REPORT

Reproductive Health Update: Post-Dobbs Fertility Rates, 2023: US, TX, CA

Abstract

Per CDC data, the US fertility rate fell by 2.7% to a new low of 54.51 births per 1,000 women 15-44 in 2023, the first year to reflect the fertility effects of the U.S. Supreme Court’s Dobbs decision. Per UH IRWGS analysis, all 50 states saw a decline in fertility rates, including all 20 states with operative abortion bans in 2023 as well as all 30 without, as did Washington, D.C. The rate of decline varied by state, from 0.11% in North Dakota (the smallest decline) to 5.36 % in Maine (the largest).

The US teen fertility rate also fell to a new low, at 13.08 births per 1,000 women 15-19, a decline of 3.96% since 2022. Declining teen births correlate to rises in high school and college graduation rates, and higher lifetime salaries for families.3 Overall, the US fertility rate declined across all age groups except 20-24-year-olds, whose rate rose by 0.40%. See Fig. 1 for the rates by age of mother, over time.

The teen rate fell in 47 states, excluding CT, WA and WI, which saw small rises. The overall teen fertility rate in Texas, the state with the most teen births and among the highest teen fertility rates, fell by 4.71%, declining among all races and ethnicities to a new low for the state.

Per our analysis, the fertility rate was higher in the sector of states with abortion bans than in the sector of states without bans (57.5 v. 52.4 births per 1,000 women 15-44); and while rates declined in all states, those in ban states declined less rapidly than those in states without bans. Since 2016, fertility rates in ban states as a group declined 11.1%, while ban-free states declined 13.8% (Fig. 2).4 Since 2022, and post-Dobbs, fertility rates in ban states declined 2% vs. 3% in ban-free states.

Post Dobbs, the public seems to have adjusted its fertility behavior, in recognition of the transformed scene. Adjustments include multiple factors: many women in ban states accessed abortions in other states or through self-managed abortions at home; greater vigilance around contraception; increases in permanent contraception through tubal ligation and vasectomy; refraining from sex; moving out of ban states to avoid these issues; some who would like to be pregnant are choosing not to, due to fear that if they have complications doctors will not feel able to render aid; and some women are dying while pregnant when doctors don’t intervene to assist. All these new factors likely contributed to the 2023 fertility fall in ban states, along with factors previously spurring decline, including concerns around economics, climate-change, and more.

Keywords:
Fertility Rates decline in all 50 US states in 2023 
First year to reflect the fertility effects of the U.S. Supreme Court’s Dobbs decision   
The US teen fertility rate also fell to a new low
Rate higher in sector with abortion bans than in the sector without