Bioethics Forum Essay

If We’re Going to Talk About My Reproductive Future . . .

When I tell people I’m going to medical school, it’s often not long until the conversation starts moving toward when and how I will have children. When I was 14 and first got the idea that I wanted to be a doctor, one of the first teachers I told asked me how I would do that and also raise children. Still just a girl, I quickly learned that people would respond to my aspirations differently because of my gender.

More recently, during a visit to a dermatologist, I mentioned that I was applying to medical school. He was very excited for me, noting the opportunity to do good in the world through medicine. And then he added, “And as a lady doctor, you can work part time!” To give him the benefit of the doubt, I think he was trying to note the progress women had made in the field. But why assume that I would want to work part time, simply because I’m a “lady?”

Those are just two examples, but I could go on and on. These comments are frustrating to me in large part because they catch me off guard. They often arise when I’m sharing my aspirations to be a humane clinician, an innovative researcher, and a committed advocate. Instead of engaging on these topics, my interlocutors take the conversation as an opportunity to communicate their assumptions about my reproductive choices – as if I obviously want to have children. Instead of asking me what kind of medicine I want to practice or how I think about health care reform, they decide we should talk about my gender and why it is going to make things tough for me.

Furthermore, instead of voicing support for social policies like paid maternity leave or subsidized child care, the comments seem to place the onus of the problem on me as an individual. In this formulation, I’ll come up short as a physicianandas a mother, and that problem will be entirely mine to bear, as if my future employer and society at large – not to mention these hypothetical children’s other parent! – won’t also play a role. It can feel like the modern version of saying “how will you balance your wifely duties of cooking and cleaning while having a career?”

These obnoxious comments often have the unfortunate and unintended effect of making menotwant to think about my reproductive future. I have to remind myself that even if I don’t like the way most people talk to me about it, figuring out how I can be a parent given my other commitments is still something worth thinking about. Rather than close off these conversations all together, I’d like to see them become more empowering and productive.

There are many aspects to the “mommy wars” that I’m not interested in engaging in at this stage in my life, like whether to work full time or part time. The more immediate issue for me is when I will get pregnant, if I decide that’s something I want to do. This medically and socially complex issue is especially ripe for improved dialogue.

While there will be no perfect time for a woman in my position to get pregnant, there are ways of understanding the issue that are more helpful than others. A recent essay in Fertility and Sterility touches on a very important point (one that Hastings scholar Josephine Johnston has often discussed with me) about how many women have come to misunderstand this issue. With the increased use of assisted reproductive technologies (ART), many women have the misperception that they can get pregnant well into their 40s.

Unfortunately, it is often exceedingly difficult for a woman to get pregnant in her 40s with a child who is genetically related to her. In their Fertility and Sterility essay, Whyndham et al explain that “among women older than 42 years who are undergoing ART only 4.2% will give birth to a child.” Women may see magazine covers with pregnant 40-year-old celebrities and think it is easy to get pregnant at that age. They most likely do not realize that a woman’s fertility declines throughout her 30s or that the women who are able to get pregnant in their 40s or older have often used donor eggs or embryos.

While the use of donor eggs or embryos is a great option for many couples, lack of awareness of their use can perpetuate myths about what ART can do for women in their late 30s and older. At a time when medical technology and the career options available to women continue to expand, the age limits of a woman’s fertility remain largely unchanged. While we are fortunate to have so many options if we find ourselves facing infertility, these options have limitations and there are compelling reasons for trying to get pregnant when one’s likelihood of success is much higher.

Yet at the same time, there are strong economic and professional pressures to try to get pregnant at a later age. Even if egg freezing becomes a standard option for women in my position, as Whyndham et al recommend, an important societal component to these decisions remains. It’s certainly important for women to recognize the limitations of ART. But it’s just as important for employers and our government to recognize the social factors that constrain women’s reproductive choices. A more just society with policies like subsidized child care, alternative tracks to tenure, or required paid maternity leave would help women more freely make these decisions.

I’d really rather not have to talk about my reproductive future when I say I’m going to medical school. But if we are going to talk about it, I hope you’ll recognize that this is a societal issue, not just an individual one. I hope you’ll also talk about this issue with young men and young women in equal numbers, recognizing the importance ofparenthood, not justmotherhood. And I hope you’ll show your support for the kind of structural change that enables women and men to pursue multiple life projects, both professional and personal.

Colleen Farrell, a research assistant at The Hastings Center, will begin medical school at Harvard later this year.

Posted by Susan Gilbert at 05/03/2012 12:22:23 PM |

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