Angel Petropanagos warns of the danger of smuggling moral arguments in under the guise of medical ‘facts’ in the advanced maternal age debate.

__________________________________________

Advancements in assisted reproductive technologies are extending the boundaries of biological reproduction. With the help of in vitro fertilization (IVF) and donor eggs an increasing number of women their forties, fifties, and sixties are bearing children. Pregnancy at an advanced maternal age has been controversial, to say the least. The growing trend towards older first time mothers has prompted individuals and professional medical associations to consider whether there is a ‘need’ for an upper age limit on women’s access to assisted reproduction and, if so, what that age limit should be.

The American Society of Reproductive Medicine recommends an upper age limit of 55 for women’s access to assisted reproduction. Canadian professional medical associations have been silent when it comes to upper age limits, and women’s access to assisted reproduction is generally left to the discretion of individual fertility clinics. Many fertility clinics will not treat women in their fifties, but others have treated women in their mid-fifties. Quebec recently proposed a Bill that aims to ban women over the age of 42 from accessing IVF. This proposal has been criticized for being paternalistic, infringing on women’s reproductive rights, and being too low of an age limit. The outrage that has ensued from this proposed age limit has made the Health Minister reconsider the IVF age restriction.

If there is a need for an upper age limit, the imposition of a particular age limit will require strong justification. This is especially true because we live in a society that constructs infertility as a medical issue, promotes reproductive autonomy, and places a high value on having children.

Justifications for upper age limits on access to assisted reproduction sometimes take the form of medical justifications, and appeal to unacceptable risk to mother and child. (This was the case with Quebec’s proposal.) While data for pregnancy in women over age 55 is limited, the evidence that is available suggests that pregnancy and neonatal risks increase with maternal age. Indeed, there may be some age at which pregnancy becomes too risky for women or the resulting children. However, the advanced maternal age controversy runs much deeper than medical disagreement concerning pregnancy risks. As evidenced by older women who are praised for being gestational surrogates for younger women, many critics are less concerned with older women simply carrying pregnancies.

Olga Boznanska, Macierzynstwo (Motherhood) 1902

The deepest disagreement over advanced maternal age instead seems to have to do with whether age is morally relevant to a woman’s ability to be a ‘good’ mother. Critics have described pregnancy and childrearing by older women as gross, unnatural, and selfish. They also fear that older women won’t have enough energy to take care of their young offspring and that children born to older women will be orphaned at a young age. Older women are generally viewed as inappropriate primary caregivers for young children. In short, critics of advanced maternal age characterize older moms as ‘bad’ mothers. In effect, pregnancy at an advanced maternal age is seen as violating the social norms surrounding motherhood—where the good mother is construed as young, beautiful, energetic, and selfless.

However, such moral criticisms of advanced maternal age rely on a particular conception of motherhood that is, arguably, ageist, sexist, and relies on traditional (yet objectionable) notions of the family. Some reasons for rejecting an upper age limit are connected to this critique of motherhood. For example, one could argue that age is irrelevant for parenting and many of the concerns raised by critics could also apply to younger women. Also, age limits are sexist because no comparable age limits exist for men, and overcoming the biological limits on reproduction can facilitate a more egalitarian society. Moreover, women need not be the sole primary caregivers for children and good parenting can also happen within extended and non-traditional family units.

Both medical and moral justifications can be given in support of upper age limits on women’s access to assisted reproductive technologies. Yet, moral considerations are often smuggled into the medical facts of advanced maternal age. For example, appeals to expected post-delivery health risks and longevity are often intertwined with the idea that a ‘good’ mother should be the primary (or sole) caregiver for children. This sort of smuggling is problematic. It serves to perpetuate biased and unjust conceptions of motherhood. And perpetuating these norms can be harmful to all mothers, not just older ones.

Separating the medical and ethical ‘facts’ surrounding advanced maternal age may not always be easy. But, moving forward, the debate about advanced maternal age would be best served if both sides put all their cards on the table. Doing so can help to make sure that any proposed restrictions on access to assisted reproduction are just.

__________________________________________

Angel Petropanagos is a postdoctoral fellow at Novel Tech Ethics, Dalhousie University @APetropanagos