Powerful lives, children powerful but optional. This week, newspapers and cable TV buzzed with the news that compared to 1970, far fewer number of women over 40 have children. And despite popular misconceptions about IVF-stimulated multiple births, older women who do have children have much smaller families:

The number of women ages 40 to 44 who remain childless has doubled in a generation, the U.S. Census reported Monday. In June 2006, 20% of women in that age group remained childless. Thirty years ago it was 10%. “A lot of women are having no children,” Jane Lawler Dye, the author of the report, says. “Also, the women who are having children are having fewer children.”

Birth rates for non-Hispanic white women, at 1.9 per woman, continue to remain lower than the rate that would be needed to replace the population (2.1 per woman), according to the report that details fertility rates in 2006 for women 15 to 44.

Beyond Botox, Part Two: Admit it: for those of us not inclined to invest in the New New Face, those new wrinkle treatments have intrigued since Retin-A made its pimply appearance 15 years ago. And this week, Nicholas Bakalar offers a concise summary of those that seem to be more real than, say, Oil of Olay:

A recent review in The Archives of Dermatology concludes that three anti-aging treatments are proven clinically effective: the topical application of retinol; carbon dioxide laser resurfacing; and injection of hyaluronic acid, a moisture-retaining acid that occurs naturally in the skin. Each depends on the same mechanism, the interaction of skin cells called fibroblasts with the collagen they produce……

Do the benefits of these treatments outweigh the risks? “It’s a matter of the kind of problem a person perceives and how he wants to deal with it,” said Gary J. Fisher, the lead author of the review and a professor of dermatology at the University of Michigan. “For these treatments, which have sound research behind them, and for people who want to improve their appearance, the benefits far outweigh any problems.”

The authors have no ties to companies that make skin care products, but the University of Michigan, where they teach, has patents on the use of matrix metalloproteinase inhibitors in the treatment and prevention of aging skin.

A mikvah for menopause? Not impossible, at least for members of Beth El Temple Center in Belmont, Massachusetts, one of a growing number of Reform congregations broadening the scope of the traditional ritual: “to mark lifecycle events or a change of personal status, to celebrate joy or sanctify grief.”

And while mikveh is traditionally practiced in privacy, some liberal mikvaot are hosting groups, including women marking the onset of menopause and men taking their sons before the High Holidays. In the early 1990s, when Temple Israel in West Bloomfield, Michigan became the first Reform synagogue to consider building a mikveh, the idea met with hostility from some in the congregation. “They considered mikveh to be sexist,” Rabbi Paul Yedwab recalls. “In their minds they were dealing only with niddah [menstruation].”

To change that perception the temple leadership held study sessions, introducing Bible texts and rabbinic commentaries on mikveh and discussing some of the new practices incorporated by liberal Jews around the country. In one such session a woman who had initially opposed the plan told the group she’d just had a double mastectomy and asked the rabbi whether she might be able to use the mikveh to mark her recovery. “I got a chill up my spine,” Rabbi Yedwab recalls. This woman would become the first person he took to the mikveh when it opened in 1995. “I believe at that moment, the first true Reform mikveh was born.”

“Really, things have got to change”:  From Knoxville, TN (via The Crone Speaks) a health-insurance horror tale that strikes fear in most midlife hearts — especially if you’ve found yourself sparring with health insurance companies at one time or another. Due to a scrawled note about her moods in one doctor’s handwriting, 45=year-old real estate agent ended up flying to Thailand for an essential hysterectomy:

Wilcox, a real-estate agent, works on contract and thus isn’t eligible for group insurance through her employer. She’s had individual insurance plans before, most recently through a large national company that dropped her after, she said, combing through past medical records and finding a passing notation by a physician that she felt “depressed” about some financial setbacks a few years ago. Wilcox said her insurer called this “depression” an undisclosed pre-existing condition and canceled her policy retroactive to almost two years, an increasingly common practice that has resulted in legal ramifications in other states for insurance companies.

Wilcox made a fruitless search for an affordable policy, considering her age – 45 – and past health problems that included a pulmonary embolism, a blood clot blocking the artery to the heart. “It was unaffordable,” she said….. “Do you know what my [Bangkok] surgery cost?” she said. “Everything: doctors’ fees, all medications, nurses, private hospital room, three-night stay – $5,800.”  Including travel, meals and a monthlong hotel stay, Wilcox estimates her entire trip and medical care came in at just under $11,000.

U.S. medical associations warn that not all stories end as well as Wilcox’s. They warn that most procedures require patients to seek more medical care afterward – care they might not be able to access at home.

By Chris Lombardi