Which career first?: Women don't want it all, but they may want children

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7520.846-b (Published 06 October 2005) Cite this as: BMJ 2005;331:846
  1. Ray Noble, co-director (r.noble{at}ucl.ac.uk)
  1. Centre for Reproductive Ethics and Rights, University College London, London WC1E 6BT

    EDITOR—The use of the phrase “epidemic of pregnancy in middle age”1 is loaded with value judgments and implies that pregnancy in middle age is akin to a disease. An epidemic by definition is a widespread occurrence of an infectious disease in a community at a particular time or a sudden, widespread occurrence of an undesirable phenomenon. In the words of Bewley et al,1 most pregnancies in women older than 35 have good outcomes. Childbearing late in life carries “risk,” but risk itself is not a disease, and there is little evidence that women in general are unaware of these risks, particularly those who elect to have children later in life.

    Bewley et al are right to target social and economic conditions influencing women's reproductive choices but give no evidence to substantiate their sweeping judgment that “women want it all.” The probable truth is that women or couples turn to fertility treatment for a variety of reasons and this is as true for those who want children late in life as it is for those who need fertility treatment early in life.

    To brand women as being selfish is absurd and unfounded. Throwing together selective data on risk from disparate sources and without context merely serves as a scare tactic rather than rational discussion. Although older women are more likely to be obese, be taking drug treatment, have a medical disorder, experience severe morbidity, or die, the reference they give for this (confidential inquiry into maternal and child health2) also shows that social disadvantage, poor communities, minority ethnic groups, late booking or poor attendance, domestic violence, substance abuse, suboptimal clinical care, and lack of inter-professional or interagency communication are all contributing factors to poor outcome. For suboptimal clinical care the contribution is higher (67%) than that given for obesity (35%).


    • Competing interests RN is a member of an NHS trust research ethics committee


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