Where the births actually are, by county
The 100 highest-birth counties of 3,144 account for 43.4% of all U.S. births. The top 250 account for 63.1%, and the top 500 for 77.3%. A firm that buys the top hundred counties is buying most of the addressable volume in the country, and a firm that buys the top five hundred is buying almost all of it. What remains after that is roughly a fifth of births spread across more than two and a half thousand counties.
The curve
| Counties | Share of national births |
|---|---|
| Top 50 | 30.6% |
| Top 100 | 43.4% |
| Top 250 | 63.1% |
| Top 500 | 77.3% |
| All 3,144 | 100% |
What follows from it
The obvious reading is that a national programme should buy the head of the distribution and stop. That is right as far as it goes and it is what almost everyone does, which is why the head is where the competition and the cost per click both are.
The less obvious reading is about the tail. Roughly a fifth of national births happen across more than two thousand counties, at a few hundred births each. No paid media plan works there: there is not enough volume in any single county to justify a campaign, and anyone selling you one is selling impressions. Those counties are reachable, but only through referral relationships and co-counsel arrangements, which is a different service line with different economics.
So the curve does not tell you where to advertise. It tells you where advertising is the wrong instrument.
| Where you are on the curve | What works | What does not |
|---|---|---|
| Top 100 counties | Paid search, LSA, paid social | Expecting cheap inventory. Everyone is here |
| Counties 100 to 500 | Paid search with tighter bid ceilings, local SEO | Broad awareness spend |
| The remaining 2,600 | Referral and co-counsel relationships | Any paid media plan |
The limits
Births are not claims. This is a distribution of deliveries, not of injuries or of viable matters. Nothing here implies that the counties with the most births generate proportionally more cases.
County lines are not media markets. Platforms buy by DMA, radius and postcode, none of which align to counties. The curve is a planning input, not a targeting specification.
Clinical measures and legal measures are never joined on this site. Adverse-event rates describe medicine; litigation describes a legal process. Where both appear together it is to describe a market, not to suggest that one predicts the other.
Sources
- U.S. Census Bureau: County Population Totals and Components of Change, 2024: births by county, 2021–2024
- U.S. Census Bureau: Cartographic Boundary Files, 2023 (1:20,000,000): county and state polygons; projected to Albers equal-area at build time
Cite this analysis
Free to reproduce with attribution, including commercially. Charts may be embedded as published.
Birth Injury Marketing. “Where the births actually are, by county.” 25 August 2026. https://birthinjurymarketing.com/insights/how-concentrated-us-births-actually-are/
Journalists and researchers: the underlying data is already published as CSV at /data/, free and without conditions, no form. Need a different cut, by state, county, hospital or year? Ask, and I will also tell you what the data cannot support.
More
Where births and legal capacity are furthest apart
Joining county births to Offices-of-Lawyers establishments produces a market map nobody has assembled, and a measure much weaker than it looks.
Data · analysisWhere the birth happened is not where the family lives
More than a thousand counties record births and have no hospital confirmed to deliver them, which puts residence and venue in different places.
Data · methodThe hospitals that never say if they deliver
The federal file most people treat as a hospital census carries no obstetric indicator either way for a fifth of the hospitals in it.
Practice economicsWhat a slow callback costs you here
A familiar marketing rule, worked through for a category where one inquiry can cost more than a month of another practice area.
Practice economicsThe counties your advertising cannot reach, and what does
The counties with no lawyer office at all are not a media opportunity. They are a referral problem, and a different service line answers them.
EconomicsCost per lead can fall while cost per signed case rises
In birth injury both movements are real at the same time, and only one of them matters. Here is the mechanism, and how to tell whether it is happening to you.
OperationsWhy more spend stops producing more birth injury cases
Signed case volume is limited by how many inquiries a firm can competently review, not by how many it receives. Above that ceiling, additional spend buys a queue.
All articles → · The data behind them → · The publications →
Authorship & review
- Author
- Kevin Schwaner, Founder; Chief Marketing Officer. Credentials.
- Last reviewed
- Corrections
- Found an error? Tell me and it goes in the dated corrections log, whether or not it flatters me.