Are Women Delaying Motherhood?

“I want to finish my degree first.”

“I am not financially stable yet.”

“I want to travel first.”

“I am just not ready.”

Obstetricians and gynecologists hear it all the time. We also hear, "Doctor, I want a baby, but is it too late?"

Over the past few decades, there has been a seismic shift in how younger generations view parenthood. The decision to start a family is no longer just about biology — it’s shaped by personal ambitions, societal norms, and economic pressures. 

This shift has led to a significant demographic trend: longer lifespans, declining birth rates, and an aging population. The consequences? Rising healthcare costs, a struggling workforce, and economic and social challenges that nations are only beginning to grasp.

As women achieve higher education and pursue ambitious careers, more delay childbirth. But biology doesn’t wait. Fertility isn’t just about the ability to conceive — it’s about ovarian reserve, which naturally declines with age. 

A woman’s chance of conceiving per cycle drops from 85% at age 25 to just 44% by age 40. In Europe, the average age of first-time mothers is now 30, bringing a surge in fertility challenges. We see the same trend in Malaysia and across Asia. 

So, is assisted reproductive technology (ART) the answer?

Here’s where reality bites. Many people — women and even healthcare professionals — remain unaware of the biological clock’s limits. ART, including IVF, cannot fully compensate for age-related fertility decline. Alarmingly, studies show that even among medical residents, nearly half lack accurate knowledge about fertility, with many mistakenly believing IVF can override aging effects. 

The truth? If a woman wants a 90% chance of having three children, she must start at age 23. Conditions like endometriosis further complicate the picture. 

As gynecologists, when we see a young woman with endometriosis, our instinct is often: How do we help her have children before her condition worsens? We talk to her about finding a partner, settling down, and starting a family early. But are we being fair? Are we considering her aspirations, her right to personal and professional fulfillment, before nudging her toward motherhood?

This is why fertility education matters more than ever. Too many individuals delay parenthood, assuming science will step in when they’re ready — but science has limits. 

Egg freezing is an option, but an expensive one, often not covered by insurance. While it offers hope, it’s no guarantee — women under 35 with 10 frozen eggs have only a 30–40% chance of conceiving. Yet many women consider egg freezing only in their late 30s or early 40s, when fertility is already on the decline.

We need a proactive, holistic approach to reproductive health — one that includes contraception access, preventive care, fertility monitoring, economic empowerment, and relationship support.

Women (and men) should be educated earlier about reproductive health, including menstrual cycles, lifestyle impacts, and conditions that affect fertility. Healthcare providers must have the right knowledge and the sensitivity to guide these conversations effectively.

Ultimately, the goal isn’t to pressure women into motherhood. It’s to ensure they have the knowledge and support to make informed, empowered choices — on their terms, in their own time. 

True reproductive equity means giving women all the options, not just the ones we think they should choose.

Dr. Premitha Damodaran is a Consultant Obstetrician and Gynaecologist at Pantai Hospital Kuala Lumpur