Having Kids at Older Age: - Myth or Fact....

How Older Parenthood Will Upend American Society The scary consequences of the grayest generation. By Juditch Shulevitz

Over the past half century, parenthood has undergone a change so simple yet so profound we are only beginning to grasp the enormity of its implications. It is that we have our children much later than we used to. This has come to seem perfectly unremarkable; indeed, we take note of it only when celebrities push it to extremes—when Tony Randall has his first child at 77; Larry King, his fifth child by his seventh wife at 66; Elizabeth Edwards, her last child at 50. This new gerontological voyeurism—I think of it as doddering-parent porn—was at its maximally gratifying in 2008, when, in almost simultaneous and near-Biblical acts of belated fertility, two 70-year-old women in India gave birth, thanks to donor eggs and disturbingly enthusiastic doctors. One woman’s husband was 72; the other’s was 77.

These, though, are the headlines. The real story is less titillating, but it tells us a great deal more about how we’ll be living in the coming years: what our families and our workforce will look like, how healthy we’ll be, and also—not to be too eugenicist about it—the future well-being of the human race. 

That women become mothers later than they used to will surprise no one. All you have to do is study the faces of the women pushing baby strollers, especially on the streets of coastal cities or their suburban counterparts. American first-time mothers have aged about four years since 1970—as of 2010, they were 25.4 as opposed to 21.5. That average, of course, obscures a lot of regional, ethnic, and educational variation. The average new mother from Massachusetts, for instance, was 28; the Mississippian was 22.9. The Asian American first-time mother was 29.1; the African American 23.1. A college-educated woman had a better than one-in-three chance of having her first child at 30 or older; the odds that a woman with less education would wait that long were no better than one in ten.

It badly misstates the phenomenon to associate it only with women: Fathers have been getting older at the same rate as mothers. First-time fathers have been about three years older than first-time mothers for several decades, and they still are. The average American man is between 27 and 28 when he becomes a father. Meanwhile, as the U.S. birth rate slumps due to the recession, only men and women over 40 have kept having more babies than they did in the past. 

In short, the growth spurt in American parenthood is not among rich septuagenarians or famous political wives approaching or past menopause, but among roughly middle-aged couples with moderate age gaps between them, like my husband and me. OK, I’ll admit it. We’re on the outer edge of the demographic bulge. My husband was in his mid-forties and I was 37—two years past the age when doctors start scribbling AMA, Advanced Maternal Age, on the charts of mothers-to-be—before we called a fertility doctor. The doctor called back and told us to wait a few more months. We waited, then went in. The office occupied a brownstone basement just off the tonier stretches of New York’s Madison Avenue, though its tan, sleek sofas held a large proportion of Orthodox Jewish women likely to have come from another borough. The doctor, oddly, had a collection of brightly colored porcelain dwarves on the shelf behind his desk. I thought he put them there to let you know that he had a sense of humor about the whole fertility racket.

The steps he told us we’d have to take, though, were distinctly unfunny. We’d start with a test to evaluate my fortysomething husband’s sperm. If it passed muster, we’d move on to “injectables,” such as follicle-stimulating and luteinizing hormones. The most popular fertility drug is clomiphene citrate, marketed as Clomid or Serophene, which would encourage my tired ovaries to push those eggs out into the world. (This was a few years back; nowadays, most people take these as pills, which are increasingly common and available, without prescription and possibly in dangerously adulterated form, over the Internet.) I was to shoot Clomid into my thigh five days a month. Had I ever injected anything, such as insulin, into myself? No, I had not. The very idea gave me the willies. I was being pushed into a world I had read about with intense dislike, in which older women endure ever more harrowing procedures in their desperation to cheat time.

If Clomid didn’t work, we’d move into alphabet-soup mode: IVF (in vitro fertilization), ICSI (intracytoplasmic sperm injection), GIFT (gamete intrafallopian transfer), even ZIFT (zygote intrafallopian transfer). All these scary-sounding reproductive technologies involved taking stuff out of my body and putting it back in. Did these procedures, or the hormones that came with them, pose risks to me or to my fetus? The doctor shrugged. There are always risks, he said, especially when you’re older, but no one is quite sure whether they come from advanced maternal age itself or from the procedures.

My husband passed his test. I started on my routines. With the help of a minor, non–IVF-related surgical intervention and Clomid, which had the mild side effects of making me feel jellyfish-like and blurring my already myopic vision, I got pregnant.

My baby boy seemed perfect. When he was three, though, the pediatrician told me that he had a fine-motor delay; I was skeptical, but after a while began to notice him struggling to grasp pencils and tie his shoes. An investigator from the local board of education confirmed that my son needed occupational therapy. This, I discovered, was another little culture, with its own mystifying vocabulary. My son was diagnosed with a mild case of “sensory-integration disorder,” a condition with symptoms that overlapped with less medical terms like “excitable” and “sensitive.”

Sitting on child-sized chairs outside the little gyms in which he exercised an upper body deemed to have poor muscle tone, I realized that here was a subculture of a subculture: that of mothers who spend hours a week getting services for developmentally challenged children. It seemed to me that an unusually large proportion of these women were older, although I didn’t know whether to make anything of that or dismiss it as the effect of living just outside a city—New York—where many women establish themselves in their professions before they have children.

I also spent those 50-minute sessions wondering: What if my son’s individual experience, meaningless from a statistical point of view, hinted at a collective problem? As my children grew and, happily, thrived (I managed to have my daughter by natural means), I kept meeting children of friends and acquaintances, all roughly my age, who had Asperger’s, autism, obsessive-compulsive disorder, attention-deficit disorder, sensory-integration disorder. Curious as to whether there were more developmental disabilities than there used to be, I looked it up and found that, according to the Centers for Disease Control, learning problems, attention-deficit disorders, autism and related disorders, and developmental delays increased about 17 percent between 1997 and 2008. One in six American children was reported as having a developmental disability between 2006 and 2008. That’s about 1.8 million more children than a decade earlier.

Soon, I learned that medical researchers, sociologists, and demographers were more worried about the proliferation of older parents than my friends and I were. They talked to me at length about a vicious cycle of declining fertility, especially in the industrialized world, and also about the damage caused by assisted-reproductive technologies (ART) that are commonly used on people past their peak childbearing years. This past May, an article in the New England Journal of Medicine found that 8.3 percent of children born with the help of ART had defects, whereas, of those born without it, only 5.8 percent had defects.

A phrase I heard repeatedly during these conversations was “natural experiment.” As in, we’re conducting a vast empirical study upon an unthinkably large population: all the babies conceived by older parents, plus those parents, plus their grandparents, who after all have to wait a lot longer than they used to for grandchildren. It was impressed upon me that parents like us, with our aging reproductive systems and avid consumption of fertility treatments, would change the nature of family life. We might even change the course of our evolutionary future. For we are bringing fewer children into the world and producing a generation that will be subtly different—“phenotypically and biochemically different,” as one study I read put it—from previous generations.

What science tells us about the aging parental body should alarm us more than it does. Age diminishes a woman’s fertility; every woman knows that, although several surveys have shown that women—and men—consistently underestimate how sharp the drop-off can be for women after age 35. The effects of maternal age on children aren’t as well-understood. As that age creeps upward, so do the chances that children will carry a chromosomal abnormality, such as a trisomy. In a trisomy, a third chromosome inserts itself into one of the 23 pairs that most of us carry, so that a child’s cells carry 47 instead of 46 chromosomes. The most notorious trisomy is Down syndrome. There are two other common ones: Patau syndrome, which gives children cleft palates, mental retardation, and an 80 percent likelihood of dying in their first year; and Edwards syndrome, which features oddly shaped heads, clenched hands, and slow growth. Half of all Edwards syndrome babies die in the first week of life.

The risk that a pregnancy will yield a trisomy rises from 2–3 percent when a woman is in her twenties to 30 percent when a woman is in her forties. A fetus faces other obstacles on the way to health and well-being when born to an older mother: spontaneous abortion, premature birth, being a twin or triplet, cerebral palsy, and low birth weight. (This last leads to chronic health problems later in children’s lives.)

We have been conditioned to think of reproductive age as a female-only concern, but it isn’t. For decades, neonatologists have known about birth defects linked to older fathers: dwarfism, Apert syndrome (a bone disorder that may result in an elongated head), Marfan syndrome (a disorder of the connective tissue that results in weirdly tall, skinny bodies), and cleft palates. But the associations between parental age and birth defects were largely speculative until this year, when researchers in Iceland, using radically more powerful ways of looking at genomes, established that men pass on more de novo—that is, non-inherited and spontaneously occurring—genetic mutations to their children as they get older. In the scientists’ study, published in Nature, they concluded that the number of genetic mutations that can be acquired from a father increases by two every year of his life, and doubles every 16, so that a 36-year-old man is twice as likely as a 20-year-old to bequeath de novo mutations to his children.

The Nature study ended by saying that the greater number of older dads could help to explain the 78 percent rise in autism cases over the past decade. Researchers have suspected links between autism and parental age for years. One much-cited study from 2006 argued that the risk of bearing an autistic child jumps from six in 10,000 before a man reaches 30 to 32 in 10,000 when he’s 40—a more than fivefold increase. When he reaches 50, it goes up to 52 in 10,000. It should be noted that there are many skeptics when it comes to explaining the increase of autism; one school of thought holds that it’s the result of more doctors making diagnoses, better equipment and information for the doctors to make them with, and a vocal parent lobby that encourages them. But it increasingly looks as if autism cases have risen more than overdiagnosis can account for and that parental age, particularly paternal age, has something to do with that fact.

Why do older men make such unreliable sperm? Well, for one thing, unlike women, who are born with all their eggs, men start making sperm at puberty and keep doing so all their lives. Each time a gonad cell divides to make spermatozoa, that’s another chance for its DNA to make a copy error. The gonads of a man who is 40 will have divided 610 times; at 50, that number goes up to 840. For another thing, as a man ages, his DNA’s self-repair mechanisms work less well.

To the danger of age-related genetic mutations, geneticists are starting to add the danger of age-related epigenetic mutations—that is, changes in the way genes in sperm express themselves. Epigenetics, a newish branch of genetics, studies how molecules latch onto genes or unhitch from them, directing many of the body’s crucial activities. The single most important process orchestrated by epigenetic notations is the stupendously complex unfurling of the fetus. This extra-genetic music is written, in part, by life itself. Epigenetically influenced traits, such as mental functioning and body size, are affected by the food we eat, the cigarettes we smoke, the toxins we ingest—and, of course, our age. Sociologists have devoted many man-hours to demonstrating that older parents are richer, smarter, and more loving, on the whole, than younger ones. And yet the tragic irony of epigenetics is that the same wised-up, more mature parents have had longer to absorb air-borne pollution, endocrine disruptors, pesticides, and herbicides. They may have endured more stress, be it from poverty or overwork or lack of social status. All those assaults on the cells that make sperm DNA can add epimutations to regular mutations.

At the center of research on older fathers, genetics, and neurological dysfunctions is Avi Reichenberg, a tall, wiry psychiatrist from King’s College in London. He jumps up a lot as he talks, and he has an ironic awareness of how nervous his work makes people, especially men. He can identify: He had his children relatively late—mid-thirties—and fretted throughout his wife’s pregnancies. Besides, he tells me, the fungibility of sperm is just plain disturbing. Reichenberg likes to tell people about all the different ways that environmental influences alter epigenetic patterns on sperm DNA. That old wives’ tale about hot baths or tight underwear leading to male infertility? It’s true. “Usually when you give that talk, men sitting like that”—he crossed his legs—“go like this,” he said, opening them back up.

Dolores Malaspina, a short, elegantly coiffed psychiatrist who speaks in long, urgent paragraphs, has also spent her life worrying people about aging men’s effects on their children’s mental state—in fact, she could be said to be the dean of older-father alarmism. In 2001, Malaspina co-authored a ground-breaking study that concluded that men over 50 were three times more likely than men under 25 to father a schizophrenic child. Malaspina and her team derived that figure from a satisfyingly large population sample: 87,907 children born in Jerusalem between 1964 and 1976. (Luckily, the Israeli Ministry of Health recorded the ages of their fathers.) Malaspina argued that the odds of bearing a schizophrenic child moved up in a straight line as a man got older. Other researchers dismissed her findings, arguing that men who waited so long to have children were much more likely to be somewhat schizophrenic themselves. But Malaspina’s conclusions have held up. A 2003 Danish study of 7,704 schizophrenics came up with results similar to Malaspina’s, although it concluded that a man’s chances of having a schizophrenic child jumped sharply at 55, rather than trending steadily upward after 35.

“I often hear from teachers that the children of much older fathers seem more likely to have learning or social issues,” she told me. Now, she said, she’d proved that they can be. Showing that aging men have as much to worry about as aging women, she told me, is a blow for equality between the sexes. “It’s a paradigm shift,” she said.

This paradigm shift may do more than just tip the balance of concern away from older mothers toward older fathers; it may also transform our definition of mental illness itself. “It’s been my hypothesis, though it is only a hypothesis at this point, that most of the disorders that afflict neuropsychiatric patients—depression, schizophrenia, and autism, at least the more extreme cases—have their basis in the early processes of brain maturation,” Dr. Jay Gingrich, a professor of psychobiology at the New York State Psychiatric Institute and a former colleague of Malaspina’s, told me. Recent mouse studies have uncovered actual architectural differences between the brains of offspring of older fathers and those of younger fathers. Gingrich and his team looked at the epigenetic markings on the genes in those older-fathered and younger-fathered brains and found disparities between them, too. “So then we said: ‘Wow, that’s amazing. Let’s double down and see whether we can see differences in the sperm DNA of the older and younger fathers,’” Gingrich said. And they didn’t just see it, he continued; they saw it “in spades—with an order of magnitude more prominent in sperm than in the brain.” While more research needs to be done on how older sperm may translate into mental illness, Gingrich is confident that the link exists. “It’s a fascinating smoking gun,” he says.

Epigenetics is also forcing medical researchers to reopen questions about fertility treatments that had been written off as answered and done with. Fertility doctors do a lot of things to sperm and eggs that have not been rigorously tested, including keeping them in liquids (“culture media,” they’re called) teeming with chemicals that may or may not scramble an embryo’s development—no one knows for sure. There just isn’t a lot of data to work with: The fertility industry, which is notoriously under-regulated, does not give the government reports on what happens to the children it produces. As Wendy Chavkin, a professor of obstetrics and population studies at Columbia University’s school of public health, says, “We keep pulling off these technological marvels without the sober tracking of data you’d want to see before these things become widespread all over the world.”

Clomid, or clomiphene citrate, which has become almost as common as aspirin in women undergoing fertility treatments, came out particularly badly in the recent New England Journal of Medicine study that rang alarm bells about ART and birth defects. “I think it’s an absolute time bomb,” Michael Davies, the study’s lead researcher and a professor of pediatrics at the University of Adelaide in Australia, told me. “We estimate that there may be in excess of 500 preventable major birth defects occurring annually across Australia as a direct result of this drug,” he wrote in a fact sheet he sent me. Dr. Jennita Reefhuis, an epidemiologist at the Centers for Disease Control, worries that Clomid might build up in women’s bodies when they take it repeatedly, rather than washing out of the body as it is supposed to. If so, the hormonal changes induced by the drug may misdirect early fetal development.

Another popular procedure coming under renewed scrutiny is ICSI (intracytoplasmic sperm injection). In ICSI, sperm or a part of a sperm is injected directly into an extracted egg. In the early ’90s, when doctors first started using ICSI, they added it to in vitro fertilization only when men had low sperm counts, but today doctors perform ICSI almost routinely—procedures more than doubled between 1999 and 2008. And yet, ICSI shows up in the studies as having higher rates of birth defects than any other popular fertility procedure. Among other possible reasons, ICSI allows sperm to bypass a crucial step in the fertilization of the egg—the binding of the head of the sperm with the coat of the egg. Forcing the sperm to penetrate the coat may be nature’s way of maintaining quality control.

A remarkable feature of the new older parenting is how happy women seem to be about it. It’s considered a feminist triumph, in part because it’s the product of feminist breakthroughs: birth control, which gives women the power to pace their own fertility, and access to good jobs, which gives them reason to delay it. Women simply assume that having a serious career means having children later and that failing to follow that schedule condemns them to a lifetime of reduced opportunity—and they’re not wrong about that. So each time an age limit is breached or a new ART procedure is announced, it’s met with celebration. Once again, technology has given us the chance to lead our lives in the proper sequence: education, then work, then financial stability, then children.

As a result, the twenties have turned into a lull in the life cycle, when many young men and women educate themselves and embark on careers or journeys of self-discovery, or whatever it is one does when not surrounded by diapers and toys. This is by no means a bad thing, for children or for adults. Study after study has shown that the children of older parents grow up in wealthier households, lead more stable lives, and do better in school. After all, their parents are grown-ups.

But the experience of being an older parent also has its emotional disadvantages. For one thing, as soon as we procrastinators manage to have kids, we also become members of the “sandwich generation.” That is, we’re caught between our toddlers tugging on one hand and our parents talking on the phone in the other, giving us the latest updates on their ailments. Grandparents well into their senescence provide less of the support younger grandparents offer—the babysitting, the spoiling, the special bonds between children and their elders through which family traditions are passed.

Another downside of bearing children late is that parents may not have all the children they dreamed of having, which can cause considerable pain. Long-term studies have shown that, when people put off having children till their mid-thirties and later, they fail to reach “intended family size”—that is, they produce fewer children than they’d said they’d meant to when interviewed a decade or so earlier. A matter of lesser irritation (but still some annoyance) is the way strangers and even our children’s friends confuse us with our own parents. My husband has twice been mistaken for our daughter’s grandfather; he laughs it off, but when the same thing happened to a woman I know, she was stung.

What haunts me about my children, though, is not the embarrassment they feel when their friends study my wrinkles or my husband’s salt-and-pepper temples. It’s the actuarial risk I run of dying before they’re ready to face the world. At an American Society for Reproductive Medicine meeting last year, two psychologists and a gynecologist antagonized a room full of fertility experts by making the unpopular but fairly obvious point that older parents die earlier in their children’s lives. (“We got a lot of blowback in terms of reproductive rights and all that,” the gynecologist told me.) A mother who is 35 when her child is born is more likely than not to have died by the time that child is 46. The one who is 45 may have bowed out of her child’s life when he’s 37. The odds are slightly worse for fathers: The 35-year-old new father can hope to live to see his child turn 42. The 45-year-old one has until the child is 33.

These numbers may sound humdrum, but even under the best scenarios, the death of a parent who had children late, not to mention the long period of decline that precedes it, will befall those daughters and sons when they still need their parents’ help—because, let’s face it, even grown-up children rely on their parents more than they used to. They need them for guidance at the start of their careers, and they could probably also use some extra cash for the rent or the cable bill, if their parents can swing it. “If you don’t have children till your forties, they won’t be launched until you’re in your sixties,” Suzanne Bianchi, a sociologist who studies families, pointed out to me. In today’s bad economy, young people need education, then, if they can afford it, more education, and even internships. They may not go off the parental payroll until their mid- to late-twenties. Children also need their parents not to need them just when they’ve had children of their own.

There’s an entire body of sociological literature on how parents’ deaths affect children, and it suggests that losing a parent distresses young adults more than older adults, low-income young adults more than high-income ones, and daughters more than sons. Curiously, the early death of a mother correlates to a decline in physical health in both sexes, and the early death of a father correlates to increased drinking among young men, perhaps because more men than women have drinking problems and their sons are more likely to copy them.

All these problems will be exacerbated if we aging parents are, in fact, producing a growing subpopulation of children with neurological or other disorders who will require a lifetime of care. Schizophrenia, for instance, usually sets in during a child’s late teens or early twenties. Avi Reichenberg sums up the problem bluntly. “Who is going to take care of that child?” he asked me. “Some seventy-five-year-old demented father?”

This question preys on the mind of every parent whose child suffers a disability, whether that parent is elderly or not. The best answer to it that I’ve ever heard came from a 43-year-old father I met named Patrick Spillman, whose first child, Grace, a four-and-a-half-year-old, has a mild case of cerebral palsy. (Her mother was 46 when Grace was born.) In his last job, Spillman, stocky and blunt, directed FreshDirect’s coffee department. Now, he’s a full-time father and advocate for his daughter. He spends his days taking Grace to doctors and therapists and orthotic-boot-makers, as well as making won’t-take-no-for-an-answer phone calls to state and city agencies that might provide financial or therapeutic assistance. How does he face the prospect of disappearing from her life? A whole lot better than I would. (My lame-joke answer, when my children ask me that question, is that I plan to live forever.) “We’re putting money aside now,” he said. Into a trust, he adds, so that government agencies can’t count it against her when she or a caregiver goes looking for Medicaid or other benefits.

Spillman also prepares Grace for the future by practicing tough love on her, refusing to do for her anything she could possibly do for herself. Her mother, he says, sometimes pleads with him to help Grace more as she stumbles over the tasks of daily life. But he won’t. At her tender age, Grace already dresses and undresses herself; every morning, Spillman explained, they do a little “tag check dance” to make sure nothing’s inside out. When, he says, someone makes fun of her way of walking and chewing and speaking, as he believes someone will inevitably do, “I want her to have years and years of confidence behind her.” He adds, “She’s going to go to college. She will be well-adjusted. She won’t be able to live on a nineteenth-floor walk-up, but she will live a normal life.”

When we look back at this era from some point in the future, I believe we’ll identify the worldwide fertility plunge as the most important legacy of old-age parenting. A half-century ago, demographers were issuing neo-Malthusian manifestoes about the overpeopling of the Earth. Nowadays, they talk about the disappearance of the young. Fertility has fallen below replacement rates in the majority of the 224 countries—developing as well as developed—from which the United Nations collects such information, which means that more people die in those places than are born. Baby-making has slumped by an astonishing 45 percent around the world since 1975. By 2010, the average number of births per woman had dropped from 4.7 to 2.6. No trend that large has a simple explanation, but the biggest factor, according to population experts, is the rising age of parents—mothers, really—at the birth of their first children. That number, above all others, predicts how large a family will ultimately be.

Fewer people, of course, means less demand for food, land, energy, and all the Earth’s other limited resources. But the environmental benefits have to be balanced against the social costs. Countries that can’t replenish their own numbers won’t have younger workers to replace those who retire. Older workers will have to be retrained to cope with the new technologies that have transmogrified the workplace. Retraining the old is more expensive than allowing them to retire to make way for workers comfortable with computers, social media, and cutting-edge modes of production. And who will take care of the older generations if there aren’t enough in the younger ones?

If you’re a doctor, you see clearly what is to be done, and you’re sure it will be. “People are going to change their reproductive habits,” said Alan S. Brown, a professor of psychiatry and epidemiology at the Columbia University medical school and the editor of an important anthology on the origins of schizophrenia. They will simply have to “procreate earlier,” he replied. As for men worried about the effects of age on children, they will “bank sperm and freeze it.”

Would-be mothers have been freezing their eggs since the mid-’80s. Potential fathers don’t seem likely to rush out to bank their sperm any time soon, though. Dr. Bruce Gilbert, a urologist and fertility specialist who runs a private sperm bank on Long Island, told me he has heard of few men doing so, if any. Doctors have a hard enough time convincing men to store their sperm when they’re facing cancer treatments that may poison their gonads, Gilbert said. The only time he saw an influx of men coming in to store sperm was during the first Gulf war, when soldiers were being shipped out to battlefields awash in toxic agents. Moreover, sperm banking is too expensive to undertake lightly, up to $850 for processing, then $300 to $500 a year for storage. “There needs to be a lot more at stake than concern about aging and potential for genetic alterations,” Gilbert said. “It has to be something more immediate.”

What else can be done? Partly the same old things that are already being done, though perhaps not passionately enough. Doctors will have to get out the word about how much male and female fertility wanes after 35; make it clear that fertility treatments work less well with age; warn that tinkering with reproductive material at the very earliest stages of a fetus’s growth may have molecular effects we’re only beginning to understand.

But I’m not convinced that medical advice alone will lead people to “procreate earlier.” You don’t buck decades-old, worldwide trends that easily. The problem seems particularly hard to solve in the United States, where it’s difficult to imagine legislators adopting the kinds of policies it will take to stop the fertility collapse.

Demographers and sociologists agree about what those policies are. The main obstacle to be overcome is the unequal division of the opportunity cost of babies. When women enjoy the same access to education and professional advancement as men but face penalties for reproducing, then, unsurprisingly, they don’t. Some experts hold that, to make up for mothers’ lost incomes, we should simply hand over cash for children: direct and indirect subsidies, tax exemptions, mortgage-forgiveness programs. Cash-for-babies programs have been tried all over the world—Hungary and Russia, among other places—with mixed results; the subsidies seem to do little in the short term, but may stem the ebbing tide somewhat over the long term. One optimistic study done in 2003 of 18 European countries that had been giving families economic benefits long enough for them to kick in found a 25 percent increase in women’s fertility for every 10 percent increase in child benefits.

More immediately effective are policies in place in many countries in Western Europe (France, Italy, Sweden) that help women and men juggle work and child rearing. These include subsidized child care, generous parental leaves, and laws that guarantee parents’ jobs when they go back to work. Programs that let parents stay in the workforce instead of dropping out allow them to earn more over the course of their lifetimes.

Sweden and France, the two showcases for such egalitarian family policies, have among the highest rates of fertility in the Western half of Europe. Sweden, however, ties its generous paid parental leaves to how much a parent has been making and how long she has been working, which largely leaves out all the people in their twenties who aren't working yet because they’re still in school or a training program. In other words, even a country with one of the most liberal family policies in the world gives steeply reduced benefits to its most ambitious and promising citizens at the very moment when they should be starting their families.

It won’t be easy to make the world more baby-friendly, but if we were to try, we’d have to restructure the professions so that the most intensely competitive stage of a career doesn't occur right at the moment when couples should be lavishing attention on infants. We’d have to stop thinking of work-life balance as a women’s problem, and reframe it as a basic human right. Changes like these are going to be a long time coming, but I can’t help hoping they happen before my children confront the Hobson’s choices that made me wait so long to have them.