Let's just look at some data of the population of northeast Ohio (NEO).
This is what the population distribution in NEO looks like:
In contrast, this is what the overall US population distribution looks like:
NEO is older than the other two big metros in Ohio, Cincinnati and Columbus:
This is what Dallas looks like:
The average ages in Cleveland, Cincinnati, and Columbus are: 41.1, 37.9, and 35.7. As a comparison, the average age of Dallas is 34.2. Cleveland population is 7 years older than that of Dallas.
The fertility rate of Cleveland, Cincinnati, and Columbus are: 4.8%, 5.2%, and 5.4%. As a comparison, the fertility rate of Dallas is 5.4%.
Hence, NEO has fewer women at birth age (15 to 50) than the national average and its fertility rate is under national average. The result? Fewer babies.