The idea of older mothers causes intense debate
A 59-year-old plans to have a baby through IVF and dissenting voices can be heard everywhere from the newspapers to the office watercooler. But is there really any reason why we should have a problem with the idea, asks medical ethicist Daniel Sokol.
Imagine walking past a poster on the street. It shows a mother and baby. The mother, however, is old enough to be the baby's grandmother. The initial reaction of many passers-by, upon being told that this grey-haired and wrinkled woman is the mother, would be one of revulsion. There is something deeply unnatural about the image.
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Too Old to Be a Mum? is on Tuesday 26 January at 2235 GMT on BBC One
These are the thoughts that many have had in response to the news that Susan Tollefsen, who became a mother at 57, is now considering IVF treatment again at the age of 59. But is there a rational basis for concern?
The "yuck" response is not uncommon in the face of new things. It is an internal red flag, telling us in an indistinct way that something is amiss. At times, that something is perfectly reasonable.
The disgust we feel at the recent torture of two young boys by brothers aged only 11 and 12 is underpinned by solid reasons. Yet, often, our "yuck" response is nothing but the external manifestation of ignorance or prejudice.
In 1840s, use of anaesthesia in childbirth strongly opposed by clergy in Church of England
Some clinicians believed it was going against God's will that women should "in sorrow, bring forth children" as punishment for Eve's sin
And some thought it caused women to become sexually aroused during labour
This is apparent by looking at history. Pain-relieving chloroform in the 19th Century, heart transplantation (involving a donor and recipient of different races), homosexuality, and in vitro fertilisation in the 20th Century, were all met with initial cries of disgust.
The birth of the first "test tube" baby, Louise Brown, in 1978 was deemed immoral by, among others, the Vatican and Nobel laureate James Watson. "I am not a wizard or a Frankenstein," said Dr Patrick Steptoe, the gynaecologist involved in the creation of Louise Brown.
These examples show that what society considers morally permissible evolves with time. They also point to the need to dissect our gut reactions.
In one sense, the computer screen in front of you is unnatural. It is the product of man's ingenuity. So too is an umbrella. Distinguishing the natural from the unnatural is not an easy task.
Rajo Devi had a baby at the age of 70
Can we say that keeping people alive on life support or resuscitating them when they would otherwise have died is natural, but that enabling an older woman to conceive a child is not?
Both are trying to "remedy" the natural ravages of ageing. If we accept that both can be viewed as unnatural, we must appeal to something else to justify treating them differently.
Welfare of mother and child
Assisted reproduction, like virtually all medical procedures, carries a risk of harm. The treatment, usually requiring several cycles of IVF, is hard on women emotionally and physically. At 60, the impact is likely to be greater than at 30. Yet, in a liberal democracy, individuals are to a large extent allowed to incur even significant risk as long as this does not harm others. "Over himself, over his own body and mind, the individual is sovereign," wrote the 19th Century philosopher John Stuart Mill.
Dr Patricia Rashbrook had child by IVF aged 62, prompting controversy
Jon Gaunt, in the Sun, wrote: "The news that the selfish 62-year-old, Patricia Rashbrook, has 'given birth' to a baby boy makes me sick to the pit of my stomach."
Karren Brady, in the Birmingham Mail, wrote: "I know that there are wrinkly old rockers like Michael Douglas, Rod Stewart and Mick Jagger who are fathers to young children, but they are because they can be. Women of the same age aren't because they can't be. Or shouldn't."
AN Wilson, in the London Evening Standard, wrote: "Women in their 60s these days are usually fit, and often make ideal carers for children. Why the uproar about supposed selfishness? Is it because the sight of a competent, pretty woman being happy fills other people with envy?"
The problem is that assisted reproduction involves a third party - the potential child. He or she cannot consent to the risk of harm. Neither, of course, can any baby. There is evidence, however, that IVF babies are at greater risk of birth defects than naturally conceived babies. A study published in the New England Journal of Medicine in 2002 suggested that IVF babies have double the risk of major birth defects compared with naturally conceived babies.
"How much more at risk with potential mothers in their 60s?" is a key question in determining the morality of assisted reproduction in that age group.
Another concern is the child's welfare in childhood and beyond. Last July, the single woman who had become the oldest mother in the world at 66 died after having cancer, less than three years after the birth of her twins. What awaits them now?
They may grow up to live a fulfilled life, as many orphans do, but their odds are not as favourable as their parented counterparts. But what about a young mother in a country where civil war, disease or other factors mean she may not see the child to adulthood? Yet we are not comparing like with like. It is always possible to point to a worse situation and say "see, it's not as bad as this". Maybe so, but that is not a cogent reason for allowing the practice.
An argument popular among philosophers is that, as long as the child's life is of acceptable quality, it is irrational to use arguments based on the child's welfare. The alternative for that particular child is non-existence. The twins would not be alive without their elderly mother's decision to undergo IVF. Is their life really so bad that they themselves would have preferred non-existence? Philosophers are still not agreed on how to solve this apparent puzzle.
The good mother
There has been much talk in recent years of reproductive autonomy, the idea that people should be able to make their own reproductive choices. Yet what are the limits of such autonomy? Did the lesbian couple who in 2002 sought a deaf sperm donor to create a deaf child overstep the mark? Can people choose to have a baby girl because they prefer girls?
Is there an ideal age for a family?
And what about our 60-year-old mothers? While these questions have no easy answer, it is clear that the limits must in part be set by the risk and severity of harm to the potential child. Who determines the cut-off point is another matter.
There are many other arguments both in favour and against allowing older women to use assisted reproduction techniques (including issues of resource allocation, age discrimination, adoption and other alternatives, feminist critiques, and slippery slope arguments), but one that appears repeatedly in everyday conversation is the feeling that there is something "not quite right" with a 60-year-old woman who wants a baby: "What kind of selfish woman would dream of such a thing? She won't be a very good mother at that age. Poor child".
This is where prejudice and societal values colour our judgement in ways that may be imperceptible to ourselves. Many passers-by will look at the woman in the poster like a jury eyeing up the defendant at the start of a trial. They will deliver an immediate verdict. Justice requires a more considered approach.
Dr Daniel Sokol is honorary senior lecturer in medical ethics at Imperial College London.
Below is a selection of your comments.
I can understand why any woman would like to become a mother, and the mothering instinct brought about by pregnancy hormones is the same, no matter what age she is. However, I had an older mother, and there were generational differences that caused problems at times, and my mum was often too tired to do some things with me that my friends took for granted. Also I had to deal with the death of my dad in my early 20s. They always told me that if they died before I was an adult, I would be taken care of. I lived as a child worrying about this.
Sarah Burns, Wimborne, UK
What about men who can have children well into their 70s, 80s or even later? While these men more often than not have children with a younger woman, and she can obviously live longer if the older father passes away, these children are still bereft of one of their parents, possibly at an early age. What is there to say that a 60-year-old woman who has children does not have a family network around her, or a younger partner to raise her children with? Why this obsession with women providing the "only possible" (or "right") care for children? What about fathers?
Janet, London, UK
My husband and I are undergoing IVF for a second time. The first one was unsuccessful. We lost our seven-year-old daughter (an only child) in 2007, when she had a brain haemorrhage. We didn't ask for this to happen, but happen it did. I am now 44 and our chances of falling pregnant naturally are pretty low. IVF, for us, is the only way we can start a family again. I do believe there should be an age at which IVF isn't allowed, but who should say what this age is? Who should play God?
What right has anyone to say that 59 is too old? I am sure these women will make far better caring, loving mothers than some little teenager who has ended up pregnant. I say good for these older mothers and having two sons, one at 23 and one also by IVF at 37, I would prefer to be the older mum, and if I could afford it I certainly would have another try now and I am over 50. Keep your opinions to yourselves - it's individual choice.
A May, Buckinghamshire
My only major anxiety about women becoming mothers at 60 is that, when the child is 10, his or her mother will be 70. It doesn't matter if she's a fit and active individual; 70 virtually all women start to slow down and suffer a variety of health problems. Making the assumption there are no older siblings, is it right for the child - still in primary education at this point - to have to shoulder responsibilities of caring for an elderly relative? Possibly two, if the father is a similar age? Aren't children growing up too early as it is? It's not an issue of whether the woman would be a good mother, it's the pragmatics of someone that age dealing with a growing child who is still to enter his/her teenage years. The mother has every right to self-advocacy, and is old enough to know perfectly well what she wants. The same cannot be said for the infant.
Caine Johnson, West Midlands, UK
You could argue that if nature does not allow conception, that something is wrong. But IVF helps so many couples who deserve to be parents achieve their goal and that is a blessing of modern science. But being over 45 in fertility terms is medically old. Look at the statistics - miscarriages, abnormalities and substantially reduced chances of conceiving past this age. The age thing for me is based on the quality of life that child will have with a mother old enough to be their grandmother. Losing a parent in your 20s is bad enough, but having older parents means they may never be around to see you mature is very sad. Personally I think having children via IVF over 50 is selfish - being a parent is about being selfless and thinking of the future happiness of your child. If you have an inherent need to be a mother at that age, there are plenty of children who need fostering now.
L Thompdon, Kent
As long as I am not paying for the treatment, or the child, through my taxes when those monies could be used otherwise to support the NHS and people who are really ill; then as long as an individual has the life expectancy, desire, means and capability to provide the financial emotional and physical support that a child needs, then fine. If not don't do it.
In researching family history, I have seen that the lot of many women was to have child after child from marriage in late teens or early 20s until they naturally could not have more, which tended to be early 40s. Many a later child had adult siblings. Many a woman had a dozen or more surviving children, and probably a few that didn't survive. Today we would not see lives lived in that way as "natural". Today women have a choice. To my mind, as long as they are not expecting me and other taxpayers to fund their lifestyle choices, why shouldn't they? I personally would not want to become a parent again in later life, but that is my lifestyle choice. Folk are different.
Marcus Oakland, Lund, Sweden
Heck, the hospital labelled me an "elderly primagravida" at 37... and now, as a 50-year-old lady with long, grey hair, I get taken for her grandmother upon occasion.
Megan, Cheshire, UK
I don't think there is a right or wrong age. People should be taught in school that if you are planning a baby, you need the financial back-up to help, so many teens bringing children into the world thinking they will get a free ride with money but instead they are finding that the money is tight and they are just scrapping by. Any woman at any age needs to plan these things.
Why not? if 60 is the new 40 and they have come to the end of their career and want a child, then they can retire and spend every waking hour with the child and be like the old days when women stayed at home, were fulltime parents and not run back to work as soon as whether by choice or necessity. I had to return to work due to divorce when mine were 4 and 6 but I really enjoyed the first few years at home with them.
Elaine Jones, Rhyl, Wales
Nobody seems to be quoting research on aged sperm and the health-related effects on babies. Personally, I wouldn't want another child in my 60s for all sorts of reasons - mostly practical and financial - but nobody bats an eyelid at aged fathers, not only celebrities (Rod Stewart et al) but ordinary guys who marry younger women. I don't hear any "yuck" sounds about 70-year-old dads but the image is just as odd surely? As people live and work longer, having children later and later will simply need to be incorporated into society. It's here to stay.
Irene Scofield, Petersfield, UK
My mother was 39 when I was born in 1989. For the time, that was quite old, and within my groups of friends at school, I always had easily the oldest mother, usually by a decade or so. She turns 60 next week (I am 20), and I am still astonished when my friends say that their mothers are in their 40s. I always felt different because of the bigger age difference. Other kids seemed to have much more fun with their parents, and whilst I accept that this is as much to do with personality as anything, I still believe that had she been younger, we would have got on a lot better. She is from a different age, a post-war baby boomer, and there is a world of difference between being brought up in the 50s, and being brought up in the 90s, which we could never cross, and meant we often didn't see eye to eye. The most important thing in this situation is the child. Whilst I fully support every woman's wish to have a child, it seems selfish to have children at a later stage of life without thinking about how it will affect the child, for example being bullied at school because of it.
My only problem with a 60-year-old woman having children is they are unlikely to still be alive at their 20th birthday. Surely the child has a reasonable right to, under normal circumstances, still have their parents alive into their 20s? The chances the child will have to deal with the death of their mother during their teenage years is unjustifiable high and this is not a fair burden to place on the child.
Martin Bryant, Rugby
What these parents are ignoring is the needs of the child and are only concerned with their selfish wants. A child needs a parent that can play with them, it requires someone with boundless energy to keep up with a child. These children will get ridiculed at school - any child that is different will - so ultimately these parents are just being incredibly selfish.
Tanya Daly, London, UK
You need to consider the needs of the child. My father was in his late 30s when I was born so when I was in school I did feel different, knowing most other kids parents were a lot younger and I was teased as a result. Also the older you have children, the less "life time" you get, generally. So you raise a child only to die when he/she is young, thus depriving them of a normal childhood. Plus there are the obvious health implications.
L Campbell, Portsmouth, Hants
What right do we as a society, supposedly civilised and democratic, to decide for a woman? These older women are not selfish, they want what any perfectly normal woman wants. Society needs to look beyond age as an excuse to prevent older women having babies. When you really think about it... are any of us that capable that we make no mistakes? Are we all perfect parents? The happiest children in the world are those who are nurtured and loved by those closest to them - fed and warm, understood and respected. Never before has the phrase "respect your elders" been more important.
Sarah Walton, Neath
As a 31-year-old woman who is just starting to hear the vague ticking of my biological clock, the idea that women can get help conceiving into their 60s does let me breathe easier and feel a little less rushed. But at the same time, something about it does make me feel a bit repulsed. While current technology allows for women to have more flexibility and freedom in their lives and with their bodies, by waiting so long these women seem to have pushed the boundaries beyond what is good for the child. I think there is an ideal age for a family - it's a fairly broad window - and it allows for the optimum health and enjoyment of all of the family members. Time is an issue for women, and will always be, and most of my male friends would agree it is an issue for them too. The choice to have children needs to be about what is best and safest for the mother and the child - and the family they are part of - but it feels like these women are making these decisions solely on their wants and without considering any other repercussions. I wonder if some of their decision is based on regrets and a strong desire to stave off loneliness as they get older - which can't be right.
As a 62-year-old grandmother I feel very sad for the children of old mothers as you do not have the energy you had when you were in your 20s and 30s. If your reproductive life has ended, so be it.
Julia Gibson, Exeter
Nature decreed that reproduction should take place at a time when the parents are at the height of their health and strength, for the good of the offspring. These days we have, through our own efforts, extended that period of health. We should not dismiss older motherhood out-of-hand, but equally it is something that needs very careful consideration by anyone thinking of taking it on both from their own point of view and, crucially, the point of view of the resulting child.