Ask A Researcher

January 2022

North Dakota Title X, Family Planning Needs Assessment.

Mariel López-Valentín works for the Office of State Epi, Division of Special Projects, and Health Analytics. On 2002 she obtained a MS in Epidemiology from the University of Puerto Rico, Medical Sciences Campus and successfully completed two fellowship programs: 2004 ASPH/CDC and (2005-2007) II Class CDC/CSTE. “I am a Data Analyst, dedicated to the expert applications of Epidemiology and Biostatistics methods, giving sense to numbers, studying public health problems in North Dakota, essential data analysis for decision making”.

Grace Njau is the director of the Division of Special Projects and Health Analytics at the North Dakota Department of Health. Grace is passionate about all-things-data, and especially rapid and targeted data dissemination to inform policy and program planning.


The North Dakota Department of Health (NDDoH) recently conducted a comprehensive family planning needs assessment. While the assessment is required under the terms for Title X federal grant requirements, more importantly, the assessment identifies and documents the need for family planning services in North Dakota by identifying trends and areas of greatest need to help guide delivery of family planning services. The Family Planning Program (FPP) will use the results of this assessment to inform and improve service delivery over the next five years. Key findings are summarized below.

Births, Fertility and Pregnancy

North Dakota continues to be one of the fastest-growing states in the nation, with over a 15.2 percent population increase between 2010 (672,591) and 2021 (774,948). The composition of the state’s population has also changed. While still predominately white, North Dakota is becoming more diverse.  In 2000, 92 percent of North Dakota’s population was White, non-Hispanic, compared to 82 percent in 2020.  The population of color has grown from 11.1 percent in 2010 to 18.3 percent in 2020. Also from 2010 to 2020, the rate of increase of persons of color in North Dakota was much higher than nationally, a 91.6 percent  increase in North Dakota compared to 24.9 percent nationally (ND Compass, 2021, Race - Demographics ).  Immigrants (foreign-born) comprise 5 percent of North Dakota’s population and five percent of North Dakota’s population were native-born Americans with at least one immigrant parent (American Immigration Council, 2021, Immigrants in North Dakota). 

Population growth has in part been due to an increase in fertility rates. According to 2020 NDDoH Division of Vital Records Data (NORTH DAKOTA ( , the fertility rate among women ages 15 to 44 in the state was 77.8 per 1,000 women, substantially higher than the United States fertility rate of 58.3 births per 1,000 women aged 15-44 (National Center for Health Statistics, National Vital Statistics System, Natality; 2021 Births in the United States).

While the rate of teen pregnancies in North Dakota (15.5 per 1,000 females 15 to 19 years of age in 2019) (NORTH DAKOTA ( is lower than national rates (16.7 per 1,000 females 15 to 19 years of age in 2019) (About Teen Pregnancy | CDC), Native American teenagers in North Dakota had substantially higher rates than white teenagers.  From 2016 to 2019, Native American teen pregnancies were almost four times that of White teenagers, 46 teenage births per 1,000 live births, compared to ten teenage births per 1,000 live births, respectively (Centers for Disease Control, WONDER).

Most women who gave birth in 2019 received prenatal care, 77.8 percent of women received first-trimester prenatal care, 15.5 percent of women received care in the second trimester and 6.8% of women received late or no prenatal care. Native Americans (44.2%) and Black (65.6%) women in the state were less likely to receive early prenatal care, beginning in the first trimester (1-3 months), compared to their White (84.4%) counterparts (National Center for Health Statistics, final natality data.  Retrieved October 21, 2021, from Peristats | March of Dimes).

In 2020 state rates for infant mortality were similar to national averages, 6.0 deaths per 1,000 live births in North Dakota compared to 5.6 deaths per 100,000 live births nationally.  The rate of low birth-rate infants is slightly better than national rates, six percent in North Dakota, compared to eight percent nationally (2020 County Health Rankings, North Dakota Report).  North Dakota is roughly in the middle of state rankings for maternal mortality.  In 2018, North Dakota had 20.1 maternal deaths per 100,000 births ((NDDoH Division of Vital Records, NORTH DAKOTA (

According to the 2017 Alan Guttmacher Institute Report on North Dakota, 29 per 1,000 pregnancies (31 %) were unintended (wanted later or unwanted pregnancy rate, women aged 15-44). Of the unintended pregnancies in North Dakota, 64 percent resulted in births and 22 percent in abortions.

The Alan Guttmacher Institute analyzed data from U.S. Census reports on the number and various characteristic of women, 2014-2019 ACS data on various demographic characteristics of women, and 2011-2015 National Survey of Family Growth to estimate the number of women who may have potential demand for contraceptive services.  The report estimates there has been an 11 percent increase the number of women who likely need public support for contraceptive services and from 2010 to 2016.  The report also estimates the number of women who likely need public support for contraceptive services and are uninsured declined by 6 percent from 8,700 in 2013 to 8,200 in 2016.  (AGI, 2016, Publicly supported family planning services in the US) Three percent of the women 15 to 44 years old in North Dakota received Title X family planning services in 2019 (NDDoH, Family Planning).

Sexually Transmitted Disease, Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV)

The 2020 North Dakota HIV, STI, TB & Viral Hepatitis Epidemiologic Profile cited 3,543 cases of chlamydia in the state, a rate of 464.9 cases per 100,000 persons and an 8.3 percent decline from 2019.  Alternately, there was a 10 percent increase in gonorrhea cases from 2018 to 2019, 1,508 cases were reported (197.9 cases per 100,000 individuals).  The Reservation Counties of Sioux, Benson and Rolette represented the highest incident of cases of both chlamydia and gonorrhea in the state.  In 2020, there was a 6 percent decrease in syphilis cases reported in North Dakota, from 97 to 91 cases. Though the overall syphilis rate decreased, some races reported increased rates in 2020. Native American/Alaskan Natives reported 46.4 of infections per 100,000 persons and Black/African Americans had the greatest rate at 94.4 infections per 100,000 persons Five hundred (500) people with HIV/AIDS were known to be living in North Dakota as of December 31, 2020.  Black/African Americans reported an incidence rate of 49.4 per 100,000. Additionally, 31 percent of all new cases were to foreign-born individuals.  Hepatitis C Virus (HCV) infections declined by 12 percent from 2019 to 2020.  There were 937 cases in 2019 and 823 cases in 2020.  (NDDoH, 2020, 2020 Epidemiologic profile of HIV, STDs, TB and viral hepatitis in North Dakota). 

Sexual Violence, Domestic Violence and Human Trafficking

In 2020 North Dakota’s state domestic and violence coalition served approximately 4,674 unduplicated new victims of domestic violence individuals and 999 unduplicated victims of sexual assault. (CAWS, Facts & Stats | CAWS North Dakota).  Since its inception in 2015, the North Dakota Human Trafficking Task Force (NDHTTF 2021) has served 576 victims of human trafficking (71% adults, 29% minors). According to National Human trafficking hotline data between the years 2016 (19 cases reported) to 2020 (20 cases reported), the number of reported human trafficking cases has remained between 14 (2018) to 24 (2017) cases per years.   For 2019, 22 cases were reported.

Substance Abuse and Behavioral Health

North Dakota is also affected by the behavioral health crisis facing the nation.  Approximately 15 percent of adolescents and 8.5 percent of adults reported at least one major depressive episode in the preceding year.  Of particular concern was the rate of binge alcohol use in the previous month among those over the age of 12. North Dakota ranked first out of 50 states, with a binge alcohol use rate of 30.6 percent, compared to a low of 16.2 percent in Utah. Binge Alcohol use is defined as drinking five or more drinks (for males) or four or more drinks (for females) on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.  Additionally, 8.5 percent of North Dakota residents over the age of 12 reported a substance use disorder, compared to the US average of 7.4 percent (2018-2019 National Survey on Drug Use and Health).  The state ranks 12th nationally in suicides rates with 18 suicides per 100,000 (NVSS - National Vital Statistics System) and was the 11th leading cause of death in 2020 (NDDoH, Division of Vital Records).


In the 2019, according to the Youth Risk Behavior Survey (YRBS) approximately 38.3 percent of students (grades 9th-12th) in the state reported having had sexual intercourse.  Approximately 29.6 percent of the students in the state reported being currently sexually active (had sexual intercourse with at least one person during the three months before the survey).
About 1 in 6 students (16.7 %) reported consuming alcohol or other drugs during their last sexual encounter. Additionally, 9.2 percent of students reported experiencing sexual violence one or more times in the 12 months before the survey. Among students who were sexually active, 8.4 percent did not use any pregnancy prevention methods during last sexual intercourse. 
(YRSB, 2019, 2019ND-High-School-YRBS-Summary-Tables).

Income and Health Disparities

In 2019 approximately 1 in 9 North Dakota residents (10.6%) lived in poverty while 1 in 4 (24%) of single female householders lived in poverty. Although the state has experienced economic prosperity and has the 13th lowest unemployment rate in the nation at 3.2 percent (U.S. Bureau Labor Statistics, Unemployment Rates for States), there was no significant change in family poverty rates from 2009 to 2019 (11.9 % and 10.6%, respectively) (US Census Bureau, American Community Survey (ACS)).

In addition to income disparities, Native Americans populations have higher rates of diabetes, cancer, addiction, heart disease, incidents of SDTs, teen pregnancy and prenatal care. All 10 North Dakota counties identified as "least healthy," according to the 2018 County Health Rankings (County Health Rankings & Roadmaps), are either within a tribal reservation or designated as rural or frontier areas .

Uninsured Population

Approximately 91.8 percent of adults ages 18 to 64 had some form of health insurance.  Five percent of children in the state had no health insurance (National Survey of Children's Health). While most women of reproductive age (15-49) had private health insurance (74%), nine percent were uninsured in 2019, and 13 percent were on Medicaid (ACS, 2019, American Community Survey).


The state's population is growing and changing. While still predominately white, North Dakota is becoming more diversified. And while the state has experienced strong economic conditions, there has been little change in household poverty rates. For some indicators, North Dakota compares favorably to national trends and other states. North Dakota’s fertility rates are higher than national average and teen pregnancies are lower. Alternately, the need for family planning and other behavioral and health services is clear. North Dakota has the highest rate of binge drinking among all the states and has seen the highest increase in suicide rates in the country. Further, health and income disparities among Native American populations are evident across nearly all indicators. The findings from this assessment will help to guide programs and policies to address the state’s need for family planning services.


Ask a researcher archive

Iyobosa Sonia Omoregie and Kendra Erickson-Dockter. Exploring Suicide Rates Among Youth
May 2024

Dean Bangsund and Nancy Hodur. Sugarbeet Industry in the Northern Plains: Economic Contribution in Minnesota and North Dakota.
April 2024

North Dakota Compass. North Dakota Compass Releases the 2024 Compass Points
March 2024

Nicholas Bauroth. City Governance: Commission or Council for Fargo, North Dakota?
February 2024

Ina Cernusca. 2024 Brings a NEW Visualization Tool and Data Updates to the North Dakota State Legislative District Profiles.
January 2024

Samuel Faraday Saidu and Chelsey Hukriede. Strapped for Safety: Exploring Insights into Car Seat Knowledge Among North Dakota Mothers.
December 2023

Debarati Kole and Kendra Erickson-Dockter. A Comprehensive Look at the Multifaceted Risk Factors of Postpartum Depression
October 2023

Valquiria F. Quirino and Avram Slone. COVID-19 pandemic in North Dakota: Significance, progression, and government response.
September 2023

Karen Olson. The Lasting Impact of Maternal Childhood Trauma
August 2023

Avram Slone. The Social Variability of COVID-19 Mortality in North Dakota between March 11th, 2020 and February 13th, 2022
July 2023

Nancy Hodur and Dean Bangsund. Agriculture a Key Driver in the North Dakota economy
June 2023

Karen Olson. Health and Well-Being in North Dakota. Understanding how the five social determinants of health are impacting the ability of North Dakotans to thrive
May 2023

Kendra Erickson-Dockter. North Dakota Compass: 10 years of Measuring Progress and Inspiring Action.
April 2023

Hannah Hanson & Grace Njau. Every Dad Counts: North Dakota Fatherhood Experiences Survey
March 2023

Nancy Hodur. Housing Market Conditions and Declining Homeownership Rates
February 2023

North Dakota Compass. 2022 Recap: Data highlighted throughout the year
January 2023

Kendra Erickson-Dockter. A Look into a Chronic Condition and Pregnancy: Preexisting Diabetes PRAMS Points 2022
December 2022

Nancy Hodur and Karen Olson. Lower-income households and baby boomers, main drivers for North Dakota housing needs in the near term
November 2022

Avram Slone. The Impact of COVID-19 on Group Quarters in North Dakota
October 2022

Chelsey Hukriede. Safe Sleep PRAMS Points 
September 2022

Kendra Erickson-Dockter. Gestational Diabetes PRAMS Points – A NEW Dashboard Format!
August 2022

Aastha Bhandari, Debarati Kole, Dr. Nancy Hodur. Mission Of Mercy: Giving hope through a smile.
July 2022

Ina Cernusca.Households with children have been disproportionately affected by the COVID-19 pandemic, especially in the first year of the pandemic.
May 2022

Andy Wiese and Karen Olson. One Health System’s Approach to Improving Community Health. Understanding what the 2021 Community Health Needs Assessment Conducted by Sanford Health means for population health
April 2022

Mariel Lopez-Valentin and Grace Njau. North Dakota Title X, Family Planning Needs Assessment
January 2022

Nancy Hodur and Dean Bangsund. North Dakota Lignite Energy Industry Workforce
December 2021

Ina Cernusca. Vaccine Acceptance and Hesitancy in North Dakota
October 2021

Nancy Hodur and Karen Olson. Rural Communities Will Benefit from a New Cooperative in Walsh County
September 2021

Matt Schmidt and Grace Njau. COVID-19 Trends Among North Dakota Children, March 2020 – March 2021
August 2021

Kendra Erickson-Dockter and Ina Cernusca. COVID Hardship on North Dakota Households: New study on the impacts on North Dakota households that lost employment income during the pandemic
July 2021

Chelsey Hukriede and Kendra Erickson-Dockter. NEW! PRAMS Points – A Brief Infographic using North Dakota PRAMS Survey Data
May 2021

North Dakota Compass: A look inside the 2021 Compass Points
April 2021

Ina Cernusca: Households with children are disproportionately affected by the COVID-19 pandemic
March 2021

Ina Cernusca: Differences in COVID-19 Risk Factors at District Level
February 2021

Kendra Erickson-Dockter, Chelsey Hukriede, and Grace Njau: An Introduction to the North Dakota Study of Associated Risks of Stillbirth (SOARS)
October 2020

Karen Ehrens: North Dakota Families are Facing Food and Other Hardships in the Wake of COVID-19 Pandemic, and Helpers Respond
September 2020

Ina Cernusca: Taking the pulse of North Dakota households during the COVID-19 pandemic.
July 2020

Nancy Hodur:Challenges of Grocery Stores in Rural North Dakota
May 2020

North Dakota Compass:2020 Compass Points: Measuring progress. Inspiring action.
March 2020

Amy Tichy:Student Veterans in the College Classroom.
February 2020

North Dakota Compass:North Dakota Compass launches the 2020 State Legislative District Profiles
January 2020

Grace Njau, Nancy Hodur:&Chelsey Hukriede: Risk Behaviors among Women with a Recent Live Birth in North Dakota: Findings from the 2017 North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS)
November 2019

Ina Cernusca:& Karen Olson: Behind the scenes – The story of the North Dakota State Legislative District Profiles
October 2019

Ina Cernusca: Key demographic trends in North Dakota.
August 2019

Karen Olson: The 30th edition of the Annie E. Casey Foundation’s KIDS COUNT® Data Book finds that 175,772 children will shape the future of a more diverse North Dakota.
July 2019

Shweta Arpit Srivastava & Dr. Ann Burnett: “Giving rope and pulling it back”: Parental dilemmas to prevent adolescent substance use
June 2019

Ina Cernusca: 2019 Compass Points: Setting direction for improving the quality of life in North Dakota
May 2019

Joshua Marineau and Onnolee Nordstrom: Learning from Fargo -- An Exploration of the Fargo-Moorhead Entrepreneurial Ecosystem
March 2019

Nancy Hodur: Improving Oral Health for Older Adults in North Dakota
November 2018

Rachelle Vettern: Engaging Volunteers across Generations
October 2018

Karen Olson: The 2018 KIDS COUNT® Data Book reveals strengths and challenges for children in North Dakota – and emphasizes that an inaccurate census in 2020 threatens to worsen existing challenges for North Dakota youth
July 2018

Lori Capouch: Is food access a concern in rural North Dakota?
May 2018

Deb Nelson: Williston Basin 2016: Employment, Population, and Housing Forecasts – An Overview
January 2018

Karen Olson: North Dakota among Top 10 States in Country for Child Well-Being
July 2017

Nancy Hodur: SEAL!North Dakota: A School Dental Sealant Program
June 2017

Grace Njau: A Brief Introduction to the North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS)
April 2017

Ina Cernusca: North Dakota’s Women study: A brief overview
March 2017

Dean Bangsund: Effects of Fargo-Moorhead Area Diversion on Spring Planting for Producers
February 2017

Deb Nelson: Vision West: Leading, Educating, and Collaborating to Mobilize the 19 Western North Dakota Counties Towards Resilience and Prosperity
December 2016

Nancy Hodur: North Dakota Statewide Housing Needs Assessment: A Brief Overview of the Population and Housing Forecast component
November 2016

Social Isolation: Experiential Narratives of African Refugee Women in the Fargo-Moorhead Community
September 2016

Sean Brotherson: Father Involvement and the Future of Children and Families
July 2016

Carol Cwiak: Bakken Oil: What Have We Learned and What Will We Do Differently Next Time
June 2016

Jessica Creuzer: The Changing Face of Western North Dakota: What are the Effects of Increased Travel from Energy Development
April 2016

ND Compass: City Profiles
February 2016

ND Department of Health: Making Change Happen
January 2016

Jennifer Weber: A Bold New Direction for the North Dakota University System - The NDUS Edge Dashboards
December 2015

Wendy Troop-Gordon: What Has Science Taught Us About Bullying?
November 2015

ND Compass: A Look at the Youngest North Dakotans
October 2015

Kendra Erickson-Dockter: Growing Older in North Dakota
September 2015

Michael Ziesch: Data You Can Trust: The Labor Market Information Center
August 2015

Malini Srivastava and Troy Raisanen: efargo: City Scale Sustainability
July 2015

Kevin Iverson: The State Repository of Census Information- The North Dakota Census
June 2015

Wonwoo Byun: Reducing Sedentary Behavior is a Key for Obesity Prevention in Children
May 2015

Kathryn Gordon: The Science of Suicide Prevention
April 2015

ND Compass: Tell a Story with Data! The Importance of Crade-to-Career Success
March 2015

Abby Gold: Community Food Systems: Food Charters and More
February 2015

Heather Fuller-Iglesias: The Importance of Recognizing the Role of Social Support in Human Development Across the Lifespan
January 2015

Michael Carbone: Using Data to End Homelessness
December 2014

Randal Coon: Tribal Colleges Contribute to the State's Economy
November 2014

Deb White: Women's Representation in Elected Office
October 2014

Randal Coon: Pull Factors Measure Retail Trade Performance
September 2014

Karen Olson: North Dakota ranks Well Nationally with Regard to Overall Child Well-Being; However, Substantial Opportunities for Improvement Exist
August 2014

Julie Garden-Robinson: Guard Against Grilling Gaffes: Healthy Grilling and Food Safety Tips
July 2014

Michael Noone: Extreme Weather Patterns- North Dakota Has It All
June 2014

Kathleen Tweeten: Why All Community Development Decisions Should Use the Community Capitals Framework
May 2014

Clayton Hilmert: Stress effects on pregnancy: The impact of the 2009 Red River flood on birth weight
April 2014

Karen Ehrens: Food Deserts and how they impact North Dakota
March 2014

Gretchen Dobervich and Kendra Erickson-Dockter: New Geographic Profiles: How they can work for you
February 2014

Compass Staff: "New Compass Team Brings Changes in 2014"
January 2014

Donna Grandbois: "Fargo-Moorhead American Indian Community-Sponsored Health Needs Assessment"
November 2013

Karen Olson: "North Dakota KIDS COUNT - why it counts for you
October 2013

Nancy Hodur: "Western North Dakota School Administrators Face Challenges"
August 2013

Megan Chmielewski: "Annual population estimates tell interesting stories about North Dakota's growth patterns"
July 2013

Ramona Danielson: "Learn how to make the ND Compass website work for you"
May 2013

Karen Olson: "About the American Community Survey (ACS)"
February 2013

North Dakota Compass

Center for Social Research
North Dakota State University

Compass created by:
Wilder Research

© 2024. All rights reserved.