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

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David Osland: “Corbyn is actually Labour’s only chance”

The veteran Labour activist on the release of his new pamphlet, How to Select or Reselect Your MP, which lays out the current Labour party rules for reselecting an MP.

Veteran left-wing Labour activist David Osland, a member of the national committee of the Labour Representation Committee and a former news editor of left magazine Tribune, has written a pamphlet intended for Labour members, explaining how the process of selecting Labour MPs works.

Published by Spokesman Books next week (advance copies are available at Nottingham’s Five Leaves bookshop), the short guide, entitled “How to Select or Reselect Your MP”, is entertaining and well-written, and its introduction, which goes into reasoning for selecting a new MP and some strategy, as well as its historical appendix, make it interesting reading even for those who are not members of the Labour party. Although I am a constituency Labour party secretary (writing here in an expressly personal capacity), I am still learning the Party’s complex rulebook; I passed this new guide to a local rules-boffin member, who is an avowed Owen Smith supporter, to evaluate whether its description of procedures is accurate. “It’s actually quite a useful pamphlet,” he said, although he had a few minor quibbles.

Osland, who calls himself a “strong, but not uncritical” Corbyn supporter, carefully admonishes readers not to embark on a campaign of mass deselections, but to get involved and active in their local branches, and to think carefully about Labour’s election fortunes; safe seats might be better candidates for a reselection campaign than Labour marginals. After a weak performance by Owen Smith in last night’s Glasgow debate and a call for Jeremy Corbyn to toughen up against opponents by ex Norwich MP Ian Gibson, an old ally, this pamphlet – named after a 1981 work by ex-Tribune editor Chris Mullin, who would later go on to be a junior minister under Blai – seems incredibly timely.

I spoke to Osland on the telephone yesterday.

Why did you decide to put this pamphlet together now?

I think it’s certainly an idea that’s circulating in the Labour left, after the experience with Corbyn as leader, and the reaction of the right. It’s a debate that people have hinted at; people like Rhea Wolfson have said that we need to be having a conversation about it, and I’d like to kickstart that conversation here.

For me personally it’s been a lifelong fascination – I was politically formed in the early Eighties, when mandatory reselection was Bennite orthodoxy and I’ve never personally altered my belief in that. I accept that the situation has changed, so what the Labour left is calling for at the moment, so I see this as a sensible contribution to the debate.

I wonder why selection and reselection are such an important focus? One could ask, isn’t it better to meet with sitting MPs and see if one can persuade them?

I’m not calling for the “deselect this person, deselect that person” rhetoric that you sometimes see on Twitter; you shouldn’t deselect an MP purely because they disagree with Corbyn, in a fair-minded way, but it’s fair to ask what are guys who are found to be be beating their wives or crossing picket lines doing sitting as our MPs? Where Labour MPs publicly have threatened to leave the party, as some have been doing, perhaps they don’t value their Labour involvement.

So to you it’s very much not a broad tool, but a tool to be used a specific way, such as when an MP has engaged in misconduct?

I think you do have to take it case by case. It would be silly to deselect the lot, as some people argue.

In terms of bringing the party to the left, or reforming party democracy, what role do you think reselection plays?

It’s a basic matter of accountability, isn’t it? People are standing as Labour candidates – they should have the confidence and backing of their constituency parties.

Do you think what it means to be a Labour member has changed since Corbyn?

Of course the Labour party has changed in the past year, as anyone who was around in the Blair, Brown, Miliband era will tell you. It’s a completely transformed party.

Will there be a strong reaction to the release of this pamphlet from Corbyn’s opponents?

Because the main aim is to set out the rules as they stand, I don’t see how there can be – if you want to use the rules, this is how to go about it. I explicitly spelled out that it’s a level playing field – if your Corbyn supporting MP doesn’t meet the expectations of the constituency party, then she or he is just as subject to a challenge.

What do you think of the new spate of suspensions and exclusions of some people who have just joined the party, and of other people, including Ronnie Draper, the General Secretary of the Bakers’ Union, who have been around for many years?

It’s clear that the Labour party machinery is playing hardball in this election, right from the start, with the freeze date and in the way they set up the registered supporters scheme, with the £25 buy in – they’re doing everything they can to influence this election unfairly. Whether they will succeed is an open question – they will if they can get away with it.

I’ve been seeing comments on social media from people who seem quite disheartened on the Corbyn side, who feel that there’s a chance that Smith might win through a war of attrition.

Looks like a Corbyn win to me, but the gerrymandering is so extensive that a Smith win isn’t ruled out.

You’ve been in the party for quite a few years, do you think there are echoes of past events, like the push for Bennite candidates and the takeover from Foot by Kinnock?

I was around last time – it was dirty and nasty at times. Despite the narrative being put out by the Labour right that it was all about Militant bully boys and intimidation by the left, my experience as a young Bennite in Tower Hamlets Labour Party, a very old traditional right wing Labour party, the intimidation was going the other way. It was an ugly time – physical threats, people shaping up to each other at meetings. It was nasty. Its nasty in a different way now, in a social media way. Can you compare the two? Some foul things happened in that time – perhaps worse in terms of physical intimidation – but you didn’t have the social media.

There are people who say the Labour Party is poised for a split – here in Plymouth (where we don’t have a Labour MP), I’m seeing comments from both sides that emphasise that after this leadership election we need to unite to fight the Tories. What do you think will happen?

I really hope a split can be avoided, but we’re a long way down the road towards a split. The sheer extent of the bad blood – the fact that the right have been openly talking about it – a number of newspaper articles about them lining up backing from wealthy donors, operating separately as a parliamentary group, then they pretend that butter wouldn’t melt in their mouths, and that they’re not talking about a split. Of course they are. Can we stop the kamikazes from doing what they’re plotting to do? I don’t know, I hope so.

How would we stop them?

We can’t, can we? If they have the financial backing, if they lose this leadership contest, there’s no doubt that some will try. I’m old enough to remember the launch of the SDP, let’s not rule it out happening again.

We’ve talked mostly about the membership. But is Corbynism a strategy to win elections?

With the new electoral registration rules already introduced, the coming boundary changes, and the loss of Scotland thanks to decades of New Labour neglect, it will be uphill struggle for Labour to win in 2020 or whenever the next election is, under any leadership.

I still think Corbyn is Labour’s best chance. Any form of continuity leadership from the past would see the Midlands and north fall to Ukip in the same way Scotland fell to the SNP. Corbyn is actually Labour’s only chance.

Margaret Corvid is a writer, activist and professional dominatrix living in the south west.