Bush met her future husband, George W. Bush, in 1977, and they were married later that year. The couple had twin daughters in 1981. Bush's political involvement began during her marriage. She campaigned with her husband during his unsuccessful 1978 run for the United States Congress, and later for his successful Texas gubernatorial campaign.
As First Lady of Texas, Bush implemented many initiatives focused on health, education, and literacy. In 1999–2000, she aided her husband in campaigning for the presidency in a number of ways, such as delivering a keynote address at the 2000 Republican National Convention, which gained her national attention. She became First Lady after her husband was inaugurated as president on January 20, 2001.
Polled by The Gallup Organization as one of the most popular First Ladies, Bush was involved in national and global concerns during her tenure. She continued to advance her trademark interests of education and literacy by establishing the annual National Book Festival in 2001, and encouraged education on a worldwide scale. She also advanced women's causes through The Heart Truth and Susan G. Komen for the Cure organizations. She represented the United States during her foreign trips, which tended to focus on HIV/AIDS and malaria awareness. She is the oldest living former First Lady, following the death of Rosalynn Carter in 2023.