The rise in multiple pregnancy rates has been increasing consistently as can be seen in the recent researches and figures reported. The fact that a woman is having multiples outrightly has an impact on the dynamics and relationships of the family members, most especially parents who face the demands of the multiples and the other siblings. Radhika, Bamigboye and Jegede elucidate on the multiple pregnancy rates that have increased phenomenally since the ‘80s because of the use of assisted reproductive technologies (ART) and the increase maternal age at conception. The authors state that the article summarizes the medical, economic, social, and psychological arguments against multiple births based on a review of literature as well as provide some options on how to prevent multiple pregnancies in the future.
Radhika and colleagues start right off by contrasting two couples who give birth to septuplets with one couple having an easier time dealing with their situation because of the help of other people while the other couple do not get the same kind of generosity. The authors just cite this contrast to begin their article against multiple births and this seems to be a weak springboard for discussion because they are proving their point from what they state in the first paragraph that says, “This increase is largely due to the use of assisted reproductive technologies (ART) and the increase in maternal age at conception.” The authors did not state if these two couples had availed of ART or what the ages of the mother was at the time of conception. If they are trying to prove their point that there is a proliferation of multiple births and that this is giving rise to several problems, they should have started with examples (not only two cases) of couples who underwent the assisted reproductive technologies.
Radhika and colleagues draw a conclusion after demonstrating the two couples’ experience saying that “These sensationalized stories of multiple births are very indicative of the very real public health epidemic that we are facing.” One surmises that this is a more sensationalized sentence that the one that they are trying to prove. Looking closer at what they say here, they use the word “very” twice as if to indicate how real the public health epidemic was. Yet, this sentence does not have a basis as to the real public health epidemic that society faces. For these two families, that probably may be so. But for the whole society in general to be affected, there needs to be more cases cited to convince readers.
From here on, the article proves how multiple births can result in the strains and stresses psychologically, socially emotionally and economically. Yet looking at these effects, they are more the effects on the families concerned and not on the whole society in general. If it had a bigger implication on the society where these births happened, then, the readers may be more convinced about their point. But they proceed to make their point on the different effects until readers come to the paragraph that says that “Due to recent change in HFEA (The Human Fertilizations and embryology Authority) guidelines which restrict the number of embryos to no more than two, there has been a reassuring stabilization in the rate of triplets, although the rate for twins remains unaffected, still continuing to rise despite increasing awareness of the risks associated with this state and universal consensus that this too, constitutes a high risk outcome.” Readers who may not be too familiar with the term HFEA (The Human Fertilizations and embryology will now wonder what these acronyms mean. The authors could have first defined what HFEA was all about and how many have already undergone this worldwide. They did not say if this had a real impact on the families and societies where these families lived. They did not state if couples who chose this alternative were actually oriented as to the effects it may have when they give birth or that they could possibly really have multiple births as many as the septuplets mentioned earlier. These are alternative procedures done on the women and not a natural case of any one of the couple’s genetic makeup.
When the authors mentioned that the “delayed childbearing has resulted in an increased maternal age at conception—one of the predisposing factors for conceiving multiples and need to use infertility treatments such as ovulation induction, IVF and ICSI as fertility decreases with age. Again, the authors assume that the readers are all medically oriented about the acronyms that they use, mentioning here another acronym that occurs for the first time—the ICSI.
Explaining the problems that families encounter with multiple births, it is logically right to dwell on these and they are indeed the hurdles that families with multiple births encounter. The troubles are magnified if the children are also mentally or physically challenged. Thus, there is more likelihood that there will be child abuse because if the decreased attention given to each child. There is also a social stigma that happens because of the “unnaturalness” of having multiples. The mother also often must give up her job so that she can attend to her growing family. Depression can start to seep in a mother’s job because she must take care of a lot of errands and chores on daily basis. These are already expected and even so in large families when the children came one after another.
Work and family life are separate enterprises. Families have become consumption units rather than production units. Children used to be an economic asset in that they contributed to the family by doing chores or contributing wages earned outside the family. Now they have become economic liability in that they not only have to be sheltered, clothed, and fed until age eighteen; they must be educated as well. In dual-earner families, the cost of childcare must be added to the economic liability. Not only do children cost a lot to raise but most cannot be counted upon to provide economic support for parents in old age. This is true not only of those families with multiple births but also with large families. So, asking if they are a blessing or a curse is more of a psychological viewpoint rather than that of a medical problem. The title itself seems to be out of place because if that was what the authors wanted to prove, then they could have dwelt on what became of these children, how they fared in school, their number of friends, they social make up and other psychological details to back up their premise. The authors dwelt very little on what needs to be done now and if there are concrete efforts at all along this line. In fact under the psychosocial considerations, the authors just mentioned that “Many studies (emphasis mine) have reported higher rates of depression in mothers, parental stress and marital disharmony in parents with multiples when compared to couples with singleton births.” What are these “many studies” about? These could have been elaborated more in that paragraph and not just resort to a sweeping statement that there are many studies along this line.
It seems that women are becoming strong and independent because their survival and the survival of their children depend on it. Images of mothers in intact families reflect a different pattern. They work for a long time and postpone their pregnancy so that multiple gestation infants are more likely to be born prematurely when it is compared to those who are single.
One of the serious problems with the health care for these women is the inability to adopt and finance new approaches to orientation of women who are more likely to have multiple pregnancies. The authors could have portrayed more of the medical, economic and psychological effects as they had stated in the beginning of their article. The health care consumer has mandated that the government must act in order to improve the accessibility, quality and cost of pregnancies health care. There is a growing awareness of the inadequacy of such an approach. This must lead to a variety of proposals and new approaches. Some consumers remain skeptical about the ability of health professionals to adopt self-regulation which is not self-serving. Professional associations and practicing health care professionals must try to meet the expectations of the\se women. This will include an in-depth analysis of the implications of multiple pregnancies. There is a long way to go, but the initial planning and implementation of quality assurance programs have been completed in many health care facilities.
In sum, it is important that pre-treatment counseling of the infertile patients must be used as a strategy because many of these infertile couples like to desire multiple pregnancies or think that these risks are even not that serious at all. The different financial, psychological, and social impact of multiples must give to couples so that they will be able to make more informed choices.