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When 41-year-old Mahira Khan announced she was expecting her second child earlier this month, the Pakistani internet lost its mind, with a depressing number of trolls asking how dare a woman with a teenager could think of having a baby at ‘this age’.

“Iss umar mein yeh sab (doing this at this age)?“ asked one troll, while others weighed in on how the unborn baby deserved “younger, more energetic” parents while some prophesied that Khan wouldn’t live long enough to see her baby have babies.

Media coverage has been equally atrocious, with one channel featuring “medical specialists” who referred to Khan as an “old woman”. 

We don’t judge older dads

Of course, such a sexist, ageist response is not a uniquely Pakistani phenomenon. Anne Hathaway was picked apart online after announcing she was pregnant at 43. Kourtney Kardashian, pregnant at 44, and Naomi Campbell, who became a mother at 50 through surrogacy, were also criticised heavily online.

I personally am a fan of how Sienna Miller handled criticism around her pregnancy announcement at 43. When people called her “irresponsible,” she hit back saying: “There’s a whole load of noise and people have a lot to say, and it’s incredibly gendered and unbelievably misogynistic and anti-feminist. If your body is capable of it, have the baby”. She went on to say, “We don’t judge men who are having kids in their 80s. Why on earth is there any sort of narrative?”

Miller was, of course, referring to a host of celebrity dads such as Al Pacino, who became a father at 83, and Robert De Niro, who welcomed a child at 79. The public’s response to these literal senior citizens joining the new dad club was mostly eye rolling and jokes about their virility with some commending them for still having “it”.

There was certainly no online mob with pitchforks accusing these men of behaving irresponsibly by bringing into the world a child they probably won’t see graduate college.

You don’t have to be a celebrity to have your age become the central part of your pregnancy journey. The women I spoke to for this story have been on the receiving end of stigmatising comments as a result of getting pregnant in their forties. 

For instance, Shehnaz — a 40-something-year-old acquaintance whose name has been changed to protect her anonymity — told me, “Instead of congratulating me, people around me asked: ‘What are you thinking? Have you gone crazy?’” Yet, for Shehnaz and every other woman I spoke to, becoming a mother — irrespective of their age — was the best thing to happen to them, and they would do it all over again. 

“It’s good that women are having kids at whatever age they want. Who are we to say when the cut off should be to have a baby? You do worry who will take care of them when you get older but life is unpredictable. My baby was Allah’s gift. She was meant to come to this world,” said Shehnaz.

Ironically, the fulfilment and excitement that all these mothers described to me is something I first heard from Mahira Khan herself.

Seven years ago, I interviewed Khan while she was promoting Superstar in Houston, Texas. I was in my first trimester with my first child. Noticing that my energy was flagging as we all stood around waiting for the event to begin, Khan asked if I was doing okay. When I told her I was fine, just fatigued because I was early in my pregnancy, she hugged me, then hugged me again. Then, holding me close, she told me, “This is the best thing… there is nothing better in the world than being a mother”. 

That day — in the throes of first trimester exhaustion — I couldn’t match her enthusiasm because I didn’t know what was coming for me. But today, six years and two kids later, I couldn’t agree more.

“Geriatric” moms

Webster’s Dictionary defines geriatric as “of or relating to the process of growing old and the medical care of old people”. Naturally, what then comes to mind is a withered, sickly person hobbling into a clinic with a cane. Yet, geriatric is the term the medical establishment deployed for a long, long time when talking about pregnant women over 35. 

According to Texas-based OB-GYN, Dr Sidra Yunus, doctors have recently begun moving toward the slightly more palatable term “advanced maternal age”.

“Geriatric pregnancy is an outdated and unnecessarily stigmatising term,” says Dr Yunus. “While it still appears in older medical literature, it is not the language I use with patients.” 

While the age of 35 as the cut-off for when a woman becomes “old” might feel arbitrary given how different every woman and their aging process is, apparently, the age was set as the threshold due to evidence indicating declining fertility and rising genetic abnormalities after that age. More on that later but, for now, the point being that labels — even when used in a neutral, medical context — matter. 

Take the case of a friend, who, speaking on the condition of anonymity, told me she would cringe every time her doctor referred to her as geriatric.

“I remember being sort of stunned the first time [the doctor] casually referred to me as one of his ‘geriatric’ patients,” she said. “I was only 35 and, in my mind, I did not feel or even look old. But every time I heard it, the implication felt like ‘I’m too old to be carrying this baby, I’m too old to care for this baby.’”

Biology 101

Labels and trolls aside, one thing is clearer now than ever: there is no perfect age to become a mother. Today more than at any point in history, motherhood in one’s forties is becoming closer to the norm than the exception. According to the CDC, the number of babies born to American women 40 and older jumped a whopping 193 per cent from 1990 to 2023. This means that in 2023, for the first time ever, more American babies were born to women 40 and older than to teenagers.

“Forty is the new 30,” Dr Joanne Stone, director of Maternal Fetal Medicine at New York’s Mount Sinai Hospital, recently joked to CBS News. “Everybody’s older. If you have somebody that’s 28, it’s like a teen pregnancy.”

Of course, women are still beholden to biology. And pregnancy later in life comes with its share of risks.

“With advanced maternal age patients, the first [concern] is the ability to become pregnant and have a live birth. With a woman’s own eggs, fertility declines considerably in the mid-40s because both the number and chromosomal quality of the remaining eggs decline. The risks of miscarriage and chromosomal abnormalities therefore increase. Also, with the increasing age I tend to see more medical comorbidities: obesity, diabetes, autoimmune conditions, hypertension,” says Dr Yunus.

Unlike men, who are able to produce sperm throughout most of their lifespan, women are born with all the eggs we will ever have. At birth, a woman has about one to two million. By puberty, that number drops to between 300,000 and 500,000. And, by 37, it has dramatically fallen to around 25,000, according to the American College of Obstetricians and Gynecologists (ACOG). 

The decrease in the number of eggs is not the only obstacle to getting pregnant. Egg quality declines too. For instance, having 100 eggs doesn’t mean all 100 will be viable. This is why the odds of getting pregnant without fertility treatment after the age of 40 drops sharply, according to the ACOG. Still, spontaneous and unplanned pregnancy after 40 is possible.

What are you waiting for?

Globally, women have more choice today than our mothers and, certainly, our grandmothers did. That choice has resulted in a cultural and lifestyle shift. We are choosing to stay in school longer. We are then spending years after that building our careers. And because we are focused on school and work in our 20s and 30s, we might be marrying later.

I can only use myself as an example. Despite subconsciously being aware of a ticking biological clock, no part of me wanted a child in my 20s. Even after I got married, there were things I wanted to do for myself, including travelling and grad school. After graduating from law school, I worked in Big Law, where 60-hour workweeks were the expectation. I remember walking into the bathroom at work once and finding a more senior attorney crying. She’d just learned she was pregnant and knew that it meant she’d be knocked back at least a year on the seven-year partnership track. And that was exactly what happened — after returning from maternity leave, she was passed over for promotion while her male counterpart made partner.

Another factor contributing to the rise in maternal age is the accessibility of birth control and fertility treatments like IVF, donor eggs and the practice of freezing one’s eggs, which all have collectively made pregnancy in one’s 40s possible for many more women.

As but one anecdotal example, my husband, who is an anesthesiologist, recently did an epidural for a 63-year-old who was using a donor egg to have a second child after her first son passed away. 

One friend who chose to freeze her eggs in her early 30s put the practice best: “I could either let desperation take over and marry the wrong person in my 20s just so I could have kids. Or, I could freeze my eggs, hope the right guy would come along, and then bring a baby into the world on my own terms,” she said. “I am 45 now and my body definitely aches after a day of chasing down a preschooler. But what I might lack in energy, I make up for in patience and emotional stability.”

According to Dr Sadia Durrani, a Texas-based OB-GYN, there is a stigma around being pregnant at 40+, but it is less pronounced than it used to be.

“Some women may feel self-conscious about being an ‘older mom’, particularly because of comments from family, friends, or even strangers,” says Dr Durrani. “There can be assumptions that the pregnancy was unexpected, that because the woman is ‘too old’ she will be significantly more tired or less able to keep up. I also think there is an emotional side that sometimes gets overlooked: a woman can be medically healthy and still feel that society is telling her that she is ‘too old’ to be starting or expanding her family. That stigma can be more significant than the medical issue itself.”

So why the backlash?

I’m 38 and still attending friends’ baby showers. This year alone, I’ve been invited to three for women over 40. Not once did I worry about the mom-to-be’s age or whether she’d live long enough to see her grandchildren, which is why I am still struggling to understand why — despite talking to several physicians and older moms for this story — there is this inevitable backlash when a woman over 40 (celebrity or otherwise) announces she’s pregnant.

If the data is telling us that pregnancy after 40 is the new normal, then why is our reaction to an older mom still so hostile? Why does the age of a 40-something pregnant woman become the headline? And why, in Pakistan and the Pakistani diaspora, does that hostility feel even louder?

Part of the answer, I think, is simple math. In Pakistan, women are still marrying and having children young. Unlike Western mothers, the average age of a first-time mother in Pakistan is 22. That means a lot of Pakistani women in their 40s aren’t planning their baby showers. They’re planning their daughter or son’s wedding and, by 45, they might even be nanis or dadis. 

So, for 41-year-old Mahira Khan with a teenage son to announce a pregnancy means she is going against a script that is internalised by Pakistani women since girlhood. Indeed, Khan, who had her first child at 25, followed that script at one point.

And because age is something Pakistani women are taught to lie about or conceal and because divorce and remarrying still carry a lot of stigma amongst Pakistanis, Khan announcing she’s pregnant with her second husband triggers a lot of our collective mental cultural baggage. Simply put: people feel threatened by a woman who refuses to lie about her age, has spoken candidly about being a single parent, and is now living proof that a person can and should have a second chance at both love and parenthood — no matter their age.

There’s also the fact that in Pakistani culture, a woman’s body — even her life — is never really her own. A pregnant woman in her 40s makes us uncomfortable because she it’s proof she is not celibate. And that’s apparently intolerable and unfathomable in a culture where a woman past a certain age is expected to drop joy from her life and instead spend her time arranging marriages instead of having a romantic life of her own. 

All this means that, for Pakistani women, the window in which to produce a child is predetermined not just by our biology but by our society. 

Get married at 24 and within the first year of marriage, you can expect to be asked the inevitable, “Khush khabri kab suna rahi ho (when will you give us good news)?” By year two, you can expect to be asked if everything is ‘normal’ followed by the suggestion that maybe you should see a doctor. Having one child means you’ll very quickly be told: “Ek bachay ko akela mat chorro” i.e. give them a sibling. But, should a child turn up in your 40s? Well then, the commentary sounds like Mahira Khan’s comment section: “iss umar mein (at this age)?” 

Meanwhile, male counterparts — no matter how geriatric they may be — get to keep finding new sources of joy in  the shape of a second, younger wife who brings forth children no matter the uncle’s age. 

Bollywood movie Badhaai Ho addresses this cultural stigma. In the movie, when a middle-aged woman (Neena Gupta) with grown sons gets pregnant, her sons are mortified while her relatives, friends, and neighbors collectively lose their mind gossiping and mocking the situation. 

So while in the West the “geriatric” label lives mostly in the doctors’ office, in Pakistan it permeates society. 

Seven years ago, Mahira Khan hugged a very tired, pregnant me and said there was nothing better in the world than being a mother. She didn’t add “if you’re the right age”. Now, she is about to find out all over again, at 41, whether she was right. I’m betting she was.

And to the people in her comments asking “iss umar mein?” I’d offer a simpler answer: yes, at this age. At any age her body and her life allow. The only thing that feels truly old here is the question.