Dr Nicola Gale and Dr Kate Warren, Health Services Management Centre
The average age that women give birth to their first child has been rising since the 1970s in England and Wales. It was 23.4 in 1969 and by 2012 that average stood at 28.1 years.
The data are of course more interesting and complicated than an average figure suggests. The shift in the average age of first child has not been caused by a huge increase in “elderly primigravidae” (mothers who have their first pregnancy aged 35 or older), but mainly by a large decrease in women having their first child in their teens or early twenties. For more detail, see the official Office of National Statistics publication and this datablog on the Guardian website, which has an animated blob chart you can play with.
But what is the best age to start a family? We are familiar with the negative associations of teenage motherhood; school drop-outs, relationship breakdown, reliance on benefits, generations of the same family becoming teenage parents. Social and health policy has focused on teenage pregnancy as a problem to be fixed. On the other hand, from a medical perspective, “delayed” childbearing has been widely associated with a risk of infertility, and pregnancy and birth risks, such as miscarriage and premature birth. In fact, the Royal College of Obstetricians and Gynaecologists (RCOG) released a statement in 2009, urging would-be mothers to have children between the ages of 20 and 35 to minimise the medical risks. It seems that there is a fine line between too early and too late.
Generally, the biomedical evidence suggests younger is better. There is an increase in maternal and child health problems with older mothers and women’s fertility declines, especially after the age of 35. The sociological evidence suggests that the older the better. Children of older parents have better educational outcomes, better mental health and are less likely to be convicted of juvenile crime. Taking both into account, there is probably a tipping point at 34 when the social benefits of waiting start to be outweighed by the massive decline in fertility, meaning that a woman’s chance of becoming pregnant at all is significantly reduced.
Ensuring that women are well informed about medical and social risks of ‘early’ or ‘delayed’ childbearing and childrearing is important, but only part of the story. The framing of these issues is nearly always negative. This is not a balanced, well-informed debate. What about the youthful fitness and physical resilience of younger mothers? What about the life experience, financial stability and emotional resilience of older mothers? Younger women are often perceived to be lacking in choice, knowledge or sense. Older women are often perceived to be controlling and too focused on choice. It seems that women are damned if they do and damned if they don’t (and the fathers are rarely mentioned).
Furthermore, attributing blame, or even responsibility, on women for the consequences of their misinformed decisions reflects an ideological assumption which fails to consider the wider issues. This advertisement from the USA that states, “I’m twice as likely not to graduate high school because you had me as a teen” is a shocking example of attempts to change the behaviour of teenagers by highlighting the risks of their decisions (and also based on a misleading confusion by the advert’s designers between association and causation). But decisions are rarely made only on the basis of objective sociological and medical evidence, but because of a range of social circumstances (structural, familial, cultural, and economic) some of which are within individual control and some of which are not.
A study of women over 35 by Cooke et al found that women perceived a lack of choice in the timing of when to start a family. Although they may have reached a juncture in their lives, at which they felt ready to have a baby, the circumstances in which they found themselves may not support this; factors such as relationship, financial stability, health and fertility, were often outside of their control.
With regards to younger mothers, data drawn from the Millennium Cohort Study show that 87% of mothers under 18 describe their pregnancy as unplanned. There is a strong association between teenage pregnancy and socioeconomic deprivation, and vulnerable girls (girls in care, involved with crime, homeless, excluded from school or experiencing sexual abuse) are more likely to become teenage mothers [NHS evidence review] . As SmithBattle explains, when studies control for deprivation, the association with negative social outcomes can be greatly reduced or eliminated. It can therefore be argued that there is a chicken and egg situation going on; is it the teenage pregnancy which hinders the mother and child’s life chances, or is it the socio-economic situation which results in both the teenage pregnancy AND the poor social outcomes? The implications for policy are huge.
At a policy level, tackling the ‘problem’ of teenage or older motherhood needs to be considered as more than a medical issue; it is about gender, economics and politics as well.
At a practice and personal level, we should actively resist stereotyping on the basis of gender, income, age, or other factors and seek to understand and support our patients or friends in their choices whatever the constraints of their individual circumstances.
At a community or institutional level, challenging others or systems that stereotype or discriminate would benefit mothers, fathers and their children.
As Patricia Hill Collins said, ‘‘survival, power, and identity shape motherhood for all women.’’, so let’s listen to the stories of all women, their stories about those they love, their stories about those people and those conditions in which they have had to survive, and their attempts to ensure they retain some power in their own lives and over their own bodies. And when we’ve listened, we do what we can to support them.
Dr Nicola Gale is a health sociologist based at the Health Services Management Centre. She works in the fields of health services research, public health, primary care and complementary health care. Dr Gale is committed to theoretically-informed empirical work and to ensuring that findings are applied to improve practice.
Dr Kate Warren is a public health registrar, based at the Health Services Management Centre.