NCHS Data Brief ■ No. 297 ■ January 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Urban and Rural Variation in Fertility-related Behavior

Among U.S. Women, 2011–2015

Kimberly Daniels, Ph.D., Gladys M. Martinez, Ph.D., and Colleen N. Nugent, Ph.D.

Key findings

Data from the National 

Survey of Family Growth

● Among women aged 18–44,

the average age at first sexual

intercourse was younger for

women living in rural areas

(16.6) compared with women

living in urban areas (17.4).

● Similar percentages of

women living in urban and 

rural areas were currently 

married, cohabiting, or never 

married. A higher percentage 

of women living in rural areas 

were formerly married.

● A higher percentage of

women living in rural areas 

had at least one birth compared 

with women in urban areas. 

● A higher percentage of

women living in rural areas 

used one of the most effective 

methods of contraception (e.g., 

contraceptive sterilization or 

intrauterine device) at last 

sexual intercourse in the past 

year compared with women in 

urban areas.

In 2010, one-fifth of the U.S. population lived in rural areas (1). There is 

known variation in social, demographic, and health characteristics across 

urban and rural residence (1–3). Recent National Center for Health Statistics 

(NCHS) reports show higher teen birth and infant mortality rates in rural 

counties than in urban counties (4,5). Less is known about urban and rural 

variation in fertility-related behavior, such as sexual activity and contraceptive 

use. Using National Survey of Family Growth (NSFG) data from 2011 through 

2015 for women aged 18–44, this report describes urban-rural differences in 

first sexual intercourse, marital and cohabitation status, number of births, and 

contraceptive use based on residence at the time of interview.

Keywords: metropolitan • births • marriage • cohabitation • National Survey 

of Family Growth

On average, women living in rural areas had their first sexual 

intercourse earlier than women living in urban areas.

Figure 1. Percentage of women who had their first sexual intercourse by age 16 and by age 18 

among women aged 18–44, by urban and rural residence: United States, 2011–2015 

1

Significant difference across residence (p < 0.05). 2

The mean age at first sexual intercourse among women who have ever had intercourse was 17.4 for those in urban areas and 

16.6 for those in rural areas. Significant difference across residence (p < 0.05). 

NOTES: Residence is measured at the time of interview. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/

databriefs/db297_table.pdf#1.

SOURCE: NCHS, National Survey of Family Growth, 2011–2015. 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 297 ■ January 2018

■  2  ■

● Among women aged 18–44, a higher percentage of women living in rural areas (51.2%) 

had their first sexual intercourse by age 16 compared with women in urban areas (41.7%) 

(Figure 1). 

● By age 18, 79.6% of women living in rural areas had ever had sexual intercourse, which is 

higher than the percentage for women living in urban areas (68.6%). 

● The mean age at first sexual intercourse was younger among women in rural areas

(16.6 years) compared with women in urban areas (17.4 years). 

Similar percentages of women in urban and rural areas were currently 

married, cohabiting, or never married, while a higher percentage of women 

living in rural areas were formerly married. 

● About 40% of women living in both urban and rural areas were currently married to an 

opposite-sex spouse (Figure 2). 

● The percentage of women currently cohabiting with an opposite-sex partner was similar for 

women in urban (15.7%) and rural (18.6%) areas.

● A higher percentage of women living in rural areas were formerly married but not currently 

cohabiting (11.6%) compared with women living in urban areas (8.7%).

Figure 2. Percent distribution of current marital and cohabitation status among women aged 18–44, by urban and rural 

residence: United States, 2011–2015

1

Significant difference across residence (p < 0.05).

NOTES: Residence is measured at the time of interview. Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db297_table.pdf#2.

SOURCE: NCHS, National Survey of Family Growth, 2011–2015. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 297 ■ January 2018

■  3  ■

● Similar percentages of women living in urban and rural areas were never married and not 

currently cohabiting (33.6% and 29.1%, respectively).

A higher percentage of women in rural areas had at least one birth, two 

births, and three or more births and had a higher average number of births.

● A higher percentage of women living in urban areas had no births (41.6%) compared with 

women living in rural areas (30.3%). A higher percentage of women living in rural areas had 

any births (69.7%) compared with women in urban areas (58.4%) (Figure 3). 

● A similar percentage of women in urban areas had one birth (18.4%) compared with women 

in rural areas (19.2%).

● A higher percentage of women living in rural areas had two births (25.7%) compared with 

women living in urban areas (20.9%).

● A higher percentage of women living in rural areas had three or more births (24.8%) 

compared with women living in urban areas (19.0%).

● The average number of births among women aged 18–44 living in rural areas (1.56) was 

higher than the average for women in urban areas (1.28). 

Figure 3. Percent distribution of number of births to women aged 18–44, by urban and rural residence: United States, 

2011–2015

1

Significant difference across residence (p < 0.05). 2

The mean number of births for women in urban areas was 1.28 and 1.56 for rural areas. Significant difference across residence (p < 0.05).

NOTES: Residence is measured at the time of interview. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db297_table.pdf#3.

SOURCE: NCHS, National Survey of Family Growth, 2011–2015. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 297 ■ January 2018

■  4  ■

A higher percentage of women in rural areas used one of the most effective 

methods of contraception at last sexual intercourse in the past year.

● Among women aged 18–44 who had sexual intercourse in the past year, similar percentages 

of women in urban and rural areas used no method of contraception at last sexual 

intercourse in the past year (21.0%) (Figure 4).

● A higher percentage of women in urban areas used a less effective (e.g., condom or 

withdrawal) (25.4%) or moderately effective (e.g., oral contraceptive pill or injectable) 

(23.3%) method of contraception compared with women in rural areas (18.6% and 19.6%, 

respectively).

● A higher percentage of women in rural areas used one of the most effective methods of 

contraception (e.g., contraceptive sterilization or intrauterine device) (40.8%) compared 

with women in urban areas (30.4%).

Figure 4. Percent distribution of contraceptive method use at last sexual intercourse in the last 12 months among women 

aged 18–44, by urban and rural residence: United States, 2011–2015 

1

Significant difference across residence (p < 0.05).

NOTES: Residence is measured at the time of interview. Less effective methods of contraception include condom, withdrawal, fertility awareness-based methods, 

female condom, foam, jelly, suppository, emergency contraception, and other methods. Moderately effective methods include oral contraceptive pill, injectable, 

contraceptive patch, contraceptive ring, and diaphragm. Most effective methods include female or male sterilizing operation or sterility, contraceptive implant, and 

intrauterine device. Women who used more than one method of contraception were classified by the method that was most effective at preventing pregnancy. 

Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db297_table.pdf#4.

SOURCE: NCHS, National Survey of Family Growth, 2011–2015. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 297 ■ January 2018

■  5  ■

Summary

This report describes similarities and differences in age at first sexual intercourse, current marital 

and cohabitation status, number of births, and contraceptive use among women aged 18–44 

by urban and rural residence at the time of interview. On average, women living in rural areas 

had their first sexual intercourse at younger ages than women living in urban areas. Similar 

percentages of women in urban and rural areas were currently married, cohabiting, or never 

married. A higher percentage of women living in rural areas were formerly married compared 

with women in urban areas. Women living in rural areas were more likely than women living in 

urban areas to have had any births and had a higher average number of births. Among women 

aged 18–44 who had sexual intercourse in the past year, a higher percentage of women living 

in rural areas used one of the most effective methods of contraception at their last intercourse 

compared with women in urban areas.

Definitions

Age at first sexual intercourse: The NSFG recode VRY1STAG indicates the age the respondent 

first reported having vaginal sexual intercourse with a male partner. This information is presented 

as the percentage who had sexual intercourse by age 16 and by age 18. Mean ages at first sexual 

intercourse are also presented for women who have had sexual intercourse.

Contraceptive use: The NSFG recode METH12M1–4 indicates contraceptive method use at last 

sexual intercourse in the past year. For this report, methods were grouped into the following four 

categories based on effectiveness at preventing pregnancy: no method, less effective method 

(i.e., condom, withdrawal, fertility awareness-based methods, female condom, foam, jelly, 

suppository, emergency contraception, and other methods), moderately effective method (i.e., oral 

contraceptive pill, injectable, contraceptive patch, contraceptive ring, and diaphragm), and most 

effective method (i.e., female or male sterilizing operation or sterility, contraceptive implant, and 

intrauterine device) (6). Women who used more than one method of contraception were classified 

by the method that was most effective at preventing pregnancy. Women using no method of 

contraception may not necessarily be at risk of an unintended pregnancy, because they could be 

pregnant, postpartum, or seeking a pregnancy.

Marital or cohabitation status: The NSFG recode RMARITAL refers to the respondent’s marital 

or cohabiting status at the time of interview with regard to opposite-sex partners. In this report, 

marital status is based on the respondent’s current status regardless of their previous marital 

status (e.g., if a respondent was formerly married and cohabiting at the time of interview, they are 

classified as cohabiting in this report). 

Number of births: The NSFG recode PARITY indicates the total number of live births the woman 

has had in her lifetime at the time of interview. 

Urban-rural residence: The NSFG recode METRO categorized the respondent’s place of 

residence at the time of interview, which was identified as a principal city of a metropolitan 

statistical area (MSA), other MSA, and not MSA. Principal city of MSA and other MSA were 

classified as urban residence, and not MSA was classified as rural residence. The respondent’s 

address was classified according to 2010 Census population counts using the Office of 

Management and Budget definitions released in December 2009 (7). 
NCHS Data Brief ■ No. 297 ■ January 2018

■  6  ■

Data sources and methods

This report is based primarily on interview data from 10,096 women aged 18–44 in the combined 

2011–2013 and 2013–2015 NSFG public-use data files. Figure 4 is based on data from the 

2011–2013 and 2013–2015 files on 8,382 women aged 18–44 who had sexual intercourse in the 

last year.

NSFG is a nationally representative survey of women and men aged 15–44 in the U.S. household 

population. It gathers data on fertility, cohabitation, marriage, divorce, infertility, use of 

contraception, and general and reproductive health. More information is available on the NSFG 

website at: https://www.cdc.gov/nchs/nsfg/index.htm. 

As noted above, urban-rural residence was measured at the time of interview. Some of the 

outcomes presented in this report occurred when the woman lived in another geographic location. 

Limited sensitivity analyses were conducted to better align the timing of the outcome and the 

measurement of residence, and results suggest similar findings. For example, restricting the 

analysis of timing of first intercourse to women aged 15–24 so residence was measured closer in 

time to average first sexual intercourse, also showed younger ages at first intercourse for women 

living in rural areas compared with women living in urban areas. 

The data presented in this report are bivariate associations that may be explained by other factors. 

For example, age differences between the two groups could explain differences in the outcomes. 

However, comparisons of the age distributions of urban and rural women in this report suggest 

that the distributions are similar. In addition, variation in intentions for future childbearing and 

other factors may explain differences in contraceptive use (8). 

Statistics for this report were produced using the SURVEY procedures in SAS software version 

9.4. Percentages were compared using two-tailed t tests at the 5% level. No adjustments were 

made for multiple comparisons. The data presented in this report are bivariate associations 

that may be explained by other factors included and not included in this report. NCHS data 

presentation standards for proportions were followed in this report (9).

About the authors

Kimberly Daniels, Gladys M. Martinez, and Colleen N. Nugent are with the National Center for 

Health Statistics, Division of Vital Statistics, Reproductive Statistics Branch.
NCHS Data Brief ■ No. 297 ■ January 2018

■  7  ■

References

1. U.S. Census Bureau. Measuring America: Our changing landscape. 2016. Available from:

https://www.census.gov/library/visualizations/2016/comm/acs-rural-urban.html?CID=acs-ruralurban.

2. Meit M, Knudson A, Gilbert T, Yu AT, Tanenbaum E, Ormson E. et al. The 2014 update 

of the rural-urban chartbook. Rural Health Reform Policy Research Center. Bethesda, MD. 

2014. Available from: https://ruralhealth.und.edu/projects/health-reform-policy-research-center/

pdf/2014-rural-urban-chartbook-update.pdf.

3. CDC. Rural health. Available from: https://www.cdc.gov/ruralhealth/.

4. Hamilton BE, Rossen LM, Branum AM. Teen birth rates for urban and rural areas in the 

United States, 2007–2015. NCHS Data Brief, no 264. Hyattsville, MD: National Center for 

Health Statistics. 2016. Available from: https://www.cdc.gov/nchs/data/databriefs/db264.pdf. 

5. Ely DM, Driscoll AK, Mathews TJ. Infant mortality rates in rural and urban areas in the 

United States, 2014. NCHS Data Brief, no 285. Hyattsville, MD: National Center for Health 

Statistics. 2017. Available from: https://www.cdc.gov/nchs/data/databriefs/db285.pdf. 

6. Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar MS. Contraceptive 

technology. 20th revised ed. New York, NY: Ardent Media. 2011.

7. Office of Management and Budget. Bulletin No. 10–02: Update of statistical area definitions 

and guidance on their uses. Available from: https://www.whitehouse.gov/sites/whitehouse.gov/

files/omb/bulletins/2010/b10-02.pdf. 

8. Daniels K, Daugherty J, Jones J, Mosher WD. Current contraceptive use and variation by 

selected characteristics among women aged 15–44: United States, 2011–2013. National Center 

for Health Statistics. National Health Statistics Reports; no 86. 2015. Available from: https://

www.cdc.gov/nchs/data/nhsr/nhsr086.pdf.

9. Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzalez JF, et al. National Center 

for Health Statistics data presentation standards for proportions. National Center for Health 

Statistics. Vital Health Stat 2(175). 2017. Available from: https://www.cdc.gov/nchs/data/series/

sr_02/sr02_175.pdf.
NCHS Data Brief ■ No. 297 ■ January 2018

Suggested citation

Daniels K, Martinez GM, Nugent CN. 

Urban and rural variation in fertility-related 

behavior among U.S. women, 2011–2015. 

NCHS Data Brief, no 297. Hyattsville, MD: 

National Center for Health Statistics. 2018.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Vital Statistics

Delton Atkinson, M.P.H., M.P.H., P.M.P., 

Director

Hanyu Ni, Ph.D., M.P.H., Associate Director 

for Science

For e-mail updates on NCHS publication 

releases, subscribe online at: 

https://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

Internet: https://www.cdc.gov/nchs

Online request form: https://www.cdc.gov/info

ISSN 1941–4927 Print ed.

ISSN 1941–4935 Online ed.

DHHS Publication No. 2018–1209

CS287619

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 4551, MS P08

Hyattsville, MD 20782–2064

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

For more NCHS Data Briefs, visit:

https://www.cdc.gov/nchs/products/databriefs.htm.

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284