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    Is it safe to have a child? Americans rethink family planning ahead of Trump’s return

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    Chris Peterson wasn’t surprised that Donald Trump won the 2024 presidential election. But he was surprised by how quickly he and his wife started asking one another: should we try to have another baby before a possible nationwide abortion ban takes effect? Or should we give up on having a second child?Peterson and his wife, who live in North Carolina, are thousands of dollars in debt because their first child needed to spend weeks in the hospital after being born prematurely. They had wanted to pay off that debt and wait a few years before having a second baby. But now, reproductive rights are again in the balance – Trump has said he would veto a nationwide abortion ban, but his allies are emboldened to push through more restrictions.Peterson is terrified of what is to come, and that his wife might not be able to get the medical care she needs if they decide to conceive again. “We should be happy thinking about expanding our family,” said Peterson, who is, like his wife, in his late 30s. “We shouldn’t be worried that we’re going to have medical complications and I might end up being a single father.”Peterson is not the only American who, in the weeks after the US election, is rethinking plans around having children. On 6 November, the number of people booking vasectomy appointments at Planned Parenthood health centers spiked by 1,200%, IUD appointments by more than 760% and birth control implant appointments by 350%, according to a statement provided to the Guardian by Planned Parenthood. Traffic to Planned Parenthood’s webpages on tubal ligation, vasectomies and IUDs has also surged by more than 1,000% for each.After the election, the Guardian heard from dozens of people in the US reconsidering whether to have children. Most pointed to fears over the future of reproductive healthcare, the economy and the climate in explaining their concerns.“I hesitate to bring more children into a world with an uncertain ecological future, assuming that the incoming administration pulls out of the Paris climate accord and ceases to support green energy transition,” a 34-year-old Minnesota mother of one wrote to the Guardian in response to a callout inviting readers to share their thoughts about post-election family planning. Trump pulled the US out of the historic agreement during his first administration; doing so again – which Trump has promised to do – could “cripple” the it, according to the UN secretary general.“We have two children and I have desperately wanted a third – but now I am fearful of being able to get adequate care if I get pregnant,” wrote another woman who lives in Louisiana. “I can’t risk leaving my two children behind if [I] die because I can’t get adequate care here. It feels like a dystopian novel, and yet here we are.”These worries are not necessarily new. In 2023, a Pew Research Center survey found that 47% of 18- to 49-year-old US adults say they are unlikely to ever have kids – a steep jump from 2018, when 37% said the same. Of the people who are unlikely to have kids, 38% said “concerns about the state of the world” were a major part of their decision-making. Roughly a quarter pointed to fears about the environment.Working in disaster relief, Catherine regularly sees the effects of the climate crisis up close. “I’m in Washington DC right now and flowers are blooming. It’s November. This should not be happening,” she said in an interview. “While I have always wanted kids, that choice has become tinged with a level of despair and anger that I didn’t have two years ago.”She continued: “Why would I bring a child into this world that is dying?”Earlier this year, Catherine got a copper IUD, which can block pregnancy for more than a decade.Like developed countries around the world, the United States is in the midst of a fertility slump. In 2023, the US fertility rate fell by 3% and reached a historic low.But this decline is not evenly distributed across the political spectrum. After Trump won the presidency in 2016, births in Republican-leaning counties rose sharply compared to those that leaned Democratic. Today, Democrats are likelier than Republicans to be childfree – a trend that, the Washington Post has hypothesized, is likely also related to the rightward drift of big-family white Protestants.That the outcome of the 2024 election has spurred such fear and hesitation around having children is apt – not only are US political parties on diverging paths when it comes to babies, but the election itself was in many ways a referendum on families and fertility. While Kamala Harris made support for abortion rights a key plank in her platform, Donald Trump promised “baby booms” and pledged to give people “baby bonuses”. Trump’s vice-president-elect, JD Vance, has built his political brand on pronatalism, a movement that urges people to have babies to benefit the greater good. Vance has a track record of deriding “childless cat ladies” and raising the alarm about the US fertility rate.“We want more babies because children are good,” Vance once said. “And we believe children are good, because we are not sociopaths.”M, a Texan mother of three who asked to go by her first initial because she feels stigmatized for voting for Trump, hopes that Trump’s victory will improve the economy to the point that she and her husband can afford to have a fourth child.“I still have a child in childcare now – like daycare – and just seeing those costs rise year after year since 2020, it’s been really hard for our family to consider having another baby,” M said. “The possibility of that being alleviated through better economic policy or even just those costs being taken away somewhere else – whether it’s groceries or utilities to whatever it is – that really makes it possible for us to consider having another kid.”M, who opposes abortion, feels confident that she would be able to get adequate care if she had a miscarriage. (Since Roe v Wade fell, at least three women have died in Texas after doctors reportedly delayed treating them for miscarriages or gave them inadequate miscarriage care.) The climate crisis worries M less than making sure her kids have access to clean water and healthy, chemical-free food.Not everyone reconsidering having kids has totally ruled it out. N, a 26-year-old from New York, is for now only delaying her plans to have kids until after Trump leaves office. (She asked to go by her first initial because she previously had an abortion.) Ruth, who has a newborn at home and is married to an undocumented person, fears abortion bans and her husband being deported – but still wants to keep the conversation about having a second kid alive.“We want to be able to dream of having a family the way we want to, on our terms,” said Ruth, who lives in Florida and asked to be identified by her middle name due to her husband’s immigration status. “My husband being an immigrant – we feel that it shouldn’t foreclose our options to build a family. We have just as much of a right to build a family on our terms as anyone else.” More

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      in US Politics

      ‘One death is too many’: abortion bans usher in US maternal mortality crisis

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      In Louisiana, doctors will no longer be able to carry a lifesaving medication with them during pregnancy emergencies. In Texas, the infant mortality rate is soaring. In Idaho, pregnant people drive hours just to give birth. And in Oklahoma and Georgia, women are bleeding out in hospital parking lots and facing dangerous infections before they can find care – and sometimes, that care comes too late.The limitations and outright bans on abortion that have taken hold in half of the US in the wake of the Dobbs decision have wreaked enormous changes to the reproductive health landscape.The restrictions put a growing burden on the health and wellbeing of patients and providers, even as more Americans find it difficult to find and access care.“The United States is, and has been for quite some time, in the midst of a maternal and infant mortality crisis,” said Dr Jamila Perritt, a board-certified obstetrician and gynecologist and president of Physicians for Reproductive Health.Banning access to reproductive healthcare, including abortion care, is “directly causing an increase in morbidity and mortality in our community”, she said. “We have really robust evidence that shows us that when people have sought abortion care and are unable to obtain it, their psychological, social, physical and emotional health is harmed.”Maternal and infant mortality will probably increase because of the restrictions – especially if national limitations, like enforcement of the Comstock Act, are put into place.“I expect in the next few years, we’re going to start to see the infant mortality, pre-term birth, maternal mortality, and maternal morbidity numbers rise for everyone, and particularly for folks from racially marginalized and low-socioeconomic communities,” said Rachel Hardeman, professor of reproductive health and founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota.Calculating mortality is often a complicated and controversial endeavor. When maternal mortality dropped in 2022, anti-abortion advocates credited the success to the Dobbs decision.But that’s not the case, according to new research in Jama Network Open.Maternal deaths surged during the first two years of the pandemic, when Covid, a deadly illness during pregnancy, accounted for one-quarter of all maternal deaths. But in 2022, that rate dropped to levels similar to pre-pandemic levels, from 32.9 deaths per 100,000 live births in 2021 to 22.3 in 2022.That rate is still higher than maternal mortality rates in peer nations, and research indicates it will increase if officials clamp down on abortion nationally – which, with the Comstock Act, would require no additional anti-abortion legislation or bans.Right now, “people can still travel to other states, but once there’s a federal ban, that won’t be an option any more,” says Amanda Jean Stevenson, co-author of the new Jama research and a sociologist at the University of Colorado Boulder. “And there could be this very different set of outcomes when people’s options are gone.”In the United States, more than 80% of pregnancy-related deaths and more than 60% of infant deaths in the first week are preventable – and those figures were estimated before the Dobbs decision.Because of abortion restrictions, there are already significant challenges to accessing reproductive healthcare – and it’s not just abortion care.In Louisiana, misoprostol – a drug used for medication abortion and other lifesaving purposes – will be labeled a controlled substance beginning on 1 October. One of its uses is keeping patients from bleeding out after childbirth, which is the No 1 cause of postpartum mortality.Yet physicians cannot keep controlled substances in their emergency carts, and they fear they won’t have enough time to fill prescriptions for patients when minutes and even seconds make the difference between life and death.In the year following Texas’s abortion ban, child mortality shot up by 12.9% – compared with a 1.8% increase in the rest of the country, according to a recent study. Congenital anomalies are the leading cause of infant death in the US – but while they went down by 3.1% in the rest of the country, they went up by 22.9% in Texas.“That study was chilling. That is a huge change,” Stevenson said.It echoed previous research finding that states with the most restrictive abortion laws saw 16% more infant deaths between 2014 and 2018.The trauma and costs of carrying to term pregnancies that are incompatible with life inflict an incalculable toll on families and providers.States are closing obstetric units and losing experienced providers who worry about not being able to offer lifesaving care as patients die on the table in front of them, and facing jail time if they provide care.More than two-thirds (68%) of obstetricians and gynecologists say the Dobbs decision has made it harder for them to respond to pregnancy-related emergencies, according to the non-partisan health research organization KFF. They also believe it has worsened mortality in pregnancy while increasing racial and ethnic inequities, and fewer doctors are now interested in entering the field.In 2022, soon after the Dobbs decision, medical residency applications dropped for states with bans.More than half of doctors surveyed in states with bans and limitations said they were very concerned about legal repercussions to providing the standard of care in pregnancy.“That can just exacerbate already pretty large gaps in the workforce,” said Usha Ranji, associate director for women’s health policy at KFF.In the past two years, more than 100 hospitals have closed their obstetric units entirely, according to a new March of Dimes report. More than one-third of US counties are now maternity care deserts, with no obstetricians or places to give birth. North Dakota, South Dakota, Alaska, Oklahoma and Nebraska have the least access to maternity care.The majority of rural hospitals (57%) no longer deliver babies, with more than 100 of the rural hospitals ending labor and delivery services in the past five years.“We’ve created policy and legislation to limit access to abortions and also have closed the exact places that people need to go to get care if they are pregnant,” Hardeman said. That puts pressure on neighboring states that still provide care, she said.“Where you live matters for your health. And I think that the Dobbs decision and the fall of Roe have demonstrated that in a very real and very obvious way, because there are literally places in this country where there is essentially no access to reproductive healthcare,” she said.“It started out in rural spaces, but more and more, there’s reports popping up of labor and delivery units closing in, like, urban Chicago.”In states with restrictions on abortion, women of color and pregnant people from low-income communities often suffer the most, said Hardeman. “Taking away access to reproductive healthcare is exacerbating those disparities.”Black women die because of pregnancy at twice the national rate, and three times more than white women, according to the US Centers for Disease Control and Prevention.“The fact that black women and birthing people are dying at three to four times greater risk than white women is shameful – and it’s preventable,” Perritt said.It’s important to shore up protections for reproductive health for all Americans before health complications and mortality rise even more, she said. “One death is too much. One is too many.” More

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      in Elections

      The Life and Courage of Daniel Ellsberg, ‘a True American Hero’

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      More from our inbox:Setbacks in the Fight Against Maternal MortalityA Trump Victory in 2024 Would Be ‘a Dark Day for Us All’‘A Small Slice of Hope’Diversity in OrchestrasDaniel Ellsberg and his wife, Patricia. His disclosure in 1971 of the Pentagon Papers and its fallout left a stamp on history that defined the bulk of his life.Donal F. Holway/The New York TimesTo the Editor:Re “Daniel Ellsberg, 1931-2023: Whistleblower Who Unveiled U.S. Deceit in Pentagon Papers” (obituary, front page, June 17):Thank you for the excellent obituary recounting the life, career and legacy of Daniel Ellsberg.I had the pleasure and honor of meeting Mr. Ellsberg in 2010 during one of the Portland, Ore., screenings of the documentary film about him, “The Most Dangerous Man in America.”After the Q. and A., I approached him and began to thank him, but even as I was about to tell him that I was born in Saigon during the Tet offensive of 1968, I began to lose my composure and eventually broke down in front of the entire crowd.Through my tears, gasps for air and apologies, I tried to convey my gratitude for a life that might have been drastically altered if it were not for his acts of courage, which I believe helped bring about the end of U.S. involvement in Vietnam. With a patient smile, one palm gently placed on my shoulder, and the other still engaged in our handshake, he whispered his response, “Thank you.”It’s impossible to know where I would have ended up as the half-American child of a U.S. soldier if the U.S. had not gotten out of Vietnam a couple of years after the Pentagon Papers were released.Where would my mother and I have found ourselves, as well as those thousands of U.S. service personnel and millions of refugees and noncombatants whose destinies were tethered to the clandestine decisions of bureaucrats, politicians and war planners?It’s really hard to calculate, but fortunately in part because of Mr. Ellsberg, I’ll never have to do the math.Mien YockmannVancouver, Wash.To the Editor:The obituary of Daniel Ellsberg is a heroic story of courage, character and determination, when those virtues are sorely missing on the current American political scene. His efforts leaked the story of government deception and led to a Supreme Court decision in favor of a free, uncensored press, and to the Watergate crimes and the fall of President Richard Nixon.What a difference between Mr. Ellsberg’s unauthorized possession of classified documents and that of our ex-president, who did not risk his freedom for the American people, but for his vulgar self-interest.Robert S. AprilNew YorkTo the Editor:Thanks for your excellent obituary of Daniel Ellsberg. His speaking truth to power has been a powerful gift to humanity!I was a good friend of Dan’s and had the privilege of being arrested and going to jail with him for protesting nuclear weapons and the wars in Central America, Iraq and Afghanistan. He devoted his life to speaking out and acting to prevent and stop wars and the suicidal nuclear arms race.Preparing for and threatening nuclear war is unconscionable. Inspired by Dan’s life, we need to step up to the plate and work to stop this crime against humanity before it is too late. Hopefully others will be inspired by Dan’s courage to become whistleblowers and speak truth in the face of the lies and half-truths by politicians and the mass media.Thanks, Dan, for inspiring us to continue the good work you had been doing.David HartsoughSan FranciscoThe writer is a co-founder of World Beyond War and Nonviolent Peaceforce.To the Editor:As I read about Daniel Ellsberg, my first reaction was gratitude. A man willing to speak truth to power, whatever cost he might personally pay. A true American hero. One can only wish there were more like him today.Lisa DickiesonWashingtonSetbacks in the Fight Against Maternal MortalityYeabu Kargbo, 19, rests post-delivery at a rural health center in northern Sierra Leone.Photographs by Malin Fezehai for The New York TimesTo the Editor:Re “Sierra Leone Is Giving Me Hope,” by Nicholas Kristof (column, June 4):Mr. Kristof is right to highlight the achievements in improving maternal and child health and reducing extreme poverty. Too much “doom and gloom” can mask all the good we have achieved and can drive donor fatigue and complacency.Yet even as we celebrate those achievements, the combination of Covid-19, humanitarian crises, climate change and the rising cost of living have been rolling back progress. The decline in maternal deaths by an average of 2.7 percent per year between 2000 and 2015 has paused: Maternal mortality did not decline globally between 2016 and 2020.Donor aid for reproductive, maternal, newborn and child health, which shot up by 10 percent from 2016 to 2017, has been on a downward trend, with a 2.3 percent decline between 2019 and 2021.And still today, seven of every 10 maternal deaths are in Africa, and Black women in America are almost three times more likely to die in childbirth than non-Hispanic white women.We can be proud of progress earlier this century, but a series of crises has shown us how fragile that was. We need new commitments, action and strong advocacy to reverse the recent negative trends.Helen ClarkAuckland, New ZealandThe writer is a former prime minister of New Zealand and the chair of the Partnership for Maternal, Newborn and Child Health.A Trump Victory in 2024 Would Be ‘a Dark Day for Us All’ Doug Mills/The New York TimesTo the Editor:Re “Trump Allies Plan to Stifle Justice Dept.” (front page, June 16):For me, the scariest thing about the former president’s candidacy is not Donald Trump himself — there have always been demagogues in American politics. Nor is it the craven politicians who enable his anti-American views for their own gain, or even the tens of millions of Americans who fervently support these views. The scariest thing is the quiet preparation in the Republican Party to take actions based on these views if Mr. Trump becomes president again.Last time, Mr. Trump chose underlings like Jeff Sessions and William Barr — well-known figures who possessed at least a shred of honor, and who refused his most extreme demands. He won’t make that mistake if elected a second time.Mr. Trump has always brought out the worst in people, and he has bent and twisted the Republican Party into something unrecognizable. A Trump victory in 2024 would allow him similarly to twist all of America into something nightmarish. It would be a dark day for us all.Tim ShawCambridge, Mass.‘A Small Slice of Hope’A photograph taken with a prism lens of a television image of Donald Trump after his federal court arraignment. Damon Winter/The New York TimesTo the Editor:Re “I Won’t Let Trump Invade My Brain,” by David Brooks (column, June 16):It is difficult to retain a sense of optimism about the future these days when surrounded by the narcissism of our politicians, the angry voices of our fellow citizens and our decaying planet.Mr. Brooks’s column brought me some comfort and a small slice of hope that maybe there are still enough of us who believe in ethical behavior and a real commitment to the common good that there is some hope for our planet and our collective future.Chris HarringtonPortland, Ore.Diversity in OrchestrasSaul Martinez for The New York TimesTo the Editor:Re “Diversity Improves, but Not for All” (Arts, June 17):So orchestras are now eager to find more Black players? For generations, while these orchestras were using cronyistic and outright discriminatory hiring practices, Black musicians found greater meaning and commercial success in their own traditions, from the blues and jazz to soul and hip-hop.If orchestras are now truly intent on supporting Black Americans, rather than simply making their own enterprises appear more visibly inclusive, perhaps they could consider programming more Black music.Ben GivanSaratoga Springs, N.Y.The writer is an associate professor of music at Skidmore College. More