Trends in pregnancy rates for the United States, 1976-97: an update.

OBJECTIVES: This report presents detailed pregnancy rates for 1996 and 1997 to update a recently published comprehensive report on pregnancies and pregnancy rates for U.S. women. METHODS: Tabular and graphic data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. RESULTS: In 1997 an estimated 6.19 million pregnancies resulted in 3.88 million live births, 1.33 million induced abortions, and 0.98 million fetal losses. The 1997 pregnancy rate of 103.7 pregnancies per 1,000 women aged 15-44 years is the lowest recorded since 1976 (102.7), the first year for which a consistent series of national pregnancy rates is available. The 1997 rate was 10 percent lower than the peak rate in 1990 (115.6). The teenage pregnancy rate dropped steadily through 1997, falling to a record low of 94.3 pregnancies per 1,000 teenagers 15-19 years, 19 percent below the 1990 level (116.3). Rates for younger teenagers declined more than for older teenagers.

Births: final data for 1999.

OBJECTIVES: This report presents 1999 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, tobacco and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 3.96 million births that occurred in 1999 are presented. RESULTS: Overall birth and fertility rates changed less than 1 percent in 1999. Teenage birth rates fell 2 to 6 percent. The rate for women aged 20-24 years declined slightly, while rates for women in their late twenties and their thirties rose 2 to 3 percent each. The number of births to unmarried women, the birth rate, and the percent of births that were to unmarried women each rose 1 percent or less. Smoking by pregnant women overall dropped again, but rose among women aged 18-24 years. Improvements in prenatal care utilization continued. The cesarean delivery rate increased for the third year after declining for 7 consecutive years. The proportion of multiple births continued to rise; however, higher order multiple births (e.g., triplets, quadruplets) declined for the first time in over a decade, following increases of 13 percent per year during 1990-98. The percent low birthweight remained at 7.6 percent, while preterm births rose to 11.8 percent. These trends are in large part the result of increases in multiple births.

Trends in cesarean birth and vaginal birth after previous cesarean, 1991-99.

OBJECTIVES: This report presents trends in rates of cesarean delivery and rates of vaginal birth after previous cesarean (VBAC) delivery for 1991-99. Data for the United States showing trends by maternal age, race/ethnicity, and State are presented. Also trends in cesarean rates by selected maternal characteristics, medical risk factors, and complications of labor and/or delivery are shown. A brief explanation of the Healthy People 2010 objective regarding cesarean and VBAC rates for low-risk women is also included. Summary statistics for 2000 based on preliminary data are also included, but most tabular and text information is based on detailed final statistics for 1999. METHODS: Cesarean and VBAC rates were computed based on the information reported on birth certificates. RESULTS: The U.S. cesarean rate dropped 8 percent between 1991 and 1996 (from 22.6 to 20.7 per 100 births) but then increased 6 percent between 1996 and 1999 (to 22.0); preliminary data show that the rate increased again by 4 percent between 1999 and 2000 (to 22.9). The decline between 1991 and 1996 was present for women of all ages but was most pronounced for those under 30 years of age. The decline was greatest for non-Hispanic white women, 10 percent, compared with a 7-percent decline for Hispanic women and only a 1-percent decline for non-Hispanic black women. All groups experienced increases in cesarean rates of about 6 to 7 percent between 1996 and 1999. The increase in cesarean rates between 1996 and 1999 was greatest for women 30 years of age and over. The VBAC rate increased 33 percent between 1991 and 1996 (from 21.3 to 28.3 per 100 births to women with a previous cesarean) but then fell 17 percent between 1996 and 1999 (to 23.4). The dramatic increase in VBAC rates between 1991 and 1996, followed by the subsequent decline, was experienced by women of all ages and for each major race/ethnicity group. Similar trends in cesarean rates were present for nearly all States and for most medical risk factors and complications of labor and/or delivery.

Births: preliminary data for 1999.

OBJECTIVES: This report presents preliminary data for 1999 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, prenatal care, cesarean delivery, and low birthweight are also presented. METHODS: Data in this report are based on more than a 97-percent sample of births for 1999. The records are weighted to independent control counts of births received in State vital statistics offices in 1999. Comparisons are made with 1998 final data. RESULTS: The crude birth rate in 1999 was 14.5 per 1,000 population, a slight decline from 1998 (14.6), returning to the level observed in 1997. However, the fertility rate, which is limited to women aged 15-44 years, was 65.8 in 1999, a slight increase over the rate for 1998 (65.6). The birth rate for teenagers continued to decline for 1998-99, dropping 3 percent to 49.6 births per 1,000 females aged 15-19 years. The 1999 rate for teenagers is 20 percent lower than the recent high point in 1991. The rate for young teenagers 15-17 years fell 6 percent, and the rate for teenagers 18-19 years declined 2 percent. Since 1991, rates have fallen 26 percent for teenagers 15-17 years, and 15 percent for teenagers 18-19 years. Birth rates for women aged 20-24 years declined slightly between 1998 and 1999 whereas the rate for women aged 25-29 years rose 2 percent. Birth rates for women in their thirties and forties continued their long increase. Rates for women in their thirties increased 2 to 3 percent and were the highest in three decades. The birth rate for women aged 40-44 years was the highest level reported since 1970. The birth rate for unmarried women in 1999 was 43.9 per 1,000, 1 percent lower than in 1998 and 6 percent lower than the peak level reported for 1994 (46.9). However, the number of births to unmarried women was up about 1 percent due to the continued increase in the number of unmarried women of childbearing age. The rate of prenatal care utilization continued to improve. The total cesarean rate increased 4 percent between 1998 and 1999 and continued a 3-year rise. The low birthweight rate remained unchanged at 7.6 percent.

Infant mortality statistics from the 1998 period linked birth/infant death data set.

OBJECTIVES: This report presents 1998 period infant mortality statistics from the linked birth/infant death data set (linked file) by a variety of maternal and infant characteristics. METHODS: Descriptive tabulations of data are presented. RESULTS: In general, mortality rates were lowest for infants born to Cuban mothers (3.6 per 1,000), Central and South American (5.3), Asian or Pacific Islander (5.5), Mexican (5.6), and non-Hispanic white mothers (6.0), followed by Puerto Rican (7.8), American Indian (9.3), and black mothers (13.8). Infant mortality rates (IMRs) were higher for those infants whose mothers had no prenatal care, were teenagers, had 9-11 years of education, were unmarried, or smoked during pregnancy. Infant mortality was also higher for male infants, multiple births, and infants born preterm or at low birthweight. In 1998, 65 percent of all infant deaths occurred to the 7.6 percent of infants born at low birthweight. The three leading causes of infant death--Congenital anomalies, Disorders relating to short gestation and unspecified low birthweight (low birthweight), and Sudden infant death syndrome (SIDS)--taken together accounted for 46 percent of all infant deaths in the United States in 1998. Cause-specific mortality rates varied considerably by race and Hispanic origin. For infants of black mothers, the IMR for low birthweight was nearly four times that for white mothers. For infants of American Indian mothers, the SIDS rate was 3.8 times that for Asian or Pacific Islander (API) mothers. For infants of Hispanic mothers, the SIDS rate was 44 percent lower than that for non-Hispanic white mothers.

Variations in teenage birth rates, 1991-98: national and state trends.

OBJECTIVES: This report presents national birth rates for teenagers for 1991-98 and the percent change, 1991-98. State-specific teenage birth rates by age, race, and Hispanic origin for 1991 and 1998 and the percent change, 1991 to 1998, are also presented. METHODS: Tabular and graphical descriptions of the trends in teenage birth rates for the Nation and each State, by age group, race, and Hispanic origin of the mother, are discussed. RESULTS: Birth rates for teenagers 15-19 years declined nationally between 1991 and 1998 for all age and race and Hispanic origin populations, with the steepest declines recorded for black teenagers. State-specific rates fell significantly in all States for ages 15-19 years; declines ranged from 10 to 38 percent. In general, rates by State fell more for younger than for older teenagers, ranging by State from 10 to 46 percent for ages 15-17 years. Statistically significant reductions for older teenagers ranged from 3 to 39 percent. Reductions by State were largest for black teenagers 15-19 years, with rates falling 30 percent or more in 15 States. Among the factors accounting for these declines are decreased sexual activity, increases in condom use, and the adoption of the implant and injectable contraceptives.

Births: final data for 1998.

OBJECTIVES: This report presents 1998 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant health characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown including teenage birth rates and total fertility rates, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 3.94 million births that occurred in 1998 are presented. RESULTS: Birth and fertility rates increased in 1998 by about 1 percent, the first increase since 1990. Birth rates for teenagers fell 2-5 percent. Rates for women in their twenties increased 1-2 percent each, whereas rates for women in their thirties rose 2-4 percent. All measures of childbearing by unmarried women increased in 1998; the number of births rose 3 percent, the birth rate increased about 1 percent while the percent of births that were to unmarried women rose to 32.8 percent. Smoking by pregnant women overall dropped again in 1998, but continued to increase among teenagers. Improvements in prenatal care utilization continued. The cesarean delivery rate increased for the second year after declining for 7 consecutive years. The proportion of multiple births continued to rise; higher order multiple births (e.g., triplets, quadruplets) rose by 13 percent in 1998, following a 14 percent rise from 1996 to 1997. Key measures of birth outcome--the percents of low birthweight and preterm births--increased. These changes are in large part the result of increases in multiple births.

Trends in pregnancies and pregnancy rates by outcome: estimates for the United States, 1976-96.

OBJECTIVES: This report presents national estimates of pregnancies and pregnancy rates according to women's age, race, and Hispanic origin, and by marital status, race, and Hispanic origin. Data are presented for 1976-96. Data from the National Survey of Family Growth (NSFG) are used to show information on sexual activity, contraceptive practices, and infertility, as well as women's reports of pregnancy intentions. METHODS: Tables of pregnancy rates and the factors affecting pregnancy rates are presented and interpreted. Birth data are from the birth-registration system for all births registered in the United States and reported by State health departments to NCHS; abortion data are from The Alan Guttmacher Institute (AGI) and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC); and fetal loss data are from pregnancy history information collected in the NSFG. RESULTS: In 1996 an estimated 6.24 million pregnancies resulted in 3.89 million live births, 1.37 million induced abortions, and 0.98 million fetal losses. The pregnancy rate in 1996 was 104.7 pregnancies per 1,000 women aged 15-44 years, 9 percent lower than in 1990 (115.6), and the lowest recorded since 1976 (102.7). Since 1990 rates have dropped 8 percent for live births, 16 percent for induced abortions, and 4 percent for fetal losses. The teenage pregnancy rate has declined considerably in the 1990's, falling 15 percent from its 1991 high of 116.5 per 1,000 women aged 15-19 years to 98.7 in 1996. Among the factors accounting for this decline are decreased sexual activity, increases in condom use, and the adoption of the injectable and implant contraceptives.

Trends in the attendant, place, and timing of births, and in the use of obstetric interventions: United States, 1989-97.

OBJECTIVES: This report presents recent trends in the circumstances surrounding live births in the United States. Specifically, this report will examine the changes in the attendant and place of birth as well as changes in the day and month of birth. Trends in the use of four obstetric procedures (electronic fetal monitoring, ultrasound, induction of labor, and stimulation of labor) are examined as well as trends in cesarean births, vaginal births after a previous cesarean, and births delivered by forceps and vacuum extraction. METHODS: Descriptive tabulations were calculated for each year between 1989 and 1997 using data reported on birth certificates. RESULTS: While the vast majority of births in 1997 were attended by physicians, 92 percent, this has declined steadily as the percent of births attended by midwives has slowly increased to account for 7 percent of all births. About 99 percent of births were in hospitals, basically unchanged from 1989, but the percent of out-of-hospital births that were in residences increased whereas those in freestanding birthing centers declined. While births were more common on weekdays than on weekends in 1989, they have become even more concentrated on weekdays since 1989. The most popular months to give birth continue to be July, August, and September. The percent of mothers receiving electronic fetal monitoring, ultrasound, induction, and stimulation all increased over the period with the most dramatic increase being the doubling of the use of induction. Between 1989 and 1996, the rate of cesarean births dropped by 9 percent whereas the rate of vaginal birth after a previous cesarean (VBAC) increased by 50 percent. However, the trends appear to have changed between 1996 and 1997--the cesarean rate increased slightly while the VBAC rate declined by 3 percent. There is wide variation by State in both of these rates. The percent of births that were delivered by forceps consistently declined during the period whereas the use of vacuum extraction consistently increased.

Recent changes in birth attendant, place of birth, and the use of obstetric interventions, United States, 1989-1997.

Although more than nine out of every ten births are attended by physicians, the percent of births attended by midwives increased during the 1989 to 1997 period and accounted for 7% of all births in 1997. About 99% of births in 1997 were in hospitals, basically unchanged from 1989, but the percent of out-of-hospital births that occurred in residences increased over the period, while those in freestanding birthing centers declined. The percent of mothers receiving electronic fetal monitoring, ultrasound, and induction and stimulation of labor increased. The most dramatic increase was a doubling of the use of induction. In 1997, approximately 18% of all births were induced. Midwives as well as physicians increased the use of these obstetric procedures over the 1989 to 1997 period, and the use of many procedures by CNMs was as high, or nearly as high, as use by physicians. The rate of cesarean births dropped by 9%, from about 23% in 1989 to about 21% in 1997, while the rate of vaginal birth after a previous cesarean increased by 50%. The proportion of births assisted by forceps consistently declined during the period, while the use of vacuum extraction consistently increased. The number of episiotomies performed in the United States declined each year during the 1990-1996 period.

Births: final data for 1997.

OBJECTIVES: This report presents 1997 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant health characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown including teenage birth rates and total fertility rates, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 3.9 million births that occurred in 1997 are presented. RESULTS: Birth and fertility rates declined very slightly in 1997. Birth rates for teenagers fell 3 to 5 percent. Rates for women in their twenties changed very little, whereas rates for women in their thirties rose 2 percent. The number of births and the birth rate for unmarried women each declined slightly in 1997 while the percent of births that were to unmarried women was unchanged. Smoking by pregnant women overall dropped again in 1997, but continued to increase among teenagers. Improvements in prenatal care utilization continued. The cesarean delivery rate increased slightly after declining for 7 consecutive years. The proportion of multiple birth continued to rise; higher order multiple births (e.g., triplets, quadruplets) rose by 14 percent in 1997, following a 20 percent rise from 1995 to 1996. Key measures of birth outcome--the percents of low birthweight and preterm births--increased, with particularly large increases in the preterm rate. These changes are in large part the result of increases in multiple births.

Recent trends in teen births in the United States.

Teenage births and birth rates have dropped steadily during the 1990s. Overall, the teen birth rate declined 15 percent between 1991 and 1997. The trend in the 1990s reverses a period of steep increases from 1986 to 1991. Despite the recent declines, the teen birth rate in 1997 is still higher than rates in the mid 1980s when they were at an all-time low (50-51 per 1,000). In general, teen birth rates have declined more for younger teenagers (15-17 years) than for older teens (18-19 years). Among all race and ethnic groups, black teenagers have experienced the greatest declines in childbearing during the 1990s. From 1991 to 1997, the rate for black teens 15-19 years dropped 23 percent to the lowest level on record. A particularly noteworthy finding is that the birth rate for second births to all teenagers who have had a first birth (repeat childbearing) declined by 21 percent between 1991 and 1996. Despite the recent decline in teen births and birth rates, a growing number and proportion are to unmarried teens. Most teenagers giving birth in the 1990s are not married--78 percent overall in 1997. Teenage childbearing has important social and health consequences for the teenage mother herself and for her baby. Most teen births are unintended, the educational attainment of teen mothers is limited, teen mothers are less likely to receive timely prenatal care, and teens are more likely to smoke during pregnancy than are older women. As a consequence of these and other factors, babies born to teen mothers are at greater risk of preterm delivery and low birthweight. Teen pregnancy prevention has become a major focus of attention over the past several years, contributing to a wide variety of initiatives and strategies at the national, state and community level.

Declines in teenage birth rates, 1991-98: update of national and state trends.

OBJECTIVES: This report presents national birth rates for teenagers for 1991-98; the percent change, 1991-98; State-specific teenage birth rates for 1991 and 1997; and the percent change, 1991-97. METHODS: Tabular and graphical descriptions of the trends in teenage birth rates by age group, race, and Hispanic origin of the mother are discussed. RESULTS: Birth rates for teenagers 15-19 years declined nationally between 1991 and 1998 for all age, race, and Hispanic origin populations, with the steepest declines recorded for black women. State-specific rates by age fell in all States, with most declines statistically significant; overall declines ranged from 9 to 32 percent.

Highlights of trends in pregnancies and pregnancy rates by outcome: estimates for the United States, 1976-96.

OBJECTIVES: This report presents key findings from a comprehensive report on pregnancies and pregnancy rates for U.S. women. The study incorporates birth, abortion, and fetal loss data to compile national estimates of pregnancy rates according to a variety of characteristics including age, race, Hispanic origin, and marital status. Summary data are presented for 1976-96. Data from the National Survey of Family Growth (NSFG) are used to show information on sexual activity and contraceptive practices, as well as women's reports of pregnancy intentions. METHODS: Tabular and graphic data on pregnancy rates by demographic characteristics are presented and interpreted. Birth data are from the birth registration system for all births registered in the United States and reported by State health departments to NCHS; abortion data are from The Alan Guttmacher Institute (AGI) and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC); and fetal loss data are from pregnancy history information collected in the NSFG. RESULTS: In 1996 an estimated 6.24 million pregnancies resulted in 3.89 million live births, 1.37 million induced abortions, and 0.98 million fetal losses. The pregnancy rate in 1996 was 104.7 pregnancies per 1,000 women aged 15-44 years, 9 percent lower than in 1990 (115.6), and the lowest recorded since 1976 (102.7). Since 1990 rates have dropped 8 percent for live births, 16 percent for induced abortions, and 4 percent for fetal losses. The teenage pregnancy rate has declined considerably in the 1990's, falling 15 percent from its 1991 high of 116.5 per 1,000 women aged 15-19 to 98.7 in 1996. Among the factors accounting for this decline are decreased sexual activity, increases in condom use, and the adoption of the injectable and implant contraceptives.

Changes in indications for cesarean delivery: United States, 1985 and 1994.

OBJECTIVES: The percentages of cesarean deliveries attributable to specific indications (breech, dystocia, fetal distress, and elective repeat cesarean) were computed for 1985 and 1994. METHODS: Data were derived from the 1985 and 1994 National Hospital Discharge Surveys. RESULTS: Dystocia was the leading indication for cesarean delivery in both years. In comparison with 1985, cesareans performed in 1994 that were attributable to dystocia and breech presentation increased, those attributable to fetal distress did not change significantly, and elective repeat cesareans declined. CONCLUSIONS: Studying indications for cesareans can be useful for hospitals, clinicians, and researchers in determining strategies to lower primary and repeat cesarean rates.

Teenage births in the United States: state trends, 1991-96, an update.

OBJECTIVES: This report provides State-specific birth rates for teenagers for 1991 and 1996 and the percent change, 1991-96. METHODS: Tabular and graphical description of trends in teenage birth rates by age group for each State. RESULTS: Birth rates for teenagers 15-19 years declined significantly in all but three States between 1991 and 1996. Declines by State ranged from 6 to 29 percent.

Report of final natality statistics, 1996.

OBJECTIVES: This report presents 1996 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, tobacco and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant health characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown including teenage birth rates and total fertility rates, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 3.9 million births that occurred in 1996 are presented. RESULTS: Birth and fertility rates declined very slightly in 1996. Birth rates for teenagers fell 3 to 8 percent. Rates for women in their twenties increased slightly in 1996, the first increase since 1990, while rates for women in their thirties rose 2 to 3 percent. The number and percent of births to unmarried women increased slightly in 1996 while the birth rate for unmarried women declined modestly. Smoking by pregnant women overall dropped again in 1996, but increased among teenagers. Improvements in prenatal care utilization continued. The cesarean delivery rate declined. The proportion of multiple births continued to rise; higher order multiple births (e.g., triplets, quadruplets) rose by 19 percent. Key measures of birth outcome--the percents of low birthweight and preterm births--increased slightly, in large part the result of increases in multiple births.

Births of Hispanic origin, 1989-95.

OBJECTIVES: This report presents trend data on births in the United States to women of Hispanic and non-Hispanic origin, from 1989 to 1995, for a wide variety of characteristics. Hispanic women data are presented where possible separately for Mexican, Puerto Rican, Cuban, Central and South American, and other Hispanic women while for non-Hispanic women data are shown for white and black women. Maternal demographic characteristics include age, marital status, live-birth order, educational attainment, and mother's place of birth. Health care utilization items include timing of prenatal care, cesarean delivery rate, place of birth and midwife attendance. Infant health characteristics include percents born preterm, low birthweight, very low birthweight, and percent born in multiple births. Trend data for the number of births by State are also presented. METHODS: Descriptive tabulations of births of Hispanic origin of the mother for births that occurred from 1989 through 1995 are presented. RESULTS: The number of births born to Hispanic women has risen every year from 1989 to 1995. In addition in 1989 Hispanic women had 14 percent of births in the United States and in 1995 they represented 18 percent. While Hispanic women as a group continue to have higher fertility rates than non-Hispanics, Mexican women in particular have dramatically higher rates. While increases in early prenatal care were observed for all women in the United States, increases were particularly substantial for Hispanic women. The cesarean section rate has been dropping in the United States; yet while rates for Cuban women have also been dropping, the rates are nearly 50 percent higher than those for any other population subgroup.