While the standard image of the nuclear family with two parents and 2.5 children has persisted in the American imagination, the number of births in the U.S. has steadily been decreasing since 1990, with about 3.6 million babies born in 2023. In 1990, this figure was 4.16 million. Birth and replacement rates A country’s birth rate is defined as the number of live births per 1,000 inhabitants, and it is this particularly important number that has been decreasing over the past few decades. The declining birth rate is not solely an American problem, with EU member states showing comparable rates to the U.S. Additionally, each country has what is called a “replacement rate.” The replacement rate is the rate of fertility needed to keep a population stable when compared with the death rate. In the U.S., the fertility rate needed to keep the population stable is around 2.1 children per woman, but this figure was at 1.67 in 2022. Falling birth rates Currently, there is much discussion as to what exactly is causing the birth rate to decrease in the United States. There seem to be several factors in play, including longer life expectancies, financial concerns (such as the economic crisis of 2008), and an increased focus on careers, all of which are causing people to wait longer to start a family. How international governments will handle falling populations remains to be seen, but what is clear is that the declining birth rate is a multifaceted problem without an easy solution.

In the United States, the crude birth rate in 1800 was 48.3 live births per thousand people, meaning that 4.8 percent of the population had been born in that year. Between 1815 and 1825 the crude birth rate jumped from 46.5 to 54.7 (possibly due to Florida becoming a part of the US, but this is unclear), but from this point until the Second World War the crude birth rate dropped gradually, reaching 19.2 in 1935. Through the 1940s, 50s and 60s the US experienced it's baby boom, and the birth rate reached 24.1 in 1955, before dropping again until 1980. From the 1980s until today the birth rate's decline has slowed, and is expected to reach twelve in 2020, meaning that just over 1 percent of the population will be born in 2020.

Over the past 30 years, the birth rate in the United States has been steadily declining, and in 2023, there were 10.7 births per 1,000 of the population. In 1990, this figure stood at 16.7 births per 1,000 of the population. Demographics have an impact The average birth rate in the U.S. may be falling, but when broken down along ethnic and economic lines, a different picture is painted: Native Hawaiian and other Pacific Islander women saw the highest birth rate in 2022 among all ethnicities, and Asian women and white women both saw the lowest birth rate. Additionally, the higher the family income, the lower the birth rate; families making between 15,000 and 24,999 U.S. dollars annually had the highest birth rate of any income bracket in the States. Life expectancy at birth In addition to the declining birth rate in the U.S., the total life expectancy at birth has also reached its lowest value recently. Studies have shown that the life expectancy of both men and women in the United States has been declining over the last few years. Declines in life expectancy, like declines in birth rates, may indicate that there are social and economic factors negatively influencing the overall population health and well-being of the country.

The fertility rate of a country is the average number of children that women from that country will have throughout their reproductive years. In the United States in 1800, the average woman of childbearing age would have seven children over the course of their lifetime. As factors such as technology, hygiene, medicine and education improved, women were having fewer children than before, reaching just two children per woman in 1940. This changed quite dramatically in the aftermath of the Second World War, rising sharply to over 3.5 children per woman in 1960 (children born between 1946 and 1964 are nowadays known as the 'Baby Boomer' generation, and they make up roughly twenty percent of todays US population). Due to the end of the baby boom and increased access to contraception, fertility reached it's lowest point in the US in 1980, where it was just 1.77. It did however rise to over two children per woman between 1995 and 2010, although it is expected to drop again by 2020, to just 1.78.

This data set contains estimated teen birth rates for age group 15–19 (expressed per 1,000 females aged 15–19) by county and year. DEFINITIONS Estimated teen birth rate: Model-based estimates of teen birth rates for age group 15–19 (expressed per 1,000 females aged 15–19) for a specific county and year. Estimated county teen birth rates were obtained using the methods described elsewhere (1,2,3,4). These annual county-level teen birth estimates “borrow strength” across counties and years to generate accurate estimates where data are sparse due to small population size (1,2,3,4). The inferential method uses information—including the estimated teen birth rates from neighboring counties across years and the associated explanatory variables—to provide a stable estimate of the county teen birth rate. Median teen birth rate: The middle value of the estimated teen birth rates for the age group 15–19 for counties in a state. Bayesian credible intervals: A range of values within which there is a 95% probability that the actual teen birth rate will fall, based on the observed teen births data and the model. NOTES Data on the number of live births for women aged 15–19 years were extracted from the National Center for Health Statistics’ (NCHS) National Vital Statistics System birth data files for 2003–2015 (5). Population estimates were extracted from the files containing intercensal and postcensal bridged-race population estimates provided by NCHS. For each year, the July population estimates were used, with the exception of the year of the decennial census, 2010, for which the April estimates were used. Hierarchical Bayesian space–time models were used to generate hierarchical Bayesian estimates of county teen birth rates for each year during 2003–2015 (1,2,3,4). The Bayesian analogue of the frequentist confidence interval is defined as the Bayesian credible interval. A 100*(1-α)% Bayesian credible interval for an unknown parameter vector θ and observed data vector y is a subset C of parameter space Ф such that 1-α≤P({C│y})=∫p{θ │y}dθ, where integration is performed over the set and is replaced by summation for discrete components of θ. The probability that θ lies in C given the observed data y is at least (1- α) (6). County borders in Alaska changed, and new counties were formed and others were merged, during 2003–2015. These changes were reflected in the population files but not in the natality files. For this reason, two counties in Alaska were collapsed so that the birth and population counts were comparable. Additionally, Kalawao County, a remote island county in Hawaii, recorded no births, and census estimates indicated a denominator of 0 (i.e., no females between the ages of 15 and 19 years residing in the county from 2003 through 2015). For this reason, Kalawao County was removed from the analysis. Also , Bedford City, Virginia, was added to Bedford County in 2015 and no longer appears in the mortality file in 2015. For consistency, Bedford City was merged with Bedford County, Virginia, for the entire 2003–2015 period. Final analysis was conducted on 3,137 counties for each year from 2003 through 2015. County boundaries are consistent with the vintage 2005–2007 bridged-race population file geographies (7). SOURCES National Center for Health Statistics. Vital statistics data available online, Natality all-county files. Hyattsville, MD. Published annually. For details about file release and access policy, see NCHS data release and access policy for micro-data and compressed vital statistics files, available from: http://www.cdc.gov/nchs/nvss/dvs_data_release.htm. For natality public-use files, see vital statistics data available online, available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. National Center for Health Statistics. U.S. Census populations with bridged race categories. Estimated population data available. Postcensal and intercensal files. Hyattsville, MD

The average for 2022 based on 196 countries was 18.19 births per 1000 people. The highest value was in the Central African Republic: 45.42 births per 1000 people and the lowest value was in Hong Kong: 4.4 births per 1000 people. The indicator is available from 1960 to 2023. Below is a chart for all countries where data are available.

The rate of legal abortions in the United States has decreased over the last few decades. In 2022, there were around 19.9 legal abortions per 100 live births, whereas the rate was 34 abortions per 100 live births in the year 1990. Since the overturning of Roe v. Wade by the Supreme Court in 2022, states within the U.S. have the right to severely limit or completely ban abortion if they wish, meaning that access to such procedures varies significantly depending on the state or region. Abortion in the U.S. In 2022, there were over 613,000 legal abortions in the United States. Abortion rates in the U.S. are highest among women aged 25 to 29 years and more common among unmarried women than those who are married. In 2022, there were approximately 38 legal abortions per 100 live births among unmarried women compared to four abortions per 100 live births among women who were married.
Public opinion The issue of abortion has been and remains a divisive topic among the general public and continues to be a relevant political issue. As of May 2023, around 44 percent of the population was estimated to be pro-life, while 52 percent were pro-choice and three percent mixed or neither. However, this distribution has fluctuated over the years, with pro-lifers accounting for a larger percentage than pro-choicers as recently as 2019.

This dataset includes Table 11 of the Maryland Vital Statistics Annual Report 2005 which includes GENERAL FERTILITY RATES (Total births per 1,000 women ages 15-44.) AND BIRTH RATES (Live births per 1,000 women in specified age group.) BY AGE OF MOTHER, RACE OF MOTHER, REGION, AND POLITICAL SUBDIVISION, MARYLAND, 2005. Rates that are based on fewer than five events in the numerator are not presented and are represented here as -1. Numbers and rates for Baltimore city and Baltimore county are combined.

Today, globally, women of childbearing age have an average of approximately 2.2 children over the course of their lifetime. In pre-industrial times, most women could expect to have somewhere between five and ten live births throughout their lifetime; however, the demographic transition then sees fertility rates fall significantly. Looking ahead, it is believed that the global fertility rate will fall below replacement level in the 2050s, which will eventually lead to population decline when life expectancy plateaus. Recent decades Between the 1950s and 1970s, the global fertility rate was roughly five children per woman - this was partly due to the post-WWII baby boom in many countries, on top of already-high rates in less-developed countries. The drop around 1960 can be attributed to China's "Great Leap Forward", where famine and disease in the world's most populous country saw the global fertility rate drop by roughly 0.5 children per woman. Between the 1970s and today, fertility rates fell consistently, although the rate of decline noticeably slowed as the baby boomer generation then began having their own children. Replacement level fertility Replacement level fertility, i.e. the number of children born per woman that a population needs for long-term stability, is approximately 2.1 children per woman. Populations may continue to grow naturally despite below-replacement level fertility, due to reduced mortality and increased life expectancy, however, these will plateau with time and then population decline will occur. It is believed that the global fertility rate will drop below replacement level in the mid-2050s, although improvements in healthcare and living standards will see population growth continue into the 2080s when the global population will then start falling.

Abstract (en): This collection provides information on live births in the United States during the calendar year 2011. The natality data in these files are a component of the vital statistics collection effort maintained by the federal government. Birth data is limited to births occurring in the United States to United States residents and nonresidents. Births occurring to United States citizens outside of the United States are not included in this data collection. Dataset 1 contains data on births occurring within the United States, while Dataset 2 contains data on births occurring in the United States territories of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands. Variables describe the place of delivery, who was in attendance, and medical and health data such as the method of delivery, prenatal care, tobacco use during pregnancy, pregnancy history, medical risk factors, and infant health characteristics. Birth rates, fertility rates, and other aggregate statistics can be found in the Detailed Technical Notes section of the ICPSR User Guide. Demographic information includes the child's sex and month and year of birth, the parents' ages, races, ethnicities, education levels, as well as the mother's marital status and residency status. This report presents detailed data on numbers and characteristics of births in 2011, birth and fertility rates, maternal demographic and health characteristics, place and attendant at birth, and infant health characteristics within the United States and its territories. The data are not weighted and no weight variables are present in the collection. ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection: Created variable labels and/or value labels.; Created online analysis version with question text.; Checked for undocumented or out-of-range codes.. Live births in the United States and its territories during calendar year 2011. Smallest Geographic Unit: County One-hundred percent of birth certificates in calendar year 2011. record abstractsThe territories file, which includes data on births occurring in Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas Islands, includes limited geographic detail. Information identifying individual territories and counties with populations of 100,000 or more by place of occurrence and residence are available in this file.This collection includes data based on both the 1989 Revision of the U.S. Standard Certificate of Live Birth (unrevised) and the 2003 Revision of the U.S. Standard Certificate of Live Birth (revised). However, in general, only data comparable between 1989 and 2003 revisions and data exclusive to the 2003 revision are included. Beginning with the 2005 data year, the micro-data natality file no longer includes geographic detail (e.g., state or county of birth). Information on the NCHS data release policy is available through the National Center for Health Statistics Web site. Tabulations of birth data by state and for counties with populations of 100,000 or more may be made using VitalStats. Procedures for requesting micro-data files with geographic detail are provided in the National Center for Health Statistics data release policy.Beginning with the 2007 data year, data items such as maternal anemia, ultrasound, and alcohol use are no longer available in public use files.Beginning with the 2011 data year, unrevised data for educational attainment, prenatal care, and type of vaginal and cesarean delivery are no longer included in the data files. Data for these items from the 1989 revision are not comparable with data from the 2003 revision. For additional information on the Natality Detail File Series, please visit the National Center for Health Statistics Web site.

This dataset assembles all final birth data for females aged 15–19, 15–17, and 18–19 for the United States and each of the 50 states.

Data are based on 100% of birth certificates filed in all 50 states. All the teen birth rates in this dashboard reflect the latest revisions to Census populations (i.e., the intercensal populations) and thus provide a consistent series of accurate rates for the past 25 years. The denominators of the teen birth rates for 1991–1999 have been revised to incorporate the results of the 2000 Census. The denominators of the teen birth rates for 2001–2009 have revised to incorporate the results of the 2010 Census.

This dataset was created from the CDC's National Vital Statistics Reports Volume 56, Number 6. The dataset includes all data available from this report by state level and includes births by race and Hispanic origin, births to unmarried women, rates of cesarean delivery, and twin and multiple birth rates. The data are final for 2005. No value is represented by a -1. "Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2005 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census".

This dataset assembles all final birth data for females aged 15–19, 15–17, and 18–19 for the United States and each of the 50 states.

Data are based on 100% of birth certificates filed in all 50 states. All the teen birth rates in this dashboard reflect the latest revisions to Census populations (i.e., the intercensal populations) and thus provide a consistent series of accurate rates for the past 25 years. The denominators of the teen birth rates for 1991–1999 have been revised to incorporate the results of the 2000 Census. The denominators of the teen birth rates for 2001–2009 have revised to incorporate the results of the 2010 Census.

The total fertility rate of the world has dropped from around 5 children per woman in 1950, to 2.2 children per woman in 2025, which means that women today are having fewer than half the number of children that women did 75 years ago. Replacement level fertility This change has come as a result of the global demographic transition, and is influenced by factors such as the significant reduction in infant and child mortality, reduced number of child marriages, increased educational and vocational opportunities for women, and the increased efficacy and availability of contraception. While this change has become synonymous with societal progress, it does have wide-reaching demographic impact - if the global average falls below replacement level (roughly 2.1 children per woman), as is expected to happen in the 2050s, then this will lead to long-term population decline on a global scale. Regional variations When broken down by continent, Africa is the only region with a fertility rate above the global average, and, alongside Oceania, it is the only region with a fertility rate above replacement level. Until the 1980s, the average woman in Africa could expect to have 6-7 children over the course of their lifetime, and there are still several countries in Africa where women can still expect to have 5 or more children in 2025. Historically, Europe has had the lowest fertility rates in the world over the past century, falling below replacement level in 1975. Europe's population has grown through a combination of migration and increasing life expectancy, however even high immigration rates could not prevent its population from going into decline in 2021.

VitalStats: A collection of vital statistics products including tables, data files, and reports that allow users to access and examine vital statistics and population data interactively. VitalStats includes pre-built tables and reports for quick access to statistics; or the user can create tables--choosing from over 100 variables. Tables can be customized to create charts, graphs, and maps. Data can be exported.

About this dataset

Context

The dataset tabulates the data for the Martinsburg, PA population pyramid, which represents the Martinsburg population distribution across age and gender, using estimates from the U.S. Census Bureau American Community Survey (ACS) 2019-2023 5-Year Estimates. It lists the male and female population for each age group, along with the total population for those age groups. Higher numbers at the bottom of the table suggest population growth, whereas higher numbers at the top indicate declining birth rates. Furthermore, the dataset can be utilized to understand the youth dependency ratio, old-age dependency ratio, total dependency ratio, and potential support ratio.

Key observations

• Youth dependency ratio, which is the number of children aged 0-14 per 100 persons aged 15-64, for Martinsburg, PA, is 28.1.
• Old-age dependency ratio, which is the number of persons aged 65 or over per 100 persons aged 15-64, for Martinsburg, PA, is 45.5.
• Total dependency ratio for Martinsburg, PA is 73.6.
• Potential support ratio, which is the number of youth (working age population) per elderly, for Martinsburg, PA is 2.2.

Content

When available, the data consists of estimates from the U.S. Census Bureau American Community Survey (ACS) 2019-2023 5-Year Estimates.

Age groups:

• Under 5 years
• 5 to 9 years
• 10 to 14 years
• 15 to 19 years
• 20 to 24 years
• 25 to 29 years
• 30 to 34 years
• 35 to 39 years
• 40 to 44 years
• 45 to 49 years
• 50 to 54 years
• 55 to 59 years
• 60 to 64 years
• 65 to 69 years
• 70 to 74 years
• 75 to 79 years
• 80 to 84 years
• 85 years and over

Variables / Data Columns

• Age Group: This column displays the age group for the Martinsburg population analysis. Total expected values are 18 and are define above in the age groups section.
• Population (Male): The male population in the Martinsburg for the selected age group is shown in the following column.
• Population (Female): The female population in the Martinsburg for the selected age group is shown in the following column.
• Total Population: The total population of the Martinsburg for the selected age group is shown in the following column.

Good to know

Margin of Error

Data in the dataset are based on the estimates and are subject to sampling variability and thus a margin of error. Neilsberg Research recommends using caution when presening these estimates in your research.

Custom data

If you do need custom data for any of your research project, report or presentation, you can contact our research staff at research@neilsberg.com for a feasibility of a custom tabulation on a fee-for-service basis.

Inspiration

Neilsberg Research Team curates, analyze and publishes demographics and economic data from a variety of public and proprietary sources, each of which often includes multiple surveys and programs. The large majority of Neilsberg Research aggregated datasets and insights is made available for free download at https://www.neilsberg.com/research/.

Recommended for further research

This dataset is a part of the main dataset for Martinsburg Population by Age. You can refer the same here

About this dataset

Context

The dataset tabulates the data for the Camden, NJ population pyramid, which represents the Camden population distribution across age and gender, using estimates from the U.S. Census Bureau American Community Survey (ACS) 2019-2023 5-Year Estimates. It lists the male and female population for each age group, along with the total population for those age groups. Higher numbers at the bottom of the table suggest population growth, whereas higher numbers at the top indicate declining birth rates. Furthermore, the dataset can be utilized to understand the youth dependency ratio, old-age dependency ratio, total dependency ratio, and potential support ratio.

Key observations

• Youth dependency ratio, which is the number of children aged 0-14 per 100 persons aged 15-64, for Camden, NJ, is 33.4.
• Old-age dependency ratio, which is the number of persons aged 65 or over per 100 persons aged 15-64, for Camden, NJ, is 16.7.
• Total dependency ratio for Camden, NJ is 50.1.
• Potential support ratio, which is the number of youth (working age population) per elderly, for Camden, NJ is 6.0.

Content

When available, the data consists of estimates from the U.S. Census Bureau American Community Survey (ACS) 2019-2023 5-Year Estimates.

Age groups:

• Under 5 years
• 5 to 9 years
• 10 to 14 years
• 15 to 19 years
• 20 to 24 years
• 25 to 29 years
• 30 to 34 years
• 35 to 39 years
• 40 to 44 years
• 45 to 49 years
• 50 to 54 years
• 55 to 59 years
• 60 to 64 years
• 65 to 69 years
• 70 to 74 years
• 75 to 79 years
• 80 to 84 years
• 85 years and over

Variables / Data Columns

• Age Group: This column displays the age group for the Camden population analysis. Total expected values are 18 and are define above in the age groups section.
• Population (Male): The male population in the Camden for the selected age group is shown in the following column.
• Population (Female): The female population in the Camden for the selected age group is shown in the following column.
• Total Population: The total population of the Camden for the selected age group is shown in the following column.

Good to know

Margin of Error

Data in the dataset are based on the estimates and are subject to sampling variability and thus a margin of error. Neilsberg Research recommends using caution when presening these estimates in your research.

Custom data

If you do need custom data for any of your research project, report or presentation, you can contact our research staff at research@neilsberg.com for a feasibility of a custom tabulation on a fee-for-service basis.

Inspiration

Neilsberg Research Team curates, analyze and publishes demographics and economic data from a variety of public and proprietary sources, each of which often includes multiple surveys and programs. The large majority of Neilsberg Research aggregated datasets and insights is made available for free download at https://www.neilsberg.com/research/.

Recommended for further research

This dataset is a part of the main dataset for Camden Population by Age. You can refer the same here

About this dataset

Context

The dataset tabulates the data for the Jefferson County, WV population pyramid, which represents the Jefferson County population distribution across age and gender, using estimates from the U.S. Census Bureau American Community Survey 5-Year estimates. It lists the male and female population for each age group, along with the total population for those age groups. Higher numbers at the bottom of the table suggest population growth, whereas higher numbers at the top indicate declining birth rates. Furthermore, the dataset can be utilized to understand the youth dependency ratio, old-age dependency ratio, total dependency ratio, and potential support ratio.

Key observations

• Youth dependency ratio, which is the number of children aged 0-14 per 100 persons aged 15-64, for Jefferson County, WV, is 27.3.
• Old-age dependency ratio, which is the number of persons aged 65 or over per 100 persons aged 15-64, for Jefferson County, WV, is 24.6.
• Total dependency ratio for Jefferson County, WV is 51.9.
• Potential support ratio, which is the number of youth (working age population) per elderly, for Jefferson County, WV is 4.1.

Content

When available, the data consists of estimates from the U.S. Census Bureau American Community Survey (ACS) 2017-2021 5-Year Estimates.

Age groups:

• Under 5 years
• 5 to 9 years
• 10 to 14 years
• 15 to 19 years
• 20 to 24 years
• 25 to 29 years
• 30 to 34 years
• 35 to 39 years
• 40 to 44 years
• 45 to 49 years
• 50 to 54 years
• 55 to 59 years
• 60 to 64 years
• 65 to 69 years
• 70 to 74 years
• 75 to 79 years
• 80 to 84 years
• 85 years and over

Variables / Data Columns

• Age Group: This column displays the age group for the Jefferson County population analysis. Total expected values are 18 and are define above in the age groups section.
• Population (Male): The male population in the Jefferson County for the selected age group is shown in the following column.
• Population (Female): The female population in the Jefferson County for the selected age group is shown in the following column.
• Total Population: The total population of the Jefferson County for the selected age group is shown in the following column.

Good to know

Margin of Error

Data in the dataset are based on the estimates and are subject to sampling variability and thus a margin of error. Neilsberg Research recommends using caution when presening these estimates in your research.

Custom data

If you do need custom data for any of your research project, report or presentation, you can contact our research staff at research@neilsberg.com for a feasibility of a custom tabulation on a fee-for-service basis.

Inspiration

Neilsberg Research Team curates, analyze and publishes demographics and economic data from a variety of public and proprietary sources, each of which often includes multiple surveys and programs. The large majority of Neilsberg Research aggregated datasets and insights is made available for free download at https://www.neilsberg.com/research/.

Recommended for further research

This dataset is a part of the main dataset for Jefferson County Population by Age. You can refer the same here

The fertility rate of a country is the average number of children that women from that country would have throughout their reproductive years. In the United Kingdom in 1800, the average woman of childbearing age would have five children over the course of their lifetime. Over the next 35 years the fertility rate was quite sporadic, rising to over 5.5 in the 1810s and 1820s, then dropping to 4.9 by 1835. This was during and after the Napoleonic Wars and the War of 1812 with the US, which was a time of increased industrialization, economic depression and high unemployment after the war. As things became more stable, and the 'Pax Britannica' (a period of relative, international peace and economic prosperity for the British Empire) came into full effect, the fertility rate plateaued until 1880, before dropping gradually until the First World War. The fertility rate then jumped from 2.6 to 3.1 children per woman between 1915 and 1920, as many men returned from the war. It then resumed it's previous trajectory in the interwar years, before increasing yet again after the war (albeit, for a much longer time than after WWI), in what is known as the 'Baby Boom'. Like the US, the Baby Boom lasted until around 1980, where it then fell to 1.7 children per woman, and it has remained around this number (between 1.66 and 1.87) since then.

The child mortality rate in the United States, for children under the age of five, was 462.9 deaths per thousand births in 1800. This means that for every thousand babies born in 1800, over 46 percent did not make it to their fifth birthday. Over the course of the next 220 years, this number has dropped drastically, and the rate has dropped to its lowest point ever in 2020 where it is just seven deaths per thousand births. Although the child mortality rate has decreased greatly over this 220 year period, there were two occasions where it increased; in the 1870s, as a result of the fourth cholera pandemic, smallpox outbreaks, and yellow fever, and in the late 1910s, due to the Spanish Flu pandemic.