Focus
Student Scene
May 6, 2002
 Photo by Jeff Cleary |
Creating a Life? Fertility and Postgraduate Medical Education
It seems that despite years of medical advances, the sequencing of the human genome, and a seemingly endless expansion of knowledge about the creation of human life, the American baby wars have started again. The war over balancing work and motherhood has restarted, with a familiar player setting the stage for the conflict. The recently released work Creating a Life: Professional Women and the Quest for Children by Sylvia Ann Hewlett, a Harvard-trained economist and "revisionist feminist," has spurred a veritable media frenzy over the fertility and family priorities of "career women."The frenzy over Hewlett's work is understandable and not solely due to her robust PR machine. In large part, the uproar over Creating a Life is proportional to its content: the book is very nearly a horror story for professional and career women who are childless and facing prospects of a long, arduous road to success.
Shock Value
Creating a Life is rife with tearful vignettes of women who believed that conception after 40 was more easily attainable. Added to these is the book's statistic that 42 percent of high-achieving American professional women over 40 are childless--and only 14 percent of these women chose to be so. Hewlett describes their roadblocks on the way to maternity--long hours at work, incessant business travel, late-in-life marriages--in a manner that is almost voyeuristic. Yet for all of the author's dubious personal commentary (stories of women who were too "predatory" or "preoccupied" due to their careers and thus delayed marriage and motherhood), the book makes an important point: conceiving a child after age 40 is an incredibly difficult endeavor with no guarantee of a favorable outcome. This message has been underscored recently by the Mayo Clinic. A study of fertility rates by age at the clinic showed that fertility drops more quickly than previously thought--20 percent after age 30 and 95 percent after age 40.This, of course, is an especially important concern for the medical community and for Massachusetts, in particular, the only state that since 1995 has consistently had more women over the age of 30 give birth than women under 30. It is a remarkable departure from the country as a whole, which has an average maternal age of 23 for first-time births. Some research points to the relatively large volume of in vitro fertilization procedures in Massachusetts as one reason why so many women in the state give birth later in life, but anecdotal evidence also suggests that higher education--as the old joke goes, the most common reason for infertility--may also be part of the reason that the average maternal age in the state is higher than the national average.
The notoriously long road of medical school, residency, fellowship, and tough years of early practice means that even some of the youngest medical students--those who entered immediately after a four-year undergraduate career--will be about 30 years old at the end of postgraduate training. And, with a nationwide average age of 26 for students entering their first year of medical school, the road to "having it all" with a balanced life of family and work seems even more difficult. This isn't an entirely new problem for doctors-in-training or medical school administration; a featured report in the summer 2001 Harvard Medical Alumni Bulletin by alums Joshua Sharfstein '96 and Yngvild Olsen '96 discussed the problems of childbearing during residency training based on their own experiences as parents-to-be and residents.
Might the System Give?
Yet despite the furor over infertility and the well-known complications that medical training imposes on future childbearing, changes in the structure of most postgraduate training programs have been slow. True, residency programs are now required to have maternity leave policies for residents and list on-site and subsidized child-care options alongside other information. Some--very few--even offer "shared positions," allowing for part-time residency, although part-time in many programs often means only 40 to 50 hours per week.Overall, though, an overview of U.S. residencies shows that few offer subsidized, accessible daycare, and fewer still offer paternity leave. More importantly, however, there are typically too few institutional policies set on how to manage employee extended absences or to accommodate a resident who takes a year off to care for a child, leaving many women and men alike without any idea of how to make child rearing a priority and still maintain some type of career path.
In short, current policies for managing family life, especially child rearing, are not sufficient to protect the fertility and future families of physicians-in-training. Improved policies on paternity leave, shared positions and, most importantly, help in mentoring young physicians on managing family life would greatly benefit them and their families--and might make beating the biological clock a bit easier for the professionals who know best its unyielding intricacies.
--Tarayn Grizzard, a second-year medical student at HMS
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.