When should the babies come?

In a country where one in every five adolescents is pregnant, the focus is on delaying child-bearing. This has been the mantra for decades.

The girls born in the 80s probably had it the toughest. They were born at a time when their mothers had witnessed the impact of education on women. They were also born at a the time when the Maendeleo Ya Wanawake Movement was at its most robust. Women were getting empowered politically, socially and economically. The awakening that was sweeping the globe was giving rise to social transformation in Kenya.

Our mothers were being recruited to the movement, especially powered by the resolutions made at the World Conferences by Women. In the second conference in Copenhagen, the then chairperson, Jane Kiano, drew attention to female genital mutilation in Kenya. The movement launched countrywide programmes on family planning, maternal and child health care, family nutrition, soil conservation, sanitation, tree planting, energy conservation and child immunisation in an effort to improve women’s welfare.

By the time Kenya was hosting the third conference, the resolutions being passed were no longer just social. Women wanted several chairs at the table in terms of politics and economic empowerment. They set up the handicraft export business and ensured they entrenched women’s issues in policy in all sectors. Long before the Beijing Conference, our mothers were already sold onto the importance of women empowerment.

The 80s daughters were expected to be the embodiment of everything our mothers were standing up for. We only heard one mantra: work hard in school, go to college and get a degree and get a good job. Distractions were not welcome. We followed this mantra to the letter, giving rise to many women who have continued to set the pace in all sectors.

The only thing our mothers forgot to build in was the family conversation. After achieving what they laid out for us, they turned around and started asking for grandbabies. They forgot that they never quite provided any guidance on when and where to meet the partner who would eventually contribute to the grandbabies.

As a result, many women have focused on professional and career development at the expense of their fertility desires. The net effect of this is that while women are empowered enough to decide they are ready to start families, this has resulted in a much later age of onset of the child-bearing career. It is now a norm for mums to be pregnant for the first time after the age of 35.

Meanwhile, the physiologic clock remains left behind. The most ideal age to bear a child still remains 20 to 29. This is when fertility is at its prime and the body is most physically fit to tolerate the physiologic burden of pregnancy, childbirth and post-partum. This is the period when the female body is at the lowest risk of; and is best prepared to handle pregnancy-related complications.

However, this is also the best time for professional development. Therefore, we expect that women will always be faced with the need to make informed choices on their fertility desires. Scientific technological advances have made it possible to be a mum even at the age of 74; however, that is not the whole story.

Motherhood isn’t just about being able to conceive and bear a baby; or have a surrogate mother carry your baby for you when you are unable to do so yourself; or being able to adopt a baby who becomes wholly yours. How about understanding the increased risk for chronic diseases that come with age and the impact of pregnancy on their progression?

Hypertension, diabetes and cardiovascular diseases are a product of lifestyle but are also largely a product of age. Pregnancy exacerbates these conditions by the additional burden it places on the body. The impact of pregnancy hormones on bones and joints always leaves one worse for wear, especially with arthritis and lower back pain, long after baby is here. 

Motherhood is not just about having the baby but also about having the physical, psychological and emotional capacity to raise the little one. How about having the energy to run after a toddler, to teach them how to ride a bike, to stay up for countless hours when they run a crazy fever, to participate in all their school events and even run in the mommy’s race.

Empowerment of women is a beautiful thing. It has given women the power to make choices that they deem to be in their best interest. It has economically empowered them to afford their choices. However, not everything is compliant with the newfound choices. The female biology isn’t about to change any time soon. The reproductive age will still last an average of 40 years and our bodies will continue on the journey of aging.

It is important to lay down the bare facts about this unique gift that women have of being able to bring forth life and its implications to the woman’s body. A woman with certain medical conditions that may impact her future fertility needs to understand how delaying child-bearing negatively impact on her ability to have the babies in future. One who has a strong family history of diabetes or hypertension needs to know that the older she gets, the more likely she is to get these conditions, and it would be better to have babies before these set in.

The ability of science to help manage these complications does not negate the advantages of not needing them in the first place. Knowing that antiretroviral medications manage HIV infection does not mean that one should knowingly get themselves infected. In the same breath, having assisted reproductive technologies does not mean that one should knowingly let their fertility period pass them by, just because they can afford the cost of in-vitro fertilisation. It simply means that the technologies are available for women who do not have other options.

For the woman to be fully empowered, she needs to know the good, the bad and the ugly. She needs to understand her unique circumstances that will determine her biologic pathway. She can only take an empowered choice when she is fully in the know!

Dr Bosire is an obstetrician/ gynaecologist