More babies were born in the United States in 2007 than in any other year in
American history, according to preliminary data reported Wednesday by the
National Center for Health Statistics.
The 4,317,000 births in 2007 just edged out the figure for 1957, at the height
of the baby boom. The increase reflected a slight rise in childbearing by women
of all ages, including those in their 30s and 40s, and a record share of births
to unmarried women.
But in contrast with the culturally transforming postwar boom, when a smaller
population of women bore an average of three or four children, the recent
increase mainly reflects a larger population of women of childbearing age, said
Stephanie J. Ventura, chief of reproductive statistics at the center and an
author of the new report. Today, the average woman has 2.1 children.
Also in 2007, for the second straight year and in a trend health officials find
worrisome, the rate of births to teenagers rose slightly after declining by
one-third from 1991 to 2005.
“The 14 years with teenage birth rates going down was one of the great success
stories in public health, and it’s possible that it’s coming to an end,” said
Sarah S. Brown, chief executive of the National Campaign to Prevent Teen and
Unplanned Pregnancy, a private group in Washington.
But officials cautioned that the reversal has been small — a rise of 2 percent
in 2006 and 1 percent in 2007 — and that it is too early to know what the rate
will do next.
Even at the low point in 2005, the United States had the highest rates of
teenage pregnancy, birth and abortion of any industrialized country. Because
teenage births carry higher risks of medical problems and poverty for mother and
child, state health agencies, schools and private groups have mounted
educational campaigns to deter teenage pregnancy.
Still, the reasons for the steep decline and recent reversal are poorly
understood. The discussion is colored by politics: some liberals say “abstinence
only” sex education and restrictions on distribution of contraceptives are only
leading to more pregnancies, while conservatives tend to blame the ever more
permissive social climate.
Teenage abortion rates have been falling for years and are not believed to be a
major factor in the birth trends. “The decline resulted from less sex and more
contraception,” Ms. Brown said. “So the new trend must involve some combination
of more sex and less contraception.”
The new report also found that the share of births to unmarried women of all
ages reached a record high of 40 percent of all births in 2007, the most recent
data available. This continued a marked trend upward in unwed births since 2002.
The growth has mainly been fueled by increases among adult women, Ms. Ventura
said. Racial and ethnic differences remain large: 28 percent of white babies
were born to unmarried mothers in 2007, compared with 51 percent of Hispanic
babies and 72 percent of black babies. The shares of births to unwed mothers
among whites and Hispanics have climbed faster than the share among blacks, but
from lower starting points.
In yet another record high, the share of deliveries by Caesarean section reached
32 percent in 2007, up 2 percent from 2006. Experts have repeatedly said some
C-sections are not medically necessary and impose excess costs, but the rate has
steadily climbed, from 21 percent in 1996.
I have said that sentence many times in the course of my life as an adopted
person. I like it so much I put it into the mouth of a character in the novel
I’m writing. The character and I are both fond of the idea. We can think of
ourselves as living in the dense pages of 19th-century fiction, where one’s
origins — the exact mother and father — are not nearly as important as one’s
“circumstances.”
Some might say I came to this rationalization because, until recently,
everything surrounding my adoption was kept secret from me. Even the date it was
finalized was a secret. (The woman on the phone said, “Those records are
sealed.” I said, “I know I can’t see what’s in them, but can I find out the date
from which I couldn’t see what’s in them?” She replied, “Even the outsides of
the records are sealed” — a confounding statement, as I envisioned envelopes
surrounding envelopes, all sealed into infinity.)
Of course, mysterious origins are a confusing business these days. One might be
gestated in an unknown womb while having genes from some combination of one’s
mother and father and a stranger; from a mother’s womb with some combination of
known and unknown genes — not to mention the complication of untold numbers of
half-siblings who might be out there from the sperm donations of one man. There
are adoptive parents and biological parents, surrogates and donors — adults of
all sorts claiming parenthood by right of blood, genes, birth, law and
affection.
Does one have the right to know all of these people? If so, do they have a
reciprocal right to find the child in whose birth they participated?
I won’t even try to answer these questions. It seems we must have a social
conversation about this subject that will last for many years. The trend,
certainly, is toward openness, a growing “right” to know. I am not against this
trend. I simply want to give not-knowing its due.
I like mysteries. I like the sense of uniqueness that comes from having unknown
origins (however false that sense may be). I have a dear friend who is also
adopted. We spoke as we were considering whether we should enter our names into
the New York State Adoption Registry, where we might learn something about our
history.
My friend grew up in a small town upstate near a university. She had constructed
for herself a satisfying fantasy in which her mother and father were in town on
fellowships from the World Bank, had the occupations “king” and “queen,” had
ruled in a remote region where everyone was fit, ate a diet centered upon yak
yogurt and lived 110 years. She decided not to register. “One family is quite
enough for me,” she said.
My own fantasies were more vague: an evolving set of parents including
actresses, folk singers, writers and intellectuals. I am certain that none were
like the computer scientists and mathematicians who run up and down the
bloodlines of my adoptive father’s family. I think it is because of them, the
example of those engineers and math professors, that I went into software
engineering, a field for which I do not have native talent. (I was good enough,
but I had to work at it.) If I had been raised by the word-eaters — writers,
readers and long-letter-writers — who I’m certain were my “natural” parents, I
never would have spent 20 years as a computer programmer.
Which is exactly my point. I could just see my birth mother looking up from
George Eliot’s “Daniel Deronda” (Book V, “Mordecai”) to say, “Darling, why
struggle so on those cold programs when you haven’t yet read ‘Middlemarch’?” And
so I might have put aside my sweaty attempt to write a bubble-sort algorithm —
and thereby missed the defining profession of my time.
No one is a genetic match to his or her parents. Nature has gone to a great deal
of trouble to see that we are not like them (a strong argument against adding
cloning to the human parental mix). Through the miracle of natural genetic
recombination, each child, with the sole exception of an identical twin, is
conceived as a unique being. Even the atmosphere of the womb works its subtle
changes, and by the time we emerge into the light, we are our own persons.
Knowing every single ancestor, therefore, will never solve the deeper mystery,
which of course is the dreadful question of who we become.
For nearly 15 years, Kim and Walt Best have been paying about $200 a year to
keep nine embryos stored in a freezer at a fertility clinic at Duke University —
embryos that they no longer need, because they are finished having children but
that Ms. Best cannot bear to destroy, donate for research or give away to
another couple.
The embryos were created by in vitro fertilization, which gave the Bests a set
of twins, now 14 years old.
Although the couple, who live in Brentwood, Tenn., have known for years that
they wanted no more children, deciding what to do with the extra embryos has
been a dilemma. He would have them discarded; she cannot.
“There is no easy answer,” said Ms. Best, a nurse. “I can’t look at my twins and
not wonder sometimes what the other nine would be like. I will keep them frozen
for now. I will search in my heart.”
At least 400,000 embryos are frozen at clinics around the country, with more
being added every day, and many people who are done having children are finding
it harder than they had ever expected to decide the fate of those embryos.
A new survey of 1,020 fertility patients at nine clinics reveals more than a
little discontent with the most common options offered by the clinics. The
survey, in which Ms. Best took part, is being published on Thursday in the
journal Fertility and Sterility.
Among patients who wanted no more children, 53 percent did not want to donate
their embryos to other couples, mostly because they did not want someone else
bringing up their children, or did not want their own children to worry about
encountering an unknown sibling someday.
Forty-three percent did not want the embryos discarded. About 66 percent said
they would be likely to donate the embryos for research, but that option was
available at only four of the nine clinics in the survey. Twenty percent said
they were likely to keep the embryos frozen forever.
Embryos can remain viable for a decade or more if they are frozen properly but
not all of them survive when they are thawed.
Smaller numbers of patients wished for solutions that typically are not offered.
Among them were holding a small ceremony during the thawing and disposal of the
embryos, or having them placed in the woman’s body at a time in her cycle when
she would probably not become pregnant, so that they would die naturally.
The message from the survey is that patients need more information, earlier in
the in vitro process, to let them know that frozen embryos may result and that
deciding what to do with them in the future “may be difficult in ways you don’t
anticipate,” said Dr. Anne Drapkin Lyerly, the first author of the study and a
bioethicist and associate professor of obstetrics and gynecology at Duke
University.
Dr. Lyerly also said discussions about the embryos should be “revisited, and not
happen just at the time of embryo freezing, because people’s goals and their way
of thinking about embryos change as time passes and they go through infertility
treatment.”
Many couples are so desperate to have a child that when eggs are fertilized in
the clinic, they want to create as many embryos as possible, to maximize their
chances, Dr. Lyerly said. At that time, the notion that there could be too many
embryos may seem unimaginable. (In Italy, fertility clinics are not allowed to
create more embryos than can be implanted in the uterus at one time,
specifically to avoid the ethical quandary posed by frozen embryos.)
In a previous study by Dr. Lyerly, women expressed wide-ranging views about
embryos: one called them “just another laboratory specimen,” but another said a
freezer full of embryos was “like an orphanage.”
Dr. Mark V. Sauer, the director of the Center for Women’s Reproductive Care at
Columbia University Medical Center in Manhattan, said: “It’s a huge issue. And
the wife and husband may not be on the same page.”
Some people pay storage fees for years and years, Dr. Sauer said. Others stop
paying and disappear, leaving the clinic to decide whether to maintain the
embryos free or to get rid of them.
“They would rather have you pull the trigger on the embryos,” Dr. Sauer said.
“It’s like, ‘I don’t want another baby, but I don’t have it in me; I have too
much guilt to tell you what to do, to have them discarded.’ ”
A few patients have asked that extra embryos be given to them, and he
cooperates, Dr. Sauer said, adding, “I don’t know if they take them home and
bury them.”
Federal and state regulations have made it increasingly difficult for those who
want to donate to other couples, requiring that donors come back to the clinic
to be screened for infectious diseases, sometimes at their own expense, Dr.
Sauer said.
“It’s partly reflected in the attitude of the clinics,” he said, explaining that
he does not even suggest that people give embryos to other couples anymore,
whereas 10 years ago many patients did donate.
Ms. Best said her nine embryos “have the potential to become beautiful people.”
The thought of giving them up for research “conjures all sorts of horrors, from
Frankenstein to the Holocaust,” she said, adding that destroying them would be
preferable.
Her teenage daughter favors letting another couple adopt the embryos, but, Ms.
Best said, she would worry too much about “what kind of parents they were with,
what kind of life they had.”
Another survey participant, Lynnelle Fowler McDonald, a case manager for a
nonprofit social service agency in Durham, N.C., has one embryo frozen at Duke,
all that is left of three failed efforts at the fertility clinic.
Given the physical and emotional stress, and the expense of in vitro
fertilization, Ms. McDonald said she did not know whether she and her husband
could go through it again. But to get rid of that last embryo would be final; it
would mean they were giving up.
“There is still, in the back of my mind, this hope,” she said.
At the Genetics and IVF Institute in Fairfax, Va., Andrew Dorfmann, the chief
embryologist, said many patients were genuinely torn about what to do with extra
embryos, and that a few had asked to be present to say a prayer when their
embryos were thawed and destroyed.
Jacqueline Betancourt, a marketing analyst with a software company who took part
in the survey, said she and her husband donated their embryos at Duke “to
science, whatever that means.” It was important to them that the embryos were
not just going to be discarded without any use being made of them.
Ms. Betancourt, who has two sons, said: “We didn’t ask many questions. We were
just comfortable with the idea that they weren’t going to be destroyed. We
didn’t see the point in destroying something that could be useful to science, to
other people, to helping other people.”
Ms. Betancourt said she wished there had been more discussion about the extra
embryos early in the process. If she had known more, she said, she might have
considered creating fewer embryos in the first place.
AUSTIN — Seven-month-old Benton Drew Smith is the spitting image of his
father, with the same blue eyes, fair hair and infectious grin.
Bouncing on his mother's lap in olive-green overalls and slippers festooned
with lizards, he also holds a special place in history: He is one of the first
children to have been conceived from sperm left behind by a soldier who was
killed in battle. Benton's dad, Army 2nd Lt. Brian Smith, was shot by a sniper
in Iraq on July 2, 2004.
"I've had some lousy luck in my life," says Smith's widow, Kathleen "K.C."
Carroll-Smith, 41. "But he has worked out," she says, gazing into her son's eyes
as he grins back. "He's a blessing. He is wonderful."
Benton was born July 14, 2006, a little more than two years after his father,
30, was cut down by a single shot while checking the treads of his Abrams tank
in Habaniyah, Iraq, west of Baghdad. The bullet sliced Smith's liver, causing
internal bleeding. His wife says she was told that her husband collapsed,
muttered that he could no longer feel his legs, lost consciousness and died.
Death did not erase him, Carroll-Smith says. "I have a piece of Brian with me
every day now."
How many children have been artificially conceived after their father's death in
war is unclear; the Department of Veterans Affairs says it knows of two similar
cases during the past three years. The commercial technology for storing sperm
did not become available until 1971, so the conflicts in Iraq and Afghanistan
are the first in which a significant number of combat troops have been able to
take advantage of the technology.
Participation remains small, relative to the number of troops in combat. About
100 troops make such deposits each year, according to officials at the nation's
three largest sperm-bank companies — Fairfax Cryobank in Fairfax, Va.,
California Cryobank in Los Angeles and Xytex in Augusta, Ga.
"This clearly is an area where medical technology has moved faster than most of
our social thinking," says Dale Smith, professor and chairman of medical history
at the Uniformed Services University of the Health Sciences in Washington, D.C.
He describes the practice as "an effort to take out a social insurance policy on
… mortality."
'Gobs of angels'
For the family of Brian Smith, the decision by his widow to become pregnant by
in vitro fertilization on Oct. 29, 2005, was not without emotional turmoil.
Smith's parents, Linda and William Smith of McKinney, Texas, concede that they
struggled at first to accept their daughter-in-law's decision. "There was
hesitancy there in the beginning," says Linda Smith, 59. "It just didn't seem
right or fair or something that Brian wouldn't be there to raise his child."
During Carroll-Smith's pregnancy, Linda Smith nonetheless remained supportive,
both women say. When Carroll-Smith asked her mother-in-law for assistance late
in the pregnancy, Linda Smith rushed to help prepare for the baby.
Smith's parents have since fallen in love with the baby. During the Christmas
season, they took Benton to a Wal-Mart in McKinney to have his picture taken in
the same sailor suit his father wore for a portrait when he was a child. The
images mirror each other, Linda Smith says.
"Once you meet that little fellow," she says of her only grandchild, "you will
think that there have been gobs of angels all over the place. He's absolutely
the most adorable child."
Less certain is how the Pentagon and the Department of Veterans Affairs will
view Benton. A child who is a legal dependent of a combat casualty is entitled
under federal law to a range of educational, financial and health benefits.
No formal policy exists, however, in cases in which conception occurred after
the parent died, says Lisette Mondello, a VA spokeswoman. In the two similar
cases, the VA granted benefits, Mondello says.
Carroll-Smith has not yet requested that the VA declare her son a dependent of
his father.
Carroll-Smith, who left her last job as a secretary in the intensive care unit
at Seton Medical Center in January, says she urged her husband to deposit his
sperm in a Fairfax Cryobank facility here about a month before he went to Iraq.
The decision had nothing to do with fear that he would die in combat, she says.
Rather, it was for reasons that William Jaeger, Fairfax Cryobank director, says
are typical of most military families that make the decision: a desire for wives
to continue to try to conceive while their husbands are deployed, or a fear that
a husband will lose fertility because of combat wounds or exposure to toxic
chemicals.
Today, however, some families are also concerned about a husband not surviving
combat.
That was what worried Army Staff Sgt. Stephen Sutherland, says his wife, Maria,
37, of North Pole, Alaska. She has two children from a previous marriage and had
undergone a tubal ligation. She says Stephen Sutherland, 33, dreamed of
fathering his own children and left behind a sperm deposit before deploying to
Iraq in 2005.
He died Nov. 12, 2005, in the rollover of a Stryker vehicle in Al Qadisiyah,
south of Baghdad. His widow became pregnant through in vitro fertilization last
October and the baby is due July 17.
"I told him that if the worst should happen," Maria Sutherland recalls, "I would
have this child no matter what."
A desire for children
Carroll-Smith says she and her husband absolutely wanted children. The couple
had met at the University of Texas, where he was a student, she was a dormitory
supervisor and both were members of a historical re-enactment group that
specialized in pre-17th-century culture. They met one night when group members
gathered to watch Star Trek: The Next Generation.
With his father's support, Smith earned a law degree at Baylor University law
school in 1998 and practiced for a few years. He and Carroll-Smith married in
2002.
Smith, who had always admired the military and whose father, grandfather and an
uncle had served, enlisted in the Army that year. He was deployed to Iraq in
January 2004.
The couple's efforts at conceiving during the previous 18 months had failed, and
Carroll-Smith wanted the option of continuing to try during her husband's
deployment, she says. Eight years his senior, she feared she had little time
left to conceive.
When she was 3 years old, a battery-operated doll had sparked and set her
clothes on fire. She suffered third-degree burns over 45% of her body.
During the next 34 years, Carroll-Smith underwent 80 reconstructive surgeries,
each under general anesthetic, and she worried that her body might no longer be
capable of pregnancy.
On July 2, 2004, she was just about to begin the process of in vitro
fertilization when the doorbell rang at the couple's home in north Austin. She
remembers the time was 6:15 p.m.
As Carroll-Smith peered out the window, she could see a woman in a suit carrying
a Bible. Thinking the caller was a Jehovah's Witness, she ignored the doorbell.
But the two people outside, one of them a female military chaplain, kept ringing
it.
In a ceremony July 10, Brian Smith's body was cremated along with a bottle of
his favorite condiment — Dave's Insanity Hot Sauce — and a copy of a fantasy
novel, Someplace to Be Flying. The ashes were buried in Smith's hometown of
McKinney.
One final attempt
For two months, Carroll-Smith says, grief left her unable to function. Smith's
parents were equally devastated. Then, as the fog of mourning began to lift,
Carroll-Smith warmed to the idea of becoming pregnant.
After all, that had been her dream — and her husband's. It also was an
opportunity that might elude her as time passed. "I'm 40," she thought then.
"This was kind of a last chance."
Fairfax Cryobank officials urged her to wait six months to ensure her choice
wasn't impulsive. And her mother-in-law warned that raising a child as a single
parent would be difficult.
Carroll-Smith describes herself as independent-minded. She owns the power tools
in the family and was the craftsman. She waited four months.
The first attempts — in October 2004 and June 2005 — failed. Each effort at in
vitro fertilization — a process in which the egg is fertilized outside the body
and implanted in the woman's uterus — cost $10,000 to $15,000.
Moreover, the process was agonizing. Hormone injections to help her produce eggs
caused intense pain in her joints, her back and her collarbone, she says.
Miserable flu-like symptoms remained for two weeks. And then there were painful
injections of progesterone to boost her ability to carry the fertilized egg.
She says she was almost ready to give up. "I kind of went back into more of a
depressed state," she recalls.
When a final death-gratuity payout from the Pentagon arrived, Carroll-Smith saw
it as an opportunity for one more attempt. This time, she was successful. The
baby boy was delivered by cesarean section at 39 weeks. He weighed 6 pounds, 10
ounces and measured 21 inches long.
She gave him the name Benton — a grandfather's surname and his father's middle
name.
The legacy
Cradling her son on a recent afternoon, she plays back the four phone messages
her husband left before and during his deployment to Iraq. They are now
keepsakes. In one, he takes a stab at singing a phrase from the Beatles'
Michelle. In the last one, he sounds tired, and signs off with: "Miss you
terribly. Love you. Bye."
As with every other wife or husband who has lost a spouse in war, the death
seemed to bring each dream to a crashing halt. "When they told me Brian died,
that was it. Everything ended," Carroll-Smith says.
Reproductive technology allowed her to cheat death, at least in one small way,
she says. It also helped ease her grief. That's why Carroll-Smith urges military
families who dream of children to do what she and her husband did.
"It's insurance that the life you wanted, you can still sort of have," she says.
Benton "does have a father figure that he will be told about and that will be
expressed to him. It's not like he doesn't have a father. It's just that his
father is not here.
"All my plans are not gone," she says. "This thing that we planned for actually
happened."
Louise Brown
was the first test-tube baby
born in Britain,
after pioneering work by the obstetrician and gynaecologist
Patrick Steptoe
and the physiologist Robert Edwards
THE world’s first test-tube baby, a girl, was
born by caesarean section just before midnight at Oldham and District Hospital,
Greater Manchester. She weighed 5lb 12oz.
Mr Patrick Steptoe, the consultant gynaecologist who has pioneered test-tube
baby research and who is in charge of the case, said: “All examinations showed
that the baby is quite normal. The mother’s condition after delivery was also
excellent.”
The mother, Mrs Lesley Brown aged 29, from Bristol, was “enjoying a well-earned
sleep”.
The embryo was implanted in Mrs Brown’s womb after being fertilised in Mr
Steptoe’s laboratories last November. He used sperm from her husband, a railway
van driver, aged 38, who has a son from a previous marriage.
By that technique Mr Steptoe was able to by-pass Mrs Brown’s blocked fallopian
tubes. The child’s financial future was assured after newspaper rights to
articles and photographs were sold by Dutch auction to Associated Newspapers,
publishers of the Daily Mail and London Evening News. They are believed to have
paid more than £300,000.
More than 5,000 couples have sought help for infertility since the work of Mr
Steptoe and Dr Robert Edwards, his partner, was first reported.
Every generation has its own particular Dread. Victorian ladies were afraid
of outspokenness and their grandmothers of indiscretion. Our own generation
suffers from a singular, rather absurd, prohibition. The middle-aged are all
afraid of being shocked.
It is a natural reaction from Victorian pruderies. Mothers of today have heard
so much of the dangers of Inhibitions and Repressions in their children, so much
of the merits of outspokenness, that for the last twenty years they have, in the
spirit of maternal self-sacrifice, set their teeth and spoken out. The modern
young person, enlightened from its earliest years in problems of which its
great-grandmothers lived and died in blissful ignorance, speaks out in reply,
and in the home quarter or in the psychological novel lets us, in their own
phrase, really have it.
Their elders in turn school themselves to attend and respond without a trace of
what they have learnt to call false modesty. Nowadays few educated mothers dare
to call their ears or tongues, much less their souls, their own. And it is all
so absurd because, by this broadmindedness, we are robbing youth of one of its
greatest pleasures — that of shocking its elders. Those of us who were growing
up thirty years ago knew the delights of that sensation. Sixty years ago we
might have run the risk of being locked up or fed on bread and water, but those
dangers were past, while we still enjoyed the glory of being daring and
revolutionary.
The hardy and heartless youth of that period flung the theories of Mr. Shaw and
Mr. Wells, with tentative references to Nietzsche and Freud, into the millpond
of family life, and enjoyed that primeval pleasure of hearing the stone splash
and seeing the ripples spread indignantly on the waters.
And then, probably at the end of the war, parents began to leave off showing
that they were shocked. Upon the old and middle-aged fell that cloak of
inferiority complex which led them to say: "The younger generation must settle
these things for themselves." So they must, but it is incomparably more
exhilarating to do so in the face of a little honest opposition. We murmur
resigned sighs of acquiescence to their Communism when we should vaunt the old
school of Liberalism to the skies.
When our children inform us that marriage is a relic of superstition and family
life a ridiculous survival it is foolish to agree resignedly. They would prefer
us to blow a fuse, and hold up our old-world standards of purity, and home life.
It is only when we face the armies of rebellious youth that they have to review
their position and test their ammunition.
