Shifting Birth Patterns, Rising Needs: Why SENT’s Maternal Health Work Matters

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The recent analyses published by the Census Bureau offer a sobering glimpse into evolving patterns of fertility and birth in the United States. In “Childlessness on the Rise — Except for Women Ages 45 to 50,” the Census shows that between 2014 and 2024, the share of women who have never had a child has increased sharply among women in their 20s and early 30s. For women aged 45–50, childlessness modestly declined (from 16.7% in 2014 to 14.9% in 2024); in younger cohorts, childbearing is being delayed or declined.

On the broader fertility front, the Census’s fertility topic overview describes how data sources (CPS, SIPP, ACS) are used to monitor fertility trends over time and across geographies, including age‐specific measures. This data indicates that fertility in the U.S. is increasingly dependent on age, region, and social or economic background.

The deeper health data support this shift. The National Center for Health Statistics reports that in 2024, the general fertility rate (births per 1,000 women aged 15 to 44) declined by 1% (to 53.8) from 2023, despite a slight increase in the absolute number of births (~3,628,934 births). Birth rates fell for women ages 15–34, held steady for women 35 to 39, and rose modestly for women 40‑44. Meanwhile, Medicaid’s share of births declined overall and across most age groups.

Taken together, these patterns indicate several broad trends: an increasing number of women postponing childbearing, fewer births among younger women (or women choosing not to have children), and somewhat higher birth rates among older reproductive ages. The result is a shifting demographic environment around pregnancy and maternity.

Why SENT’s Maternal Health Program Matters — and Will Become Even More Critical

The statistics above could suggest that “fewer births” means “less demand for maternal health services.” But that interpretation would be misleading. In fact, the changing fertility landscape places greater, not less, urgency on robust, high‑quality maternal health support. Here’s why SENT’s model is well aligned with these emerging needs:

1. More complex maternal risk profiles

As women delay childbearing, pregnancies often occur at older maternal ages, which tend to carry increased risks (e.g., higher rates of hypertensive disorders, gestational diabetes, need for cesarean delivery, and other complications). The Census and health data show rising birth rates in the 40‑44 age band, and stability or decline among younger women, underscoring that the ages at which women bear children are shifting upward.

When pregnancies are higher risk, enrollees benefit from more intensive monitoring, increased access to specialty care, stronger continuity of care systems, and better upstream support. SENT’s comprehensive, neighborhood‑based, one‑stop model is designed to meet exactly that need: caring for mothers before, during, and after pregnancy in an integrated fashion.

2. Gaps in Medicaid coverage & rising complexity

The decline in the proportion of births covered by Medicaid (across nearly all maternal age groups) suggests a shifting payer mix and possibly more gaps in coverage or cost burdens on families. As coverage becomes more fragmented, continuity and wraparound support (for insurance, social services, referrals) are more essential. SENT’s pilot, conducted in partnership with the Kansas Department of Health and Environment and the Topeka Doula Project, is specifically designed to enhance maternal and infant health outcomes, particularly among high-risk populations.

In addition, even when coverage exists, adverse maternal outcomes (including mortality and morbidity) remain concentrated in communities with higher social risk exposures (poverty, structural barriers, health disparities). Thus, having a strong, place‑based maternal health infrastructure helps reduce these inequities.

3. Postpartum & interpregnancy care is more important than ever

When birth rates fall overall, each birth—and each mother’s health trajectory—carries greater weight. Investing in postpartum care, mental health, chronic disease prevention, and planning for future pregnancies or childbearing becomes critical for ensuring long-term maternal well-being. SENT’s model emphasizes care beyond delivery, not just during pregnancy.

Because fewer births may lead to sparser health system attention in some locales, organizations like SENT will play a vital role in maintaining continuity of care, advocating for maternal health, and preventing a “hollowing out” of services in communities where births are less frequent.

4. Better outcomes, lower costs, stronger resilience

With shifting fertility patterns, health systems may underestimate or underinvest in maternal health infrastructure, especially in areas of declining birth rates. That creates a risk of underpreparedness when demand arises. In contrast, SENT’s proactive investment in maternal health — utilizing data, neighborhood-based care, and wraparound services — helps reduce severe adverse outcomes, thereby saving costs and improving equity.

Moreover, because SENT’s approach is holistic and neighborhood-rooted, it can be more adaptive in regions witnessing fluctuating birth demand. The model is less fragile than one that depends solely on volume or centralized hospital systems.

The Role of Housing and Economic Mobility

Access to stable housing and pathways to economic mobility are also deeply connected to the fertility and maternal health patterns described above. Families who struggle with housing insecurity or limited financial opportunity often face higher stress levels, poorer nutrition, inconsistent prenatal care, and greater difficulty accessing safe birthing options. These social determinants of health can amplify the risks already present in higher age pregnancies or in communities where Medicaid coverage is declining. SENT’s work in affordable housing, workforce development, and neighborhood stabilization, therefore, supports maternal health in a direct and measurable way. By ensuring that mothers are not only medically supported but also stably housed and on a path toward greater economic stability, SENT strengthens the conditions that make healthy pregnancies and positive maternal outcomes possible.

In Sum

The Census Bureau’s recent findings make clear that fertility is in flux. Delays in childbearing, declines in younger women’s birth rates, and growing birth rates in older age brackets all signal that pregnancies in the coming years will likely carry more complexity, greater disparities, and more opportunity for intervention.

In that context, SENT’s maternal health program is not an optional add-on — it is a forward‑looking necessity. By focusing on comprehensive, neighborhood‑embedded care before, during, and after pregnancy, SENT is positioning itself to meet the changing maternal health landscape, reduce inequities, and safeguard healthier mothers and babies in the years ahead.

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