US-Mexico border fertility and the Hispanic paradox

Background: The “Hispanic paradox” has been described chiefly as the surprisingly low mortality of US Hispanics despite their low socioeconomic status. This has led to extensive discussion of the reliability of Hispanic mortality data. Information on Hispanic birth outcomes, particularly for border Hispanics, may provide additional evidence for the paradox.

Methods: 2004 birth and death certificate data provide information for the 44 border counties nearest the border for fertility, access to prenatal care, complications of pregnancy, and birth outcomes. Results are presented for Hispanics and non-Hispanic Whites and compared to data for border states and the nation.

Results: The total fertility rate for border Hispanics was 75% higher than for border non-Hispanic Whites and far above the national rate. Risk factors such as low income, low education and access to care were worst for border Hispanic mothers, exceeding risk factor levels for border non-Hispanic Whites and all race/ethnicity groups nationally; smoking rates were much lower for border Hispanics. Despite these problems, birth outcomes for border Hispanics for low birth weight (6.8%), preterm delivery (9.9%) and infant mortality (4.6/1000) were similar to rates for border non-Hispanic Whites and lower than national figures.

Conclusion: Border Hispanic women are among the most disadvantaged nationally for many risk factors, but their birth outcomes are surprisingly good. This provides further evidence for the “Hispanic paradox”, evidence that is not subject to many of the reliability issues associated with mortality data. Possible explanations include low smoking rate, good maternal nutritional stores, community support and others.