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Inside NCHS: Featured Topics from the National Center for Health Statistics

Closer Look: The Standard Birth Certificate

April 21, 2014

birth certificate page 1 page 2 thumbnail field 3 field 4 field 8b field 15 field 26 page 1 thumbnail field 31, 32 field 35 field 37 field 38 field 39 field 46 field 49 field 52


The birth certificate is central to the nation’s Civil Registration and Vital Statistics system. It tells us how families are formed.

Vital statistics collection began in 1850, with the first census, which included public health questions. At that time, vital registration—births, deaths, marriages, divorces—was done in churches. By 1900, at the federal government’s encouragement, states began to move vital registration out of the churches and into state registration areas. Complete nationwide coverage was achieved in the mid-1930s.

According to Charles Rothwell, NCHS director and former director of the Center’s National Vital Statistics System (NVSS), the current Standard Birth Certificate is used by 57 U. S. jurisdictions—50 states, the District of Columbia, five territories, and New York City. Almost all births are now reported electronically. Jurisdictions collect birth data via their own individually-developed electronic birth registration systems. Their systems are self-supporting, paid for by the fees citizens pay for copies of certificates and other services.

The federal government is required by statute to collect national vital statistics. The jurisdictions, however, are not required to report them. To that end, NVSS pays the 57 jurisdictions more than $20 million annually for their data. NVSS also assists with needed jurisdiction system upgrades. For example, the 2003 release of the Standard Birth Certificate doubled the amount of data previously processed and collected. Because some states were unable to switch to the new birth certificate because of new system requirements, additional NVSS funding helps them make the necessary improvements.

As the nation changes, so, too, does the birth certificate. The most recent revision clarified and defined “Mother” as the woman who physically gives birth to the child being registered. This came about in response to the increased involvement of surrogate mothers, creating situations in which the birth mother and the legal mother are not necessarily one in the same.

To take a closer look at the latest available data, click on any of the birth certificate’s 13 highlighted fields.  You can also examine current Standard Birth Certificate, and the worksheets recommended to be used to collect these data, to better understand how we monitor the nation’s births.

Open the 2003 revision of the U.S. Standard Certificate of Live Birth [PDF - 145 KB]
Review worksheets

NOTE: This graphic represents the full scope of information that comprises the 2003 Revision to the Standard Birth Certificate. This form is not used by the 57 independent reporting jurisdictions to collect birth data. All jurisdictions submit birth data electronically to NCHS via systems developed by the jurisdictions themselves, based on worksheets recommended to be used to collect these data.

3. Sex
Boys and Girls

In 2012, as in all previous years since at least 1940, more boys than girls were born,* with a sex ratio of 1,047 male births per 1,000 female births.

The sex ratio at birth affects critical demographic measures, according to a 2005 National Vital Statistics Report, "Trend Analysis of the Sex Ratio at Birth in the United States." For example, the "doubling-time" of a population (the number of years required for the population to double its size given a rate of population growth) rises as the ratio of males to females at birth increases. Data about the sex ratio at birth is necessary to understand trends in infant morbidity, such as low birthweight and mortality, as male infants are more susceptible to illness and have higher infant mortality rates, including rates of Sudden Infant Death syndrome (SIDS), than females.

The highest sex ratio at birth occurred in 1946 (1,059 male births per 1,000 female births), whereas the lowest occurred in 1991 and again in 2001 (1,046 male births per 1,000 females).

*Births: Final Data for 2012, Table 13

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4. Child's Date of Birth
Birth Rate Continue to Decline

A total of 3,952,841 babies were born in the United States in 2012,* 749 fewer births than in 2011. From 2007 through 2011, the number of births declined, falling steadily from 2007 through 2010, but the pace of the decline slowed from 2010 to 2012.

Among the three largest race and Hispanic origin groups, the number of births declined by 1% for non-Hispanic black, non-Hispanic white, Hispanic, and American Indian/Alaska Native women, but rose 7% for Asian or Pacific Islander women between 2011 and 2012.

The 2012 U.S. general fertility rate (GFR) was 63.0 births per 1,000 women aged 15–44, down slightly from the record low rate reported for the nation in 2011 (63.2). The GFR declined from 2011 to 2012 for the three largest race and Hispanic origin groups and for American Indian/Alaska Native women, but rose among Asian/Pacific Islander women.

The 2012 total fertility rate (TFR) for the United States was 1,880.5 births per 1,000 women, 1% below the 2011 rate (1,894.5).   TFRs declined for nearly all race and Hispanic origin groups in 2012, down 1–2% for non-Hispanic white, non-Hispanic black, Hispanic, and American Indian/ Alaskan Native women. The rate for Asian/Pacific Islander women rose by 4%, however.

*Births: Final Data for 2012, Table 5.

Please note that information on the date of birth of the mother is not available in NCHS public-use data sets. Information on mother’s age, derived from the infant’s date of birth, is available.

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8b. mother's Date of Birth
Teen Birth Rates Fall

The 2012 teenage birth rate was 29.4 births per 1,000 women aged 15–19,* another historic low for the nation and down 6% from the 2011 rate (31.3). The rate has fallen by more than one-half since 1991 (61.8), when the long-term decline in births to teens began. The number of births to teenagers aged 15–19 declined 7% from 2011 to 2012, to 305,388, the lowest number of births since 1945.

What’s behind the falling teenage birth rate? Two researchers using NCHS natality microdata, Nielsen ratings, and Twitter records say MTV’s reality show, 16 and Pregnant, played a big role. See our coverage of their report.

Birth rates also declined for women aged 20–29 years from 2011 to 2012, but rose for women aged 30–44. The rates for women aged 10–14 and 45–49 were unchanged in 2012.

*Births: Final Data for 2012, Table 4

Please note that information on the date of birth of the mother is not available in NCHS public-use data sets. Information on mother’s age, derived from the mother’s date of birth, is available.

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15. Is Mother Married?
Rates for Unmarried Moms Fall

The birth rate for unmarried women declined for the fourth consecutive year in 2012.* The rate fell 2% from 2011 to 2012, to 45.3 births per 1,000 unmarried women aged 15–44, the lowest rate since 2003.

The percentage of all births to unmarried women was 40.7 in 2012, essentially stable for the third consecutive year.   The number of nonmarital births rose very slightly from 2011 (1,607,773) to 2012 (1,609,619). The 2012 total is 7% lower than the 2008 peak.

Birth rates for unmarried women fell in 2012 for women in age groups under age 30; the rate was essentially unchanged for women 30–34 years, and increased to historic peaks for women 35 years of age and older. Although the majority of nonmarital births are for women under age 25 (54% in 2012), this level has dropped from 64% in 2002. 

*Births: Final Data for 2012, Tables 15 and 16

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26. Place Where Birth Occurred
Hospitals Over Homes

The vast majority of births in the U.S. are delivered in hospitals. In 2012, 98.6% of all U.S. births occurred in hospitals.*

This ratio of hospital to home births was not always the case. In 1900, almost all U.S. births occurred outside a hospital, the vast majority of which occurred at home. By 1969, that proportion had dropped to 1%. By 2012, however, U.S. out-of-hospital births increased from 1.36% of all births. In 2012, 53,635 births in the United States occurred outside of a hospital, including 35,184 home births and 15,577 birthing center births.

Trends in Out-of-Hospital Births in the United States, 1990–2012

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31, 32. Mother's Height, Mother's Prepregnancy Weight
Obese Moms

Overall, 23.4% all mothers in the 2011 36-state reporting area and the District of Columbia were obese before pregnancy began, according to a recent NCHS report.* Levels of obesity ranged from a low of 18.0% in Utah to a high of 28.6% in South Carolina. 

Obesity is not a measure of weight; the Body Mass Index, or BMI, is used to determine obesity. BMI is calculated as weight, in kilograms, divided by height in meters squared. People with a BMI of 40 or more are considered obese.

Obesity varied by race and Hispanic origin. For the total reporting area and most jurisdictions, non-Hispanic white women were less likely to be obese than non-Hispanic black and Hispanic women. 

*Newly Released Data From the Revised U.S. Birth Certificate, 2011, Table 1.
*User Guide to the 2012 Natality Public Use File, Table 3.

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35. Number of Previous Live Births
First-Time Moms Waiting Longer

A useful measure for interpreting childbearing patterns is the mother’s mean age at first birth, which is the arithmetic average of the age of mothers at the time of birth, and is computed directly from the frequency of first births by age of mother. In 2012, the mean age of mother at first birth was 25.8 years,* up from 25.6 years in 2011, and up from 21.4 years—an increase of more than five years—in 1970.

Mean age at first birth varied by race and Hispanic origin in 2012, from 22.5 years for American Indian/Alaska Native women to 29.3 years for Asian/Pacific Islander women. The average ages at first birth for the three largest race and Hispanic origin groups were 23.6 years for non-Hispanic black, 23.8 years for Hispanic, and 26.6 years for non-Hispanic white women.

*Births: Final Data for 2012, Table I-1.

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37. Smoking Before and During Pregnancy
Mothers-to-Be Who Smoke

In 2012, 8.7 % of mothers reported smoking during pregnancy,* based on data reported by 37 states and the District of Columbia. Of the women who smoked in the three months prior to pregnancy, about one of every five women quit smoking during pregnancy.

Hispanic women were the least likely to smoke during pregnancy (2% compared with 12.8% of non-Hispanic white and 7.3% of non-Hispanic black mothers) and were also the most likely to quit smoking during pregnancy (32% compared with 18.7% for non-Hispanic white and 23.8% for non-Hispanic black mothers).

*User Guide to the 2012 Natality Public Use File, Table 4.

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38. Principal Source of Payment for the Delivery
Who Pays for the Delivery?

More than 9 out of 10 births in the 2011 reporting area (38 states and the District of Columbia) were insured by either private insurance (46.1 percent) or Medicaid (44.9 percent) in 2011,* according to a recent NCHS report. “Other” payment sources (4.8 percent) and self-pay (4.2 percent) accounted for less than 10 percent of all births. 

Private insurance was the most common payment source in the majority of states (23), while Medicaid was the most common source in 11 states and the District of Columbia.  Births insured by these two payment sources were not significantly different in two states (Illinois and Kentucky). There was wide variation in Medicaid-insured births by state, ranging from less than 30 percent of births in North Dakota (28.8 percent) and Utah (29.4 percent) to almost two-thirds of births in Louisiana (64.2 percent).

Medicaid-insured deliveries were highest for births to teenagers and for non-Hispanic black and Hispanic mothers. Privately insured mothers were most likely to receive early prenatal care and to have cesarean deliveries. 

*Newly Released Data From the Revised U.S. Birth Certificate, 2011, Table 7.
*User Guide to the 2012 Natality Public Use File, Table 10.
*Source of Payment for the Delivery: Births in a 33-state and District of Columbia Reporting Area, 2010.

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39. Date of last Normal Menses
Steady Drop in Preterm Babies

The preterm birth rate declined to 11.55% in 2012,* down 2% from 2011 (11.73%) and 10% from 2006 (12.80%). The percentage of infants born preterm (less than 37 completed weeks of gestation) rose by more than one-third from 1981 to 2006, but was down each year 2007–2012.

Births delivered “early term” (37–38 weeks) were also down between 2011 and 2012.  The rate of births at 37 weeks of gestation declined 2%, and births at 38 weeks were down 4%.  Since 2006, births at 37 weeks have declined 10% and births at 38 weeks by 16%.  Concurrently, the percentage of infants delivered at 39 weeks (full term) rose 2% for 2011–2012 and by 17% from 2006 to 2012.  Rates at 40 weeks (also full term) and 41 weeks (late term) have also risen over both time periods, but at a slower pace. 

The 2012 preterm rate among non-Hispanic black infants was 10% lower than the recent peak in 2006 (18.46%) and another record low.  Since 2006, preterm levels have decreased 12% for non-Hispanic white and 5% for Hispanic infants.

From 2006 to 2012, preterm births declined for 44 states and the District of Columbia; rates in the remaining six states were essentially stable. 

*Births: Final Data for 2012, Table 24.

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46D. Method of Delivery
C-Sections Leveling Off?

Nearly one-third of all U.S. births (32.8%) were delivered by cesarean in 2012,* unchanged since 2010.  Prior to 2010, the cesarean delivery rate had increased each year since 1996, when about one-fifth of births (20.7%) were delivered by cesarean. 

As in prior years, cesarean delivery rates were higher for older mothers in 2012.  One in two births to women aged 40–54 were delivered by cesarean compared with fewer than one in four births to women under age 20.

Historically, Hispanic women have had lower cesarean delivery rates than non-Hispanic white and non-Hispanic black women; however, in 2012, cesarean delivery rates for non-Hispanic white and Hispanic women were essentially the same.  Non-Hispanic black women continued to have the highest rate of cesarean delivery. 

The primary (first) cesarean delivery rate declined for 28 states and the New York City reporting area from 2009 to 2012.** The primary cesarean delivery rate for the 38 states that were using the revised certificate by January 1, 2012, the District of Columbia, and New York City was 21.5%. State-specific rates ranged from 12.5% (Utah) to 26.9% (Florida and Louisiana).

*Births: Final Data for 2012, Table 21.
**Primary Cesarean Delivery Rates, by State: Results From the Revised Birth Certificate, 2006–2012, Table B.

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49. Birthweight
Fewer Small Babies

The U.S. low birthweight rate (LBW) dipped 1% for 2012,* to 7.99% from 8.10%, in 2011, and 3% lower than the 2006 high (8.26%).  Following increases of nearly 20% from 1990 to 2006, the percentage of LBW infants (less than 2,500 grams or 5 pounds, 8 ounces) has slowly declined.

LBW declined among non-Hispanic white infants from 7.09% to 6.97% from 2011 to 2012 and also among non-Hispanic black births (from 13.33% to 13.18%) but was essentially unchanged for Hispanic births (6.96% in 2012). Since 2006, the LBW rate has declined 5% among non-Hispanic white, and 6% for non-Hispanic black infants; rates for Hispanic infants have fluctuated only slightly. 

During 2006–2012, declines in the percentage of LBW infants were reported for 25 states and the District of Columbia. Levels for the remaining states were not statistically changed. 

*Births: Final Data for 2012, Table 24.

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52. Plurality
Seeing Double

The 2012 twin birth rate was stable at 33.1 per 1,000 births,* essentially unchanged from both 2010 and 2011.  The twinning rate (births in twin deliveries per 1,000 total births) rose steadily from 1980 to 2009 (from 18.9 to 33.2 per 1,000), but has fluctuated only from 33.2 to 33.1 since.  The number of infants born in twin deliveries was 131,024 in 2012, the lowest number in almost a decade (2003), but still nearly twice as high as the number of twins in 1980 (68,339).

The triplet and higher order multiple birth rate (triplet/+) declined 9% from 2011 to 2012, to 124.4 per 100,000 births, the lowest rate in 18 years. The triplet/+ rate (number of triplets, quadruplets, and quintuplets and other higher-order multiples per 100,000 births) rose more than 400% from 1980 to 1998 but has since fallen by more than one-third (Tables 26 and 27). The number of triplet/+ births also declined 9% in 2012, to 4,919, the lowest number of triplets/+ since 1994. The 2012 triplet/+ number included 4,598 triplets, 276 quadruplets, and 45 quintuplets and higher order multiple births.

Recent declines in triplet/+ birth rates may be associated with guidelines from the American Society for Reproductive Medicine, which were  developed to reduce the incidence of higher-order multiple gestation pregnancies resulting from assisted reproductive technologies (ART) and also with improvements in ART procedures. Infants born in multi-gestation pregnancies tend to be born smaller and sooner than singletons and are at higher risk of early death compared with infants in singleton pregnancies.  In 2010, the latest year for which mortality data are available, twins were more than 4 times, triplets 10 times, and quadruplets more than 20 times as likely to die in infancy.  

*Births: Final Data for 2012, Table 27.

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