Total U.S. Births, 1990-2017* Source: Annual NCHS Reports on Births U.S. Births have dropped substantially since 2007, though there was a slight increase between 2013-2014. This corresponded initially to the recession. What’s most notable at this point is that as the economy has recovered the number of births haven’t gone back up. This is largely the result of a major drop in the birth rate among Hispanics. Source: Annual NCHS Reports on Births *2017 data is preliminary BirthByTheNumbers.org

Fears of a “Majority/Minority” of births are unfounded…for now Proportion of all U.S. Births, 1989-2016* Non-Hispanic white births accounted for about two out of every three (66%) births in 1990. This was followed by a steady decline in the proportion of all births to whites. By 2000 they accounted for 59% of all U.S. births and by 2010 54%. The decline was driven primarily by a rapid growth in births to Hispanic mothers which, by 2007 had reached almost a quarter (24.6%) of all births. However the recent decline in the Hispanic birth rate has led to a slight decline in that proportion. The proportion of all births to non-Hispanic blacks has remained relatively steady across the last quarter century. Source: Adapted from NCHS Annual Birth Reports *2016 data is preliminary www.BirthByTheNumbers.org

US Cesarean Rates, 1989-2016* % 31.9% www.BirthByTheNumbers.org There were 3,977,745 births in the US in 2015. If the 1996 rate of 20.7% had been maintained, there would have been 823,393 cesareans or about 450,000 fewer than the 1,272,878 cesareans that were recorded in the US in 2015. That’s what would happen if we’d just stayed at 1996 levels. In 2010 for the first time in 13 years, the US cesarean rate decreased slightly (from 32.9% to 32.8%)and by 2015 it would drop to an even 32%. Between 2014 and 2015, 33 states experienced a decline, led by Montana (1.7 percentage point decline), District of Columbia (1.0 percentage points) and Michigan, New Jersey and Louisiana (0.8 percentage points each). 16 states saw and increase, led by Hawaii (1.3 percentage point increase). Source: NCHS Annual Birth Reports *2016 data preliminary www.BirthByTheNumbers.org

Total cesarean rates by race/ethnicity, U.S. 1989-2016* 1989 WNH +1.4percentage points 2016 BNH +5.0 percentage points This slide breaks down cesarean rates by race/ethnicity into the three major groups reported on by NCHS (data on births to Asian Mothers is not readily available nationally though it is in many states). It undermines the myth that the rising cesarean rate was driven by white mothers, perhaps demanding scheduled cesareans. Actually there’s a more interesting pattern with the decline in cesarean rates in the early 1990s happening only among white non-Hispanic and Hispanic mothers. Rates for black non-Hispanic mothers were essentially unchanged from 1990-1997. When rates began to rise in the mid 1990s, they rose slightly faster among black mothers than the other groups. The result is that over the 20 year period documented, the US went from white non-Hispanic mothers having a cesarean rate 1.4 percentage points higher than black non-Hispanic mothers to the latter group having a rate 2.6 percentage points higher by 2009 when the overall rate peaked. Since 2009, the cesarean rate has remained essentially unchanged among non-Hispanic black mothers (approximately 35.5%) and Hispanic mothers (31.7%). NOTABLY THE OVERALL DECLINE IN U.S. CESAREAN RATES BETWEEN 2009-2015 WAS DRIVEN BY THE DECREASE AMONG NON-HISPANIC WHITE MOTHERS (32.8% TO 31.1%). The result is that the disparity in the cesarean rate between white and black mothers is now 4.4 percentage points, the largest ever recorded. Source: National Center for Health Statistics Annual Birth Reports *2016 data is preliminary www.BirthByTheNumbers.org