Title : The silent sacrifice: How society and medicine set women up for struggle
Abstract:
Over the past century, societal shifts have significantly changed women’s role, particularly those who wish to have children. If we fail to recognize and address the challenge women face in balancing professional ambitions with family life, fertility rates will likely remain at or below replacement levels- an unsustainable trend for the economic health of our country.
Women have gradually entered the workforce over more than a century, but the most substantial shift occurred between 1960 and 1980, when women’s participation in the U.S. workforce, exceeded 40%, peaking in the 1999. With the introduction of the birth control pill, regulation of reproduction became more feasible. Women were able to pursue higher levels of education while delaying childbearing. The exorbitant cost of medical education has led to record-setting level of student loans. This financial burden likely contributes further to delay in childbearing. The consequences of these societal and personal changes now include rising maternal age and decreasing time period for reproduction. CDC reports that between 2016 and 2023, the average age at first birth rose from 26.6 to 27.5 years, with similar increases for subsequent births. The rise spanned all racial, ethnic, and geographic groups.
Fertility rates decrease after age 35, and a pregnancy in this age group carry higher risks, such as hypertension, pre-eclampsia, pregnancy loss, fetal anomalies, stillbirth, and cardiovascular disease, amongst others. Women are now storing eggs or embryos for the “right time” to have a family. Women who are unable to conceive naturally or have age-related diminished fertility are increasingly opting for assisted reproductive techniques, resulting in a 49% increase of babies born via in vitro fertilization (IVF) between 2012 and 2021, but may not be aware of the increased health risks to them associated with advanced maternal age.
Parents face an unprecedent level of stress related to providing and organizing childcare and coordinating schedules. US Surgeon General reported that weekly time spent on primary childcare increased by 40% for mothers from 8.4 hours in 1985 to 11.4 in 2022, and by 154% for fathers from 2.6 hours to 6.6 in 2022, confirming that women continue to be responsible for majority of the time. The combination of all of these factors has led to decreasing fertility rates, which threatens the viability of society.
Comprehensive approach addressing duration and cost of education, increasing health care literacy, improving accommodation for pregnancy in the workforce, providing access to affordable childcare, and ensuring personal accountability by both parents making informed decision on work/life balance are critical to solving this critical problem. Obstetricians and gynecologist and other primary care providers can advocate for women in national conversations and assist in developing solutions.
