Get Real: Age 13 and “100%” Ready for Sex?

Heather Corinna

Just. Slow. Down. You keep saying you just don't know about all of this. That's okay: you don't have to know. But do yourself a favor and don't put yourself in a position where you have to.

vergin_13confussd asks:

Im 13 and a vigin and my boyfriend is 13 and not a vigin, and we’re 100% ready 2 have sex, but the problem is that hes in south carolina and im in minnsota. Wen I lived in sc he went 2 my skool and we never talked. But there was a girl that would always say bad stuff about him, like hes slept wit every girl in the skool and hes such a bad guy, blah blah blah. so 1 day i messaged him on myspace and i gave him my number 2 txt me. i wanted 2 hear his side of the story. we got 2 no each other and we fell in love. im just worried that hes not done with his cheating ways, n that after we have sex hes gunna leave me. 1 of his ex’s says that hes telling her that he doesnt love me and that he wuld cheat on me, but it depends on who. and that hes jus using me. idk wat 2 believe anymore!! i love him with all my heart and we believe were soulmates!!! ive never felt like this b4. and he says the same thing. my question is: how do ik he is gunna change and not leave me? and how do ik hes not jus tellin me wat i wanna hear? he says that im gunna b perfect in bed, but im jus so worried that im not gunna b as gudas he hopes. how do ik i’ll b good? i really need 2 no!! im desperatly confused and dk wt 2 do!!!! my mom says he means wat he says 2me and that she’s been threw sumthin like this. my heart says to stay with him and my gut says that stay with him but yor gunna get hurt. i jus dk. i really need help!! Thanks Heather!!!

Heather Corinna replies:

I can’t make these choices for you, and I think it’s really important you make and own your own choices in relationships and in sex once you start choosing to have them be part of your life. What I can do for you is to try and give you some extra information and perspective, based on what you’ve said here, that I think you might need and would be good to consider when you’re making these choices.

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A lot of what you’re saying suggests that both of your expectations, about sex and also about this relationship, are probably unrealistic. When that’s the case, it’s so hard to make good choices. In your profile here at the site, you talk about how you want to have sex just to get it over with, but that you want it to be very “romantic, memorable and special.” Those two things are usually at odds with each other, and from the sound of your question here, you’re much more invested in that big stuff than you are in just “getting sex over with.” People who earnestly want to just get sex over with don’t tend to ask the things you’re asking.

What I’d like to do is go through some pieces of what you’ve posted here and give you a reality check around them. Hopefully, what perspectives I can add to what you’re asking and what you’re already thinking, feeling and wanting will help you get more clarity around all of this and help you make the choices that are most likely to result in what you really, really want.

We’re 100% ready to have sex

I’m not sure anyone can know we’re 100% ready for sex with anyone we haven’t had that kind of sex with before and/or when we haven’t had sex with anyone, period. Until we’ve been having that kind of sex with that particular person — or have at least had some kind of sex with them, and have been interacting with then in ways that give us real cues about how it might go, which does mean time spent together in-person — we just can’t predict a lot of how it’s going to go, what it could be like, how we’re all going to feel about it, or what the outcomes are going to be, positive, negative and neutral. If we’re also not in touch with the overall and general possible realities and outcomes of something in general, we can’t say we’re ready because we can’t know all that we’d possibly need to be ready for.

I’ve talked about this in a few columns in the past, but one thing we know about sex and age that’s very well documented is that the younger someone is, the more unrealistic their expectations of sex tend to be. In other words, what you expect sex to be like, to go like, to require of you and a partner at this age is probably a bit more off base than your expectations two years from now, a lot more off-base than your expectations will probably be four or five years from now, and way, way more off-base than your expectations will probably be ten years from now. That’s because in all those years, you’ll learn not just more about sex and relationships, and about other people, but you’ll find out and learn a lot more about yourself, including what you really want and need in sex and in love, what you can and can’t deal with, and what you being ready — not anyone else, just you, uniquely — really looks and feels like. In your teens and twenties, a lot of development happens pretty fast sometimes, so even just a difference of one year can be a lot bigger than it seems like it might be.

My guess is, particularly given your age, that you’re probably not ready for some of those potential outcomes of sex, and that he might not be either. If only the good stuff is being talked about, or the sexy stuff, and not any of the tough stuff, that’s another clue that one or both of you probably aren’t ready, because if you were, you’d know those things need to get talked about, too. For instance, you’re probably not ready to handle a pregnancy. You’re probably not ready to handle having sex, then having this relationship tank right after you’ve been so vulnerable and exposed. You or he may not be ready to handle taking safer sex seriously, which includes not just always using condoms, but each of you getting tested for STIs, something that if he hasn’t done yet having already been sexually active, which he probably hasn’t, gives you a big clue he’s so not ready.

You also might not be ready to handle even some outcomes you think you might want, like your boyfriend winding up very attached to you… maybe too much for your comfort. Or your own feelings being stronger…but him not reacting well to that and running scared. Or him indeed finding out he thinks you’re great in bed… and deciding that means that he only wants a sexual relationship with you, not something romantic after all. Even just managing having sex we really enjoy, and a sexual relationship that’s awesome can be tough to fit into the rest of our lives in a way we don’t blow the other important stuff, and that’s a lot harder when we’re a lot younger than it is a little later down the road.

I love him with all my heart and we believe we’re soulmates! I’ve never felt like this before, and he says the same thing.

Here’s the tricky thing about the idea of soulmates. Really, until we’ve lived a whole life, if there is such a thing as soulmates, or we feel we had one or more than one, we probably won’t be able to know who ours were until we’re old and grey when we can look back at many decades of life. I don’t mean to harsh your love buzz. I’m glad that you are experiencing such wonderful feelings, feelings I think matter and are important whether or not you’re soulmates, and whether or not this relationship lasts two weeks or fifty years. I think you should enjoy and value those feelings.

But when people say they believe that they’re soulmates, especially when they haven’t spent a lot of time together in their lives, when they haven’t been though some big life challenges together to know how they do or don’t help each other when the chips are seriously down, it’s usually mostly because they want that to be true. If that’s something you want — maybe even something you feel you need — then you want to walk here, not run. Because if you rush in too much, throw your whole heart in, take big risks and find out that isn’t true, it’s going to hurt like hell when it really doesn’t have to. People who believe in soulmates generally have the idea that those people have been together in lives before and/or will be important to each other for the whole life they’re in, and maybe even past that. That’s a long time. If someone really is going to that important for that long, and is somehow deeply linked to us that way, then it seems to me that there’s no hurry at all, and those folks have got all the time in the world — literally! — to get to know each other over time, to build a relationship over time, and to take plenty of time in all their choices together.

Both of you may not have felt this way before. However, chances are good that you will both not only probably feel this way again in your lives, with other people, you’ll probably experience feelings a lot deeper and more enduring than these, not because you’re shallow people or anything, but simply because the more life experience we gather, the more we grow, the richer and more complex feelings of love (and lust!) can tend to become.

What’s most common is for romantic relationships when we’re very young to be relatively short, or, if they last for more than a few weeks or months, for our feelings and interests to change well before adulthood. That doesn’t mean they’re not a big deal or not important: a relationship lasting a long time, or a lifetime, isn’t automatically more important or more valuable just because it did. There are an awful lot of people in long-term relationships that are really crappy, after all. It just means that both of you having these feelings for the first time doesn’t mean they’re the last time you’ll have them, are the last people you’ll have them with, or that this is as big as it gets. Believe it or not, these feelings can get a whole lot bigger.

How do I know he is going to change and not leave me? How do I know he’s not just telling me what I want to hear?

You don’t. You can’t know either of those things now. What you can do is take some more time to see how things pan out not just over weeks, but over months and years. You say you texted him because you wanted to hear his side of the story, but you also say you’re worried that he’ll “return to his cheating ways.” Does that mean that he verified that some of what had been said about him was true? If it does, then he’s got a pattern to change. That’s something he’ll need to take real time with to work on on his own, not something that’ll be magically fixed just by loving you a lot. If he has tended to make commitments he doesn’t honor, some of the work he’ll need to do is to stop being so quick to make those kinds of commitments, taking more time to make them and not making them until he really knows he can honor them. Time that, from the sounds of things, he hasn’t taken.

It’s crystal that it’s important to you that a person you have sex with is loyal to you and also doesn’t ditch you; that you’re not likely to feel comfortable with a sexual situation where you’re not strongly sure that’s not going to happen. That’s something that’s important to a lot of people, and also something that informs a lot of people’s decisions about who they have sex with and when they have any kind of sex. Some people are comfortable just going on hope and a prayer and seeing what happens, feeling capable of managing any rough emotional fallout. Other folks need more than that, or know they either aren’t up for handling that kind of fallout, or really want to try and avoid it.

You sound like the latter to me, and I’d honor yourself in your own wants and needs there. If you want and need those things, and it sounds like you do, take good care of yourself in that by taking the time to be pretty darn sure you’re going to get those needs met. You also seem to be saying it’s possible this guy has treated other partners poorly in the past, and it certainly sounds like more than one girl has not had a stellar experience with him. While sometimes people just talk trash, it’s always sound to figure you can’t know what’s trash and what’s truth in this kind of situation until you take more time to see how this person actually behaves over time.

He says that I’m going to be perfect in bed. How do I know I’ll be good? I really need to know!

This is another one of those things you can’t know, but I’d also think about why it’s so important to you to “be good in bed.” Being sexual with someone is an intimate thing to do with them, and when we’re getting that close to somebody, it should be okay to be as human as we are, including sucking at things sometimes or not knowing what the heck we’re doing. If you feel like you have to be perfect or worry you won’t perform up-to-par, remember, this isn’t supposed to be a performance. Sex — the first time or the 201st — is supposed to be an experience, and one where, ideally, all that’s expected of you is that you be yourself, you let the other person be themselves, and you both treat each other with care.

Just so you know, I think the whole idea of “good in bed” is stupid. I don’t think you’re stupid, or stupid for thinking that means something, just that it’s a stupid idea a lot of smart people get fooled into thinking is something other than stupid. Someone being a good lover generally has to do with things magazines don’t talk about and movies don’t show us: things like being a good communicator and a good listener, like being creative and imaginative, like being respectful and thoughtful and kind, like being willing to make a fool out of yourself, like being comfortable and confident in your own skin and around other people’s bodies. All of that stuff? All of that stuff tends to be what most of us do without trying too hard when we care about and have confidence in ourselves, care about and have confidence in other people, and when we are really invested in ourselves and other people and they’re really invested in themselves and us.

That feeling of just wanting to get first-time sex over with often comes from wanting to just get worries and anxieties like this over with — Will I be good? Will someone else think so? Will a sex partner stick around after I had sex with them? Will I get my heart broken? Will I even like sex? What if I don’t? What if I do? Here’s the thing a lot of people thinking that way don’t know yet: once you start having any kind of sex, if you’re still thinking the same way about those things — something that won’t change just because you had sex, but only if you change the way you think about it — those worries usually stick around or get even more crazymaking. On top of that, being sexually active brings with it a host of new things to worry about you aren’t worrying about yet, or things you have to be concerned with because they’re real and happening, not imagined or not happening yet. So, having sex to try and get rid of those worries is not exactly the smartest strategy most of the time, especially since having sex involves opening yourself up to a bunch of risks.

Here’s the good news: you can chill those worries and anxieties, without taking any risks at all you’re not ready to deal with, by changing how you think about this and by taking the pressure off by not getting involved with sex with someone else just yet. If you’re WAY worried about being good in bed, that tends to be because you’re not in the right space in your life or your own personal or sexual development to be secure enough in yourself to have sex with someone else. So, you don’t have to. Which means you don’t have to be concerned about this at all right now. I’m not trying to be a brain surgeon, nor am I doing any brain surgery, so it doesn’t matter whether or not I’m good at it. Get it?

When you are in a space where sex is the right thing for you and someone else, when you are in a relationship you feel pretty secure in, when you feel more secure with yourself, and when you’ve taken more time to develop, think about and explore your own sexuality (the one you have all by yourself and can explore in your own head and heart, and with your own hands), you won’t worry as much about this stuff. I promise. You’ll feel a lot more relaxed, and it’ll all seem like less of a huge deal. Some of why some of these worries probably feel so big is that you’re just not ready for the place you’re thinking about putting yourself in. I think your worries are trying to tell you something important that can help you make your own best choices.

While I know that long-distance relationships can be a bummer when you feel very strongly about someone and miss them, in this case, I actually think it’s probably a good thing. I’m saying that because I don’t think you two leaping into bed right now would be so great for you or be like you think it would. I strongly suspect you’d not get what you want and need in it, that it’d be way more likely for things to happen you really didn’t want or weren’t able to handle now than later. It sounds like in person, you’d have a hard time not being impulsive. There are also some cool parts of long-distance relationships I think you can take advantage of right now.

A lot of deep communication that’s not easily distracted by strong sexual feelings tends to happen when things are long-distance, for instance. I’m not talking about texting or IMs. I’m talking about long phone conversations and letters, things we put real time and effort in. Ideally, in that kind of communication you two will be talking about more than wanting to go to bed together, who is going to be good in bed, or sussing out if someone’s rep is or isn’t factual. You can also see if both of you feel strongly enough to keep up with letter writing, to really put some creativity into your communication, and to find out how deep all of this really is for both of you(or isn’t). Long-distance relationships also mean we have to take things more slowly, which is a good thing if we’re otherwise inclined to jump into the deep end before we have any idea of how to swim. It sounds like you need more time, and it sounds like you have that time.

I want to add that while it’s great you’re able to talk with your Mom, and great that she supports you in your feelings, she isn’t psychic. She can’t know that this guy means what he says, and whatever her previous dating experiences were can’t tell her that. It sounds like she may be projecting some of her own stuff here, and also like she just doesn’t want you to be upset, but I’d not put too much stock in her feeling that this guy must be on the up-and-up because someone she dated was. She didn’t date this guy (at least I certainly hope not!), so she can’t know his deal. That’s something only he, you and your mother can find out over time based on this relationship, not her past relationships.

I’ll leave you with some extra links that I think might help you out, but what I’d suggest is that you just. Slow. Down. You keep saying you just don’t know about all of this. That’s okay: you don’t have to know. But since you don’t know now, do yourself a favor and don’t put yourself in a position where you have to. I know it’s hard to slow things down when feelings are intense, but I think you’ll feel a whole lot better, and be better able to decide what’s right for you with your choices in this relationship, including any sexual choices, if you do. What you have here isn’t running so you have to chase it (and if it is, you know it’s not going to be a good deal). You can take plenty of time not only to make decisions, but also to just enjoy all the good stuff in this and see how it goes and where you’re comfortable taking it, step by step.

Culture & Conversation Maternity and Birthing

On ‘Commonsense Childbirth’: A Q&A With Midwife Jennie Joseph

Elizabeth Dawes Gay

Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Jennie Joseph’s philosophy is simple: Treat patients like the people they are. The British native has found this goes a long way when it comes to her midwifery practice and the health of Black mothers and babies.

In the United States, Black women are disproportionately affected by poor maternal and infant health outcomes. Black women are more likely to experience maternal and infant death, pregnancy-related illness, premature birth, low birth weight, and stillbirth. Beyond the data, personal accounts of Black women’s birthing experiences detail discrimination, mistreatment, and violation of basic human rights. Media like the new film, The American Dream, share the maternity experiences of Black women in their own voices.

A new generation of activists, advocates, and concerned medical professionals have mobilized across the country to improve Black maternal and infant health, including through the birth justice and reproductive justice movements.

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Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

At her clinics, which are located in central Florida, a welcoming smile and a conversation mark the start of each patient visit. Having a dialogue with patients about their unique needs, desires, and circumstances is a practice Joseph said has contributed to her patients having “chunky,” healthy, full-term babies. Dialogue and care that centers the patient costs nothing, Joseph told Rewire in an interview earlier this summer.

Joseph also offers training to midwives, doulas, community health workers, and other professionals in culturally competent, patient-centered care through her Commonsense Childbirth School of Midwifery, which launched in 2009. And in 2015, Joseph launched the National Perinatal Task Force, a network of perinatal health-care and service providers who are committed to working in underserved communities in order to transform maternal health outcomes in the United States.

Rewire spoke with Joseph about her tireless work to improve maternal and perinatal health in the Black community.

Rewire: What motivates and drives you each day?

Jennie Joseph: I moved to the United States in 1989 [from the United Kingdom], and each year it becomes more and more apparent that to address the issues I care deeply about, I have to put action behind all the talk.

I’m particularly concerned about maternal and infant morbidity and mortality that plague communities of color and specifically African Americans. Most people don’t know that three to four times as many Black women die during pregnancy and childbirth in the United States than their white counterparts.

When I arrived in the United States, I had to start a home birth practice to be able to practice at all, and it was during that time that I realized very few people of color were accessing care that way. I learned about the disparities in maternal health around the same time, and I felt compelled to do something about it.

My motivation is based on the fact that what we do [at my clinic] works so well it’s almost unconscionable not to continue doing it. I feel driven and personally responsible because I’ve figured out that there are some very simple things that anyone can do to make an impact. It’s such a win-win. Everybody wins: patients, staff, communities, health-care agencies.

There are only a few of us attacking this aggressively, with few resources and without support. I’ve experienced so much frustration, anger, and resignation about the situation because I feel like this is not something that people in the field don’t know about. I know there have been some efforts, but with little results. There are simple and cost-effective things that can be done. Even small interventions can make such a tremendous a difference, and I don’t understand why we can’t have more support and more interest in moving the needle in a more effective way.

I give up sometimes. I get so frustrated. Emotions vie for time and energy, but those very same emotions force me to keep going. I feel a constant drive to be in action and to be practical in achieving and getting results.

Rewire: In your opinion, what are some barriers to progress on maternal health and how can they be overcome?

JJ: The solutions that have been generated are the same, year in and year out, but are not really solutions. [Health-care professionals and the industry] keep pushing money into a broken system, without recognizing where there are gaps and barriers, and we keep doing the same thing.

One solution that has not worked is the approach of hiring practitioners without a thought to whether the practitioner is really a match for the community that they are looking to serve. Additionally, there is the fact that the practitioner alone is not going to be able make much difference. There has to be a concerted effort to have the entire health-care team be willing to support the work. If the front desk and access points are not in tune with why we need to address this issue in a specific way, what happens typically is that people do not necessarily feel welcomed or supported or respected.

The world’s best practitioner could be sitting down the hall, but never actually see the patient because the patient leaves before they get assistance or before they even get to make an appointment. People get tired of being looked down upon, shamed, ignored, or perhaps not treated well. And people know which hospitals and practitioners provide competent care and which practices are culturally safe.

I would like to convince people to try something different, for real. One of those things is an open-door triage at all OB-GYN facilities, similar to an emergency room, so that all patients seeking maternity care are seen for a first visit no matter what.

Another thing would be for practitioners to provide patient-centered care for all patients regardless of their ability to pay.  You don’t have to have cultural competency training, you just have to listen and believe what the patients are telling you—period.

Practitioners also have a role in dismantling the institutionalized racism that is causing such harm. You don’t have to speak a specific language to be kind. You just have to think a little bit and put yourself in that person’s shoes. You have to understand she might be in fear for her baby’s health or her own health. You can smile. You can touch respectfully. You can make eye contact. You can find a real translator. You can do things if you choose to. Or you can stay in place in a system you know is broken, doing business as usual, and continue to feel bad doing the work you once loved.

Rewire: You emphasize patient-centered care. Why aren’t other providers doing the same, and how can they be convinced to provide this type of care?

JJ: I think that is the crux of the matter: the convincing part. One, it’s a shame that I have to go around convincing anyone about the benefits of patient-centered care. And two, the typical response from medical staff is “Yeah, but the cost. It’s expensive. The bureaucracy, the system …” There is no disagreement that this should be the gold standard of care but providers say their setup doesn’t allow for it or that it really wouldn’t work. Keep in mind that patient-centered care also means equitable care—the kind of care we all want for ourselves and our families.

One of the things we do at my practice (and that providers have the most resistance to) is that we see everyone for that initial visit. We’ve created a triage entry point to medical care but also to social support, financial triage, actual emotional support, and recognition and understanding for the patient that yes, you have a problem, but we are here to work with you to solve it.

All of those things get to happen because we offer the first visit, regardless of their ability to pay. In the absence of that opportunity, the barrier to quality care itself is so detrimental: It’s literally a matter of life and death.

Rewire: How do you cover the cost of the first visit if someone cannot pay?

JJ: If we have a grant, we use those funds to help us pay our overhead. If we don’t, we wait until we have the women on Medicaid and try to do back-billing on those visits. If the patient doesn’t have Medicaid, we use the funds we earn from delivering babies of mothers who do have insurance and can pay the full price.

Rewire: You’ve talked about ensuring that expecting mothers have accessible, patient-centered maternity care. How exactly are you working to achieve that?

JJ: I want to empower community-based perinatal health workers (such as nurse practitioners) who are interested in providing care to communities in need, and encourage them to become entrepreneurial. As long as people have the credentials or license to provide prenatal, post-partum, and women’s health care and are interested in independent practice, then my vision is that they build a private practice for themselves. Based on the concept that to get real change in maternal health outcomes in the United States, women need access to specific kinds of health care—not just any old health care, but the kind that is humane, patient-centered, woman-centered, family-centered, and culturally-safe, and where providers believe that the patients matter. That kind of care will transform outcomes instantly.

I coined the phrase “Easy Access Clinics” to describe retail women’s health clinics like a CVS MinuteClinic that serve as a first entry point to care in a community, rather than in a big health-care system. At the Orlando Easy Access Clinic, women receive their first appointment regardless of their ability to pay. People find out about us via word of mouth; they know what we do before they get here.

We are at the point where even the local government agencies send patients to us. They know that even while someone’s Medicaid application is in pending status, we will still see them and start their care, as well as help them access their Medicaid benefits as part of our commitment to their overall well-being.

Others are already replicating this model across the country and we are doing research as we go along. We have created a system that becomes sustainable because of the trust and loyalty of the patients and their willingness to support us in supporting them.

Photo Credit: Filmmaker Paolo Patruno

Joseph speaking with a family at her central Florida clinic. (Credit: Filmmaker Paolo Patruno)

RewireWhat are your thoughts on the decision in Florida not to expand Medicaid at this time?

JJ: I consider health care a human right. That’s what I know. That’s how I was trained. That’s what I lived all the years I was in Europe. And to be here and see this wanton disregard for health and humanity breaks my heart.

Not expanding Medicaid has such deep repercussions on patients and providers. We hold on by a very thin thread. We can’t get our claims paid. We have all kinds of hoops and confusion. There is a lack of interest and accountability from insurance payers, and we are struggling so badly. I also have a Change.org petition right now to ask for Medicaid coverage for pregnant women.

Health care is a human right: It can’t be anything else.

Rewire: You launched the National Perinatal Task Force in 2015. What do you hope to accomplish through that effort?

JJ: The main goal of the National Perinatal Task Force is to connect perinatal service providers, lift each other up, and establish community recognition of sites committed to a certain standard of care.

The facilities of task force members are identified as Perinatal Safe Spots. A Perinatal Safe Spot could be an educational or social site, a moms’ group, a breastfeeding circle, a local doula practice, or a community center. It could be anywhere, but it has got to be in a community with what I call a “materno-toxic” area—an area where you know without any doubt that mothers are in jeopardy. It is an area where social determinants of health are affecting mom’s and baby’s chances of being strong and whole and hearty. Therein, we need to put a safe spot right in the heart of that materno-toxic area so she has a better chance for survival.

The task force is a group of maternity service providers and concerned community members willing to be a safe spot for that area. Members also recognize each other across the nation; we support each other and learn from each others’ best practices.

People who are working in their communities to improve maternal and infant health come forward all the time as they are feeling alone, quietly doing the best they can for their community, with little or nothing. Don’t be discouraged. You can get a lot done with pure willpower and determination.

RewireDo you have funding to run the National Perinatal Task Force?

JJ: Not yet. We have got the task force up and running as best we can under my nonprofit Commonsense Childbirth. I have not asked for funding or donations because I wanted to see if I could get the task force off the ground first.

There are 30 Perinatal Safe Spots across the United States that are listed on the website currently. The current goal is to house and support the supporters, recognize those people working on the ground, and share information with the public. The next step will be to strengthen the task force and bring funding for stability and growth.

RewireYou’re featured in the new film The American Dream. How did that happen and what are you planning to do next?

JJ: The Italian filmmaker Paolo Patruno got on a plane on his own dime and brought his cameras to Florida. We were planning to talk about Black midwifery. Once we started filming, women were sharing so authentically that we said this is about women’s voices being heard. I would love to tease that dialogue forward and I am planning to go to four or five cities where I can show the film and host a town hall, gathering to capture what the community has to say about maternal health. I want to hear their voices. So far, the film has been screened publicly in Oakland and Kansas City, and the full documentary is already available on YouTube.

RewireThe Black Mamas Matter Toolkit was published this past June by the Center for Reproductive Rights to support human-rights based policy advocacy on maternal health. What about the toolkit or other resources do you find helpful for thinking about solutions to poor maternal health in the Black community?

JJ: The toolkit is the most succinct and comprehensive thing I’ve seen since I’ve been doing this work. It felt like, “At last!”

One of the most exciting things for me is that the toolkit seems to have covered every angle of this problem. It tells the truth about what’s happening for Black women and actually all women everywhere as far as maternity care is concerned.

There is a need for us to recognize how the system has taken agency and power away from women and placed it in the hands of large health systems where institutionalized racism is causing much harm. The toolkit, for the first time in my opinion, really addresses all of these ills and posits some very clear thoughts and solutions around them. I think it is going to go a long way to begin the change we need to see in maternal and child health in the United States.

RewireWhat do you count as one of your success stories?

JJ: One of my earlier patients was a single mom who had a lot going on and became pregnant by accident. She was very connected to us when she came to clinic. She became so empowered and wanted a home birth. But she was anemic at the end of her pregnancy and we recommended a hospital birth. She was empowered through the birth, breastfed her baby, and started a journey toward nursing. She is now about to get her master’s degree in nursing, and she wants to come back to work with me. She’s determined to come back and serve and give back. She’s not the only one. It happens over and over again.

This interview has been edited for length and clarity.

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.