In 2024, Indiana averaged 11.6 live births per 1,000 people, according to data from the Indiana Department of Health.

But the differences among counties is stark.

Crude birth rates, or CBR, is based on a mother’s county of residence.

LaGrange County (18.9) topped the list with nearly three times the rate of Brown County (6.4), which ranked 92nd. Other counties with the highest rates included Adams (18.2), Daviess (17.6), Jay (15.1), and Marion (14.8).

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Dr. Jill Inderstrodt, assistant professor at the Indiana University Richard M. Fairbanks School of Public Health, quickly pointed out the high-fertility demographic shared by the top three counties.

“I definitely can tell you that the reason that Adams, Daviess, and LaGrange counties have the highest birth rate is because they have the highest population of Amish people,” she said.

Other counties with the lowest rates included Monroe (7.2), Crawford (8.6), Rush (8.7), and Warren (9.1). Inderstrodt noted Monroe County had a low infant mortality rate along with other factors missing from some of the more remote counties.

“Monroe County has more access to medical services, hospitals that have labor and delivery units, obstetric providers, where folks aren’t going to have to drive an hour to only get to an emergency room,” she said. “And Monroe County is overall a more educated population than the general population of Indiana. It also has a much lower percentage of Medicaid enrollees than the state does on average.”

Though Indiana and the U.S. saw an uptick in births in 2024 — and Indiana’s CBR was higher than the national rate of 10.6 — births in both the state and the nation have been declining since 2007 when it was at 14.1. In fact, older adults are expected to outnumber children in nearly half of Indiana’s counties by 2050, according to an article from the Indiana Business Research Center at Indiana University’s Kelley School of Business.

“The number of older adults will continue to grow as the youngest of the baby boomers continue to reach retirement age in the coming years,” wrote analyst Rachel Strange.

Cause and effect

Matt Kinghorn, senior demographer at Indiana Business Research Center, said the reasons for low CBRs in the Hoosier State and across the country are complex.

“You can’t point to one factor or even a handful of factors contributing to what is now approaching a two-decade decline in fertility rates in Indiana and across the U.S.,” he said. “A lot of it is changing priorities among young adults and changing views on parenting. But rising costs will certainly play a role and increased education — the more time spent in school, delaying marriage and starting a family.”

An aging population, coupled with a sustained trend of young adults migrating out of rural and mid-sized towns and cities, also leaves little opportunity to increase rates in many counties, according to Kinghorn.

“It’s not just declining fertility rates; it’s a declining number of people of childbearing age in these communities,” he said.

Inderstrodt observed that people are having fewer children overall because of economic reasons, and nonurban areas particularly are feeling the strain regarding the cost of living.

“Rural families are struggling. This is compounded by healthcare becoming more expensive and an impending loss of Medicaid for many poor families,” she said.

Kinghorn asserted continuously low CBRs can lead to a wide range of implications at the county, state, and national level, starting with declining school enrollments.

“We expect to see a decline in the size of our labor force, which is bad news for our employers. It impacts our prospects for economic growth in the future,” he said. “Then there’s the fiscal health of our state and local governments. How do we keep maintaining the same level of services, and how do we support the growing ranks of retirees and the programs that they depend on: Social Security, Medicare, etc.?”

As a cautionary example of declining school enrollments, Inderstrodt mentioned South Korea, where thousands of schools have closed because the birth rate is so low.

“A lot of that is thought to be due to women working and the lack of support for families and women in particular, which disincentivizes having more children or having children at all. In a lot of cases, if both parents want to work, there’s not a support system to make that happen,” she said.

Counties with persistently higher CBRs have a different challenge: planning for and addressing rapid growth.

“How do you make sure that you have growing school systems and the right infrastructure and programs needed to support a growing community?” said Kinghorn.

Boosting births; lowering mortality

While the Trump administration has announced initiatives to increase access to in vitro fertilization and proposed $5,000 “baby bonuses” for new mothers, the state of Indiana has focused on measures to support growing families such as strengthening paid parental leave for state employees, allowing eligible state employees to bring infants to work for the first six months, and focusing on affordability for all residents.

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“I’ve heard across all 92 counties that there’s more work to be done to make life affordable. Hoosiers need solutions that help make ends meet, and my 2026 agenda is focused on tackling these kitchen table issues,” said Indiana Gov. Mike Braun in a news release.

He promised in his State of the State address in January to address childcare in 2027 — a key hurdle that is likely deterring some from having kids. And Braun recently put an additional $200 million to childcare vouchers for low-income Hoosiers.

In Indianapolis, a pilot program called the BIRTH Fund (Building Independent Resilient Thriving Homes) aims to support low-income expectant mothers living in zip codes with the highest infant mortality rates.

Benjamin Tapper, chief diversity and equity officer for the city, said 150 mothers enrolled in the endeavor will receive direct cash assistance over three years. The Regenstrief Institute plans to conduct surveys and study electronic health record data to evaluate birth outcomes.

“Things like birth rates, maternal health, mental health, a lot of times we look at these as separate, distinct issues, but they’re all interconnected,” Tapper said. “To sit across from a mom who’s benefiting from this program, who’s getting the cash every month and to see the baby that’s been born and is healthy, hopefully in some small part because of this program, I can’t substitute that for anything.”

As for addressing specific causes for low birth rates in Indiana counties, Inderstrodt emphasized the need for more granular data to draw definite conclusions.

“There’s a lot we don’t have here,” she said. “We’d want to look at all of this data by race. We’d want to look at it by education … Are births happening increasingly to older moms, to teen moms? That sort of data would give us a better idea of what’s happening. The birth rate doesn’t always paint the whole picture.”

Indiana Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Indiana Capital Chronicle maintains editorial independence. Contact Editor Niki Kelly for questions: info@indianacapitalchronicle.com.