Since the most recent peak in the total fertility rate (the estimated number of lifetime births expected per 1,000 women) in 2007, the United States has experienced a decreasing total fertility rate and an increasing mean, or average, age of mothers at first birth (1-4). Previous research shows rural areas have persistently higher fertility and worse birth outcomes compared with metropolitan (metro) areas (2,5-8). This report describes trends and differences in total fertility rates and mean maternal age at first birth overall, and by race and Hispanic origin, between rural and small or medium metro, and rural and large metro counties, from 2007 through 2017.
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