U.S. births fell last year, resuming a long national slide.
A little under 3.6 million babies were born in 2023, according to provisional statistics released Thursday by the Centers for Disease Control and Prevention. That’s about 76,000 fewer than the year before and the lowest one-year tally since 1979.
U.S. births were slipping for more than a decade before COVID-19 hit, then dropped 4% from 2019 to 2020. They ticked up for two straight years after that, an increase experts attributed, in part, to pregnancies that couples had put off amid the pandemic’s early days.
But “the 2023 numbers seem to indicate that bump is over and we’re back to the trends we were in before,” said Nicholas Mark, a University of Wisconsin researcher who studies how social policy and other factors influence health and fertility.
Birth rates have long been falling for teenagers and younger women, but rising for women in their 30s and 40s — a reflection of women pursuing education and careers before trying to start families, experts say. But last year, birth rates fell for all women younger than 40, and were flat for women in their 40s.
Mark called that development surprising and said “there’s some evidence that not just postponement is going on.”
Rates fell across almost all racial and ethnic groups.
The numbers released Thursday are based on more than 99.9% of the birth certificates filed in 2023, but they are provisional and the final birth count can change as they are finalized. For example, the provisional 2022 birth count appeared to show a dip, but ended up being higher than 2021’s tally when the analysis was completed.
There could be an adjustment to the 2023 data, but it won’t be enough to erase the “sizeable” decline seen in the provisional numbers, said the CDC’s Brady Hamilton, the new report’s first author.
Experts have wondered how births might be affected by the June 2022 U.S. Supreme Court decision that allowed states to ban or restrict abortion. Experts estimate that nearly half of pregnancies are unintended, so limits to abortion access could affect the number of births.
The new report indicates that the decision didn’t lead to a national increase in births, but the researchers didn’t analyze birth trends in individual states or dissect data among all demographic groups.
The new data does raise the possibility of an impact on teens. The U.S. teen birth rate has been falling decades, but the decline has been less dramatic in recent years, and the drop seems to have stopped for teen girls ages 15 to 17.
“That could be Dobbs,” said Dr. John Santelli, a Columbia University professor of population and family health and pediatrics. Or it could be related to changes in sex education or access to contraception, he added.
Whatever the case, the flattening of birth rates for high school students is worrisome and indicates that “whatever we’re doing for kids in middle and high school is faltering,” Santelli said.
More findings from the report:
—From 2022 to 2023, the provisional number of births fell 5% for American Indian and Alaska Native women, 4% for Black women, 3% for white women and 2% for Asian American women. Births rose 1% for Hispanic women.
—The percentage of babies born preterm held about steady.
—The cesarean section birth rate rose again, to 32.4% of births. Some experts worry that C-sections are done more often than medically necessary.
—The U.S. was once among only a few developed countries with a fertility rate that ensured each generation had enough children to replace itself — about 2.1 kids per woman. But it’s been sliding, and in 2023 dropped to about 1.6, the lowest rate on record.
Surveys suggest many U.S. couples would prefer to have two or more kids but see housing, job security and the cost of child care as significant obstacles to having more children.
“There’s something getting in the way of them being able to achieve those goals,” Mark said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Vice President Kamala Harris on Monday said the first rule to set minimum staffing levels at federally funded nursing homes and require that a certain portion of the taxpayer dollars they receive go toward wages for care workers is a long-overdue “milestone” that recognizes their value to society.
Harris announced the rules in Washington before she flew to LaCrosse, Wisconsin to meet with nursing home care employees. In the battleground state, the Democratic vice president also held a campaign event focused on abortion rights.
“It is about time that we start to recognize your value and pay you accordingly and give you the structure and support that you deserve,” Harris told a small group of care workers.
The federal government is for the first time requiring nursing homes to have minimum staffing levels after the COVID-19 pandemic exposed grim realities in poorly staffed facilities. The change will mean more staff at these facilities, fewer emergency room visits for residents and peace of mind for caregivers, who will be able to spend more time with their patients, Harris said.
The vice president said that Medicaid, the federal-state health insurance program for lower-income people, pays $125 billion annually to home health care companies, which were not required to report on how they were spending the money. A second rule being finalized Monday will require that 80% of that money be used to pay workers, instead of administrative or overhead costs, Harris said.
“This is about dignity, and it’s about dignity that we as a society owe to those in particular who care for the least of these,” she said.
President Joe Biden first announced his plan to set nursing home staffing levels in his 2022 State of the Union address. Current law only requires that nursing homes have “sufficient” staffing, leaving it up to states for interpretation.
The new rules implement a minimum number of hours that staff members spend with residents. They also require a registered nurse to be available around the clock at federally funded facilities, which are home to about 1.2 million people.
Allies of older adults have sought the regulation for decades, but the rules drew pushback from the nursing home industry.
Mark Parkinson, president of the American Health Care Association, which lobbies for care facilities, said Monday in a statement that the organization was disappointed and troubled that the federal government was moving forward with what he said was an “unfunded mandate.”
“It is unconscionable that the administration is finalizing this rule given our nation’s changing demographics and growing caregiver shortage,” Parkinson said. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers.”
Wisconsin Republicans echoed the staffing concerns, noting shortages particularly in rural parts of the state. In Elroy, Wisconsin, for instance, an 80-bed nursing home would be required to hire six additional nurses, but “we simply don’t have the bodies,” said Wisconsin state Rep. Tony Kurtz.
Noting the added costs and requirements, Republican U.S. Sen. Ron Johnson bluntly insisted to reporters on a conference call that the rule “might sound good. It won’t work.”
Health and Human Services Secretary Xavier Becerra said the change is about setting a standard for quality of care.
“We believe, that with more and more Americans going to nursing homes, it’s time to make sure that quality is the standard that everyone strives for,” Becerra said in an interview.
He said the administration listened to feedback from the nursing home industry and is allowing the rule to be phased in with longer timeframes for nursing homes in rural communities and temporary hardship exemptions in places where it’s hard to find staff.
The care event marked Harris’ third visit to the battleground state this year and is part of Biden’s push to earn the support of union workers in his bid for reelection. Republican presidential challenger Donald Trump made inroads with blue-collar workers in his 2016 victory. Biden regularly calls himself the “most pro-union” president in history and has received endorsements from leading labor groups such as the AFL-CIO, the American Federation of Teachers and the American Federation of State, County and Municipal Employees.
Lisa Gordon, a certified nursing assistant who told Harris, “I’ve been doing this job for 29 years,” said she was grateful that Biden and the vice president were “finally getting something done.”
“I entered this field because I care about taking care of our elderly,” Gordon said during a talk with other care providers, Chiquita Brooks-Lasure, administrator of the Centers for Medicare and Medicaid Services, and April Verrett, secretary-treasurer of the Service Employees International Union.
“Being short-staffed is not taking care of them like they should be,” Gordon said. “They didn’t ask to be there. Your residents are your family. They’re your loved ones. We need these changes.”
The coronavirus pandemic, which claimed more than 167,000 nursing home residents in the U.S., exposed the poor staffing levels at the facilities and led many workers to leave the industry. Advocates for the elderly and disabled reported residents who were neglected, going without meals and water or kept in soiled diapers for too long. Experts said staffing levels are the most important marker for quality of care.
The new rules call for staffing equivalent to 3.48 hours per resident per day, just over half an hour of it coming from registered nurses. The government said that means a facility with 100 residents would need two or three registered nurses and 10 or 11 nurse aides as well as two additional nurse staff per shift to meet the new standards.
The average U.S. nursing home already has overall caregiver staffing of about 3.6 hours per resident per day, including RN staffing just above the half-hour mark, but the government said a majority of the country’s roughly 15,000 nursing homes would have to add staff under the new regulation.
The new thresholds are still lower than those that had long been eyed by advocates after a landmark 2001 study funded by the Centers for Medicare and Medicaid Services recommended an average of 4.1 hours of nursing care per resident daily.
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Associated Press writer Scott Bauer in Madison, Wisconsin, contributed to this report.
President Joe Biden’s administration will help 50 countries identify and respond to infectious diseases, with the goal of preventing pandemics like the COVID-19 outbreak that suddenly halted normal life around the globe in 2020.
U.S. government officials will work with the countries to develop better testing, surveillance, communication and preparedness for such outbreaks in those countries, according to a senior Biden administration official who briefed reporters Monday about the program on the condition of anonymity. The official did not share a list of countries that will participate in the program.
The U.S. program will rely on several government agencies — including the U.S. State Department, the Centers for Disease Control and Prevention, Health and Human Services and the U.S. Agency for International Development, or USAID — to help countries refine their infectious disease response.
Congo is one country where work has already begun, the official told reporters. The U.S. government is helping Congo with its response to an mpox virus outbreak, including with immunizations. Mpox, a virus that’s in the same family as the one that causes smallpox, creates painful skin lesions. Last year, the World Health Organization declared mpox a global emergency, with more than 91,000 cases spanning across 100 countries to date.
The White House on Tuesday is releasing a website with the names of the countries that are participating in the program. Biden officials are seeking to get 100 countries signed onto the program by the end of the year.
The U.S. has devoting billions of dollars to the effort. Biden, a Democrat, is asking for $1.2 billion for global health safety efforts in his yearly budget proposal to Congress.
These monkeys — called “rhesus macaques” — were originally brought to Florida by the manager of a glass-bottom boat operation, who released six on an island in the Silver River to attract tourists.
However, the monkeys swam away from the island into the surrounding forest, breeding and increasing their numbers over the years.
While the population of monkeys in the Silver Springs State Park has reached as high as 400 at some points, trapping and removal efforts have kept them from getting out of hand. As of 2015, the FWC reported that there were around 190 inside the park.
Nowadays, these monkeys can be found throughout the state, though the FWC says that these sightings likely stem from the group of monkeys at Silver Springs.
Aside from environmental concerns, these monkeys pose a threat to public health, as rhesus macaques in Florida have tested positive for herpes B.
The CDC states that this viral infection is extremely rare, but it can lead to severe brain damage or even death. The virus can be transmitted by these monkeys through bites, scratches or contact with bodily fluids.
In addition, these monkeys may become aggressive when fed by people, so the FWC passed a rule in 2017 prohibiting locals from feeding any wild monkeys in the state.
According to the FWC’s rhesus monkey tracker, the following counties have had credible sightings of these monkeys outside of the core population:
The FWC provides these tips for rhesus macaque encounters:
Never approach or offer food to wild monkeysIf a monkey is encountered, keep children close and pets leashedDispose of uneaten food and garbage in closed trash containersIf bitten or scratched by a wild monkey, immediately wash the wound and seek medical attention. Call the National B Virus Resource Center for emergency information at (404) 413-6550.If you observe a wild monkey that poses a threat to people, call the FWC’s Wildlife Alert Hotline at (888) 404-3922Any rhesus macaque observations seen outside of the core population near Silver Springs should be reported by calling the Exotic Species Hotline at (888) 483-4681 or by clicking here
Tucked away inside the teachers lounge at a New Hampshire elementary school, Amber Warner was having her teeth checked out for the first time.
The 5-year-old sat back on what looked like a beach chair and wore a pair of dark sunglasses as certified public health dental hygienist Mary Davis surveyed Amber’s teeth and then with a tiny syringe applied traditional dental sealants, which had the consistency of nail gel.
“Close down and bite your teeth together, bite down like you are biting down on a hot dog or a cheeseburger,” Davis told Amber, to ensure the sealants were done properly. After that, Davis flossed all of the “popcorn and the chicken, pizza between your teeth.” The whole visit took 15 minutes.
“Look at you. You are a pro on your first dental visit. I am so proud of you,” Davis said to the kindergartener, who got up from the chair and was hugged by a teacher’s assistant.
The portable clinic is part of a cavity prevention program developed by NYU College of Dentistry and being rolled out in Concord and two other New Hampshire districts. CariedAway New Hampshire hopes to expand to Maine and Vermont — and eventually nationwide — as part of a growing effort to improve pediatric oral health, especially in children from lower-income families.
There isn’t a good national estimate of dental programs in schools but many larger school districts have them. Boston University’s program operates in 20 schools and 30 preschools in Boston and eight other cities in Massachusetts and covers 3,000 children from 6 months to 21 years. In New York City, 81,000 students across 820 schools — a little over half of all public schools — were treated last school year.
Nationwide Children’s Hospital has seen 1,700 children in central Ohio since 2021 with its roving school-based dental clinics, while Minnesota nonprofit Ready, Set, Smile is in 44 schools in the Twin Cities, serving 2,225 children.
“Dental care typically is looked at as an extra or an add-on,” said Terri Chandler, who is the founder and executive director of Future Smiles in Clark County, Nevada, which includes Las Vegas and serves 7,500 kids in 75 schools. “It is not part of medical care.”
Intermittent dental care, if at all
Nearly half of all U.S. children don’t receive regular dental care, according to a 2022 report from the National Institute of Dental and Craniofacial Research, which is a federal agency.
That can lead to cavities quickly: More than half of children ages 6 to 8 had a cavity in at least one baby tooth and more than half adolescents ages 12 to 19 have a cavity in at least one of the permanent teeth, according to the U.S. Centers for Disease Control and Prevention.
Too many children fail to see a dentist before they enter school — forcing them to go to the hospital to get treatment for a mouthful of cavities, Harvard School of Dental Medicine’s Catherine Hayes said.
“If their parents aren’t getting any kind of oral health education in the physician’s office, these kids develop extensive decay,” she said, noting it can take a month or more to fix. She added: “… It’s completely preventable. We know how to prevent it.”
At Boston Children’s Hospital, there’s a waiting list of eight to nine months for the dental clinic, said Man Wai Ng, the dentist-in-chief. Ng points in part to worsening dental care during the pandemic.
“I have patients who were going to bed without brushing their teeth. They ate and drank at all hours of the day because those normal daily routines weren’t there,” Ng said. “They weren’t able to get in for … preventive dental care. Kids were developing more dental disease without the ability to get timely care.”
Ruth Langwell struggled to find a dentist for her granddaughter Lola, a 10-year-old who has autism. She recently was able to get the girl into the clinic.
“She needs somebody who is very patient, obviously … We’ve tried two other dentist and they have been reluctant because of Lola’s challenges,” said Langwell, who added she wanted Lola to see a dentist at age 2, but didn’t until she was five.
Funding programs to build habits
The challenge for many programs, especially mobile and school-based clinics, is sustainability, said Richard Niederman, a professor of epidemiology and health promotion at NYU Dentistry and founder of CariedAway. That’s because school-based programs like Neiderman’s lean heavily on donations because they often serve low-income populations who are either uninsured or on Medicaid.
Niederman has spent two decades developing his program. Other ones he tried in the Bronx and Boston ended due to a lack of funding, but this time, Niederman has $1 million from Northeast Delta Dental, which ensures his New Hampshire program will remain in place for at least three years.
“It breaks my heart that kids don’t get effective care that they could get … and the system doesn’t support it,” he said.
But the picture for pediatric oral health is improving — even outside of school programs.
Untreated tooth decay in preschool children is down 50% since 2000, according to the federal dental research agency’s report. It pointed to an increased use of sealants, which prevent cavities.
Jane Grover, the senior director of the American Dental Association’s Council on Advocacy for Access and Prevention, said there has been “tremendous growth” of dental programs in community health centers, as well as efforts to deploy dental hygienists in pediatric offices.
Some states are also better coordinating pediatric and dental care. MassHealth, the Medicaid program in Massachusetts, started requiring physicians last year to ensure a child has two fluoride varnish applications and refer them to a dentist, Hayes said.
“I remember my first dental cleaning and and that left a lasting impression,” Grover said. “We want to have children understand that, but we want their families to understand that sugar-sweetened beverages all day on primary teeth where the enamel is a little thinner than it is on adult teeth, it doesn’t take long … to go from a potentially serious situation to a very serious situation.”
Neiderman’s team treated more than 60 students over a week at the Concord school. Among them was softspoken 10-year-old Evette Sesay, who dutifully detailed how she brushes twice a day and flosses.
She wondered aloud whether the treatment would “hurt,” only to be assured by Davis that it shouldn’t — but that she could raise a hand if she felt pain. Evette, who went to the clinic because she “wanted to check” on her teeth, never did.
She said it felt like a typical exam at her dentist’s office: “They cleaned my teeth very well. The bubble gum flavor was good, too.”
The drive to Bristol, Virginia, from Jacksonville, Florida, takes more than eight hours. It’s over 10 from Orlando and closer to 14 from Miami. Despite that distance, Bristol Women’s Health Center is preparing for an influx of women from Florida seeking abortions when a stricter ban kicks in next month.
For many people who otherwise would have obtained abortions in Florida, the clinic in southwest Virginia will become the closest practical option — as it already is for a swath of the South after a Florida policy change expected to resonate far beyond the state’s borders.
“The majority of the patients we do serve are coming from banned states,” said Karolina Ogorek, the clinic’s administrative director. “I think that Florida will just become another one of the states that we serve.”
On Monday, the Florida Supreme Court upheld the state’s ban on abortion after 15 weeks of pregnancy. That step allows another, stricter ban to take effect on May 1, making abortion illegal in the state after six weeks’ gestation — before many women realize they’re pregnant. The ban includes exceptions for pregnancies caused by rape, incest or human trafficking, or that threaten the life or physical health or the woman and for fatal fetal anomalies.
In a separate but closely related ruling, the court also allowed a referendum that will let the state’s voters decide in November whether they want an amendment to the state constitution allowing abortion until viability.
Stephanie Loraine Piñeiro, executive director of the Florida Access Network, which helps pay for abortion care for Florida women, said that the law coupled with a 24-hour waiting period for abortion will be a “total ban” in practical terms.
And getting to a provider elsewhere, she said, will drive the average cost of abortion — including transportation, lodging, meals, child care and clinic fees — to around $4,000, about twice what it is now. That will strain organizations like hers, which already often hits its budget limit well before the end of the month, as they shift to helping people get care elsewhere.
That could strand people who can’t get time off work, afford travel, arrange child care or lack documentation to travel, Piñeiro said.
“The people who are most marginalized are going to cotinine to not have access,” she said.
She said she expects some of the state’s clinics to close for lack of patients.
Currently, the average distance to a facility that provides abortion for Florida residents is 20 miles (32 kilometers), said Caitlin Myers, an economics professor at Middlebury College in Vermont who studies the impact of abortion bans. But when the new ban takes effect, the average distance to one that offers abortion after the first six weeks of pregnancy will be 584 miles (940 kilometers).
And that only gets patients to North Carolina, where two in-person visits are required 72 hours apart to receive an abortion — and only for the first 12 weeks of pregnancy in most cases.
It’s more than 100 miles (160 kilometers) farther to Virginia.
Some areas already have long drives to the nearest abortion providers — eight hours from San Antonio, Texas, to Santa Teresa, New Mexico, for instance, and nine from New Orleans to Carbondale, Illinois, or Houston to Wichita, Kansas. But the geography will make South Florida the most highly populated place in the U.S. that’s farthest from in-person abortion access past the first six weeks.
Georgia and South Carolina, which have bans that begin after about six weeks and Ohio, which had a similar one for a time, have seen in the neighborhood of half as many abortions with those policies in effect. Some people are able to obtain abortion close to home earlier in pregnancy rather than traveling.
It’s not only Florida residents who will be affected by the new ban.
“Florida is a really important state for Southern abortion access, and it has been a state that has experienced a surge in travelers from Georgia and Alabama, Mississippi, Louisiana who are traveling out of those states, avoiding near total or six-week bans to facilities,” Myers said.
Of the 84,000 abortions provided in Florida last year, about 7,700 were for people who live out of state. Now most of those patients will travel farther for access, too.
The total number of abortions in the country has been roughly stable since the U.S. Supreme Court overturned Roe v. Wade and ended a nationwide right to abortion in 2022. But the details have changed.
Far more are provided by pills rather than surgery, with a major increase in prescriptions through telehealth — including to patients in states with bans from providers where laws seek to protect such prescriptions. But there could be legal tests of whether those protections are valid. And the U.S. Supreme Court is already considering an effort to roll back approvals for one of the two drugs usually used in combination for medication abortion.
Planned Parenthood centers in Florida have been preparing for the stricter ban to take effect. Laura Goodhue, executive director of the Florida Alliance of Planned Parenthood Affiliates, said they’ve implemented rapid blood tests to determine pregnancy earlier, increased education and contraception programs, and ramped up efforts to help people travel elsewhere for abortion.
“We’re doing what we can,” she said. “But we’ve as we’ve seen in other states, it’s still going to have a devastating impact on our public health system.”
Since states began enforcing bans after the 2022 ruling, the Bristol clinic has added appointment slots in afternoons, Saturdays and some Sundays — and has adjusted to the idea that patients could be late because of traffic jams as far away as Atlanta.
“In order for them to come to Virginia, there’s a lot of planning involved,” Ogorek said. “It’s not just taking a few hours off of work and driving 20 minutes”
