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MURRAY — The last thing on Angelina and Roberto Castorena's minds Monday was the latest statistics on Utah's total fertility rate.
They were instead riveted by the images of their unborn child revealed by an ultrasound administered by Becky Greene, who is an ultrasound technician and manager of Fetal Fotos in the Salt Lake suburb of Murray.
The couple has two boys and they were anxious to learn whether their third child, due in September, would join the band of brothers or if the Castorena family would be welcoming a baby sister.
"This baby's a girl," said Angelina Castorena, brimming with excitement. "We were definitely ready for a girl."
Even in kid-rich Utah, where 1 in 5 Utahns is a school-age child, Angelina Castorena is a statistical outlier when it comes to Utah's total fertility rate, or TFR.
Total fertility rate refers to the number of children a woman has in her lifetime, expressed in terms of one per 1,000 population. It is different from the birth rate, which is the number of live births per thousand of the population in a given year.
Utah's total fertility was the nation's highest until 2016. It has been in decline in recent years, falling faster than the U.S. rate since 2009.
Currently, Utah's TFR is the fourth-highest nationally, behind South Dakota, North Dakota and Nebraska, according to the CDC's 2020 births report.
Teen, unintended pregnancies declining
Among those four states, Utah has the lowest age-specific fertility rate for 15- to 19-year-olds, indicating a decline in teen births, which researchers point to as a positive trend.
Compared to babies born to older mothers, babies born to adolescent mothers, particularly young adolescent mothers, are at higher risk of low birth weight and infant mortality, according to Utah's Public Health Indicator Based Information System.
"These babies are more likely to grow up in homes that offer lower levels of emotional support and cognitive stimulation, and they are less likely to earn a high school diploma. For mothers, giving birth during adolescence is associated with limited educational attainment, which in turn can reduce future employment prospects and earning potential," according to the public health data resource.
According to the records, Utah's birth rate per 1,000 females aged 15 to 19 dropped from 15.7 in 2016 to 10.7 in 2020.
"It's hard to argue that's a bad thing," said Emily Harris, senior demographer for the University of Utah's Kem C. Gardner Policy Institute.
Jessica Sanders, the University of Utah School of Medicine's director of family planning research, said in addition to a decline in teen births, there has been a reduction in unintended pregnancies in Utah, as well.
While population data does not reflect causality, national surveys indicate a delay in first intercourse and an increase in the use of contraception at first intercourse, she said.
At the same time, the use of highly effective reversible contraception, such as intrauterine devices and implants, is growing. Previously, those methods were not available to women who have not been pregnant before "so we've seen a large uptake over the past 10 years with those methods," Sanders said.
Utah has also had a number of initiatives to increase access to contraception, including HER Salt Lake, a partnership between the University of Utah's Family Planning Research Group and Planned Parenthood of Utah that provided contraception to more than 11,000 people between 2015 and 2017.
The partners have followed the participants' education and economic advances and reproductive life plans.
Researchers are also looking at how the program impacted Utah's fertility rate as well as maternal and child health outcomes, Sanders said.
Fertility and declining fertility can be "good or bad for lots of reasons," Harris said.
"The main thing is, we want women to have children if that's what they want to do. If there are societal and economic conditions that are making it harder for people who want to have children, that's a problem, right?" she said.
Why is the fertility rate dropping?
Again, the cause of Utah's declining total fertility rate is difficult to pinpoint, whether its economic hardship, sharply rising housing costs or cultural shifts in views of childbearing and marriage.
More Americans are postponing first marriage and growing numbers of adults ages 25 to 54 people are "unpartnered" — neither married nor living with a partner, according to a 2021 Pew Research Center analysis of 2019 census data.
Harris said while Utah's total fertility rate declined again, it did not decline faster than the U.S. rate. That's a first for the past decade.
"So, to me and other fertility experts, it signals a possibility that maybe Utah's fertility rate is about to stabilize. When we look at the births for most of 2020 and part of 2021, we don't actually see a significant decline in births at this point. It doesn't necessarily look like COVID-19 impacted births in Utah and that's a good thing, too. We don't have a full year's worth of data yet, but we have about nine months' worth of data to make that assessment," she said.
Sanders said HER Salt Lake investigators' follow-ups with their cohort during the pandemic revealed that "people felt more committed to their reproductive goals. Folks who wanted to become pregnant placed more importance on that. Likewise, folks that did not want to become pregnant or parents put much more importance on that, too," she said.
While some people during their fertile years might be willing to say, "Let's see what happens" under normal circumstances, "I think that these uncertainties probably pushed people into feeling like they wanted control over that," Sanders said.
Harris said trends over time indicate large economic recessions tend to impact major life decisions "whether that's buying a house, having a baby, moving somewhere. So for example, that the latest decline you've seen in fertility in Utah really started in 2009 right after the Great Recession, and we saw a fairly similar decline in fertility in the late '70s, early '80s."
Lessons from South Korea
Sojung Lim, director of the Yun Kim Population Research Laboratory at Utah State University, has researched how socioeconomic status in South Korea impacts married couples becoming parents and how it factors into second births in families.
South Korea has one of the lowest fertility rates in the world, reaching a record low of 0.98 in 2018, so understanding socioeconomic differentials in fertility has become an important social and policy issue, said Lim, also an associate professor of sociology at USU.
According to Lim's research, socioeconomically disadvantaged married couples tend to delay their transition to parenthood. Couples with high socioeconomic status are more likely than their counterparts with low economic status to have second births.
"If these patterns persist, they have important implications for the demographic process and social stratification," Lim wrote in her demographic research titled "Socioeconomic differentials in fertility in South Korea," published in May 2021 in the journal Demographic Research, a peer-reviewed open-access journal of population sciences.
Stable housing arrangements and the husband's employment security appear to be the most important factors for a married couple's fertility decisions, Lim found. The research also revealed that the wife's employment is negatively associated with both first and second childbirth, particularly among women who hold full-time, stable positions.
While cultural differences play a factor in Lim's findings, they point to the need for government and corporate policies that support working parents.
Lim's sister-in-law works for Samsung, a South Korean company that is one of the world's largest producers of electronic devices. Samsung offers on-site child care, which helps support Samsung's labor needs while giving parents peace of mind that their children are well cared for while they work.
"As a working mom, that little thing actually makes a huge difference," Lim said.
Samsung is a large global company with more resources than most but Lim said "decent-sized" companies could offer similar benefits if government incentives were available.
Falling fertility rates difficult to reverse
Americans tend to view child-rearing as a private responsibility so there is less inclination to institute family-friendly policies or practices, Lim said. The United States' total fertility rate is higher than other Western countries so "many people don't see that as a real issue."
Lim said she hopes that policymakers address the factor contributing to the decline in total fertility rate "before it gets too late."
Once a country declines to a low total fertility rate, "and we think of 1.3 as a threshold," Lim said, "it is really hard to reverse the trend. I don't see any countries that have been successful so far."
The impacts of a population with comparatively fewer young people to contribute to the workforce, tax base and otherwise help support the nation's elders are significant, particularly as seniors live longer.
In Japan, just 7% of the population was over age 65 in 1970 and now it's more than 20%, she said.
It is predicted that by 2040, the Japanese government will need to spend at least 20% of its gross domestic product for its social safety net policies, a number that will continue to grow as the senior population swells, Lim said.
Scholars speculate that means there will be less money available for other services funded by the government, such as defense, she said.
Lim said poverty among the elderly is a grave concern, particularly among women who spent less time in the workforce than their spouses, if any, which means they have smaller pensions or receive a portion of their deceased spouses' pensions.
"That's also why we should care about this individual impact," she said.
Children as a 'public good'
Projections indicate further declines in the total fertility rate will result in "severe consequences," Lim said.
It suggests a need to reframe the debate over social and economic policy, to view children and childbearing as a "public good," she said. Some scholars envision that in the future, there will need to be a shift to the approach of Nordic countries that consider childbearing and child care "more like a responsibility that should be shared."
In the United States, childbearing and child care are viewed as private choices, thus a personal responsibility.
As the impacts of a reduction in the total fertility rate come to bear, Lim said she believes those sensibilities will change.
"If you know that how severe the consequences of low fertility will be, then maybe you start to think of children more like a public good," she said. "It's really an investment in the future population, which has an immediate impact on you," who as an aging adult will be reliant on pensions, Social Security and Medicare.
"That means that we do need a younger generation to support you. It's not just about your neighbors' choice, it has impact on you," Lim said.
The Castorenas choose to take an optimistic view of their growing family.
Their daughter, whom they plan to name Alihea, was a surprise addition, said Angelina Castorena.
"Once we found out that we were having a third one, it was kind of a shock. But after a while, it wears off and you get excited. A baby's always a good thing. It's always a blessing," she said.
The couple's next happy event was sharing the good news with their boys, ages 4 and 2, the youngest born during the uncertainty of the COVID-19 pandemic.
"I think it'll go good," Angelina Castorena said. "The little one doesn't quite know what's going on yet but the older one, he wants a sister."