At the beginning of March 2023, Russian media circulated the words of an expert from the Russian Ministry of Health, who said that a woman’s life expectancy increases if she gives birth to many children. We decided to check whether this statement is supported by scientific data.
On March 3, at the Congress of Russian Pediatricians, Natalia Dolgushina, chief freelance specialist on women's reproductive health of the Ministry of Health of the Russian Federation, said that mothers of many children live longer, since each child gives a woman “a reserve of strength and energy.” According to Dolgushina, this “has been proven in research.”
The statement of the expert from the Ministry of Health of the Russian Federation was quoted by major media outlets (“Moscow speaks", "Gazeta.ru", "News", "360tv.ru", IA "Red Spring"). However, many social network users did not appreciate this advice to extend their lives and, in the comments to the news, doubted the expert’s words. For example, community subscribers "Dvach" on VKontakte they left the following reactions: "What kind of myths can they come up with to try to increase the birth rate", "Women who have never given birth always look younger than those who have given birth. And age-related diseases appear later,” “The Ministry of Health is trying to do PR.” Twitter users also doubted in the words of an expert from the Ministry of Health: “[Mothers of many children live longer] except for those who die during childbirth” or “What do mothers with many children live on, the Ministry of Health did not say?”
On the one hand, pregnancy is a difficult test for the female body; social network users are absolutely right about this. Most often after pregnancy and childbirth, women collide with the following pathologies: postpartum bleeding, including life-threatening hypotonic and atonic infections of the uterus, bladder, kidneys or mammary glands, hemorrhoids, problems with breastfeeding, postpartum depression. Do not also forget about the difficulties during pregnancy: toxicosis, gestosis, preeclampsia and eclampsia, anemia, gestational diabetes And thyrotoxicosis, varicose veins. By data According to obstetricians and gynecologists at Medsi, the largest Russian network of private clinics, only about 40% of pregnancies proceed physiologically, that is, without complications, and this proportion is constantly decreasing. However, doctors are successfully fighting complications of pregnancy and childbirth - from 2000 to 2020, the maternal mortality ratio (the number of maternal deaths per 100,000 live births) worldwide decreased by approximately 34%, and in Russia - by 73.6%.
According to Statista, in Russia in 2021 this figure amounted to a record 34.5 deaths, however, as they say experts, the reason for this is not the low quality of medical services, but the coronavirus pandemic. This explanation correlates well with the fact that in pre-pandemic years the maternal mortality rate was several times lower - for example, in 2018 there were only 8.8 deaths per 100,000 live births.
Despite all the difficulties of pregnancy and childbirth, childbirth can benefit the female body. Perhaps the most well-known are the facts about the benefits of lactation. Yes, breastfeeding reduces risks of developing cardiovascular diseases in the mother. In women who breastfed for at least 12 months, below the risk of arterial hypertension, hyperlipidemia (excess fat in the blood, which can lead to atherosclerosis) and other cardiovascular pathologies. Moreover, every next six months of breastfeeding after 24 months of lactation reduces the risk of heart disease by another 3-4%. Only six months of lactation reduces the risk of developing type II diabetes is 25%, and a year or more is 47%. Every year of breastfeeding reduces a 4% risk of developing breast cancer in women without a genetic predisposition to breast and ovarian cancer. In carriers of the BRCA1 gene mutation (it increases the risk of breast cancer is up to 85%, and the risk of ovarian cancer is up to 28–44%), the risk reduction is even more impressive - by as much as 37% in one year of lactation.
However, it is not only lactation that brings health benefits; pregnancy can also provide certain bonuses to a woman. During pregnancy, the level of female sex hormones increases in a woman’s blood - estrogen, which, among other things, protect the body from oxidative stress, slow down the development of certain types of cancer and inhibit the degeneration of stem cells into adipose tissue. Pregnancy also “rejuvenates” a woman’s brain. Scientists from Norway, the Netherlands and Great Britain trained artificial intelligence to determine the age of a woman from MRI images of the brain and then compared the answers received with the real age of those who underwent tomography. It turned out that one child “rejuvenates” the mother’s brain by 0.4 years, the second gives another 0.5, the third - as much as 0.75, and the fifth and then up to the eighth - 0.82 years each. Scientists explain this by the fact that during pregnancy some areas decrease in size, and after childbirth they are restored to a greater extent. Thus, the brain of a mother of five children will be more than 2.5 years younger than the brain of her childless peer.
But what about the life expectancy of a person, and not the health of individual organs? To assess the correctness of the words of the Ministry of Health expert, you will need to refer to certain statistical parameters. At first glance, the most logical parameter would be the actual life expectancy, that is, analyze the age of death of women who had different numbers of children. However, such a parameter will be subject to temporary distortion. Maternal mortality has dropped sharply over the past decades, and standards of obstetric care have also changed. The second possible parameter is the life expectancy of living women with different numbers of children. However, there is almost no publicly available data on women's life expectancy broken down by number of children. And finally, the third important statistical parameter is the risk of death from all causes, which is calculated by scientists both for the population as a whole and for individual groups of the population. For the most complete analysis, we will refer to the first and third parameters.
In 2012, Danish scientists published his observations of more than 21,000 childless couples undergoing the IVF protocol. It turned out that those couples who gave birth to a child during nine years of observation reduced their risk of mortality from all causes by 25%. Interestingly, couples who adopted a child during the same period reduced their mortality risk by almost the same amount. However, when interpreting the results of this study, one should take into account that the couples were not initially healthy, as well as the fact that childlessness in this group was not a voluntary choice, but a medical diagnosis.
In 2016, Canadian scientists let down results of a 13-year follow-up of 75 women from Guatemala. Researchers studied how volunteers changed length telomere - the terminal sections of chromosomes, which are shortened with each cell division, thus determining its “age”. It turned out that the telomeres of mothers with many children shortened more slowly than women who gave birth to one or two children. Researchers attribute this to the beneficial effects of estrogen, which functions as a powerful antioxidant and protects cells from telomere shortening.
But perhaps the most amazing thing study was published in 2006. Scientists from the University of Maryland School of Medicine (USA) analyzed the family tree of the local Amish community - representatives of an extremely conservative branch of Protestantism with a significant number of large families. It found that life expectancy for fathers increased linearly with the number of children (each child added 0.23 years), while life expectancy for mothers increased linearly up to 14 children (0.32 years each), but decreased with each additional child after the 14th. However, the Amish, who practice marriage only with co-religionists, are not very indicative, since in principle have a unique genetic mutation that significantly prolongs life, protecting them from type II diabetes, as well as initially longer telomeres.
Also interesting conclusions, by Kieron Barclay of Germany's Max Planck Institute for Demographic Research and Martin Kolk of Stockholm University. Scientists compared the actual life expectancy of childless men and women with one to eight biological children and those with one to four adopted children. In total, data on 4 million Swedes born between 1915 and 1960 was analyzed. It turned out that the first and second children, for the most part, prolong the life of both parents compared to childless ones, the fourth again reduces it to the level of childless ones, and this trend is observed until the seventh. But the eighth equates the life expectancy of his parents with their childless peers. But it is not only blood children that influence the life expectancy of their parents. The first and second adopted children significantly (much stronger than their own) increase the life expectancy of their parents. The third slightly reduces the life expectancy of the mother, but increases the life expectancy of the father, while the fourth adoption negatively affects the life expectancy of both parents, while still prolonging it compared to their childless peers.
However, not all studies are so optimistic. There is another view on the problem, reflected, for example, in published in 2006 research specialists from the Jagiellonian University in Krakow. After analyzing fertility and mortality data in four rural regions of Poland between 1886 and 2002, scientists found that each daughter prolongs the father's life by an average of 74 weeks, while each child born, regardless of gender, shortens the mother's life by 95 weeks. Scientists explain the decrease in maternal life expectancy by “reproductive costs” - an increased need for nutrition during pregnancy and breastfeeding, which is not always possible to satisfy.
These results of Polish scientists are in good agreement with theory disposable (or consumable) soma. In 1977, Thomas Kirkwood, an employee of the British National Institute of Biological Standards and Control, suggested that the body and each of its cells, in conditions of permanently limited resources, have a choice between two life strategies: renewal and repair of their own structures or reproduction. This principle is good described at the cellular level, but there is insufficient evidence that it works identically in multicellular organisms. In particular, the application of such a theory cannot explain the increase in maternal life expectancy demonstrated in the studies described above.
However, when analyzing the conclusions of each specific scientific article, a number of limiting factors should be taken into account. Some of the populations examined are societies with natural fertility, that is, contraception either does not exist in them or is not used due to religious and other restrictions. In such populations, having many children indicates initially better health; a childless woman is most likely unhealthy and in any case has no chance of becoming a long-liver. The second limitation is socio-economic, that is, whether a woman decides to give birth to the next child for her own personal reasons, realizing that she has the resources for this, or follows the standards accepted in society, for example, that it is unacceptable to terminate a pregnancy, even if the family does not have enough funds to raise a son or daughter. Finally, the third limitation can be conditionally called cultural - it is associated with the age of birth of the first child and the role of the father or relatives in raising children. It is also worth considering how much the mother’s lifestyle changes while carrying a child and after his birth, namely, whether drinking alcohol and smoking is acceptable for young girls in a particular culture and whether it is acceptable to give up these bad habits after the birth of a child; how women’s work changes during pregnancy and after; does a woman’s diet change during these periods and is there, in principle, a cultural tendency to consume potentially unhealthy foods (fast food, processed foods, etc.). All these factors can also affect the mother's life expectancy, shortening or extending it.
Eric le Bourg, a scientist from the University of Toulouse, tried to analyze research on this topic and derive a general pattern. He came to the conclusion that in communities with natural fertility, when fertility is close to its biological maximum, maternal life expectancy does not decrease in proportion to the number of children born, but in communities with controlled fertility, mortality may increase slightly for those who have five or more children.
Also the results of the meta-analysis presented Chinese specialists. After studying 18 scientific articles from different regions of the world, which analyzed the relationship between fertility and mortality in a base of 2,813,418 people, they plotted the pattern.
As this graph shows, a woman's risk of all-cause mortality decreases immediately after the birth of her first child, a trend that continues after the birth of her second and third. But the fourth child already negatively affects the risk of death of the mother from all causes. Both women who have not given birth to a single child and those who have given birth to six have similar risks of mortality from all causes.
However, the longevity recipe of having three or four children is not suitable for every woman. If the first child was born by caesarean section (and statistics WHO, every fifth newborn in 2020 was born in this way), the likelihood of a second and subsequent cesarean section is quite high. Some doctors still adhere to the principle of “once cesarean, always cesarean,” although statistics indicates that successful vaginal birth after surgery is possible in 60–80% of cases (but only about 35% of women are being decided on this). And although women are known to have had more than five caesarean sections, doctors usually advise do not have children after the third operation.
Not only the method of delivery affects the very possibility of having many children. For certain health problems, doctors may advise women to abstain from pregnancy and childbirth or to terminate an existing pregnancy. In Russia all such pathologies approved legislatively, this list includes various malignant processes, an active form of tuberculosis, some mental illnesses, severe epilepsy, some cardiovascular pathologies (for example, tetralogy of Fallot), osteogenesis imperfecta, etc.
To summarize, we can say that the idea voiced by the expert of the Ministry of Health of the Russian Federation is fully consistent with scientific data. Large families in Russia counts having three or more children. As most studies show, this amount can actually increase a woman’s life expectancy and reduce the risk of death from all causes. Not only relatives, but also adopted children can have a positive impact on a mother’s life expectancy. True, as in the case of relatives, this pattern is not linear. At the same time, both scientific data and Dolgushina primarily focus on the biological aspects of childbirth, and not on the socio-economic ones. Taking into account the fact that, according to statistics, every seventh Russian lives below the poverty line, it is unlikely that this method of extending life is suitable for any resident of the country.
Cover image: East Idaho News
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