Topic Guide: Older Mums

Is it acceptable for women to use fertility treatment to have babies when they have clearly gone beyond their ‘natural’ childbearing years? In May 2009, a woman of 66 became the UK’s oldest mother, following fertility treatment at a Ukrainian clinic using donated eggs and sperm [Ref: Daily Telegraph]. How old can mothers possibly go? In India in 2008, two women have been headlined as the world’s oldest mothers after both giving birth at the age of 70. Omkari Panwar, who gave birth to twins, and her 77-year-old husband already have two adult daughters but were reportedly determined to have a son [Ref: Daily Mail]. Later that year, another Indian septuagenarian, Rajo Devi, gave birth to a girl, and promptly declared her desire to have another baby [Ref: Daily Telegraph]. In February of 2010 the London Women’s Clinic announced that it had revised its policy of only providing IVF treatment to women 50 and under, citing the fact that we are living much longer as the spur to their decision. [Ref: Evening Standard] This came in the wake of the BBC programme screened in January, Too Old to be a Mum?, which generated much discussion about the issue and featured women such as Lauren Cohen, a working mum with three children all under five at the age of 63 [Ref: BBC].

Medical opinion has historically recognised that women having babies later in life carries a higher level of risk to their own health, and that of their babies, than pregnancy in younger women [Ref: BBC News]. Until recent times, it was considered more socially acceptable for women to have babies when in their twenties than in their forties and women’s ability to have children later in life was limited by their own biology, as they would simply be unable to conceive. But advances in Assisted Reproductive Technology (ART), particularly techniques such as egg donation [Ref: Wikipedia], mean that women are able now to have babies even when they have passed through the menopause and reached the end of their natural reproductive life. The question is not about women becoming pregnant accidentally or naturally at an age that some consider older than ideal, but about whether they should be helped to do this by doctors and technology. Should a line be drawn – and if so, where and by whom? And are our reservations about older mums influenced by outdated and potentially ageist views of older people?

What are the regulations?
In the UK, there is no upper legal age limit at which a woman can receive fertility treatment, and no limit that is specified or enforced by the regulatory body the Human Fertilisation and Embryology Authority [Ref: HFEA]. Clinicians are required to meet the clinical best practice standard that: the patient’s health will allow them to go through during the treatment and the potential pregnancy. They are also required by law to carry out a Welfare of the Child assessment before starting any treatment. This looks at factors which are likely to cause serious physical, psychological or medical harm, either to the child to be born or to any existing child of the family, possibly including the eventuality that a mother might die before her child reaches adulthood, or become unable to care for the child. In practice, most UK clinics will not treat women over the age of 50. However, one London clinic has helped women to become mothers up to the age of 60 [Ref: Daily Mail]. Many of the news reports about ‘oldest mums’ refer to women who have travelled from the UK to obtain treatment from other countries. This is often referred to as ‘fertility tourism’, and regulators are concerned that women obtaining treatment abroad may expose themselves to increased health risks and other problems [Ref: HFEA]. However, others argue that if women cannot obtain the treatment that they want – and are prepared to pay for – in their home country, there’s no reason why they shouldn’t go elsewhere [Ref: BioNews]. Guidance from the National Institute for Clinical Excellence (NICE) recommends a maximum age limit of 39 for women obtaining fertility treatment on the NHS, so much older mums will find themselves paying for private treatment. But critics point out that the NHS still has to meet the costs of caring for these mothers and their babies in the (relatively likely) circumstance that there will be complications with the pregnancy and birth [Ref: Daily Mail].

Bad for the mother?
One obvious criticism of post-menopausal women using fertility treatment to have babies is that this subverts the laws of nature. But others counter that all fertility treatment is unnatural - indeed, that is the point of it. It is now widely accepted that younger women should be able to use ARTs to overcome the barriers that nature has placed in their way, and great joy is brought to these women, so why deny post-menopausal women the same chance? It is said that the phenomenon of ostmenopausal women having children disrupts the generational order of things in society, and that a woman in this situation will be out of kilter with her peers [Ref:Daily Telegraph]. Others argue that the age of motherhood is rising [Ref: Independent], as is the proportion of IVF babies born to women in their forties, so these older mums might not be as abnormal as we think, and there is no clear place to draw the line. In this view, decisions should be made on a case-by-case basis, and the choice should be down to the woman and the doctor who treats her. Parenthood is widely accepted to be a choice these days, and people have children for many and varied personal reasons. Why should older women’s reasons for choosing motherhood be any less valid than those of younger women?

Bad for the child?
Some medics have raised concerns about the more general societal trend for women having children later, and the associated risks this carries for both mothers and their babies [Ref: Guardian]. For example, whilst the risk of giving birth to a child with Down’s Syndrome is about 1 in 1,000 for a woman in her late twenties, this risk rises to around 1 in 100 for women giving birth at the age of 40. [Ref: The Times]. More specifically, a key concern about women over 50 giving birth is the increased likelihood of their falling seriously ill and being unable to care for their young offspring. The death in July 2009 of María Carmen del Bousada de Lara, a single mother who had given birth to twins at the age of 66, reignited debate about the ‘selfishness’ of post-menopausal women who have children [Ref: The Times]. Ms Bousada learnt that she had a tumour before giving birth to her sons in Spain, and died when they were aged two, leaving the boys orphaned. Much commentary focused on the problems caused for children by having mothers who were statistically more likely to die, or become ill or infirm, before their children reached adulthood. In this view, concern about the welfare of the child born as a result of fertility treatment should provide a clear reason why much older mothers should be denied treatment. But others point out that there is a double standard here, in that older men are able to father children naturally and talk positively about the experience [Ref: The Times], so why should such a fuss be made when women do the same thing? No parent, whatever their age, can guarantee that they will not become ill or die before their children are grown up, and some women are healthier in their 60s than others in their 20s. Defenders of older mums point to research suggesting that they can be just as good parents as their younger counterparts [Ref: Guardian] – in which case, decisions based on the ‘welfare of the child’ should arguably treat such cases more favourably. If it is assumed that children love their parents whatever age they are, how can being born to an older mother actually damage the child?

Perceptions of older people
The perception of older people and their place in society is one that can often be negative. Recently, the BBC has been accused of ageism by replacing older female presenters with younger, less experienced, women – most notably in the cases of the newsreader Moira Stewart and Strictly Come Dancing Judge Arlene Phillips. Some have argued that this focus on youth indicates a wide-spread attitude which says older women do not contribute to society [Ref: Guardian], with Harriet Harman suggesting it indicated that older women were not valued [Ref: Independent]. In the recent debates about free care for the elderly and in fears over a ‘demographic timebomb’, older people have been frequently described as a burden upon others and as an increasingly soaring cost to younger generations [Ref: Guardian]. These negative attitudes towards ageing and the elderly come despite the fact that older people are now living, healthier lives than ever before, continuing to be active and contributing to society [Ref: The Times]. However, the recent questioning of the current retirement age does indicate that society is beginning to question its assumptions about the elderly - with more people living longer and healthier lives past the current retirement age, it has been argued that we should cease to see older people as liabilities, but more as assets to society [Ref: Guardian]. A London fertility clinic recently used the fact that women are living longer lives to justify its providing IVF to women over-50, despite the fact the NHS continues to have a cut-off for treatment of 39 [Ref: Evening Standard]. Sue Tollefsen, a 59 year old patient of the clinic who had her first child aged 57 following IVF treatment in Russia, defended her decision to try for a second child, telling the Sun newspaper “Don’t just look at me as a 59 year old - look at my child and how happy and lovely she is. …I’m full of energy. I’m very health-conscious, and I do everything other young mums can do.” [Ref: Sun] Is the unease over older mums in part informed by a negative outlook on ageing in general? Or are there objective reasons, such as the greater likelihood of the child being born disabled or the mother falling seriously ill, why it remains irresponsible for women over 50 to have babies? And whilst women in their late 50s might be full of energy and drive, some experts warn that ‘motherhood can take a bigger psychological and physical toll on older mothers than on younger ones’ [Ref: The Times].