The inconvenient truth of fertility decline

The July/ August edition of the US magazine, The Atlantic, featured the article 'How long can you wait to have a baby?' (also published in The Observer). The premise of Jean Twenge's piece, which spread quickly across social media and more traditional sites, was that science has 'oversold' the effects of age on female fertility. My commentary will not address the validity of the science that was cited in The Atlantic - others are more qualified to do that - but instead focuses on the implications of such journalism.

In response to this article, the Huffington Post astutely suggested that Twenge's piece was 'essentially telling women what they wanted to hear'. I agree. And who could blame women for hoping that they are more reproductively robust than is actually the case? Childbearing decisions are made within the cultural and historical context in which people live. The current environment is one in which women are encouraged to make the most of their education, by developing their presence in the workplace. Yet, the workplace and society make it exceptionally difficult for women to do this and also have a family. In an attempt to satisfy these two competing demands, women often delay having children in order to buy themselves some time. Unfortunately, women sometimes wait too long and find that they are unable to have children, or have great difficulty in doing so.

The issue with Twenge's article is not necessarily the science that it cites, but the research she has failed to cite. For example, Tietze's 1957 study of the Hutterite community (1), which established natural fertility decline in a non-contracepting community, is not discussed. Neither is there any reference to the work of Roger Gosden or Malcolm Faddy, who have investigated the depletion of ovarian reserve (2). Yet the author's persuasive style and reference to having extensively searched the academic literature increases the plausibility of her argument, especially to a readership that may be less scientifically literate.

More worrisome still is the way in which other media organisations covered this story. Any of the points in Twenge's original piece that could be considered well-reasoned and balanced, were lost. Online magazine Slate ran a headline saying: 'Everything You Thought You Knew About Age and Fertility Was Wrong'. While the coverage by The Times, which paraphrased the original, but presented it as fact, lends what is essentially an opinion piece, mainstream credibility.

The accuracy, or otherwise, of the science reported in such pieces is, in many ways, not the point. The real elephant in the room is the way in which the media both argues against the case for not delaying childbearing while also propagating a very particular stereotype of educated women. Specifically, Twenge suggests that couples 'shouldn't let alarmist rhetoric push them to become parents before they're ready'. While in response to Twenge's article, Slate stated: 'it's wonderful news that the statistics about fertility decline have potentially been exaggerated. Then perhaps we can push back against attitudes that women are '"waiting too long" because they're deluded or selfish or career-obsessed'.

And herein lies the problem. The media is constantly fighting this persistent stereotype that women are deliberately not having children because they are - to use Disraeli's famous phrase - climbing to 'the top of the greasy pole'. It is easy to blame age-related infertility on women's career-mindedness, given that the trend towards advanced maternal age coincides with a radical and rapid change in women's roles in society. However, when older motherhood is discussed in conjunction with sentiments such as 'careerism', 'selfishness' and 'wanting it all', the well-intentioned warning that comes from establishments, such as the Royal College of Obstetricians and Gynaecologists, that women should not leave it too late if they want to have children, gets lost.

Yet, in the same breath, the media themselves are perpetrating the stereotype of the selfish career woman. For example, in 2011, the Sunday Times carried the headline, 'Generation X puts work before kids', accompanied by pictures of professional women, but not men. As such the media itself is singling women out implying that they are almost intentionally compromising their fertility. Ironically, they frequently use alarmist rhetoric to do so.

By playing both sides the media is doing women a disservice and treats them as pawns in a complex societal issue. The media would be better served by not 'pushing back' against the scientific community, no matter how inconvenient their truth is. Instead it should focus its considerable energies on busting the myth of the career-obsessed woman and shine a light on the structural and institutional barriers that constrain reproductive choices for both men and women. Perhaps then women will not feel berated for their life choices and less resistant to hearing the inconvenient truth of fertility decline.