Why it helps to have a baby

Ruby Sinha, 39, had all she had wanted - a well-paying job, caring husband and an independent lifestyle. And yet, all was not well. She was getting bouts of depression and gaining weight despite exercise and diet control, and would feel weak, irritable and cry at the slightest provocation.

The couple consulted a physician, a gynaecologist and even a psychiatrist. Nothing came of it till the gynaecologist and the psychiatrist exchanged notes. Ruby's problem was then diagnosed to be a disorder close to depression, which can lead to obesity and other related illnesses like hypertension and diabetes. Most importantly, the root cause of her depression was the feeling of emptiness she had, of having nothing to look forward to ... because she did not have any children.

Dr Asha Sharma, senior gynaecologist at Rockland hospital in Delhi, calls it a typical case of "nulliparity syndrome" which manifests itself only after 35 or 40 years of age in women who don't conceive due to lifestyle choices. "Pregnancy regulates the hormonal flow in a woman's body. If a woman doesn't conceive, the hormonal balance may get disrupted and manifests in the form of weight gain and menstrual problems later, especially after 45-50 years of age," she explains.

Take Gayatri Desai, a 42-year-old twice-married advertising professional. She put off having children in her first marriage (at the age of 29) till she was sure of the guy. The marriage didn't work out eventually. At 35, she married a widower with two kids. He didn't want more children and Gayatri drowned herself in work. All was well until she discovered, to her horror, that she had developed ovarian cancer.

Dr Anuradha Kapoor, senior gynaecologist at Max Healthcare, who is treating Gayatri, says, "Ovarian cancer is a silent killer - there are no symptoms, no conditions. In those women with normal menstrual cycles, who choose not to have a baby, ovulation keeps happening all the time. So hyper-ovulation, in some cases, leads to ovarian cancer.

"Although it's not very common and happens in say, around 1 in 500 women who don't conceive by choice, there's greater risk. And the worst part is, it's very hard to detect and there are no early symptoms. Moreover, since they don't breastfeed, there is a greater risk of breast cancer also."

The American Cancer Society, in its recent report, says: "A woman who has had children has a lower risk of ovarian cancer than women who have no children. The risk gets even lower with each pregnancy. Breastfeeding may lower the risk even further. Using birth control pills also lowers the risk of ovarian cancer."

According to Breast Cancer Risks and Prevention, a booklet published by New York-based Breast Cancer Prevention Institute: "If a woman does not have a full-term pregnancy, she has increased risk of breast cancer since she never develops cancer-resistant type 3 and 4 lobules. If she has children later in life (after 30) she has increased risk because, for most of her menstrual life, her estrogen has been stimulating immature cancer-vulnerable type 1 and 2 breast lobules. If she has children in her twenties, she has decreased risk of breast cancer since her breast tissue matures very early in her menstrual life to type 3 and 4 lobules."

To put it simply, an early pregnancy matures the breast tissue as it prepares to produce milk for the baby. Mature cells are much less likely to become cancerous than immature cells. The booklet says that though there is no direct cause and effect, abortions do cause changes in breast tissues, producing many more places where breast cancer is likely to develop.

As early as 1986, US scientists Bruce Stadel and Phyllis Wingo, convinced of an abortion-cancer link, wrote a letter to the British journal, Lancet, saying that "induced abortion before first-term pregnancy increases the risk of breast cancer". Likewise, in a study of 1,531 patients with endometrial cancer treated at the University of Texas between 1989 and 2003, doctors found that 55% of patients were nulliparous. Researchers said the majority of the patients were obese and nulliparous.

Experts say nulliparity is one of the causes of such reproductive organ-related cancers. But it has to be added that women with kids may also develop cancer along with those exposed to radiation, those with a family history or those on the pill for more than five years.

Non-conception has adverse effects on psychological health too. Chandigarh-based psychologist Nirmal Sharma says: "As long a woman is busy and enjoying her work, all's fine but once she crosses a certain age, she does need kids. It does satisfy her maternal instincts, failing which she can develop mental disorders."

Dr Mala Srivastava, senior gynaecologist at Gangaram hospital, Delhi, says nulliparity is becoming rampant among the urban privileged class. "Many double-income couples these days choose to dump their family plans, either because they are 'too busy' or 'not prepared' for it. We even get cases where women who have accidentally conceived would come for MTPs. And it's amazing how they have no regrets.

"But this attitude can be dangerous. Apart from cancer, nulliparity can also cause endometriosis. Even if you conceive at that stage, you can't ward off such complications," says Srivastava.

Dr Sharma adds: "Many of these women realize in their forties that they need a baby. But, by then, either their ability to conceive has reduced or eggs have become unhealthy. However, conception is possible with the help of assisted reproductive techniques."

(Names of patients have been changed to protect identity)