In recent decades, the U.S. has experienced a decline in birth and fertility rates. Since 1990, the total fertility rate (TFR) has dropped from the replacement level of approximately 2.1 to 1.62 births per woman in 2023. Like other developed nations’ fertility patterns, this trend has spurred debate regarding the causes of the decline and its challenges for American society and economy. This National Vital Statistics Report examines how fertility trends at different ages have contributed to the decline in birth numbers, TFRs, and general fertility rates (GFRs).
In this study, data were collected from the National Center for Health Statistics’ National Vital Statistics System birth data files between 1990 and 2023. This report analyzes U.S. birth trends, including total births, maternal age distribution, GFRs, age-specific birth rates, and TFRs. TFRs represent the average number of children a woman would have if current age-specific birth rates remained constant. Adjusted rates and totals were calculated by applying the 1990 rates for each maternal age group to all following years.
The study results showed that the actual number of births in the U.S. decreased by 14% from 1990 (4,158,212) to 2023 (3,596,017). Births to females aged <20 years dropped by 73% from 1990 to 2023. The largest decline among all age groups resulted in 390,740 fewer births. Females aged 20-24 years had 476,760 fewer births (declined 44%) in 2023 compared to 1990. Meanwhile, those aged 25-29 had 290,541 fewer births (a decline of 23%). Women aged ≥30 years had experienced an increase in birth rates. Females aged 30-34 showed a 24% increase (211,989) in the number of births in 2023 compared to 1990. While those aged 35-39 showed a 90% increase (287,048), and those aged ≥40 years showed a 193% increase (96,809) in 2023 compared to 1990.
Between 1990 and 2023, GFR decreased by 23%, and TFR decreased by 22%. Women aged 30 years had more adjusted GFRs, births, and TFRs in 2023. If 1990 birth rates had remained constant, females aged 30 had greater adjusted GFRs, TFRs, and total births in 2023, which would have been lower than actual figures due to rising birth rates. Additionally, in 2023, the adjusted TFRs for women under 20, 20-24, and 25-29 were 1.86, 1.91, and 1.77, respectively. These were 9% to 18% higher than the actual 2023 TFR of 1.62.
Birth rates among women under 30 declined sharply, resulting in an overall decline in fertility rates. Overall, with changes in age-specific birth rates, the GFR reduced from 70.9 to 54.5 (1990 to 2023), with a 23% decline.
This report concluded that declining fertility rates over the past few decades were due to a combination of smaller rises in birth rates among older women and falling rates among females under 30.
Reference: Driscoll AK, Hamilton BE. Effects of age-specific fertility trends on overall fertility trends: United States, 1990–2023. CDC National Vital
Statistics Reports; Â 2025. 3. https://stacks.cdc.gov/view/cdc/174576
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