I don't know if I'm able to do this, but... Is something I have think since the begining, but never dared to do a proposal. It's not very noteworthy, or important, but I think is ever overlooked.
Something that I think we lack in realism concerns the children and everything related. As you know children mortality was quite high in Middle Ages, and also in Westeros, huntings accidentes, children diseases and plagues decimated many times the nobility offspring. Also, pregnancy could be improved greatly. My suggestions, humble and small:
-Children should have a slight, but existing, chance of dying every year, until they reach manhood, or 'flower', in middle ages, when the teenage years have been reached, the chances of dying were quite low, so from 1 to 13-4 years they could have a 5/20 chance of dying (fiting if we think maybe 20-25% of children died before adulthood). That could be avoided, or slightened, by a maester's presence (+1, Grand Maester +2).
-Pregnancy: Teen mothers should be more likable to have miscarriages, as they are still too young, such, marrying a child bride would have it's risk, for a Lord should wait, before bedding his teen wife, because there is more danger, as not even the waist bones are entirely grown. But that doesn't mean that if a King or Lord are eager to have children they could try mindless of the risk. Elder mothers on the other hands should too! So we have more chances of miscarriages between 13-16 years, and +30.
--->Miscarriages lead me to the following point: Miscarriages are a traumatic experience, and there is an existing chance of becoming barren, or increasing the danger in the next pregnancy, so after an abortion, should be a chance, maybe 4/20, of the wife turning barren, or another that the next year should be more likely to be a risky pregnancy (more chance to stillborn babies or death of the mother).
-However, there are certain individuals that are barren and infertile, such, when a char reaches manhood a roll is done, with a slight chance of the character being barren, for example that could lead in infertile marriages, that were fruitful political alliances, and could create grudges and such.
Thus, we could have some insight into children and wifes, that are somewhat neglected, and bring more realism to the game, because pregnancy or childhood weren't so easy in settings like this. Also could bring into unexpected consequences, the King's offspring dying, extinction of Lordly families, infertile marriages, dead wifes...




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