BBN-Website-Slides-7..

Report
US Birth Outcomes in a
Comparative Context
Update of Data from Birth By the Numbers.
These slides largely mirror those used in the video, but
add some others of interest and update the originals
with the most recent available data as of
July 1, 2013
Gene Declercq, PhD
NOTE: There is a lag of 2-4 years in the reporting of
vital statistics from the US and abroad
BirthByTheNumbers.org
Key Question
Is the U.S. really doing as
badly as it seems in
international
comparisons?
BirthByTheNumbers.org
BirthByTheNumbers.org
Is the U.S. really doing that badly?
How Do we Compare Outcomes?
Neonatal Mortality Rate
Infant Deaths in
First 28 days
X 1,000
________________
Live
Births
BirthByTheNumbers.org
Outcomes: Comparative Neonatal Mortality Rates
Rank
1
7
13
Country
San Marino (1)
Rank
14
Country
Israel
Rank
27
Country
Belarus
Andorra
Monaco
Netherlands
Iceland
Republic of Korea
Greece
Japan
Ireland
Cuba
Singapore
Belgium
Lithuania
Cyprus
Czech Republic
New Zealand
Luxembourg (2)
France
United Kingdom
Slovenia
Sweden
Germany
Italy
Switzerland
Croatia
Finland
Denmark
Malaysia
United States (4)
Estonia
Norway
24
Portugal
26
Source: State of the World’s Children2013.
http://www.unicef.org/sowc2013/statistics.html
Austria (3)
Spain
Australia
37
Canada, Hungary, U.A.E.
Poland, Qatar, Serbia
BirthByTheNumbers.org
TWO PROBLEMS
Outcomes: Comparative(1)Neonatal
Comparisons Mortality
– Five countriesRates
Rank
1
Country
San Marino (1)
Rank
14
Andorra
7
13
highlighted had fewer combined births
Country than the state
Rank Country
of Alaska
– Is neonatal mortality the
Israel (2) MeasurementBelarus
best measure to use?
Monaco
Netherlands
Iceland
Republic of Korea
Greece
Japan
Ireland
Cuba
Singapore
Belgium
Lithuania
Cyprus
Czech Republic
New Zealand
Luxembourg (2)
France
United Kingdom
Slovenia
Sweden
Germany
Italy
Switzerland
Croatia
Finland
Denmark
Malaysia
United States (4)
Estonia
Norway
24
Portugal
26
Source: State of the World’s Children2013.
http://www.unicef.org/sowc2013/statistics.html
Austria (3)
Spain
Australia
37
Canada, Hungary, U.A.E.
Poland, Qatar, Serbia
BirthByTheNumbers.org
Outcomes
Five countries in red
background share a
particular characteristic
– almost no one actually
lives there. Total Births
in these countries in
2012 were 11,429 or
fewer than the 11,450 in
Alaska in 2011
Country
Andorra
2012
Births
757
Iceland
4,146
Luxembourg
6,034
San Marino
285
Monaco
207
TOTAL
11,429
BirthByTheNumbers.org
What’s a Fair Comparison with
the US?
In the most recent year available (2010):
• Countries with at least 100,000 births
• Countries with a total per capita annual
expenditure on health of at least $1,500 in
US dollars.
BirthByTheNumbers.org
Defining a Set of Countries to Compare with the U.S.
17 Comparison Countries
(SOURCE: OECD, Health Data 2012
& State of World’s Children)
2010
Total Births
(000)
2010
Total exp. health –
PC, US$ PPP
2010-11
% Births by
Cesarean
Australia
307
3,670
31.2
Belgium
123
3,969
19.9
Canada
388
4,445
26.1
Czech Republic
116
1,884
23.3
France
792
3,974
20.2
Germany
699
4,338
30.8
Greece
117
2,914
NA
Hungary
100
1,601
33.4
Italy
557
2,964
37.7
Japan
1,073
3,035
18.0
Korea
478
2,035
34.6
Netherlands
181
5,056
15.6
97
2,728
33.0
Spain
499
3,076
24.9
Sweden
113
3,758
16.2
United Kingdom
761
3,433
24.1
3,954
7,990
32.8
Portugal
United States
BirthByTheNumbers.org
IOM chose 16 peer
countries. 13 are same
as the one’s we’ve used.
They use 3 countries
(Denmark, Finland,
Switzerland) that have
100,000 births. We
include Belgium, Czech
Republic, Greece and
Hungary
BirthByTheNumbers.org
How is the U.S. doing relative to
comparison countries?
Neonatal Mortality Perinatal Mortality
Rate
Rate
Infant Deaths in
First 27 days
X 1,000
_____________
Live
Births
Fetal deaths + deaths in
the first week
X 1,000
_______________
Live births + fetal
deaths
BirthByTheNumbers.org
Neonatal Mortality Rates (per 1,000 births), 2010,
Industrialized Countries with 100,000+ Births
4.2
Uni ted States
Canada
3.8
3.4
U.S. Whi te
Uni ted Kingdom
3.2
3
Australia
2.8
Net herlands
France
2.6
2.5
2.5
2.4
2.3
2.3
Portugal
Bel gium
Kor ea
Italy
Ger many
Spai n
2.1
2
Greece
Sweden
1.6
1.6
Czech Republ ic
Japan
1.2
0
1
2
Source: OECD Health Data 2013 and NCHS, Deaths Final Data for 2007.
3
4
5
BirthByTheNumbers.org
Perinatal Mortality Rates (per 1,000 births),
2010, Industrialized Countries 100,000+ Births
France
United Kingdom
Hungary
United States*
Canada#
Belgium#
Netherlands
Germany
Greece
Sweden
Italy#
Spain
Australia*
Portugal
Czech Republic
Korea
Japan
12.1
7.3
6.9
6.6
6.2
6.0
5.6
5.4
5.0
4.8
4.4
*2005;
#2008
3.8
3.6
3.5
3.4
3.3
2.9
0
2
4
6
8
10
12
14
BirthByTheNumbers.org
Maternal Mortality Ratios
Maternal Mortality Ratio
Maternal Deaths all causes
X 100,000
_______________
Live births
Maternal Mortality Rates, (per 100,000 births), 2010,
Industrialized Countries with 200,000+ births
14.7
Korea*
12.7
United States**
10.5
US WNH**
9
Canada#
7.7
France#
5.5
Germany
5
United Kingdom
4.2
4.1
Japan
Spain
3.4
Italy*
U.S. 2007:
Black non-Hispanic
White non-Hispanic
Hispanic
28.4
10.5
8.9
*2009; #2008;
**2007
2.4
Australia*
2
Maternal Mortality Rate
Sources: OECD Health Data 2013; NCHS. 2009. Deaths, Final Data, 2007.
15
Other countries do better because
the U.S. is different:
-- more diversity,
-- weaker social support system,
-- inequality in our health care
system.
What if we compared subgroups
in the U.S. to other countries?
BirthByTheNumbers.org
US Subgroups in Comparative Context
with other Industrialized Countries
US Subgroup
All
U.S. IMR
2009
6.4
Rank
(17 - 100K)
17
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics
from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD:
NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
US Subgroups in Comparative Context
with other Industrialized Countries
US Subgroup
U.S. IMR
2009
Rank
(17 - 100K)
All
6.4
17
White Non-Hispanic
5.3
17
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics
from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD:
NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
US Subgroups in Comparative Context
with other Industrialized Countries
US Subgroup
U.S. IMR
2009
Rank
(17- 100K)
All
6.4
17
White Non-Hispanic
5.3
17
White NH, Native Born
5.4
17
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics
from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD:
NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
US Subgroups in Comparative Context
with other Industrialized Countries
US Subgroup
U.S. IMR
2009
Rank
(17- 100K)
All
6.4
17
White Non-Hispanic
5.3
17
White NH, Native Born
5.4
17
White NH, Singleton Birth
4.6
15
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics
from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD:
NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
US Subgroups in Comparative Context
with other Industrialized Countries
US Subgroup
U.S. IMR
2009
Rank
(17- 100K)
All
6.4
17
White Non-Hispanic
5.3
17
White NH, Native Born
5.4
17
White NH, Singleton Birth
4.6
15
White NH, 30-34 yrs old
4.1
13
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics
from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD:
NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
US Subgroups in Comparative Context
with other Industrialized Countries
US Subgroup
U.S. IMR
2009
Rank
(17- 100K)
All
6.4
17
White Non-Hispanic
5.3
17
White NH, Native Born
5.4
17
White NH, Singleton Birth
4.6
15
White NH, 30-34 yrs old
4.1
13
White NH, 37-41 weeks
2.3
1
Source: U.S. subgroups: Mathews & M. MacDorman. 1/24/13. Infant mortality statistics
from the 2009 period linked birth/infant death data set. NVSR v. 61 (8).Hyattsville, MD:
NCHS, Table 2. *Other IMRs from OECD Health Data 2013.
Examining Trends over Time
U.S.
5
13% decrease
4.6
4
4.2
3
3.1
2
Industrialized
Countries
26% decrease
2.2
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
Rate per 1,000 live births
Neonatal Mortality Rate (per 1,000 births), 20002011, U.S., & Ave. for Industrialized Countries*
* Countries with 100,000+ births (2011): Australia, Belgium, Canada, Czech Republic, France, Germany,
Greece, Hungary, Italy, Japan, Netherlands, Portugal, S. Korea, Spain, Sweden, U.K.
Source:
OECD Health
Data,
2013 Data,
& MacDorman
Source:
OECD
Health
2013MF, et al. Recent declines in infant mortality in the
United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: NCHS. 2013.
Rate per 1,000 live births
Neonatal Mortality Rate (per 1,000 births), 20002011, U.S., & Ave. for Industrialized Countries*
U.S.
5
4.6
4
4.1
3
3.1
2.3
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
2 neonatal mortality rate
If the U,S.
equaled the current average rate of the
other countries in 2011, that would
mean almost 6,955 fewer deaths to
babies 28 days or younger annually.
* Countries with 100,000+ births (2009): Australia, Belgium, Canada, Czech Republic, France, Germany,
Greece, Hungary, Italy, Japan, Netherlands, Portugal, Spain, S. Korea, Sweden, U.K.
Source: OECD Health Data, 2013 & MacDorman MF, et al. Recent declines in infant mortality in the
United States, 2005–2011. NCHS data brief, no 120. Hyattsville, MD: NCHS. 2013.
Perinatal Mortality Rates, 2000-2010 ,
U.S., & Ave. for Industrialized Countries*
7
6.5
U.S.
6%
decrease
6
5.5
Industrialized
Countries
21% decrease
5
4.5
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
* Countries with 100,000+ births (2006): Australia, Belgium, Canada, Czech Republic, France, Germany, Greece, Hungary,
Italy, Japan, Netherlands, Portugal, S. Korea, Spain, Sweden, United Kingdom
BirthByTheNumbers.org
Deaths per 100,000 live births
Maternal Mortality Ratios (per 100,000
births), 2000-2009, U.S. & Ave.
Industrialized Countries*
16
Case
Ascertainment??
U.S.
30%
Increase
12
Industrialized
Countries
3 % Decrease
8
4
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
* Countries with 200,000+ births (2009): Australia, Canada, France, Germany, Italy, Japan, S. Korea , Spain, United Kingdom
Sources: OECD Health Data 2013; NCHS. 2010. Deaths, Final Data, 2007.
What about process?
BirthByTheNumbers.org
US Cesarean Rates, 1989-2011
34
32
30
1,296,779
% 28
% 26
24
22
20
'89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11
% Tot US 23 22.7 22.622.3 21.821.2 20.820.720.8 21.222.0 23 24 26 28 29 30 31 32 32 33 33 33
If the 2011 cesarean rate was the same as in 1996, there
would have been 478,000 fewer cesareans in the U.S. in ’11.
Source: National Center for Health Statistics Annual Birth Reports
Primary Cesarean and VBAC Rates,
U.S., 1989-2010
30%
Prim Ces Rate
VBAC
25%
20%
15%
Source: NCHS. Annual Birth Reports & Vital Stats
20
09
20
07
20
05
20
03
19
97
19
95
19
93
19
91
19
89
5%
20
01
Note: 2005-2010
unofficial
19
99
10%
r = -.95
Cesarean Rates in Industrialized
Countries* with 100,000+ Births, 2011
Italy
Korea
Hungar y
*Portugal
United States
*Australia
Germany
*Canada
Spain
United Kingdom
Czech Republic
France
*Belgium
Japan
Sweden
*Nether lands
10%
37.7%
34.6%
33.4%
33.0%
32.8%
31.2%
30.8%
26.1%
24.9%
24.1%
23.3%
20.2%
19.9%
18.0%
16.2%
15.6%
*2010
* No data on cesarean rates in Greece
45%
Sources: OECD Health Data 2013; U.S. Natality Data; Japan – sample; Lancet 6736(09)61870-5.
Total cesarean rates by
race/ethnicity, U.S. 1989-2011
WNH
BNH
Hisp
Source: National Center for Health Statistics Annual Birth Reports
20
11
20
09
20
07
20
05
20
03
20
01
19
99
2011 BNH
+3.1 percentage
points
19
97
19
95
19
93
1989 WNH
+1.4percentage
points
19
91
19
89
36
34
32
30
28
26
24
22
20
18
Total Cesarean Rates (per 100 births) by Age
of Mother: United States, 1996 and 2011
Overall increase,
1996-2010: 58.5%
60
1996
50
2011
49.2
Percent
42.2
40
35.9
31.5
28.0
30
10
14.5
27.4
23.8
22.4
20
31.6
20.6
17.4
54%
61%
53%
51%
54%
56%
%
<20
20-24
25-29
30-34
35-39
40-54
0
Source: National vital statistics system, NCHS, CDC.
BirthByTheNumbers.org
VBAC Rates*, U.S.,1990-2010
30%
25%
20%
NOTE: Rates
for 2005-2010
are unofficial
15%
10%
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
5%
* Number of VBACs among women with prior cesarean
Source: NCHS Vital Stats. http://www.cdc.gov/nchs/VitalStats.htm
VBAC Rates, Selected Countries, 2004
U.S.
Latvia
Lithuania
Canada
Estonia
Malta
Slovenia
Spain-Valencia
Scotland
Belg-Flanders
France
Denmark
Czech Rep
Germany
Sweden
Finland
Norway
Netherlands
VBACs
8
9
19
20
24
25
25
25
27
32
35
39
41
41
0 from Peristats,
10
20 & Canadian
30 Data 40
Source: Adapted
US
45
51
51
55
50
60
Do High Rates of
Intervention Matter?
1. Outcomes (NMR & GA)
2. Costs
BirthByTheNumbers.org
Gestational Age, U.S. All Births, 1990, 2011
30%
1990
2011
25%
20%
15%
10%
5%
0%
<32
32-33
34-36
37-38
39
40
41
42+
* Only births occurring at home.
Source: Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, and Mathews TJ. Births: Final data for 2011.
National vital statistics reports; vol 62 no 1. Hyattsville, MD: National Center for Health Statistics. 2013.
Cesarean Rates and
Neonatal Mortality
Low Income
Medium Income
High Income
Source: Althabe F.Cesarean Section Rates and Maternal & Neonatal Mortality Birth.2006;33:270
Percent of singleton preterm (<37 weeks)
births by method of delivery, United States,
1991-2006
12
10
11.0%
9.7%
Cesarean no
induction
Percent
8
6
Cesarean after
induction
attempt
6.7%
5.7%
Induced
vaginal
4
Spontaneous
vaginal
2
0
1991
1996
2001
2006
Note: Births with method of delivery and induction of labor not stated are excluded.
Source: MacDorman et al. AJPH, 2011.
National Costs and
Hospitalizations
LEADING MAJOR DIAGNOSTIC CATEGORIES by
NUMBER OF HOSPITAL DISCHARGES, U.S., 2009
Diseases of The Circulatory System
5,801,081
Pregnancy, Childbirth
4,591.515
Newborns & Other Neonates
4,300,390
Respiratory System
3,964,889
Digestive System
3,429,592
Musculoskeletal System
3,370,140
Nervous System
2,210,056
Kidney & Urinary Tract
1,621,592
Mental Diseases & Disorders
1,490,050
,00
0
7,0
00
,00
0
6,0
00
,00
0
5,0
00
,00
0
4,0
00
,00
0
3,0
00
,00
0
2,0
00
,00
0
1,274,786
1,0
00
0
Endocrine, Nutritional & Metabolic
AHRQ. 2011. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD: AHRQ. http://hcupnet.ahrq.gov.
Accessed 7/16/2011.
MEDIAN FACILITY LABOR & BIRTH CHARGES
BY SITE & MODE OF BIRTH, U.S., 2010
NOTE: Hospital charges; no physician costs
$18,000
Charge in 2010
$17,688
Increase in Charge in 2000-2010
$14,938
Charge in 2000
$10,234
$8,962
$7,519
$8,570
$5,231
$4,489
$7,419
$4,081
$8,726
$5,003
$0
Hospital Vaginal
no Complications
Hospital Vaginal Hospital Cesarean Hospital Cesarean
Complications No Complications Complications
Sources: AHRQ. 2010. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD:
AHRQ. http://hcupnet.ahrq.gov. Accessed 4/12/13;
Estimated Total Charges, Hospital
Birth, U.S., 1993-2010 (000,000)
Vag no Compl.
Vag w Compl.
Ces no Compl.
Ces w/ Compl.
60,000
50,000
40,000
$ 51,031
30,000
$ 14,039
20,000
10,000
20
09
20
07
20
05
20
03
20
01
19
99
19
97
19
95
19
93
0
Sources: AHRQ. 2009. HCUPnet, Healthcare Cost & Utilization Project. Rockville, MD:
AHRQ. http://hcupnet.ahrq.gov. Accessed 4/16/13.
Have maternal request
cesareans played a
major role in these
increases?
BirthByTheNumbers.org
Asking Mothers
about
Maternal Request
Cesareans
http://www.childbirth
connection.org
Two Components to Maternal
Request Primary Cesarean
1. Mother made request for planned
cesarean before labor
BirthByTheNumbers.org
Two Components to Maternal
Request Primary Cesarean
1. Mother made request for planned
cesarean before labor
2. Cesarean for no medical reason
BirthByTheNumbers.org
Patient Choice Primary Cesareans
• Combining reason for cesarean and timing of
decision found only about 1% of respondents
had a planned primary cesarean for no
medical reason.
“I think that [cesarean] is… the best way … to give
birth. It is a planned way, no hassle, no pain, the baby
doesn’t struggle to come out, the baby is not pressed
to come out …I think that … everybody should have
the baby by cesarean section.” (quote from LtM2)
Studies from England and Canada confirm very
low rates of maternal request cesareans
BirthByTheNumbers.org
Pressure to Accept Interventions by Method
of Delivery
Did you feel pressure from any health
professional to have a cesarean? % yes
Repeat
Cesarean
22%
Primary
Cesarean
28%
VBAC
28%
Vaginal
7%
0%
5%
10%
15%
20%
Source: Declercq et al. 2013. Listening to Mothers III.
25%
30%
BirthByTheNumbers.org
Have maternal request
cesareans played a major
role in these increases?
NO!
So what is the reason for the
increasing cesarean rate?
BirthByTheNumbers.org
Have maternal request
cesareans played a major
role in these increases?
NO!
So what is the reason for the
increasing cesarean rate?
Practice Changes
BirthByTheNumbers.org
Cesarean Rates, Low Risk*, First-Time Mothers
for Medical Risk Factors & Labor Complications
Diabetes
Eclampsia
PregAss Hypertension
Chronic Hypertension
Prolonged Labor
Birthweight > 4000g
50
45
40
35
30
1991
*Singleton, Vertex, Full Gestation Births
1996
2009
Revisiting the trend in cesareans
in the US for comparison
34
32
1,296,779
% 30
28
%
26
24
22
20
'89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11
% Tot US 23 22.7 22.622.3 21.821.2 20.820.720.8 21.222.0 23 24 26 28 29 30 31 32 32 33 33 33
BirthByTheNumbers.org
Source: National Center for Health Statistics Annual Birth Reports
Cesarean Rates, Low Risk*, First-Time Mothers
for Medical Risk Factors & Labor Complications
Diabetes
Eclampsia
PregAss Hypertension
Chronic Hypertension
Prolonged Labor
Birthweight > 4000g
50
45
40
35
30
1991
*Singleton, Vertex, Full Gestation Births
1996
2009
BirthByTheNumbers.org
Cesarean Rates, Low Risk*, First-Time Mothers
for Medical Risk Factors & Labor Complications
Diabetes
Eclampsia
PregAss Hypertension
Chronic Hypertension
Birthweight > 4000g
50
45
40
35
30
1991
1996
2009
Source: CDC Vital Stats. http://www.cdc.gov/nchs/VitalStats.htm
*Singleton, Vertex, Full Gestation Births
BirthByTheNumbers.org
Women have not changed nearly
as much as practice patterns have
BirthByTheNumbers.org
Other Cool Slides that Might
be Useful in Class
BirthByTheNumbers.org
Cascade of intervention in
first-time mothers who
experienced labor
First-time mothers who experienced labor
Base: first-time mothers with
full term births who
experienced labor n=821
Induction No
53%
Induction Yes
47%
Epidural No
39%
Epidural Yes
61%
Epidural No
22%
Epidural Yes
78%
Cesarean
Yes
5%
Cesarean
Yes
20%
Cesarean
Yes
19%
Cesarean
Yes
31%
Note: in this group, which included 93% of first-time mothers, the overall epidural rate was 71% and overall
cesarean rate was 19%
BirthByTheNumbers.org
Inductions in Vaginal Births, U.S.,
1990-2010
30%
25%
20%
15%
10%
20
10
20
08
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
5%
Source: Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats.
http://www.cdc.gov/nchs/vitalstats.htm.
BirthByTheNumbers.org
BirthByTheNumbers.org
Total U.S. Births, 1990-2011
4,400,000
4,300,000
4,200,000
4,316,233
Net Decrease 2007-2011
362,640 or 8.4%
4,100,000
4,000,000
3,900,000
3,953,593
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
3,800,000
BirthByTheNumbers.org
U.S. Fertility Rates (per 1,000) by
Race/Ethnicity, 1989-2011
All
WNH
BNH
Hisp
110
100
90
80
70
60
Fertility rates computed by relating total births, regardless of age of
mother, to women 15-44 years.
20
11
20
09
20
07
20
05
20
03
20
01
19
99
19
97
19
95
19
93
19
91
19
89
50
BirthByTheNumbers.org
Proportion of Births to Older Mothers, U.S.
1990-2011
45%
40%
>30
35%
30%
25%
20%
NOTE: Since 2003
Cesarean Rate
Increased by 20%
15%
10%
5%
> 35
> 35
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
0%
BirthByTheNumbers.org
Are Babies Getting Bigger?
% Singleton Babies by Birthweight, U. S.,
1991-2010
3500-3999gms
4000+gms
50%
41%
40%
41%
39%
36%
35%
28%
27%
30%
30%
30%
29%
20%
10%
11%
11%
10%
8%
8%
1991
1996
2001
2006
2010
0%
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Rates of Multiple Births (proportion of all babies
in multiple births), U.S., 1980-2011
4.0%
3.5%
3.0%
2.5%
2.0%
20
10
20
08
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
1.5%
BirthByTheNumbers.org
Percentage of Live Births Attended by
Certified Nurse Midwive’s, U.S. 1989 - 2011
10%
8%
6%
4%
2%
'89
'90
'91
'92
'93
'94
'95
''96 '97
'98
'99
'00
'01
'02
'03
'04
'05
'06
'07
'08
'09
'10
'11
All 3.3% 3.6% 4.1% 4.6% 4.9% 5.2% 5.6% 6.2% 6.7% 7.1% 7.3% 7.3% 7.6% 7.7% 7.6% 7.5% 7.4% 7.4% 7.3% 7.5% 7.6% 7.8% 7.8%
Source: National Center for Health Statistics, Final Data Births, annual reports,1989-2011
For more information and
additional resources regularly
check:
BirthByTheNumbers.org
The site is updated as additional
data becomes available.
BirthByTheNumbers.org

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