There’s a particular exhaustion that comes from being studied. From knowing too much about the systems designed to fail you. From watching statistics become your body, your sister’s body, your mother’s body.
Adia R. Louden knows this exhaustion intimately. With a Ph.D. in maternal and child health from UNC Chapel Hill, she’s spent her career understanding the mechanics of maternal mortality among Black women. Now, as she approaches her 30th birthday, she’s confronting a question that transcends personal preference: should she have a baby in a country that may not protect her life if she does?
The numbers she’s studied for years suddenly feel very close. Black women face maternal mortality rates of 44.8 deaths per 100,000 live births in 2024, a slight decline from 2023’s 50.3, but still dramatically higher than rates for white, Hispanic, and Asian women. These aren’t abstract figures. They represent real women, real families, real absence.
When Education Doesn’t Protect You
Here’s what makes this crisis particularly brutal: it doesn’t discriminate by degree.
Maternal deaths among Black women occur “regardless of income or education,” according to Louden’s analysis. A Ph.D. won’t save you. Stability won’t save you. The causes run far deeper than individual circumstances. They’re baked into health systems through structural and systemic racism, provider bias, inadequate culturally appropriate care, and the cumulative toll of chronic stress and weathering.
Weathering is what researchers call the accelerated aging of the body under chronic stress. For Black Americans, it’s not metaphorical. It’s physiological.
Louden learned to frame this through something called the social-structural determinants of health. Individual factors matter. Interpersonal relationships matter. Community and societal structures matter even more. All of these layers stack on top of each other, compressing risk. And if you’re a Black woman thinking about motherhood, you’re staring directly at that stack.
Geography as Destiny
Then there’s the matter of where you live.
Reproductive rights have become a patchwork of restrictions across America. Currently, 41 states have abortion restrictions in effect, with 13 of those states imposing total bans. Your ZIP code now determines your access to reproductive care. Your socioeconomic position determines the quality of that care. This isn’t poetic language. This is how policy works on the ground.
For someone thinking about pregnancy, this means something simple and terrifying: your options depend on your address. Your ability to make choices about your own body depends on state lines drawn by politicians who don’t know you, won’t meet you, and won’t be held accountable when outcomes go wrong.
Louden is acutely aware that her decision to become a mother is no longer purely personal. It’s political. It always has been for Black women, but the walls are closing in visibly now.
The Vaccine Wars and Eroding Trust
Things got worse recently. Since 2025, federal officials have launched what Louden describes as “major assaults” on established vaccine policies and public health recommendations. The CDC’s vaccine guidance for pregnant people and infants is under siege.
For someone whose entire professional life has been spent understanding how to protect maternal and child health, watching those protections dismantled is its own form of weathering. It’s corrosive. It creates distance between you and the institutions supposedly built to care for you.
Louden was never fully trusting of government anyway. Now she’s left with even less reason to be.
The Weight of Other People’s Hope
There’s a particular cruelty in how people talk to Black women about motherhood. They express hope, excitement, expectations. “When are you having a baby? What kind of mom will you be? What will your children be like?”
These questions carry love, sometimes. They also carry assumption. They flatten the complexity of a decision that involves survival, access, systemic bias, and personal autonomy into something simple. As if desire for motherhood functions like a shield against racism and dismissal. As if it’s just a personal choice in a country where reproduction itself has become a political battleground.
At 29, approaching her 30th birthday, Louden is tired. She’s tired of dreaming in a country that doesn’t want to see her wake up. She’s tired of being the person who has to advocate for what should be basic. Tired of the perpetual question mark hovering over her reproductive future.
She’s considered egg freezing. She’s discussed it with family. They told her she has time. Maybe they’re right. Maybe she doesn’t need to decide everything right now.
But she does know this: Black women deserve more than commemorative weeks. More than slogans. More than incremental improvements to systems designed to exclude them.
They deserve care that’s actually protective. Safety that’s actually guaranteed. Support that doesn’t require them to become martyrs to the cause of their own survival.
And they deserve to make the choice about motherhood freely, without the weight of a country’s failures pressing down on that choice.
