We need to banish the myths about "late" pregnancy. Photo: Getty Images
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What's wrong with older mothers? Nothing. Time to dispel the "fertility cliff" myth

We read between the lines of newspapers' scare stories about infertility and "late" pregnancy to find the science doesn't back them up at all.

There has been a fanfare of publicity, mainly involving ova, over the past month. Frontpage headlines splashing on differing deadlines for when a woman should have children. According to the Mail, Telegraph and Mirror, among others, women should start having children before 30,  or by 30, or before 37 (which is it, guys?) to avoid the risk of infertility:
 

 

 


Alternatively, according to the papers, women should freeze their eggs by the age of 35.

This is irresponsible scaremongering. It also undermines the biological complexities associated with a women’s fertility, which is further complicated by socio-economic factors, as well as the sex and gender hierarchies that still exist.

In a new study published in Harvard Business Review, sociologists Pamela Stone, Robin J Ely and Colleen Ammerman surveyed more than 25,000 men and women who graduated from Harvard Business School over the past several decades. Around 40 per cent of the "Generation X" and "Baby Boomer" women said their spouses’ careers took precedence over theirs. Compare that with men, where more than 70 per cent of Generation X and Boomer men say their careers are more important than their wives.

And the numbers on childcare responsibility may induce hyperventilation: 86 per cent of Generation X and Boomer men said their wives take primary responsibility of childcare. And the women are agreeing: 65 per cent of Generation X women and 72 per cent of Boomer women – most of whom work full-time – say they are prepared to do most of the childcare in their relationships.

It seems society is still, whether consciously or not, conforming to outmoded notions of which behaviours are masculine or feminine.

In the UK, it’s not generally biology that drives a woman's approach to reproduction; it’s the access to effective contraception, giving women the choice to construct their lives around partners, careers and friendships. Although hotly-debated, having children later in life is neither good nor bad – it’s autonomous. A decision entirely dependent on the person in question. 

One common argument against older mothers (30+) is their inability to get pregnant and give birth to a healthy child. This simplifies and distorts the science around fertility, and this is further perpetuated by the media for the sake of a sensationalist headline.

Delving deeper into the truths about fertility: the stats and scientific reports

The Office for National Statistics (ONS) reports that the total fertility rate (TFR) in 2010 for all four constituent countries in the UK was higher than a decade previously. After a steady decline in TFR through the Nineties, there was a gradual increase from early 2000s onwards – with the exception of 2009. The drop in fertility experienced by all UK constituents in 2009 is most likely related to the Great Recession. Fertility in England and Wales peaked in 2010 with the highest fertility rate since 1973.

Total fertility rate in the UK and EU15 (1985 to 2010). Graph: ONS

The ONS reports that in 2010, the average age for a woman to give birth has steadily increased over the last 25 years. In Northern Ireland it reaches 30 years, 29.6 in both Scotland and England and 28.9 in Wales.

Age-specific fertility rates the UK (2010). Graph: ONS

The ONS reports that in 2012, almost half (49 per cent) of all live births were to mothers aged 30 and over. More specifically, 29 per cent of births are to women aged 30 to 34, 16 per cent are to women aged 35 to 39, 4 per cent are to women aged 40 to 44 and less than 1 per cent are to women over 45. One in 25 babies are now born to those over forty, a four-fold increase in 30 years.

Live births by age group of mother (1938 to 2012). Graph: ONS

The term "period of optimum fertility" doesn’t mean a woman becomes barren the second she turns 35. If a woman wants just two children, the chances of her conceiving in her mid to late thirties still remain high.

"It is important to remember that the great majority of pregnancies in older women are relatively uncomplicated and end quite satisfactorily," says WR Cohen in a 2014 commentary published in the British Journal of Obstetrics and Gynaecology

In a 2004 paper published in Obstetrics and Gynecology, statistician David Dunson of Duke University and colleagues found that if a woman has sex twice a week, 82 per cent of woman aged between 35 and 39 would fall pregnant within a year.

The frequency here is important because if a woman had sex once per week instead of twice, "the rates of infertility increase substantially to 15 per cent, 22 to 24 per cent and 29 per cent for women aged 19 to 26, 27 to 34, and 35 to 39 years, respectively".

The paper concludes: "Increased infertility in older couples is attributable primarily to declines in fertility rates rather than to absolute sterility. Many infertile couples will conceive if they try for an additional year".

So women in their thirties might have to try harder to get pregnant, particularly if their partner is also in his late thirties. However, their age alone is unlikely to shut down their fertility.

Population-level data cannot predict when in individual woman will experience infertility. A woman in her late thirties may experience infertility, not because it’s common for women of her age, but because she is atypical (eg, premature menopause affects one in 100 women before the age of 40, and 5 in 100 women before the age of 45).

Therefore it is misleading to automatically associate infertility with age – like any problem that may occur in the human body, premature menopause is a problem with oestrogen production.

The additional complications of pregnancy and birth for women over 35

2005 study in Obstetrics and Gynaecology reports that:

The majority of studies are optimistic with regard to maternal and neonatal outcomes' in older mothers. This study found that ages 35 to 39 were associated with a statistically significant increased risk for fetal/neonatal congenital anomalies, gestational diabetes, placenta praevia, macrosomia, and caesarian delivery. Crucially, however, the clinical significance of these associations in practice was less clear. That is, while women aged 35 to 39 years were significantly more likely to experience one of these outcomes statistically, the level of increased risk was not overly large and should be interpreted cautiously.  

How foetuses are affected by later maternal age

Most of the common risks associated with later maternal age are foetal anomalies, particularly Down's, Edwards' and Patau syndrome. However, about 75 per cent of babies with Down’s syndrome are born to women who are under 35. This is because older women tend to have fewer babies. Despite this, the risk of any woman having a child with a foetal anomaly is low: 99 out of 100 per cent of women will not have a pregnancy affected by Down’s syndrome.

Older women are more likely to have twins or triplets, which, as well as having a higher risk of birth defects (5 per cent higher than singleton pregnancies), are at risk of growth restriction and preterm birth – these risks are associated with cerebral palsy and learning difficulties.

Moreover, women are more likely to suffer from multiple illnesses like diabetes and high blood pressure if they carry more than one baby. If the illnesses are thought to be a serious threat to the mother or babies, the clinician may suggest an abortion of the foetus(es). In general, there is a one in 25,000 risk of maternal mortality during singleton pregnancy or birth versus a two in 25,000 risk of maternal mortality during twin pregnancy or birth, and so on.

Moral of the story?

Doctors like Geeta Nargund need to tread carefully when advising a woman on the best time to have a child. It is important to be honest – yes, women who are below 30 are likely to conceive more easily, but women in their thirties and fourties have no problem conceiving either – and this fact shouldn’t be brushed under the carpet. 

Part of this honesty means we should not blow the problem out of proportion by intentionally presenting the worst-case scenario, scaring women in their early thirties into rushing into pregnancy.

The way things are going, women are likely to have children in their mid to late thirties, and the most likely outcome of that is that most pregnancies, births and babies will be healthy. 

In fact, women don’t respond to media headlines, scientific articles or what a bloke from the Royal Society says; they base their circumstances on those around them. And what they’ll find is that having children in your thirties is quite normal.

As the British Pregnancy Advisory Service (BPAS) puts it in a briefing on older mothers: "Being aware that fertility treatment exists as a last resort does not encourage women to 'put off' having babies, just as knowing that abortion is there when contraception fails does not stop women from using contraception."

BPAS adds:

If policymakers are worried by the consequences of later maternal age, they should be focusing on supporting prenatal screening services, preparing maternity services to be better able to cope with obstetric complications, and funding decent miscarriage care and fertility treatment. What they should not be doing is nagging women to get pregnant before they are ready, just so they fit neatly into the "period of optimum fertility"".

Tosin Thompson writes about science and was the New Statesman's 2015 Wellcome Trust Scholar. 

This article first appeared in the 01 July 2015 issue of the New Statesman, Crisis Europe

Photo:Getty
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Why isn't Labour putting forward Corbynite candidates?

Despite his successes as a candidate, the organisational victories have gone the way of Corbyn's opponents. 

The contest changes, but the result remains the same: Jeremy Corbyn’s preferred candidate defeated in a parliamentary selection. Afzhal Khan is Labour’s candidate in the Manchester Gorton by-election and the overwhelming favourite to be the seat’s next MP.

Although Khan, an MEP, was one of  the minority of Labour’s European MPs to dissent from a letter from the European parliamentary Labour party calling for Jeremy Corbyn to go in the summer of 2016, he backed Andy Burnham and Tom Watson in 2015, and it is widely believed, fairly or unfairly, that Khan had, as one local activist put it, “the brains to know which way the wind was blowing” rather than being a pukka Corbynite.

For the leader’s office, it was a double defeat;  their preferred candidate, Sam Wheeler, was kept off the longlist, when the party’s Corbynsceptics allied with the party’s BAME leadership to draw up an all ethnic minority shortlist, and Yasmine Dar, their back-up option, was narrowly defeated by Khan among members in Manchester Gorton.

But even when the leadership has got its preferred candidate to the contest, they have been defeated. That even happened in Copeland, where the shortlist was drawn up by Corbynites and designed to advantage Rachel Holliday, the leader’s office preferred candidate.

Why does the Labour left keep losing? Supporters combination of bad luck and bad decisions for the defeat.

In Oldham West, where Michael Meacher, a committed supporter of Jeremy Corbyn’s, was succeeded by Jim McMahon, who voted for Liz Kendall, McMahon was seen to be so far ahead that they had no credible chance of stopping him. Rosena Allin-Khan was a near-perfect candidate to hold the seat of Tooting: a doctor at the local hospital, the seat’s largest employer, with links to both the Polish and Pakistani communities that make up the seat’s biggest minority blocs.  Gillian Troughton, who won the Copeland selection, is a respected local councillor.

But the leadership has also made bad decisions, some claim.  The failure to get a candidate in Manchester Gorton was particularly egregious, as one trade unionist puts it: “We all knew that Gerald was not going to make it [until 2020], they had a local boy with good connections to the trade unions, that contest should have been theirs for the taking”. Instead, they lost control of the selection panel because Jeremy Corbyn missed an NEC meeting – the NEC is hung at present as the Corbynsceptics sacrificed their majority of one to retain the chair – and with it their best chance of taking the seat.

Others close to the leadership point out that for the first year of Corbyn’s leadership, the leader’s office was more preoccupied with the struggle for survival than it was with getting more of its people in. Decisions in by-elections were taken on the hop and often in a way that led to problems later down the line. It made sense to keep Mo Azam, from the party’s left, off the shortlist in Oldham West when Labour MPs were worried for their own seats and about the Ukip effect if Labour selected a minority candidate. But that enraged the party’s minority politicians and led directly to the all-ethnic-minority shortlist in Manchester Gorton.

They also point out that the party's councillor base, from where many candidates are drawn, is still largely Corbynsceptic, though they hope that this will change in the next round of local government selections. (Councillors must go through a reselection process at every election.)

But the biggest shift has very little to do with the Labour leadership. The big victories for the Labour left in internal battles under Ed Miliband were the result of Unite and the GMB working together. Now they are, for various reasons, at odds and the GMB has proven significantly better at working shortlists and campaigning for its members to become MPs.  That helps Corbynsceptics. “The reason why so many of the unions supported Jeremy the first time,” one senior Corbynite argues, “Is they wanted to move the Labour party a little bit to the left. They didn’t want a socialist transformation of the Labour party. And actually if you look at the people getting selected they are not Corbynites, but they are not Blairites either, and that’s what the unions wanted.”

Regardless of why, it means that, two years into Corbyn’s leadership, the Labour left finds itself smaller in parliament than it was at the beginning.  

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.