Thursday, August 7, 2008

Babies, Biology, and Ideology

Photo by Flickr user JeremyHall, used under a Creative Commons license.

For feminists and women's health advocates, it's not exactly news that the life sciences aren't quite the beacons of objectivity that they purport to be. Even so, a study released today on the risks of pregnancy over age 40 is startling in how its conclusions are totally warped by ideology.

Published in the Journal of Women's Health, the study - "Pregnancy Late in Life - A Hospital-Based Study of Birth Outcomes," by Ali Delpisheh et al. - concludes that fetal risks rise sharply after about age 40.
Background: Pregnancy in older women is of great relevance, particularly in developed countries where many women experience pregnancy late in the childbearing age.

Methods: A hospital-based data analysis of 9506 delivery records from 1998 to 2003 at the Liverpool Women's Hospital was undertaken to assess pregnancy outcomes in older women of reproductive age.

Results: Overall, 2.4 % of mothers were >40 years of age (advanced), 5.6% were <20 style="font-style: italic;">followed a U-shaped curve with nadirs in the middle age classes. ... [my emphasis]

Conclusions: Pregnancy in older women is associated with adverse birth outcomes, particularly in primigravidas. Increased health promotion is required to highlight the risk of adverse birth outcomes in women who become pregnant for the first time in the late childbearing years.
So, okay. We already knew that pregnancy becomes riskier for both mother and child as the mother grows older. But first, note that the data follow a curve. Women don't suddenly drop off a cliff after age 40. If you go to the full-length study (available for free in .pdf format) you'll see that it really is a U-shaped curve.

Second, and more importantly: The data in the full text of the study clearly show that by all three measures (low birthweight, preterm birth, and small for gestational age), the babies of young mothers - defined here as less than 20 years old - fare just as poorly.

Yet the intro and conclusion of this abstract fail to even hint that extreme youth could be just as problematic as advancing age. Indeed, given that adolescents outnumbered the older gals by a ratio of 5 to 2 in this study, their babies' health problems represent a greater public health problem and an even larger contribution to human suffering.

Moreover, this study was conducted in Great Britain, a nation with universal health insurance. In the United States, the rate of complications among very young mothers is likely to be higher yet because they are less likely to be insured than the older crowd. In the United States, furthermore, complications of prematurity among uninsured adolescent mothers mean that 1) taxpayers will foot much of the bill for the NICU, and 2) those adolescent mothers will suffer financial worries along with the emotional rollercoaster of caring for a baby born too soon. Having watched friends deal with significant prematurity, I know I'd struggle even at my "advanced age." How much harder would that be if you, the mother, were only 16 or 18!

Now why would careful scientists fail to highlight the second half of their findings? Could it be that the cultural anxieties about women deferring marriage and childbearing have spilled into the hospital and lab, too? Because I honestly see no other reason why the abstract (which is all many doctors and journalists will read) should omit the sufferings of adolescents. The way the problem is currently framed, it plugs right into a discourse of blaming women for first establishing a career before starting a family, while ignoring the real physical risks of very early motherhood.


Heather Munro Prescott said...

Given the tendency by scientists to publish the smallest possible unit of data (aka "salami scholarship"), thereby expanding their CVs, I would reckon that the report on mothers below the age of 20 is on its way!

Sungold said...

Heh. I'm skeptical. But yeah, fluffing up one's CV might actually trump ideology. And if it does, it'll fall squarely into *your* field.

Are you gonna blog on your foray into disability history? I'd love to hear how the conference in SF went for you.