Social advantage may make up for biological disadvantage

General practice p 1708

When is the best time in life to be a mother? Or a father? These questions have been raised in the past, but the answers have left uncertainties. To address some of these issues, Andersen et al, in their paper on maternal age and fetal loss in this issue of the BMJ, have used a large set of data from the Danish Epidemiology Science Centre to good effect (p 1708).1 Their findings are largely confirmatory: older age strongly increases a woman's chances of at least three untoward outcomes—namely, stillbirth, miscarriage, and ectopic pregnancy. Prospective parents concerned about their age might hope for answers to other questions as well.

Over the past 50 years or so, options for controlling or enhancing fertility have grown. These changes began with the introduction of oral contraception and have continued with the legalisation of induced abortion and the development of ever more sophisticated techniques of in vitro fertilisation and advances in obstetrics that ensure safe deliveries. Older women especially benefit from all of these; each has had an impact on the age at which women bear children.

For instance, the Danish tables show trends in the rates of induced abortions over the period 1978-92. On one side of the reproductive age span, these occur proportionately most frequently during the teens, when the greatest social disadvantage is associated with childbearing. On the other side, the greatest number of induced …