US fertility rates in sharp decline

But neonatal syphilis is on the rise.

Until the recession erupted in 2007, fertility rates were even higher in the U.S. than the so-called “replacement level.” But then they started to decline, reaching historic lows last year.

A new Databrief published by the Centers for Disease Control and Prevention (CDC) on October 17 expressed concern regarding this drop.
The decline in the total fertility rate (TFT) was more pronounced in urban areas or large metropolitan counties, where it fell from 2007 to 2017 by 18 percent, according to the data released by the CDC.

In small or medium metropolitan counties the decline was slightly lower, that is, 16 percent, and in rural counties 12 percent.
 While in the rural areas the TFT was higher by about 5 percent in 2007 compared to the suburban and urban ones, in 2017 this difference was respectively 10 percent for suburban areas and 14 percent for urban areas. In 2017, the fertility rate was 1,950 births per 1,000 women in rural areas, compared to 1,778 in suburban areas and 1,712 in urban areas.


Among the possible causes of this decline, the experts do not exclude a correlation with what is called the “male fertility crisis” in the U.S. According to the American Society for Reproductive Medicine, in about 40 percent of cases of infertility the cause is attributable in full or at least partially to the male partner, according to Newsweek (September 12, 2017).

Decline seen in Hispanic women
 

While the decline in fertility rates occurred in all three large ethnic-racial groups, namely African-American, white and Hispanic, the sharpest decline was registered among Hispanic women: 26 percent in rural areas, 29 percent in suburban areas and finally 30 percent in urban areas.
 Despite this, the birth rate among Hispanic women remains higher than the other two large ethnic-racial groups, particularly when compared to white women. In 2017, the total fertility rate among Hispanics in rural areas was in fact 2,320.5 births per thousand women, or almost 1.5 times higher than white women in urban areas, which was recorded at a rate of 1,575.5 children for every 1,000 women. 

This difference was even clearer, when, in 2007, the TFT among Hispanics in rural areas was 3,126.5 births per 1,000 women. In the same year in urban areas, the fertility rate was 1,820.5 births per 1,000 white women.

Average age of first-time mothers


The average age of women at the birth of their first child is increasing. In the period from 2007 to 2017, the average age at which women have their first child increased by 1.3 years in rural areas, 1.5 years in suburban areas, and almost two years, that is, 1.8 years, in urban areas.
The youngest mothers at the time of their first child are those of rural areas. In 2017 they gave birth to their first child at an average age of 24.5 years (23.2 years in 2007). In suburban areas the average age of first birth was 25.8 years in 2017 (24.3 in 2007) and in urban areas 27.7 years (25.9 in 2007). The highest age of first time mothers is found among white women in urban areas; in 2017 it was 29 years (27.5 years in 2007).


Again with regard to the average age at first birth, the largest increase was recorded among African-American women. In 2007-2017, their average age rose by 1.7 years in rural areas, 1.9 years in suburban areas and 2.4 years in urban areas. At the same time, African-Americans had the youngest mean age at first birth in rural areas: in 2017 they had their first child at 22.7 years (21 years in 2007).

Congenital syphilis on the rise


The number of children born with congenital or neonatal syphilis is also on the rise in the United States. In fact, in the last four years, the rate has more than doubled. This was reported by the Sexually Transmitted Disease Surveillance Report, published September 25 by the CDC. (Here is a link to the report on STDs in Women and Infants).


According to the report, the increase in cases of congenital syphilis usually follows the trend of primary and secondary syphilis infections (P&S) in adults and in particular in women of reproductive age (15-44 years). In the latter category, the rate of syphilis P&S has grown in the period 2013-2017 by 142.8 percent, from 2.1 to 5.1 cases per 100,000 women of childbearing age.
In 2017, 918 cases of congenital syphilis were recorded throughout the United States, a number corresponding to a national rate of 23.3 cases per 100,000 live births. This is an increase of 43.8 percent compared to 2016 and 153.3 percent compared to 2013, when there were 362 cases. Across the United States the rate of congenital syphilis rose by 60.3 percent in the South, by 40.7 percent in the West, and 5.7 percent in both the North-East and the Midwest. There have been cases reported in 37 of the 50 States.

Serious consequences


You can cure syphilis with antibiotics, but if it is left untreated, the possibility that the mother can pass the infection on to the child through the placenta increases by 80 percent.

“To protect every child, we have to start protecting every mother,” said the director of the CDC Division of STD Prevention, Gail Bolan, in a press release.


Syphilis — a sexually transmitted disease caused by the bacterium Treponema pallidum — can have serious consequences for the development and health of the unborn child. The pathology can lead to miscarriages, to premature births, or to the death of the fetus and neonatal death. As Bolan points out (link), in 2017, 64 stillbirths from congenital syphilis were reported, which means means 23 cases more than in 2016 (41). The late form of congenital syphilis can also lead to blindness, for example.


One of the problems in the fight against this disease is the fact that many women do not have access to health care. According to data from the Census Bureau, almost 9 percent of the population has no health insurance coverage, as Maggie Fox recalls on NBC News, which also cites the CEO of the Association of State and Territorial Health Officials, Michael Fraser. The CEO said: “With cuts in public health budgets, it is not surprising that rates are rising.”