In Israel, Policy Produces Babies, Even for a 60-Year-Old Mother
On August 2, a 60-year-old woman became the oldest mother ever to give birth at Kaplan Medical Center, in Rehovot, Israel. The woman, who asked not to be identified by the press, was admitted to the hospital with pre-eclampsia, a pregnancy complication often seen in first-time and older mothers. Her healthy daughter was delivered by cesarean section, and after two-and-a-half weeks in the hospital, the pair went home.
The birth, made possible by in vitro fertilization, made headlines in Israel and across the globe. But even she was not the oldest woman to give birth in Israel. In May 2015, a 65-year-old Hasidic woman who had been trying to get pregnant for decades finally gave birth with the help of a donor egg. Hasidic newspapers deemed it a “miracle.” Five months before that, a 56-year-old woman gave birth to her first son, also at Kaplan.
First-time births by much older women make up just a fraction of all births in Israel. But they are on the rise. According to the Israeli Ministry of Health, in 2015, 577 Jewish women over age 45 gave birth, as compared to 333 in 2005. There’s a particularly Israeli reason that so many older women are having children: Israel wants Jewish women to have more babies, and makes the technologies to facilitate these births widely available.
“The state conveys a very strong message that women should try and give birth,” said Daphna Birenbaum-Carmeli, a medical sociologist at University of Haifa. “It’s not only about founding a family, it’s about having your own biogenetic child.”
At the most basic level, the Israeli drive to create more Jewish babies is about Jewish survival. Israel’s pro-family policies reflect the state’s push to secure a Jewish demographic majority. It also reflects the “Jewish ethos of family and the ethos of procreation” said Avraham Steinberg, chief medical ethicist at Jerusalem’s Shaare Zedek Medical Center. “That is an ideology we carry with us almost genetically.”
To be sure, the childbearing age is also rising because Jewish Israeli women, like women in most Western nations, are delaying childbirth, said Yael Neeman, a gynecologist at Kaplan who was present for the August 2 birth.
“It is not that common, but it is becoming more and more common,” Neeman said of births by older women.
According to a 2011 study in the journal Sterility and Fertility, first-time births to women in Israel who are over 45 had more than doubled since the decade prior. (The study didn’t specify the number of new mothers over 45 in Israel.)
Israel has the highest rate of IVF in the world, with 40,000 cycles a year, Birenbaum-Carmeli said. That’s twice as high as the country second on the list, Denmark. IVF is covered by Israel’s health insurance up until a woman is 45, and it is completely free for up to two births. The procedure is available to Jewish and Arab citizens alike, though Arab women are less likely to use it. While egg freezing is not covered by public health insurance, it has been widely embraced by Israelis. Birenbaum-Carmeli said that in 2011, when egg freezing was considered experimental in other parts of the world, it was already approved for use by healthy women in Israel.
These technologies have made it possible not only for women to give birth much later in life, but also to try again and again over decades until they succeed.
Although after a certain age, the women must pay for the procedures themselves.
There are, of course, health risks associated with giving birth at an advanced age. In the Sterility and Fertility report, Israeli scientists noted that eight out of 10 mothers who gave birth over age 45 experienced health problems such as pre-eclampsia and pregnancy-related diabetes.
Steinberg said that ethical issues could arise when a doctor facilitates a birth for a much older woman, knowing the clear health risks to the mother. He also said that older women who use donor eggs could be seen as using a resource that theoretically should be used by a younger woman with a higher chance of a successful pregnancy. But, he added, the patient’s desire to be a mother should, and in most cases does, trump these ethical concerns.
“I don’t think it is advisable, but I don’t think you can outlaw it,” he said. “That really is infringing on the autonomy of the patient.”
Israel’s pro-natalist policies reach back to the origins of the state. According to an article by Birenbaum-Carmeli in the journal Sociology of Health and Illness, Israeli founding father David Ben-Gurion himself offered a monetary award to “heroine mothers” who had 10 children. Growing the population was, from the very beginning of the Zionist project, a way to grow the Jewish state and outnumber the native Arab population, an impetus that continues today. In the article, Birenbaum-Carmeli argues further that the “Jewish quest for survival” was tied up in Israel’s natalist policies.
Yet while Israel’s population has grown tenfold over the past 68 years, to 8,522,000 in 2016 from just over 800,000 in 1948, the social and political impetus to help women conceive — even women many years past childbearing age — remains deeply embedded in the state policy. Though the demographic question still motivates Israel’s liberal adoption of fertility technologies, there are other issues at play. According to Birenbaum-Carmeli’s study, Israel uses its status as the world leader in IVF as a way to gain “international prestige.” Israeli politicians champion the pro-natalist policies as a way to help “anguished women” in their quest to become mothers. Birenbaum-Carmeli noted the positive way that older births are covered in the Israeli press, often as a tale of the woman overcoming great odds in order to become a mother.
Israel’s liberal use of fertility technologies also has a potential downside in overpopulation. Alon Tal, a professor at Ben-Gurion University, addressed this issue in a recent New York Times op-ed, arguing that “the relentless expansion of [Israel’s] population” is ruining quality of life and the environment in Israel.
Even so, Israel is likely to see more 60-year-olds giving birth in the future.
“We know from history there were older women who gave birth, including our foremother Sarah, who gave birth at age 90, and everything was fine,” Steinberg said. “If that wouldn’t have happened, we wouldn’t be here.”
Contact Naomi Zeveloff at [email protected] or on Twitter, @naomizeveloff