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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What is the Scottish Six and why are people getting so upset about it?

The BBC is launching a new Scottish-produced TV channel. And it's already causing a stooshie. 

At first glance, it should be brilliant news. The BBC’s director general Tony Hall has unveiled a new TV channel for Scotland, due to start broadcasting in 2018. 

It will be called BBC Scotland (a label that already exists, confusingly), and means the creation of 80 new journalism jobs – a boon at a time when the traditional news industry is floundering. While the details are yet to be finalised, it means that a Scottish watcher will be able to turn on the TV at 7pm and flick to a Scottish-produced channel. Crucially, it will have a flagship news programme at 9pm.

The BBC is pumping £19m into the channel and digital developments, as well as another £1.2m for BBC Alba (Scotland’s Gaelic language channel). What’s not to like? 

One thing in particular, according to the Scottish National Party. The announcement of a 9pm news show effectively kills the idea of replacing News at Six. 

Leading the charge for “a Scottish Six” is John Nicolson, the party’s Westminster spokesman for culture, media and sport. A former BBC presenter himself, Nicolson has tried to frame the debate as a practical one. 

“Look at the running order this week,” he told the Today programme:

“You’ll see that the BBC network six o’clock news repeatedly runs leading on an English transport story, an English health story, an English education story. 

“That’s right and proper because of the majority of audience in the UK are English, so absolutely reasonable that English people should want to see and hear English news, but equally reasonable that Scottish people should not want to listen to English news.”

The SNP’s opponents think they spy fake nationalist outrage. The Scottish Conservatives shadow culture secretary Jackson Carlaw declared: “Only they, with their inherent and serial grievance agenda, could find fault with this.” 

The critics have a point. The BBC has become a favourite punch bag for cybernats. It has been accused of everything from doctored editing during the independence referendum to shrinking Scotland on the weather map

Meanwhile, the SNP’s claim to want more coverage of Scottish policies seems rather hollow at a time when at least one journalist claims the party is trying to silence him

As for the BBC, it says the main reason for not scrapping News at Six is simply that it is popular in Scotland already. 

But if the SNP is playing it up, there is no doubt that TV schedules can be annoying north of the border. When I was a kid, at a time when #indyref was only a twinkle in Alex Salmond’s eye, one of my main grievances was that children’s TV was all scheduled to match the English holidays. I’ve migrated to London and BBC iPlayer, but I do feel truly sorry for anyone in Glasgow who has lost half an hour to hearing about Southern Railways. 

Then there's the fact that the Scottish government could do with more scrutiny. 

“I’m at odds with most Labour folk on this, as I’ve long been a strong supporter of a Scottish Six,” Duncan Hothershall, who edits the Scottish website Labour Hame. “I think the lack of a Scotland-centred but internationally focused news programme is one of the factors that has allowed SNP ministers to avoid responsibility for failures.”

Still, he’s not about to complain if that scrutiny happens at nine o’clock instead: “I think the news this morning of a new evening channel with a one hour news programme exactly as the Scottish Six was envisaged is enormously good news.”

Let the reporting begin. 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.