At 27, I’m thinking about what my future looks like, including the possibility of having children. Like many women today, I’ve felt the struggle of balancing difficult “needs” with personal “wants.” For a long time, I thought I didn’t want kids. But now, after five years with my partner, we’ve started discussing having children in the next five to seven years. It would mean a lot for us to have our own family and embark on the parenthood journey together. While many factors figure into whether to have kids — fertility, cost, child care, timing, paid leave, etc. — the poor state of women’s health care is one of my biggest concerns. 

Data shows that over 80% of pregnancy-related deaths are preventable, an unacceptable number for one of the world’s wealthiest countries. More recent research shows that, compared to other high-income nations, women in the U.S. are more likely to die from maternal complications, with Black women dying at the highest rates. Yet another study shows that American women have the highest uninsured rates, lowest life expectancy (by far), and worse mental health, compared to women in 13 other high-income countries.

When the Supreme Court overturned Roe v. Wade in 2022, I knew we would see significant changes in what women’s health care looks like across the country. That ruling has impacted women’s health beyond whether they can get an abortion. In fact, it’s deterring medical residents from seeking opportunities in states with abortion restrictions. With fewer providers in certain states, the Roe v. Wade repeal is poised to have a much broader effect on statewide health care.  

The shift in available care not only amplifies my concerns about having children, but also makes me question where I should live, and whether I will receive the health care I need throughout my life. Earlier this summer, the Commonwealth Fund published a state scorecard on women’s health and reproductive care that used 2022 data to demonstrate how states were faring. The short answer was not well, particularly in southeastern states with abortion restrictions. 

While I recognize the privilege of being a white, insured woman in Virginia — a top-half performer according to the Commonwealth Fund’s scorecard, and the only state in the South without an abortion ban — I know that things can change quickly, depending on the policymakers in power. For example, Gov. Youngkin of Virginia tried to implement a 15-week abortion ban with exceptions, but was stopped by Democrats in the state legislature. I lament the fact that millions of women’s health outcomes are determined by where they live. 

I have several female cousins in Texas, which ranks second to last in the Commonwealth Fund’s scorecard, with poor marks across the board on health and reproductive care outcomes, coverage, access, and affordability, along with health care quality and prevention. I can’t help but worry about them and the health care they might receive (or not receive) as women with or without children, simply because they live in Texas. Women’s health affects more than half of the population, and policymakers should prioritize proven strategies to improve care and outcomes such as: 

  • Mandatory paid family leave: The U.S. is the only high-income country without a federal paid leave mandate for new mothers.
  • Maternity care coverage: Without universal health coverage, millions of women lack coverage to essential maternity care services.
  • Accessible midwifery care: Many insurances don’t cover midwifery services — despite positive outcomes and the ability to strengthen the maternal care workforce. 

The upcoming election will have a substantial impact on women’s health care across the country. Former President Trump’s Supreme Court appointees were responsible for overturning Roe v. Wade, and he now says he believes that abortion rights should be determined by states. On the other side, Vice President Kamala Harris has cemented federal abortion rights as a key cornerstone of her campaign and potential presidency. The two sides are also likely to differ on issues such as expanding/restricting Medicaid coverage and Title IX funding, emergency abortion care, medication abortions, contraception, addressing disparities and more. Saying there is a lot at stake is an understatement.

Women should not underestimate the power of their voices — through advocacy and voting, we can pressure policymakers to make meaningful change. I urge others who feel similarly to join us in calling for change.

Giving birth comes with inherent risks, but preventable death shouldn’t be one of them. While I still have hope for meaningful policy and system changes, the current state of women’s health care gives me pause on having children. When (and if) the time comes, I want to feel confident and supported in my care. American women deserve to live in a country where they don’t have to choose between life and death when becoming mothers.