The Politically Incorrect Guide to Women, Sex, and Feminism

by Carrie L. Lukas

  A healthy thirty-year-old woman has a 20 percent chance of getting pregnant in a given month. Ten years later, that forty-year-old has just a 5 percent chance.

  New York City buses featured hourglass shaped baby bottles, with milk—representing time—dripping away. The image was certainly provocative. Like most issue ad campaigns, the point was to get women talking about the issue and encourage them to get more information.

  The text of the ad was actually quite matter of fact. The headline stated: “Advancing age decreases your ability to have children.” The text continued “While women and their partners must be the ones to decide the best time when (and if) to have children, women in their twenties and early thirties are most likely to conceive. Infertility is a disease affecting 6.1 million people in the United States.”

  The National Organization for Women was outraged. Kim Gandy, NOW’s president, complained: “Certainly women are well aware of the so-called biological clock. And I don’t think that we need any more pressure to have kids.”1 In an interview conducted at the time of the campaign, Kim Gandy is reported to have “kept adamantly reiterating that there are women in their 40s who have no trouble conceiving, and women in their 20s who just can’t seem to make a baby.”2

  In a more carefully crafted reaction to the advertising campaign in an op-ed in USA Today, Gandy stressed the importance of women getting information about their health: “NOW commends the good doctors for attempting to educate women about their health, but we think they are going about it in the wrong way—by blaming individual women and their behavior for a problem that is caused by many factors, some behavioral, but most not. The ASRM gets free publicity, and women are, once again, made to feel anxious about their bodies and guilty about their choices.”3

  Gandy doesn’t explain how a statement of fact is an attempt to make women feel “guilty” about their choices. The ad simply reminds women that they are making a choice when they put off children and that there may be unwelcome consequences. The very essence of making a choice is to understand fully the costs and benefits of each option. Without all of the relevant information, women may make decisions that don’t reflect their true preferences.

  Guess which one is politically incorrect?

  There’s reason to believe that many women don’t recognize the choices they are making when they delay childbirth. In spite of Gandy’s accusation that the non-profit was motivated by a desire for “publicity,” a spokesman explained that the association wanted to run the ads because doctors were tired of having women in their late thirties and forties shocked, frustrated, and heartbroken to find that their dreams of having children had vanished.

  No taboo about smoking’s drawbacks

  Neither NOW nor any other groups complained about the anti-smoking fertility ad, which was much more hard-hitting. That picture showed a baby bottle being used as an ashtray. The headline gave a stern warning: “If you smoke this might be your only use for a baby’s bottle.”

  When it comes to smoking, no one follows Gandy’s logic that because the public already knows about the health hazards there shouldn’t be more advertising harping on the problem; or that these issue ads are designed to make smokers “feel guilty” about their choices. The federal government pours money into education campaigns on the dangers of smoking, in spite of research that shows that Americans are well aware of the dangers. Clearly the assumption behind anti-smoking ads is that it takes more than just knowing the facts; those facts have to be repeated many times to change behavior.

  It’s far from clear that women do know the facts about fertility. Many women have been led to believe that they can postpone childbearing without consequence and regret that decision later in life.

  While there are numerous websites and forums that allow women to receive and share information about fertility issues and treatments, the natural decline in fertility is rarely a topic in mainstream women’s magazines, particularly among those that cater to a twenty-something audience. The cover of the May 2005 issue of Marie Claire includes the alarming headline: “30 & Infertile? Why YOU are at RISK.” The story focuses on the difficult to diagnosis condition called premature ovarian failure (POF) that can inflict young women and make them unable to conceive. A similar column in the March 2005 Cosmopolitan focused on the plight of a twenty-three-year-old inflicted with POF. These articles are important for raising awareness about health problems among women, and helping women understand the need to monitor their fertility, but does little to encourage the healthy twenty- or thirty-something woman to consider the natural decline in her fertility.

  The March 2005 issue of Glamour provides readers with tips on how not to get pregnant and how to get pregnant, but barely touches on how getting pregnant becomes more difficult with age. Tip number three for how to conceive—“The Importance of Being Healthy”—encourages readers to quit smoking, limit caffeine and alcohol, and achieve a healthy body weight. Age’s role in fertility is buried in the last paragraph. A doctor who assures readers “we all know women over forty who got pregnant without aid of technology” before recommending women get started before thirty-five, and at the latest thirty-nine.

  Without Issue

  Fertility and aging “is a non-issue.”

  —Julie Shah, co-director, Third Wave Foundation (a feminist organization representing young feminists)

  Hit television shows have depicted female characters struggling with problems of infertility. On Sex and the City, Charlotte undergoes fertility treatments and suffers a miscarriage while attempting to overcome natural fertility obstacles. On Friends, Monica and Chandler find that due to a combination of his low sperm count and problems with her womb, they’re unlikely to ever get pregnant. In both cases, the couples go on successfully to adopt babies.

  While these shows may be helpful in making women aware of the potential for health problems that contribute to infertility, neither characters’ situation is a result of age-related fertility.

  In general, without good information, women can easily avoid consideration about fertility until they are seriously thinking about having children. By that time, fertility already could be a problem.

  Infertility: a “non-issue” for feminists and women’s studies

  The organized feminist movement and women’s studies programs do next to nothing to address the lack of information about age related infertility. Julie Shah, co-director of the Third Wave Foundation (a group representing and promoting young feminists), described fertility and aging as “a non-issue.”4 NOW’s centerpiece issue is abortion rights, but information about problems associated with fertility is all but absent on their website.

  A sampling of textbooks used by introductory women’s studies classes suggests that the subject of fertility is seldom considered. In Virginia Sapiro’s textbook Women in American Society: An Introduction to Women’s Studies, there’s a chapter entitled “Reproduction, Parenthood, and Child Care.”5 It covers attitudes toward motherhood, growing availability of contraception, the change in demographics as more women choose to have children later in life, and the challenges of raising children. Twelve pages are dedicated to a discussion of the history and growing availability of contraception, more than half of which is dedicated to abortion. Never in her discussion of women’s greater ability to prevent childbearing does Sapiro discuss the problems some women face in not being able to conceive or carry a child to term.

  Hilary M. Lips’s Sex and Gender dedicates seven pages to women’s menstrual cycle and another two pages to exploring the possibility of men having a similar “cycle,” but there’s no discussion about how age affects women’s fertility. After a section on pregnancy, expectant fatherhood, childbirth and the postpartum experience, and abortion, readers begin to read about menopause. The section begins: “At about age 40, women’s ovaries begin to stop responding to stimulation by pituitary hormones to produce estrogen and progesterone.”6 After describing some of the physical symptoms experienced during menopause, she me
ntions the loss of fertility: “A woman at this stage is losing her ability to bear children—an ability that our culture tends to emphasize as crucial to the feminine role.”7

  While Lips may believe our culture is too fixated on women’s fertility and that too much value is attached to this ability to bare children, many women personally attach a great deal of importance to having children and are willing to go to great lengthens to get pregnant. Their lack of understanding of the realities of fertility can lead to serious heartbreak and regret.

  Facing the facts

  The realities of fertility are masked by highly publicized examples of women who are having babies in their forties and beyond. In November 2004, the fifty-five-year-old Ms. Aleta St. James gave birth to twins. This received press attention both in New York where the babies were born, and nationwide. Some stories discussed the hard road this mother had to achieving pregnancy, but others left the story of her conception as an aside. Women’s magazines and entertainment television shows often feature celebrities who give birth late in life. Rarely do they discuss the challenge of getting pregnant or the expensive measures that many of these celebrities have taken in order to conceive. But it’s critically important that women consider that it took St. James three years and in vitro fertilization treatments that cost $25,000 to create those twins.8

  Kim Gandy certainly is correct that some women easily get pregnant in their forties while other twenty-somethings struggle with infertility. There are also people who smoke a pack per day and live into their nineties while twenty-year-olds who follow all the rules of a healthy life are tragically struck down by illness. The fact that exceptions exist doesn’t mean that women ought to ignore medical research and assume that they will be among the lucky who defy the odds.

  So what are the facts about fertility?

  According to American Society for Reproductive Medicine, an estimated one in three couples in which the female is over age thirty-five will have fertility problems. By age forty, two out of three women will not be able to achieve pregnancy spontaneously.9 According to RESOLVE, a woman in her late twenties is about 30 percent less fertile than she was in her twenties.

  The American Society for Reproductive Medicine describes how age is associated with a decline in fertility:Although the average age of menopause is 51, peak efficiency in the female reproductive system occurs in the early 20s with a steady decline thereafter. There is a gradual loss of fertility as a function of female age with the rate of decline in fertility becoming more dramatic after the age of 35.10

  A healthy thirty-year-old woman has a 20 percent chance of getting pregnant in a given month. Ten years later, that forty-year-old has just a 5 percent chance of conceiving.11

  The reason for this decline in fertility is simple. A woman is born with all of the eggs that she will produce during her lifetime. This supply of eggs depletes over time. Her eggs also age, declining in quality so that they are less likely to be successfully fertilized and brought to term.

  While conception becomes more difficult as a woman ages, the potential for something to go wrong during pregnancy also increases. Just one in ten women under thirty suffers a miscarriage; by age forty, one in three women will lose their child through miscarriage.

  The potential for other problems also rises with age. Older eggs are more likely to contain genetic abnormalities, making the incidence of Down Syndrome or other chromosomal abnormalities more common.12

  Of course, women confronting fertility problems should know that there are treatments that can help women reproduce. The American Infertility Association’s brochure entitled “What Mother Didn’t Tell You About Fertility... Because No One Ever Told Her,” contains this comforting statistic: “as many as 90 percent of infertile couples achieve families with the assistance of a vast array of increasingly refined medical therapies and treatments, including oocyte and sperm donation.”13

  However, women need to realize that the effectiveness of these treatments also declines as women age. In vitro fertilization works about one-third of the time in women under age thirty, nearly 30 percent of the time for women in their mid thirties, but just 5 to 15 percent of the time for those over forty years old.14 Even this statistic may delude some women, since many fertility clinics limit treatment to those under a threshold age, such as forty-four.

  Perhaps breakthroughs are around the corner. And some research may indicate that women’s prospects for conceiving a child at a given age are slightly better or slightly worse than the numbers from the American Society of Reproductive Medicine. But women should be aware and take into account the basic facts about how their bodies age and their reproductive life diminishes with time. Women may want to monitor medical breakthroughs, but should be cautious in assuming that medicine will be able to alter this reality in time to make a difference for them.

  Another one-in-four figure

  Gallup found that about one-third of Americans over age forty do not have children and only one-quarter of those say that they would have no children if they had it to do over again.

  The consequences of not knowing the facts

  If all women were aware of how age affects fertility, then Kim Gandy would have a point that advertisements warning of age-related problems might needlessly torment them. Women choosing to delay childbirth would be taking a calculated risk. Women for whom pregnancy was not an option—due to a lack of a partner or other life circumstances—wouldn’t benefit from these reminders, but could be upset by having to confront once again their lack of options.

  But surveys suggest that there is an information deficiency and that many women are unaware of the factors that affect fertility. The American Infertility Association surveyed 12,383 women and found that 88 percent overestimated by five to ten years the age at which fertility begins to diminish.15 Nearly half wrongly assumed that general health was an indicator of fertility.

  Getting information to these women so that they can make informed decisions is key. Unfortunately, as a result of the initial outcry against the ad campaign in 2001, when the American Society of Reproductive Medicine planned to run these ads again in 2002, shopping malls and movie theaters in San Francisco, Boston, Houston, and Washington, D.C., rejected them. The venues claimed that they preferred “mall friendly” and “happy environment” ad campaigns.

  Fertility treatment is a $2.7 billion industry.16 According to the American Society for Reproductive Medicine, an estimated 300,000 couples are now undergoing treatment for infertility.

  A Book You’re Not Supposed to Read

  Creating a Life: Professional Women and the Quest for Children, Sylvia Ann Hewlett; New York, Talk Miramax Books, 2002

  Those statistics mask the real heartbreak of this story. In 1998, Sylvia Ann Hewlett set out to write a book “celebrating the achievements of the breakthrough generation—that first generation of women who broke through barriers and became powerful figures in fields previously dominated by men.”17 In the course of conducting interviews, Hewlett discovered that “none of these women had children,” and, more disturbingly, “none of these women had chosen to be childless.”18 She then changed courses and focused on the issue of childlessness among professional women.

  Hewlett interviewed several highly successful women, seeking a better understanding of how they had come to be childless, and described her shock at the extent of their heart-break and feelings of loss from not having children:I was taken aback by what I heard. Going into these interviews I had assumed that if these accomplished, powerful women were childless, surely they had chosen to be. I was absolutely prepared to understand that the exhilaration and challenge of a megawatt career made it easy to decide not to be a mother. Nothing could be further from the truth. When I talked to these women about children, their sense of loss was palpable. I could see it in their faces, hear it in their voices, and sense it in their words.19

  One of these highly successful, childless women described her “creeping nonchoice” of having the potential f
or children disappear.

  In addition to these interviews, in January 2001, Hewlett partnered with Harris Interactive and the National Parenting Association to conduct a survey targeting the top 10 percent of women in terms of earnings in two age groups: twenty-eight to forty and forty-one to fifty-five. The groups were broken down into “high-achievers,” who earned over $55,000 or $65,000 depending on age, and “ultra-achievers,” who earned in excess of $100,000.

  The survey revealed that 33 percent of high-achieving women and nearly half of ultra-achieving women in corporate America were childless at age forty. In contrast, just one-quarter of high-achieving men and 19 percent of ultra-achieving men (earning more than $200,000) were childless at forty.20

  The survey also confirmed that for most women, the lack of children was not the result of a conscious choice. Women were asked to look back to when they had graduated college and consider whether they had then wanted children. Only 14 percent responded that they had definitely not wanted children at that time. Even among those women who had children, nearly one in four stated that they wanted more children than they were finally able to produce.21

  Many women had not yet come to terms with the reality that bearing children was likely not in their future. Sadly, almost one-quarter of high-achieving women and one-third of ultra-achievers age forty-one to fifty-five that Hewlett interviewed still hoped to have children. Hewlett concluded: “Given the odds against these midlife women bearing children, these responses point to a mother lode of pain and yearning.”22