Sex and Gender-based Analysis of this topic
Definition
The rate of live births to older mothers is often defined as the number of live birth deliveries to mothers 30 years of age or older, expressed as a proportion of all live births within a specific location and time range [1]. The rate of live births to older mothers has steadily increased across Canada; between 1991 and 2003 the rate increased from 34% to 48% [3]. In British Columbia, a majority of live births were to older mothers in 2001/2002 and the average maternal age has continued to rise each year through 2005/2006 [2]. Some research points to elevated rates of negative birth outcomes for both mothers and infants when maternal age is over 30 years old. Some negative birth outcomes include: higher rates of Down Syndrome [4], as well as elevated rates of caesarean section births, low birth weights, preterm births, small for gestational age, macrosomia, low one-minute Apgar scores, and admission to newborn intensive care [5-7].
Sex Issues
Fertility rates begin to decline after the age of 30 [8]. A combination of biological factors contribute to this decline including increased risks of miscarriage, gestational diabetes, diabetes mellitus, hypertension, early pregnancy loss, placenta previa, and for women over age 35, an increased risk for macrosomia [9-10]. These factors contribute to an increased risk of maternal mortality for older mothers [11]. Many older women also turn to assisted reproductive technology, a process that increases the risk for obstetrical complications, adverse perinatal outcomes, multiple gestations, structural congenital abnormalities, chromosomal abnormalities, imprinting disorders, and childhood cancer [12].
Gender Issues
Reflecting shifting gender roles, women in recent decades have gradually come to represent a larger proportion of the workforce. Many of these women have delayed the decision to have children in order to focus on their careers, contributing to the rise in the rate of live births to older mothers. Other gender-related factors include increases in the use of effective birth control, rates of higher education for women, and delayed marriages and rates of divorce followed by remarriage [13].
Diversity
The steady increase in the rate of live births to older mothers has occurred in each of the Canadian provinces over the past two decades; however, there exist significant provincial differences. Quebec has the highest overall rate at 55%, while British Columbia has the highest age-specific rate for mothers aged 35-39 at 17%. Contrastingly, Nunavut’s rate of live births to older mothers is at 23%, the lowest rate for any of the provinces/territories [14].
Critique
The factors that have contributed to the increasing rate of live births to older mothers across Canada are not necessarily negative and a number of factors have contributed to the empowerment of women in the workplace and in society as a whole. Additional research on negative birth outcomes for both mothers and infants is needed as the average maternal age continues to rise. Additionally, some reports have indicated that women often do not have a complete understanding of the risks associated with delayed childbirth [15]. This gap in education needs to be addressed.