The message that ages 20 to 35 are the best for a woman to have a child should be taught in schools alongside education about teenage pregnancies and contraception, the leader of the UK's maternity doctors has said.
Dr Tony Falconer, the president of the Royal College of Obstetricians and Gynaecologists (RCOG), warned against the pronounced trend towards older motherhood and said women and couples have to become "better at resolving the conflict" between their careers and family plans.
"It's never our responsibility [as doctors] to tell people when they should have their family, because there are all sorts of societal pressures," he told the Guardian in his first major interview since taking up the post in October.
But he added: "There's no doubt that between 20 and 35 is the time to have your children. We are building up a difficulty for ourselves as a society by people's expectations that they will wait until they are older. That's a very complex issue, but it is a problem."
His views on what he sees as the increasing problem of women waiting to have children could cause controversy.
But Falconer said there is strong evidence that women who leave starting a family until they are 35 will have reduced fertility and so find it harder to conceive, even more so once they hit 40.
Older women are also more likely to face medical complications. They include a greater risk of miscarriage, stillbirth, multiple pregnancy, cancer, needing a caesarean or assisted delivery, foetal anomalies such as Down's syndrome and even a heart attack in pregnancy, albeit that is a rare event, he said.
"Reproductively, tragedies can result as a direct result of later motherhood," said Falconer, citing the case of a 40-year-old woman who, carrying her first child, experiences a stillbirth. (The stillbirth rate is one in 200 across all ages, but higher for older women). While younger would-be mothers can resolve to try again for another baby, the older woman may not be able to because she is less fertile – "an awful, appalling situation that most of us have come across at some stage in our career," Falconer said.
He cited a graph in a medical textbook which showed the chances of a woman losing a baby to miscarriage, ectopic pregnancy or stillbirth relative to her age when she conceived. It is about a 30% risk for a 40-year-old and 45% for a 45-year-old. "The incidence of tragic outcome and sadness will be more common the older the mother is," said Falconer.
He said he wanted the message about 20 to 35 being the ideal years for childbearing to be much better understood. Schools could help, he suggested. "When you're educating children about contraception and teenage pregnancy, you could introduce other concepts at the same time, such as parenting and feeding babies, and you might tag on to that what the best age is to have children.
"As a 15-year-old girl, when you're doing your GCSE preparation, it might just sow a seed for them if you give them information at that stage that the best time to have children was 20-35."
One of Falconer's colleagues described him as "a quiet radical". The new leader of the UK's maternity doctors is keenly aware that this area of medicine involves some high-profile issues – not just older mothers but abortion; greater maternal obesity; fertility; sexually-transmitted infections; and the quality of NHS childbirth services received by the 790,000 women who have a baby in the UK each year.
Until now Falconer has been more associated with health overseas than here. But that is about to change and in the interview he marked himself out as a medical leader unafraid to speak plainly on issues that matter to him, the doctors he represents and their patients.
He described the pitfalls of the NHS operating in effect a two-tier quality of obstetric care, meaning that women who give birth overnight receive a lesser service than those during the day. With maternity services still the object of much dissatisfaction, despite government initiatives in recent years, his candid analysis is unlikely to please health secretary Andrew Lansley.
Nor will his description of the choice of place of birth – a central tenet of official policy and a "right" that women in England at least are meant to have but usually do not – as largely an illusion. What matters more, he suggested, is improving the experience for the 98% of women who, whether voluntarily or of necessity, have their child in hospital.
Falconer's colleagues praised his work: Paul Roberts, chief executive of Plymouth Hospitals Trust, where he still works several days a week as a consultant obstetrician, said of the new RCOG boss: "Tony is a real leader, his values are strong and he is amongst the most principled clinicians I have ever worked with", says Pau, despite having become the president of the Royal College of Obstetricians and Gynaecologists (RCOG) in October. "... he has been a tireless campaigner and activist on global women's health issues and in particular the health of women in Africa."
