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WebMD
2 days ago
- Health
- WebMD
Your 3-Item Prepregnancy Health Checklist
May 28, 2025 — Planning a pregnancy? Go ahead, envision it: the birth, the name, the color scheme of the nursery. But have you thought about squeezing in your cardiologist appointments between school pickups and soccer practice? Probably not, but maybe you should: More moms than ever are at risk of heart problems around the time their child turns 10. They may even watch a tiny blood-pressure cuff get wrapped around their toddler's arm — because childhood high blood pressure is linked to mom's health during pregnancy. In fact, a flurry of new science provides stark details about how prepregnancy health can impact your child's lifelong health — and your own during the prime parenting years. 'More women now than ever are entering pregnancy with risk factors such as obesity,' said Jaclyn D. Borrowman, PhD, a postdoctoral fellow in preventive medicine at Northwestern University Feinberg School of Medicine. About 40% of American women have obesity, and that could hit 60% by 2050, she said. It's not just weight. A new analysis looked at eight factors affecting pregnancy health: sleep, diet, physical activity, blood pressure, prepregnancy diabetes, body mass index, cholesterol, and smoking history. 'While some may be aware of these risks, many aren't,' Borrowman said. 'Even when they are, it's not always easy to act on that knowledge.' The first step in pregnancy planning, she said: Meet with your doctor before getting pregnant. Here are three ways new research says you can optimize your own and your baby's lifelong health. 1. Manage Your Weight Pregnancy is often called a 'window into your future health.' Pregnancy-related health problems like gestational diabetes or high blood pressure often lead to chronic health problems later in life. A new study connects the dots from prepregnancy health to pregnancy complications and to — about 11 years later — serious risk factors for heart trouble. The key link: obesity heading into pregnancy, the researchers found. 'Even in those without pregnancy complications, we saw that obesity before pregnancy was linked to a higher risk of heart disease down the road,' said Borrowman, the study's author. On average, the mothers in the study were around 30 years old when they gave birth and about 41 when heightened heart disease risk factors showed up in their medical records. In a separate new study, a mother's weight during the first trimester was the strongest health factor (out of eight) associated with developing a gestational blood pressure condition. Put simply: The lower the mother's body mass index, the lower the odds of developing these problems. That means every little bit of prepregnancy weight loss or weight management during pregnancy can make a big health impact. Obesity is a complex disease with multiple causes, Borrowman stressed. It's not just about lifestyle but also 'things like family history, health conditions like thyroid problems or polycystic ovarian syndrome (PCOS), and where someone lives,' she said. If you're struggling, don't go it alone. Your primary care doctor can help guide you. 2. Improve Your Blood Pressure 'It's not all about weight,' said researcher Michael C. Honigberg, MD, a cardiologist at Mass General and assistant professor at Harvard Medical School. While his study (mentioned above) found weight to be the strongest factor linked to blood pressure problems during pregnancy, it also showed that even small reductions in blood pressure before pregnancy can make a big difference — even for women without diagnosed high blood pressure. Women whose systolic blood pressure (top number) was between 120 and 129 had 1.5 times greater odds of developing a blood-pressure-related pregnancy problem, compared with women who had normal blood pressure (when the top and bottom numbers are below 120 and 80, respectively). Another new study showed that children whose mothers had high blood pressure during pregnancy were significantly more likely to have elevated blood pressure during childhood, and the problem worsened as the child got older (the study included measurements from ages 2 to 18). Children were at the highest risk if their mother had both obesity and high blood pressure during pregnancy. Taken together, Honigberg said, these latest studies show that 'much of the risk associated with these pregnancy complications reflect prepregnancy cardiometabolic and cardiovascular health. Not all of it, but a lot of it.' One overlooked problem with prepregnancy assessments, he said: Young women look healthy. 'We often ignore or brush off cardiometabolic risk factors in young patients because they're young, so they're fine,' he said. Conclusions about health risks of mothers and their children point toward 'a slightly glib summary of the way the medical system thinks about risk factors in young adults.' 3. Improve a Little Bit of Everything About Your Health Honigberg's study created a score for pregnant women based on Life's Essential 8 — a set of health metrics defined by the American Heart Association to measure heart health. These include sleep, diet, physical activity, blood pressure, prepregnancy diabetes, body mass index, cholesterol, and smoking history. The team then calculated women's odds of developing blood pressure problems during pregnancy, including preeclampsia and eclampsia. They analyzed how genetic predisposition compared to having a poor score for all eight health factors. The upshot: Don't let genetics discourage you. Higher scores of Life's Essential 8 were linked to lower odds of gestational blood pressure problems — regardless of genetic risk. True, weight and diabetes status were among the biggest single drivers. But by analyzing all health factors during the first trimester, this study uncovered other areas to focus on before and during pregnancy. For example, increasing nightly sleep from less than four hours to at least seven can greatly lower risk, and so can increasing physical activity. 'Making lifestyle changes can be difficult, but small changes can make a huge difference in your overall health,' Borrowman said. 'Pregnancy can be an exciting time, but it also comes with a lot of unknowns and that can be stressful. The truth is, we all do the best we can with the information and resources we have. 'If you're currently pregnant and reading this, please know that taking the time to learn and care about your health already shows your deep commitment to giving yourself and your baby the best possible start. That matters and it makes a difference.'
CNN
5 days ago
- Health
- CNN
Women face medical gaslighting for chronic pain, experts say
EDITOR'S NOTE: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation. For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people — most of whom identify as women — sexual intercourse and routine pelvic exams are unbearable. Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women. Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain. READ MORE: Ovarian cysts can be painful when they burst. When do you need to see a doctor? We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions. We've consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training. A 2024 study of patients who went to a clinic for vulvovaginal pain — pain experienced in the external female genitals and vagina –- found that 45% of these patients had been told that they 'just needed to relax more' and 39% were made to feel that they were 'crazy.' A staggering 55% had considered giving up on seeking care. These results echo what one of us — Elizabeth Hintz — found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this 'it's all in your head' response from doctors. Another study followed patients in two different major US cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information. These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care? 'Let me describe the pain that would drive me to try so many different doctors, tests and treatments,' a patient with vulvovaginal pain said to her doctor. For her, sex 'is like taking your most sensitive area and trying to rip it apart.' 'I can now wear any pants or underwear that I want with no pain,' said another patient after successful treatment. 'I never realized how much of a toll the pain took on my body every day until it was gone.' Many patients worldwide experience medical gaslighting — a social phenomenon where a patient's health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright. Medical gaslighting is rooted in centuries of gender bias in medicine. Women's reproductive health issues have long been dismissed as psychological or 'hysterical.' Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy. These historical views help shed light on why these symptoms are still not taken seriously today. In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity. This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed. Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist. Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men. This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women's health has actually declined over the past decade. Despite these known disparities, in April the Trump administration threatened to end funding for the Women's Health Initiative, a long-running women's health research program, further worsening the problem. READ MORE: The Women's Health Initiative has shaped women's health for over 30 years, but its future is uncertain Without sustained federal funding for women's health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded. As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race. One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients' pain and offered them less accurate treatment recommendations. Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men. Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine. These lingering erroneous beliefs about gender and race are key reasons patients' pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death. Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients' lived experiences and admit when an answer isn't known. In the meantime, people navigating the health care system can take practical steps when encountering dismissive care. They can educate themselves about chronic gynecological pain conditions by reading books like 'When Sex Hurts: Understanding and Healing Pelvic Pain' or educational information from trusted sources like the International Society for the Study of Women's Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease. Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting. READ MORE: Endometriosis pain leads to missed school and work in two-thirds of women with the condition, new study finds If someone you know has experienced medical gaslighting and would like support, there are resources available. Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information — like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.
CNN
5 days ago
- Health
- CNN
Women face medical gaslighting for chronic pain, experts say
EDITOR'S NOTE: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation. For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people — most of whom identify as women — sexual intercourse and routine pelvic exams are unbearable. Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women. Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain. READ MORE: Ovarian cysts can be painful when they burst. When do you need to see a doctor? We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions. We've consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training. A 2024 study of patients who went to a clinic for vulvovaginal pain — pain experienced in the external female genitals and vagina –- found that 45% of these patients had been told that they 'just needed to relax more' and 39% were made to feel that they were 'crazy.' A staggering 55% had considered giving up on seeking care. These results echo what one of us — Elizabeth Hintz — found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this 'it's all in your head' response from doctors. Another study followed patients in two different major US cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information. These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care? 'Let me describe the pain that would drive me to try so many different doctors, tests and treatments,' a patient with vulvovaginal pain said to her doctor. For her, sex 'is like taking your most sensitive area and trying to rip it apart.' 'I can now wear any pants or underwear that I want with no pain,' said another patient after successful treatment. 'I never realized how much of a toll the pain took on my body every day until it was gone.' Many patients worldwide experience medical gaslighting — a social phenomenon where a patient's health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright. Medical gaslighting is rooted in centuries of gender bias in medicine. Women's reproductive health issues have long been dismissed as psychological or 'hysterical.' Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy. These historical views help shed light on why these symptoms are still not taken seriously today. In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity. This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed. Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist. Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men. This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women's health has actually declined over the past decade. Despite these known disparities, in April the Trump administration threatened to end funding for the Women's Health Initiative, a long-running women's health research program, further worsening the problem. READ MORE: The Women's Health Initiative has shaped women's health for over 30 years, but its future is uncertain Without sustained federal funding for women's health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded. As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race. One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients' pain and offered them less accurate treatment recommendations. Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men. Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine. These lingering erroneous beliefs about gender and race are key reasons patients' pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death. Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients' lived experiences and admit when an answer isn't known. In the meantime, people navigating the health care system can take practical steps when encountering dismissive care. They can educate themselves about chronic gynecological pain conditions by reading books like 'When Sex Hurts: Understanding and Healing Pelvic Pain' or educational information from trusted sources like the International Society for the Study of Women's Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease. Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting. READ MORE: Endometriosis pain leads to missed school and work in two-thirds of women with the condition, new study finds If someone you know has experienced medical gaslighting and would like support, there are resources available. Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information — like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.
CNN
5 days ago
- Health
- CNN
Women face medical gaslighting for chronic pain, experts say
Fighting disinformation Women's health Chronic diseasesFacebookTweetLink Follow EDITOR'S NOTE: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation. For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people — most of whom identify as women — sexual intercourse and routine pelvic exams are unbearable. Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women. Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain. READ MORE: Ovarian cysts can be painful when they burst. When do you need to see a doctor? We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions. We've consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training. A 2024 study of patients who went to a clinic for vulvovaginal pain — pain experienced in the external female genitals and vagina –- found that 45% of these patients had been told that they 'just needed to relax more' and 39% were made to feel that they were 'crazy.' A staggering 55% had considered giving up on seeking care. These results echo what one of us — Elizabeth Hintz — found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this 'it's all in your head' response from doctors. Another study followed patients in two different major US cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information. These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care? 'Let me describe the pain that would drive me to try so many different doctors, tests and treatments,' a patient with vulvovaginal pain said to her doctor. For her, sex 'is like taking your most sensitive area and trying to rip it apart.' 'I can now wear any pants or underwear that I want with no pain,' said another patient after successful treatment. 'I never realized how much of a toll the pain took on my body every day until it was gone.' Many patients worldwide experience medical gaslighting — a social phenomenon where a patient's health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright. Medical gaslighting is rooted in centuries of gender bias in medicine. Women's reproductive health issues have long been dismissed as psychological or 'hysterical.' Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy. These historical views help shed light on why these symptoms are still not taken seriously today. In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity. This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed. Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist. Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men. This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women's health has actually declined over the past decade. Despite these known disparities, in April the Trump administration threatened to end funding for the Women's Health Initiative, a long-running women's health research program, further worsening the problem. READ MORE: The Women's Health Initiative has shaped women's health for over 30 years, but its future is uncertain Without sustained federal funding for women's health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded. As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race. One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients' pain and offered them less accurate treatment recommendations. Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men. Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine. These lingering erroneous beliefs about gender and race are key reasons patients' pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death. Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients' lived experiences and admit when an answer isn't known. In the meantime, people navigating the health care system can take practical steps when encountering dismissive care. They can educate themselves about chronic gynecological pain conditions by reading books like 'When Sex Hurts: Understanding and Healing Pelvic Pain' or educational information from trusted sources like the International Society for the Study of Women's Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease. Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting. READ MORE: Endometriosis pain leads to missed school and work in two-thirds of women with the condition, new study finds If someone you know has experienced medical gaslighting and would like support, there are resources available. Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information — like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.
Yahoo
10-05-2025
- General
- Yahoo
I interviewed moms with 5 or more kids − here's what I learned about the women who are quietly going against the grain
Commentators link America's declining birth rate to a number of factors: a lack of support for mothers in the workplace, expensive child care, delayed marriage and a rising cost of living. But what about women in the U.S. who, despite these obstacles, have bucked the trend and managed to have all the children they want? I count myself in that camp: I have eight kids of my own. But I wanted to learn how other American women were able to reach their childbearing goals. So beginning in 2019, I decided to talk to some of the 5% of U.S. women who have five or more kids. My recent book, 'Hannah's Children: The Women Quietly Defying the Birth Dearth,' is an account of what I learned. In April 2024, the Centers for Disease Control and Prevention, the agency that counts annual births in America, released its provisional estimate of the total babies born in 2023. At 1.62 expected children per woman – down from 3.8 in 1957 – the fertility rate is the lowest it's been since the government started tracking it in the 1930s. Americans simply aren't having enough children to replace themselves. Studies have shown how, without enough immigration to offset the loss, this will cause the population to shrink, which in turn can lead to economic stagnation, political instability and social fragmentation. But falling birth rates go along with one more troubling pattern: the so-called 'fertility-gap.' The gap refers to the fact that women widely report having fewer children than they intended to have when they were younger. In the U.S., women say that about 2.5 kids is ideal, and that they realistically plan to have around 2.0 kids. They end up having 1.62, leaving a gap of about 0.4 to 0.9 kids. This discrepancy exists mainly because women are getting married later than ever in history – near the age of 28 for the average American woman – which has moved back the median age of having their first child to 30. Despite the rosy rhetoric of influencers boosting child-free lives, this fertility gap can be a big deal – particularly for women. Having children usually matters more to women's happiness than to men's, and women are generally more bothered by childlessness. So, low birth rates aren't just a crisis for societies and economies. They tell a deeply personal story about women failing to reach their goals for motherhood. Motivated by these circumstances, I interviewed 55 women with five or more children who lived in all parts of the U.S., from the Pacific Northwest to the Carolinas to New England. Their homes were in a range of socioeconomic areas, including wealthy, middle class and low-income ZIP codes. Some of them worked full time, others were part-time employees, and some didn't work at all. Their husbands held blue-collar jobs, white-collar jobs and everything in between. What they had in common was religious faith – they belonged to Jewish, Catholic, Latter-day Saint, evangelical and mainline Protestant communities. They also tended to value having a big family above other things they could do with their time, talents and money. One woman I spoke to, a mother of five named Leah, has no regrets about having a large family. (The names used in my book are pseudonyms in accordance with best practices and federal regulations for the protection of human subjects in academic research.) 'I think our culture really values the sort of very rigid perception of success, and has started to devalue a mother's contribution to society,' she told me. 'It's almost, like, radical and feminist to say that my contribution is healthy, well-balanced children. Coming from a divorced family, that was a big motivation for me in choosing this life: the family unit being the priority above career and personal identity.' The women bucking the trend weren't necessarily wealthier and didn't seem to face lower childbearing costs. Rather, they believed that children were blessings from God and the main purpose of their marriages. As Leah told me: 'Every child brings a divine gift into the world that nobody else can bring.' Most of them ended up having more children because they valued having a big family so highly. They didn't plan their family sizes around other life goals – they planned other life goals around having children. And the very high accord they granted to childbearing ordered their priorities in ways that made it more likely for them to get married and have kids, even while meeting career and financial milestones. Prior to my study, it was known that women who have more children than average are more likely to go to church. Less understood was why. Most churches today do not prohibit the use of contraception in marriage. None of the women in my sample reported having a large family because they believed family planning was wrong. The economic theories of 1986 Nobel laureate James Buchanan helped me see the women I interviewed as rational actors like all other women – not as blind adherents to religious dogma. According to Buchanan, people size up the gains and losses to the choices they make. Anything that adds value to one course of action tips the scale in favor of that choice. Incentives don't have to be monetary. They can come from ideas and convictions, including religious values. Conversely, anything that detracts value from a course of action makes it less likely. Disincentives can be monetary, like the price of a good. But the cost of missing out on other things can factor even more heavily. Whether the women I interviewed were rich or poor, they often cited the costs of missing out when they chose to have an additional child. They gave up or put aside hobbies, professions, alone time and financial status – not to mention eight hours of sleep each night – when they decided to have more kids. They didn't report not valuing those things. They felt the sting of being misunderstood, overwhelmed and limited in their work options. What stood out in the interviews was how much worth they accorded to having another child. They got to higher numbers of kids because they had something on the other side of the scale that weighed more than the losses. A mom named Esther summed it up: 'The three big blessings that we talk about in Judaism are children, good health and financial sustenance. I don't feel like you could ever have too much of any of those things. These are blessings. They're God's expression of goodness.' Drawing on these insights, my interviews suggested how mothers in my sample managed to defy the country's declining birth rate and fertility gap. First, because having a big family mattered so much to them, they pursued marriage deliberately. They chose colleges, churches and social settings where others prioritized marriage, increasing the chances of finding a partner in time to have kids. Second, they sought partners who also wanted high numbers of kids. One mom, a devout Catholic, told us she fell in love with a Protestant guy in college who wanted a big family. She had known what she wanted from her life partner. Finally, the women overcoming the fertility gap adjusted their careers to fit their childbearing goals. They didn't try to squeeze their kids around professional milestones. As such, they tended to select careers that were more flexible, such as teaching, nursing, graphic design or running a small business out of the home. Though not all Americans share the religious convictions that tipped the scales for the women in my study, lessons from understanding their motivations may have tremendous value for the millions of young Americans aspiring to be mothers. This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Catherine Ruth Pakaluk, Catholic University of America Read more: More than 1 in 5 US adults don't want children Taxing bachelors and proposing marriage lotteries – how superpowers addressed declining birthrates in the past Fatherhood changes men's brains, according to before-and-after MRI scans Catherine Ruth Pakaluk received funding from the Wheatley Institute at Brigham Young University (2019, 2020), the APGAR Foundation (2022), and the Ortner Family Foundation (2022) to undertake the research for and preparation of the book mentioned in this article.
