Pravda in the Intake

Amanda Marcotte

Laws that mandate scripts for doctors providing abortions make for bad medicine.

Sadly, the pro-choice movement doesn't have much in the way of regular triumphant victories over those who want to roll back attitudes about sex and women's rights to the Victorian era, but last week, we did have a moment of joy when the New Jersey Supreme Court ruled against a lawsuit that could conceivably have forced doctors to lie to their patients. The lawsuit in question was brought by a Rose Acuna, who claimed that the doctor should have told her that her embryo was a separate human being before performing the abortion. Acuna appears to be one of the many women out there waving the "choice for me but not for thee" flag, which is to say that they join anti-choice causes after getting an abortion themselves, and gain pity within the anti-choice community by playing up how badly they were "duped" to get an abortion. The court, helpfully, pointed out that the state has no business forcing professionals to use their authority to spread misinformation.

The ACLU described the lawsuit as an underhanded attempt to mandate anti-choice scripts to be read by doctors that could be similar to scripts that have been pushed on doctors in other states through legislation. These sort of mandated scripts are often sold in paternalistic terms that assume both that women are too stupid to know what an abortion is and that legislators working from their low opinion of women have a better grasp on the practice of medicine than doctors with medical degrees. Perhaps the issue is that there are few, if any, courses at medical school in the fine art of assuming that all women seeking reproductive health services are stupid and slutty and need a lie-laden scolding for the high crime of having a normal sex life.

Aside from the official selling point of these laws, there's the unspoken selling point of pure sadism. Scripts like the one the plaintiffs wished to push on doctors in New Jersey usually have overwrought, maudlin, guilt-tripping (and inaccurate) language, in hopes that when the script is sprung on some already stressed out woman obtaining an abortion, she'll become upset or even cry. Considering how sadistic fantasies of suffering women are not unknown to anti-choice legislators, the idea that a lot of them dwell delightedly on the idea of adding to women's pain when voting for these laws is not completely out of the question. Think of South Dakota Republican Senator Bill Napoli's unnerving fantasy of the levels of degradation a woman would have to reach before he was satisfied that she deserves an abortion: "A real-life description to me would be a rape victim, brutally raped, savaged. The girl was a virgin. She was religious. She planned on saving her virginity until she was married. She was brutalized and raped, sodomized as bad as you can possibly make it, and is impregnated. I mean, that girl could be so messed up, physically and psychologically, that carrying that child could very well threaten her life."

First you get messed up bad and then you get your abortion. And if you weren't messed up before you step inside the clinic, there's a state-mandated guilt trip awaiting you in hopes to push you over the edge. Odds are that this script almost never achieves its sadistic intentions, but that doesn't justify its existence. Thankfully, the women of New Jersey will not have this extra obstacle put in front of them.

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There's a strong whiff of the Soviet Union to these right wing attempts to remake reality by legislative fiat. Mandated clinic scripts are far from the only or even most famous example. The ongoing attempts to turn a religious teaching (creationism) into a scientific theory on par with evolutionary theory through legislation certainly get more press. But I'd put these abortion scripts right up there in the Soviet-esque ideology-trumps-reality category. A script in every doctor's office that equates an embryo with a five-year-old child doesn't make it true anymore than forcing patients to clap furiously will start saving fairy lives.

Nor does forcing doctors to read the script mean that you force anyone to believe it or even force them to read it with a convincing air about them. Even if the laws specify that doctors should read the script straightforwardly without giving any lip, how would you enforce that law? Is there a ban on a doctor rolling her eyes while reading the script? A ban on the doctor whipping out the script and prefacing her reading by saying, "The nutcases in the legislature require that I read you this load of horse puckey?" A law forbidding you from reading the script with a put-upon air of someone having to recite total nonsense?

If I were a clinic worker forced to read from an anti-choice script, I'd carry it around in a red folder labeled Pravda. Having a world-weary attitude about government-mandated nonsense is a rare pleasure in America. Most of the time, we're still up in arms about propagandistic lies and nonsense, because there's always a strong sense that a significant percentage of people buy into it. But inside the abortion clinic, amongst a group of people who either perform abortions or are seeking abortions, it's probably pretty rare to find anyone who's going to swallow the government line whole without question.

With that in mind, it's hard not to wonder what legislators who pass these laws intend to achieve, since they'll be convincing no one. No doubt plenty of legislators are motivated by the glow from making self-righteous but pointless symbolic gestures. But there's quite possibly more to these scripts than that. Mandatory scripts seem to be in the same category of abortion clinic regulations as mandatory sonograms or landscaping requirements—in other words, they're TRAP laws, which is short for Targeted Regulation of Abortion Providers. The idea behind TRAP laws is that if you put enough arcane and pointless regulations on abortion providers, eventually they'll be unable to keep up with them all, fined for breaking the pointless laws and then run out of existence.

Congratulations to the state and the women of New Jersey for evading one more trap set for them by right wing activists.

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.