The impact of women’s reproductive health on their lives is one of the novel’s key themes. The story explores women’s health issues at multiple stages of life, including middle age. Because middle-aged and aging female protagonists aren’t as common as young female characters in the literary world, this choice (which is one of the author’s hallmark interests) creates critical representation of middle-aged women in literature.

The reproductive health crises that primarily consume Rocky’s mental energy are her pregnancies. She carried two pregnancies to term, terminated one, and lost another. The sense of loss she experiences as a result of the two unsuccessful pregnancies haunts her throughout her adult life, not only as a source of emotional pain but as a secret that places distance between Rocky and her family, particularly Nick. These kinds of difficult, negative experiences aren’t typically part of public discourse surrounding pregnancy and pregnant women, and the author’s exploration of pregnancy’s complexity is an important intervention into how society at large discusses pregnancy.

However, Rocky also struggles with other reproductive health issues. She recalls her youth as regularly interrupted by various gynecological infections, the by-product of her particular physiology and being a sexually active woman.