since 1991, black teenagers have shown the largest declines in teen childbearing.
The overall rate for black teens fell 24 percent from 1991 to 1997 (115.5 per 1,000 aged
15-19 in 1991 to 88.2 in 1997).
The rate for young black teenagers dropped 28 percent from 1991 to 1997 (84.1 per 1,000
aged 15-17 in 1991 to 60.8 in 1997).
The rate for older black teenagers declined 18 percent during 1991-97, from 158.6 to 130.1.
In addition, birth rates have fallen since 1991 for non-Hispanic white teenagers. The overall rate
fell 17 percent (43.4 per 1,000 aged 15-19 in 1991 to 36.0 in 1997), but rates declined more for
younger than for older teens. Teen birth rates have declined for Hispanic teenagers as well, but
the declines began later (just since 1994) and have been smaller (10 percent). Overall, birth rates
continue to be substantially higher for Hispanic and black teenagers than for non-Hispanic white
teenagers; since 1994, Hispanic teens have had higher rates than any other group.
Fewer Teenage Mothers Have Second Child. One of the key HHS findings has been that the
rate of second births to teenagers who have already had one child has declined 21 percent from
1991 to 1997 (221 per 1,000 in 1991 to 174 in 1997)¹,². In other words, the proportion of teen
mothers who gave birth to a second child fell from 22 percent to 17 percent. The first birth rate
for teenagers fell by 6 percent from 1991 to 1996 and then declined an additional 4 percent from
1996 to 1997; the first birth rate has thus declined 10 percent since 1991.
Births to Unmarried Teens. Birth rates for unmarried teenagers declined again in 1997 for the
third consecutive year. Despite these declines, out-of-wedlock childbearing for teen remains a
serious concern. Since 1994, the rate for teens 15-17 years has fallen 12 percent, and the rate for
teens 18-19 dropped 7 percent. Despite these declines in birth rates, the proportion of teen births
that were to unmarried teenagers continued to increase in 1997. Eighty-seven percent of births to
15-17-year-olds and 73 percent of births to 18-19-year-olds were non-marital in 1997.
Data Collection and Analysis. Accurate and timely reporting of trends and variations in teen
birth rates is based on information reported on the birth certificates of all babies born in the
United States. This information is provided to the National Center for Health Statistics (NCHS)
by the state health departments through the Vital Statistics Cooperative Program. NCHS and the
states share the costs for collecting and processing the data. The last three years have seen faster
data collection and processing at the state level and by NCHS. Information can now be analyzed
and released more quickly.
The preliminary files provided by NCHS' new statistical series contain very large samples; for
example, the most recent preliminary file, for 1997 births, was based on over 99 percent of all
births. Data from that file were published in October 1998, and the findings from the preliminary
file have recently been validated with publication of the final data for 1997 1,3
More information on the collection and reporting of teen birth data is presented in Appendix I.
I
Ventura SJ, Martin JA, Curtin SC, Matthew S TJ. Births: Final Data for 1997. National Vital Statistics Reports;
Vol. 47, No. 18. Hyattsville, Maryland: National Center for Health Statistics. 1999.
2
Ventura SJ, Matthews TJ, Curtin SC. Declines in Teenage Birth Rates, 1991-97: National and State Patterns.
National Vital Statistics Reports, Vol. 47, No. 12. Hyattsville, Maryland: National Center for Health Statistics. 1998.
3
Ventura SJ, Anderson RN, Martin JA, Smith BL. Births and Deaths: Preliminary Data for 1997. National Vital
Statistics Reports, Vol. 47, No. 4. Hyattsville, Maryland: National Center for Health Statistics. 1998.
BUILDING PARTNERSHIPS
Building partnerships remains a critical aspect of the Department's National Strategy to Prevent
Teen Pregnancy. HHS is committed to sustaining current partnerships and creating opportunities
for new partnerships to grow. Because HHS recognizes that each group and individual can make
valuable contributions to prevention efforts, the Department is committed to involving a
wide-range of partners in its work. HHS partnerships involve national, state, and local
organizations; schools; health and social service organizations; business; religious institutions;
tribes and tribal organizations; federal, state, and local governments; parents and other family
members; and teens themselves. HHS seeks to develop partnerships among all groups and
individuals concerned about teen pregnancy.
While valuing the potential of partnerships to increase cooperation, reduce duplication, pool
resources, integrate services and ultimately, build communities, it is also important to recognize
the challenges of developing and sustaining them. Partnerships, particularly at the community-
level, take a long time to establish and require considerable energy to maintain. Reaching true
community consensus on controversial issues is a difficult and time-intensive process.
Collaboration is particularly challenging when partners come from different racial, ethnic,
linguistic, religious, class and/or educational backgrounds - yet it is exactly this cross-sectional
involvement that is the most valuable product of collaboration.
Community Partnerships
HHS is involved in several projects and programs that promote partnerships in communities
interested in preventing teen pregnancy. Following are highlights and updates of HHS efforts to
build and strengthen partnerships in communities across the country.
Get Organized: A Guide to Preventing Teen Pregnancy. In partnership with the National
Campaign to Prevent Teen Pregnancy, a three volume guide for states and communities to use in
their fight against teen pregnancy is being developed. The guide includes chapters on important
topics such as: "Promising Approaches", "Involving Teen Boys and Young Men", "Involving
Parents", "Involving the Faith Community", "Involving Health Care Professionals", and "
Involving the Business Community." Other chapters will address issues that often challenge
community leaders in their efforts to prevent teen pregnancy such as how to conduct a
community needs assessment, how to raise funds for prevention programs, how to create an
effective teen pregnancy prevention message, and how to move forward in the face of conflict.
The Indian Health Service. The Indian Health Service (IHS) is a direct care organization with
most efforts concerning teen pregnancy concentrated on providing appropriate prenatal and
neonatal care. There is, however, a growing effort to work with various organizations - federal,
state, and local - to develop and implement strategies that deal with all issues surrounding teen
parenthood, including prevention.
Working with IHS, the Center for American Indian and Alaskan Native Health at Johns Hopkins
University is currently providing outreach workers to tribal members of three Navajo units and
the White Mountain Apache. The workers conduct a curriculum-based outreach program on
healthy pregnancies and well-child care, which includes family planning on an individual basis.
With partnerships and funding from the C.S. Mott Foundation and the Ford Foundation, they are
now in the planning phase of a program expansion to include fathers and male outreach workers.
Girl Neighborhood Power! - Building Bright Futures for Success (GNP). This five year
national demonstration program, begun in 1997, centers on involving communities as active
partners in helping girls (9-14 years old) successfully navigate adolescence and reach their
maximum potential. Currently, the program consists of four community partners (Girls Inc. of
Memphis, TN; Crispus Attucks of York, PA; City of Madison, WI; and Youth & Family
Services Inc. of Rapid City, SD) and a national leadership consortium (Healthy Mothers, Health
Babies Coalition, Inc. of Alexandria, VA).
GNP encourages and supports partnerships at both the local and federal levels. To be eligible for
funding, communities were required to demonstrate local commitment through a broad-based
coalition of community agencies and parental involvement. In addition, GNP is supported by
several HHS agencies, including the Centers for Disease Control and Prevention, the National
Institutes of Health, the Public Health Service's Office of Women's Health, the Administration
for Children and Families, and the Health Resources and Services Administration.
This year, the community partners focused on strengthening local coalitions and neighborhood
site development. Many valuable partnerships formed at the community level, for example,
partnerships with the Association of Retarded Citizens, local churches, community centers,
mental health providers, and local justice agencies.
To reach its goal of promoting the well-being of girls, GNP will continue to build strong
partnerships among a network of organizations and individuals in order to communicate positive
messages and provide meaningful opportunities for girls. Additional information on the
promising approaches being used by GNP can be found in the next section.
The Centers for Disease Control and Prevention (CDC) Community Coalition Partnership
Programs for the Prevention of Teen Pregnancy. The CDC supports and works closely in
partnership with thirteen communities with high rates of teen pregnancy. These demonstration
projects, begun in 1995, are currently in their second phase. In this phase coalitions of local
public and private agencies and community organizations are working together to implement
their action plans, test promising interventions, build financial and programmatic sustainability,
and conduct site-specific evaluations. CDC will continue to work with these innovative
communities for the next several years. Further details about the promising approaches and
evaluation efforts of this program will be discussed later in this report.
Building and Sustaining Partnerships Report. To better understand the potential of
partnerships to enhance teen pregnancy prevention efforts, HHS published "Building and
Sustaining Community Partnerships for Teen Pregnancy Prevention." This report, issued by the
Assistant Secretary for Planning and Evaluation in July 1998, is based on an extensive literature
review of various partnership relationships focusing on teenage pregnancy and other risk-taking
behaviors. Research in the fields of violence prevention, substance abuse prevention, teen
pregnancy prevention, youth development, community development, environmental protection,
and general business enterprises were explored and reviewed. In addition, the report discusses
the process of partnership development, including how to mobilize a community, organize,
implement, and sustain a partnership, and provides models of community development and
detailed case studies. By providing this publication, HHS hopes to assist in the development of
teen pregnancy prevention partnerships across the country. Copies of this report are available at
http://aspe.hhs.gov.
Preventing Pregnancy through Youth Development. Published by the Family and Youth
Services Bureau (FYSB), "Preventing Adolescent Pregnancy: A Youth Development Approach",
provides useful information and background on using a youth development approach with teen
pregnancy prevention efforts. Topics discussed include: "Ideas for Getting Started" and "
Building on Lessons Learned." This year, FYSB's National Clearinghouse on Families and
Youth (NCFY) distributed over 5,000 copies of the guide to a diverse audience, including:
federal, state, and local lawmakers, school representatives, private industry, non-profit
organizations, and the academic community. In addition, NCFY produced an article based on
this guide that was included in the December 1998 edition of the Preventing Pregnancy for
Youth: An Interdisciplinary Newsletter (funded by the C.S. Mott Foundation). Copies of the
book are available through the National Clearinghouse on Families and Youth at
http://www.ncfy.com.
HHS Partnerships
In addition to working directly with communities to form partnerships, HHS frequently works on
broader collaborative efforts to improve teen pregnancy prevention efforts. The following are
highlights and updates of major partnership efforts by HHS over the past year.
The Girl Power! Campaign. Since its formation in November 1996, the Girl Power! Campaign
has successfully used multiple and varied partnerships to accomplish its goal of helping girls
between the ages of 9 and 14 make the most of their lives. Because studies show that girls at this
age have a tendency to neglect their own aspirations and interests, in addition to becoming less
physically active, Girl Power! uses a comprehensive approach that addresses both health issues
and the topics of self-worth, motivation, and opportunity. Given young girls' increased
vulnerability at this stage to negative influences and mixed messages regarding health risk
behaviors, the Girl Power! Campaign focuses on increasing their skills and competence in
academics, arts, sports, and other beneficial activities. By encouraging girls to develop their
skills and sense of self, Girl Power! hopes to decrease the likelihood that they will participate in
risky and unhealthy behavior.
As a multi-issue, national public education campaign, Girl Power!, led by the Center for
Substance Abuse Prevention in the Substance Abuse and Mental Health Services Administration,
has partnered with many national non-profit organizations, including over sixty national
endorsing organizations and 300 state and local affiliations, to develop and implement unique
Campaign promotional materials, public service announcements, and an award-winning web site
(http://www.health.org/gpower). The success of working together is evidenced by the thousands
of Girl Power! community programs throughout the country.
This year, the Girl Power! Campaign has formed many exciting partnerships to help promote its
message. In cooperation with Girl Power!, the Girl Scouts of the USA developed an official Girl
Power! Girl Scout patch and accompanying guides to be used as resources for earning the patch.
Through a unique partnership with the Women's World Cup 1999, the campaign promoted and
distributed Girl Power! products at selected matches through the 22-day soccer tournament held
in the United States this summer. Other partnerships include the National Family Partnership,
Avon Running, the WNBA's Washington Mystics basketball team, and the American
Association of University Women.
Future products of the Girl Power! Campaign include a Community Education Kit featuring
resources for Girl Power! programs. The Girl Power! Campaign plans to continue working with
various national, state, and local organizations to improve the future for all young girls.
Joint Work Group on School-Based Teen Pregnancy Prevention. With support from the
Centers for Disease Control and Prevention's Division of Adolescent and School Health, nine
national non-governmental organizations (NGOs) are working together to help state and local
education and health policy makers, school administrators, maternal and child health
professionals, school health professionals, and other school personnel prevent unintended teen
pregnancies. These organizations include the American Association of Maternal and Child
Health Programs (AMCHP), American Association of School Administrators (AASA),
American School Health Association (ASHA), Association of State and Territorial Health
Officials (ASTHO), Council of Chief State School Officers (CCSSO), National Association of
State Boards of Education (NASBE), National Conference of State Legislatures (NCSL),
National Education Association (NEA), and the National School Boards Association (NSBA).
Through the Work Group, the NGOs and HHS learned about what their respective constituents
needed to help schools implement effective teen pregnancy prevention programs. In its second
year, the Work Group has been focusing on helping its constituents implement specific strategies
to improve the effectiveness of programs such as collecting, interpreting, and disseminating
epidemiological data about teen pregnancy; identifying effective school policies and programs;
conducting outreach activities to parents, educators, and the public; helping schools engage
parents in pregnancy prevention; helping schools work with community organizations in a shared
effort; and helping schools implement youth development activities.
SUPPORTING PROMISING APPROACHES
In 1999, HHS provided support to efforts ongoing since the first year of the Strategy. The
Department of Health and Human Services has continued to ensure that at least 25 percent of
communities had teen pregnancy prevention programs in place-as mandated by section 905 of
the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
In FY 1998, the Department estimated that
of communities had teen pregnancy
prevention programs in place. This is a conservative number because it represents only HHS-
funded programs that flow directly to communities. HHS also supports other teen pregnancy
prevention efforts through its various state block grant programs. In addition, there
are numerous activities supported by funding sources outside of HHS.
Highlights of HHS Activities. The National Strategy is built on the belief that
successful teen pregnancy prevention efforts are specifically tailored to the unique
needs, interests, and challenges of diverse individuals and communities. Although the
National Strategy sends the strongest possible message to all teens that postponing
sexual activity, staying in school, and preparing to work are the right things to do, the
research has shown that girls and boys, for example, experience adolescence in
different ways. Therefore, different approaches are required to meet the unique needs
of different adolescent populations. This year the Department has continued to fund a
broad spectrum of programs that actively involve family and community members, as
well as young people themselves. In particular, HHS has promoted the involvement of
boys and young men in teen pregnancy prevention.
Abstinence Education
The Department funds abstinence education through two programs. In 1996, the Personal
Responsibility and Work Opportunity Reconciliation Act (PRWORA) created a new program
entitled the Abstinence Education Grant Program which is funded under Section 510 of Title V
of the Social Security Act. The grants funded under this program must meet specific criteria
defined in the legislation. In addition, the Department has been funding abstinence education
through its Adolescent Family Life Program (AFL) since 1981. New AFL programs, initiated
since 1997, now also conform to the PRWORA definition of abstinence.
Abstinence Education Grant Program. The Department's Health Resources and Services
Administration, Maternal and Child Health Bureau (MCHB) is responsible for the administration
of the Abstinence Education Grant Program. The law provides for a mandatory annual
appropriation of $50 million for each fiscal year (FY) 1998 through 2002. Fifty-two states and
territories applied for and received FY 1999 funding (one less than in FY 1998).
In March 1999, MCHB completed an annual program summary based on the states and
territories' FY 1998 annual reports and FY 1999 grant applications. Multiple activities and
contracts are being funded in the majority of states and territories. Thus, the following totals
exceed the total number of states and territories (54) that received an FY 1998 and/or FY 1999
Abstinence Education Grant. While states and territories differed in their approaches, there were
some general consistencies.
The most frequently funded state/territory activities are community-based projects (45¹),
program evaluations (41), state media campaigns (37), and technical assistance and training
(36).
The most frequently funded local program activities are adult mentoring, counseling and
supervision (32), social skills instruction, character-based education, and assets building
(31), curriculum development and implementation (31), school-based programs (26),
public awareness campaigns (24), parent education groups (21), peer mentoring and
education (20), and before- and after-school programs (18).
The two age groups most frequently served by the states and territories are 13-14 year olds
(51) and 9-12 year olds (50). Other frequently served age groups are 15-17 year olds (37)
and 18-19 year olds (26).
Special population groups frequently targeted by the states/territories are parents (39), at-
risk populations, such as youth of color, out-of-school youths, and youths in areas with
high rates of out-of-wedlock pregnancies (26), males (25), and teachers and youth serving
professionals (20).
Adolescent Family Life Program (AFL). As mentioned earlier, the AFL program's prevention
approach, as required by statute, has always been abstinence-based; promoting the postponement
of sexual activity as the most effective way for adolescents to prevent pregnancy and STD/HIV
infection. In FY 1998, $9.0 million of the total $16.7 million AFL appropriation was spent to
support 57 prevention projects using the abstinence-only definition under PRWORA. An
additional $3.6 million was spent to continue support for 17 prevention and care projects
originally funded in FY 1995 and $1.0 million to support seven research projects.
Many address self-esteem and decision-making, life, social, and negotiation skills. Specific
components for parent involvement and education are incorporated by most and all are required
to include an independent evaluation.
Family Planning
The Department, through the Title X National Family Planning Program, is a primary
provider of subsidized family planning services, serving nearly 4.5 million persons annually.
The Title X program has always played an important role in adolescent pregnancy prevention;
approximately 30 percent of those receiving services are under 20 years of age. In addition to
clinical services, outreach and education - including counseling to encourage continued
postponement of sexual activity for adolescent clients who are not yet sexually active - are also
important components of Title X services for adolescents. The program has also been expanding
Number of States and Territories
adolescent pregnancy prevention through special initiatives sponsored regionally.
For example:
Region IV (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South
Carolina, Tennessee) has been funding community-based organizations to implement
adolescent pregnancy prevention initiatives. Interventions include sexuality education,
parent involvement, mentoring, peer counseling, tutoring, job skills training, career
planning and recreational activities in various combinations.
Region VI (Arkansas, Louisiana, New Mexico, Oklahoma, Texas) has funded a number of
programs to coordinate the linkage of family planning providers with community-based
organizations that serve hard to reach populations, including adolescents, in providing
appropriate services and activities related to family planning and reproductive health.
All ten regions have been supporting projects in Title X clinics designed to increase male
responsibility with respect to reproductive health and family planning and to enhance
young men's futures through training and employment. Selected clinics employ adolescent
males, as well as provide them with on the job training in various aspects of clinic
operation, family planning, and reproductive health education.
Community Collaboratives
The Community Coalitions Partnership Program and Girl Neighborhood Power! are two of the
Department's cornerstone programs aimed at reducing teen pregnancy. Over the course of this
year, the communities involved in these two programs progressed in their efforts to develop and
maintain multi-sectoral collaborations responsible for planning, implementing and evaluating
prevention strategies.
Since 1995, the CDC, through the Community Coalition Partnership Program for the
Prevention of Teen Pregnancy, has supported demonstration projects in thirteen communities
with high rates of teen pregnancy (Boston, Chicago, Jacksonville, Kansas City, Milwaukee,
Oklahoma City, Orlando, Philadelphia, Pittsburgh, Rochester, San Antonio, San Bernardino, and
Yakima). Moreover, eleven of the thirteen communities are actively working with Latino youth
and Latino neighborhoods as part of their overall plan to prevent teen pregnancy. In Phase II of
the demonstration, which began in 1997 and continues for five years, coalitions of local public
and private agencies and organizations in communities are working on implementing their action
plans, field testing promising interventions, building toward financial and programmatic
sustainability of their programs, conducting site-specific evaluations, and participating in
cross-site evaluations.
This year, each of the thirteen demonstration communities continued their efforts to develop and
strengthen community-wide coalitions. They have continued to mobilize and organize
community resources in support of comprehensive, risk-specific, effective and sustainable
programs for the prevention of initial and repeat teen pregnancies. The communities are
pursuing a wide variety of strategies to provide health, education, employment, recreation and
other youth development services, programs and opportunities for youth and their families.
Ongoing activities include: training for community leaders and neighborhood residents on
community engagement and empowerment; the selection of intervention programs and
components that address the documented needs and assets of specific neighborhoods; field
testing of promising approaches; parent-child communication workshops; the development of
youth councils; the use of health communications to enhance the planning and delivery of
programs; and fund development to sustain programs.
Girl Neighborhood Power! - Building Bright Futures for Success (GNP), a five-year national
demonstration program that started October 1997, fits under the umbrella of the Department's
Girl Power! campaign. Its several purposes include: (1) promoting the health and well-being of
girls and young female adolescents between the ages of nine and fourteen; (2) preventing the
onset of health risk behaviors among girls during their adolescence; (3) connecting girls and the
communities in which they live and supporting the growth of girls' citizenship; (4) developing
leadership skills in girls and young female adolescents; and (5) fostering communities' and
neighborhoods' investments in their youth.
The first year of this project included efforts to invest in neighborhood site development, to
strengthen coalitions, and to develop a common process to monitor activities across sites. On
average, the four neighborhood sites of each community partner enrolled about 50 girls (at least
200 girls per community partner) during the first project year. The racial and ethnic composition
of participating girls varied by community site.
Although each community partner's programming is unique, several common themes have
emerged across sites in this past year. Each community partner has:
developed mechanisms to help girls and their families identify physical and mental health
needs, to enroll in Medicaid and the Children's Health Insurance Programs, and to access
appropriate health care services;
convened an advisory council composed of girls;
worked to help girls with their schoolwork and to feel connected to their schools (school
success is protective against engagement in health risk behaviors and helps young people to
thrive as adolescents and as adults);
developed creative community service programs to enhance girls' connectedness to
community, pride in citizenship, and leadership skills (examples include transforming a
vacant lot into a community garden, gathering canned goods at Halloween ("trick or treat
for others to eat"), developing public service announcements, and advocating for a
Neighborhood Watch program); and
incorporated field trips, which broaden girls' horizons, into its regular programming
activities and developed sports programming activities to improve girls' opportunities for
and attitudes toward physical activity.
In addition to these two programs that target teen pregnancy, in 1998 the Family and Youth
Services Bureau announced the award of more that $1 million in State Youth Development
Collaboration Projects. FYSB awarded funding to nine states to develop and support
innovative youth development strategies. Each of the following states received a grant of
$120,000: Arizona, Colorado, Connecticut, Iowa, Maryland, Massachusetts, Nebraska, New
York, and Oregon.
The grants will support efforts that focus on all youth, including vulnerable youth in at-risk
situations. Youth development programs have been shown to promote youth self-efficacy, build
competencies and encourage young people to delay childbearing. Each state has designed a
unique plan for implementing the project on the basis of identified youth needs and prior state
activities with regard to youth development.
Programs for Boys and Young Men
Traditionally, adolescent pregnancy prevention research and programs have focused on
adolescent girls. It has become increasingly clear, however, that adolescent boys and young men
must share that focus. The National Strategy along with the Administration's Fatherhood
Initiative have continued to work on ways to expand the Department's efforts to target boys and
young men. In 1998, the Office of Population Affairs funded several research grants aimed at
improving the knowledge of what works in male involvement by developing new program
models. This year, the Office of the Assistant Secretary for Planning and Evaluation (ASPE)
funded a project to identify abstinence programs for males, and also supported several meetings
to synthesize what is known thus far about male involvement programs.
Title X Male Involvement Grants. In FY 1998, the Office of Population Affairs funded ten
research grants, through the Title X Family Planning Program, to support community-based
organizations in developing, implementing, and testing approaches for involving young men in
family planning education and reproductive health services programs. Research has shown that
young men recognize unintended pregnancy as a serious problem and its prevention as a joint
responsibility; nevertheless, drawing them into family planning/reproductive health information
and service programs continues to be difficult. This year, the grantees completed their program
development and began implementing new approaches to bringing family planning services and
education components into programs where young males were already receiving other health,
education, and social services.
While each program reflects the specific needs of its community, several themes predominate the
interventions. Because most of the programs place significant emphasis on the role of adult men
as guides, teachers or examples for younger men in their transition to adulthood, nearly every
program is anchored on a strong mentoring component. This component is then often paired
with community, cultural and recreational activities, as well as life skills instruction. (Several
sites are using the nationally-known Wise Guys curriculum, while others have developed their
own curricula for life skills and reproductive health education.) In addition, these programs have
seen both the benefit and the appeal of youth development activities. Components such as
academic tutoring, sports, and talent shows are used as incentives to draw young men into the
project. Finally, some of the grant programs are targeting specific populations such as the Latino
community by using culturally appropriate services and language.
Abstinence Based Teen Pregnancy Prevention Programs Focusing on Males. Consistent
with the Department's focus on abstinence education, ASPE commissioned a paper, written by
the South Carolina State University Policy Analysis Consortium, to identify and describe
existing abstinence programs targeting boys and young men. The study will identify 66
programs that provide either abstinence-based (40%) or abstinence only (60%) programming to
boys and girls or to boys only. The authors found that the majority of abstinence programs serve
9 to 14 year old boys. The most frequently used service approaches were teen support groups
and mentoring types of activities as well as parent/teen classes. The matrix of existing programs
will be published and will be regularly updated with new and promising strategies for reaching
boys and young men with an abstinence message. A final report will be available in the Fall of
1999.
Federal, State, and Local Strategies for Promoting Male Involvement in Teen Pregnancy
Prevention. The Department sponsored several meetings to identify innovative male
involvement strategies that might be disseminated to a larger audience. The meeting results are
being summarized in a report that outlines multi-pronged strategies for reaching a much wider
population. The report draws upon the experiences of numerous local and one statewide
(California) male involvement initiatives.
The report will first identify "stakeholder" audiences whose activities stand to benefit from male
involvement and who have resources, networks and capacities to help promote and strengthen it.
These audiences include: (1) regional, state and local public officials administering family
planning, maternal and child health, education and family/social service programs; (2) teen
pregnancy prevention programs; (3) responsible fatherhood programs; (4) community-based
reproductive health programs; and (5) male serving programs in the armed services, juvenile
justice, prison systems, and youth development and recreation programs.
Specific strategies designed to inform and collaborate with these stakeholder audiences and other
community-based partners include creative use of the media and social marketing, regional and
state forums and summits, peer-to-peer networking opportunities and technical assistance. The
goal is to promote and support a view of boys and men wherever they live, learn, work or play as
responsible members of families--sons, fathers, spouses, grandfathers.
The report (available in the Fall, 1999) will outline some inherent tensions and barriers to
promoting male involvement and discusses the most critical challenge to be faced--identifying
state and national leaders and vehicles to coordinate and steer the wide ranging efforts needed to
effectively promote male involvement.
Welfare Reform
Welfare reform included an incentive for states to reduce the incidence of out-of-wedlock
childbearing and encourage the development of new approaches to pregnancy prevention. The
Bonus to Reward Decrease in Illegitimacy Ratio will reward those states with the largest
decrease in the ratio of out-of-wedlock to total births, provided they also show a decrease in
abortion rate relative to 1995. The bonus will be awarded in FY 1999 through 2002, based on
data releases from NCHS. This provision is targeted toward all women, not just teenage
mothers; however, in measuring state decreases in out-of-wedlock births, this measure would
also include births among unmarried teens. Although the bonus is part of the TANF grant, the
funds can be used to support a wide variety of programs extending beyond the TANF population.
In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) is
supporting an initiative on teen parents and welfare reform that generates knowledge on the
effects of welfare reform on parenting teens, and measures the effects of preventive interventions
on teen parents and their children. The four objectives in support of this goal are: (1) prevention
or reduction of alcohol, tobacco, and drug use; (2) improvement in academic performance; (3)
reduction of subsequent pregnancies; and (4) improvement in life skills and general well-being.
SAMHSA has awarded ten cooperative agreements which are in the process of collecting
baseline data for the evaluation of the initiative.
RESEARCH AND EVALUATION ACTIVITIES
Research Activities-From Data Collection to Findings
In the past year, the Department has continued its commitment to support research related to teen
pregnancy. This commitment includes investment in long-term research to follow trends in
important areas. With such a commitment, many of the Department's activities reported here are
continuations of research initially highlighted in last year's report. Areas of research include:
Adolescent sexual activity
Timing of first intercourse
Use of contraceptives
Intent to become pregnant
Adolescent decision making
Male Involvement
Data Collection. While often overlooked, the data sets used to conduct research in the area of
teen pregnancy are vital to the Department's mission to prevent teen pregnancy. To conduct
quality research, the Department has invested resources to gather and maintain high-quality,
comprehensive data. These data serve as a critical foundation for the information we now have
with regard to teen pregnancy and for the information we will need in the future. A brief
description of each data set is in Appendix IV.
Research Activities. The Department's research activities cover a wide spectrum of topics.
Continuing research on the sexual activity of adolescents allows for an understanding of the
patterns of sexual behavior. Examinations of whether and which adolescents intend to become
pregnant or cause a young woman to become pregnant clarifies how adolescents feel about
becoming pregnant and has important implications for the decisions they make, their physical
and emotional well-being, and potentially for the well-being of their children. Research funding
is also spent in designing, implementing and evaluating pregnancy prevention programs, so that
resources may be used to replicate programs that are demonstrably effective.
Adolescent decision making impacts on many risk-behaviors, including sexual activity and
contraceptive use, and is a vital factor not only in understanding how and why teens become or
make someone pregnant. Knowledge of how adolescents make decisions also enhances the
ability to create effective prevention and intervention programs. Research on male involvement
in teen pregnancy highlights the role, often ignored, that men have in sexual, romantic, marital
and parenting relationships. The couple relationship, as well as peer relationships, have
important influences on sexual risk behaviors.
Adolescent Sexual Activity. Research supported by the National Institute of Child Health and
Human Development (NICHD) indicates that, between 1988 and 1995, a decrease has occurred
in the proportion of teenagers aged 15-19 who had ever had sexual intercourse¹. This decline
occurred primarily among young men²⁻³. Research conducted by the NCHS revealed that the
levels for young women remained stable²⁻³. These trends are departures from trends since the
early 1970s, which had been toward increasing percents of sexually experienced teens.
Young Women's First Intercourse. NCHS and other researchers have found that many
teenage girls are ambivalent about their first intercourse. More complete knowledge about
adolescents' feelings about their first intercourse may help understand its timing, and clarify
relationships between sexual initiation, contraceptive use, and teenage pregnancy. 4 Among
women who had their first intercourse at age 13 or younger, 24 percent report the experience to
have been non-voluntary, compared with 10 percent of those who were between 19-24 at first
premarital intercourse. Yet, women's experiences are not simply voluntary or non-voluntary.
Women were asked to rate, on a scale of 1-10; how much they wanted their first intercourse to
occur. About one-quarter of respondents who reported their first intercourse as voluntary also
rated it as more unwanted than wanted. Women whose first partner was seven or more years
older than themselves were more than twice as likely as those whose first partner was the same
age or younger to rate it more unwanted than wanted (36 percent VS. 17 percent). These same
women were also less likely than other women to have used contraceptives at first intercourse.
Contraceptive Use. Research supported by NCHS indicates that the principal trend in
contraceptive method choice in 1988-1995 was an increase in condom use, especially among
black, Hispanic, or unmarried women under the age of 25. The increase in condom use at first
intercourse, which dramatically increased in the 1980s and 1990s, was accompanied by a
decrease in use of other methods that do not prevent HIV and STDs.⁵
Twenty-four percent of all black teens using contraception were using injectable or implant
contraception, methods which are very effective against pregnancy. 5 The use of injectable and
implant contraception may help to explain the decline in the second and higher order birth rates
for teen mothers - teens who already had a child. This adoption of injectable and implant
contraception and the increase in condom use at first intercourse and afterward may have been
important factors in the sharp decline in black teen birth rates. 3,6 For white teens, declines in
current sexual activity as well as the increases in condom use may be significant factors in
declines in birth rates For further information, please see Appendix I.
Unintended Pregnancies. Research conducted by the NCHS indicates that a large proportion of
recent pregnancies to women of all ages in the United States -- over 50 percent are unintended
even though contraceptives are widely available and widely used.⁷ Unintended pregnancies that
were wanted, but came too soon, or that were not wanted at all, are associated with a woman's
attitudes about her pregnancy at the time it was conceived.
The National Survey of Family Growth (NSFG) (see Appendix IV), which has long been the
principal national source of information on intended and unintended pregnancy in the United
States, traditionally classifies women's pregnancies as intended, mistimed, or unwanted. To
study whether young women were having inconsistent feelings about pregnancy, researchers
developed a set of scales to measure these feelings.⁸ The scales were used to show a woman's
positive, negative, or conflicting (ambivalent) feelings about her pregnancy and were compared
with the traditional measures of unintended pregnancies. Though she may not have actively
wanted to get pregnant at the time she did, the young woman may have felt some attraction to
what being pregnant would add to her life, for example, looking forward to the new experiences
that having a baby would bring. These results affirm the impressions of many service providers
that the strength of the motivation to prevent pregnancy, or ambivalence about preventing it, is a
prime determinant of both the likelihood of getting pregnant and how effectively contraceptives
are used among young and teenaged unmarried women. By measuring ambivalent feelings,
service providers may be able to better address teen's feelings and concerns about pregnancy and
contraception.
Many unintended pregnancies are pregnancies toward which the mother's attitude was not
entirely negative as measured in a new series of questions asked of teens and young women
under age 25 in the 1995 wave of the NSFG. In 1995, as in 1988 and 1982, teenaged women
had high levels of unintended pregnancy (about 78 percent of recent pregnancies in 1994)¹⁰
Teens 15-19 years of age were also more likely to have lower values on a "happiness to be
pregnant" scale, which suggests that they had stronger negative or ambivalent feelings about
their pregnancies than young women ages 20-24. Overall, the greatest amount of ambivalence
was shown by teen women 15-19 years old.
Adolescent Decision Making. The Office of the Assistant Secretary for Planning and
Evaluation (ASPE) funded a workshop in January, 1998 which was convened by the Board on
Children, Youth, and Families (a joint activity of the National Research Council and the Institute
of Medicine) to explore the role that decision making plays in adolescents' involvement in
high-risk behaviors.
The changes associated with adolescence, including physical, cognitive, social, and emotional
growth, impact decision making. Cognitive changes create an increased capacity for more
complex and abstract reasoning. Social cognition-the way one thinks about one's social world,
the people with whom one interacts, and the groups in which one participates-may change from
adolescence to adulthood. External factors, such as the media-television, radio, movies, music
videos-may influence decision making by helping to set both positive and negative social
norms.
Research examined at this workshop can assist those involved in the development of programs
designed to prevent health risk behaviors. Research on drug use prevention programs, for
example, has found that promising programs: (1) are long term, (2) are designed to counter social
influences, (3) begin in elementary or middle school, and (4) are supplemented by booster
sessions throughout the high school years. Programs may not explicitly use a decision-making
model, yet may incorporate decision-making skills such as providing information that teenagers
need for effective decision making in a clear and personalized way; encouraging teenagers to
take responsibility for their actions and to analyze their options; and showing adolescents how to
discuss decisions in a group setting. The report is available on the web at http://aspe.hhs.gov.
Male Involvement. Research on male involvement is another important piece of the
Department's research focus on teen pregnancy. Examples of programs in this area are
highlighted in the section "Supporting Promising Approaches." Including males in the
examination of teen pregnancy means investigating how men feel about their sexuality and
sexual relationships, attitudes of males regarding what it means to be a man, and attitudes
towards and use of contraceptives. Further, male involvement can incorporate issues not directly
involving sexuality such as family relationships and parenting, career and educational goals and
opportunities among a host of other issues that directly affect young men in the United States.
One area of research in this area is the expansion of the NSFG (see Appendix IV for details on
the current NSFG). The 6th cycle of the NSFG, due to be conducted in 2001 will include, for the
first time, a national sample of men 15-49 years of age. It is anticipated that the expanded survey
will be done every 3-4 years instead of every 6-7 years to more accurately monitor trends. Future
improvements under consideration are to include populations of men who are often excluded
from national surveys: the military and prisoners. These improved data can be expected to yield
reliable national estimates of male sexual behavior and contraceptive use, attitudes toward
marriage, cohabitation and fatherhood, extent to which births are wanted by males, and
father-child contact and the father's role in raising his children. Further, these data are expected
to allow for examinations of similarities and differences in attitudes and behaviors between men
and women and subgroups of men and women.
Attitudes Towards Sexual Activity. Small research projects funded at the NIH are addressing
adolescents' attitudes toward sexuality. Data collected under the AddHEALTH project (see
Appendix IV) are demonstrating, among other things, that a young person's public profession of
an intention to remain virgin does have a strong effect upon that person's abstaining from sex for
the next year, even when controlling for other influences such as family structure, religiosity, and
school success. Other researchers are able to examine how the strength of young people's sense
of connection to school and family protect against initiating health risk behaviors, including early
and unprotected sex.
Evaluation-Assessing Promising Approaches
The Department continues to be committed to learning what approaches have an effect on teen
pregnancy and its related antecedents so that better interventions can be effectively designed.
HHS continues to support ongoing evaluations and seeks to incorporate evaluation in HHS
funded demonstration projects and programs. To expand knowledge in this area, the Department
supports a number of efforts.
Abstinence-Only Education Programs-National Evaluation. The Department, through the
Office of the Assistant Secretary for Planning and Evaluation (ASPE), is responsible for
conducting an evaluation of the state abstinence-only education grants described in the Promising
Approaches section of this report. The Balanced Budget Act of 1997 set aside funding to
evaluate a select number of sites receiving funding from this program. In August, 1998, a
contract was awarded for a three-year multi-site effort to improve knowledge about programs
aimed at preventing teen sexual activity and its negative consequences. The process of site
selection is well underway and is expected to be completed by the summer of 1999. Data
collection will begin in the fall of 1999. The evaluation will focus on approximately six sites:
five sites will involve random assignment experiments of particular programs and one site will
involve a rigorous evaluation of a comprehensive community approach to abstinence-only
education. Outcomes of interest will include--but will not be limited to--the four performance
measures identified in the Department's program guidance. These four measures are:
The rate of pregnancy to teenagers aged 15 to 17
The proportion of adolescents aged 17 years and younger who engage in sexual
intercourse
The incidence of sexually transmitted diseases among youths aged 15-19
The rate of births to teenagers aged 15-17
Teenage Pregnancy Prevention Program Evaluation. Much remains to be learned about
what works to prevent teen pregnancy. Before large scale pregnancy prevention initiatives can
be implemented, current knowledge about pregnancy prevention programs needs to be expanded
to delineate which strategies are the most promising, which aspects of which programs
demonstrate the strongest impact, and which programs are successful in affecting behavior across
various communities and population characteristics, such as ethnicity and socio-economic status.
To contribute to the expansion of this knowledge base, ASPE provided grants to enhance three
existing evaluations of teen pregnancy prevention interventions that were rigorous in design and
already had funding. The following are brief descriptions of these three evaluations.
California Adolescent Sibling Pregnancy Prevention Program (UCSD)
Researchers from the University of California, San Diego are evaluating the California
Adolescent Sibling Pregnancy Prevention Program (CASSP) which targets the siblings of
pregnant and parenting teens. The evaluation is providing important information about a
significant subpopulation of girls who have been shown to be at elevated risk for teen pregnancy.
There are two goals to the enhanced evaluation: (1) to analyze the differential impact of specific
services and (2) to analyze community level factors that may be contributing to the risk of
pregnancy for this population. The research around these two questions should add meaningfully
to the knowledge base about solid teen pregnancy prevention practices. Basic knowledge about
the high risk of the siblings of pregnant and parenting teens was funded under an earlier NIH
grant.
Inwood House
Inwood House is a well-established agency in New York City that has long-established
pregnancy prevention programs as well as an array of services for pregnant and parenting
adolescents in middle through senior high school. The research team is currently comparing three
differing levels of intervention (and no intervention) with respect to outcomes for students
transitioning into high school. One of the interventions is an abstinence plus program funded by
the AFL program.
The researchers are using ASPE funds to improve the quality of the abstinence program's
comparison group while establishing comparison groups for the other two levels of intervention.
This enhanced study will provide an important comparison of interventions provided by the same
agency, and undergirded by the same philosophical approach toward working with adolescents.
The interventions differ in their emphasis on abstinence and in the breadth and intensity of
services they provide.
Institute for Health Policy Studies (UCSF)
The Center for Reproductive Health Policy Research, at the Institute for Health Policy Studies
(UCSF), is conducting a large scale evaluation of the California Community Challenge Grant
Program. This program funds 112 sites in the state to provide services to pregnant and parenting
teens and teen pregnancy prevention programs. Each site has implemented its own program and
is given a choice of a variety of modules to complete process, outcome or impact evaluations.
This has allowed the Center to provide an alternative to the "one size fits all" evaluation
approach which would be less appropriate for these community-driven programs. The
enhancement of the evaluation is developing comparison groups for these communities.
Community Coalition Partnerships Program. CDC's 13 community demonstration projects,
described previously, are conducting site-specific evaluations, and participating in cross-site
evaluations. These evaluations include process and progress evaluation, and additionally, in six
of the communities, enhanced evaluations of the impact of the program, or of specific program
components.
Process and Progress Indicators. Each of the demonstration sites is engaged in efforts to monitor
its process and progress. In partnership with CDC and the Academy for Educational
Development, the demonstration sites have collectively defined Cross Site Process Indicators
for Adolescent Pregnancy Prevention in the following areas: (1) needs and assets assessment; (2)
health outcomes; (3) defining the program; (4) project administration; (5) positioning for
financial sustainability. The analysis of the cross-site indicators over the life of the project will
enhance the communities' capacity to evaluate and strengthen their programs. Furthermore, the
documentation of these aspects of program development may also benefit other communities
seeking to address teen pregnancy.
Enhanced Evaluation Activities. Six of the 13 communities receive supplemental funding to
support evaluations of the impact and outcome the demonstration projects have had in their
communities. The studies underway include the following:
Longitudinal study measuring the timing and frequency with which youth use the
activities and services supported by the coalitions.
An examination of changes in birth and STD rates in school populations based on
whether the schools are in an intervention or comparison area.
Annual surveys of adult knowledge, attitudes and behaviors with regards to youth
development activities and issues in the intervention and comparison communities.
Longitudinal study of parents and their children who participate in parent-child
communication programs to assess changes in communication and connectedness.
Survey of households in intervention and comparison communities assessing community
and neighborhood resources, family and youth assets, and adolescent risk behaviors to
assess changes in inter-organizational relationships among key community agencies in
intervention and comparison communities.
Girl Neighborhood Power! (GNP) Evaluation. The GNP initiative, described earlier in this
report, has also stressed the importance of evaluation. Each project is responsible for developing
and implementing its own evaluation for determining how successfully it has achieved its goals
and objectives. In addition, the sites have together developed and agreed on the use of a
common form to document and monitor project activities. Supplemental funding is being
provided by the Office on Women's Health so that community partners will be able to use a
common set of variables to explore how they influenced participating girls and their families, to
measure the degree of community investment in programming for girls, and to explore how their
projects' activities have affected participating neighborhoods.
1 Abma JC, Chandra A, Mosher WD, Peterson LS. Piccinino LJ. Fertility, Family Planning, and Women's Health: New Data
from the 1995 National Survey of Family Growth. National Center for Health Statistics. Vital and Health Statistics, Series 23,
No. 19. 1997.
2 Abma JC. Sonenstein FL. Teenage Sexual Behavior and Contraceptive Use: An Update. Paper presented at Conference: "
Teenage Sexual Activity and Contraceptive Use: An Update," at the American Enterprise Institute Welfare Reform Academy,
May I, 1998.
3
Sonenstein FL, Ku L. Lindberg LD, Turner DF, Pleck JH. Changes in Sexual Behavior and Condom Us Among Teenaged
Males: 1988 to 1995. AJPH 88(6):956-959. 1998.
4 Abma JC, Driscoll A, Moore K. Young Women's Degree of Control Over First Intercourse: An Exploratory Analysis. Family
Planning Perspectives 30(1): 12-18. 1998.
5 Piccinino LJ, Mosher WD. Trends in Contraceptive Use in the United States: 1982-1995. Family Planning Perspectives
30(1):4-10, 46. 1998.
6 Ventura SJ, Mathews TJ, Curtin SC. Declines in Teenage Birth Rates, 1991-97: National and State Patterns. National Vital
Statistics Reports, Vol. 47, No. 12. Hyattsville, Maryland: National Center for Health Statistics. 1998.
7 Piccinino, LJ. Unintended Pregnancy and Childbearing. In: Wilcox, LS and Marks, JS, eds. From Data to Action. Atlanta:
Centers for Disease Control and Prevention, pp. 73-82. 1994.
8 Adler, NE. Unwanted Pregnancy and Abortion -- Definition and Research Issues. Journal of Social Issues 48 (3). 1992.
9 Piccinino, L, Peterson, LS. Ambivalent Attitudes and Unintended Pregnancy. In: Severy, L and Miller, W, eds. Advances in
Population, Vol. 3. London: Jessica Kingsley Publishers Ltd., 227-249. 1999.
10 Henshert, SK. Unintended Pregnancy in the United States. Family Planning Perspectives 30 (1):24-29,46. 1998.
APPENDIX II
Measuring the Proportion of Communities with Teen
Pregnancy Prevention Programs
Recent declines in the teen birth rate, and indications of further declines in the teen pregnancy
rate, suggest that the numerous public- and private-sector efforts across the country to prevent
teen pregnancy are having a positive impact. Measuring all factors that help adolescents postpone
premature sexual activity and avoid pregnancy is difficult, however, since individual, family, and
community characteristics are all influential. Nevertheless, measuring the proportion of
communities that have at least one teen pregnancy prevention program in place (estimated by
dividing the number of such communities by the number of communities in the United States)
provides a rough sense of how many communities are responding to this problem with specific,
targeted prevention efforts. In 1997, at least 31 percent of communities had HHS-supported teen
pregnancy prevention and related programs.
To develop a sound, albeit conservative, estimate of this proportion, the estimate includes only
those programs supported by HHS. HHS-supported programs which include teen pregnancy
prevention services as a component are diverse, ranging from comprehensive health and social
services to substance abuse treatment and HIV prevention education. In this report, the number
of teen pregnancy prevention programs funded by HHS includes those programs funded in the
year FY 1998 (including the latest year for which complete information on grants awarded is
available).
To determine the number of communities with at least one program, the location of each program
was identified based on the site of the services provided and/or the location of the grant recipient.
A community with more than one program was counted only once. The estimate excludes HHS
funding provided directly to states (e.g., Medicaid, Maternal and Child Health Block Grant)
which states may use to fund activities in multiple communities. Since there is no single
standard definition for community in the United States, the estimate uses a definition of
community based on areas identified by the Commerce Department's Bureau of the Census. This
definition includes all incorporated places with a population of 10,000 individuals or more
(2,673) and all counties where, excluding these incorporated places, the remaining population
reaches 10,000 or more (2,079), for a total of 4,752 communities. Under this definition, for
example, Montgomery County, Maryland would consist of four communities, including three
incorporated places of 10,000 or more inhabitants (Gaithersburg, Rockville, and Takoma Park)
and one community representing the balance of the county's population, which exceeds 10,000.
Using these calculations, the resulting estimate of the proportion of communities in the United
States with HHS-supported teen pregnancy prevention and related programs is at least XXX
percent for FY 1998. This proportion represents about XXX communities across the country.
Appendix II I
APPENDIX III
HHS Activities
The Department of Health and Human Services supports a variety of efforts to help communities
develop comprehensive teen pregnancy prevention strategies that reflect five principles: parental
and adult involvement, abstinence and personal responsibility, clear strategies for the future,
community involvement, and a sustained commitment.
HHS Programs
State Children's Health Insurance Program (CHIP) was established by the Balanced Budget
Act of 1997 under Title XXI of the Social Security Act. This program, administered by the
Health Care Financing Administration (HCFA) and Health Resources and Services
Administration (HRSA), enables states to provide health insurance coverage to uninsured
targeted low-income children. States have the opportunity to involve communities as they design
and implement their CHIP programs so that the new programs, including teen pregnancy
prevention programs, may be an additional avenue to provide services to adolescents at risk. As
of April 1999, 53 states, territories, and the District of Columbia have submitted CHIP plans, of
which 51 have been approved. The submitted plans include 27 Medicaid expansions, 14 separate
State Child Health plans, and 12 combination plans.
The Abstinence Only Education Program was part of the Personal Responsibility and Work
Opportunity Act of 1996 to enable states to provide abstinence education through activities such
as mentoring, counseling, and adult supervision designed to promote abstinence from sexual
activity until marriage. The program, administered by the Health Resources and Services
Administration (HRSA), has a mandatory appropriation of $50 million for each Fiscal Year from
1998 through 2002.
The Girl Neighborhood Power! - Building Bright Futures for Success is challenging
America's communities to become active partners in assisting 9- to 14-year-old girls to
successfully navigate adolescence and achieve maximum potential. The initiative, administered
by HRSA, strives to combine several elements including strong "no use" messages about tobacco
alcohol, and illicit drugs with an emphasis on physical activity, nutrition, abstinence, mental
health, social development, and future careers.
The Center for Disease Control's Community Coalition Partnership Program for the
Prevention of Teen Pregnancy has supported demonstration grants for the prevention of teen
pregnancies in 13 communities in 11 states since 1995. Coalitions of local and public and private
agencies and organizations in communities with high rates of teen pregnancy have been working
over the last two years to develop community action plans, coordinate efforts to reduce teen
pregnancy, identify gaps in current programs and services, target existing resources, and design
evaluation plans. CDC awarded approximately $250,000 per year for two years to 13
communities in 11 states to help these communities mobilize and
organize their resources to support effective and sustainable teen pregnancy prevention
programs. For FY 1998, a total of $13.7 million was made available to help the 13 community
Appendix III - 1
coalition partnerships implement their action plans and evaluate their impact, as well as to
support related data collection, evaluation, and dissemination activities.
Reproductive Health and Family Planning Services (under Title X of the Public Health
Service Act) are provided to nearly 5 million persons each year, nearly one third of whom are
under 20 years of age. Abstinence counseling and education are an important part of the Title X
service protocol for adolescent clients. These services are provided by 84 grantees with more
than 4,000 clinic locations. These sites offer reproductive health services including pregnancy
prevention, family planning, and diagnosis of sexually transmitted diseases, either on site or by
referral. The program has also launched an adolescent male initiative called the "Young
Men/Family Planning Partnership Training Program." Under this initiative, Title X clinics
employ male high school students as interns while also providing training in clinic operation and
peer education; assisting in identifying career paths in allied health and related occupations; and
increasing their use of services in a family planning setting.
Healthy Schools, Healthy Communities, a Health Resources and Services Administration
program created in 1994, has established school-based health centers in 26 communities in 20
states to serve the health and education needs of children and youth at high risk for poor health,
teenage pregnancy, and other problems. For the first three years of the program, $1 million each
year was provided to fund health education and promotion programs that were coordinated with
the health services grants.
The Social Services Block Grant (SSBG) (under Title XX of the Social Security Act) provides
funding to prevent, reduce, or eliminate dependency; achieve or maintain self-sufficiency;
prevent neglect, abuse, or exploitation of children and adults; prevent or reduce inappropriate
institutional care; and provide admission or referral for institutional care when other forms of
care are inappropriate. SSBG Grants are made directly to the 50 states, the District of Columbia,
Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Commonwealth of the
Northern Mariana Islands to fund social services tailored to meet the needs of individuals and
families residing within each jurisdiction.
The Community Services Block Grant, which operates in all 50 states, the District of
Columbia, and the territories, enables local community agencies to provide low-income
populations, including youth at risk, with job counseling, summer youth employment, GED
instruction, crisis hotlines, information and referral to health care, and other services.
The Independent Living Program, run by the Administration for Children and Families,
provides funds to states to support activities ranging from educational programs to programs that
help young people who are making the transition from foster care to independent living to avoid
early parenthood. This program supports activities in all 50 states and the District of Columbia.
Youth Programs including Runaway and Homeless Youth Programs, Transitional Living
Programs, and the Youth Sports Program, address a wide range of risk factors for teen
pregnancy. Together, these programs operate in 500 communities in 50 states and the District of
Columbia.
Appendix III - 2
Healthy Start, administered by HRSA, has 62 projects to reduce infant mortality in the highest-
risk areas and to improve the health and well-being of women, infants, and their families. Among
a broad array of services provided (including state prenatal hotlines), thousands of teenagers
participate in prevention programs exclusively designed for adolescents. The programs
encourage healthy lifestyles, youth empowerment, sexual responsibility, conflict resolution, goal
setting, and the enhancement of self-esteem.
Maternal and Child Health Services Block Grant (Title V) funds support a variety of
adolescent health programs in 57 states and jurisdictions, including adolescent pregnancy
prevention programs, state adolescent health coordinators, family planning, technical assistance,
and other prevention services.
The Adolescent Family Life Program (AFL), created in 1981, supports research into the
causes and consequences of adolescent pregnancy; demonstration projects that provide health,
education, and social services to pregnant and parenting adolescents, their children, male
partners, and families; and programs aimed at promoting abstinence among pre-adolescents and
adolescents as the most effective way of preventing adolescent pregnancies, sexually transmitted
diseases, and HIV/AIDS. In FY 1997, the AFL program funded 83 projects in 37 states and the
District of Columbia. AFL is administered by the Office of Population Affairs.
Empowerment Zones and Enterprise Communities in 105 rural and urban areas in 43 states
and the District of Columbia have been awarded grants to stimulate economic and human
development and to coordinate and expand support services. As they implement their strategic
plans, some sites are including a focus on teenage pregnancy prevention and youth development.
Health Education in Schools supports the efforts of every state and territorial education agency
to implement local school health programs to prevent the spread of HIV and sexually transmitted
diseases (STDs). Assistance is also provided to 13 states to build an infrastructure for school
health programs. Efforts are targeted at preventing early sexual activity, STDs, HIV, drug and
alcohol abuse, tobacco use, and injuries.
Community and Migrant Health Centers, including family and neighborhood health centers,
operate in 3,032 community-based sites through 685 center grantees in all 50 states, the District
of Columbia, and six territories. The centers provide primary and specialized health and related
services to medically-underserved adolescents. Some centers include special hours or clinics for
adolescent patients.
Indian Health Service (IHS) provides a full range of medical services for American Indians and
Alaska Natives. IHS supports projects targeted at preventing teenage pregnancy, and its
prevention and treatment programs also have a special emphasis on youth substance abuse, child
abuse, and women's health care.
Appendix III - 3
Drug Treatment and Prevention Programs include services to prevent first time and repeat
pregnancies among teenagers. One hundred twenty-two residential substance abuse treatment
programs for pregnant and postpartum women, as well as for women with dependent children,
receive support to provide family planning, education, and counseling services in 39 states, the
District of Columbia, and the Virgin Islands. Also, 25 programs to prevent substance use and
other adverse life outcomes serve high-risk female teens in 13 states and the District of
Columbia.
Health Care and Promotion under Medicaid provides Medicaid-eligible adolescents under age
21 with access to a comprehensive range of preventive, primary, and specialty services within its
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program.
The Medicaid program also funds family planning services at an enhanced match rate for
states. The federal government pays 90 percent of state expenditures for Medicaid family
planning services, while the state funds the remaining 10 percent. The enhanced match
encourages states to fund family planning programs which include patient counseling and
education concerning pregnancy prevention and reproductive health.
Appendix III - 4
APPENDIX IV
HHS Funded Data Sets
NSFG-National Survey of Family Growth. The National Survey of Family Growth (NSFG),
conducted by the National Center for Health Statistics (NCHS), is based on personal interviews
with a national sample of women 15-44 years of age in the United States. Its main function is to
collect data on factors affecting pregnancy and child bearing. Please see
http://www.cdc.gov/nchswww/about/major/nsfg/nsfg.htm for more information.
NSAM-National Survey of Adolescent Males. The National Survey of Adolescent Males
(NSAM), conducted by the Urban Institute and supported by the National Institute of Child
Health and Human Development (NICHD), provides data exclusively on teenage males ages
15-19, specifically their contraceptive and sexual behavior. This data set complements the data
on teenage females which is available from the NSFG. Please see
http://silk.nih.gov/silk/DBSB/nsam.htm for more information.
Add Health-National Longitudinal Study of Adolescent Health. The National Longitudinal
Study of Adolescent Health (Add Health), conducted by the Carolina Population Center,
University of North Carolina and supported by the NICHD and seventeen other federal agencies,
is a school based study of adolescents in grades 7 to12 which provides information on physical,
mental, and emotional health status, and health behaviors, including sexual behavior and
contraceptive use. It provides the first comprehensive view of the health and health behaviors of
adolescents and the antecedents-personal, interpersonal, familial, and environmental-of these
outcomes. This study will follow-up with these young people in to their late teens and early 20s.
Please see http://www.cpc.unc.edu/addhealth/ for more information.
YRBSS-Youth Risk Behavior Surveillance System. The Youth Risk Behavior Surveillance
System (YRBSS), established by the Centers for Disease Control and Prevention (CDC),
monitors the prevalence of youth behaviors that most influence health. This national
school-based survey focuses on priority health-risk behaviors established during youth that result
in the most significant mortality, morbidity, disability, and social problems during both youth
and adulthood. Please see http://www.cdc.gov/nccdphp/dash/yrbs/ov.htm for more information.
NLSY-National Longitudinal Survey of Youth. The NLSY, supported by the NICHD and the
Bureau of Labor Statistics, is a national sample of approximately 12,000 men and women who
were aged 14-21 in 1979. The sample is oversampled for the black and Hispanic population.
Data have been collected annually through 1994 and every other year beginning in 1996 on
topics which include employment, fertility, marriage, divorce, child care, and infant health. In
1986, and biannually since then, data were collected from and about the children of the female
respondents. Please see http://stats.bls.gov/nlshome.htm for more information.
NVSS- National Vital Statistics System. The National Vital Statistics System (NVSS),
operated by the National Center for Health Statistics (NCHS), CDC, is based on the collection of
individual record data for every birth registered in the United States. Data are collected by each
State and transmitted to NCHS through the Vital Statistics Cooperative Program (VSCP). Under
this program, NCHS partially supports State costs of producing vital statistics through a contract
with each State. Please see http://www.cdc.gov/nchswww/about/major/natality/natality.htm. for
more information.
Appendix IV - 1
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fele teen
HHS NEWS
pregnancy
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOR IMMEDIATE RELEASE
Contact: NCHS/CDC Press Office
Monday, Oct. 25, 1999
(301) 436-7551
CDC Media Relations
(404) 639-3286
NEW GUIDE TO HELP LOCAL COMMUNITIES
ESTABLISH TEEN PREGNANCY PREVENTION PROGRAMS
HHS Secretary Donna E. Shalala released a new guide today to help communities and non-
profit organizations establish successful local teen pregnancy prevention programs. The
comprehensive guide, developed by the National Campaign to Prevent Teen Pregnancy, will be
distributed nationwide for local health organizations' use.
Titled Get Organized: A Guide to Preventing Teen Pregnancy, the publication stresses a
localized approach, a long-term commitment, and careful evaluation. It also provides novel
approaches for addressing teen pregnancy, including ways to involve faith leaders and the business
community, suggestions on how to target young men in prevention efforts, and mechanisms for
channeling community views on pregnancy prevention into effective, localized strategies for
addressing the overall issue.
"We've seen a continued decline in teen pregnancy and teen birth rates in the last several
years, which has been very encouraging," Secretary Shalala said. "But we can't afford to stop our
efforts now-too many teenagers are still jeopardizing their futures. By making this guide available
to local communities, we hope to strengthen existing teen pregnancy prevention programs-and build
others-that will coach girls and boys with common sense guidance, positive alternatives and the
emotional support it takes to stand up to peer pressure."
According to a new report released today by the National Center for Health Statistics
(NCHS), the teen birth rate is at its lowest level since_1987. After years of rising rates, teen births
began to decline in 1991, continuing to decline every year and falling another 2 percent in 1998.
Declines have been particularly marked in younger teens, with the birth rate for teenagers 15-17 years
dropping 5 percent for 1998 to a record low of 30.4 per 1,000.
Despite this decline, however, four out of 10 American girls get pregnant at least once before
they turn 20, leading to more than 900,000 teen pregnancies a year. Today's guide is a three-volume
publication that includes strategies for collecting basic data, reaching out to religious leaders, raising
money and conducting program evaluation.
"The National Campaign to Prevent Teen Pregnancy was created in response to the President
and Vice President's challenge to parents and leaders all across our country," Secretary Shalala said.
"The message was clear: winning the fight against teen pregnancy isn't the sole responsibility of
parents, religion, school or the government. Winning this crusade is everyone's job-and the only
way we'll win is if all of us join together."
- More -
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The NCHS report also contains state-by-state data for 1991-1997. That data show that teen
birth rates have declined in every state and the declines have exceeded 20 percent in ten states and the
District of Columbia.
Founded in 1996, the National Campaign to Prevent Teen Pregnancy is a nonprofit, non-
partisan initiative supported almost entirely by private donations. The campaign's mission is to
prevent teen pregnancy by supporting values and stimulating actions that are consistent with a
pregnancy-free adolescence. The campaign's goal is to reduce the teen pregnancy rate by one-third
between 1996 and 2005.
Copies of today's report can be viewed or downloaded on the NCHS Home Page at:
http://www.cdc.gov/nchs.
###
Note: For other HHS Press Releases and Fact Sheets pertaining to the subject of this announcement,
please visit our Press Release and Fact Sheet search engine at: http://www.dhhs.gov/news/press/
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National Vital Statistics Reports
NUSS
nchs
From the CENTERS FOR DISEASE CONTROL AND PREVENTION
MIDO
National Center for Health Statistics
National Vital Statistics System
Volume 47, Number 26
October 25, 1999
Declines in Teenage Birth Rates, 1991-98:
Update of National and State Trends
by Stephanie J. Ventura, M.A., T. J. Mathews, M.S., and Sally C. Curtin, M.A., Division of Vital Statistic
Abstract
Details of trends and variations in teenage childbearing in the
1990's, including some discussion of the health consequences and the
Objectives-This report presents national birth rates for teen-
demographic and behavioral changes accounting for the recent trends,
agers for 1991-98; the percent change, 1991-98; State-specific
have been published in a recent report (2). This report updates the
teenage birth rates for 1991 and 1997; and the percent change,
findings through 1998 for national data and through 1997 for State
1991-97.
statistics.
Methods-Tabular and graphical descriptions of the trends in
teenage birth rates by age group, race, and Hispanic origin of the mother
Most teenage births are to unmarried women
are discussed.
Results-Birth rates for teenagers 15-19 years declined nationally
The proportion of births to teenagers that were to unmarried
between 1991 and 1998 for all age, race, and Hispanic origin popu-
teens continued to increase in 1998, according to preliminary data.
lations, with the steepest declines recorded for black women. State-
The proportion unmarried rose to 78.8 percent for all teenage births,
specific rates by age fell in all States, with most declines statistically
up from 78.2 percent In 1997. For teenagers 15-17 years, the percent
significant: overall declines ranged from 9 to 32 percent.
increased from 86.7 to 87.4 percent, while for older teens, it rose from
72.5 to 73.5 percent (table A).
Keywords: teenage fertility . State-specific birth rates . fertility
The total number of births to teenagers 16-17 years and the
trends
number of births to unmarried leenagers 15-17 years declined from
teenage pregnancy
1997 to 1998. However, the total number declined even more than the
number of nonmarita) births. As a result the percent unmarried for
Teenage birth rate down 18 percent since
teenagers 15-17 years continued to increase.
1991, close to record low
Although the proportion of teenage binhs that are nonmarital
continues to rise, it is still the case that most births to unmarried women
The birth rate (preliminary) for U.S. teenagers in 1998 was 51.1
are not to teenagers. In 1998, 70 percent were to women aged 20 and
live births per 1,000 women aged 15-19 years, 2 percent lower than
older.
the rate in 1997, and 18 percent lower than in 1991 (table 1 and
figure 1) (1). The 1998 rate (preliminary) is close to the 1986 record
Teenage birth and pregnancy rates fall
low of 50.2 (2), The U.S. teen birth rate rose 24 percent from 1986 to
1991, when it reached 62.1, the highest level recorded in 20 years
When data on five births are combined with information for
(64.5 in 1971). The previous peak period for teen birth rates was the
induced abortions and fetal losses, pregnancy rates can be computed.
late 1950's; the birth rate was highest in 1957, at 96.3 births per 1,000
(2).
The total of 484,975 births (preliminary number) to women aged
Acknowledgments
15-19 years in 1998 was slightly higher than the number in 1997
This report was prepared in the Reproductive Statistics Branch (RSB) of the
(483,220). but still 7 percent lower than the recent high in 1990 of
Division of Vital Statistics (DVS). Melissa
Park of RSB provided table review.
The report was edited by Patricia Keaton
Williams, typesel by Jacqueline M.
521,826. The small 1997-98 increase in the number reflects the
Davis, and graphics produced by John
Chang of the Publications Branch.
3-percent increase in the number of teenage females in the population
Division of Data Services.
between 1997 and 1998 (3).
U.S. DEPARTMENT or HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
CDC
National Center for Health Statistics
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Birth rates decline for teenagers in all age
175
groups
150
The birth rate for the youngest teenagers, 10-14 years, fell to 1.0
per 1,000, its lowest level since 1969 (also 1.0) (table 1). Moreover,
125
the number of births to teenagers in this age group fell, to 9,481 in
1998, down 6 percent from 1997 and down 27 percent from its recent
high in 1994 (12,901 births).
The birth rate for teenagers 15-17 years dealined 5 percent from
10D
1997 to 1998, to 30.4 per 1,000. a record low for this age group. The
rate has fallen 21 percent since 1991; this decline assentially reverses
18-19 years
the 27-percent Increase in the rate from 1986 (30.5) to 1991 (38.7). The
Births per 1,000 women (log scale)
number of births in this age group dropped to 173,252, the lowest
75
number since 1987 (2),
The birth rate for teenagers 18-19 years declined 2 percent in
1998, to 82.0. This rate has dropped 13 percent since its 1992 high of
94.4. The number of births in this age group Increased 3 percent,
15-19 years
reflecting the 5-percent increase in the number of teenage females
50
18-19 years (3).
Birth rates fall most steeply for black
teenagers
15-17 years
Birth rates have dropped sharply for black teenagers since 1991,
declining overall by 26 percent, from 15.5 in 1991 to 85.3 per 1,000
aged 15-19 (lable 1, figure 2). lower than in any year since 1960,
when data for black women first became available (2). The rate for
25
1960
1970
1980
1990
1998
Hispanic women has declined steadily since 1984 (107.7) and was
Year
93.7 in 1998, dropping 13 percent in 4 years. Despite these declines,
birth rates for black and Hispanic teenagers continue to be higher
Figure 1. Birth rates for teenagers by age: United States,
than those for other groups; the rates for Hispanic teens have been
1960-98
higher than the rates for black teens since 1994. Asian Dr Pacific
Islander teenagers have the lowest rate (23.1 in 1998).
Birth rates have declined as well for non-Hispanic white (35.2 per
Because information on the latter two outcomes is not as current as
1,000 in 1998), American Indian (71.8). and Asian or Pacific Islander
information on live births, the most recent year for which teenage
teenagers (23.1), with declines ranging from 16 to 19 percent since
pregnancy rates can be computed is 1996. The estimated teen
1991 (table 1).
pregnancy rate in 1996 was 98.7 per 1,000 women aged 15-19, down
15 percent from its high point of 116.5 in 1991 (4). A consistent series
of pregnancy rates for teenagers have been available since 1976; the
Teenage birth rates vary greatly by State
1996 rate is lower than the rate of any year since 1976.
Birth rates vary substantially by State. In 1997 the most recent
year for which State-specific rates can be computed. the rates per
Table A. Number of total births and percent of births to
1,000 women aged 15-19 years ranged from 26.9 (Vermont) to 73.7
unmarried women, all ages and women under 20 years:
(Mississippi) (table 2). The highest rate reported was for Guam
United States, final 1997 and preliminary 1998
(106.3).
Births to
As previously reported, differences in overall rates by State reflect
unmarried
Percent
in part the differences in the composition of the teanage populations of
Total births
women
unmarried
the States by race and Hispanic origin (2,5,6). Rates are much higher
Age of mother
1998
1997
1998
1997
1998
1997
for Hispanic and black teenagers than for non-Hispanic white teenagers
(table 1). This pattern is found for all States (except Louisiana) for which
All ages
3,944,046
3,880,894
1,292,534
1,257,444
32.8
32.4
Under 20 years
494,456
493.341
389,721
385,802
reliable rates could be computed for each population (table 3). There-
78.8
78.2
Under 15 years
9.491
10,121
2,162
9,505
00.2
95.7
fore. States with relatively high proportions of Hispanic and/or black
15-19 years
484,975
483,220
380,569
376,117
78.5
77.8
teenagers would be expected to have higher overal teenage birth rates.
15-17 years
173,252
180,154
151,445
156,253
87.4
86.7
18-19 years
371,724
303,066
228,124
219.864
73.5
72.5
These compositional differences should be considered when comparing
teenage birth rates across States (6).
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3
References
160
1.
Martin JA, Smith BL, Mathews T. Ventura S. Births and dealhs:
140
Preliminary data for 1998. National vital statistics reports; vol 47 no 25.
Hyattsville, Maryland: National Center for Health Statistics. 1999.
2.
Ventura SJ, Mathews TJ, Curtin SC. Declines in teenage birth rates,
120
1991-97: National and State patterns. National vital statistics reports;
Hispanic
vol 47 no 12. Hyatisville, Maryland: National Center for Health
Statistics. 1998.
100
3.
U.S. Bureau of the Census. U.S. population estimates. by age, sex,
race, and Hispanic origin: 1990 to 1998. Washington, DC: D.S. Bureau
of the Census. Internet release, June 4. 1999 Http://www.census.gov/
Black
BO
population/www/esitlmates/uspop.html.
4.
Ventura SJ, Mosher WD, Curtin SC, et al. Trends in pregnancies and
American Indian
pregnancy rates by outcome: Estimates for the United States, 1976-96.
Vital Health Stat 21(56). Hyattsville, Maryland National Center for
60
Health Statistics. In preparation.
5.
U.S. Bureau of the Census. Estimates of the population of states by
age, sex, race, and Hispanic origin: 1990 10 1997. STREST97.bil.
Product Announcement CB98-122. Released July 21, 1998.
Births per 1,000 women 15-19 (log scale)
6.
Ventura SJ, Clarke SC, Mathews TJ. Recent declines in teenage birth
White, total
rates in the United States: Variations by State, 1990-94. Monthly vital
statistics report; vol 45 no 5. supp. Hyattsville, Maryland: National
40
Center for Health Statistics. 1996.
Non-Hispanic
List of detailed tables
White
Asian or Pacific Islander
1. Number of births to women under 20 years by age, race, and
Hispanic origin of mother: United States, 1998, and birth rales,
1991-98: and percent change in rates) 1991-98
5
2. Birth rates for Leenagers aged 15-19 years by age group and
State, and percent change by age: United States and each State,
1991 to 1997
6
20
1985
1995
3. Birth rates for leenagers 15-19 years by age and race/Hispanic
1980
1990
1998
origin: United States and each State, 1997
7
Year
Figure 2. Birth rate for teens aged 15-19 years by race
and Hispanic origin: United States, 1980-98
Between 1991 and 1997, birth rates for teenagers 15-19 years fell
in all States and the District of Columbia and the Virgin Islands, with
statistically significant reductions in all areas except Rhode Island and
Guam (table 2 and figure 3). Declines exceeded 20.0 percent in 10
States and the District of Columbia.
Birth rates for teenage subgroups also vary greatly by State. Rates
for teenagers 15-17 years fell significantly in all but six States, the Virgin
Islands, and Guam, with declines exceeding 20.0 percent in 14 States
and the District of Columbia. The rates for the District of Columbia,
Maine, and Vermont declined at least 35 percent. State-specific rates
for older teenagers 18-19 years also declined, with statistically sig-
nificant reductions reported for all but six States, the District of
Columbia, Puerto Rico, and Guam. The declines for older teenagers
were generally smaller than those for younger leens; rates fell signifi-
cantly by 20.0 percent or more in live States and the Virgin Islands.
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4 National Vital Statistics Reports, Vol. 47, No. 26. October 25, 1999
DC
20.0 percent or more
16.0-19.9 percent
13.0-15.9 percent
Less than 13.0 percent
No significant change
Figure 3. Percent decline in teenage birth rates by State, 1991 to 1997
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5
Table 1. Number of births to women under 20 years by age, race, and Hispanic origin of mother: United States, 1998
birth rates, 1991-98; and percent change in rates, 1991-98
[Rates per 1,000 wamen in specified group]
Birth rates
Percent
change
Age, race, and Hispanic
Number of
in rates,
origin of mother
births, 1998'
1998'
1997
1996
1995
1994
1993
1992
1991
1991-98
10-14 years
Total
9,481
1.0
1.1
1.2
1.3
1.4
1.4
1.4
1.4
-28.6
White. total
4,821
0.7
0.7
0.8
0.8
0.8
0.8
0.8
0.8
-12.5
Non-Hispanic white
2,145
0.4
0.4
0.4
0.4
0.5
0.5
0.5
0.5
-20.0
Black
4,291
2.9
33
3.6
4.2
4.6
4.6
4.7
4.8
-39.6
American Indian²
195
1.6
1.7
1.7
1.8
1.9
1.4
1.6
1.6
0.0
Asian or Pacific Islander
174
0.4
0.5
0.6
0.7
0.7
0.6
0.7
0.8
-$0.0
Hispanic3
2,721
21
2.3
2.6
2.7
27
2.7
2.6
2.4
-12.5
15-19 years
Total
484,975
51.1
52.3
54.4
56.8
589
59.6
60.7
62.1
-17.7
White, total
340,894
45.4
46.3
48.1
50.1
57.1
51.1
51.8
52.8
-14.0
Non-Hispanic while
212,292
35.2
36.0
37.6
39,3
40.4
40.7
41.7
43.4
-18.9
Black
126,865
85.3
88.2
91.4
96.1
104.5
108.6
112.4
115.5
-26.1
American Indian²
8,174
71.8
71.8
73.9
78.0
80.8
83.1
84.4
85.0
-15.5
Asian or Pacific Islander
9,043
23.1
23.7
24.6
26.1
27.1
27.0
26.6
27A
-15.7
Hispanic
121,455
93.7
97.3
101.8
106.7
107.7
106.8
107.1
106.7
-12.2
15-17 years
Total
173,252
30.4
32.1
33.8
36.0
37.6
37.8
37.8
38.7
-21.4
White. total
116,699
25.9
27.1
2B.4
30.0
30.7
30.3
30.1
30.7
-15.6
Non-Hispanic white
68,657
18.4
19.4
20.6
220
22.8
227
22.7
23.6
-22.0
Black
50,062
56.8
60.8
64.7
69.7
76.3
79.8
B1.3
84,1
-32.5
American Indian2
3,155
44.3
45.3
16.4
47.8
513
53.7
53,8
52.7
-75.9
Asian or Packic Islander
3,336
13.7
14.3
14.9
15.4
16.1
15.0
15.2
16.1
-14.9
Hispanic
48,265
62.3
66.3
69.0
72.9
74.0
71.7
71.4
70.6
-11.6
18-19 years
Total
311,724
82.0
83.6
86.0
89.1
91.5
92.1
94.5
94.4
-13.1
White, total
224,195
74.7
75.9
78.4
81.2
82.1
82.1
83.8
83.5
-10.5
Non-Hispanic white
150,535
60.5
61.9
63.7
66.1
67.4
67.7
69.8
70,5
-14.0
Black
76,803
126.8
130.1
132.5
137.1
148.3
151.9
157.9
158.6
American Indian²
-20.1
5.019
118.0
117.6
122.3
100.7
130.3
130.7
132.6
134.3
-12.1
Asian or Pacific Islander
5,707
38.2
39.3
40.4
43.4
44.1
43.3
43.1
Hispantc³
43,1
-11.4
73,789
140.2
144.3
151.1
157.9
158.0
159.1
159.7
158.5
-11.5
'Data for 1998 Bro preliminary.
"Includes births to Aleuts and Eskimas.
Sincludes all persons of Hispanic origin of any raco.
009
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Table 2. Birth rates for leenagers aged 15-19 years by age group and State, and percent change by age: United State
and each State, 1991 to 1997
[Rstes per 1,000 women in specified group)
1991
1997
Percent change, 1991-97
15-19
15-17
18-19
15-19
15-17
18-19
15-19
18-17
18-19
State
years
years
years
years
years
years
years
years
years
United States'
62.1
38.7
94.4
523
32.1
89.1
-158
-17.2
-5.6
Alabama
73.9
47.7
109.5
56.6
43.4
100.2
-9.9
-9.1
-8.5
Alaska
65.4
35.3
111.7
44.6
25.1
73.6
-318
-29.0
-14.1
Arizona
80.7
51.4
122.6
69.7
44.0
111.2
-13,6
-14.4
-9.3
Arkansas
79.8
49.4
1228
72.9
42.9
119.2
-8,6
-13.1
-2.9°°
California
74.7
46.9
113.6
57.3
36.2
90.5
-23.3
-22.9
-20.3
Colorado
58.2
35.3
91.4
48.2
29.9
77.2
-17.2
-15.5
-15.5
Connecticut
40.4
26.3
59.4
36.1
22.5
58.1
-10/6
-14.5.
-2.2"
Delaware
61.7
40.3
87.1
55.8
36,8
83.3
-8.7
-8.6"
-4.3"
District of Columbia
114.4
102.8
125.5
91.0
65.9
122.4
-20,5
-35.9
-2.5"
Florida
68.8
44.0
1028
57.7
35.1
94.2
-16/1
-20.2
-B.4
Goorgia
76.3
50.6
110.9
67.2
44.0
102.8
-11,9
-13.0
-7,3
Hawali.
58.7
34.7
91.5
43.8
25.3
69,6
-25.4
-27.1
-23.9
Idaho
53.9
29.3
90.8
43.3
23.3
72.5
-19.7
-20.6
-20.2
Illinois
64.8
40.6
99.7
54.7
34.4
87.6
-15.6
-15.2
-11.7
Indiana
60.5
36.2
95.2
54.2
32.1
87.6
-10.4
-8.7
-7.9
lowa
42.6
22.8
71.5
35.7
20.1
60.4
-16.2
-12.1
-15.5
Kansas
55.4
29.4
94.1
48.5
27.5
81.7
-125
-6,4"
-13.2
Kentucky
68.9
42.6
105.5
59.6
35.4
95.0
-13.5
-17.0
-9.9
Louisiana
76.1
51.1
111.4
66.3
42.1
101.4
-12.9
-17.6
-9.0
Maine
43.5
23.8
70.1
320
15.4
58.3
-26.4
-35.0
-16.8
Maryland
54.3
35.2
78.8
43.9
28.2
68.8
-192
-19,9
-13,7
Massachusetts
37.B
25.2
52.9
31.7
19,1
50.8
-16,1
-24.3
-4.0"
Michigan
59.0
35.5
91.7
43.9
25.4
72.2
-25.6
-28.4
-20.8
Minnesota
37.3
20.7
61.4
32.0
17.8
55.1
-14.2
-14.1
-10.2
Mississippi
85.6
60.1
120.4
73.7
50.2
108.8
-139
-16.4
-9.6
Missoun
64.5
38.7
100.7
51.5
29.6
86.3
-20.2
-23.7
-14.2
Montana
46.7
23.6
83.0
37.6
20.1
65.2
-19.5
-14.8
-21.4
Nebraska
42.4
23.6
69.2
37.2
21.3
61.6
-123
-9.8"
-10.9
Nevada
75.3
43.9
179.1
67.7
42.2
109.1
-10.1
-3.8"
-8.4
New Hampshire
33.3
17.1
53.8
286
14.0
53.0
-14.1
-18.2
-1.4°
New Jersey
41.6
26.3
629
35.0
21.3
56.7
-15.9
-19.0
-9.9
New Mexico
79.B
50.0
124.4
68.4
44.4
106.3
-143
-11.2
-14.5
New York
46.0
29.1
69.0
38.8
23.4
62.3
-15.7
-10.4
-9.8
North Carolina
70.5
46.2
107.7
61.3
37.7
97.3
-13.0
-18.5
-4.3
North Dakota
35.6
18.1
62.4
30.1
14.3
55.0
-15.4
-20.9
-11.8
Ohio
60.5
36.2
93.8
49.8
28.6
826
-17.7
-21.1
-12.0
Oklahoma
72.1
41.7
115.6
64.3
37.3
107.4
-10.8
-10.7
-7.1
Oregon
54.9
31.3
90.7
46.9
27.0
78.2
-14,6
-13.7
-13.8
Pennsylvania
46.9
29.2
70.5
37.3
21,8
61.3
-20.5
-26.0
-13.0
Rhode Island.
45.4
30.1
63.6
42.7
27.6
65.6
-5.9°
-B.2"
3.2"
South Carolina
72.9
48.0
105.4
61.4
40.0
93.0
-15.B
-16.6
-11.8
South Dakota
47.5
26.3
79.2
39.7
21.8
66.3
-16.4
-17.2
-16.3
Tennessee
75.2
47.8
1121
64.5
38.5
1038
-14.2
-19.4
-7.4
Texas
78.9
50.4
119.3
71.7
47.1
110.1
-9.1
-6.6
-7.7
Utah
48.2
27.0
79.8
42.6
23.7
68,3
-11.6
-12.3
-74.5
Vermont
39.2
21.3
62.0
26.9
12.1
$1.2
-31.0
-83
-17.6
Virginia
53.5
31.8
81.2
44.2
26.1
70.B
-17.0
-17.8
-12.8
Washington
53.7
31.0
86.5
42.5
24.5
70.7
-20.8
-20.8
-18.2
West Virginia
57.8
32.4
93.2
49.1
27.5
80.3
-15.3
-16.1
-13.9
Wiscansin.
43.7
24.8
71.2
35.9
21.4
58.8
-17.8
-13.7
-17.4
Wyoming
64.2
26.4
98.6
43.3
23.3
75.8
-20.1
-12.1"
-23.1
Pueno Rico
72.4
50.8
105.9
77.8
57.6
106.6
7.5
13.4
0.7"
Virgin Islands
77.9
48.6
124.0
66.0
45.6
96.7
-15.3
-8.2"
-22.0
Guam
95.7
55.0
156.1
106.3
61.4
178.2
11.)
11.6"
14.2**
American Samoa
43.9
20.7
81.5
Not significant al pc0.05.
Date not available.
Excludes data for Puerto Rico, Virgin Islands, Guam, and American Samas.
NOTE: Birth rates by State In this table are based on population estimates provided by the U.S. Bureau of the Censug (5) and, Cherefore. the rales shown here may differ from rates computed on the
basis of other population estimates.
Table 3. Bill rates for leenagers 15-19 years by age
race/Hispanic origin: United States
each State, 1997
[Rates pr 1,000 women in specified group]
15-19 years
White
66/C7/01
10/25/99
15-17 years
18-19 years
White
White
State
All
Total
Non-Hispanic
Black
Hispanic'
All
Total
Non-Hispanic
Black
Hispank
AI
Total
Non-Hispanic
Black
Hispanic'
50
United Sales
52.3
46.3
36.0
88.2
97.3
32.1
27.1
19.4
60.8
66.3
89.7
75.9
61.9
130.1
144.3
Alabama
66.6
54.5
53.9
90.1
87.5
43.4
31.6
31.3
66.7
.
100.2
88.5
87.5
122.3
60:80
FAX
Alaska
44.6
33.6
32.3
73.6
25.1
17.2
16,3
73.6
57.6
56.0
.
Arizona
69.7
70.0
41.2
74.9
126.3
440
43.9
226
49,5
86.7
111.2
111.6
71.1
116.6
188.0
Arkansas
72.9
63.9
51.9
104.2
123.2
42.9
34.1
326
73.7
82.2
119.2
110.5
108.0
248.8
Calformia
57.3
61.5
28.6
71.6
95.2
36.2
39.2
14.9
44.4
64.9
90.5
96.0
50.2
113.3
140.7
Colorado
48.2
47.2
31.1
69.8
112.9
29.9
29.4
16,2
41.1
83.5
77.2
75.2
54.7
113.1
159.4
Connectiut.
36.1
306
17.6
78.2
115.5
22.5
18.4
9.2
53.3
79.9
58.1
50.2
31.3
118.2
171.0
Delaware
55.8
40.3
37.2
107.8
36.8
25.4
23.6
73.8
-
83.3
61.1
56.2
160.7
District o'Columbia
91.0
22.0
7.1
139.4
88.6
65.9
27.0
79.0
122.4
19.7
7.3
285.7
Florida
57.7
48.0
42.9
92.2
65.3
35.1
27.2
23,2
53.2
42.0
94.2
87.9
75.9
137.4
99.0
Georgia
67.2
34.0
50.0
926
125.9
44.0
31.4
29.1
68.0
74.9
102.8
89.3
82.7
129.6
200.6
Hawaii.
43.8
220
19.5
37.2
95.4
25.3
8.4
6.7
60.0
69.6
39.4
35.9
142.1
Idaho
43.3
43.3
37.6
101.8
23.3
23.3
19.5
60.4
72.5
72.3
64.1
156.1
Illinois
54.7
420
29.9
115.1
105.3
34.4
23.9
16.0
82.6
65.5
87.6
71.2
52.2
168.0
168.3
Indiana
54.2
49.5
47.8
99.1
97.1
32.1
28.1
26.8
68.5
65.2
87.6
81.8
79.4
148.2
143.6
lowa
35.7
33.6
32.1
104.7
93.4
20.1
18.2
17.2
76.8
62.6
60.4
57.7
55.5
145.9
140.2
Kansas
48.5
44.5
39.7
105.3
106.3
27.5
24.3
20.6
71.3
72.7
81.7
76.6
70.7
158.7
159.3
Kentucky
59.6
56.6
56.2
90.9
102.0
35.4
32.6
32.4
65.7
:
95.0
92.1
91.3
125.2
Louisiana
66.3
48.1
48.5
94.0
34.7
42.1
26.8
26.8
66.0
25.4
T01.4
80.0
81.2
132.5
46.6
Maine
32.0
31.9
31.7
15.4
15.4
15.3
58.3
58.0
57.8
Maryland
43.9
30.0
28.4
75.0
49.1
28,2
167
15.6
53.3
32.1
68.8
51.0
48.9
109.1
72.8
CONTROL
Massachusetts
31.7
28.0
19.9
75.4
115.0
19.1
16.2
10.1
47.5
77.9
50.8
46.0
34.B
123.9
176.9
Michigan
43.9
35.4
33.2
8B.3
84.2
25.4
18.9
17.2
59.1
57.4
72.2
60.7
578
132.8
123.9
+
Minneseu
32.0
26.1
23.6
119.4
137.4
17.8
13.2
11.5
84.6
88.3
55.1
46.9
430
178.7
210.6
Mississipp
73.7
51.9
57.7
98.9
.
50.2
30.3
30.3
73.4
-
108.8
84.5
84.4
136.4
Missouri.
51.5
44.3
43.5
97.6
79.3
29.6
23.6
229
67.8
64.3
86.3
77.3
76.3
146.6
131.7
Montana
37.6
31.0
30.0
20.1
14.7
140
.
65.2
56.5
54.B
4
Nebraska
37.2
33.3
29.4
101.2
99.5
21.3
18.2
15.6
71.7
62.3
61.6
56.2
50.3
151.5
156.3
Nevada
67.7
65.5
48.0
98.0
121.0
42.2
39.7
27.0
70.5
82.3
109.1
107.4
83.2
141.2
177.6
92024567431
New Hanyshire
28.6
28.7
28.3
14.0
13.0
13.4
53.0
53.5
53.2
New Jersey
35.0
26.0
14.1
79.6
78.7
21.3
14.5
6.7
55.4
52.0
56.7
44.3
26.2
116.7
117.4
New Mexico
68.4
69.0
40.5
50.0
91.3
44.4
45.2
22.6
39.2
63.4
106.3
106.3
69.5
134.4
New York
38.B
33.2
21.9
64.1
74.3
23.4
19.3
11.6
41.1
47.1
62.3
54.0
37.3
T00.9
116.4
North Cantina
61.3
51.0
45.4
85.6
204.2
37.7
29.1
25.8
58.3
122.4
97.3
84.5
75.4
125.9
321.9
North Dabta
30.1
24.7
23.9
.
14.3
10.8
10.3
55.0
46.5
45.2
Ohio
49.8
42.1
41.1
100.4
83.8
28.6
22.5
21.8
68.0
53.6
82.6
72.3
71.0
151.0
128.7
Oldahoma
64.3
37.9
54.B
94.7
1029
37.3
31.9
29.5
67.3
69.9
107.4
99.1
95.1
134.8
154.0
Oregon
46.9
46.1
38.8
72.4
126.2
27.0
26.1
21.0
50.6
85.6
78.2
77.9
67.4
105.5
186.9
Pennsylvania
37.3
29.4
25.8
100.7
117.5
21.9
15.8
13.1
69.2
84.4
61.3
50.5
45.7
151.7
168.3
Rhode Island
42.7
3B.2
27.6
83.9
145.4
27.6
24.3
15.7
50.6
106.2
65.6
59.1
45.1
South Carling
61.4
48.3
47.4
62.7
66.6
40.0
29.1
20.4
57.2
64.8
93.0
76.2
T5.1
121.2
National Vital Statistics Reports, Vol. 47, No. 26, October 25, 1999
South Dabla
39.7
30.1
29.6
21.8
15.2
14.8
66.3
51.4
50.5
Tennessee
64.5
55.0
53.9
99.5
121.5
38.5
29.9
29.1
70.2
77.5
103.8
93.2
91.5
143.5
Texas
71.7
71.4
43.5
85.3
107.7
47.1
46.7
23.9
57.5
77,0
110.1
109.8
74.2
128.1
155.2
Utah
42.6
41.9
36.5
118.5
23.7
23.2
19.2
60.8
68.3
67.4
60.1
168.4
010
See footnoles al end of table.
7
P008/011
Table 3. Birth rates for leenagers 15-19 years by age and race/Hispanic origin: United States and each State, 1997-Con.
8
Rates pr 1,000 women in specified group]
15-19 years
15-17 years
18-19 years
10/25/99
10/25/99
White
White
White
State
AS
Total
Non-Hispanic
Black
Hispank'
Afl
Total
Non-Hispanic
Black
Hispanic'
All
Total
Non-Hisparic
Black
Hispanic
Vermont
26.9
27.4
27.6
12.1
12.3
12.4
51.2
52.0
52.7
Virginia
44.2
35.0
32.9
76.0
68.6
26.1
18.4
16.9
51.9
43.7
70.8
59.4
56.3
110.9
101.7
69.6
60.0
104.2
160.8
National Vital Statistics Reports, Vol. 47, No. 26, October 25. 1999
08:10
FAX 08:50
Washington
42.5
41.4
34.8
67.4
106.3
24.5
23.3
18.6
43.1
69.2
70.7
West Virginia
49.1
48.5
48.6
723
27.5
26.8
26.8
50.1
80.3
79.9
803
100.2
Wisconsia
35.9
21.2
24.5
127.9
103.6
21.4
14.6
12.8
88.9
65.3
59.B
46.9
42.9
197.6
166.7
Wyoming.
43.3
42.4
40.2
725
23.3
22.2
20.3
75.8
75.0
72.4
Figure des not meet standards of reliability D precision (based on fewer than 20 births Df fewer than 1,000 women in specified group).
Persons 4 Hispanic origin may be of any race.
NOTE: Raes by race and Hispanic origin cannot be computed for Puerto Rice, the Vegin Islands, Guam, and American Samoa, because populations are not available by race and Hispanic origin for these areas. Birth rates shown in this lattle are based on
population estimates provided by the U.S. Bureau of the Census (5) and, therefore, may differ from rates computed on the basis of other population estimates.
NCHS CTR FOR DISEASE CONTROL
92024567431
NO.046 P009/011
011
012
10/25/99 09:50 FAX
10/25/99 08:10
NCHS CTR FOR DISEASE CONTROL 92024567431
NO.046 P010/011
National Vital Statistics Reports, Vol. 47, No. 26, October 25, 1999
9
Technical notes
Data shown in this report for 1997 and earlier years are based
on 100 percent of the birth certificates registered in all States and the
District of Columbia. More than 99 percent of births occurring in this
country are registered. Data shown for 1998 are preliminary. based on
a sample file of more than 99 percent of births for that year (1):
Tabulations by State also include Puerto Rico, the Virgin Islands,
Guam, and American Samoa. However, totals shown for the United
States do not include these areas.
Tabulations by race and Hispanic origin of mother are based on
this information as reported on the birth certificate. Race and Hispanic
origin are reported as separate items on the birth certificate. Although
the overwhelming majority of Hispanic births (97 percent) are to white
women, substantial differences in teenage childbearing patterns exist
between Hispanic and non- Hispanic white women. Therefore data are
shown separately for these groups,
Population data for computing birth rates were provided by the U.S.
Bureau of the Census (3,5). Rates by State shown here may differ from
rates computed on the basis of other population estimates. State rates
are based on mother's place of residence. Population estimates by race
and Hispanic origin are not available for Puerto Rico, Virgin Islands,
Guam, and American Samoa. Rates are not available for American
Samoa for 1991, because birth data were not collected.
Rates were not computed if there were fewer than 20 births in the
numerator or fewer than 1,000 women in the specified group in the
denominator. An asterisk is shown in place of the rate. Additional
information on the tabulation of birth data by race, random variation, and
relative standard error is provided in earlier reports (1,6).
10/25/99 09:50 FAX
013
10/25/99 08:10
NCHS CTR FOR DISEASE CONTROL
92024567431
NO.046 P011/011
12 National Vital Statistics Reports, Vol. 47, No. 26, October 25, 1999
Suggested citation
Contents
Ventura SJ, Mathews TJ, Curtin SC. Declines in teenage birth rates,
Abstract
1
1991-98: Update of national and State trends, National vital statistics
Teenage birth rate down 18 percent since 1991
1
reports: vol 47 no. 26. Hyattsville. Mary|and: National Center for Health
Most teenage births are to unmarried women
1
Statistics 1999.
Teenage birth and pregnancy rates fall
1
Birth rates decline for teenagers in all age groups
2
Birth rates fall most steeply for black teenagers
2
National Center for Health Statistics
Teenage birth rates vary greatly by State
2
Director, Edward J. Sondik, Ph.D.
References
3
Deputy Director, Jack R. Anderson
List of detailed tables
3
Technical notes
9
Division of Vital Statistics
Director, Mary Anne Freedman
To receive this publication regularly, contact the National Center for Health
Statistics by calling 307-436-8500 E-mail: [email protected]
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file teen pregnancy
\
fy;
THE
NATIONAL
CAMPAIGN TO
PHONE: 202.261.5655
PREVENT TEEN PREGNANCY
FAX: 202.331.7735
2100 M STREET NW SUITE 300
EMAIL: [email protected]
WASHINGTON DC 20037
WEB: WWW.TEENPREGNANCY.ORG
December 3, 1999
Ms. Melanne Verveer
Chief of Staff
Office of the First Lady
The White House
Washington, DC 20500
Dear Ms. Verveer:
As you may know, I have chaired the Board of the National Campaign to Prevent Teen
Pregnancy since it was established in February 1996. I took on this job because I was appalled
by the teen pregnancy problem in this country. Every year, nearly one million teenage girls
become pregnant - that means approximately 4 in 10 teenage girls get pregnant at least once
before they reach age 20. This is wrong - for teens, for our society, and particularly for the
children born to teenagers. I also became involved with the Campaign because I strongly believe
that there is no more effective way of reducing persistent child poverty than by ensuring that
more children are born to parents who are ready and able to care for them.
The Campaign's strategy for reducing teen pregnancy has two parts: (1) influencing
cultural values and messages by working with the entertainment media, parents, faith
communities, teens, and others, and (2) building a more coordinated and effective grassroots
movement by working with states and local communities. The Campaign's approach at both
levels is distinctive in at least three ways. First, we are non-ideological and have worked hard to
reduce the conflict that too often has impeded action on this issue. Second, we rely extensively
on high-quality research to inform everything we do. And third, we are working in highly
leveraged ways with some of the most powerful individuals and organizations in America to
change young people's lives.
Leveraging our efforts is particularly important. As a small organization working on a
big problem in a big country, the Campaign must be very strategic in its work, getting the most
bang for the buck. With this basic idea in mind, the Campaign is working to:
Build public awareness about the importance of the problem of teen pregnancy by
working with opinion leaders and others to create a consensus that more needs to be done.
(Example: in the first nine months of 1999, the Campaign was mentioned in the print
press over 500 times, including coverage in top-flight newspapers.)
Provide easily accessible sources of information for individuals working in
communities and at the national level to prevent teen pregnancy. (Example: the
Campaign's website, www.teenpregnancy.org, provides data, ideas, and a teen forum. It
received almost one million hits in October alone.)
Leverage funds to prevent teen pregnancy, including those provided by states and by
the federal government. (Example: legislation was recently introduced by the Co-Chairs
of our House Advisory Panel that will provide more funds for both programs and
evaluation.)
Improve the effectiveness with which those funds are spent by encouraging
programmatic innovation and by publishing credible research on the effectiveness of new
or existing efforts. (Example: many state teen pregnancy prevention plans have been
shaped by our advice and publications, especially our very well-received review of what
programs work to prevent teen pregnancy.)
Change both adult and youth attitudes and knowledge by working with the
entertainment media that reaches tens of millions of households every day. (Example:
our partnerships with Black Entertainment Television and the WB Network have reached
up to 50 million households with shows that address teen pregnancy, and our work with
Teen People is reaching eight million-plus teens every month with articles and advice
pertaining to teen pregnancy prevention.)
Encourage parents to talk with their children about love, sex, and relationships.
(Example: our Ten Tips for Parents brochure has already reached a wide audience,
including the 90 million readers of Ann Landers' advice column.)
Change the priorities and practices of other organizations through work with
churches, youth-serving organizations, health professionals, and school personnel that are
heavily involved with young people. (Example: our partnership with NBC put materials
on teen pregnancy into 68,000 schools; our Nine Tips for Faith Communities has been
distributed to every Catholic diocese in the nation and reprinted in the Salvation Army's
newsletter.)
Stimulate more, and more effective, efforts in local communities through site visits,
technical assistance, and publications dealing with the issues of greatest concern to local
groups. (Example: the Campaign's new, three-volume manual, Get Organized: A Guide
to Preventing Teen Pregnancy, provides concise tips for communities on how to develop
teen pregnancy prevention programs and partnerships. The federal government as well as
six leading national non-profit groups are disseminating the manual widely. In addition,
Campaign staff have visited 43 states in the last few years to provide direct assistance to
those working in the field.)
Encourage more youth-led efforts to reduce risky behaviors and change peer norms in
the process. (Example: each year we are training a new group of youth leaders recruited
from organizations that have a national reach, and our tips for teens from teens have been
published in Teen People, Ann Landers, and many other places.)
These examples indicate how extensive the Campaign's activities are and how they reach all the
way from home computers to Congress, from entertainment television to local communities.
The good news is that teen pregnancy and birth rates have declined - led by both less
sexual activity among teenagers and better contraceptive use by teens who are sexually active.
But we must not become complacent. Teen pregnancy rates in the U.S. remain much too high -
two or three times those in other industrialized countries. And the hard truth is that yesterday's
news about declining teen pregnancy and birth rates won't mean much to the boys and girls who
turn 13 next year. For them, we must redouble our efforts to make sure that they benefit from the
successes that their older brothers and sisters have begun to see. I am convinced that we will
succeed only by engaging a whole new set of players in this issue - whether entertainment
leaders and business executives, faith leaders and sports figures, or parents and teens.
I want to thank you for your continuing support of the Campaign and hope that you will
consider a gift to help us this year. Your contribution will be used to support our current
programs and continue the important progress that has been made thus far. Together, we can
help to ensure a brighter future for this generation and the next.
Best wishes for a joyous holiday season,
Sincerely,
Tom h
Thomas H. Kean
Chairman
Enclosures
THE
NATIONAL
CAMPAIGN
PREVENT TEEN PREGNANCY
2100 M STREET NW SUITH 300
WASHINGTON DC 20037
BOARD MEMBERS
Chairman
Thomas H. Kean, former Governor of New Jersey and President, Drew University
President
Isabel V. Sawhill, Senior Fellow, The Brookings Institution
Linda Chavez, President, Center for Equal Opportunity
Annette Cumming, Executive Director and Vice President, The Cumming Foundation
William Galston, Professor, School of Public Affairs, University of Maryland
David R. Gergen, Editor-at-Large, U.S. News & World Report
Whoopi Goldberg, actress
Katharine Graham, Chairman of the Executive Committee, The Washington Post Company
David A. Hamburg, M.D., President Emeritus, Carnegie Corporation of New York
Alexine Clement Jackson, National President, YWCA of the USA
Sheila Johnson, Executive Vice President of Corporate Affairs, Black Entertainment Television, Inc.
Judith E. Jones, Clinical Professor, Columbia University School of Public Health
Leslie Kantor, Vice President of Education, Planned Parenthood of New York City, Inc.
Nancy Kassebaum Baker, former U.S. Senator
Douglas Kirby, Senior Research Scientist, ETR Associates
John D. Macomber, Principal, JDM Investment Group
Sister Mary Rose McGeady, President and Chief Executive Officer, Covenant House
Jody Greenstone Miller, former Acting President and Chief Operating Officer, Americast
John E. Pepper, Chairman of the Board, The Procter & Gamble Company
Stephen W. Sanger, Chairman and Chief Executive Officer, General Mills, Inc.
Victoria P. Sant, President, The Summit Foundation
Isabel C. Stewart, National Executive Director, Girls Inc.
Judy Woodruff, Prime Anchor and Senior Correspondent, CNN
Andrew Young, former Ambassador to the U.N. and Co-Chairman, GoodWorks International
Trustees Emeriti
Charlotte Beers, Chairman, J. Walter Thompson
Irving B. Harris, Chairman, The Harris Foundation
Barbara Huberman, Director of Training, Advocates for Youth
The Hon. C. Everett Koop, M.D., former U.S. Surgeon General
Judy McGrath, President, MTV
Kristin Moore, President, Child Trends, Inc.
Hugh Price, President, National Urban League, Inc.
Warren B. Rudman, former U.S. Senator and Partner, Paul, Weiss, Rifkind, Wharton & Garrison
Campaign Director
Sarah Brown
The Washington Post
SATURDAY, JUNE 12. 1999
ANN LANDERS
Dear Ann:
trouble. Let your kids know that you value
This article appeared in the Voices for Illinois
education highly.
Children magazine. It was helpful to me, and I
9. Know what your kids are watching, reading
believe it will help other parents as well. Please,
and listening to. You can always turn the TV off,
Ann, print It in your column.
cancel subscriptions and place certain movies off
A Chicago Parent
limits.
10. These tips work best when they are part of
Parents of teenagers need all the help they can
strong, close relationships with your children that
get these days. I'm grateful to you for sendifig it
are built from an early age. Express love and
on. Here it is:
The National Campaign to Prevent Teen
affection clearly and often, and listen carefully to
Pregnancy recently published Ten Tips for Par-
what your children say. Spend time with them,
ents to Help Their Children Avoid Teen Pregnan-
and engage in activities they like. Be supportive
cy. Here is an abbreviated version: Ten Tips for
and interested in what interests them, and help
Parents
them build self-esteem. Remember, it's never too
1. Be clear about your own sexual values and
late to improve a relationship with a child or
attitudes. Communication with your children
teenager.
about sex will be more successful when YOU are
certain about these issues.
2. Talk with your children early and often
about sex, and be specificl Initiate the conversa-
tion, and make sure it's a dialogue, not a
monologue.
3. Supervise and monitor your children by
establishing rules, curfews and standards of
expected behavior, preferably through an open
process of family discussion.
4. Know your children's friends and their
families. Welcome them into your home, and talk
openly.
5. Discourage early, frequent and steady
dating. One-on-one dating before age 16 can lead
to trouble.
6. Take a strong stand against your daughter
dating a boy who is significantly older, and don't
allow your son to develop an intense relationship
with a girl who is much younger. The age
difference between younger girls and older boys
or men can lead girls into risky behavior.
7. Show your teenagers that there are options
for the future that are more attractive than early
parenthood. Help them set meaningful goals for
the future, and discuss what it takes to make
those goals come true.
8. School failure is often the first sign of
E
DITORIAL
By DAVID GERGEN
EDITOR AT LARGE
A sense of belonging
B
ack in the early 1980s, the Rev. Billy Graham paid
Education. While SAT scores are up 16 points since the be-
a visit to Harvard and was greeted with a yawn. A few
ginning of the decade, overall student performance has not
weeks ago, he returned to an entirely different at-
yet shown serious improvement. But, as reported here ear-
mosphere. Students camped out all night on Saturday so
lier, the "standards" movement is now catching on and rep-
they could have a seat in Memorial Church when he
resents the most promising reform in 30 years. Linked with
preached on Sunday. His later appearance at the Kennedy
charter and choice, educational gains could come sooner
School of Government drew a packed house, which turned
than we think.
into a religious revival as, one after another, young peo-
Youth behavior. Teenage pregnancy has dropped seven
ple proclaimed their faith in God.
years in a row, and as the National Campaign to Prevent
There is something new in the air-and not just at Har-
Teen Pregnancy moves ahead, it could conceivably cut
vard. Across the land, Americans are hungering for some-
rates in half in the next few years. Teen drug use is also
thing more than money and a new car. They are looking for
down, and the Partnership for a Drug-Free America re-
answers that satisfy the soul and restore a sense of be-
ported last week that the number of teenagers who think
longing to one another. We are a long
refusal to use drugs is "really cool" is
way from there, but signs of cultural
up to 40 percent.
renewal are springing up all about us-
and just in time.
Across the land,
Popular culture and religion. Charita-
ble giving rose 16 percent from 1997 to
In 1994, William J. Bennett issued
1998, the largest jump on record. We
the first Index of Leading Cultural In-
Americans hunger
could be seeing the beginnings of a
dicators, one of his many contributions
boom in philanthropy as donors create
to the common weal. In his report, he
for something more
accounts at institutions like Fidelity
provided a boxcar of graphs and charts
and scan the AOL Web site to identi-
substantiating his main conclusion.
"In many ways, the condition of Amer-
than money and a
fy worthwhile charities. While mem-
bership in mainstream churches drifts
ica is not good," he wrote. "Over the
past three decades we have experi-
brand-new car.
downward, we are also seeing huge
growth in large, new churches, many
enced substantial social regression
of them nondenominational. And con-
Unless these exploding social patholo-
versation about God is returning to the
gies are reversed, they will lead to the decline and perhaps
dinner table, even as talk of sex seemingly diminishes.
even to the fall of the American republic."
Some say these trends simply reflect a better business
Bennett set forth five areas of social life that concerned
climate. But the economy was bounding up in the 1960s
him. Witness some of the changes in the years since:
and 1980s, too, and yet social indicators went south. More
Crime. The national crime rate has declined seven years
likely what we are seeing is an America that looked into the
in a row, and latest numbers are the lowest since 1985.
abyss and decided to change its mind.
Violent crime has followed a similar downward slope, drop-
No one should pop champagne corks yet. As Bennett
ping more than 6 percent in 1998. The Centers for Disease
warns in the introduction to his latest Index, "The nation
Control and Prevention reports that gun deaths dropped
we live in today is more violent and vulgar, coarse and cyn-
21 percent between 1993 and 1997, while firearm-related
ical, rude and remorseless, deviant and depressed, than
injuries are down 41 percent.
the one we once inhabited." We still have much to reverse
Family and children. While there was a slight uptick in
and rebuild.
1997, the divorce rate for married women is hovering at
Nonetheless, these signs of cultural renewal should lift
its lowest rate since 1974. Abortion, which steadily in-
our sights as we head toward the holidays and a new cen-
creased from 1983 through 1990, has been declining in the
tury. Progress is possible. We still control our own destiny.
1990s. Statistics show there were at least 208,000 fewer
One of our greatest strengths as a society is our resiliency-
abortions per year toward the end of the decade than at
our capacity to snap back from bad times. Just in time, it
the beginning.
seems, we're recovering our bearings.
108
U.S.NEWS & WORLD REPORT, DECEMBER 6, 1999
OCTOBER 17, 1999
THE SUNDAY RECORD RO-5
How to combat the problem of teen pregnancy
TOM KEAN
that two-thirds of the drop in sexual activity
"Contraception works, but only if you use it every
"Nine Tips to Help Faith Leaders and Their
among teenage males was the result of a change in
time," and "If we want to reduce pregnancy among
Communities to Address Teen Pregnancy." to every
their attitude.
our daughters, we need to talk to our sons."
diocese in the nation. The Religious Coalition for
A
8 many of you know, I have
3) A strong economy with increases in the minimum
Our ideas are showing up in programs and maga-
Reproductive Choice has distributed thousands of
been chairing the National
wage and the Earned Income
zines. For example, ABC's
copies as well - and so has the Salvation Army.
Campaign to Prevent Teen
Tax Credit. More jobs mean
"One Life to Live" recently
Pregnancy since 1996. I took on
more incentives to avoid
Our goal Is to reduce teen pregnan-
did a story line about a teen
one of this would be effective unless we were
the job because I was appalled by
early childbearing.
cy by one-third by the year 2005.
dealing with an unwanted
the the extent of the problem in
4) Welfare reform and, in
pregnancy, and last week's
N
also working with teens themselves. Over the
last few years the Campaign Youth
this country.
particular, much tougher
issue of People magazine
Leadership Team, a group of young people from
Nearly 1 million teenage girls
enforcement of child-support laws.
featured a story on what it's like to be pregnant.
around the country, has made a real difference.
Former NJ.
become pregnant a year. That
Despite all this, our teen pregnancy rates remain
Basketball star Grant Hill is appearing in commer-
These teens help us to design the media messages.
governor and
means four in 10 teenage girls get
much too high - two or three times those of other
cials for us in Teen People and Sports Illustrated.
president of
provide feedback, and come up with creative ways to
pregnant at least once before they
industrialized countries.
Drew University
The media is the most visible but no more impor-
involve other teens. They are our ambassadors in
reach the age of 20. That is unac-
In the National Campaign we have adopted a two-
tant than groups like Best Friends and Planned
their communities and nationwide. We cannot
ceptable for teens, for our society,
faceted approach: first, to influence cultural values by
Parenthood Most of all, parents must talk to their
change teen culture without the teens.
and particularly for the children
working with the media, parents, teens, and faith com-
children and not just about the "birds and bees."
born to children.
munities; and second, to build more effective grass-
Woodrow Wilson was asked in 1920 why he was
I strongly believe there is no more effective way of
roots movements by working with local communities.
There must be ongoing conversations about sexu-
working so tirelessly on behalf of the League of
breaking the cycle of poverty than making sure that
al feelings and relationships, about dating and pres-
Nations. He replied, "My clients are the children.
more children are born to parents who are ready and
et's start with the media. Twenty-eight million
sures, and about parents' own moral values. The
My clients are the next generation."
able to care for them.
L
people a week watch "ER" Thirty million read
Campaign's hottest-selling publication, already dis-
We have made progress, but there is 80 much work
There is finally some good news. The 1990s have
People Magazine, and more people watch soap
tributed to more than 150,000 people, is called "Ten
still to do. Our goal is to reduce teen pregnancy by
seen teen pregnancy begin to decline.
operas than the news. We are working with writers
Tips for Parents." It has appeared in Ann Landers'
one-third by the year 2005. I'm convinced we can do it
There are a number of possible reasons:
and producers to convince children that although
syndicated column featured in 12,000 newspapers
by bringing a whole new set of players into the arena
1) The fear of AIDS and other sexually transmit-
sex may seem glamorous, its consequences are not
reaching more than 90 million people.
entertainment moguls. business executives. faith
ted diseases.
Woven into popular shows are simple messages
Faith communities are doing their part. The
leaders. sports figures, parents, and teens - in other
2) A change in attitude. A recent survey showed
such as "Not everyone is doing it, or
Catholic Church has already sent our paperback,
words. each and every one of us can make a difference.
04/27/99 22:17 FAX
002
fite been pregnancy
NEWS
THEALAN
GUTTMACHER
CONTACT:
INSTITUTE
Susan Tew/Chris Kirchgaessner
212-248-1111
NEW YORK &
WASHINGION
[email protected]
Embargoed For Release to
Print/Broadcast Media:
120 Wall Street, NY, NY 10005
THURSDAY, APRIL 29, 1999
U.S. TEENAGE PREGNANCY RATE DROPS
ANOTHER 4% BETWEEN 1995 AND 1996
TEENAGE PREGNANCY DECLINES IN ALL STATES
Levels of teenage pregnancy continued their downward trend at both the national and the state levels in
1996. Nationwide, the teenage pregnancy rate, including births, abortions and miscarriages, declined 4% between
1995 and 1996, from 101.1 to 97.3 pregnancies per 1,000 women aged 15-19. The teenage binhrate also declined
4%, and the abortion rate declined 3% in this short period, according to new data released by The Alan
Guttmacher Institute. Teenage Pregnancy: Overall Trends and State-by-State Information presents data for
the last decade, including national trends by race and among Hispanics.
Teenage pregnancy rates in 1996 varied widely by state, from 50 pregnancies per 1,000 young women in
North Dakota to 140 in Nevada and 256 in the District of Columbia. In all but one state-NewJersey-the
teenage pregnancy rate was lower in 1996 than in 1992.
Steep decreases in the early 1990s in the pregnancy rate among sexually experienced teenagers accounted
for most of the drop in the overall U.S. pregnancy rate. Most of this decline is due to slight increases in the
proportion of sexually active teenagers using a contraceptive method; teenagers' using highly effective, long-acting
methods; and modest reductions in failure rates among those using condoms and oral contraceptives.
"Many groups want to take credit for the drop in teenage pregnancy, but the credit truly goes to the
teenagers. About 20% of the decrease since the late 1980s is because of decreased sexual activity, and 80% of the
decrease is because of more effective contraceptive practice- the methods teenagers are choosing to use and how
well they are using them Many sexually active teenagers are using the highly effective contraceptive implant,
Norplant, and injectable, Depo-Provera, which only became available in the early 1990s. Many factors
undoubtedly account for these behavioral changes and are much harder to measure. But it is clear that efforts to
promote both responsible sexual decision-making and effective contraceptive practice can have big impacts,"
comments Jacqueline E. Dartoch, the Institute's vice president for research.
###
The Alan Guttmacber Institute-www.agi-usa.org- is a nonprofit organization focused on reproductive
health research, policy analysis and public education, with offices in New York and Washington, D.C.
04/27/99
Methods used by teens at risk for
22:17 FAX
unintended pregnancy have changed
Women 15-19 at risk for unintended pregnancy
46%
26%
6%
Implant-2.2%
1988
Injectable-8.3%
Pill
11%
35%
29%
5%
Condom
1995
Other
0% 20% 40% 60% 80% 100%
003
The Alan Guttmacher Institute
Tabulations from 1988 and 1995 NSFG
04/27/99 22:17 FAX
004
Teenage Pregnancy
Overall Trends and State-by-State Information
THE ALAN
GUTTMACHER
INSTITUTE
NEW YORK &
WASHINGTON
120 Wall Street
New York, NY 10005
Phone: 212.248.111
Fax: 212.248.1951
The Alan Guttmacher Institute, April 1999
E-mail: [email protected]
web site: www.agi-usa.org
04/27/99
22:17
FAX
005
Summary
Pregnancy, birth and abortion rates among U.S.
Florida and Texas. Minnesota, New Hampshire, Maine
teenagers continued their downward trend in 1996.
and Iowa had the lowest rates after North Dakota's.
Nationwide, the pregnancy rate declined 4% between
Wide variation is also seen in state teenage
1995 and 1996, from 101.1 to 97.3 pregnancies per
birthrates for 1996 (Table 4). The highest rates
1,000 women aged 15-19 (Table 1). The rate has
(70-75 births per 1,000 women aged 15-19) were
dropped 9% since 1986 and, more significantly, 17%
found in Mississippi, Arkansas, Arizona, Texas and
since peaking in 1990.
New Mexico; in the District of Columbia, 102 births
The birthrate for teenagers also declined 4%
occurred per 1,000 teenage women. The lowest rates
between 1995 and 1996, to 54.4 births per 1,000
(29-32 per 1,000) were in New Hampshire, Vermont,
women (Table 1). Although the 1996 rate was 8%
Maine, Minnesota and Massachusetts.
higher than the 1986 rate, it was 12% lower than the
Statewide teenage abortion rates were highest
peak rate of 62.1 births per 1,000 reached in 1991.
(45-53 abortions per 1,000 women aged 15-19) in
Teenagers' abortion rate declined 3% between
New York, Nevada, New Jersey, Maryland and Cali-
1995 and 1996 (Table 1). Since 1986, the rate has
fornia (Table 4); the rate in the District of Columbia
dropped 31%, to 29.2 abortions per 1,000 women
was 121 per 1,000. Teenagers in Utah, North
aged 15-19. At the same time, the proportion of
Dakota, South Dakota, West Virginia, Idaho and
teenage pregnancies ending in abortion has fallen
Iowa had the lowest abortion rates (8-12 abortions
from 46% to 35%-a decline of 24%.
per 1,000).
White and black adolescents have experienced
Overall, 35% of pregnancies among 15-19-year
declines in pregnancy rates, although the magnitude
olds ended in abortion in 1996 (Table 4). However,
of the changes has varied considerably. Among black
in New Jersey, nearly six in 10 (58%) teenage preg-
women aged 15-19, the nationwide pregnancy rate
nancies ended in abortion; the proportion also
fell 20% between 1990 and 1996; among white
exceeded 50% in New York, Massachusetts and the
teenagers, it declined 16% during that time (Table 1).
District of Columbia. By contrast, only 15% of preg-
The pregnancy rate among Hispanic teenagers, who
nancies among teenagers in Utah ended in abortion;
can be of any race, increased between 1990 and
the proportion was also below 20% in Oklahoma,
1992, but then fell 6% by 1996 (Table 2).
Mississippi, Kentucky, Arkansas, Louisiana and West
Roughly 880,000 pregnancies occurred among
Virginia.
women aged 15-19 in 1996; 62% of these pregnan-
Between 1985 and 1996, teenage pregnancy rates
cies were to 18-19-year olds (Table 3). California
declined in 47 states; in the remaining three (Illinois,
reported the highest number of adolescent pregnan-
Indiana and Nevada) and the District of Columbia,
cies (126,300), followed by Texas, New York, Florida
rates declined between 1992 and 1996 (Table 5). In
and Illinois (with about 40,000-80,000 cach). The
27 states and the District of Columbia, teenage
smallest numbers of teenage pregnancies were in Ver-
birthrates wcre higher in 1996 than in 1985; in all but
mont, North Dakota, Wyoming, South Dakota and
one of these states, however, the rate was lower in
Alaska, all of which reported fewer than 2,000 preg-
1996 than in 1992. Teenage abortion rates declined
nancies among women aged 15-19.
in every state bctween 1985 and 1996. In the District
Teenage pregnancy rates in 1996 varied widely by
of Columbia, the rate was higher in 1996 than in
state, ranging from 50 pregnancies per 1,000 women
1985, but it declined between 1992 and 1996.
aged 15-19 in North Dakota to 140 per 1,000 in
Nevada and 256 per 1,000 in the District of Columbia
This information is provided through the support of The
(Table 4). The highest state adolescent pregnancy rates
Andrew W. Mellon Foundation and The Educational Foun-
after Nevada's were found in California, Arizona,
dation of America.
006
04/27/99 22:18 FAX
About the Tables
Data Sources and Methodology
were obtained from nonhospital abortion facilities,
Pregnancies are calculated as the sum of births, mis-
again on the assumption that the proportion of nonresi-
carriages (including stillbirths) and abortions. The
dents was the same for teenagers as for all women.
number of births to tcenagers in each state and
For the years before 1996, no data on the state of
teenage birthrates were obtained from the National
residence for teenagers were used, and teenagers
Center for Health Statistics.¹ The number of miscar-
were assumed to have obtained abortions in other
riages was estimated as 20% of births plus 10% of
states in the same proportions as other women
abortion; these proportions attempt to account for
All rates were calculated using population denomi-
miscarriages that occur after the pregnancy has lasted
nators estimated by the U.S. Bureau of the Census.⁴
long enough to be noted by the woman (6-7 weeks
The 1990 census found slightly more teenagers than
after the last menstrual period).²
had been projected. National population estimates for
The number of abortions, however, is measured
earlier years were adjusted on the basis of these find-
less directly. For 1996, the number of abortions
ings, but state estimates were not.
obtained by teenage residents of each state was calcu-
lated by starting with the number of abortions in
Interpreting the Data
each state that were provided to teenagers (residents
Because health department abortion statistics are
and nonresidents) and then reallocating abortions to
imperfect or nonexistent in many states, care should
the woman's state of residence. The number of abor-
be used in interpreting the teenage abortion and preg-
tions performed in each state for women of all ages
nancy data. For the six states with no information on
was derived from a survey of all abortion providers
the age of women having abortions, the teenage abor-
conducted by The Alan Guttmacher Institute (AGI).
tion rate was estimated from the overall abortion
The number of abortions obtained by women aged
rate, which correlates highly (but not perfectly) with
15-17 and 18-19 in each state was estimated by
the rate for teenagers. For these states and several
applying the proportion of abortions provided to
others, no information specific to teenagers was avail-
women in these age-groups, as documented by the
able indicating the state of residence of women hav-
state abortion reporting system, to the AGI total
ing abortions in the state; the assumption that
number of abortions in the state. For states with no
teenagers come from other states for abortions at the
information on the age of women having abortions
same rate as all women may not be completely accu-
(California, Delaware, Florida, Iowa, New Hamp-
rate. In particular, minors in states with parental
shire and Oklahoma), the proportion of abortions
involvement requirements for abortion may travel to
obtained by teenagers was estimated on the basis of
other states at higher rates than all women, and some
information from neighboring or similar states.
of these minors may not havc been reassigned to
The reassignment of abortions to the woman's state
their state of residence. Time trends may also be
of residence was also based on information provided by
affected, since before 1996, no data specific to
state abortion reporting agencies. For states that did not
teenagers were used to assign abortions to the
supply information on the state of residence of
teenager's state of residence.
teenagers having abortions, the proportion of abortion
Births and abortions have been recorded according
patients who came from other states and the states
to the woman's age at the time of the event, not the agc
from which they came were assumed to be the same for
when she became pregnant; pregnancy rates are there-
teenagers as for women of all ages. For states with no
fore understated. For example, the rate for women aged
information about the state of residence of women hav-
18-19 would be higher than that shown if pregnancies
ing abortions, data or estimates of state of residence
beginning at age 19 and ending at age 20 were included.
References
1. Vencura SJ. Mathews TJ and Curtin SC, Teenage births in the United States: state trends, 1991-96, an update, Monthly Vital Statistics Report,
1998, Vol. 16, No. 11, Suppl. 2.
2. Leridon H, Human Fertility: The Baric Components, Chicago: University of Chicago Press, 1977, Table 4.20.
3. Henshaw SK, Abortion incidence and services in the United Scates, 1995-1996, Family Planning Perspectives, 1998, 30(6) 263-270 & 287.
4. U.S. Bureau of the Census, Estimates of the population of scaces by age, sex, race, and Hispanic origin: 1990 5 1996, Dcc. 1997,
<http://www.cenus.gov/populacion/estimates/stare/sasrh/sasrh86.bt>.
04/27/99
22:18
FAX
007
Table 1. Pregnancy, birth and abortion rates per 1,000 women aged 15-19, and abortion ratio (sbortions per 100 pregnancies), by
race, 1986-1996
Race and measure
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
Total
Pregnancy rate'
All women 15-19
106.7
106.6
111.4
114.9
117.1
115.8
111.9
109.3
106.1
101.1
97.3
Sexually active women 15-19
210.7
206.7
212.2
218.5
224.3
222.4
215.5
211.1
205.4
196.3
189.5
Birthrate
50.2
50.6
53.0
57.3
60.4
62.1
60.7
59.6
58.9
56.8
54.4
Abortion rate
42.3
41.8
43.5
42.0
40.6
37.6
35.5
34.3
32.2
30.0
29.2
Abortion ration
45.7
45.2
45.1
42.3
40.2
37.7
36.9
36.5
35.3
34.6
34.9
White
Pregnancy rate*
90.0
89.6
93.0
95.8
98.3
97.0
93.0
90.9
88.9
86.0
82.6
Birthrate
42.3
42.5
44.4
47.9
50.8
52.6
51.8
51,1
51.1
50.1
48.1
Abortion rate
35.6
35.1
36.1
34.8
33.9
30.5
28.1
26.9
25.1
23.5
22.6
Aportion ratiot
45.7
45.2
44.9
42.1
40.1
36.6
35.2
34.5
33.0
32.0
32.0
Nonwhite
All
Pregnancy rate*
180.7
180.1
189.1
193.4
189.6
189.6
185.2
180.4
172.5
158.7
153.3
Birthrate
84.8
85.5
89.2
95.9
96.5
98.4
95.5
92.5
89.1
82.2
78.1
Abortion rate
71.8
70.4
74.6
71.3
67.1
65.1
64.2
63.1
59.6
54.6
54.2
Abortion ratiot
45.8
45.2
45.5
42.6
41.0
39.8
40.2
40.5
40.1
39.9
41.0
Black
Pregnancy rate"
U
U
U
U
224.3
223.7
218.7
212.7
202.1
184.8
178.9
Birthrate
95.8
97.6
102.7
111.5
113.1
115.5
112.4
108.6
104.5
96.1
91.4
Abortion rate
U
u
u
u
80.5
77.4
76.2
74.9
69.7
63.2
62.9
Abortion rallot
U
u
u
u
41.6
40.1
40.4
40.8
40.0
39.7
40.8
"Includes estimated number of pregnancies ending In miscarriages. *Denominator excludes miscarriages. Notes: Data are tabulated according to the woman's age at the pregnancy out-
como and, for births, according 10 the mother's race (not the child's). No data are presented separately for nonwhite women other than blacks because of amall numbers and the heserogeneity
of the group. u=unavallable.
Table 2. Pregnancy, birth and abortion rates
per 1,000 Hispanic women aged 15-19, and
abortion ratio (abortions per 100 pregnan-
cies), 1990, 1992 and 1996
Measure
1990
1992
1996
Pregnancy rate'
163.4
176.0
164.6
Birthrate
100.3
107.1
101.8
Abortion rate
39.1
43.2
38.6
Abortion ration
28.0
28.7
27.5
*Includes estimated number of pregnancies ending in miscar-
riages. +Denominator excludes miscarriages. Note: Data are lab-
vialed according 10 the woman's age at the pregnancy outcome.
Hlapanic teenagers may be of any race.
Teenage Pregnancy: Overall Trends and State-by-State Information, AGI, April 1999
04/27/99
22:18
FAX
008
Table 3. Number of pregnancies among
women aged 15-19, by state of residence,
according to age-group, 1996
State
15-17
18-19
15-19
U.S. total
337,530
542,640
680,170
Alabama
6,400
10,120
16,520
Alaska
640
1,130
1,770
Arizona
7.050
10,600
17,650
Arkansas
3,660
6,430
10,090
California*
49,110
77,190
126,300
Colorado
4,660
7,270
11,930
Connecticut
3,440
4,790
8,230
Delaware*
910
1,310
2,220
Dist. of Columbiat
1,400
2,000
3,400
Florida*
18,300
29,990
48,290
Georgia
11,270
16,950
28.220
Hawaii
1,510
2,440
3,950
Idaho
1,240
2,430
3.670
[linois
17,380
25,130
42,510
Indiana
6,650
12,020
18,670
lowa"
2,200
4,010
6,210
Kansas
2,720
4,760
7,480
Kentucky
4,600
8,070
12,670
Louisiana
6,700
10,650
17,350
Maine
840
1,580
2,420
Maryland
6,550
9,930
16,480
Massachusetts
5,160
9,010
14,170
Michigan
11,350
18,490
29,840
Minnesota
3,480
5,960
9,440
Mississippi
4,940
7,150
12,090
Missouri
6,060
10,350
16,410
Montana
780
1,440
2,230
Nebraska
1,350
2,520
3,870
Nevada
2,690
4,150
6,840
New Hampshire*
720
1,410
2,130
New Jersey
9,420
14,280
23,700
New Mexico
3,010
4,390
7,400
New York
23,960
37,740
61,700
North Carolina
9,770
15,470
25,240
North Dakota
390
840
1,230
Ohio
11,510
20.270
31,780
Oklahoma
3,950
7,090
11,040
Oregon
3,740
6,310
10,050
Pennsylvania
10,090
17,040
27,130
Rhode Island
930
1,690
2,620
South Carolina
5,160
7,830
12,990
South Dakota
640
1,130
1,770
Tennessee
6,800
11,360
18,160
Texas
31,800
48,690
80,490
Utah
2,070
4,140
6,210
Vermont
420
790
1,210
Virginia
6,960
12,080
19,040
Washington
6,220
10,110
16,330
West Virginia
1,730
3,230
4,960
Wisconsin
4,250
7,300
11,550
Wyoming
580
930
1,510
"Abortion estimates are based on the proportion of abortions
oblained by women of the same age in neighboring or similar
states. tDistribution 01 abortions among teenagers into age-
groups 15-17 and 18-19 is based on the proportion among all
black leenagers nationally. Notes: Data are tabulated according
to the woman's age at the prognancy autcome. Even though abor-
tions have been tabulated according to state of residence where
possible, in states with parantal notification or consent require-
ments for minors, the number of pregnancies shown may be too
low because minors may have traveled to other states for abor.
lion services. Pregnancies include estimales ol the number of
miscarriages. Numbers are rounded to the nearest 10.
Teenage Pregnancy: Overall Trends and State-by-State Information, AGI, April 1999
04/27/99
22:18
FAX
009
Table 4. Ranking of pregnancy, birth and abortion rates per 1,000 women aged 15-19, these rates by age-group, and abortion ratio (abortions
per 100 pregnancies), all according to state, 1996
State
Pregnancy rate"
Birthrate
Abortion rate
Abortion
ratio#
Rankt
15-19
15-17
18-19
Rankt
15-19
15-17
16-19
Rankt
15-19
15-17
18-19
U.S. total
na
97
62
153
na
54
34
86
na
29
19
46
35
Alabama
12
106
69
160
7
69
45
104
24
21
13
32
23
Alaska
35
75
46
117
29
46
26
75
33
18
13
25
28
Arizona
3
118
80
176
3
74
49
111
16
27
19
39
27
Arkansas
B
108
65
174
2
75
45
122
37
16
10
25
18
California
2
125
80
196
14
63
39
99
5
45
30
70
42
Colorado
21
90
58
141
25
50
30
80
15
28
20
41
36
Connecticut
29
86
58
131
42
37
24
58
8
37
26
55
50
Delaware$
20
95
65
137
18
57
41
80
20
24
15
37
30
Dist. of Columbia**
na
256
185
349
na
102
79
133
na
121
82
173
54
Floridas
4
115
71
185
16
59
37
94
6
40
24
65
40
Georgia
7
109
72
167
8
68
45
103
19
25
16
39
27
Hawaii
15
101
66
149
26
48
28
76
7
39
30
53
45
Idaho
38
70
40
114
27
47
26
78
45
12
7
19
20
Illinois
11
106
70
164
17
57
36
91
10
34
25
50
38
Indiana
25
88
52
143
19
56
33
91
30
19
11
30
25
Iowas
46
56
34
96
41
38
21
64
46
12
7
18
23
Kansas
34
79
47
130
24
50
28
84
35
18
12
26
26
Kentucky
24
89
54
140
15
61
37
98
43
14
9
21
18
Louisiana
19
97
62
148
9
67
43
102
41
15
10
23
19
Maine
47
57
32
96
48
31
17
55
34
18
11
28
36
Maryland
13
106
68
165
30
46
30
72
4
46
30
71
50
Massachusetts
33
79
48
126
46
32
20
51
9
37
22
59
53
Michigan
27
B7
54
140
28
46
28
75
14
29
18
45
38
Minnesota
49
56
33
93
47
32
19
54
38
16
10
25
33
Mississippi
10
108
74
160
1
75
52
110
39
16
10
25
17
Missouri
30
86
52
140
20
54
31
90
29
19
13
30
27
Montana
40
65
38
107
40
39
21
66
36
17
11
26
31
Nebraska
41
62
36
101
39
39
22
64
42
14
6
22
26
Nevada
1
140
90
220
6
70
42
114
2
51
36
76
42
New Hampshire$
48
57
31
100
50
29
15
51
25
20
12
3S
42
New Jersey
18
97
63
152
44
35
23
55
3
50
32
78
58
New Mexico
6
110
73
168
5
71
46
111
22
22
16
32
24
New York
9
108
70
166
36
42
26
66
1
53
36
78
56
North Carolina
14
105
68
161
11
63
41
97
18
26
17
40
29
North Dakota
50
50
28
88
45
32
16
58
49
10
6
17
24
Ohio
32
81
48
131
22
50
30
83
32
18
11
29
27
Oklahomas
23
90
53
149
12
63
37
105
44
13
7
21
17
Oregon
22
90
55
146
21
51
29
85
17
26
18
40
34
Pennsylvania
38
70
42
112
38
39
24
63
26
20
12
34
34
Rhode Island
28
87
51
142
35
42
27
66
11
32
16
57
43
South Carolina
17
98
65
145
13
63
41
94
27
20
14
29
24
South Dakota
45
59
35
95
37
39
22
66
48
10
7
15
20
Tennessee
16
100
62
158
10
66
40
106
31
18
12
28
22
Texas
5
113
74
174
4
73
49
111
21
23
14
36
24
Utah
44
60
34
95
34
43
24
69
50
8
5
12
15
Vermont
43
60
34
103
49
30
15
54
23
22
14
35
42
Virginia
26
87
54
136
31
46
28
72
12
30
19
46
40
Washington
31
85
54
135
32
45
26
74
13
29
20
42
39
West Virginia
37
73
43
117
23
50
29
82
47
11
8
17
19
Wisconsin
42
61
37
100
43
37
22
61
40
15
10
24
29
Wyoming
36
74
46
120
33
44
25
75
28
20
15
27
31
*Includes estimated number of pregnancies ending in miscarriages. tBased on rates for women aged 15-19. Denominator excludes miscarriages. SAbortion estimates are based on the proportion of abor.
llone obtained by women of the same age in neighboring or similar states. "Distribution of abortions among teenagers Into age-groups 15-17 and 18-19 is based on the propertion among all black leenagers
nationally, Notes: Data are labulated according to the woman's age al the pregnancy outcome. Even though abortions have been labulated according to state of residence where possible, in states with parental
notification or consent requirements for minors, the pregnancy and abortion rates may be too low because minors may have traveled to other states for abortion services. na=not applicable.
Teenage Pregnancy: Overall Trends and State-by-State Information, AGI, April 1999
010
04/27/99
22:18
FAX
Table 5. Pregnancy, birth and abortion rates per 1,000 women aged 15-19, by state of residence, selected years
State
Pregnancy rate"
Birthrate
Abortion rate
1985
1988
1992
1996
1985
1988
1992
1996
1985
1988
1992
1996
U.S. total
110
111
112
97
51
53
61
54
44
43
35
29
Alabama
112t
1101
117
106
64
3
73
69
32+
32+
27
Alaska
21
144+
111t
1091
75
66
57
64
46
59+
38+
Arizona
30t
18
128
127
133
118
67
69
82
74
43
40
32
Arkansas
27
111
115
116
108
72
70
75
75
23
27
23
California
16
1511
154t
1591
125t
54
58
74
63
791
76+
64+
45t
Colorado
112
102
111
90
46
49
58
so
51
39
37
28
Connecticut
96
107
96
86
33
36
39
37
52
58
44
37
Delaware
101+
1171
1211
95+
50
53
60
57
37+
49+
44t
Dist. of Columbia
24+
211
209
277
256
72
74
116
102
113
110
125
121
Florida
126+
133T
127+
115t
58
63
66
59
51t
52+
43t
40t
Georgia
132
122
127
109
70
69
75
68
44
37
34
25
Hawaii
125
134
138
101
48
49
54
48
61
68
67
39
Idaho
78
73
77
70
46
45
52
47
21
17
14
12
Illinois
103+
112t
112t
106
50
54
64
57
3BT
43t
33t
34
Indiana
87
89
95
88
51
52
59
56
24
25
22
19
lowa
67+
69+
67+
sat
33
33
41
38
25t
27+
16t
12+
Kansas
84
88
90
79
49
49
S6
50
23
27
21
18
Kentucky
92t
96
99
89
62
60
65
61
16t
22
19
14
Louisiana
109
107
109
97
71
68
76
67
22
23
15
15
Maine
92
82
70
57
44
41
40
31
36
30
20
18
Maryland
121
129
118
106
47
51
51
46
59
61
52
46
Massachusetts
86
97
87
79
30
32
38
32
45
53
38
37
Michigan
107
111
108
67
44
47
57
46
50
49
37
29
Minnesota
62
69
64
56
30
31
36
32
24
29
19
16
Mississippi
113
106
122
108
77
73
84
75
19
16
19
16
Missouri
95
99
100
86
53
55
63
54
29
30
22
19
Montana
82
74
81
65
42
39
46
39
28
24
24
17
Nebraska
75
75
71
62
37
37
41
39
27
27
20
14
Nevada
125
142
145
140
53
65
71
70
57
59
54
51
New Hampshire
89+
87+
62+
571
32
33
31
29
46+
43t
22+
20+
New Jersey
113
112
97
97
36
39
39
35
63
60
45
50
New Mexico
116
124
129
110
70
72
80
71
30
35
30
22
New York
117
116
120
108
39
40
45
42
64
61
60
53
North Carolina
114
122
121
105
57
61
70
63
41
45
34
26
North Dakota
60
57
59
50
34
31
37
32
17
18
13
10
Ohio
96
96
93
81
50
52
58
50
33
31
21
18
Oklahoma
113t
105t
100+
90t
67
62
70
63
29+
27+
14+
13t
Oregon
95
105
99
90
42
48
53
51
41
43
32
26
Pennsylvania
87
87
84
70
4'1
41
45
39
35
34
27
20
Rhode Island
89
56
96
87
37
38
48
42
40
36
36
32
South Carolina
102
114
110
98
61
65
70
63
26
33
23
20
South Dakota
70
69
74
59
42
44
48
39
18
15
14
10
Tennessee
104
110
112
100
60
64
71
66
29
31
24
18
Texas
131+
117
123
113
73
69
79
73
39t
31
26
23
Utah
75
69
65
60
49
44
46
43
15
15
9
B
Vermont
82
81
71
60
35
33
36
30
36
37
26
22
Virginia
106
106
101
87
47
46
52
46
45
46
35
30
Washington
103
109
107
85
43
47
51
45
46
47
42
29
West Virginia
B7T
78t
85
73
55
50
56
50
19t
17+
16
11
Wisconsin
73t
74
73
61
37
38
42
37
25t
26
21
15
Wyoming
98
82
B1
74
54
48
50
44
30
23
19
20
*Includes astimated number of pregnancies ending in miscarriages. tAbortion estimates are based on the proportion of abortions obtained by women of the same age In neighbaring or similar states
Notas: Abortion data for 1996 are not exactly comparable with those for earlier years because of a change in the way state of residence was calculated. Data are (abulated according to the woman's age ai
the pregnancy outcome. Even though for 1996 abortions have been tabulated according to state of residence where possible. in states with parental noirfication or consent requirements for minors. the preg-
nancy and abortion rates may be too low because minors may have traveled to other states for abortion services.
Teenage Pregnancy: Overall Trends and State-by-State Information, AGI. April 1999
04/27/99 22:18 FAX
011
National Vital Statistics Reports
NUSS
nchs
From the CENTERS FOR DISEASE CONTROL AND PREVENTION
National Center for Health Statistics
NWOO
National Vital Statistics System
Volume 47, Number 18
April 29, 1999
Births: Final Data for 1997
by Stephanie J. Ventura, M.A.; Joyce A. Martin, M.P.H.; Sally C. Curtin, M.A.;
and T.J. Mathews, M.S., Division of Vital Statistics
Abstract
Highlights
Objectives-This report presents 1997 data on U.S. births according
Births in the United States declined very slightly in 1997, to
to a wide variety of characteristics. Data are presented for maternal
3,880,894, the lowest number since 1987. The birth rate also
demographic characteristics including age, live-birth order, race, Hispanic
dropped in 1997, to 14.5 births per 1,000 total population, a record
origin, marital status, and educational attainment; maternal lifestyle and
low for the Nation. The fertility rate, which relates births to the
health characteristics (medical risk factors, weight gain, and tobacco and
number of women of childbearing age, declined In 1997 to 65.0 births
alcohol use); medical care utilization by pregnant women (prenatal care,
per 1,000 women aged 15-44 years, matching the record low
obstetric procedures, complications of labor and/or delivery, attendant at
reported in 1976.
birth, and method of delivery); and infant health characteristics (period of
Fertility rates for women In raclal and Hispanic origin sub-
gestation, birthweight, Apgar score, abnormal conditions, congenital anoma-
groups increased for Puerto Rican, American Indian, and Asian or
lies, and multiple births). Also presented are birth and fertility rates by age,
Pacific Islander women, but declined for other groups by up to 3 percent.
live-birth order, race, Hispanic origin, and marital status. Selected data
Rates differ considerably among groups, with Mexican women having
by mother's State of residence are shown including teenage birth
the highest rate, 116.6 per 1,000 aged 15-44 years. Rates are suc-
rates and total fertility rates, as well as data on month and day of
cessively lower for non-Hispanic black, Puerto Rican, American Indian,
birth, sex ratio, and age of father. Trends in fertility patterns and
Asian or Pacific Islander, Cuban and non-Hispanic white women.
matemal and infant characteristics are described and interpreted.
The birth rate for teenagers continued to decline in 1997, falling
Methods-Descriptive tabulations of data reported on the birth
4 percent to 52.3 births per 1,000 women aged 15-19 years. The rate
certificates of the 3.9 million births that occurred in 1997 are presented.
for young teenagers 15-17 years declined 5 percent to 32.1 per 1,000,
Results-Birth and fertility rates declined very slightly in 1997. Birth
while the rate for older teenagers 18-19 years declined 3 percent to
rates for teenagers fell 3 to 5 percent. Rates for women in their twenties
83.6. During 1991-97, the rate for ages 15-19 years dropped 16 per-
changed very little, whereas rates for women in their thirties rose
cent, while rates for teenagers 15-17 and 18-19 years fell 17 and
2 percent. The number of births and the birth rate for unmarried women
each declined slightly In 1997 while the percent of births that were to
unmarried women was unchanged. Smoking by pregnant women
overall dropped again in 1997, but continued to Increase among teen-
Acknowledgments
agers. Improvements in prenatal care utilization continued. The
This report was prepared under the general direction of Kenneth G. Keppel,
Acling Chief of the Reproductive Statistics Branch (RSB). Nicholae F. Pace,
cesarean delivery rate increased slightly after declining for 7 consecu-
Chief of the Systems, Programming, and Statistical Resources Branch
tive years. The proportion of multiple births continued to rise; higher
(SPSRB), and Manju Sharma and Jaleh Mousavi of SPSRB provided
order multiple births (e.g., triplets, quadruplets) rose by 14 percent in
computer programming support and statistical tables. Thomas D. Dunn and
Vanella Harrington of SPSRB and Melissa Park of RSB provided content
1997, following a 20 percent rise from 1995 to 1996. Key measures of
review. Slaff of the Data Acquisition and Evaluation Branch carried out quality
birth outcome-the percents of low birthweight and preterm births-
evaluation and acceptance procedures lor the State dala files on which this
increased, with particularly large increases in the preterm rate. These
report le based. The Registration Melhode staff of the Division of Vital
Statetics consulted with State vital statistics offices regarding the collection of
changes are in large part the result of increases in multiple births.
birth certificate data. This report was edited by Demarius V. Miller, typesel by
Keywords: birth certificate maternal and infant health birth rates
Jacqueline M. Davis, and graphics were produced by Jarmila Ogburn of the
Publications Branch, Division of Date Services.
maternal characteristics
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
CDC
National Center for Health Statistics
CONTENT CENTACL
AND INVOICEMENT
012
04/27/99 22:19 FAX
2 National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
11 percent, respectively. From 1991 to 1997, the rates for non-Hispanic
a previous cesarean delivery (VBAC) Increased 50 percent between
black and Puerto Rican teenagers dropped 24 to 27 percent. Teenage
1989 (18.9) and 1996 (28.3) but fell 3 percent from 1996 to 1997 (27.4).
birth rates fell significantly in all but one State during 1991-97. The
The percent of births delivered by forceps continued to decline (2.8 per-
teenage pregnancy rate has continued to fall in the 1990's, as reflected
cent in 1997) while the percent by vacuum extraction rose (6.2 percent
in concurrent declines In birth and abortion rates.
in 1997).
Birth rates for women In their twentles, the peak childbearing
The remarkable rise in multiple births continued in 1997; the
ages, changed little in 1997. The rate for women 20-24 years declined
number of twin births rose 3 percent (from 100,750 to 104,137), and the
slightly to 110.0 per 1,000, while the rate for women 25-29 years rose
number of triplets climbed 16 percent (from 5,298 to 6,148). Births in
1 percent to 113.8 per 1,000. Birth rates for women in their twenties have
quadruplet and quintuplet and other higher order births were down
been relatively stable over the past two decades.
slightly, however. The twinning rate has increased 11 percent since 1990
Birth rates for women In their thirties increased 2 percent in
(from 22.6 to 26.8 per 1,000), and by 42 percent since 1980 (from 18.9
1997, to 85.3 per 1,000 for women aged 30-34 years, and to 36.1 for
per 1,000). The higher order multiple birth rate has more than doubled
women aged 35-39 years. These rates have risen almost without
just since 1991 (from 81.4 to 173.6 per 100,000), and has quadrupled
interruption since the mid-to-late 1970's. However, the pace of increase
since 1980 (from 37.0 per 100,000).
has slowed in the 1990's, especially for women aged 30-34 years. The
The rate of preterm birth (less than 37 completed weeks of
birth rate for women aged 40-44 years also increased in 1997, to 7.1
gestation) increased sharply from 11.0 percent in 1996 to 11.4 percent
per 1,000.
in 1997. The percent of births bom preterm has risen 8 percent since
The first birth rate declined in 1997 to its lowest level ever, 26.5
1990, and more than 20 percent since 1981 (from 9.4 percent). The
first births per 1,000 women aged 15-44 years. Among teenagers, first
recent upward trend in this rate has been partly driven by the rise in
birth rates declined 3 to 5 percent. Rates for second births to teenagers
multiple births that are at much greater risk of shorter gestations than
who have had one birth changed little in 1997, after dropping sub-
singletons. (The preterm rate for singletons was 10.0 percent compared
stantially from 1991 to 1996. First birth rates for women in their thirties
with 54.9 percent for twins, and 93.6 percent for higher order multiples.)
rose again in 1997, continuing a long-term trend.
The preterm birth rate was up for most racial/ethnic groups, but the
The birth rate for unmarried women in 1997 was 44.0 births per
largest rise (4 percent) was observed among births to non-Hispanic
1,000 unmarried women aged 15-44 years, 2 percent lower than in
white mothers (from 9.5 to 9.9 percent).
1996 and 6 percent lower than its highest level, 46.9 in 1994. The
The proportion of Infants bom low birthweight (LBW) rose again
number of births to unmarried women declined slightly to 1,257,444 in
for 1997 to 7.5 percent (from 7.4 percent for 1996), the highest level
1997, while the percent of all births occurring to unmarried women was
reported since 1973. This rate has risen slowly over the last decade.
unchanged at 32.4 percent. The birth rate for unmarried teenagers fell
Low birthweight was up slightly among non-Hispanic white (6.4 to
2 percent in 1997 to 42.2 per 1,000, down 9 percent from its 1994 high,
6.5 percent) and Hispanic mothers (6.3 to 6.4 percent). The current year
46.4.
rise in LBW was only partly attributable to the increase in multiple births;
Cigarette smoking during pregnancy continued to decline in
low birthweight among singleton births rose from 6.03 percent in 1996
1997, to 13.2 percent of women giving birth. Tobacco use during
to 6.08 percent in 1997. The 1997 level of low birthweight was
pregnancy has fallen steadily since 1989. However, smoking among
unchanged among non-Hispanic black mothers from the previous year
pregnant teenagers increased again in 1997, with particularly large
at 13.1 percent.
increases for black and Puerto Rican teenagers. In general, smoking
rates are lowest for Hispanic and Asian or Pacific Islander women.
Maternal smoking has a strong adverse impact on intant birthweight.
Introduction
In 1997. 12.1 percent of births to smokers compared with 7.1 percent
of births to nonsmokers weighed less than 2,500 grams (5 lb 8 oz).
This report presents detailed data on numbers and characteris-
First trimester prenatal care improved for the 8th consecutive
tics of births in 1997, birth and fertility rates, maternal lifestyle and
year, rising from 81.9 in 1996 to 82.5 percent in 1997. Timely care has
health characteristics, medical services utilization by pregnant women,
risen among all race/ethnic groups for the 1990's, but gains have been
and infant health characteristics. These data provide important infor-
the most pronounced among groups with lower levels of care. Since
mation on fertility patterns among American women by such charac-
1989, first trimester care has risen by at least 20 percent among
teristics as age, Ilve-birth order, race, Hispanic origin, marital status,
Mexican, Puerto Rican, Central and South American, and non-Hispanic
and educational attainment Up-to-date information on these fertility
black women, and by more than 15 percent among American Indian and
patterns is critical to understanding population growth and change in
Hawaiian mothers. Despite these improvements, rates of first trimester
this country and in individual States. Data on maternal characteristics
care are still low for American Indian, Mexican, and non-Hispanic black
such as weight gain, tobacco and alcohol use, and medical risk
women.
factors are useful in accounting for differences in birth outcomes.
Data on method of delivery show that the rate of cesarean
Information on use of prenatal care, obstetric procedures, complica-
delivery increased slightly between 1996 and 1997 (from 20.7 to
tions of labor and/or delivery, attendant at birth and place of delivery.
20.8 percent) after declining for 7 consecutive years. The rate in 1997
and method of delivery by maternal demographic characteristics can
was 9 percent lower than in 1989 (22.8 percent). The primary cesarean
also help to explain differences in birth outcomes. It is very important
rate was also 9 percent lower in 1996 and 1997 than in 1989 (14.6 first
that data on birth outcomes, especially levels of low birthweight and
cesareans per 100 women who had no previous cesarean in 1996 and
preterm birth, be continuously monitored, because these variables are
1997 compared with 16.1 in 1989). The rate of vaginal birth following
important predictors of infant mortality and morbidity.
04/27/99 22:19 FAX
013
National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
3
A report of prellminary birth statistics for 1997 presented data on
characteristics (except items on which length of gestation is calculated)
selected topics based on a substantial sample (about 99 percent) of the
are not imputed; see Technical notes. Births for which a particular
1997 birth file (1). The selected measures Included birth rates by age,
characteristic is unknown are subtracted from the figures for total births
race, and Hispanic origin of mother, and by live-birth order, and births
that are used as denominators before percents, percent distributions,
by marital status, prenatal care, cesarean delivery, and low birthweight.
and medians are computed. Thus, for example, the proportion of women
Findings for these selected measures based on the preliminary data are
receiving care in the first trimester of pregnancy is computed on the
essentially identical to those presented here based on final data.
basis of births for which month pregnancy prenatal care began was
In addition to the tabulations included in this report, more detailed
reported. Levels of nonreporting vary substantially by specific Item and
analysis is possible by using the natality public-use data tape, which
by State. Table 1 in the Technical notes provides information on the
is issued for each year. Birth data are also available in CD-ROM format
percent of records with-missing information for each item by State for
since 1991 (2).
1997. Readers should note that the levels of Incomplete reporting for
some of the medical items are quite high in some States. Data for
Connecticut, Hawaii, and Oklahoma are of particular concern.
Methods
Data shown in this report are based on 100 percent of the birth
Demographic characteristics
certificates registered in all States and the District of Columbia. More
than 99 percent of births occurring in this country are registered (3).
Births and birth rates
Tables that show data by State also provide separate information for
Puerto Rico, Virgin Islands, Guam, and American Samoa; however,
Number of births
data for these areas are not included in totals for the United States.
Data for American Samoa are available for the first time in 1997.
The number of births in the United States declined very slightly in
In this report, tabulations of births beginning with 1980 data are
1997, to 3,880,894, compared with 3,891,494 in 1996. Between 1995
by race of mother; for years prior to 1980, tabulations are by race of
and 1997 the number of births fell less than half of 1 percent. The
child. Details of the differences in tabulation procedure are described
1997 total is 7 percent fewer than the number in 1990, the most
in the Technical notes. Text references to black births and black mothers
recent high point in U.S. births and is the lowest recorded in a decade
or white births and white mothers are used interchangeably.
(see tables 1-12 for national and State birth data by age,
Race and Hispanic origin are reported independently on the birth
Ilve-birth order, race, and Hispanic origin). According to provisional
certificate. In tabulations of birth data by race and Hispanic origin, date
data for 1998, births have increased about 2 percent.
for Hispanic persons are not further classified by race because the vast
The number of births for most race and Hispanic origin groups
majority of women of Hispanic origin are reported as white. Most tables
increased In 1997 (tables 1 and 6). Increases of 1 to 2 percent were
in this report show data for these categories: white, total; white, non-
reported for non-Hispanic black, Puerto Rican, American Indian, Fili-
Hispanic; black, total; black, non-Hispanic; and Hispanic. When data
pino, Mexican, and Cuban births. The small overall decline in U.S. births
other than birth rates for Hispanic subgroups are shown, they are
reflects almost entirely the 1-percent decline in the number of births to
presented for the following five groups: Mexican, Puerto Rican, Cuban,
non-Hispanic white women. Births to Central and South American,
Central and South American, and other and unknown Hispanic. When
Chinese, and Japanese women also declined-by less than 1 percent.
reporting birth rates for Hispanic subgroups, births to Central and South
Hawalian births fell 4 percent.
American women are added to births to other and unknown Hispanic
women because more detailed population data for Central and South
Crude birth rate
American women are not separately available. Data are shown for five
The crude birth rate in 1997 was 14.5 live births per 1,000 total
Asian or Pacific Islander (API) subgroups: Chinese, Japanese,
population, a record low for the Nation. The 1997 rate was 1 percent
Hawaiian, Filipino, and "other" API. In addition, eight States report data
lower than in 1996 and 13 percent lower than in 1990 (16.7). The
on API subgroups included In the "other" API category (Vietnamese,
previous low point for the U.S. birth rate was recorded in 1975 and
Aslan Indian, Korean, Samoan, Guamanian, and remaining API); see
1976 (14.6). Provisional data for 1998 suggest a small increase in the
Technical notes. A report on births in 1992 to women in these API
birth rate.
subgroups has been published (4).
U.S. and State-level birth and fertility rates in this report were
computed on the basis of population denominators provided by the U.S.
Fertility rate
Bureau of the Census. Rates by State shown in this report may differ
The fertility rate, which relates births to the number of women in
from rates computed on the basis of other population estimates. Addi-
the childbearing ages, was 65.0 live births per 1,000 women aged
tional Information on the measurement of marital status, gestational age,
15-44 years in 1997, less than 1 percent below the 1996 rate (65.3).
and birthweight; the computation of derived statistics and rates; popu-
The fertility rate for 1997 was 8 percent below the rate in 1990 (70.9),
lation denominators; random variation and relative standard error; and
and matched the previous low recorded in 1976 (table 1 and
the definitions of terms are presented in the Technical notes.
figure 1). The decline in the fertility rate in the 1990's reverses an
Information on births by age, race, or marital status of mother is
8-percent rise from 1986 to 1990. Provisional data for 1998 indicate
imputed if it is not reported on the birth certificate. These items were
an increase in the fertility rate.
not reported for less than 1 percent of U.S. births in 1997. (See
Fertility rates for most race and Hispanic origin groups
Technical notes for additional information.) All other maternal and infant
declined in 1997 (tables 1 and 6). Rates declined less than 1 percent
04/27/99
22:19
FAX
014
4 National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
Table A. Birth rates for teenagers by age, race, and
5
200
Hispanic origin of mother: United States, 1991, 1996,
180
and 1997
4
160
Number
140
Millions of births
Rate per 1,000 woman aged 15-44 years
(Rates per 1,000 women in specified group]
Non-Hispanic
3
120
Year and age
Total'
While
Black
100
Hispanic
2
80
10-14 years
Rate
60
1997
1.1
0.4
3.4
2.3
1
1996.
1.2
40
0.4
3.8
2.6
1991²
1.4
0,5
4.9
2.4
20
0
0
15-19 years
1930
1940
1950
1960
1970
1980
1990
1997.
52.3
36.0
1997
90.8
97.4
NOTE: Beginning with 1959, trend lines are based on registered live births; trend lines
1996.
54.4
37.6
94.2
101.8
for 1930-59 are based on live births adjusted for underregistration.
1991²
62.1
43.4
118.9
108.7
Figure 1. Live births and fertility rates: United States,
15-17 years
1930-97
1997
32.1
19.4
62.6
68.3
1996
33.8
20.6
66.6
69.0
1991²
38.7
23.6
86.7
70.6
each for non-Hispanic black (72.4 per 1,000) and non-Hispanic white
women (57.0). The rates for Mexican women (116.6), Cuban women
18-19 years
(57.4), and "other" Hispanic women (which includes all births to Central
1997
89.6
61.9
134.0
144.3
and South American and other and unknown Hispanic women) (87.6)
1996,
86.0
63.7
136.6
151.1
1991²
94.4
70.5
163.1
158.5
fell by 2 to 3 percent each. The rates for Puerto Rican (71.7), American
Indian (69.1), and API women (66.3) increased 1 percent each.
Includes races other than white and black and origin not stated.
The modest reductions in fertility rates for non-Hispanic white and
2See reference 5 for Information on reporting areas in 1991.
black women indicate a slowdown in the steady downward trend in
these rates in the 1990's. During the years 1990-96, the fertility rate
1991 (38.7) to 1997 (table 4 and figure 2). The number of births to
for non-Hispanic white women declined 9 percent, and the rate for
teenagers 15-17 years fell 3 percent from 1996 to 1997 to 180,154.
non-Hispanic black women fell 19 percent. The increases in fertility
The birth rate for older teenagers 18-19 years declined 3 percent
rates for American Indian and API women in 1997 mark a halt, even
to 83.6 per 1,000. This rate fell 12 percent from 94.5 in 1992 (its recent
if temporarily, in the general downward trend in these rates during the
high) to 1997. The number of births to older leenagers dropped just
1990's.
1 percent In 1997 to 303,066.
The fertility rate for Hispanic women in 1997 was the lowest
Teenage birth rates by race and Hispanic origin vary substan-
reported since 1989 when data accounting for virtually all Hispanic births
tially (tables 3, 4, 8, and 9). Rates in 1997 were highest for Mexican,
in the United States first became available. Trends in fertility for Hispanic
non-Hispanic black, Puerto Rican, and American Indian teenagers and
women by subgroup for 1989-95 are presented in more detail in a
lowest for non-Hispanic white, Cuban, and API teenagers, a pattem that
recent report (5).
has been observed since 1994. Between 1996 and 1997, teenage birth
Age of mother
rates declined for all race and Hispanic origin groups except Cuban and
"other" Hispanic teenagers. Rates dropped 7 to 9 percent for Mexican
Teenagers-The birth rate for the youngest teenagers was
and Puerto Rican teenagers, and 3 to 4 percent for American Indian,
1.1 births per 1,000 females 10-14 years in 1997, matching the rate
API, non-Hispanic white, and non-Hispanic black teenagers.
reported in 1980-83 (table 4). This rate has declined steadily since
From 1991, when rates for teenagers generally were at a peak,
1994 (the rate was 1.4 in each year 1989 through 1994). The number
to 1997, birth rates fell 24 to 27 percent for non-Hispanic black and
of births to 10-14-year-olds fell 9 percent from 1996 to 1997, to
Puerto Rican teenagers. Rates dropped 14 to 17 percent for non-
10,121, the lowest total reported since 1984 (9,965). The decline in
Hispanic white, American Indian, and API teenagers. The rate for
the number of births to very young teenagers occurred solely as a
Mexican teenagers has declined 4 percent since 1991.
result of the reduction in the birth rate: the number of female
The factors accounting for the current downtum in teenage birth
teenagers has increased steadily in the 1990's (6).
rates are discussed in a recent report (6). Briefly, the proportion of
The birth rate for teenagers 15-19 years fell 4 percent to 52.3
teenagers who are sexually experienced has stabilized in the mid-
per 1,000. This rate was 16 percent lower than the rate in 1991 (62.1)
1990's, reversing the steady Increases over the past two decades.
(table A). The recent declines in the teenage birth rate partly reverse
Moreover, teenagers are more likely to use contracaptives at first
the 24-percent increase that occurred from 1986 to 1991. State-specific
intercourse, especially condoms (7,8).
birth rates for teenagers are discussed in the section "Births and birth
Teenage pregnancy rates (based on the sum of live births, induced
rates by State."
abortions, and fetal losses) have also declined in recent years (6, 9, 10,
Birth rates for teenage subgroups 15-17 and 18-19 years also
11). The pregnancy rale for teenagers 15-19 years fell 12 percent from
fell between 1996 and 1997. The rate for teenagers 15-17 years
117 per 1,000 in 1991 to 103 in 1995, reversing an 11-percent rise from
declined 5 percent to 32.1 per 1,000. This rate fell by 17 percent from
1986 to 1991 (6, 10). Further declines in the teenage pregnancy rate
04/27/99 22:19 FAX
015
National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
5
300
300
20-24 years
200
200
25-29 years
100
100
BO
18-19 years
ao
Rate per 1,000 women in specified group
30-34 years
60
60
15-19 years
40
40
15-17 years
20
20
35-39 years
10
10
8
8
6
6
40-44 years
4
4
3
3
1960
1965
1970
1975
1980
1965
1990
1995
1997
NOTE Rates are platted on a log scale,
Figure 2. Birth rates by age of mother: United States, 1960-97
since 1995 are indicated by the steady decline in the teenage birth rate
14 percent higher than the rate in 1990 (31.7). Because the birth rate
and declines in abortions among teenagers, according to preliminary
and the number of women each increased, the number of births to
data (12).
women aged 35-39 years rose again in 1997, to a record high, 409,710
Women aged 20 years and over: Women in their twentles-The
(13). Among women in their thirties, birth rates were highest for API,
birth rate for women aged 20-24 years declined slightly in 1997,
Mexican, and "other" Hispanic women (tables 3 and 8).
resuming the steady decline reported for 1990-95 (tables 3, 4, 8, and
Women In their forties-The birth rate for women aged 40-44
9). The rate for women aged 20-24 years was 110.0 per 1,000 in 1997.
years increased from 6.8 per 1,000 to 7.1 in 1997. This rate rose
The birth rate for women aged 25-29 years rose 1 percent in 1997 to
29 percent from 1990 (5.5) to 1997. From 1981 to 1997, the rate
113.8 per 1,000; this rate increased for 2 consecutive years, following
increased by 87 percent; the 1997 rate matches the previous high
steady declines during 1990-95. The rates for women in their twenties,
recorded in 1971. The number of births in this age group rose 6 percent
the principal childbearing ages, have been relatively stable over the past
to 76,084, the highest number reported since 1965.
two decades.
The birth rate for women aged 45-49 years increased from 0.3
Birth rates for women in age groups 20-24 and 25-29 years were
births per 1,000 in 1996 to 0.4 In 1997. The number of births to women
consistently highest for Mexican women. For example, the rate for
in this age group rose 9 percent to 3,333, the highest number recorded
Mexican women aged 20-24 years, 204.9 per 1,000, was nearly three
since 1969 (3,398).
times the rate for API women in this age group (70.5).
Births to women aged 50 years and over-In this report, sta-
Women In their thirtles-Birth rates for women in their thirties
tistics are shown for births to women aged 50-54 years in 1997, the
rose 2 percent in 1997. Rates for women in these age groups have
first time this information is available since 1963. For the years 1964-96,
generally increased steadily since the late 1970's, a pattern unlike any
mother's age was edited for ages 10-49 years (3). Additional infor-
other age group (table 4). The rate for women aged 30-34 years
mation on the editing procedures is presented in the Technical notes.
increased in 1997 to 85.3 per 1,000. This rate increased by 63 percent
Because of the recent advances in fertility-enhancing therapies, an
since 1975. Most of this increase occurred by 1990. The number of
increasing number of women are giving birth at age 50 years and over.
births to women aged 30-34 years dropped 1 percent in 1997, reflecting
In 1997, 144 births were reported to women aged 50-54 years (tables 2
the 3-percent reduction in the number of women (13).
and 7). This number is too small for computing an age-specific birth rate.
The birth rate for women In their late thirties increased 2 per-
Therefore, in computing birth rates by age of mother, births to women
cent to 36.1 per 1,000 women aged 35-39 years. This rate has
aged 50-54 years have been included with births to women aged 45-49
increased without interruption since 1978 (19.0) by 90 percent. Although
years; the denominator for the rate is women aged 45-49 years.
the pace of increase slowed in the 1990's, the 1997 rate was still
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6 National Vital Statistics Report, Vol. 47, No. 18. April 29,
Although sustained increases in birth rales have been most long-
Births and birth rates by State
lasting for women aged 30 years and over (14), the pace of increase
has slowed since 1990 as noted above (table 4). Among the factors
Birth data by race and by Hispanic origin for 1997 are shown in
contributing to the slowdown include declining birth expectations among
tables 10-12 for the 50 States and the District of Columbia, Puerto
childless women and relatively high proportions of currently childless
Rico, the Virgin Islands, Guam, and American Samoa. The American
women aged 35-44 years reporting impaired fecundity according to the
Indian, Asian or Pacific Islander (API) and Hispanic populations (and
1995 National Survey of Family Growth (7. 15, 16).
Hispanic subgroups) are highly concentrated geographically.
The number of births increased in 28 States and Puerto Rico, the
Virgin Islands, and Guam and declined in 22 States and the District of
Live-birth order
Columbia. Increases and declines of up to 2 percent were found In 41
The first birth rate dropped 1 percent in 1997 to 26.5 first births
of the States, Puerto Rico, and Guam. The number increased 4 percent
per 1,000 women aged 15-44 years (table 5). This was the lowest
in Georgia and Oklahoma and 6 percent in the Virgin Islands and
level ever recorded. The first birth rate dropped 9 percent compared
declined 6 percent in Hawaii and the District of Columbia.
with 1990 (29.0), its recent high point. The rate for third births rose
Crude birth rates by State ranged from 11 births per 1,000
slightly. Birth rates for other birth orders were unchanged.
population (Maine, Vermont, and West Virginia) to 21 per 1,000 (Utah)
While the first birth rate declined 1 percent overall, there were
(table 10). Birth rates per 1,000 total population declined in 32 States
substantial differences in the trends by age of mother (table 3; tabular
and the District of Columbia, increased in 9 States, Puerto Rlco, the
data not shown for 1996 and earlier years). Rates declined for teenage
Virgin Islands, and Guam, and were unchanged in 9 States; changes
subgroups 15-17 and 18-19 years and for women aged 20-24 years
were no more than 2 percent in most States. Changes were not
by 3 to 5 percent; the rate was unchanged for women aged 25-29 years.
significant in 29 of the States and the District of Columbia or in Puerto
In contrast, first birth rates rose 3 percent for women in their thirties.
Rico, the Virgin Islands, and Guam. Statistically significant declines of
Reflecting these variations by age, the proportion of all first births
4 to 5 percent were recorded for Califomia, Hawaii, and South Dakota,
occurring to women aged 30 years and over increased slightly in 1997
whereas Oklahoma recorded a significant increase of 4 percent.
to 23 percent compared with just 5 percent in 1975 (14). First birth rates
Fertility rates per 1,000 women aged 15-44 years ranged from
for API women aged 30-34 and 35-39 years were substantially higher
a low of 50 (Maine and Vermont) to a high of 89 (Utah) (table 10). Rates
in 1997 than for any other group.
declined in 21 States and the District of Columbia, increased in 25
The birth rate for second births to teenagers who have had a
States, Puerto Rico, the Virgin Islands, and Guam, and were unchanged
first birth was essentially unchanged in 1997 compared with 1996, after
in 4 States. Changes in most States were no more than 2 percent and
falling 21 percent from 1991 to 1996 (6). All of the decline in teenage
were not statistically significant in 33 States and the District of Columbia,
birth rates in 1997 was thus due to declines in first birth rates.
Puerto Rico, the Virgin Islands, and Guam. Significant declines of 5
percent each were reported for Hawaii and South Dakota, while a
4-percent increase was found for Oklahoma.
Total fertility rate
State-specific total fertility rates for 1997 are shown in table 10.
The total fertility rate (TFR) indicates the number of births that a
These rates provide a summary measure of lifetime fertility at the State
hypothetical group of 1,000 women would have if they experienced
level; rates for 1980, 1990, and 1996 have been published (17-19).
throughout their childbearing years the age-specific birth rates
Rates by State for 1997 vary substantially, from a low of 1,573.5 (or 1.57
observed in a given year. This measure shows the potential impact of
births per woman) for Vermont to a high of 2,632.0 (2.63 births per
current fertility patterns on completed family size. Because it is
woman) for Utah. Differences in the TFR's and changes between 1996
computed from age-specific birth rates, the TFR is age-adjusted; it is
and 1997 by State are quite similar to those In the general fertility rate.
not affected by changes over time in age composition.
The TFR in 1997 was 2,032.5, less than 1 percent higher than in
Birth rates for teenagers
1996 (tables 4 and 9). The TFR has Increased from 1995-by 1 percent
Birth rates for teenagers by age group and State are shown for
overall-following a 3-percent decline from 1990 to 1995. The increase
1997 in table 10. Rates per 1,000 women aged 15-19 years ranged
in the TFR resulted from the rise in age-specific birth rates for all women
by State from 26.9 (Vermont) to 73.7 (Mississippi). The highest rate
in age groups 25-49 years, which more than compensated for the
was reported for Guam, 106.3. Birth rates for teenagers have been
declines in the teenage birth rates.
declining in the United States since 1991. Between 1991 and 1997,
The U.S. total fertility rate remains below "replacement" level
teenage birth rates fell in all States and the District of Columbia and
(2,100), the rate at which a given generation can exactly replace itself.
the Virgin Islands; declines were statistically significant in all States
The TFR has been below "replacement" since 1971 (2,266.5). TFR's
except for Rhode Island (table B). Declines exceeded 20.0 percent in
vary substantially among racial and Hispanic origin groups. In 1997, as
10 States and the District of Columbia. More detailed information on
in recent years, the TFR was above "replacement" for Mexican, non-
current trends and variations in State-specific teenage birth rates by
Hispanic black, and Puerto Rican women. Rates were below "replace-
age, race, and Hispanic origin is presented in a recent report (6).
ment" for American Indian, API, Cuban, and non-Hispanic white women
(tables 4, 9, 13, and 14). Changes between 1996 and 1997 in most
Sex ratio
TFR's were 2 percent or less. State-specific TFR's for 1997 are dis-
cussed in the next section.
There were 1,985,596 male live births in 1997 compared with
1,895,298 female live births. These numbers ylelded a sex ratio of
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National Vital Statistics Report, VoL 47, No. 18, April 29, 1999
7
Table B. Birth rates for teenagers 15-19 years by State, 1991 and 1997, and percent change, 1991-97: United States
and each State, Puerto Rico, Virgin Islands, Guam, and American Samoa
(Birth rates per 1,000 estimated female population aged 15-19 years in each area]
Percent
Percent
change,
change,
Slate
1991
1997
1991-97
State
1991
1997
1991-97
United States'
62.1
523
-15.8
Nebraska
42.4
37.2
-123
Nevada
75.3
67.7
-10,1
Alabama
73.9
66.6
-9.9
New Hampshire
33.3
28.6
-14.1
65.4
44.8
-31.8
New Jersey
41.6
35.0
-15.9
Arizona
80.7
69.7
-13.6
New Mexico
79.8
68.4
-14.3
A
79.8
72.9
-8.6
New York
46.0
38.8
-15.7
Callfornia
74.7
57.3
-23.3
North Carolina
70.5
61.3
-13.0
Colorado
58.2
48.2
-17.2
North Dakota
35.6
30.1
-15.4
Connecticut.
40.4
38.1
-10.6
Ohio
60.5
49.8
-17.7
Delaware
61.1
55.8
-8,7
Oklahoma
72.1
64.3
-10.8
District of Columbia
114.4
91.0
-20.5
Oregon
54.9
46.9
-14.8
Florida
68.8
57.7
-16.1
Pennsylvania
46.9
37.3
-20.5
Georgia
76,3
67.2
-11.9
Rhode Island
45.4
427
-5.9"
58.7
43.8
-25.4
South Carolina
72.9
61.4
-15.8
Idaho
53.9
4a.3
-19.7
South Dakota
47.5
39.7
-16.4
Illnois
64.8
54.7
-15.6
Tennessee
75.2
64.5
-14.2
Indiana
60.5
54.2
-10.4
Texas
78.9
71.7
-9.1
lowa
42.8
35.7
-16.2
Utah
48.2
42.6
-11.6
Kansas
55.4
48.5
-12.5
Vermont
39.2
26.9
-31,4
Kentucky
68.9
59,8
-13.5
Virginia
53.5
44.2
-17.4
Louisiana
78,1
66.3
-129
Washington
53.7
42.5
-20.9
Maine
43.5
32.0
-20.4
West Virginia
57.8
49.1
-15.1
Maryland
54.3
43.9
-19.2
Wisconsin.
43.7
35.9
-17.8
usetts
37.8
31.7
-18.1
Wyoming
54.2
43.3
-20.1
Michigan
59.0
43.9
-25.6
Minnesota
37.3
320
-14.2
Puerto Rico
724
77.8
7.5
Mississippi
85.8
73.7
-13.9
Virgin Islands
77.9
66.0
-15.3
Missouri.
64.5
51.5
-20.2
Guam
96.7
106.3
11.1**
Montana
46.7
37.6
-19.5
American Samoa
43.9
- Not significant at P < 0.05.
Data not available.
"Excludes data for Puerto Rico, Virgin tstands, Guam, and American Samoa.
1,048 male per 1,000 female live births (tables 13 and 14). The sex
was 81.5. As in past years, births occurred most frequently on
ratio has changed very little over the last 50 years and was 1,047 in
Tuesdays with an index of 113.8 in 1997 (table 16).
1996. Similar to previous years, Asian or Pacific Islander mothers had
A weekend deficit is apparent for vaginal and cesarean deliveries,
the highest sex ratio (1,072), followed by non-Hispanic white mothers
but is far larger for cesarean deliveries, particularly repeat cesareans.
(1.052). Hispanic mothers (1,040), American Indian mothers (1,036),
In 1997 the Sunday index for vaginal births was 78.2, compared with
and non-Hispanic black mothers (1,031).
63.9 for primary cesareans and 37.7 for repeat cesareans.
Month of birth
Births to unmarried women
Monthly birth rates in 8 months of 1997 were below the rates for
The birth rate for unmarried women in 1997 was 44.0 births
the same months observed in 1996. The peak months of occurrence
per 1,000 unmarried women aged 15-44 years, 2 percent lower than
of births in 1997 were July, August, and September (table 15). When
In 1996 (44.8), and 6 percent below its highest level, 46.9 in 1994.
the seasonal component is removed from the monthly birth rates, the
The number of births to unmarried women declined slightly, to
underlying trends can be observed. All months except for April, June,
1,257,444 in 1997. The percent of all births occurring to unmar-
and December had the lowest seasonally adjusted birth rates in at
ried women was unchanged at 32.4 percent in 1997. (See table C
least 20 years. The rate for August 1997 was the lowest observed in
and tables 17 and 18,)
the more than 60 years for which monthly seasonal adjustments are
The procedures for reporting the mother's marital status
available (3, 20).
changed In California, Nevada, and New York City beginning January
1, 1997. California and Nevada now report the mother's marital status
Day of the week of birth
from a direct question. The question is on the California birth certificate.
Nevada obtains this information from the electronic birth registration
Variation in the daily pattern of births can be measured by an
process; the question does not appear on certified or paper copies of
index of occurrence. In 1997 the Sunday index was 73.2, an
the Nevada certificate. New York City infers marital status and changed
indication that there were nearly 27 percent fewer births on Sundays
its procedures beginning in 1997. The reporting changes in California
than the daily average, considered to be 100.0. The Saturday index
and New York City, which account for 17 percent of U.S. births, are
04/27/99 22:20 FAX
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8 National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
Table C. Number, rate, and percent of births to unmarried
procedures; see Technical notes. The reporting changes in New York
women, and birth rate for married women: United States,
City affected the overall data and the data by age, with large decreases
1980 and 1985-97
found for all age groups. If these reporting changes had not occurred,
Births lo unmarried women
statistics for nonmarital births would have been unchanged in New York
Birth rate for
Year
Number
Rale'
Percent2
City (21, 22). It is important to note that as a result of the changes
married women³
implemented by California, Nevada, and New York City, their birth data
1997
1,257,444
44.0
32.4
84.3
by marital status are more accurate in 1997 than in prior years. The
1
1,260,306
44.8
324
83.7
factors affecting the birth data by marital status are discussed in more
1995
1,253,976
45.1
322
83.7
1994,
1,289,592
detail in the Technical notes.
46.9
32.6
83.8
1993
1,240,172
45.3
31.0
86.8
Birth rates for unmarried women vary considerably by race
1992
1,224,876
45.2
30.1
89.0
and Hispanic origin. In 1997 the rates per 1,000 unmarried women
1991
1,213,789
45.2
29.5
89.9
1,165,384
43.8
28.0
93.2
were 27.0 per 1,000 for non-Hispanic white women, 73.4 for black
1,094,169
41.6
27.1
91.9
women, and 91.4 for Hispanic women, The birth rate for unmarried black
1,005,299
38.5
25.7
90.8
women has declined 19 percent since 1989 (90.7). The birth rate for
1987
933,013
38.0
24.5
90.0
878,477
34.2
23.4
90.7
unmanied Hispanic women in 1997, 91.4 per 1,000, was at its lowest
1
828,174
328
22.0
93.3
level since 1990 (89.6).
665,747
29.4
18.4
97.0
Birth rates for unmarried women by age continue to be highest
'Births to unmarried women per 1,000 unmarried women aged 15-44 years.
for Women aged 18-19 and 20-24 years, followed closely by women
-Pe
of all births to unmarried women.
aged 25-29 years (figure 3). Rates for younger teenagers and women
Births to married women per 1,000 married women aged 15-44 years.
In age groups 30 years and over are considerably lower (tables 17 and
18). Among teenagers and women aged 20-24 years, rates for unmar-
discu
in some detail in this section (and the Technical notes)
ried black and Hispanic women on average were 3 to 4 times the rates
becal
of their potential impact on national statistics on births to
for non-Hispanic white women in the same age groups. Among age
unmarried women. Prior to 1997. the mother's marital status was
groups 25-29 years and over, rates were considerably higher for
inferred in California by comparing the surnames of the mother, father,
Hispanic women than for black or non-Hispanic white women.
and child. Beginning in 1997, two changes were implemented. First, a
Changes in age-specific birth rates for unmarried women have
law went into effect mandating that the father's name could not be
been affected by the changes in reporting procedures for Califomia and
included on the birth certificate unless the parents were married or a
New York City described above. However, in most cases, the one-year
paternity affidavit was filed. Second, a direct question on the mother's
changes for 1996-97 reinforce and enhance changes already underway
marital status, similar to the one in effect in most other States, was
since 1994. Therefore this summary of trends will focus on the longer-
added to the California birth certificate (see Technical notes). Reporting
term changes since 1994. The birth rates for unmanied teenagers
procedures for marital status in California, as well as the procedures
15-17 and 18-19 years declined 12 and 7 percent, respectively, from
in Nevada, are now essentially the same as those in most other States.
1994. The rate for young black teenagers has dropped steeply, by
The mother's marital status is inferred in New York City, but the
19 percent since 1994. Birth rates for women in age groups 20-24
procedures for inferring this information changed beginning in 1997.
through 40-44 years have fluctuated since 1994; rates in 1997 were
Beginning in 1997, the mother is assumed to be unmarried if the father's
2 to 5 percent lower than In 1994. These patterns were generally found
name is missing from the birth certificate, or if a patemity affidavit was
for all population groups.
filed; these are the same procedures that have been in effect in the
The proportion of all births occurring to unmarried women was
balance of New York for many years. Prior to 1997, the inferential criteria
unchanged at 32.4 percent in 1997. The proportions for subgroups in
in New York City had also included a comparison of the sumames of
1997 were 21.5 percent, non-Hispanic white; 69.4 percent, non-
the mother and father.
Hispanic black; and 40,9 percent, Hispanic; each changed very little in
A comparison of the changes in nonmarital births for the entire
recent years (see tables 13, 14, 17, and 19 for 1997 data).
United States and for California and New York City separately shows
Changes in the proportion of births to unmarried women are
that these changes had little impact on the national totals and relatively
affected by trends in birth rates for married as well as unmarried women,
little impact on the total numbers for California. As a direct result of the
and the number of unmarried women (table C). The proportion of births
reporting changes in California, the national numbers and proportions
to unmanied women has changed very little since 1994 even though
of nonmarital births tended to increase for women aged 15-24 years
the number and rate of births for unmarried women have generally
and to decline for women aged 25 years and over. When the inferential
declined, because total births- mostly births to married women-have
procedures were in effect prior to 1997, births to older women who had
also declined. Trends in the factors affecting the proportion of births to
retained their birth surname after marriage were often erroneously
unmarried women should be kept in mind when examining trends in the
inferred as nonmarital because the parents' current surnames did not
proportion (23).
match. For California, the changes in nonmarital birth patterns by age
The numbers and proportions of births to unmarried women
were compensating, so that the overall levels of nonmarital births are
by State and by race and Hispanic origin for 1997 are shown in table 19
only modestly higher in 1997 compared with 1996. There is a similar
for the 50 States and the District of Columbia, Puerto Rico, the Virgin
effect for Nevada, although the percent unmarried based on the direct
Islands, Guam, and American Samoa, The numbers increased in 32
question is somewhat lower than the percent based on the inferential
States, Puerto Rico, the Virgin Islands, and Guam and declined In 18
019
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National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
9
80
There is considerable varlation in educational attainment among
70
race and Hispanic origin groups. Among women giving birth in 1997,
20-24 years
60
18-19 years
87 percent of non-Hispanic white mothers had completed high school,
25-29 years
compared with 73 percent of non-Hispanic black mothers, and 50 per-
50
Rate per 1,000 unmarried women in specific group
cent of Hispanic mothers. Although the overall proportion of Hispanic
40
mothers with at least 12 years of schooling was low, there was tre-
30-34 years
mendous variation among Hispanic subgroups, ranging from 44 percent
30
15-17 years
of Mexican mothers to 86 percent of Cuban mothers (table 14). Thirty
15-19 years
percent of non-Hispanic white mothers had at least 4 years of college
compared with 11 percent of non-Hispanic black mothers and 7 percent
20
of Hispanic mothers. Only two-thirds of American Indian mothers had
35-39 years
12 or more years of schooling, whereas nearly all Japanese (98 percent)
and Filipino mothers (93 percent) had attained this educational level, the
highest of any group (table 13).
10
9
Maternal lifestyle and health characterIstics
8
1980
1985
1990
1995
1997
Weight gain
NOTE: Rates are plotted on a log scale.
Maternal weight gain is one of the components in the complex
Figure 3. Birth rates for unmarried women, by age of
relationship between lifestyle characteristics of the mother and the
mother: United States, 1980-97
development of the fetus (25). In 1990 the National Academy of
Sciences published weight-gain guidelines that varied according to
mother's body mass index (BMI), which is calculated from her
States and the District of Columbia. Similarly, increases in the propor-
prepregnancy weight and height. The guidelines recommend that
tions exceeded declines: the proportion increased in 32 States, Puerto
women who are underweight (low BMI) gain 28-40 pounds, those
Rico, the Virgin Islands, and Guam, declined in 15 States and the District
who are of normal weight (average BMI) gain 25-35 pounds, those
of Columbia, and was unchanged in three States.
who are overweight (high BMI), 15-25 pounds, and obese women,
not more than 15 pounds (26).
Information on maternal weight gain is collected on the birth
Age of father
certificate, but information on the mother's prepregnancy weight and
The birth rate per 1,000 men aged 15-54 years declined for
height is not. Therefore, it is not possible to determine whether the
the seventh straight year in 1997 to 50.4 (table 20). This rate fell by
weight gain was within the recommendations for the mother's BMI.
14 percent between 1990 and 1997, following a 7-percent increase
Differences between subgroups in maternal weight gain may reflect
during 1986-90. Information on age of father is often missing on birth
differences in the proportion of mothers who gained outside the rec-
certificates of children born to unmarried women. Age of father was
ommended range but could also be the result of group differences in
not reported for 15 percent of births In 1997. The procedures for
maternal height and prepregnancy weight.
computing birth rates by age of father are described in the Technical
In 1997 all States except California reported information on weight
notes.
gain. Births to mothers residing in these States accounted for 86 percent
of all births in the United States. In 1997 the majority of women
(64 percent) gained 26 pounds or more during pregnancy (table 22).
Educational attainment
The median weight gain was 30.5 pounds in 1997 and changed very
The educational attainment of women who give birth is important
little during the 1989-97 period. Despite the consistency of the median
because higher educational attainment is associated with more timely
weight gain, the percent of mothers who gained at either end of the
receipt of prenatal care and fewer lifestyle and health behaviors that
weight gain spectrum was higher in 1997 than in 1989-weight gains
are detrimental to birth outcome (discussed in later sections).
of less than 16 pounds increased from 9.4 percent In 1989 to 11.1 per-
Data from the birth certificate show that the educational attainment
cent in 1997 while weight gains of 46 pounds or more increased from
of women who gave birth increased substantially over the last few
9.1 percent in 1989 to 11.4 percent in 1997.
decades, partly reflecting the increases in educational attainment of all
The weight gain of the mother during pregnancy varied con-
women during the time period (24). More than three-fourths of women
siderably by period of gestation. Mothers who had preterm infants
who gave birth in 1997 had at least 12 years of schooling (78 percent)
(gestations of under 37 completed weeks) gained about 3 pounds less
and 23 percent had at least 4 years of college (table 21). The percent
during pregnancy (27.4 pounds) than mothers who had babies with
of mothers with at least a high school diploma increased with advancing
gestations of 40 weeks and over (30.8 pounds). The median weight gain
age. to 90 percent for women who gave birth in their thirties, and then
for non-Hispanic white women (30.8 pounds) was about a pound higher
declined slightly for mothers 40 years of age and over (88 percent). The
than for either non-Hispanic black women (29.6 pounds) or Hispanic
percent of mothers with at least 4 years of college was highest for
women (29.B pounds).
mothers 35 years of age and over (42 percent). The median educational
The percent of non-Hispanic black, American Indian, and Mexican
attainment for all mothers in 1997 was 12.8 years.
mothers who had weight gains of less than 16 pounds (16.7, 15.3, and
04/27/99
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10 National Vital Statistics Report, Vol. 47, No. 18, April 29, 1
14.8 percent, respectively) was much higher than for Chinese (6.4 per-
Medical risk factors during pregnancy can also vary greatly by
cent), Cuban (7.3 percent). Filipino (8.4 percent), or non-Hispanic white
race/ethnicity. For example, for 1997, pregnancy-associated hyper-
mothers (9.4 percent) (tables 24 and 25). These differences in weight
tension complicated nearly 5 percent of American Indian pregnancies,
gain are reflected in differences among groups in the percent of births
but less than 2 percent of Japanese (tables 27 and 28).
bom preterm. Data on weight gain for Hawallans (table 24) are unre-
liable because of incomplete reporting In Hawaii.
Tobacco use during pregnancy
Within Hispanic subgroups, the percent of Mexican mothers who
gained less than 16 pounds (14.8 percent) was twice as high as for
Smoking during pregnancy continued to decline according to
Cuban mothers (7.3 percent) while the remaining groups were inter-
birth certificate data. In 1997, 13.2 percent of women giving birth were
mediate (table 25).
reported to have smoked, down 3 percent compared with 1996
Maternal weight gain has been shown to have a positive
(13.6 percent) and 32 percent since 1989 (19.5 percent), when this
correlation with the birthweight of the Infant (27). This relationship
information first became available on the birth certificate (32). Tobacco
is substantiated by the data In table 23. The percent of infants with low
use was reported in a comparable manner on the birth certificate In
birthweight drops steadily with increasing weight gain through 45
1997 by 46 States, the District of Columbia, and New York City,
pounds, from 14.5 to 4.8 percent, and then increases slightly for
comprising 80 percent of U.S. births. Comparable Information was not
mothers who gained 46 pounds or more (5.3 percent). This pattern is
available for California, Indiana, South Dakota, and the remainder of
generally replicated when the data are examined according to the period
New York State. (See tables 24, 25, and 29-32 for 1997 data.)
of gestation.
Some studies have suggested that smoking may be underreported
on birth certificates due to a variety of factors, Including the lack of a
specific time reference for smoking status, variations in the source of
Medical risk factors
this information for each birth, and the growing stigma associated with
Maternal medical risk factors can severely complicate pregnancy
smoking (33-36). Nevertheless, trends in maternal smoking based on
and result in poor birth outcomes, particularly when not adequately
the birth certificate are generally consistent with those reported for
treated (28-30). Sixteen medical risk factors affecting pregnancy are
recent years from the National Survey of Family Growth, and variations
separately identified on the birth certificate. Although data for this item
in smoking among population subgroups found in birth certificate data
were missing from only 1.2 percent of records for 1997, birth
have been corroborated in other studies (7. 37-39).
certificate data may underreport medical risk factor prevalence (31).
Tobacco use during pregnancy is associated with a variety of
Also, rates for less common medical risk factors and for smaller
adverse outcomes, including low birthweight, intrauterine growth retar-
population groups can vary widely from year to year and should be
dation, and infant mortality, as well as negative consequences for child
used with caution.
health and development (40-42).
The rate of pregnancy-associated hypertension, the most fre-
Maternal smoking declined or was unchanged In most racial
quently reported medical risk factor, rose for the sixth consecutive year,
and Hispanic origin groups; smoking rates increased for Chinese and
from 35.9 to 36.8 per 1,000 for 1996-97. (See table 26 for 1997 data.)
Hawaiian women. As in previous years, rates were highest for non-
The rate for this risk factor has risen among all age and race and ethnic
Hispanic white, American Indian, and Hawaiian women, and lowest for
groups since the early 1990's. Rates for the related hypertensive
Mexican, Cuban, Central and South American, and Asian or Pacific
disorders, chronic hypertension and eclampsia, were largely
Islander women (API) (except Hawaiian) (tables 24 and 25). The
unchanged for 1997, at 6.9 and 3.3 per 1,000, respectively, and have
generally very low smoking rates found for Mexican, Central and South
not risen notably during the 1990's.
American, Chinese, and Filipino women from birth certificate data have
Diabetes and anemia are the second and third most frequently
been confirmed by other studies (38, 39). Women born In the 50 States
reported complications of pregnancy. The diabetes rate was 26.4 per
and the District of Columbia had substantially higher smoking rates than
1,000 for the current year compared with 26.3 for 1996, and the anemia
women bom outside these areas, a pattern that has been described
rate was 20.2, compared with 19.6 per 1,000.
elsewhere (tables 24 and 25) (43).
The prevalence of acute or chronic lung disease (e.g., asthma,
Maternal smoking among teenagers rose about 2 percent
tuberculosis) was 9.7 per 1,000 for 1997, higher than the 1996 level of
overall, the third consecutive year of increase (figure 4) (35). The
6.3. Although still quite rare, the level of lung disease has more than
smoking rate among non-Hispanic black teenagers 15-19 years rose
tripled since 1990 (3.0) with large Increases found among all age and
12 percent from 1996 to 1997 (6.6 percent) and has increased by
racial/ethnic groups. The reported rate of hydramnios/ollgohydramnios
one-third since 1994 (5.0 percent) (see table 30 for 1997 data). The rate
(the excess or shortage of amniotic fluid) has also been on the rise since
for non-Hispanic white teenagers increased 2 percent (29.2 percent);
data on this risk factor first became available and has more than doubled
their rates are 4 to 5 times the rates for non-Hispanic black teenagers.
during the 1990's (from 5.9 to 13.0 between 1990 and 1997).
Non-Hlspanic white women aged 18-19 years had the highest smoking
Medical risk factor rates often differ widely by maternal age.
rate of any group, 29.6 percent (table 30). Smoking rates rose as well
Anemia, for example, is more common among younger mothers (28.6
in 1997 for Puerto Rican teenagers. Smoking during pregnancy gen-
for mothers under 20 years of age compared with 17.3 for mothers 40
erally declined for women in age groups 20-39 years. Patterns of
years of age and over), but younger mothers are much less likely to
smoking rates and trends by age, race, and Hispanic origin are
have chronic conditions such as diabetes (8.2 compared with 64.9).
described in detail in a recent NCHS report (35).
Some risk factors, however, such as pregnancy-assoclated hyperten-
Among smokers, the proportion smoking at least half a pack
sion, follow a U-shaped pattern, with the highest levels at the extremes
of cigarettes dally has declined steadily in recent years-to 32 percent
of the maternal age distribution.
in 1997 (compared with 42 percent in 1989) (32). Non-Hispanic white
04/27/99
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National Vital Stalistics Report, Vol. 47, No. 18, April 29, 1999
11
tables 24 and 25 for 1997 data) (19, 32). A recent study based on an
25
20-24 years
analysis of responses by nearly 6,000 pregnant women in the Center
20
for Disease Control and Prevention's nationally representative Behav-
loral Risk Factor Surveillance System, found that about 15 percent of
15
15-19 years
women used alcohol during pregnancy in 1995. The researchers also
30-34 years
reported that alcohol use declined from 1988 (23 percent) to 1992
25-29 years
35-39 years
(10 percent) before rising to 15 percent in 1995 (48).
Percent
40-49 years
The nature of the birth certificate questions on alcohol use appar-
10
ently contribute to the underreporting because they focus on the number
of drinks per week, whereas other studies Inquire about drinks per
month. Women who drink one to two drinks per month may believe that
Less than 15 years
their alcohol consumption is too little to report In response to the birth
certificate questions. The stigma associated with alcohol use also
5
contributes to the underreporting (25, 48).
1990
1991
1992
1993
1994
1995
1996
1997
NOTE: California, Indiana, New York State, and South Dakota did not report smoking
Medical services utilization
during pregnancy for 1990-97. New York City for 1890-1993, Oklahoma for 1990.
Percents are plotted on a log scale.
Prenatal care
Figure 4. Percent of mothers who smoked during
pregnancy by age: Total reporting areas, 1990-97
The percent of women beginning prenatal care In the first
trimester of pregnancy rose to 82.5 for 1997, from 81.9 in 1996.
Essentially stagnant during the 1980's, first trimester care has risen
mothers and older mothers are more likely than other mothers to smoke
from 75.5 percent since 1989 (table D). The proportion of mothers
half a pack or more (tables 29 and 31).
with delayed (care beginning In the third trimester) or no care,
Rates of smoking by maternal educational attainment are
was 3.9 percent for the current year, compared with 4.0 percent for
persistently highest for women with 9-11 years of education, 26 percent
1996. The proportion of women with late or no care worsened during
in 1997, and lowest for women with 4 years or more of college, 2 percent
the 1980's, but has Improved from the high of 6.4 percent reported for
(table 31). Even among women aged 20 years and over, smoking rates
1989 (49). (See tables 33-35 for 1997 data.)
were highest for mothers who attended but did not graduate from high
The effects of prenatal care are difficult to measure (50, 51), but
school-30 percent overall and 48 percent of non-Hispanic white
early competent care can promote healthier pregnancies by detecting
women (tabular data not shown).
and managing preexisting medical conditions, providing health behavior
Bables bom to mothers who smoke during pregnancy are at
advice, and assessing the risk of poor pregnancy outcome (52). Pre-
greatly elevated risk of low birthweight (LBW), a finding documented
natal care can also be vital to maternal health and can serve as a
In birth certificate data as well as in numerous other studies (40, 44,
gateway into the health care system, especially for socially disadvan-
45). In 1997, 12.1 percent of infants born to smokers weighed less than
taged women (51).
2,500 grams (5 lb 8 oz) compared with 7.1 percent of births to non-
According to the Adequacy of Prenatal Care Utilization Index
smokers (table 32). This substantial differential is found for every race
(APNCU), an alternative measure of prenatal care utilization (53), the
and Hispanic origin group. The LBW risk is heightened as the number
of cigarettes increases, although LBW is elevated even among babies
Table D. First trimester prenatal care by race and
born to the lightest smokers (one to five cigarettes daily), 10.9 percent
Hispanic origin of mother: United States, 1970, 1975,
(tabular data not shown). Advancing maternal age exacerbates the risk,
1980, 1985, 1990-97
probably a consequence of the much greater cigarette consumption
among older women (table 29).
Non-Hlspanic
All
Year
races'
White
Black
Hispanic²
Alcohol use during pregnancy
1997
82.5
67.9
72.3
73.7
Pregnancy and birth outcome can be jeopardized by maternal
1996
81.9
87.4
71.5
72.2
1985
alcohol use during pregnancy. Even low-to-moderate alcohol use has
81.3
87.1
70.4
70.8
1994
80.2
86,5
68.3
68.9
been shown to compromise birth outcome, independent of other risk
1993
78.9
85.6
66.1
66.6
factors such as tobacco use and other matemal risk factors (46, 47).
1992
77.7
84.9
64.0
64.2
1991
All States except California and South Dakota Included items on
76.2
83.7
61.9
61.0
1990
75.8
83.3
60.7
60.2
alcohol use on their birth certificates in 1997. This reporting area
1989
75.5
82.7
59.9
59.5
accounted for 86 percent of U.S. births.
1985
76.2
1980
Alcohol use during pregnancy is substantially underreported on the
76.3
1975
724
birth certificate (31). According to birth certificate data, alcohol use
1970
68.0
declined again in 1997 to just 1.2 percent of mothers reporting any
alcohol use compared with 1.4 percent in 1996 and 4.1 percent in 1989,
Data not available.
'Includes races other than white and black and origin not stated.
the first year this Information was reported on the birth certificates (see
2ncludes al persons of Hispanic origin of any rece.
04/27/99 22:21 FAX
022
12 National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
in prenatal care use for 1996-97 occurred among mothers with
95
intensive use of care (women for whom the number of visits exceeded
Cuban
the American College of Obstetricians and Gynecologists recommen-
Japanese
dations by a ratio of observed-to-expected visits of at least 110 percent).
85
White (non-Hlspanic)
(See table E.) Based on the APNCU, intensive use of prenatal care has
Chinese
risen 67 percent from 18.4 to 30.7 percent since 1981 (the first year
comparable data on period of gestation used to compute this index
became available), adequate care (not including intensive use of care)
Percent
75
Fillpino
Puerto Rican
has declined 4 percent (from 45.1 to 43.5 percent), and less than
adequate care has declined 29 percent (from 36.5 to 25.9 percent) (54).
Hawalian
Gains in the proportion of mothers with care beginning In the first
American Indian
trimester of pregnancy were observed for the current year among most
65
race and ethnic groups (levels for Japanese and Hawaiian mothers
Black
did not rise for 1997). Improvement continues to be most pronounced
among those with less favorable levels of care, somewhat reducing the
Mexican
considerable disparity among groups (figure 5). Since 1989 first tri-
55
mester care has risen by more than 20 percent among Mexican (from
1989
1991
1993
1995
1997
56.7 to 72.1 percent), Central and South American (from 60.8 to
NOTE: Percents are platted on a log soale,
76.9 percent). Puerto Rican (from 62.7 to 76.5 percent), and non-
Hispanic black mothers (from 59.9 to 72,3 percent); and by less than
Figure 5. Percent of mothers with first trimester prenatal
10 percent among Cuban (83.2 to 90.4 percent), Japanese (86.2 to
care by race and Hispanic origin of mother:
United States, 1989-97
89.3 percent), and non-Hispanic white mothers (82.7 to 87.9 percent).
(See tables 24 and 25 for 1997 data.)
Most States reported higher levels of first trimester care for 1997
compared with 1996. Four New England States reported the highest
Complications of labor and/or delivery
proportions of mothers with first trimester care (89-90 percent), and the
Of the 15 reported complications of labor and/or delivery, 3 were
lowest proportions of mothers with late or no care (less than 2 percent)
reported at a rate greater than or equal to 30 per 1,000 live births in
for 1997: Connecticut, Maine, New Hampshire, and Rhode Island
1997: Meconium, moderate/heavy (56 per 1,000). fetal distress (40
(table 34).
per 1,000), and breech/malpresentation (38 per 1,000) (table 37).
Rates for these three complications varied by race and Hispanic origin
(tables 27 and 28). It has been shown that levels of these complica-
Obstetric procedures
tions may be underreported on the birth certificate (55).
Six specific obstetric procedures are reported on the birth
certificate. It has been shown that these procedures may be under-
Attendant at birth and place of delivery
reported on the birth certificate (31, 55). The most prevalent obstetric
procedure in 1997 was electronic fetal monitoring, reported for over
More than 9 out of 10 births in 1997 (92.3 percent) were
3.2 million births, or 83 percent of all live births (table 36).
attended by a physician In a hospital, making this arrangement by far
According to data from the birth certificate, 64 percent of mothers
the most typical (table 38). However, the percent of births attended by
who had live births in 1997 received ultrasound. The overall rates of
a physician in a hospital was slightly lower in 1997 than in 1996
stimulation of labor and induction of labor in 1997 were 174 and 184,
(92.9 percent) and has declined from 98.4 percent in 1975. For
respectively, per 1,000 live births. The rates of both of these procedures
physician-attended births, 4 percent were by doctors of osteopathy
have been rising annually since 1989 (56).
(DO's) while the remaining were attended by doctors of medicine
(MD's). Although small, the number and percent of births attended by
DO's has grown steadily since 1989, the first year data on DO's were
available from the birth certificate. The percent of births attended by
midwives increased sharply between 1975 (1.0 percent) and 1997
Table E. Adequacy of Prenatal Care Utilization Index:
(7.0 percent). About 95 percent of midwife-attended births in 1997
United States, 1981, 1985, 1990, and 1995-97
were by certified nurse midwives (CNM's).
Intensive
About 99 percent of births in 1997 were delivered in hospitals,
Year
Use
Adequate
Intermediate
Inadequate
No care
almost unchanged from the 1975 level. The majority of out-of-hospital
1997
30.7
43.5
16.3
8.4
1.2
births were in a residence (64 percent) while 28 percent were in a
1996
29.3
43.8
17.1
8.7
1.1
freestanding birthing center.
1995'
28.8
43.9
17.2
8.9
1.2
1990'
About 93 percent of births to non-Hispanic white women were
24.6
42.6
19.1
11.8
1.9
1985'
21.1
44.8
21.0
11.8
1.5
attended by a physician in a hospital compared with about 92 percent
1981
18.4
45.1
23.2
12.0
1.3
of births to non-Hispanic black women and 90 percent of births to
Hispanic women. Hispanic women were more likely to have midwife-
'See reference 54 for detailed data on trenda.
attended hospital births (9 percent) than were either non-Hispanic black
NOTE: See reference 53 for information on calculation of this measure.
women (7 percent) or non-Hispanic white women (6 percent).
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National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
13
Method of delivery
There was considerable variation In cesarean rates by State
The rate of cesarean delivery increased slightly between 1996
ranging from a high of 26.7 per 100 live births in Mississippi to a low
and 1997 (from 20.7 per 100 live births to 20.8) after falling each year
of 15.3 in Colorado (table 41). The rate for Puerto Rico was 33.4. There
during 1989-96 (table F and table 39). The 1997 rate was 9 percent
was also considerable variation in VBAC rates by State. Data for Hawaii
lower than the rate of 22.8 in 1989, the first year this Information was
(table 41) and for Hawaiian births (table 24) are unreliable because of
available on the birth certificate. The primary cesarean rate (first
incomplete reporting.
All of the selected medical risk factors in table 42 were associated
cesareans per 100 live births to women who had no previous
cesarean) was unchanged between 1996 and 1997, at 14.6, after
with overall cesarean rates that were higher than the national average.
falling each year during 1989-96. The primary rate in 1997 was
Cesarean rates for the medical risk factors ranged from 21.7 per 100
9 percent lower than in 1989 (16.1). Concomitant with the decline in
Ilve births for mothers with Rh sensitization to 48.0 for mothers with
cesarean rates during the 1969-96 period was a 50-percent increase
eclampsia. Certain complications of labor and/or delivery are also
in the rate of vaginal birth after previous cesarean delivery
associated with high cesarean rates. Nearly all births with cephalopelvic
(VBAC)-from 18.9 In 1969 to 28.3 in 1996. However, in 1997 the rate
disproportion were cesarean deliveries (96.2), and the cesarean rates
dropped to 27.4. a 3-percent decline from 1996.
for breech/malpresentation (84.5) and placenta previa (82.0) were also
Overall cesarean rates increased steadily by age of the mother and
very high.
were more than twice as high for mothers 40-54 years of age (32.4)
During the 1989-97 period, the percent of births that were deliv-
as for teenagers (14.3) (table 40). Primary cesarean rates Increased
ered by elther forceps or vacuum extraction remained steady at about
with additional age after ages 20-24 years, to 22.6 for women 40-54
9 percent. During that period, however, there was a shift as the number
years of age. VBAC rates declined with increasing age-a third of
and percent of births delivered by forceps declined each year, whereas
teenagers who had a previous cesarean had a VBAC delivery (33.4 per-
the use of vacuum extraction consistently increased. In 1997, 2.8 per-
cent) compared with 20.5 percent of mothers 40-54 years of age.
cent of births were delivered by forceps compared with 5.5 percent in
Total and primary cesarean rates declined or held steady in 1997
1989-a 49-percent decline. Vacuum extraction was used In 6.2 percent
compared with 1996 for all age groups under 30 years but increased
of births in 1997, a 77-percent increase compared with 1989 (3.5
between the 2 years for mothers in age groups of 30 years of age and
percent).
over. All age groups experienced declines in VBAC rates between 1996
and 1997. Non-Hispanic black women had a higher cesarean rate in
Infant health characteristics
1997 (21.8 per 100 live births) than either non-Hispanic white women
(20.9) or Hispanic women (20.2). Similarly, the primary cesarean rate
Period of gestation
for non-Hispanic black women (15.6) was higher than the rate for
non-Hispanic white women (14.8) and Hispanic women (13.4). The
The preterm birth rate rose sharply for 1996-97, from 11.0 to
VBAC rate in 1997 was highest for non-Hispanic white women (28.5),
11.4 percent. The proportion of preterm births (infants born prior to 37
lowest for Hispanic women (23.5), and intermediate for non-Hlspanic
completed weeks of gestation) has risen 8 percent since 1990 (from
10.6 percent) and more than 20 percent since 1981 (from 9.4 per-
black women (26.4).
Japanese, American Indian, Hawaiian, and Chinese mothers had
cent). The current year rise included increases In both very preterm
lower cesarean rates (ranging from 15.1 to 19.1 per 100 live births) than
births (prior to 32 completed weeks of gestation) and moderately
Puerto Rican, non-Hispanic white, non-Hispanic black, Fillpino, or
preterm (32-36 weeks) births. (See tables 43 and 44.) Preterm birth
Cuban mothers (ranging from 20.8 to 30.5) (tables 24 and 25).
is a major cause of infant mortality and has been associated with
long-term neurodevelopmental and respiratory disorders (57, 58).
The primary measure used to determine the inlant's gestational
age, the interval between the first day of the last normal menstrual
Table F. Total and primary cesarean rates and vaginal
period (LMP) and the date of birth, is subject lo error for several reasons
birth after previous cesarean delivery rates:
including imperfect maternal recall or misidentification of the LMP
United States, 1989-97
because of postconception bleeding, delayed ovulation, or intervening
early miscarriage (59). See Technical notes for additional information
Cesarean rate
VBAC
on procedures for measuring gestational age.
Year
Total'
Primary2
rates
The increase In preterm births was most pronounced among
1997
20.8
14.6
27.4
non-Hispanic white women, for whom a rise of 4 percent (from 9.5
1996,
20.7
14.6
28,3
to 9.9 percent) was observed. The percent of births bom very preterm
1995.
20.8
14.7
27.5
was 1.49 for 1997 compared with 1.43 for 1996. Since 1989, the preterm
1994
21.2
14.9
26.3
1993,
21.8
15.3
24.3
rate among non-Hispanic white births has risen from 8.4 percent, and
1992.
22.3
15.6
22.6
the very preterm rate from 1.34 percent. Recent increases in multiple
1991
22.6
15.9
21.3
births, which are disproportionately preterm, have particularly influenced
1990
22.7
16.0
19.9
1989
22.8
16.1
18.9
the upward trend in preterm birth for this group. Analysis of only
non-Hispanic white singleton births for 1989-97 reveals a 14 percent
Percent of all live births by cesarean delivery.
increase in moderately preterm births (compared with a 19-percent rise
2Number of primary ceaareans per 100 live births to women who have not had a previous
cesarean.
for all births) and essentially no change in the proportion of very preterm
Number of vaginal births after previous cesarean (VBAC) delivery per 100 live births to women
births (compared with a rise from 1,34 to 1.49 percent for all births)
with a provious cosarean delivery.
(figure 6) (60).
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14 National Vital Statistics Report, Vol. 47. No. 18, April 29, 1999
20
Black (non-Hispanic), Total
20
18
18
16
Black (non-Hispanic), Singlatons
16
14
14
Percent
Black LBW
12
White (non-Hispanic), Total
12
10
10
8
White (non-Hispanic), Singletons
Percent
8
6
Total LBW
1989
1991
1993
1995
1997
Year
6
NOTE: Preterm is <37 completed weeks of gestation. Parcents are plotted on a log scale,
White LBW
Flgure 6. Rate of preterm birth by plurality and
4
race/Hispanic origin of mother: United States, 1989-97
1970
1975
1980
1985
1990
1995
1997
The risk of preterm birth increased slightly among non-Hispanic
NOTE: Low birthweight (LBW) is less than 2,800 grams. Percents are plotted on a
log scale.
black births for 1997 (17.6 percent) compared with 1996 (17.5 per-
cent), checking the downturn observed since 1993 (18.6 percent). The
Flgure 7. Percent low birthweight by race: United States,
very preterm birth rate was largely unchanged at 4.19 percent, but has
1970-97
declined from 4.68 percent since 1989. Among non-Hispanic black
singleton births, however, levels of moderately and very preterm births
were unchanged from the previous year (data not shown).
a slower pace: from 4.90 to 4.95 percent for 1996-97, and from
Preterm births also increased among Hispanic women, rising from
4.60 percent since 1989 (see table G).
10.9 to 11.2 percent for 1996-97; the increase was concentrated among
LBW among non-Hispanic black Infants was unchanged for 1997
moderately preterm births (9.2-9.5 percent). The overall preterm rate
at 13.1 percent. LBW has declined somewhat among black births during
has changed only slightly since 1989 (from 11.1 percent), and the very
the 1990's (from 13.6 for 1991), but the rate of VLBW has not improved;
preterm rate has dipped from 1.76 to 1.68 percent. (Relative trends in
for 1997 the percent VLBW was 3.05, compared with the 1989 level of
preterm rates for Hispanic births are largely unaffected by trends in
2.97. Increases in multiple births have only moderately influenced trends
multiple births.) Preterm rates were up for most of the Hispanic sub-
in non-Hispanic black LBW; that is, the decline in LBW since 1993 is
groups between 1996 and 1997 (tables 24 and 25).
slightly steeper when only singletons are examined.
Overall Hispanic LBW was 6.4 percent in 1997 compared with
Birthweight
6.3 percent for the previous year. The percent VLBW among Hispanic
The rate of low birthweight (LBW) (less than 2,500 grams) rose
births was essentially unchanged at 1.13 percent. Since 1989, when
to 7.5 percent for 1997, from 7.4 percent for 1996, the highest level
national data on Hispanic births first became available, Hispanic VLBW
reported since 1973. Low birthweight has risen slowly over the last
and LBW have shown a moderately upward trend (from 1.05 and
decade (from 6.8 percent for 1986) after declining during the 1970's
6.2 percent). LBW rates were up slightly for each Hispanic subgroup for
and early 1980's. (See tables 43-47 and figure 7.) The rise in
multiple births, which are much more likely than singletons to be LBW,
Table G. Percent low birthweight among singletons by
has influenced this upward trend; whereas overall LBW has risen
race/Hispanic origin of mother: United States, 1989-97
10 percent since 1986, LBW among singleton births has increased
Non-Hispanic
Non-Hlspanic
4 percent (from 5.84 to 6.08 percent).
Year
Total
While
Black
Hispanic
The percent of very low birthweight (VLBW) (less than1
1997
grams) was 1.42 percent for 1997, compared with 1.37 for 1996. This
6.08
4.95
11.46
5.43
1996
6.03
4.90
11.55
5.34
level has also risen in recent years (from 1.15 percent in 1980). LBW
1995
6.05
4.67
11.66
5.36
infants, particularly VLBW infants, are at greater risk than heavier babies
1994
6.06
4.79
11.79
5.37
of long-term morbidity and early death (60). In 1996, VLBW infants
1993
6.05
4.70
11.90
5.34
1992
5.93
4.59
11.91
5.22
accounted for about 1 percent of all births, but 50 percent of all infant
1991'
5.99
4.61
12.15
5.29
deaths (infant deaths through 11 months per 1,000 live births) (58).
19902
5.90
4.56
11.92
5.23
1989
The proportion of non-Hispanic white LBW infants rose from 6.4
6.00
4.60
12.22
5.35
to 6,5 percent between 1996 and 1997. Since 1989 non-Hispanic white
Excludes data for Now Hampshire, which did not require reporting of Hispanic origin of mother.
LBW has risen 16 percent (from 5.6 percent) and VLBW has increased
Excludes dala for New Hampshire and Oklahoma which ald not require reporting of Hispanic
from 0.93 to 1.12 percent. The sharp increase in the multiple birth rate
origin of mother.
Excludes dala for Louisiana, New Hampshire, and Oklahoma which did not require reporting of
explains some, but not all of the rise for non-Hispanic white births as
Hispanic origin of mother.
LBW among singleton births has also risen over this period, but at
NOTE: Low birthweight is less than 2,500 grams or 5 lb B OZ.
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National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
15
1997, and ranged from 6.0 percent for Mexican to 9.4 percent for Puerto
These areas included 99 percent of births in the United States. It has
Rican infants. (See table 25.)
been shown that these anomalies are underreported on the birth
For 1997, 6.8 percent of American Indian births were LBW.
certificate (55, 62).
Among the Asian or Pacific Islander subgroups, LBW levels were
Because many of the congenital anomalies tracked on birth cer-
generally up for the current year, and ranged from 5.1 for Chinese to
tificates occur Infrequently, the rates shown in this report are calculated
8.3 percent for Filipino births (table 24).
per 100,000 live births (table 49). Caution should be used in comparing
The percent macrosomia (birthweight of at least 4,000 grams) was
yearly rates for a specific anomaly as a small change in the number
10.1, down slightly from the figure reported for 1996 (10.2 percent).
of anomalles reported can result in a relatively large change in rates.
Macrosomic births have been declining since 1991, after peaking at
about 11 percent in the 1980's.
Multiple births
The median birthweight for all births for 1997 was 3,350 grams
(7 lbs, 7 oz.) unchanged from 1996. The median for white births was
The number of births In multiple deliverles climbed to 110,874
3,390 grams, and for black births 3,180 grams.
for 1997 and included 104,137 twins, 6,148 triplets, 510 quadruplets,
LBW and VLBW risk varies by State; among non-Hispanic white
and 79 quintuplets and other higher order multiple births, representing
births for 1997, LBW levels ranged from a low of 5.1 percent in Hawaii
a 3-percent increase in the number of twins, and a 16-percent jump in
to a high of 9.0 percent for Wyoming. Among States with at least 1,000
the number of triplet births over 1996. (See table 50 for 1997 data.)
births to non-Hispanic black mothers, the proportion of LBW for this
Slightly fewer births were reported In quadruplet and quintuplet and
population ranged from 10.2 percent in lowa and Washington to
other higher order multiple deliveries for 1997 (table H). Since 1980
16.2 percent for the District of Columbia (table 46).
the number of twins has risen 52 percent (from 68,339) and the
number of triplets and other higher order multiple births by 404 per-
cent (from 1,337) (63, 64).
Apgar score
The twin birth rate (the number of twin births per 1,000 live births)
The Apgar score was developed by the late Virginia Apgar, M.D.,
rose 3 percent for 1996-97, to 26.8 (or 2.7 percent of all births). Since
as a means of evaluating the physical condition of newborns shortly
1980 the twinning rate has risen 42 percent (from 18.9 per 1,000). After
after delivery (61). The score considers five characteristics of the baby
a rise of 20 percent for 1995-96, the higher order multiple birth rate
that are easily identifiable-heart rate, respiratory effort, muscle tone,
(the number of triplet, quadruplet and quintuplet, and other higher order
reflex irritability, and color. Each of these characteristics is assessed
multiples per 100,000 live births). jumped another 14 percent for 1997,
and assigned a value of 0-2 with 2 being optimum. The total score is
to 173.6 per 100,000. The higher order multiple birth rate has more than
the sum of the five components and a score of 7 or better indicates
doubled since 1991 (from 81.4), and quadrupled since 1980 (from 37.0)
that the baby is in good-to-excellent physical condition. The 5-minute
(figure 8). Put another way, one in every 576 births was a triplet or other
Apgar score is based on an assessment 5 minutes after delivery and
higher order multiple in 1997, compared with about one of every 2,700
used to predict the newbom's chance of survival.
births in 1980. Older matemal age (women in their thirties are more likely
In 1997 all States except California and Texas collected information
to have a multiple birth than those in their twentles, even without the
on the 5-minute Apgar score. Births to residents in these States
use of fertility therapy), and the more widespread use of fertility-
accounted for 78 percent of all births in the United States. Only 1.4 per-
enhancing therapies (fertility drugs and techniques such as in vitro
cent of babies had Apgar scores that were considered low (less than
fertilization), have been associated with the unprecedented rise in
7) at 5 minutes after birth, unchanged since 1993 (tables 24 and 25).
multiple births (64-66).
Of all racial groups, Asian or Pacific Islander babies were in the
Twinning rates rose among the three largest racial and ethnic
best physical condition shortly after delivery-only 1 percent had scores
groups for 1996-97, but continue to be highest for non-Hispanic black
less than 7. The percent of babies with low scores was intermediate
women (30.0 compared with 28.8 for non-Hispanic white, and 19.5 for
for non-Hispanic white and Hispanic women (1.2 each) while 2.5 per-
Hispanic women). In contrast, and despite substantial increases in
cent of non-Hispanic black babies had low 5-minute scores.
higher order multiple births among non-Hispanic black women
Table H. Numbers of twin, tripiet, quadruplet and
Abnormal conditions of the newborn
quintuplet, and other higher order multiple births:
Of the eight specific abnormal conditions reported on the birth
United States, 1989-97
certificate, the rates per 1,000 live births in 1997 were highest for
Quintuplete
assisted ventilation less than 30 minutes (22 per 1,000), assisted
and other
ventilation 30 minutes or longer (9 per 1,000), and hyaline membrane
higher order
Year
Twins
Triplets
Quadruplets
multiples
disease/respiratory distress syndrome (RDS) (6 per 1,000) (table 48).
It has been shown that these conditions may be underreported on the
1997
104,137
6,148
510
79
1996
100,750
5,298
560
81
birth certificate (55).
1995
96,736
4,551
365
57
1994.
97,064
4,233
315
46
1993
96,445
3,834
277
57
Congenital anomalies
1992
95,372
9,547
310
26
1991
94,779
3,121
203
22
In 1997 congenital anomalies were reported on the birth certifi-
1990
93,865
2,830
185
13
1989
90,118
2,529
cates of the District of Columbia and all States except New Mexico.
229
40
04/27/99 22:22 FAX
026
16 National Vital Statistics Report, Vol. 47, No. 18, April 29, 1
6. Ventura SJ, Mathews TJ, Curtin SC. Declines in teenage birth rales,
250
White (non-Hispanic)
1991-97: National and State patterns. National vital statistics reports;
vol 47 no 12. Hyaltsville, Maryland: National Center for Health
Per 100,000 live births
Statistics. 1998.
100
All races
7. Abma JC, Chandra A, Mosher WD, Peterson LS, Plccinino LJ. Fertility,
family planning. and women's health: New data from the 1995 National
White, total
Black, total
Survey of Family Growth. National Center for Health Stalistics. Vital
50
Hispanic
Health Stat 23(19). 1997.
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25
1980
1985
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1990
1995
1997
9. Ventura SJ, Curtin SC. Recent trends in teen births in the United
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NOTES: Higher order multiples include births In greater than twin deliveries. Rates are
10. Ventura SJ, Taffel SM, Mosher WD, Wilson JB, Henshaw S. Trends in
plotted on a log scale.
pregnancies and pregnancy rates: Estimates for the United States,
Figure 8. Higher order multiple birth rates by race and
1980-92. Monthly vital statistics report; vol 43 no 11, supp. Hyattsville,
Maryland: National Center for Health Statistics. 1995.
Hispanic origin of mother, 1980-97
11. Henshaw SK. U.S. Teanage pregnancy statistics. New York, New York:
The Alan Guttmacher Institute. 1998.
12. Centers for Disease Control and Prevention. Abortion surveillance:
(64 percent) and Hispanic women (93 percent) since 1991, non-
Prefiminary analysis-United Stales, 1996. MMWR 47(47):1025-28,
Hispanic white women were more than twice as likely as non-Hispanic
1035. 1998.
black women, and more than three times as likely as Hispanic women
13. Hollmann FW, Kuzmeskus LB, Perkins RC, Weber EA. U.S. population
to have a triplet, quadruplet, or quintuplet birth (230.8 compared with
estimates, by age, sex, race, and Hispanic origin: 1990 to 1997.
90.0 and 72.7 per 100,000, respectively) in 1997. Non- Hispanic white
PPL-91R. U.S. Bureau of the Census. Rounded populations consistent
with U.S. Bureau of the Census file NESTV97. 1998.
mothers tend to be older, and are more likely than their black and
14. Ventura SJ. Trends and variations in first births to older women,
Hispanic counterparts, to seek infertility services (16).
1970-86. National Center for Health Statistics. Vital Health Stat 21(47).
Multiple birth rates generally rise with increasing maternal age
1989.
(there is a slight dip at age 40-44 years), with rates peaking for older
15. Bachu A. Fertility of American women: June 1992. Current population
mothers 45 to 54 years of age. For 1997, 16.6 percent of births to
reports; series P-20-470. Washington: U.S. Department of Commerce.
mothers aged 45 years and over was a multiple, a level 10 times higher
1993.
than that for mothers under 20 years of age (1.5 percent) and more than
16. Chandra A, Stephen EH. Impaired fecundity in the United States:
3 times higher than that for women in their thirties (3.9 percent).
1982-1995. Fam Plann Persp 30(1):34-42. 1998.
Multiple births are more likely than singletons to be bom preterm
17. Clarke SC, Ventura SJ. Birth and fertility rates for States: United States,
(57 versus 10 percent) or LBW (56 versus 6 percent). Multiples com-
1990. National Center for Health Statistics. Vital Health Stat 21(52).
prised only 3 percent of all births in 1997, but 21 percent of all LBW
1994.
infants, 24 percent of VLBW, 14 percent of preterm, and 20 percent of
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very preterm infants. The rising multiple birth rate and the accompanying
National Center for Health Statistics. Vital Health Stat 21(42). 1984.
high risk for these births has increasingly influenced measures of
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17. Number, rate, and percent of births to unmarried women by age,
Vital Records and Health Statistics. Traverse City, Michigan. June
race, and Hispanic origin of mother: United States, 1997
42
25-27, 1990.
18. Birth rates for unmarried women by age of mother. United
76. Mathews TJ, Ventura SJ. Birth and fertility rates by educational
States, 1970, 1975, and 1980-97, and by age, race, and
attainment: United States, 1994. Monthly vital statistics report, vol 45 no
Hispanic origin of mother. United States, 1980-97
43
10, supp. Hyattsville, Maryland: National Center for Health Statistics.
19. Number and percent of births to unmarried women by race and
1997.
Hispanic origin of mother. United States and each State, Puerto
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45
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78. Curtin SC. Rates of cesarean birth and vaginal birth after previous
1980-97
46
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Hyattsville. Maryland: National Center for Health Statistics. 1997.
completing 12 years or more and 16 years or more of school. by
age and race and Hispanic origin of mother: United States,
1997
47
List of tables
22. Number of live births and percent distribution by weight gain of
mother during pregnancy and median weight gain, according to
1. Live births, birth rates, and fertility rates, by race: United States,
period of gestation, race and Hispanic origin of mother: Total of
specified years 1940-55 and each year. 1960-97
22
49 reporting States and the District of Columbia, 1997
49
2 Live births by age of mother, live-birth order, and race of mother:
23. Percent low birthweight by weight gain of mother during preg-
United States, 1997
23
папсу, period of gestation, and race and Hispanic origin of
3. Fertility rates and birth rales by age of mother, live-birth order,
mother. Total of 49 reporting States and the District of Columbia,
and race of mother: United States, 1997
24
1997
50
4. Total fertility rates and birth rates by age of mother: United
24. Percent of births with selected medical or health characteristics,
States, 1970-97, and by age and race of mother: United States,
by specified race of mother, by place of birth of mother: United
1980-97
25
States, 1997
51
5. Fertility rates and birth rates by live-birth order and race of
25. Percent of births with selected medical or health characteristics,
mother: United States, 1980-97
27
by Hispanic origin of mother and by race for mothers of
6. Live births, birth rates, and fertility rates by Hispanic origin of
non-Hispanic origin and by place of birth of mother: United
mother and by race for mothers of non-Hispanic origin: United
States, 1997
52
States, 1989-97
28
26. Live births to mothers with selected medical risk factors and
7. Live births by age of mother. live-binh order, Hispanic origin of
rates by age of mother, by race of mother: United States,
mother, and by race for mothers of non-Hispanic origin: United
1997
53
States, 1997
29
27. Number and rate of live births to mothers with selected medical
B. Fertility rates and birth rates by age of mother, live-birth order,
risk factors, complications of labor, and obstetric procedures. by
Hispanic origin of mother. and by race for mothers of non-
specified race of mother: United States, 1997
54
Hispanic origin: United States, 1997
31
28. Number and rate of live births to mothers with selected medical
9. Total fertility rates, fertility rates, and birth rates by age and
risk factors, complications of labor, and obstetric procedures, by
Hispanic origin of mother and by race for mothers of non-
Hispanic origin of mother and by race for mothers of non-
Hispanic origin: United States, 1989-97
33
Hispanic origin: United States, 1997
55
10. Number of births, birth rates, fertility rates, total fertility rates, and
29. Number of live births by smoking status of mother. percent
birth rates for teenagers 15-19 years by age of mother: United
smokers, and percent distribution by average number of ciga-
States and each State. Puerto Rico, Virgin Islands, Guam, and
rettes smoked by mothers per day, according to age and race of
American Samoa, 1997
35
mother. Total of 46 reporting States, the District of Columbia,
11. Live births by race of mother: United States and each State,
and New York City, 1997
56
Puerto Rico, Virgin Islands, Guam, and American Samoa,
1997
30. Number of live births by smoking status of mother and percent of
36
mothers who smoked cigarettes during pregnancy, by age and
12 Live births by Hispanic origin of mother and by race for mothers
Hispanic origin of mother and by race for mothers of non-
of non-Hispanic origin: United States and each State, Puerto
Hispanic origin: Total of 46 reporting States. the District of
Rico, Virgin Islands, Guam, and American Samoa, 1997
37
Columbia, and New York City, 1997
57
04/27/99 22:23 FAX
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National Vital Statistics Report, Vol. 47, No. 18, April 29, 1999
19
31. Number of live births, percent of mothers who smoked cigarettes
50. Live births by plurality of birth and ratios, by age and race and
during pregnancy, and percent distribution of average number of
Hispanic origin of mother: United States, 1997
82
cigarettes smoked by mothers per day, according to educational
attainment and race and Hispanic origin of mother: Total of 46
reporting States, the District of Columbia, and New York City,
1997
58
32. Percent low birthweight by smoking status. age, and race and
Hispanic origin of mother: Total of 46 reporting States, the
District of Columbia, and New York City. 1997
59
33. Live births by month of pregnancy prenatal care began and
percent of mothers beginning care in the first trimester and
percent with late or no care. by age and race and Hispanic origin
of mother: United States, 1997
60
34. Percent of mothers beginning prenatal care in the first trimester
and percent of mothers with late or no prenatal care by race and
Hispanic origin of mother: United States and each State, Puerto
Rico, Virgin Islands, and Guam, 1997
62
35. Live births by month of pregnancy prenatal care began, number
of prenatal visits, and median number of visits, by race and
Hispanic origin of mother. United States, 1997
63
36. Live births to mothers with selected obstetric procedures and
rates by age of mother, by race of mother: United States,
1997
65
37. Live births to mothers with selected complications of labor and/or
delivery and rates by age of mother, by race of mother. United
States, 1997
66
38. Live births by attendant place of delivery, and race and Hispanic
origin of mother: United States, 1997
67
39. Live births by method of delivery and rates of cesarean delivery
and vaginal birth after previous cesarean delivery, by race and
Hispanic origin of mother: United States, 1989-97
68
40. Live births by method of delivery, and rales of cesarean delivery
and vaginal birth after previous cesarean delivery, by age and
race and Hispanic origin of mother: United States. 1997
69
41. Rates of cesarean delivery and vaginal birth after previous
cesarean delivery by race and Hispanic origin of mother: United
States and each State, Puerto Rico, Virgin Islands, and Guam,
1997
70
42. Rates of cesarean delivery and vaginal birth after previous
cesarean delivery, by selected maternal medical risk factors and
complications of labor and/or delivery: United States, 1997
71
43. Live births by birthweight and percent very low and low
birthweight. by period of gestation and race and Hispanic origin
of mother: United States, 1997
72
44. Percent of live births very preterm and preterm and percent of
live births of very low birthweight and low birthweight, by race
and Hispanic origin of mother: United States. 1981-97
74
45. Number and percent low birthweight and number of live births by
birthweight, by age and race and Hispanic origin of mother:
United States, 1997
75
46. Number and percent of births of low birthweight by race and
Hispanic origin of mother: United States and each State, Puerto
Rico. Virgin Islands, Guam, and American Samoa, 1997
77
47. Number and percent of births of very low birthweight by race
and Hispanic origin of mother: United States and each State.
Puerto Rico, Virgin Islands, Guam, and American Samoa.
1997
78
48. Live births with selected abnormal conditions of the newborn and
rates by age of mother, by race of mother: United States.
1997
79
49. Live births with selected congenital anomalies and rates by age
of mother, by race of mother: Total of 49 reporting States and the
District of Columbia, 1997
80