I Love Roe

Frances Kissling

Roe v Wade was a visionary decision made in a country that was not ready for it. We need straight talk about access to safe abortion, pregnancy related health care, and safe delivery.

I love Roe v Wade. It took my breath away in 1973 and its promise continues to do so. It marked the United States as one of only two countries—South Africa is the other—with constitutions that enshrine the right to choose. Roe, under the penumbra of a right to privacy recognized that women were competent moral agents capable of making complex moral decisions. We did not need the legislature, the court, the church or our male partners to "help" us figure out right from wrong. What more sweeping affirmation of women's rights could a Catholic and a feminist hope for?

But Roe was a socially transformative decision made in a country that was not yet socially transformed. It was a visionary decision and we were not ready for it. And so it has failed.

We now have a seeming constitutional right to choose abortion and more restrictions on that right than countries with more "moderate" laws. We do not provide government funds for abortions for poor women although most countries where abortion is legal provide funding for all women. We regulate adolescent access, waiting periods, and what a doctor must tell a woman.

How did this happen? Not, as some claim, because the court shut down the democratic process by precluding debate in the state legislatures. The number of state bills introduced and state restrictions imposed is staggering. Articles, books, campus debates and TV programs on abortion probably exceed the total in all of the countries of the industrialized world. More alternative "crisis pregnancy centers" exist in the United States than in any other country. It happened because the core value behind Roe, the vision of women as moral agents, has never been realized. The Harris v McCrae decision in 1980 which allowed states and the federal government to prohibit the use of government funds for women on Medicaid demonstrated that we were not ready to recognize poor women as moral agents. The majority opinion in Gonzales v. Carhart provides the rhetorical case for the view that women are weak and need protection.

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While opinion is divided on whether Roe will be explicitly overturned or eviscerated through restrictions, it will only be available if we can convince the American public that it is a responsible choice as well as a right. At present, public opinion is not far removed from the Court's opinion. The public believes abortion is serious moral business. It can be justified but should not be celebrated. And above all, efforts should be made to avoid needing it.

Pro-choice forces share that view, although our historic and unrelenting emphasis on the promise of Roe and our fear of contributing to the stigmatizing of women who chose abortions often keeps us from leading with those beliefs. Our well founded suspicion of conservative moralism buries our deep morality in rights talk.

It is time to substitute straight talk for rights talk. Straight talk acknowledges that women themselves don't want to need abortions. They want to prevent pregnancies they can't bring to term. Legislatively that means an all out effort to increase funding for family planning and to end the idiocy of abstinence-only sexuality education. It means saying over and over again, that if you can't afford financially or emotionally to bring a child into the world, if you simply do not want children or a child, you have a responsibility to use contraception. Straight talk means accepting that however justifiable and whatever good comes from the decision to end a pregnancy, the act of abortion involves a departure from our common desire to live in a world where all positive forms of life can be nourished. On those grounds, it would be a better world if abortion were less frequently necessary. The Clinton formulation of "safe, legal and rare" is good ethics.

Straight talk includes an acknowledgment that abortion involves weighing competing values. Even if we believe they should be legal, abortions at the later stages of fetal development are morally more complex for most people. Only a few of us believe that fetuses have no value and only a few of us believe they have absolute value. Most believe they increase in value as the pregnancy continues. Adolescents have rights, but we want their parents involved—and they have a responsibility for the health and well being of their children. Health care professionals have a conscience, just as women do. Both need to be respected. Advances in fetal surgery, treatment of premature infants and the ability to bond with a wanted fetus through ultrasound are good things, not threats to the right to choose an abortion.

Most importantly, the moral high ground on abortion can best be found in the context of social justice and a commitment to all reproductive rights. It is found in insisting that the millions of women who rely on the government for health care have as much of a need to make the choice about abortion or childbirth freely as do women who are better off financially. In the United States, this means an all out consistent effort to secure federal and state Medicaid funds for low income women.

It also means working to reduce maternal mortality and morbidity world wide. The need for the abortion rights movement to take up the cause of Safe Motherhood is critical to the integrity of choices. Women world wide do not just die from unsafe abortions. In fact, a far larger number, at least 500,000, die from pregnancy related causes such as post partum hemorrhage and lack of skilled birth attendants. Solving the reproductive health problems of poor women in the United States who choose abortion and of poor women in the developing world who want healthy children requires a belief that women are not just moral adults, but that they matter.

I like to think that in the not too distant future, in a socially transformed United States, women will matter. Roe will be looked at as one of the most-forward-thinking, principled decisions for women in the 20th century. Right now our job is to be sure on whatever basis works that as many women as possible have access to safe affordable abortion services and to pregnancy related health care and safe delivery. That is what choice means. And our government aid, whether for Africa or Alabama, will reflect that value.

Roundups Law and Policy

Gavel Drop: Republicans Can’t Help But Play Politics With the Judiciary

Jessica Mason Pieklo & Imani Gandy

Republicans have a good grip on the courts and are fighting hard to keep it that way.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

Linda Greenhouse has another don’t-miss column in the New York Times on how the GOP outsourced the judicial nomination process to the National Rifle Association.

Meanwhile, Dahlia Lithwick has this smart piece on how we know the U.S. Supreme Court is the biggest election issue this year: The Republicans refuse to talk about it.

The American Academy of Pediatrics is urging doctors to fill in the blanks left by “abstinence-centric” sex education and talk to their young patients about issues including sexual consent and gender identity.

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Good news from Alaska, where the state’s supreme court struck down its parental notification law.

Bad news from Virginia, though, where the supreme court struck down Democratic Gov. Terry McAuliffe’s executive order restoring voting rights to more than 200,000 felons.

Wisconsin Gov. Scott Walker (R) will leave behind one of the most politicized state supreme courts in modern history.

Turns out all those health gadgets and apps leave their users vulnerable to inadvertently disclosing private health data.

Julie Rovner breaks down the strategies anti-choice advocates are considering after their Supreme Court loss in Whole Woman’s Health v. Hellerstedt.   

Finally, Becca Andrews at Mother Jones writes that Texas intends to keep passing abortion restrictions based on junk science, despite its loss in Whole Woman’s Health.

Culture & Conversation Human Rights

Let’s Stop Conflating Self-Care and Actual Care

Katie Klabusich

It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.

As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.

I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.

International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.

“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”

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In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.

The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.

The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.

“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”

The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.

Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”

Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:

Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.

It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.

We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.

I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.

Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.

Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.

Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.

My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.

It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.

Over the past year I’ve noticed a spike in articles on how much of the emotional labor burden women carry—at the Toast, the Atlantic, Slate, the Guardian, and the Huffington Post. This category of labor disproportionately affects women of color. As Minaa B described at the Huffington Post last month:

I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.

The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

While her words ring true for me, they are certainly more weighted and applicable for those who don’t share my white and cisgender privilege. As covered at Ravishly, the Feminist Wire, Blavity, the Root, and the Crunk Feminist Collective recently, self-care for Black women will always have different expressions and roots than for white women.

But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.