Health

There's an "epidemic" and it's not bird flu nor tuberculosis. No: it's in the UK, it affects females over the age of 35 and the disease is "older mothers". For, as a British Medical Journal editorial said last week, older motherhood is less probable in the first place, more dangerous and "risks heartbreak".

Delaying babies, the authors say, "defies nature". Increased maternal age, they add, brings, among other things, an increased risk of miscarriage, ectopic pregnancy and chromosomal abnormalities and an increased rate of the baby being premature, stillborn or admitted to intensive care. Additionally, older fathers are linked with an increased risk of schizophrenia and certain genetic diseases in their children. While for a pregnant older woman as an individual, the chances are still for a good outcome, the shift of the population towards older pregnancy is concerning, the authors say.

But is older motherhood really "defying nature"? Earlier in the year I was meandering along a series of bookshelves in an eccentric hotel. I happened across an ancient book that showed exactly what "nature" did for Victorian women who, as was perfectly normal then, married young and had babies straightaway. The illustrations showed family trees where the branches mainly ended in child-sized coffins.

Defying nature is often a very good thing. We defy nature when we don't accept meningitis as being "nature's way" of disposing of a few hundred children each year and inject large amounts of penicillin as quickly as possible. We "defy nature" every time we take out infected appendixes, shrink brain tumours with chemotherapy, or immunise babies against measles.

We only have to look at child mortality statistics over the past hundred or so years to see just how far we have come. National Statistics figures show that in 1901, 25 per cent of annual deaths were of infants. The graphs a century later show the shrunken figure: the numbers on the bar chart for 2001 are a faint sliver compared with the chunk representing the same age group 100 years ago. We have defied a cruel and ugly "nature" - and it has done our children good.

So does that mean that we should recommend that women should continue to get pregnant whenever it suits - seemingly increasingly later in life - and trust that medicine will provide the necessary back-up as required?

While women certainly should have accurate and useful information about when their fertility is likely to decline, and their comparative risk of pregnancy according to their age, there is never going to be a perfect time to have a baby. Guarantees of a healthy infant are impossible. Some "fertility agencies" offer hormone tests and sperm analysis to "make sure", but this is no guarantee of future fertility. In fact, infertility is "unexplained" in around a third of cases. Despite a burgeoning IVF industry, medicine does not have all the answers, or treatments. The live birth rate of IVF for women over 40 is slender and usually quoted at around 5 per cent at best.

It is therefore interesting that the government and the medical profession have spent a large amount of time and energy effectively demonising teenage girls who become - quite "naturally" - pregnant. Of course no one wants a child to bear her own. The Teenage Pregnancy Unit says that there were 7,600 under-16 pregnancies in England in 2003, almost 60 per cent of which ended in abortion. Additionally, very young mothers have distinct obstetric problems to do with physical immaturity.

However, most older teenagers make it into the lower-risk obstetric class. True, start having sex early or have more sexual partners and you're at higher risk of cervical cancer or infections - but you are still statistically better off for achieving pregnancy at all. And while the the reasons as to why teenagers get pregnant is another story, suffice to say that it isn't always the disaster it is usually heralded as.

For all the financial advantages that older motherhood can bring, there are also advantages in having a young mother. And if the argument is one of NHS resources, the numbers of teenage births are small compared with the amount of births in "higher risk" older mothers: in 2003, in England and Wales, there were 97,000 births where the mother was aged between 35-39, and over 19,000 births in women over 40.

Rather than making the older mother out to be a selfish, must-have-it-all woman, perhaps there should be a little less moral judgment about what a woman's reproductive age "means" in a wider sense. Women should be able to decide for themselves - and if the decision is to take their chances in waiting to have a baby, fine. As the authors of the paper suggest, women need clear, unbiased information about age and changes to fertility.

But that may be easier said than done. I once attended a series of lectures on reproductive health. First was a contraception specialist, who gave graphic warnings about how easy it was to have a contraception failure. This was followed by an infertility specialist who sombrely told us just how hard it was to become pregnant at all.

We defy nature constantly, but we can't defy the uncertainty inherent in our fertility, whatever our age.

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