How to (Un)pack for a Real Conversation About Abortion

Heather Corinna

In talking about abortion, if inaccurate, misleading or ideologically-loaded language is being used, or myths are being held as truths, our communication and understanding is always going to be limited.

The murder of abortion provider Dr. George Tiller on May 31st has
resulted in a lot of conversation about abortion. It’s a topic
frequently hushed, or spoken about more around its politics than the
actual procedure, the experience itself and the real women who have
abortions. So this increased discussion is certainly something
potentially positive happening because of something horribly tragic.
More discussion around anything which is or may be treated as
unspeakable is always a good thing.

However, often in these conversations and news stories, language is
used that’s confusing or inaccurate, and some statements are made about
abortion or women who choose abortion which are false, unrepresentative
or misleading. And any of this can come from either "side" of abortion
debates or discussions, due to political aims or motivations,
ideological ideas or agendas or just out of plain old ignorance. Just
like a whole lot of people don’t know the finer points of open-heart
surgery, a lot of people just don’t know what goes on with an abortion
procedure, especially from a provider’s point of view. If inaccurate,
misleading or ideologically-loaded language is being used, or myths are
being held as truths, our communication and understanding is always
going to be limited. And that’s never a good thing, unless we don’t really want to understand something at all.

Let’s start with a few typical language issues. When the politics of
abortion are discussed, often language is used in talking about
abortion that doesn’t actually exist in the practice itself, that
providers don’t usually use or have any practical use for, and some of
which is absolutely meaningless or invented only to try and
misrepresent abortion or pregnancy.

"Late-term abortion"

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Plenty of you have probably heard the term "late-term abortion,"
lately because Dr. Tiller was one of the few providers who provided
abortions for women past 24 weeks. "Late-term" is a phrase that we
don’t use in practice because it doesn’t mean anything solid, practical
or medical. Even in common use it’s pretty meaningless: when some
people say that they mean an abortion from the 20th week through the
current legal limit (which in some states is up to 28 weeks), others
mean the whole second trimester, and some are talking about abortions
into a period of time when legal abortions can no longer even be
performed (past that 28th week or less in some states) except when the
life or health of the mother is in danger, as determined by her doctor.

Whether a doctor or healthcare worker is talking about a pregnancy
that ends in a birth, miscarriage or with an abortion, we talk about
the timing of pregnancy either in weeks (as in, labor and delivery
usually happen around the 40th week) or in trimesters. The first
trimester of pregnancy is from gestation (from the date of a woman’s
last menstrual period) through 12 weeks, the second from weeks 13-28,
and the third from week 29 until a full-term, which is generally
considered to be between the 37th and 42nd week, even though some women
may deliver earlier or later.

Viability is more of a legal term than one used in healthcare, and
in legal use has been defined as a fetus "potentially able to live
outside the mother’s womb, albeit with artificial aid." In other words,
for much of pregnancy, even with amazing care and medical technology, a
fetus cannot survive outside a mother’s uterus. But at a certain point,
even if it has not fully developed yet, it can or may be able to.

What viability is considered to be, in terms of at what number of
weeks, varies from state to state and has also changed over time. When
Roe Vs. Wade was decided, viability was considered to be around 28
weeks, but since that time, it has changed in some areas or countries
to be as early as 22 weeks. However, in practice, viability is
generally determined more by unique development, like lung development
(which will vary some from fetus to fetus) rather than by weeks.

An astute bit of commentary in the Wiki on pregnancy
adds about the increasing time period of viability that,
"Unfortunately, there has been a profound increase in morbidity and
mortality associated with the increased survival to the extent it has
led some to question the ethics and morality of resuscitating at the
edge of viability."

Babies and Conception

"Baby" is another term we don’t use in medical practice: it’s an
infant or newborn when we’re talking about a live birth. Before birth,
we are talking about an embryo, around two weeks after gestation, or a
fetus, from the end of the tenth week of gestation onward. This
language is not meaningless or just about semantics: we’re talking
about very different phases of development when we talk about a zygote,
a blastocyst, an embryo, a fetus and an infant. But for those of us
working in abortion, embryo or fetus are the only terms we’re using:
anything before an embryo is to early for a termination (and often even
for a pregnancy test), and an infant at or post-birth is not something
we ever see in our practice.

Conception is also not a term we use in abortion. We don’t have any
need to argue when conception does or doesn’t start, or to use this
term at all because it doesn’t give us any information we need. What we
need to know is if a woman is pregnant, and if so, what the size (via
an ultrasound) of the fetus or embryo is, and, for legal purposes, how
many weeks pregnant she is based on that size and her last menstrual
period.

"Partial-birth abortion"

This this is not a medical term, and there is no such medical
procedure that exists by this name. Rather, it was a term invented by
Douglas Johnson, the legislative director for the National
Right to Life Committee in 1995.

We have a legal ban — put in place during the Bush administration,
and which remains in place now — on something by this name, even
though it has no meaning in actual practice. Incidentally, the law itself
also contains some pretty strange language for a law or policy. (In
fact, if you also click the link to Roe V. Wade on that page, check out
how different the language is. It’s a pretty major difference.)

What people using this term usually mean is a termination which is
done around or after the legal limit for elective (as in, chosen, and
with no need for a doctor’s order) abortions. The actual medical
practice often being called "partial-birth" is an intact dilation and
extraction (an ID&X, which is very different than a standard
D&E), which is almost exclusively done for health reasons,
stillbirth or profound fetal abnormalities, and/or also if the mother
or parents would like the fetus to remain intact (for their own
emotional process or for burial) or an autopsy is recommended. I won’t
go into depth here about all that procedure can involve, but now that
you know the right term, you can look it up for yourself, or take a
look here, here or here for some sound general information.

Abortion procedures done at this time make up less than 2% of all
abortions every year: they are exceptionally rare. An ID&X is not
usually the procedure used for second-trimester procedures, and never
for first-trimester procedures. ID&X is a type of abortion
procedure for women who, very late in the game (usually in the third
trimester) discover that either their fetus has very serious problems,
that their health or life will be or is in grave danger with a birth or
continued pregnancy, and/or if a fetus was already was stillborn (had
died in the womb). A termination done like this and at this time can
spare the mother the physical risks and emotional pain of going through
the rest of her pregnancy, then labor and delivery with an infant
absolutely known to be born still (to be dead before birth), or which
would die shortly after birth. An ID&X can also be done more
quickly than an induced labor and delivery, and with life or health at
stake, that’s another reason why it has sometimes been done.

"Abortion doctor"

I don’t know of anyone with a doctorate degree in abortion, nor of
any programs where you can get a doctorate in abortion. "Abortionist"
is also a problematic term for this reason. "Abortion provider" is the
preferred term by most. Many doctors who provide abortions are OB/GYNs:
they are obstetricians and gynecologists. Some nurses also administer
medical abortions.


With those linguistic foibles cleared up, let’s take a brief look at
some common statements you may have heard before the last few weeks,
but may be hearing more of now. Nearly all of these statements are
either false, misleading or only represent one group of women or one
kind of experience while rendering another invisible. And all or some
of them have been used by more than just one "side" of debates around
abortion, too. Some of these phrases are used by those who are
pro-choice (who support every woman’s right to choose parenting,
adoption or abortion, whichever a woman feels is best for her), some by
those who are antichoice (who do not support a woman’s right to choose
all three of her options), some by both.

Some of the statements or my responses to them may make you
uncomfortable. I don’t state or respond to them to vilify anyone, to
call out one group any more than another, to put anyone’s rights at
risk or to enable these statements or ideas. I make them because I
think it is so important that we do our best to tell the truth about
abortion and about women. All too often I hear even some pro-choice
people who are not being truthful: sometimes out of ignorance, limited
exposure to abortion and the diversity of women who terminate,
sometimes because they seem to be trying to simply walk the party-line
and limit talk to those situations or women where abortion is the least
challenged out of a fear of losing our reproductive rights.

The thing is, when it comes to reproductive rights, choice and
experience, something as simple as a glib party line is too simple,
because women’s lives and reproductive experiences are not at all
easily simplified. We cannot be easily reduced down to one or two
groups when it comes to our experiences with pregnancy, any choice we
make around a pregnancy, or mothering. Those experiences and situations
are just much too varied for that.

If we deny or hide some truths — and usually the ones that challenge
us the most — I don’t think we’re helping anyone. If our rights are
based on falsehoods, or are only about one group of women and exclude
others, then they may not actually give everyone rights or be rights
which are particularly solid, rather than arbitrary or mercurial.

In my responses to these statements, I’m coming at them from a few
spheres of experience: from the decade and some I have run Scarleteen
and talked with or read women talking about abortion, from the year and
a half I have worked part-time at an abortion clinic (which provides
abortions up to 24 weeks), from a lot of academic reading on the
subject, both in terms of the medical aspects and the first-person
experience of pregnancy, decision-making and abortion, as well as from
my own life: my experiences and those of my friends and family.

"No woman wants to have an abortion."

Many women, if not most, who choose an abortion want to have one. If
a woman freely chooses abortion for herself, rather than being
pressured or coerced into it, then an abortion is absolutely what she
wants.

And let’s be real about that: women are pressured or coerced into all
of the possible choices with a pregnancy with some frequency. Sometimes
that pressure is direct, from family, partners, friends. Sometimes that
also comes from communities, cultures, religions, politics. No matter
WHAT choice a woman is making about her pregnancy, from a pro-choice
perspective, pressure, coercion or force is absolutely unacceptable.

By all means, some women have pregnancies they do NOT want to
terminate, where the last thing they want is an abortion, yet they
still decide to terminate, usually based on very serious or grave
circumstances. Some women feel that of the three choices available they
don’t want to make any of those choices: but one has to be made, even if none of them are wanted.

There is a range in this: for some, abortion is an ideal choice,
what is most wanted, full-stop and without any feelings of conflict.
For others, neither abortion nor childbirth are wanted outcomes, but
abortion is the more wanted choice and what seems best to that woman
with her pregnancy. For many, feelings lie somewhere in between those
two poles.

"Every woman who choses abortion does so with sadness, or finds the decision to terminate one that is exceptionally difficult."

In the United States (and many other areas) abortion is legal.
And there is no legal requirement that a woman must feel a certain way
in order to have or retain the right to terminate her pregnancy.

There is no way all women feel with the end of every or any
pregnancy: all women who terminate do not experience feelings of pain
or deep sadness, just as all women who give birth do not experience
bliss and perfect joy (a myth which is propagated just as much as the
opposite around abortion has been). Women’s feelings vary widely with
every pregnancy, every termination, every delivery. There is not a
"right" way to feel with any of these choices, with any part or
experience of pregnancy, nor if a woman does or doesn’t feel a given
way is she any more or less entitled to her own choices with her
pregnancy.

"No woman has an abortion casually."

Just as the case is with the great range of experiences with how a
woman feels about abortion, so it is with the motivation for, or
decision-making process with abortion. Some women DO have abortions in
a way you or I – or even they – might call or see as "casual." For some
women, having an abortion is not a big deal, is not upsetting,
is not something she feels carries a lot of weight for her. It should
also be noted — though this is not to say if a woman is "casual" about
abortion it is only for this reason — that certain developmental
disabilities, addictions, traumatic life experiences or psychological
conditions can cause a woman to give any number of things, like death,
abuse or pregnancy, less gravity than others might give them or feel
about them.

Having talked to a lot of women about their abortions, would I say
there are many women who feel casually about abortion or take it
lightly? No, I would not: in my experience, that’s the exception rather
than the rule. In fact, I think we can go one step further and say few
women feel casual about a pregnancy, period. But again, we have to be
very careful not to deny any woman’s real experience, even if the
reason we might be tempted to do so is in an effort to try and retain
her/our rights.

"Abortions in the second trimester are only done in cases of rape, incest, or when the health of the mother and/or fetus are at risk."

That is not true. While in the third trimester, past viability,
abortion procedures can only be done when the mother’s life is at risk,
this is not so for most or all of the second trimester. While
second-trimester procedures are much less common than those done in the
first trimester, many second-trimester abortions are chosen electively,
and it is absolutely legal to do so.

Why do women terminate in the second trimester? Well, this is a big
topic, because we’d need to address the myriad of reasons why a woman
has an abortion at any time. We’d also be irresponsible if we
didn’t explore why it is that second-trimester procedures are
considered so different than first-trimester procedures by many people,
even though that doesn’t fit everyone’s experience of pregnancy. So,
I’ll have to shortcut a bit here to avoid writing a thesis.

There are some common reasons why women do not terminate by the end
of the first trimester, but in the second: because she didn’t accept or
know she was pregnant until later (remember that not all women have
regular periods, and some women experience bleeding during pregnancy
they mistake for a period), because she couldn’t afford a termination
until later, because she couldn’t get access to an abortion in her area
earlier, because she originally wanted a pregnancy, but then changed
her mind, often based on something major changing in her life (loss of
a home or job, loss of healthcare, a natural disaster, another child or
family member becoming ill or in need, loss of a spouse or husband or
of a partner’s support for a pregnancy or child, a relationship
becoming abusive or existing abuse increasing, etc.), and also because
of maternal or fetal health issues or abnormalities (often these can’t
be identified until later in a pregnancy).

If you want to know more about women who have had later
terminations, some sites have recently been compiling first-person
stories. Rewire has a bunch here, and The Atlantic has a good round-up of some from their site here.
And for general first-person abortion stories from women at all stages,
the clinic I work for has kept a story archive for a long time right here.

"If everyone had access to birth control and all the methods we had were 100% effective, all pregnancies would be wanted and we would have no abortions." 

While some women have very firm and consistent feelings before and
during the whole of a pregnancy that a pregnancy is wanted, not
everyone feels that way. Given how much pressure expectant mothers are
under to express nothing but joy about a pregnancy, we can’t even
accurately say how many women have mixed or mutable feelings: we just
don’t live in a world yet which allows women that kind of honesty
around pregnancy.

Even if every wanted pregnancy remained wanted, we can be certain
that many women would still want and need abortion. Life doesn’t just
stay put while we’re pregnant, so our circumstances can always change,
like some of the changes I talked about above, and some of those
changes can seriously alter our plans, previous wants and needs or the
status of our pregnancy. In fact, I think it’s pretty strange to talk
about a process which is about nothing but constant change – for a developing, as well as for a pregnant woman – as if it could be unchanging.

That said, birth control access and efficacy is a huge issue, and
given that in America alone, nearly half of all pregnancies which end
in abortion are unintended, we know that lack of access to methods, not
knowing how to use methods properly or having a lack of cooperation
around contraception in sexual partnerships and the level of
effectiveness methods provide does very much contribute to more
abortion than we would see otherwise. Those earnestly looking to help
reduce the number of abortions drastically should absolutely be working
to increase birth control access, awareness and the development of
reliable methods of contraception, since this is the one thing we know
would make a huge difference which does not in any way diminish or
remove women’s reproductive rights.

"Women who have abortions don’t like or love children."

In the United States around 60% of women who have abortions are
already mothers; mothers who love their children no more or less than
anyone else. Often already being a mother informs much of their choice:
they know, after all, without having to guess, what parenting requires
and what their children need, and if they can or cannot meet those
needs. Lower-income women have always had more abortions than higher
income, and that’s part of this piece, too: many women know when we
cannot afford any children or are already finding it very difficult to
provide care for existing children. Some women choose abortion in part
or entirely out of love for the children they already have: they know
when another mouth to feed and child to care for will make providing
good care for all their children impossible.

There’s an old pro-choice slogan which is "If you can’t trust me with a choice, how can you trust me with a child?"
It’s been pretty popular because it feels so true for so many women.
When women make decisions around pregnancy, they usually are not just
about either themselves or a child, but about the welfare of both.
Mothering is not an easy business and mothers have to make choices for
their children every day, often many times a day, and some of those
choices are tough ones. Deciding to be a mother or not is one of those
choices, potentially the biggest and most important of all of them.

"Abortion is a bloody, ugly, brutal, painful — insert any other words here used to make surgery sound like a world war — procedure."

I spent a lot of my childhood in a hospital: my mother was a nurse
and a single parent, the hospital was often my after-school hangout,
and I was a curious kid. I probably saw more blood and guts than most
children do for that reason. I was also an adventurous child who got
injured a lot: I severed two of my fingers when I was seven, scraped
the mush of them off the sidewalk, and carried them rather casually
back to our apartment. (Some of my ability to do that without flinching
was likely shock, mind you, but some was probably because I was used to
dealing with or seeing injuries.) I also personally have seen blood and
violence in my personal life outside medical situations, and have lived
through a few incidents of brutality, as have other members of my
family. And I have observed a number of abortion procedures, both in
the first and second-trimester. I’ve also had a termination myself, and
did so only with a local anesthetic.

Certainly, to some people, any surgery seems or looks bloody and
brutal, especially those who get queasy around this stuff. Too, not
everyone can manage emotions well around blood and other things
involved in surgery and healthcare.

However, ANY surgical procedure usually involves blood. Most involve
pain or discomfort, either before, during and/or in recovery from the
surgery, and when a surgery is not painful, it’s usually because
anesthetic and/or sedation was used: some abortion providers offer
both, others just one. Are abortions more bloody than most other
procedures? No. More bloody or physically (or emotionally, though that,
varies very widely from women to women and birth to birth) intense for
a woman than childbirth? Not usually.

Are most women I have observed in horrible pain during their
abortions? No. All of our pain thresholds vary, so what a woman
experiences varies, but again, we’re not talking about a birth here
(birth is usually painful, but we hardly suggest that’s a reason women
should not give birth), and remember, too, that most abortion
procedures only take a few minutes, not hours and hours. Most abortions
are not highly painful procedures, and pain can also be managed with
medications, as with any surgery. While like other aspects of abortion,
experiences of pain vary, some women even report that their monthly
menstrual cramps or some sex they have in their lives had has been more
painful than an abortion was.

I have yet to see an abortion procedure I’d describe as brutal or
violent. As someone who has observed procedures first-hand, I’m always
amazed by how many people who have NOT done so will tell me how things
happen, or how awful everything is, apparently forgetting that of the
two of us, I’m the only one who actually knows and has experienced how
abortions are performed.


By no means is this an inclusive list of either the language used or
misused with and around abortion or the various mythologies around
abortion and women who have abortions. But it’s a place to start, and
we truly are long overdue at even just starting truthful collective
conversation about abortion. If we truly can do that, I strongly
suspect that it can play a part in both reducing clinic violence and in
everyone starting to see women’s lives more clearly, accurately, fully
and compassionately.

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.