By Giulia Cavaliere and James Rupert Fletcher.
The UK government has just amended the Human Fertilisation and Embryology Act 1990 and extended the limit for storing gametes (eggs and sperm) and embryos from 10 to 55 years. Previously, only people with a medical reason, such as infertility caused by cancer treatment, could store their gametes and embryos for over 10 years (up to 55).
The extended gamete storage limit represents the most substantive legislative response to reproductive ageing and declining fertility in the UK to date. The extension reflects global political concerns regarding shifting reproductive demography, whereby women in high-income countries are having fewer children and at later ages. Many fear that this will hasten population ageing and decline, driving long-term economic recession that will be difficult to reverse. Population and economic decline are not inherently bad, and from some environmentalist perspectives are even desirable. However, some scholars and policy makers view such trends as problematic given the potential for falling living standards.
Intriguingly, survey data suggest that the ideal family size in several affected countries remains around, or even above, replacement fertility (2.1 children per woman). Hence, declining fertility is not directly indicative of a declining desire to reproduce. Rather, the reproductive lifecourses of women in high-income countries have been shaped by a range of intersecting social determinants of fertility, including economic development, healthcare access, shifting relationship norms, female education, workforce feminisation, among other factors. These developments are broadly laudable, having improved the circumstances of millions of women globally, and we must therefore be cautious of any pronatalism that seeks to intervene here, for instance, via anti-abortion legislation.
These changes have contributed to delaying conception. Average maternal age at childbirth in the UK has risen from 24 to 29 years old in under 50 years, and is expected to continue to rise. Women begin to try to conceive at increasingly later ages, which partially explains the increase in seeking access to fertility treatment. In the UK, fertility treatment provision is heavily restricted by age, with CCGs limiting state-funded access to IVF to women younger than 35-year-old in some regions. As we have argued elsewhere, this is deeply anachronistic with the current circumstances of women in the UK and other high-income countries. Therefore, the extension of gamete storage limits potentially offers some response to how these trends affect people who would like to conceive and are unable to do so unassisted. It brings fertility treatment legislation more in line with the circumstances of women.
At the same time, it showcases the limits of pronatalist legislation in the context of reproductive ageing, particularly regarding repro-tech. Ignoring the structural determination of the reproductive lifecourse, and solely altering the legislative parameters of niche repro-tech, is at best facile and at worst risks presenting women with additional problems. Gamete storage exemplifies some of these problems. For optimal results, eggs must be frozen early in a woman’s life, meaning that prospective mothers should ideally forecast their social and economic prospects in their 20s. As with other forms of fertility treatment in the UK, NHS provision of gamete storage is complicated and private costs can be substantial, especially given the potentially long-term nature of the service. Success is not assured, with 80% of embryos surviving thawing and 30% of those resulting in successful pregnancies. Overall, expanding the time and age parameters of gamete and embryo storage will likely benefit a small number of people and produce some babies, but it is unlikely to have widespread notable effects on fertility. Moreover, it represents another instance of interventions that individualise responses to broader social trends and dynamics. Individual women will be responsible for freezing their eggs early in life, paying the costs of keeping them in storage and undergoing fertility treatment to be able to conceive.
This seems at odds with other, possibly more desirable, forms of political intervention to address structural determinants of reproductive ageing. Childcare inaccessibility, housing unaffordability, social isolation and even existential fears about humanity’s future all potentially disincentivise reproduction. Such negative determinants present less contentious and less individualised opportunities for pronatalist legislation to support women to pursue their preferred reproductive lifecourses. If we want women to participate meaningfully in formal labour markets as well as reproducing and raising children, then perhaps we should ensure childcare provision during working hours, ensure that labour is recompensed sufficiently to feed, clothe and house children, ensure that labour is secure enough to safeguard standards of living for 18 years, and so on.
In practice, the UK has developed a political economy of reproduction that is almost comically anachronistic with the circumstances of its citizens. The financial capacity for raising children on a single income has declined while the number of single parent households has increased. IVF age-restricted accessibility has tightened while the average age of reproduction has increased. Childcare affordability has declined while geographic mobility and family dispersal has increased. Hence, as the nature of motherhood moves toward working women in their late 30s with fewer informal resources, society grows evermore impeditive to their reproductive ideals.
Discussions of fertility are too often individualised in regard to both cause and effect. A person’s decisions do not exist in a vacuum. Given the above constraints, delaying reproduction to later ages, and ultimately indefinitely, is entirely understandable, logical and perhaps even responsible. The ramifications of mass childlessness, such as a shrinking tax base, will likely impact on all our lives. In this context, an overly-individualising choice-based rational actor conceptualisation of reproductive ageing is rather trite. Conversely, a purely macro-policy view of population structure can foster illusory notions of population management. Historic examples of forceful demographic policy exemplify the risks, and profound naivety, of attempts to shape population, China being the infamous example.
On average, people in high-income countries struggling with low fertility rates generally want more children than they have. Beyond technological tinkering, the soundest legislative responses to reproductive ageing and declining fertility are likely to be those that foster social environments which simply support people to realise their reproductive preferences. Hence, extending the limit for storing gametes and embryos can seem a clumsy, if not problematic, response to reproductive ageing—especially if it translates in increased pressure on women to manage their fertility alongside competing, and often somewhat incompatible, social expectations and economic realities.
Authors: Giulia Cavaliere and James Rupert Fletcher.
Affiliations: GC: Lecturer in Medical Law & Medical Ethics, Dickson Poon School of Law, King’s College London. JRF: James Rupert Fletcher, Wellcome Fellow, Department of Sociology, University of Manchester
Competing interests: None declared.