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Fertility: when is too late?
00:28:14
Psychologist Jean Twenge argues that women in their late thirties shouldn’t be as of...
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- [00:00]
Tim Harford
Thank you for downloading More or Less from the BBC. This is the version of the programme first broadcast on BBC Radio 4. Here's Tim Harford.
- [00:09]
Presenter (possibly Tim Harford or main host)
Hello and welcome to More Or Less the programme which puts a bit of va va voom in your statistical life this week. Are we still in recession, but can't see that because we're mismeasuring gdp? Alarming claims about how common rape is in Asia, but what's really being counted
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Boniface Ndrangu
and is Africa Drunk Alcohol has become probably the only source of relief. It has become a really huge problem.
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Presenter (possibly Tim Harford or main host)
But first, the comedian Tina Fey has been looking at her magazine collection.
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Guest or correspondent (possibly Ruth Alexander or another contributor)
The COVID story of New York Magazine this week is Baby Panic. This goes perfectly with the other magazines on my coffee table.
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Presenter (possibly Tim Harford or main host)
Where are the babies? Why haven't you had a baby? And for God's sake, have a baby? That's from the US show Saturday Night Live back in 2002. It is, of course, possible that some of those headlines weren't genuine, but this one is. It's from the Scotsman just this week.
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Pete Comley
Have babies by age 35, say experts,
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Presenter (possibly Tim Harford or main host)
and so is this one from the male.
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Tim Harford
Pregnancy after 35 is like an Iron man challenge.
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Presenter (possibly Tim Harford or main host)
Let me tell you the story of Jean Twenge, a professor of psychology at San Diego University. Back when that edition of Saturday Night Live went out, Jean was having a tough time. She was 30 years old and on the verge of a divorce. A few years later, she had found love again. Hurrah. But Jean and her new husband wanted to have children and panic quickly set in.
- [01:33]
Jean Twenge
I read a lot of very scary
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Presenter (possibly Tim Harford or main host)
statistics, and one in particular made her feel pretty desperate.
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Jean Twenge
One out of three women over the age of 35 will not be able to get pregnant within a year.
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Presenter (possibly Tim Harford or main host)
So that means that after 12 months of trying to conceive naturally, only 2/3 of women will have been successful. But Jean was determined to find out more. Where had that figure come from?
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Jean Twenge
The data on which that statistic is based is from birth records from 1700s France.
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Presenter (possibly Tim Harford or main host)
1700s France, yeah, yeah.
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Jean Twenge
I mean, 1680 to 1810 or something like that.
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Presenter (possibly Tim Harford or main host)
We're talking about women who have never seen electric light bulb, no antibiotics, no modern health care. I mean, it's quite extraordinary that that's where the data is coming from.
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Jean Twenge
Well, you know, I can empathize slightly with the researchers in this area because it is difficult to draw conclusions about age and fertility from modern populations where birth control is widely used.
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Presenter (possibly Tim Harford or main host)
But surely there are some more modern studies. In her statistical search, Jean then came across a paper by David Dunson at Duke university in the US.
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Jean Twenge
It was published in 2004 and it found that women over 35 had a much higher chance of getting pregnant than those historic birth records would suggest. It found 82% got pregnant within a year. What was really interesting is that wasn't all that different from women in their late 20s and early 30s, where the figure was 86%.
- [03:08]
Presenter (possibly Tim Harford or main host)
So to put that another way, instead of one in three women in their late 30s not being pregnant after a year of trying, this study said that fewer than one in five women would be in that position. Of the women who did have trouble conceiving, many of them would have had trouble even if they'd started trying earlier on. Now, our reporter Hannah Barnes is with me now. And Hannah Jean was looking at data and statistics widely quoted in the United States. Do the experts here in the UK back her up?
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Hannah Barnes
Yep, they do. I've been talking to David James from the National Institute for Health and Care Excellence, and he said the Dunson study is far more reliable than others, using
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David James
historic data that is much more realistic for couples trying to conceive in the uk. It was a single study undertaken relatively recently of about 780 women in seven different European centres. And the important point about that was that these were women who were trying to conceive. The other study which produced these very pessimistic figures for chances of success, were actually merely reporting the reproductive performance in a group of women over many centuries without the same criteria of intending to get pregnancy. So, in other words, this was a report which should not have been used to form the basis of saying, what is the chance of a woman conceiving at age whatever?
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Hannah Barnes
And of course, they could have actively been trying to avoid getting pregnant.
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David James
Correct. They may not have had intercourse. I mean, that's rather crucial to the chance of success, too.
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Hannah Barnes
Alongside the studies that look at women hundreds of years ago, we're also often confronted with statistics looking at IVF success rates or artificial insemination. And there are obvious problems with both of those. Couples undergoing ivf, for example, have an established fertility problem. They've already tried and failed to conceive naturally. And with artificial insemination, the numbers show that the success rates just aren't as high as natural conception rates.
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Presenter (possibly Tim Harford or main host)
Okay, so back to couples trying to conceive naturally. We've been talking about the chances of women getting pregnant in their late 30s. What happens at 40?
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Hannah Barnes
Well, there hasn't actually been very much research on it, but David James, who helped compile the NICE guideline on fertility says 40 isn't an absolute cutoff point.
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David James
It would appear from the limited and poor quality data that we have that that rate falls significantly. But as we know, for some notable celebrity cases, it is not impossible to get pregnant in early or indeed late 40s. But the chances are certainly much less than they are when a woman is in her late 30s.
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Hannah Barnes
Is there any evidence that generally fertility is just increasing as time goes on?
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David James
Yes, is the short answer. And we've recently updated the NICE guideline on fertility, and it is clear that the chances of women naturally conceiving at the age are much higher now than they were when the original guideline was written.
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Presenter (possibly Tim Harford or main host)
Now, Hannah, it just doesn't feel right doing an item on fertility without speaking to the nation's most beloved expert on it, Professor Lord Robert Winston.
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Hannah Barnes
I agree. Here's what he had to say.
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Professor Lord Robert Winston
I think it's great that women are having babies later and later in life. I mean, there are all sorts of advantages nowadays. Our health is better, they're more secure, they're often in a stable relationship. But of course, there is some degree of payoff in fertility problems, and that is a risk, but it's not a major risk.
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Presenter (possibly Tim Harford or main host)
But of course, there are other risks with delaying having children, the chance of having a baby with chromosomal abnormalities, the most common of which is down syndrome. That chance also increases.
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Hannah Barnes
It does, and so does miscarriage. And Jean Twenge accepts all of that in her book the Impatient Woman's Guide To Getting Pregnant. But again, it might be that those risks are overstated. Here's David James.
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David James
The risk of any chromosomal abnormality at the age of 20 is 1 in 500. At the age of 30, it's about 1 in 400. At the age of 40, it's about 1 in 60 to 70. Turning that on its head, if you take the 1 in 60 figure for age 40 women, it does mean that 59 out of 60 women age 40 will have no chromosomal problem in their baby at all. One has to keep a sense of perspective. If you're 40, you have twice the chance of having blood pressure problems in pregnancy than if you're 30. But the figure are 2%, rising to 4%. In other words, the great majority of women who conceive and carry their babies in their late 30s, and indeed, if you're 40, will have a normal outcome to their pregnancy.
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Presenter (possibly Tim Harford or main host)
Just finally, did you pick up any handy tips for couples trying to have a baby?
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Hannah Barnes
Funny you should say that. Robert Winston did have a suggestion.
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Professor Lord Robert Winston
The fact of the matter is the best way to have a baby is either in bed or on the, you know, by the far side, on the hearthrug or whatever shittam.
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Presenter (possibly Tim Harford or main host)
You're listening to.
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David James
More or less.
- [08:14]
Presenter (possibly Tim Harford or main host)
At least I hope you're still listening. Now, I'm not sure what the collective noun is for positive economic data. It often seems to be a raft, but perhaps it should be a bounce or a surge or perhaps a gloat of economic good news. George Osborne was certainly pretty chuff with himself this week. We held our nerve when many told us to abandon our plan. And as a result, thanks to the efforts and the sacrifices of the British people, Britain is turning a corner. Well, I think we can file that one under Correlation is not causation, but regardless of the rough and tumble of political life, there's an interesting statistical point here, and perhaps an alarming one. A few weeks ago, the estimate of economic growth in the second quarter of this year was revised up to 0.7%. And while that's not the final verdict, it's distinctly promising. The standard measure of economic output is GDP or gross Domestic Product. And the disturbing question is what if we don't really know what GDP is at all? What if we can't measure it properly? And what if our recent measurements have systematically been too optimistic? GDP is measured in various ways, but the simplest to understand is that it's all the money we spend in the course of the year adjusted for imports and exports. But we also need to adjust for changes in prices. There are two well known measures of inflation, rpi, the Retail Price Index and cpi, the Consumer Price Index. But they're not much good for adjusting GDP as a whole, because GDP isn't just about consumer spending. There's the little question of what the government spends too. And so GDP is adjusted using a little known measure of inflation, called by the rather alluring title of the GDP deflator. And here's the thing about the GDP deflator. Right now it's a lot lower than either RPI or CPI.
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Pete Comley
Last year in 2012, the GDP deflator was 1.5%, CPI was 2.8%. That's quite a lot lower.
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Presenter (possibly Tim Harford or main host)
That's Pete Comley, author of Inflation Tax Getting the right measure of inflation Matters. If the GDP deflator is actually underestimating inflation, that means that what looks like economic growth might just be price increases that we're not counting properly. Pete Comle is worried that that might be the case. There are three components used to calculate the GDP deflator. Household expenditure, capital formation which is how much we spend on things like roads and bridges. And then you've got government expenditure, which accounts for about a quarter of gdp. And it's this part which looks a bit strange.
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Pete Comley
The GDP deflator for government expenditure has now become negative. It's minus 1.6% in 2012. So, in other words, where effectively assuming that for every pound we spend, we are getting increases in productivity of 1.6%. And that is very perverse, because in the rest of the economy, productivity is going down.
- [11:13]
Presenter (possibly Tim Harford or main host)
When the Office for National Statistics calculates RPI and cpi, they literally send people out to the shops to see what's happening to prices. But the Government's paying for the National Health Service schools. What's the price of an education or a trip to the gp? How could we say that that price was rising or falling? In health and education, there are hundreds of indicators that can be looked at to try to assess accident and emergency emissions, GP appointments, pupil numbers, attendance and GCSE results. They're all added together, given different weightings, and that's how the price of the bulk of government expenditure is calculated. There seem to be three main explanations as to why government expenditure seems to be getting cheaper and cheaper. Number one, the Government's reforms are really working and they're getting better value for money. Two, there's a delayed reaction. We spend money recruiting nurses, educating children. This year's GCSEs, for instance, are the result of 12 years of education. And now we're cutting back, but we won't see the effect of that cutback for a time, so we're getting illusory productivity. Number three, we just can't measure the cost of these things and so the data are moving around randomly. So what's Pete Comley's preferred choice?
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Pete Comley
I have a favourite in number two of those hypotheses, which is that in the Blair Brown years of the early noughties, we spent a lot on public services. But of course, you know, when you build a new school and you train teachers, as you say, it takes a long time for that to sort of filter through. And indeed, the evidence and the numbers do seem to back up that hypothesis, because the effective GDP deflator 5, 10 years ago was very high and it's been trending down and has now become negative.
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Presenter (possibly Tim Harford or main host)
Well, I put these points to the people who come up with a number the Office for National Statistics, personified by Pete Lee, Assistant Deputy Director. He says that the negative figure for government expenditure in the last quarter was predominantly down to health, where Spending fell, but output held up.
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Pete Comley
If you think about some of the things that go on within government, they're not immediately related to the amount spent. So the numbers of operations or numbers of GP visits wouldn't be determined by a short term change in government spending. It will be governed more by how many people needed those services.
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Presenter (possibly Tim Harford or main host)
So I'm trying to figure out, are we getting more for our money in healthcare or not? Or are we just saying, look, there's a squeeze on health spending, but that's not actually an efficiency gain, it's not really an increase in productivity, it's just a short term blip. And over the next few years that'll sort of disappear. It'll sort itself out.
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Pete Comley
Certainly this one quarter, taken in isolation, you've seen exactly what you just described. What might happen in the future remains to be seen.
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Presenter (possibly Tim Harford or main host)
So why does this matter? Well, if the GDP deflator has actually been more in line with more familiar measures of inflation, GDP growth has been lower than we realized. The recent recession has been deeper and longer. We just haven't been able to measure it. To get a wider perspective on this debate, I talked to the economist Diane Coyle, who's putting the finishing touches to her forthcoming book, A Brief and Affectionate History.
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Diane Coyle
So if you think about a nurse working in a hospital, is he or she more efficient if they see 10 times more patients in a day and get through the numbers, or more efficient if they spend more time with that patient and are kind to them and deliver a better quality of care? Either would be valid.
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Presenter (possibly Tim Harford or main host)
So this isn't just an issue as to how we measure inflation for government expenditure, although that is a big part of it. Actually, there are big chunks now of how we measure quality in GDP that are starting to get very fuzzy.
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Tim Harford
Yes.
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Presenter (possibly Tim Harford or main host)
So we have this huge political argument about has the recovery begun or not. Is it actually of any practical importance? Should we care that. That we don't really know to any degree of accuracy what GDP really is.
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Diane Coyle
We should care in the sense that to set monetary and fiscal policy appropriately, the government needs to have some idea of generally how quickly has the economy been growing and is it too fast or is it too slow? I think the pitfall is taking the actual figures too seriously. So every quarter the number comes out and people in the financial markets and the media pay huge attention to the is it 0.2 or 0.3 or is it a wonderful 0.7? And actually this statistic is so complicated and so kind of artificial in the way it's constructed that you just can't put that weight on a quarterly change of a small amount like that.
- [15:57]
Presenter (possibly Tim Harford or main host)
Diane Coyle, if there are any numbers you'd like us to check out, please email us atmore or lessbbc.co.uk.com as Hans has a loyal listener in Germany.
- [16:08]
Survey Researcher (unnamed, possibly a contributor or expert)
From my own work as a survey researcher, I know that violence against women is a serious problem and needs to be addressed. But I do have to say that I was a bit concerned by the headlines.
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Guest or correspondent (possibly Ruth Alexander or another contributor)
Every fourth man in Asia Pacific region has raped.
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Survey Researcher (unnamed, possibly a contributor or expert)
I wonder what you make of this. It is a super sensitive issue and one should do as much as possible to reduce violence against women. And making sure that the public claims are plausible is a good first step in that direction.
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Presenter (possibly Tim Harford or main host)
Well, this headline and many others like it are reporting a UN study published in the Lancet, and perhaps they're simplifying it somewhat. Ruth Alexander has been looking into this for us.
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Tim Harford
The Researchers surveyed about 10,000 men in a handful of urban and rural areas in six countries. Bangladesh, China, Cambodia, Indonesia, Papua New guinea and Sri Lanka. Half the respondents were in just two countries, Bangladesh and Indonesia. And most samples weren't nationally representative.
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Presenter (possibly Tim Harford or main host)
So conclusions can't be drawn about men in the whole of each country, never mind the whole of Asia and the Pacific, contrary to what many news reports around the world would have you believe. But Ruth, the numbers are still high for these areas.
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Survey Researcher (unnamed, possibly a contributor or expert)
Yeah.
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Tim Harford
It's worth noting, though, that two of the areas studied have relatively recently suffered periods of conflict. The island of Bougainville in Papua New guinea and Jayapura in Indonesia. And the numbers reporting rape are much higher there than in the other areas.
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Presenter (possibly Tim Harford or main host)
So by conducting surveys in those areas, they're pulling up the average. And and another interesting detail is what questions the men were asked.
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Tim Harford
The study looked at both rape within relationships and outside of relationships. About 12% of men admitted to rape outside of relationships, although this number falls to 6% if you take out the areas which have seen conflicts recently. Rape within relationships is where you see the biggest numbers. About 24% of men, almost a quarter, admit what's classed in this study as sexual violence with girlfriends or wives, past and present. This number falls to about 18% if you take out those two former conflict areas.
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Presenter (possibly Tim Harford or main host)
Still, that's nearly one in five men.
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Tim Harford
Now let's have a look at what questions the men were asked about their relations with their partners or former partners. There was a question about forced sex and this was asked in Bangladesh, where the survey was started. The figures there are lower than anywhere else now in other countries. A second question was introduced into the survey and this question doesn't explicitly mention force or violence. It's simply that have you had sexual intercourse with a partner when you knew she didn't want to, but believe she should agree because she was your wife or partner? Speaking to the lead technical advisor on the study, Professor Rachel Jukes from South Africa, I asked her about this second question.
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Professor Rachel Jukes
The question is basically, did you make your wife have sex when she didn't want to because you thought she should do so? If you were to stand up in a British court and say to a judge, I didn't rape her, I made her have sex because I'm her husband, she didn't want it, but that's why I did it. You'll get convicted of rape and you'll get sent to jail. In Britain, sex is rape if you don't consent to sex.
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Tim Harford
But is it clear from the question that we're talking about making someone have sex without consent?
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Professor Rachel Jukes
It's implicit in the question that that's what had happened, was that consent wasn't the issue.
- [19:24]
Presenter (possibly Tim Harford or main host)
Rachel Dukes talking to Ruth Alexander. At the G20 summit in St Petersburg last week, a spokesman for the host, Vladimir Putin, was reported to have announced that Britain was a small island. No one listens to the Prime Minister. David Cameron was quick to leap to this island's defence.
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Guest or correspondent (possibly Ruth Alexander or another contributor)
Yes, we are a small island. In fact, a small group of islands. But I would challenge anyone to come up with a country with a prouder history, with a bigger heart, with a greater resilience.
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Presenter (possibly Tim Harford or main host)
It must have made for the most awkward diplomatic summit since Cleopatra accidentally invited Caesar and Mark Antony over for a glass of wine on the same evening. Now, this apparent snub from the Kremlin had loyal listener Nigel Hubble rushing to his computer to fire off an email.
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Professor Rachel Jukes
Putin says small island, and no one disputes the geographical ranking. Yet Great Britain is the ninth largest island in the world. Even if you counted Australia ridiculously, it would be in the top 10.
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Presenter (possibly Tim Harford or main host)
Sounds like we need an expert on islands. What about Professor Godfrey Baldacchino, research Chair in Island Studies at the University of Prince Edward island in Canada and executive editor of the Island Studies Journal?
- [20:41]
Guest or correspondent (possibly Ruth Alexander or another contributor)
Well, of course, I'm not surprised that the comment by Putin said generated that kind of reaction amongst your audience. Britain is a fairly large island as far as islands go. Of course, it's always going to be problematic to define how large an island is in order to define itself as an island. There are usually cutoff points, both at the very top end and at the lower end. At the top end, we usually define the very largest islands as continents, for example. And from a geographical point of view, there are four huge continents in the world. Eurasia, Africa being the largest, of course, then America, then Antarctica, and then Australia, in that order. So if we include those as mega islands, large islands, Britain would actually be the Lucky 13, the 13th island on that list in terms of land size. If we switch our parameters and we go for population instead of land, then Britain would score even higher up the list. Britain would be fourth largest island by population in the world. I'm talking about exclusively island nations, the largest being Indonesia, followed by Japan and the Philippines. So by no stretch of the imagination is Britain a small island. And then, of course, there's nothing wrong about small islands having a stature, a clout, a footprint, much larger than they would suggest. I'll just mention the island of Manhattan, which is much, much smaller than Britain. And of course, it's an island that one could call at the very center of the world.
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Presenter (possibly Tim Harford or main host)
How large is the typical island compared with the island of Great Britain?
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Guest or correspondent (possibly Ruth Alexander or another contributor)
Well, there are differing definitions of what an island is. Where does an island start off? Is a rock. An is island is a coral atoll, you know, a few feet across or a few miles across, an island. So it's very difficult to come up with these hard and fast scientific definitions as far as populated islands go. Britain, however, is definitely one of the largest. It is not just an island, it is also an archipelago. It is surrounded by other islands. It has also been, of course, the center of an empire. Britain shares a historical position with very few other civilizations, including Tonga and the Pacific, including Crete in the Mediterranean, including Venice in the Mediterranean, as having been, in the case of Britain, of course, for many centuries, the center of a sprawling global empire.
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Presenter (possibly Tim Harford or main host)
Are there any other distinctions that the island of Britain has that others don't?
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Guest or correspondent (possibly Ruth Alexander or another contributor)
Yes. One other distinction is that Britain is one of the few islands that officially calls itself great. Now, I'm not sure whether that's a gesture of pomposity or presumptuousness, but it could merely be a factual indication of its relevance on the world stage.
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Presenter (possibly Tim Harford or main host)
I can't think off the top of my head of any other islands that call themselves great. Are there any?
- [23:15]
Guest or correspondent (possibly Ruth Alexander or another contributor)
There are many others, actually, but they are usually much smaller.
- [23:19]
Presenter (possibly Tim Harford or main host)
Well, there we go. Call us pompous. We're the ones who rightly apply the term great to ourselves. No man is an island, except one, Professor Godfrey Baldaccino. Now, we haven't heard much from Nairobi this series, and this man reckons the news is bad.
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Boniface Ndrangu
It is catastrophic. Alcohol has become probably the only source of relief out of extreme poverty. It has become a really huge problem.
- [23:49]
Presenter (possibly Tim Harford or main host)
That's Bonifas Ndrangu. He used to be an alcoholic and now he runs two rehabilitation centres in Kenya. Kenya was at the centre of an article in Time magazine with the alarming
- [23:59]
Tim Harford
headline, Africa's Drinking Problem. Alcoholism on the Rise As Beverage Multinationals Circle.
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Presenter (possibly Tim Harford or main host)
The piece described the country as consuming ever more alcohol and stated that Africa has a drinking problem. But is it correct to make such a general statement about a continent of 55 countries? Well, we're not the only ones who are wondering. Kate Wilkinson is a researcher at the website Africa Fact Check, and she investigated the claims made by the Time article.
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Kate Wilkinson
What we discovered was that out of Africa's 55 countries, they have varied drinking habits. There are different attitudes towards alcohol, different religious beliefs about consuming alcohol. And to simply make this broad generalization about the continent doesn't give us much insight. It doesn't let us know where people are drinking, how many people abstain from alcohol altogether? Many African countries have large Muslim populations. If you want to look at how many people in Africa are lifetime abstainers, that being that they don't drink alcohol at all and never have, it's 57.3%. And then if you look at how many people haven't drunk alcohol in the last 12 months, that figure increases to 70.8%.
- [25:09]
Presenter (possibly Tim Harford or main host)
Part of the difficulty here is that Time magazine wanted human stories of alcohol abuse. They weren't so interested in leafing through the statistics. Well, the best data we can find comes from the World Health Organization, and it makes for interesting reading. The world average alcohol consumption is 6.13 litres of pure alcohol per person over the age of 15 each year. Now, in Africa, the average is 6.15 litres. That's just a 20 milliliter difference, a mere double measure of whiskey extra over the course of a whole year. And driving up the average for Africa. The WHO excluded seven African countries with a large Muslim population where alcohol is either restricted or banned. Now, Europe, by contrast, consumes 12.18 litres per person per year, almost double the alcohol consumed in Africa. But there's a third way to look at this story. Through the data on binge drinking or heavy episodic drinking, to use the formal term. Africa has the highest proportion of heavy episodic drinkers to return to Kenya. While 85% of Kenyans haven't had a drink in the past year. Compare that with 14.4% in the UK the ones who do drink are drinking a lot, almost twice as much per person as in the uk. The lesson for Time magazine and for us always take a look at the statistics. Simply looking at average alcohol consumption in Africa would have put a lie to the idea that Africa is drunk. And then take a second look at the statistics, because while averages are useful, they're not the only statistical fact worth considering.
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Boniface Ndrangu
Boniface Ndrangu There is a good percentage of hardcore drinkers. The moment you put down a drink you start realizing actually majority of the people don't. It's only this section that drinks maybe 10 to 15% drink. The culture is that on a really drinking silly and it's like fashionable to them. Getting drunk is a really cool thing.
- [27:12]
Presenter (possibly Tim Harford or main host)
Bonifas Ndrangu, Executive Director of the Eden House foundation and that's all we have time for this week, but you can always download a copy of the program from BBC.co.ukmorealls and listen to it on a continuous loop until we're back on air. Or you can send us an email more or lessbc.co.uk although I'm not sure I would encourage you to do both simultaneously. This episode of More or Less was brought to you by the number 100. And for those of you who are currently trying for a baby, good luck, have fun, and until next week, goodbye.
- [27:57]
Tim Harford
More or LESS was presented by Tim Harford, the Financial Times undercover Economist. It was produced by Ruth Alexander and made in association with the Open University. You can Download many more Radio 4 programmes for free. Find these@BBC.co.uk Radio 4.