Reversing Minnesota's declining birthrate is costly — and controversial

Minnesota appears stuck in a vortex of declining births.

The 61,715 children born in the state last year represent a 16% decline from a peak of 73,735 births in 2007, according to birth data from the Centers for Disease Control and Prevention. And the state may see another drop in 2024.

The pattern of declining births is consistent across racial and ethnic groups, and it's visible everywhere from the state's urban core to its rural corners.

Couples are starting families at later ages, when they may be dealing with obesity or health problems that increase pregnancy risks for mothers, reducing the number of children they are likely to have over time.

More women are also choosing not to get pregnant, at least for now, because they are anxious about costs, access to child care, and the political and environmental futures in which they would raise children, said Kathrine Simon, an Allina Health midwife.

Requests for new or renewed forms of long-acting birth control have increased after elections in which women believed new leaders would curtail their access, she added: "We did see women coming in who had a product that would have lasted for another year, perhaps two, asking for that to be replaced."

Births among Minnesotans 15 to 19 have fallen 33% since 2016 — a hard-won outcome following public health campaigns to convince teens that unplanned pregnancies can hurt their futures. But births also are declining among women 20 to 34, despite a generational uptick in young adults in their childbearing years.

The decline will accelerate in the next decade when millennials exit that age range and the smaller Generation Z enters it, said Susan Brower, Minnesota's state demographer. "That's going to have kind of echo effects into the future."

The trend has already had an impact, forcing some small hospitals to close their delivery units, and will eventually hit Minnesota in its pocketbook, Brower said.

Over time, fewer children will result in fewer workers — from doctors to farmers to bankers to builders. That will mean fewer people making Target runs, buying Vikings tickets and paying taxes to keep up Minnesota's infrastructure.

"This is playing into the longer-term trajectory of how our economy works," Brower said. "Eventually, and it's already happening, we won't be able to find people to do some of these essential services ... to keep our economy and our society going."

Minnesota had the 15th-sharpest decline among states in births between 2016 and 2023. Only Tennessee and South Carolina reported childbirth gains in that timeframe.

Reversing the baby bust is an emerging national concern, but no solutions are easy.

Boosting fertility

Optimizing the health of women who want children is one strategy. Childbirths have declined as obesity has surged, along with related conditions such as diabetes and hypertension that reduce the odds of getting pregnant.

Births among moderately or severely obese women have increased more than 10% in Minnesota since 2016, showing that it is possible, especially with good prenatal care. But behind those births is a growing population of women struggling to get pregnant because of weight-related health issues, said Dr. Rachel Pilliod, an Allina Health maternal-fetal medicine specialist.

"Women can have different body sizes and types and have a very successful outcome to their pregnancy," she said, "but obesity can make achieving pregnancy more difficult."

State lawmakers have considered strategies to increase childbirths. They approved $210,000 last session to promote the "Count the Kicks" campaign, which could reduce the estimated 360 stillbirths in the state each year by teaching women to track fetal movements.

They also debated mandating insurance coverage of in-vitro fertilization (IVF), an infertility procedure that fertilizes eggs in optimal lab conditions before transferring them back in women. The number of children born through IVF in Minnesota has doubled over the past decade, reaching 1,632 last year, but the cost has prevented infertile couples from seeking the procedure or trying again if initial attempts fail.

Adding incentives

Births increased slightly in Denmark after a travel agency's "Do It For Mom" campaign, which encouraged grandmothers to pay for sunny, sexy vacations so their adult children could produce grandchildren.

The agency even promised free baby supplies for parents who conceived during travels. The cause-effect link was dubious, though, and experts argued that Minnesota's decline has more to do with economic uncertainties than opportunities for sex.

Danielle Sonnek, 34, had her second child this year, but rising costs could dictate when, or if, she and her husband have the third they always planned. Health insurance is costly for the Easton, Minn., couple because Sonnek's husband farms and she is a self-employed mental health specialist who works from home. Sonnek still pays for part-time child care 10 miles away in Wells.

"You can't exactly do therapy with a baby at home," she said.

Some countries have responded with monetary incentives. Poland tried to boost childbirth by paying almost $200 per month per minor child to qualifying families under its 500+ program. U.S. politicians such as Vice President-elect JD Vance have backed the idea, but research has questioned whether the expensive investment pays off. In some cases, it might motivate couples to start earlier, but not have more children. Opponents also question the social implications of monetizing motherhood.

Affordable child care is a particular concern in Minnesota, where nearly 60% of opposite-sex married couples have both spouses working. The national rate is 52%. The monthly cost for one toddler ranges from $700 to $1,300 for licensed care in Minnesota, at least when parents can find it. Access has been a challenge as the number of licensed family child care providers has plummeted over the past decade.

St. Paul this year proposed increasing taxes to make child care free for a small number of families in the city, but the measure was voted down on Tuesday amid disputes among city leaders about whether it would be affordable and effective.

Migration

Attracting young families from other states is another way to increase births. States have always competed for tourists and businesses, but increasingly they are competing for young adults who can pad their employment base. Explore Minnesota remains primarily a travel resource, but has added marketing materials for families pondering moves, and has promoted a survey showing Minnesota as a top-three state for raising children.

However, Minnesota is exporting more college students than it attracts, according to the latest U.S. census data. And some of those young adults don't return. The University of Minnesota has increased recruiters and marketing efforts to make secondary education in the state more enticing.

Scholarships and tuition forgiveness programs are mostly targeting the immediate need for nurses and other badly needed professionals in Minnesota, but they could have downstream benefits, Brower said. "The secondary effect is that you would have more young people in the state, and so those births would stay higher."

Immigration

International immigration has sustained growth in Minnesota's population and employment base for decades. The Hmong population that started with refugees fleeing Southeast Asia in the late 20th century has tripled in Minnesota since 2000.

If not for immigrants who started new families in Minnesota, the state's decline in births would be sharper, Brower said. "You compare that to, say, Japan, that doesn't have the same level of immigration, and they are in that kind of downward spiral of fewer and fewer births."

Even that trend has shifted. Births to foreign-born mothers predictably declined during the COVID-19 pandemic, but they haven't rebounded. Births in Minnesota are down 14% among U.S.-born women since 2016, but also down 3% among immigrants.

Brower said immigration, nonetheless, remains the most immediate strategy, because a change in cultural attitudes about childbirth can't be manufactured overnight.

"It's much less likely we would see a turnaround in people's preferences, generally," she said. "Just the uncertainty of the future in terms of economics, in terms of stability, can lead to lower birth preferences ... or that we don't know what our planet will look like in 15 years."