The CDC says a country’s birth rate is one of its most important metrics, determining population growth and impacting decisions about health care, education and the economy.
In women younger than 35, who are responsible for the majority of births in the U.S., birth rates are decreasing, partly due to changing social and cultural norms, but also because of an increase in education and contraceptive use.
For women older than 35, there has been an increase in live births. The CDC attributes this to a rise in reproductive technology providing more options for women who want to postpone childbirth until later in life.
But numbers aside, fertility is a deeply personal topic for many, and one that until recently wasn’t discussed outside the home, much less shared on something as public as social media. We spoke with local experts and advocates in the interest of furthering that conversation.
Dr. Dean Moutos, reproductive endocrinologist and medical director at Arkansas Fertility and Gynecology, co-founded his practice in 2004 after 12 years at UAMS and now helps patients navigate fertility challenges.
“In general, just across the board, the prevalence of infertility is about 12 to 15%,” Moutos says.
He points out that, if there are no other obvious problems like pelvic surgery, irregular periods or concerning medical or gynecologic history and the patient is less than 35 years old, the recommendation is to try for one year to get pregnant through regular, unprotected intercourse.
“Reproduction in humans is relatively inefficient,” Moutos says. “Even women in their prime, their chance of getting pregnant each month when they’re at their peak fertility is about 25%. It may happen the first cycle, but it can take several months.”
He cautions that as women get older, that one-year timeframe shortens to six months because of age-related decline in fertility and egg quality and numbers.
STIGMA & SHAME
Michelle Barnes is the founder and executive director of Real Images, a Little Rock-based nonprofit dedicated to ensuring young girls and women are empowered and educated to become the healthiest versions of themselves through programs, scholarships, service and with events like its Phenomenal Women Luncheon and the #SlashTheShame Power Walk and Run.
At 18, Barnes was diagnosed with endometriosis and polycystic ovary syndrome (PCOS) and for 20-plus years has been dealing with everything that comes with it, including concerns over fertility.
“I felt really ashamed because everything was on a timeline,” Barnes says. “I literally was told at 18, ‘You’ve got to have your first baby by 25. Your fertility is going to decrease the older you get.’ And so I just felt like 25 was just like, dun, dun, dun, you know?”
Through her nonprofit’s work, she learned these diagnoses were more common than she thought. At the end of 2021, she finally told the board at Real Images that she wanted to do something regarding endometriosis, PCOS and women with fertility issues.
#SlashTheShame was born in September of 2022. Gov. Asa Hutchinson proclaimed that month PCOS Awareness Month in Arkansas, and by all accounts, the race was a professional success for Real Images and Barnes.
“I had just gone to my annual exam, nothing really was going on. October comes around, and I feel a little nodule in my belly button. Come to find out my endometriosis came back, and it came back in my belly button, which is very rare,” says Barnes, who is still recovering from surgery.
“I’m turning 40 soon and I still do not have any children. I still haven’t given up. I'm not getting a hysterectomy right now, but I know that's going to be something that’s going to be in my future.”
Barnes found that when she talked about it, more women told her “me too,” bringing about a sense of community, diminishing the stigma that comes from talking about conditions that affect women.
“When we talk about women and our wombs, people cringe,” Barnes says. “You’re not supposed to talk about that. But you have women who are really struggling with PCOS, and they are more likely to have depression and hormone changes and all of these things.”
Both Moutos and Barnes suggest seeing a specialist if a woman has been actively trying to get pregnant, but hasn’t after one year, has a diagnosis that affects reproduction or if something about her body just doesn’t seem right.
“The treatment could be something as simple as placing you on medication to regulate ovulation. It could be correcting other hormonal imbalances. Sometimes it’s surgery to treat endometriosis. Sometimes it’s male factors, so the treatment really depends on what the underlying cause is,” says Moutos, whose practice offers artificial insemination and, in patients who have insurmountable problems, in vitro fertilization.
Getting pregnant is not the finish line. Regular prenatal care by a medical professional, healthy habits and vitamins with folic acid are best practice according to the American College of Obstetricians and Gynecologists, and there are other things a mother can do to help prevent difficulties during pregnancy.
The Arkansas Department of Health, UAMS and national campaign Count the Kicks have recently teamed up to help prevent stillbirth. Using an evidence-based campaign to educate expectant parents about the importance of tracking a baby’s movements daily in the third trimester of pregnancy, these groups have a goal of preventing 86 stillbirths each year.
For Arkansas families, one in every 138 pregnancies end in stillbirth, and families in the state are 10 times more likely to lose a baby to stillbirth than to SIDS. Nearly 30% of stillbirths can be prevented through tracking a baby’s movements daily starting at 28 weeks.
By using the Count the Kicks free app, expectant parents can increase the chances of their baby arriving safely with a simple, noninvasive way to monitor their babies’ well-being every day.
Every year in the U.S., approximately 700 women will die from childbirth complications and 22,300 babies will be stillborn. The risk is even greater for Black women who are twice as likely to lose a baby to stillbirth and three times more likely to die of pregnancy complications than their white friends.
Share is the largest perinatal bereavement support group in the country and Baptist Health Medical Center in Little Rock sustains a local chapter.
Pregnancy and infant loss is something no family expects to experience, and the support of others who have had similar experiences can often help coping with and processing the loss.
Patients who have received a life-limiting diagnosis can receive help in preparing for their baby’s birth. While in the hospital, patients and their families receive compassionate care from nurses and staff on what most describe as the worst day of their life.
Nurses provide keepsakes like footprints, personalized bracelets, clothing and blankets appropriate for the size of the infant, detailed plaster molds, a personalized plate created by Mamie’s Poppy Plates and photos by Now I Lay Me Down to Sleep.