Commentary Maternity and Birthing

Hyperemesis is Serious Business, Whether You’re a Princess or a Pauper

Jodi Jacobson

Hyperemesis is no stroll in the palace park. Kate may be a princess, but she is also human. Women of every race, class, and income level face risks in pregnancy and put their bodies on the line every time they get pregnant. The only differences between the princess and the pauper are that one has proper food, nutrition, and care and the other has none.

As you might imagine, virtually every news outlet still located on planet Earth has covered the fact that Princess Catherine, Duchess of Cambridge, is officially pregnant. A feeding frenzy of press coverage on the royal pregnancy has been virtually guaranteed since the day she and Prince William got engaged.

But unlike those princesses in the fairy tales, Princess Kate’s pregnancy is so far neither easy nor uneventful. An announcement from the Royal Family stated that she was hospitalized with hyperemesis gravidarum, which the American Pregnancy Association explains as “a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Mild cases are treated with dietary changes, rest and antacids. More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line (IV).”

Major news organizations are not widely known for their effective treatment of women’s health issues, and so it’s not been surprising to me that many have reported Kate is suffering with a “bad case of morning sickness.” Others have been downright rude and ignorant. Gawker’s Caity Weaver, for example, wrote that “hyperemesis gravidarum [is] what they call regular old morning sickness when you are a princess.”

I beg to differ.

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Unless I am missing something, I am no princess; otherwise, my butler has been missing in action for quite a while and my diamond tiaras are nowhere to be found. I suffered from hyperemesis in both of my pregnancies. I assure you it has no relationship to the quaint notion of saltine-crackers-and-ginger ale morning sickness we all think about if and when we think about morning sickness at all. Really, it doesn’t.

From the very day of the six-week mark in my first pregnancy, I began to throw up. I never stopped. I vomited until there was nothing left to throw up, and then I would keep vomiting, resulting in sustained convulsing dry heaves. And this was day two. If I took a sip of water, it came right back up. If I tried to drink plain broth, same thing. Pregnancy vitamins? No way. If you have ever had a really, really bad case of food poisoning and gotten to the point where you were begging God just to let you die, you have a sense of what I am talking about here. But food poisoning lasts at most a few days. Try nine months like that.

In my case, within a couple of days of my “hyperemetic episode,” I was unable to walk around; when the dry-heave convulsing became literally painful, I was taken to the hospital for intravenous (IV) fluids. In that first pregnancy, I spent a cumulative total of five months in the hospital or at home in bed on IVs, with home health aides, catheters, nausea medicine, and the rest, unable to eat enough to sustain myself and tethered to IVs. I lost more than 30 pounds. (That made for great jokes *after* the baby was born, about how I never realized that all I needed to do to lose weight was to get pregnant.)

I was virtually unable to work for the better part of five months of my pregnancy, because I became so weak that walking up and down stairs—and some days lifting my head off the pillow at all—was difficult and made me excruciatingly tired and dizzy. When I did go places, we brought my IV bag. And the IVs only worked to keep me hydrated as long as I had them in; take out that IV, and I would go back into convulsive vomiting and lapse back into serious dehydration. I was six months pregnant and still on IVs before I could sip chicken broth or drink what oddly enough I most craved, Diet Pepsi, and hope to keep some down. When I expressed (constantly) to my doctor my concern for the baby, she reassured me: “Don’t worry. You came into this healthy and well-nourished. Its not the baby that is in danger right now, it is you, because the baby is feeding off all your reserves and you have nothing with which to replenish yourself.”

My daughter arrived as a healthy, alert 8-plus-pound baby. And, much to my obstetrician’s shock, I went through it all over again with my son.

Like Kate, I was lucky. I had a job I could keep; disability insurance; health insurance; and help from my then-husband, who had to take off work to change the intravenous fluids and take care of me. I had contraception to plan my pregnancies, great medical care, a wonderful Ob-Gyn, and the reassurance, even when I did not believe it, that my babies would be okay. Kate may have it worse or better than I did medically, but either way she is suffering from a potentially serious complication of pregnancy. And, what is more, she is going to be expected to “perform” for the cameras some time very soon, putting more pressure on her as a woman dealing with a serious condition in early pregnancy. The very thought of mixing cameras with hyperemesis makes me sick all over again.

The treatment of Kate’s condition by at least some media outlets as just another bout of morning sickness is at least in part a failure to really understand and report on pregnancy as anything other than a fantastic event, a tug of war between “choice” and anti-choice movements, a struggle to *get* pregnant, or a major social drama (think teen pregnancy).

Missing is an examination of just how dangerous pregnancy can be, and how dependent the lives of pregnant women are on access to good nutrition, good medical care, and good support systems. This same reality was illustrated in a different but tragic way in the case of Savita Halappanavar, who died last month in an Irish hospital because doctors refused to terminate her pregnancy at 17 weeks even though it was clear she was miscarrying and even after it became clear she could not survive unless in fact they terminated the pregnancy, quickly. They let her die.

But it is a reality played out every day in places throughout the world in which papparazzi have no interest. More than 350,000 women die each year from complications of pregnancy and unsafe abortion. The malnutrition, anemia, and other health conditions rampant among pregnant women worldwide are contributing factors. Cultural, economic, and social discrimination mean that both women and girls are exceptionally vulnerable to poverty and are less likely than men and boys to have  adequate food intake. Iron deficiency anemia, for example, contributes to 20 percent of all maternal deaths worldwide. One study conducted by UNICEF in Samburu, Kenya revealed that 60 percent of the pregnant women were malnourished, and even so, they still gave up shares of their food to make sure they could give more to their children.

Data show that HIV-positive pregnant women are more likely to be malnourished than their HIV-negative counterparts, a serious problem in regions like Africa where women make up the majority of those infected with HIV. Lack of emergency obstetric care is one of the leading factors in high rates of maternal death and illness throughout Africa, Asia, and Latin America. And in regions where under-nourishment in pregnant women is widespread, infants are far more likely to be born at low birth weight, a risk factor for neonatal deaths, learning disabilities, mental, retardation, poor health, blindness and premature death in infants.

So if I were a woman with hyperemesis in, say, rural Kenya, Nigeria, or Uganda, the outlook for me and my baby would have been dramatically different than it was in fact for the middle class United States me, or than it is for Kate (barring, of course, any other complications with her pregnancy). There would have been no IV fluids, little rest, and likely no extra resources to assist me. I might have died, along with my baby, and even if I had survived, my daughter would have a higher risk of dying and far poorer prospects in life.

Kate may be a princess, but she is also human. And as human beings, women of every race, class, and income level face many risks in pregnancy. What Kate—and Savita before her—have reminded us is that women put their bodies on the line every time they get pregnant. I wish Kate all the best. But the only differences between the princess and the pauper in this case are that one has proper food, nutrition, and care and the other has none.

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.

Commentary Abortion

Language Matters: Why I Don’t Fear Being Called ‘Pro-Abortion’

Maureen Shaw

Words can and do hurt, especially when they cast people who seek or provide abortion care as immoral or murderers. But pro-choice activists can embrace unapologetic language that represents hope, self-determination, and bodily autonomy.

Recently, an anti-choice website profiled me, repeatedly describing me as “pro-abortion.” I understood immediately that this was meant to be an insult and a negative character judgment. But instead of taking offense or feeling bullied, I smiled—even as the vitriol poured into my Twitter mentions.

I haven’t always been able to smile at anti-choice trolls. They attack your ideology, personality, and even your family. It’s threatening and can feel very unsafe, and with good reason; just ask any clinic escort, pro-choice journalist, or abortion provider who has been targeted by anti-choice zealots or organizations. Online harassment and bullying is deliberate and meant to incite fear; it’s also a stepping stone to physical violence and intimidation.

The first time I was on the receiving end of such hatred, it made me sick to my stomach and I was tempted to abandon social media altogether. But removing my pro-choice voice from the conversation felt like handing trolls a victory. So with a few tweaks to my public profiles (like erasing my location and no longer posting photos of my children), I’ve decidedly moved beyond that fear and refuse to shrink in the face of online harassment (Twitter’s mute function certainly helps too).

These experiences taught me two very important lessons: first, about cowardice (it’s so easy to spew hatred from the anonymity of the internet) and second, about the importance of language. Most of us here in the United States have heard the saying, “Sticks and stones may break my bones, but words will never hurt me.” While this is certainly true in the most literal of interpretations, we know words can hurt when they come in the form of threats against abortion providers or calling women who have abortions “murderers.”

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Indeed, the way we talk about abortion is critical, from how we describe our adversaries to legislative bill titles and abortion procedures themselves. When anti-choice lawmakers and activists wield language that is inflammatory, misleading, or demonizing, the public’s perceptions of abortion are compromised. The ensuing negativity, in turn, helps transform commonplace medical procedures into “morally repugnant offenses”—to use the language of ethics, which the anti-choice movement so often co-opts—that abortion opponents want to heavily restrict (at best) or outlaw (at worst).

The so-called pro-life constituency understands this all too well and has done a brilliant job of manipulating language to guide the national discourse on abortion. Even the “pro-life” moniker is a calculated—not to mention hypocritical—move. After all, if a person is not “pro-life,” they’re implicitly anti-family and anti-child. This automatically puts pro-choice activists and allies in a needlessly defensive position and posits anti-choice ideology as favorable.

This perceived favorability runs deep and has very real implications for pregnant people. For example, politicians and activists alike jumped at the chance to essentially redefine dilation and extraction (a surgical procedure used in later abortions) as “partial birth abortion” (and sometimes, “dismemberment abortion”). It’s an obvious misnomer and a dangerous conflation, as one cannot be born and aborted; that would be murder, not abortion. As a result, the procedure was banned without a health exception, courtesy of the 2003 federal Partial Birth Abortion Act. And there’s no ignoring the current onslaught of anti-choice legislation with catchy names like the “Women’s Public Health and Safety Act,” the “Born-Alive Abortion Survivors Protection Act,” and the “Pain-Capable Unborn Child Protection Act.”

Let’s be honest: These bills are not about protecting women’s health or safety. Their sole purpose is to demean women by prioritizing unviable fetuses over women’s very real health-care needs. And they’re successful in part due to their phrasing: The words “child,” “survivor,” and “protection” all evoke positive imagery, while simultaneously (and not so subtly) vilifying the person who no longer wishes to be pregnant.

To be fair, anti-choicers aren’t the only ones with a working knowledge of the power of language. The pro-choice community has made serious efforts in recent years to reclaim the word “abortion” and paint it as a positive (or at the very least, common) experience. Just look at 1 in 3 Campaign’s Abortion Speakout, the #ShoutYourAbortion social media campaign, and websites that curate positive abortion stories, and you’ll see a plethora of women embracing this shared reality. And it’s not just grassroots activists who have thrown down the proverbial gauntlet: Developers recently created a Google extension to change all “pro-life” mentions to “anti-choice.” Take that, anti-choice interwebs!

There have been efforts to move away from the terms “pro-choice” and “pro-life” altogether, because those simple labels don’t reflect a truly intersectional approach that goes beyond the traditional narrative around reproductive rights. I continue to identify as pro-choice because the term works for me. I believe it accurately expresses my support of the full spectrum of choice—parenting, pregnancy, adoption, and abortion—though I also understand and support activists’ rejection of the label.

As a pro-choice activist, I am heartened by these efforts and the ground gained. For so long, we’ve been on the defensive, from fighting stereotypes that pro-choicers can’t be parents to furiously trying to keep clinics open nationwide (and it doesn’t help that the mainstream media often fails to responsibly or fairly report on abortion). It’s been like trying to climb a steep hill covered in oil slicks.

But no longer. Thanks to the campaigns I’ve mentioned and others like them, pro-choicers everywhere—myself included—can more easily reclaim the power of language to shatter stigma surrounding abortion.

While I don’t pretend to have a new dictionary for those of us who work to support abortion rights, there are simple ways to leverage the words already in our lexicon to achieve success on this front. For starters, we can refuse to use the term “pro-life” in exchange for a more accurate description of the movement fighting to end access to a basic health service: “anti-choice.” We can also explicitly describe abortion as mainstream health care more consistently; doing so helps dispel the myth that abortion is rare, immoral, and a marginalized component of women’s health. And finally, we shouldn’t be afraid to embrace being called “pro-abortion.”

Why? Because “abortion” is by no means a dirty word—or thing, for that matter. I will happily embrace being called “pro-abortion.” Admittedly, the term is problematic when it’s used to suggest that all pregnancies should end in abortion or used to simplify reproductive justice and human rights issues. For me, pro-abortion means hope, self-determination, and bodily autonomy. And I’m most definitely in favor of all of those things.

I’d like to think the tables will turn in the very near future: that our courts nationwide will follow the Supreme Court’s lead and affirm the right to abortion without political interference, and that people will no longer be shamed for seeking abortion care. Until then, it’s paramount that each and every individual of the pro-choice community continues to demand progress. And what better way than with powerfully pro-choice and pro-abortion words? They’re the building blocks of our movement, after all.