Declining U.S. Fertility and Births Rates: A Shrinking Nation

On April 4, 2024, the National Vital Statistics System (NVSS) of the Centers for Disease Control and Prevention (CDC) released the final “Births” report for 2022 as well as the provisional “Births” report for 2023. ^1,2 Both reports attested to a worrisome trend for maintaining current population levels, that is, a decline in the general fertility rate among women ages 15–44 and thus in the attendant annual number of live births in the United States. ^1,2 As such, these data are compatible with the reality that the birth rate of the United States witnessed a sharp decline on the order of 22% between 2007 and 2022. ^1,2 Just as notably, none of the constituent U.S. states reported an increase in the recorded state-specific birth rate. ^1,2 Viewed globally, however, the U.S. data hardly constitute an outlier in that similar decrements in the national birth rate (below the replacement rate) were noted and reported for other developed nations across the globe. ^{1 –3} Stated differently, the inability to sustain, let alone grow the national population—a “low fertility future”—has evolved to constitute a global reality. ³ In this commentary, we consider the number of live births and the general fertility rate per 1,000 U.S. women ages 15–44 over the 2022–2023 interval and discuss the implications thereof.

Calendar year 2022 was associated with a total of 3,667,758 registered U.S. births. ¹ A comparable number of births (n = 3,664,292) was recorded for calendar year 2021. ¹ In so doing, calendar years 2021 and 2022 capped a sustained decline in the national birth rate (births per 1,000 population), which dates back to 2007. ¹ Viewed across time, the annual number of U.S. births declined by an average of 2% per year from 2007 to 2013 and by an average of 1% per year from 2014 to 2019. ¹ The general fertility rate (births per 1,000 women ages 15–44), for its part, declined from 64.1 in 2010 to 56.0 in 2022. ¹ Most notably, the total fertility and birth rates of the United States remained below replacement, that is, “the level at which a given generation can exactly replace itself.” ¹ It is also of note that the total fertility rate for the United States was below replacement “for all race and Hispanic-origin groups in 2022 except for Native Hawaiian and Other Pacific Islander women.” ¹ It is a direct consequence of the aforementioned realities that the lion’s share of U.S. states and counties has seen the incidence of deaths routinely outpace the eventuality of births. ¹

Though provisional, the data released by the NVSS of the CDC for calendar year 2023 are highly instructive as well. ² Notably, the provisional number of U.S. births in 2023 (n = 3,591,328) represented a 2% reduction relative to the 2022 birth complement. ^1,2 Broken down by ethnicity, the number of U.S. births declined by as much as 5% for American Indian and Alaska Native women, 4% for Black women, 3% for White women, and 2% for Asian women. ² In contrast, U.S. birth rates rose by 1% for Hispanic women but remained essentially unchanged for Native Hawaiian or Other Pacific Islander women. ² The provisional general fertility rate for the United States in 2023 was determined to be 54.4 births per 1,000 females ages 15–44, a historic low that represents a decrease of 3% relative to its 2022 counterpart. ^1,2 Note is also made of the fact that the general fertility rate for the United States decreased consistently by 2% per year from 2014 to 2020. ² The provisional 2023 birth rate for teenagers was “13.2 births per 1,000 females ages 15–19, down 3% from 2022 (13.6) and another record low for this age group.” ²

Why is declining fertility a problem? After all, our world and this country had many fewer people in the last century. It is important to distinguish questions regarding the size of the population with questions about decline in fertility—it is the latter, the transition, that spells trouble ahead. The most evident problems have to do with how low fertility interacts with the graying of our population. Importantly, there are short- and long-term effects pushing in different directions. For states, lower fertility rates mean short-term savings for expenditures on education and children’s health care needs. ³ But extrapolated out to the longer term, lower fertility means a smaller working age population and thus smaller income tax revenue to support an aging population, especially when combined with earlier retirement trends. ³ Even states that depend more heavily on sales tax revenue as opposed to income tax revenue will face challenges, although more moderate in severity. ³ On the flipside, as a larger proportion of the population becomes elderly, more governmental and private spending is required to meet their health care needs. Furthermore, until very recently, the U.S. population has been living longer and longer. Increased longevity was often celebrated as good news, but in combination with low fertility, it leads to a further mismatch between spending and revenues.

Broadly speaking, there are two large categories of policy changes that can be pursued to increase our fertility rates. They are not mutually exclusive. The first is to increase immigration since fertility rates tend to be higher among immigrant populations. ⁴ Unfortunately, as the last several years have shown us, immigration reform has stalled and the current political climate may be particularly hostile to reform that would increase the number of immigrants with the aim of improving our fertility rates. The second possible route is to design social programs to make having families more attractive and more possible. Congress could counter some of the barriers faced by those considering procreating such as housing costs, enhanced parental leave, providing support for accessing reproductive technologies, more investment against maternal mortality, and free childcare to name a few benefits. It has yet to do so, and even in countries where such efforts have received more governmental support altering fertility rates, it has proven a hard row to hoe.

Viewed broadly, fertility rates are projected to decline worldwide going forward. ⁴ Highly constrained total global fertility rates of 1.83 and 1.59 are also projected for 2050 and 2100 by the aforementioned Global Burden of Disease (GBD) study. ⁴ The number of countries and territories with fertility rates remaining above replacement (i.e., capable of sustaining population size) is forecast to be 49 (24.0%) in 2050 and only 6 (2.9%) in 2100. ⁴ As made plain by the GBD study, the aforementioned alterations stand to have “far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries” replete with an increasing share of livebirths in the poorest regions of a world appropriately deemed “demographically divided.” ⁴

Declining human fertility in the United States has been underway for close to 50 years during which the natural “replacement rate” of offspring per female fell below the critical 2.1 minimum. ⁵ It is the projection of the GBD model that the U.S. fertility rate will decline to 1.53 in 2100. ^4,5 Notably, however, the aforementioned realities are hardly U.S. specific. The populations of 34 nations (including China) are projected to decline by 25–50%. ⁵ Moreover, the populations of 23 other nations including Japan, Thailand, Spain, and Ukraine are predicted to decline by ≥50%. ⁵ Faced with the aforementioned odds and an ever-growing reliance on immigration, it is high time for Congress as well as for the Executive Branch to implement sweeping nation-wide measures to enable all people in the United States to have and support a family. Failing to do so will all but accelerate the inevitable.