Cassandra’s Prophecy fulfilled: a response to Khalaf

Abstract

Khalaf, 2013Khalaf Y. Cassandra’s prophecy and the trend of delaying childbearing: is there a simple answer to this complex problem?.Reproductive BioMedicine Online. 2013; 27: 17-18Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar is right. It is indeed true that women and men ‘know’ about reproductive aging. A plethora of articles reporting recent empirical research around the world indicates that this is the case (Bretherick et al., 2010Bretherick K.L. Fairbrother N. Avila L. Harbord S.H. Robinson W.P. Fertility and aging: do reproductive-aged Canadian women know what they need to know?.Fertility and Sterility. 2010; 93: 2162-2168Abstract Full Text Full Text PDF PubMed Scopus (131) Google Scholar, Cooke et al., 2010Cooke A. Mills T.A. Lavender T. 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Childbearing, the desire to have children and awareness about the impact of age on female fertility among Finnish university students.European Journal of Contraception and Reproductive Health Care. 2011; 16: 108-111Crossref PubMed Scopus (95) Google Scholar). Yet, just as these articles reveal ‘knowledge’, so too do they highlight the inaccuracies and limited extent of that knowledge. Furthermore, by offering mostly multiple-choice answers, they enable an educated population ‘vaguely aware’ of fertility decline with age to deduce a reasonable answer. Whilst such an approach certainly has validity, it may well, through methodology, magnify the extent and distort the nature of the ‘knowledge’ and ‘understanding’ so ‘revealed’. Moreover, through asking respondents to select from prescribed choices, these surveys permit communication only through the voices of those who work in the disciplines from which the studies have grown. Everywoman’s voice is ‘merely’ her own. Yet, it is distinct from the usual public narratives in popular culture about experiences of IVF: perhaps that is why its message is unsettling? For its format seeks to move forward from something irreparably lost and broken, rather than to showcase a battle triumphantly ‘won’ or tragically ‘lost’, as lay narratives associated with assisted reproduction treatment so often require. In seeking to learn and rebuild from tragedy, pain must at least be recognised even if it cannot be assuaged. Moreover, to question the voice of an individual – which reflexively lays bare its own subjectivity – is to deny that voice the legitimacy of its lived experience, to question its authenticity and credibility – the very features that make qualitative research meaningful and valid. Individual biographies are linked to, and exemplify, profound social changes and predicaments and it is precisely because individuals with similar experiences (the grief-stricken thousands who facelessly connect in the shadows of cyberspace) have seldom spoken out in formal professional contexts, as opposed to ‘just’ newspapers, blogs or magazines, that the article was written. It was written for the millions of people for whom assisted reproduction treatment has failed, and for the many around the world who will, unfortunately, experience its failure (Zoll, 2013Zoll M. Cracked Open. Liberty Fertility and the Pursuit of High-tech Babies. A Memoir. Interlink Books, Northampton, MA2013Google Scholar). Mrs Lesley Brown’s experience undoubtedly signified a true milestone in the history of science. But in focusing on that great joy let us not ever forget the painful stories of Sue and Jean who were treated alongside Lesley in the Royton Cottage hospital that same year, who did not have babies nine months after treatment (Brown et al., 1979Brown L. Brown J. Freeman S. Our Miracle called Louise. Paddington Press, London1979Google Scholar). If Khalaf, 2013Khalaf Y. Cassandra’s prophecy and the trend of delaying childbearing: is there a simple answer to this complex problem?.Reproductive BioMedicine Online. 2013; 27: 17-18Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar interprets the concept of the ‘biological clock’ as unwelcome ideology, then it is indeed that which seeks to ‘herd’ women into certain collective actions. However, to use the construct in this way is to ignore biological fact and cleave to the potent discourse of ‘personal choice’ that has been so deeply embedded in notions of contraception and by association, reproduction, since the later twentieth century. Women’s menopause is inevitable, and the reproductive decline that precedes it actually happens. Men experience reproductive decline too. Natural fertility decline cannot yet be prevented and fertility really cannot yet be ‘extended’ in any satisfactory and safe way. It has long been recognised that technologies available today cannot fully compensate for demographic trends, even though they are frequently ‘sold’ to patients (or understood by them) as such, being characterised so often as increasing one’s chances (even though a ‘chance’ is not a live baby) (Leridon, 2004Leridon H. Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment.Human Reproduction. 2004; 19: 1548-1553Crossref PubMed Scopus (325) Google Scholar). ‘Solutions’ to these problems, and the evidence brought to bear to solve them, are rarely ‘simple’ or transparently ‘right’. Thus, to say that print and other media disseminate appropriate warnings about age-related fertility decline that are assimilated by men and women (Shalev and Lemish, 2011Shalev S. Lemish D. Women as consumers of reproductive technology: media representation versus reality.Journal of Interdisciplinary Feminist Thought. 2011; 5 (article 2): 1Google Scholar, Shalev and Lemish, 2012Shalev S. Lemish D. ‘Dynamic infertility’: the contribution of news coverage of reproductive technologies to gender politics.Feminist Media Studies. 2012; 12: 371-388Crossref Scopus (16) Google Scholar), and that research has discovered that people do reassuringly ‘know’ about reproductive aging and its implications and can subsequently act on that understanding in timely ways, is to expose Khalaf, 2013Khalaf Y. Cassandra’s prophecy and the trend of delaying childbearing: is there a simple answer to this complex problem?.Reproductive BioMedicine Online. 2013; 27: 17-18Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar as guilty of the same simplistic thinking of which he appears to accuse the present author of indulging. The phenomenon of delayed childbirth in the developed world represents a complex, multi-dimensional knot of problems, which concern the increasing asynchronicity of the biological and socio-cultural aspects of the life course, and which are occurring in the historical contexts of the social changes brought by the women’s movement, and the medical advancements that have given rise to reliable contraception, increasing longevity and assisted reproduction treatment procedures. These problems are now framed by economic cycles placing unprecedented demands on couples to form dual income households. The multi-faceted solutions to these problems will come from a range of academic domains working together within multidisciplinary contexts. They will also take account of the fact that young people form beliefs about the timing of the lifespan as they develop into adulthood, and those beliefs and assumptions themselves are further modified as people age. People must indeed not be ‘herded’ into action unthinkingly. However, given that we are aware that peoples’ social clocks are becoming increasingly divorced from their biological reproductive ones, and that there is an increasing ‘structural lag’ between the way people are having to live their lives now and the family and professional structures in place to support them (Riley, 1998Riley M.W. A life course approach. Autobiographical notes.in: Giele J.Z. Elder G.H. Methods of Life Course Research. Sage, London1998: 28-51Google Scholar), there is a duty to tell them honestly, and carefully, what this may mean for them. This is because adults do have the right to public health information and education, so that they can, as autonomous individuals, make the best possible choices for themselves. It is also because children, according to article 29 of the 1989 UN Convention on the Rights of the Child, have a right to education that prepares them for a responsible life in a free society (UNICEF, 2009UNICEF, 2009. <http://www.unicef.org.uk/UNICEFs-Work/Our-mission/UN-Convention> (accessed 14 September 2013).Google Scholar). Cassandra’s predicament is re-enacted again. So, rather than dwelling on what went wrong, we must focus on what to do next and spend our energies on moving forward towards the many answers to the problematic situation in which we find ourselves. ‘Individuals choose the paths they follow, yet choices are always constrained by the opportunities structured by social institutions and culture’ (Elder et al., 2003Elder G.H. Johnson M. Crosnoe R. The emergence and development of life course theory.in: Mortimer J.T. Shanahan M.J. Handbook of the Life Course. Sage, London2003: 3-19Crossref Google Scholar).