What is the biggest anxiety for women? Many people’s answer may be: age. And the biggest anxiety usually appears around the age of 28 to 30, because of aging, because …… fertility.
Since childhood, every girl has heard the rule that “women need to hurry up to have children, after a certain age they will not be able to give birth”, and the media is constantly playing up the idea that “the best time for women to have children is only the golden years”.
Despite this, there seems to be a trend of “women having children later” both at home and abroad, and the age of women’s first birth is rising. From 1990 to 2017, the average age of first childbirth for women in China has increased from 23.4 to 26.8 years old, and this trend is still being maintained.
This trend is even more pronounced in large cities. For example, in 2020, the average age of first childbirth for women registered in Shanghai has reached 30.3 years old.
Are women ignoring the optimal age for childbearing?
The first thing to acknowledge is that in medical terms, the ‘optimal age of childbearing’ exists objectively.
Statistically speaking, the age between 25 and 34 years is the lowest risk time for both maternal complications and fetal abnormalities or poor prognosis. Therefore, the age of 35 is also defined as the dividing line between “advanced maternal age” and “normal maternal age”.
The risk of fetal chromosomal abnormalities, for example, increases after the age of 35 years. (See Figure 1)
In 2009, a study of more than 7 million hospitalizations across the United States showed the relationship between different age groups and maternal-related complications. Figure 2 shows the number of people with each complication in a population of 1000.
However, if we look farther back and zoom in on the vertical coordinate to the unit of 1000 people, we see that age 35 is not a steep inflection point for maternal complications; nor is the actual impact on individuals as dramatic as public opinion makes it out to be.
For example, between the ages of 25 and 29, 67.5 out of 1,000 people have a preterm birth; between the ages of 35 and 39, the figure is 75.4. This is an 11% increase in the probability of occurrence, but in reality there is an increase of 7.9 per 1000 pregnancies.
In the case of gestational hypertension, for example, the incidence of hypertension at age 35-39 years increased by 28.5% per 1,000 compared to age 25-29 years, which seems very significant. However, the actual number is 15 more per 1000 people.
Even after the age of 35, the majority of people who get pregnant and eventually have a baby safely still do.
However, in order to keep the risk as low as possible, there are special clinical treatments for “advanced maternal age,” which not only require stricter control of blood pressure and blood sugar, but also require doctors to recommend the use of tests such as non-invasive DNA and amniocentesis to minimize the risk of having a child with chromosomal abnormalities.
For a variety of reasons, both friends and family and doctors habitually advise women time and time again that having a baby early will give both mother and child a better chance of being healthy.
This persuasion is not without merit, but it is somewhat out of balance – out of balance in terms of population and out of balance in terms of decision-making.
For example, in terms of population, the discussion of fertility risk seems to focus on one gender, one age group. In fact, there is a biological “optimal age” for both men and women to have children (generally defined as 27-35 years for men). It is also important to mention that while the average age of marriage and childbearing is being delayed in China, the situation of early child marriage and childbearing is also worsening.
In 2016, the fertility rate for women aged 15 to 19 years reached 0.9%, even surpassing that of women aged 40 to 44 years. And the combined risk of having a child at age 19 is higher than at age 35, and the combined risk of having a child at age 14 is higher than at age 40.
Furthermore, age is not the only factor in fertility.
For each of us who needs to participate in society, having a child is never just a medical thing. What medicine can assess is the short-term health status before and after childbirth, but childbirth is something that has long-term effects on women, children, and families, and cannot be simply defined by ‘age’.
For example, many studies in the field of sociology and economics have found that it may be more beneficial for both the mother and the child for the mother to accumulate certain resources before having children.
Even for women, becoming a mother means facing the “Motherhood Penalty”, which is reflected in economic income differences between women and men, and between mothers and non-mothers, in large part because women who become mothers take on more childbearing and caregiving labor. In 1989, each additional child resulted in about a 9% reduction in women’s wages, and by 2015, each additional child resulted in about a 13% reduction in women’s wages.
In contemporary society, more and more women are pursuing their own careers, and the timing of childbearing is naturally changing – for example, when they are able enough to consider marriage and childbearing.
When discussing the “optimal age for childbearing”, it is important to remember that this optimal is only a statistical “prettiest number”. Statistics are a very useful reference, however, there are some unique ‘numbers’ for each person’s life that only they know, such as
What kind of person do you want to be? What is your physical condition, your family health history? What will it cost you to raise a child? What help can you get? ……
These are things that medical data cannot tell you, but things that can profoundly affect your life after childbirth.
Seriously, having a baby is an adventure, and we expect to weave an incredibly tight net to keep all the uncertainties out, and to catch the little life that is coming. However, life is full of uncertainties and it is hard to say when we are truly sure.
When complicated issues such as personal values, career development, family relationships and life extension are intertwined, I hope that every woman and every family can make the most suitable choice after evaluation and preparation, instead of compromising on the so-called “countdown” under the hostage of external anxiety.
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