In between pages, I waded out into the lake, watched families play volleyball and teach their kids to swim, and had a variety of conversations about work, life, and its ever-changing nature with the people I was there with. It was necessary—I needed to get out into nature, even if it was so hot that the top of my friend’s water bottle exploded. While out there, I had a few passing thoughts on what it means to be well, which is the point of Global Wellness Day. Sharing them below, unfiltered and untailored. If you’re so inclined, tell me in the comments how you spent your weekend. Even if you didn’t know it was Global Wellness Day, I’m curious to know what you did with your summer Saturday.

• I love the feel of wet sand between my toes. There’s something about mushing them into the earth that makes me feel grounded, like I’m part of it. I mean, I am part of the earth. I come from it and, one day—hopefully far into the future—I’ll return to it. It is me. I am it.

• “Every body is a beach body” is most evident at the beach. I’m not sure why I feel so insecure in mine right now, but I should figure that out! There are so many humans here, of so many shapes and sizes, having fun. God, I need to bring this up in therapy. Moving on!!!

• A woman tells us she’s had enough sun to last a lifetime, per her dermatologist, and it makes me sad. I can’t imagine not roasting in its rays. (Editor’s note: With sunscreen on, of course!) She loves the sun, too, but good on her for choosing longevity over the health risks. That self-care inspires me.

• I’m reading The Wilderness to escape, and because of book club, but instead, I keep seeing myself in all of these women, which isn’t a bad thing. Still, they’re exhausted in the exact ways I am, so, in a way, I feel like Desiree, January, Monique, Nakia, and Danielle are keeping me company versus offering me an escape from my own search for equilibrium.

• It is so fucking hot, but I feel most alive when I’m enduring the elements. That sounds weird, but it’s true. Something about the friction, or, really, any friction, reminds me of my humanity. It’s humbling. I’m cocky, but I am not greater than nature. How relieving in a world where oligarchs are working to be bigger than the program. They aren’t. None of us are.

When I walked into the 7/11 attached to the Courtyard Marriott in NoMa to buy a pack of smokes, a Drake song popped into my head. Weird, I know. I’m not a fan, but these few lines from Blue Tint spoke to the situation.

Look who I’m fuckin’ again

I had her on ice but then

I watched the ice get thin

Now, does she sink or swim?

I was smoking Marlboros again. I did have them on ice for a bit. The ice was thinning out because I was stressed and considering ending my 10 years of being smoke-free. I decidedly sank when I lit one.

Corny, but fitting.

I’d been thinking for a few weeks about our current wave of cigarette nostalgia and, before I gave in, I sent a pitch about my urge to smoke again off to Allure. I’ve written about what cigarettes do to our brains from an addiction standpoint in the past. This time, I was interested in how living in a country with virtually no infrastructure to mitigate stress was fueling the resurgence.

Allure took it. Here’s an excerpt for ya, then I encourage you to read the piece in full on their website.

I’m a Health Reporter, and I’m Considering Smoking Again

I do everything a reasonable person is supposed to do.

I meditate. I do breathwork. I show up at my weekly therapy appointments, even when I would rather sleep in. I take the SSRIs that my therapist, my former primary care physician, and I all agree I should take. I work out several days a week. I go for a walk every evening before dinner. And, despite applying for hundreds of jobs, I’ve been out of work for a year. The stress of being without a stable income and benefits has affected my well-being on a cellular level, and the protocols that are supposed to work do not—even though, by every measure of wellness culture, I am taking my own care seriously. Before I left D.C. to move in with friends in North Carolina, I spent every day on edge, wondering when someone would unlock the door and force me and my possessions out onto the curb.

I do everything a reasonable person is supposed to do. And now, for the first time in a decade, I want a cigarette. To get even more specific, I would kill for a Marlboro 27.

Cigarettes are the leading cause of preventable deaths in the U.S. While the long-term health effects of the occasional cig are tricky to track, we do know smoking even just one causes immediate damage to the body, and, of course, you run the risk of developing a really nasty habit. Despite this, they are having a cultural resurgence, and many writers have spent the last few months parsing out why. In The Cut, Xochitl Gonzalez made a melancholy case for smoking as a rebellion against the productivity-poisoned way we live now, a way of stepping outside our optimized matrix and engaging with another person for the length of a cigarette. In Allure, Gabriella Onessimo followed the smoking aesthetic into the makeup aisle, rightly clocking that the beauty industry is glamorizing a deadly addiction.

At my peak, I smoked half a pack on a mild day, though most were bad ones where I would have nearly the whole 20. When I quit, the effects were immediately noticeable. Within weeks, my skin was better, my resting heart rate was going down, and I could take deeper breaths. Quitting was one of the few unambiguously good decisions I have ever made about my own health, and I do not regret it. Still, the desire to smoke pops up. Most likely because addiction, even one I had a long time ago, has rewired the neural pathways in my brain a bit, but also there’s the intense stress I find myself under.

A class story lurks beneath this current wave of cigarette nostalgia, too. Why do Americans deal with stress by grabbing a $10 pack of cancer sticks from their local corner store?

read the full piece

Micros

• Unfortunately, I read some of the comments on the Allure IG post, and I didn’t realize I needed to tell adults that smoking is bad for them! But, even funnier, in a macabre way, someone suggested drinking instead… Okay, for the hell of it, let’s say substitution worked. I’d be swapping one Group 1 carcinogen with highly addictive properties for another Group 1 carcinogen with highly addictive properties. Goes to show you how people just be talking fr.

• The Cut parsed out the tension between loneliness influencers and the parasocial relationships they’re fostering with the followers they’re making feel seen.

• The Guardian made a good case against being too hot via face-freezing plastic surgery. Pointing out Margot Robbie in Wuthering Heights reminded me of how awful the film was, and how much of that was due to the actors' unrealistic hotness.

• Researchers, for the first time, have mapped the nerves in the clitoris. A healthy future, to me, is one where the clit gets the respect it deserves!! There’s also a joke here, somewhere, about how if it’s so big, how do so many men miss it?

That’s all for this edition. See y’all soon.

It’s hot on the porch, but I’m gearing up to do the work anyway. I have a 30-pound vest, two 15-pound kettlebells, a jump rope coiled up on a pollen-covered couch, and the concrete steps leading down into the yard at my disposal. This is the gym now.

Before moving to North Carolina, I had a real one. It had a squat rack, a full set of dumbbells going up to 100 pounds, machines, mirrors, and, perhaps most appeasing, air conditioning. I went most days since it was a measure of my discipline. Despite being without robust equipment, I still work out as often as my burnout allows. This week marks the start of a new block. I’ve planned a squat and lunge focused lower body on Monday, an aerobic burner using my jump rope on Tuesday, a high volume push/pull set for Wednesday, my second lower body lift, which is hinge focused, on Thursday, and push/pull plus conditioning for Friday. The rep tempos are written out, too, along with rest periods. I ramp up my push-ups a little each week. I’m doing pistol squats again, and they suck.

The porch imposes its own terms on how I train as well. When it rains, I don’t workout. This past week, I’ve lost five days of training. My runs are on the road and trails now, not on a treadmill, so I answer to the heat, too, cutting cardio sessions short. The weather gets a vote it never used to have.

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I’m making the most of it, though. The only thing I can’t do effectively is add load to preserve the insane strength goals I’ve achieved in the past 18 months.

Unfortunately, adding load is the whole game for certain adaptations. Achieving and maintaining maximal strength is the most load-dependent thing the body does, and it starts slipping within weeks. I can mostly keep my muscle mass since hypertrophy isn’t dependent on weight itself, but pushing every set close to failure. Cardio’s not an issue; the jump rope handles that, and I can take walks. Another concern is bone loss. Heavy resistance training is one of the best interventions for strengthening bone. A 30-pound vest and two 15-pound kettlebells do not replicate that for me. I’m in my 30s. The decisions I make about load now compound as I enter my 60s.

I’m probably overthinking the long-term effects here, but this all runs through my mind as I flick an ant off my arm, lying flat on my back, trying to catch my breath after a 60-second AMRAP round of single arm kettlebell swings. I’m confronting the limits of my current reality as someone who doesn’t believe that anything limits me. Everything about this is stranger than I expected. But the body needs the movement, whether or not there’s a gym to put it in.

So tomorrow, if it doesn’t rain, I’ll put on the vest and do it again.

It’s hot in North Carolina, which means it’s hot in the kitchen. My playlist is blasting, rotating between MGMT, Hall & Oates, Donna Summer—so much Donna Summer—Michael Jackson, a sprinkle of Beyonce, a bit of Bee Gees, and anything else electric and funky. I’m wiping sweat off my brow with the back of my hand before I dump the chicken into a bowl of cool water and vinegar. I pat it dry after getting the gunk off, then put it bottom-up in a lightly oiled, well-seasoned cast iron pan that belonged to my friend’s late grandmother. Once I wash my hands of the hazmat shit (salmonella), I season it up with salt, pepper, and red pepper, on both sides, before pouring over a freshly mixed honey mustard garlic sauce. Fatty side down, I pop the pan into the oven—400 for 25 minutes. I spray the sink with Lysol and have a seat at a small wooden table to prep the sides.

Kale is in season right now, and its herbaceous, spicy, green scent persisted through a washing, a chopping, a massaging with salt to soften it up, the addition of fresh carrots and cucumber, a homemade lemon vinaigrette, and a crack of pepper. When it got close to our noses during dinner, the faint hint of earth drifted in and left behind a gentle burn. The potatoes were much easier to deal with—a simple chop, olive oil, garlic, onion, salt, pepper, on a sheet pan at 425 for 20 minutes left a nice crust on the bottom and a soft, creamy middle.

This is what my life in North Carolina has consisted of since I got here 10 days ago. Between sleeping in, long naps, and walks to grab coffee or a soda, I’ve done nothing of substance. I sit on the porch and have my morning coffee. I talk to my friends, and I spend most of my time sitting in silence, doing nothing. I feel a deep sense of peace and, because I am here with people who love me, I feel safe. I can adjust. I can regroup. That fills me with a sense of gratitude I can’t even begin to articulate.

That level of peace is why I’m surprised I can even write this. My brain turned off once I got settled in, which is odd for me, an ambitious high achiever, but it all feels necessary, as if this is the mental, physical, and emotional reboot before I head out on my next adventure. Who knows where that will take me? For the first time in my life, I have no idea what I want to do, where I want to go, or how I want my life to look. And I’m not exaggerating. The life I’ve lived since 2010 is, for the most part, the one I planned out when I was a teenager. Perhaps that’s why I get antsy when people talk about optimizing to attain their dream life. I did optimize. I did obtain my dream life. It didn’t make me happy. My experiences, of course, don’t speak for everyone’s, but there’s a lesson to be learned from people who did the thing, made the sacrifices to do the thing, and one day noticed they were standing on a foundation made of sticks instead of concrete. Looking back on it, I appreciate that girl’s big dreams. They took me to some amazing places to do some really cool stuff. I also realize now that that kid didn’t know shit about burnout. She was a kid!

As a grown woman with tons of experience, I get to rebuild my life at 33 with my current perspective. I’m circling back to a question I asked a few months ago. What does a healthy future look like for me? What does a Tuesday feel like when you’re not in survival mode? What do you want out of life when the wanting isn’t shaped by fear or instability?

I don’t know the answer yet, but I’m sure I will once my brain turns back on. Until then, I’ll be sitting on the porch, taking a nap, rereading Faulkner and Morrison and Cade Bambara and Hurston, or enjoying the delicious scent of fresh, North Carolina kale.

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A new study investigating the correlation between breathing in fine particulate matter (PM2.5), or soot, and brain health, published in Alzheimer's & Dementia: Behavior & Socioeconomics of Aging on May 18, found that 10+ years of exposure to PM2.5 is associated with lower semantic memory. This is the long-term memory system that stores concepts, facts, vocabulary, and how these things may relate to one another, acquired through everyday life. Since this is the part of our brain that helps us understand language, how to communicate, and share our ideas, when it becomes impaired, it fractures how people perceive reality.

The findings in the new study are particularly relevant right now, as Trump’s EPA is planning to roll back regulations that protect communities from PM2.5. In 2024, under the Biden Administration, the EPA set stronger PM2.5 standards. A little more than a year later, under Trump, the EPA asked the court to vacate those protections and reinstate the 2020 rule, which allowed higher levels of soot in the air and created more adverse public health consequences.

In 2017 and 2018, during the first Trump Administration, I reported on the respiratory effects of fine particulate matter on the Parramore neighborhood in Orlando. Jacqueline Young, who lived in Griffin Park, a federal housing project surrounded by two major highways, for 15 years, dealt with a sore throat, and her granddaughter had violent asthma attacks. The AC unit in her apartment spat out dust, forcing her to keep the windows open, which let soot from the highways float in. Marita Wilson, who was 70 when we spoke, said her apartment was often covered in dust, and she also dealt with asthma and allergies. She also attributed it to pollution. Latoya Lee was able to move her family to a different part of the neighborhood, which, sadly, sat next to a superfund site. Lee, who passed shortly before this story was published, was troubled by respiratory issues. Her loved ones attributed her death from cardiac arrest to the air she was breathing. (Note: In the years since this was published, the highway expansion further into the neighborhood was halted, and several years after that, the remaining residents of Griffin Park were relocated.)

It’s upsetting to see a new layer added to the continued carnage of history and policy.

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On April 29, the Supreme Court undermined a key provision of the Voting Rights Act. The vote in Louisiana v. Callais came down along the party line, and the ruling will result in election districts throughout the South redrawing their maps to reduce the power of the Black electorate, meaning there will be fewer Democratic candidates and people of color being elected into office. I believe Richard L. Hasen summed up the implications of this best in his piece for Slate:

Louisiana v. Callais will go down in history as one of the most pernicious and damaging Supreme Court decisions of the past century. All six Republican-appointed justices on the court signed onto Justice Samuel Alito’s opinion gutting what remained of the Voting Rights Act protections for minority voters, while pretending they were merely making technical tweaks to the act.

This decision will bleach the halls of Congress, state legislatures, and local bodies like city councils, by ending the protections of Section 2 of the act, which had provided a pathway to assure that voters of color would have some rudimentary fair representation. It’s the culmination of the life’s work of Chief Justice John Roberts and Samuel Alito, who have shown persistent resistance to the idea of the United States as a multiracial democracy, and a brazen willingness to reject Congress’ judgment that fair representation for minority voters sometimes requires race-conscious legislation. It gives the green light to further partisan gerrymandering. It protects Alito’s core constituency: aggrieved white Republican voters. It’s a disaster for American democracy.

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There is a lot of informative writing about the long-term political implications of this, so I will focus on what this means for the health and well-being of Black folks going forward. Voter suppression is a structural form of discrimination, and like every other form, it makes people less healthy. When you can’t vote, you have less say in the political decisions that shape the conditions of your life—meaning you lack power when choices are made about Medicaid, hospital funding, data center locations, environmental protections, housing, maternal health, and other facets of public health.

A few research points to back up this correlation:

• The VRA, in its first five years, prevented roughly 6,700 Black babies from dying before their first birthday in the counties where federal voting protections kicked in hardest.1

• People who live in areas with restrictive voting measures are more likely to self-report having a lower quality of health, and this association is stronger for Black Americans, even after controls for individual behaviors are considered.2

• Felony disenfranchisement laws, which are grounded in white supremacy and have a legacy of targeting Black voters, negatively affect the health of Black people.3

• Harvard researchers found that Black infant death rates were higher in Jim Crow states than in those without the policies from 1960 to 1964. The rate had shrunk by 1970–1974, with convergence occurring between 1965 and 1969, immediately following the passage of the VRA and the Civil Rights Act.4

• A companion study found that being born in a Jim Crow state is associated with increased odds of estrogen-receptor-negative breast tumors among Black women, with the effect only found in women born before 1965. ER-negative tumors are more aggressive and harder to treat, meaning the political geography of someone’s birth is detectable in their tumor biology decades later.5 Even though these studies don’t isolate voting rights, they provide evidence that civil rights protections, of which voting rights were a central part, function as health interventions.

I’m particularly concerned about how this plays out at the state and local levels. Even though statewide elections—like for governor, attorney general, or ballot initiatives—can’t be technically gerrymandered since the state votes as one constituency, state legislative districts can be. The Callais ruling will allow those legislatures to redraw their maps to lock in supermajorities that will then set the rules governing every statewide election. That’s the mechanism by which the ruling cascades down ballot and ultimately into micro-level health policy decisions.

We’ve seen time and time again that if a community doesn’t have a say in policy, it won’t have a fair chance at being healthy. Sadly, this is another moment that, a decade from now, will have more data points to add to this ledger.

Healthy Futures is free to read and always will be. Paid subscribers get Wellness Debrief, The Shelf, and a few paid essays per month. If you’re not ready for that but want to support the work, you can also leave a tip via PayPal. Now, let’s get into it.

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Pew Research Center dropped a new study this week confirming what the timeline has been telling us for years: half of American adults under 50 get their health and wellness information from influencers and podcasts. The majority of those influencers—about 60 percent—don’t describe themselves as healthcare professionals. Around one in six don’t claim to have any expertise at all.

The bulk of the reporting on this study focuses on the lack of healthcare credentials among wellness influencers and on the fact that most people take the information they’re given with a grain of salt, despite seeking out the shaker. But the most interesting finding to me is that Black, Hispanic, and Asian Americans are more likely to get health information from influencers, as are people without health insurance.

A few more interesting nuggets:

• Fourteen percent of people who get their information from health and wellness influencers say “learning about things I don’t want to ask my doctor about” is a major reason they look online. But for Black, Hispanic, and Asian consumers, that number jumps to roughly 20 percent. For White consumers, it’s 10 percent.

• When Pew asked whether the information from influencers was “extremely or very different” from what people get from their healthcare providers, 24 percent of Black consumers said yes, against 16 percent of White consumers and 14 percent of Asian consumers. Twenty-three percent of lower-income consumers said the same, compared with 13 percent of upper-income consumers.

It makes sense that the populations the formal medical system has historically failed are the same ones leaning hardest on the parallel economy looking to fill the gaps. Plus, healthcare in America has been in free fall for a while now. Appointments are getting shorter, costs are rising, and patients increasingly feel like doctors don’t care about them. The misinformation that poured onto the internet during COVID—and pushed even more Americans to distrust medical institutions—didn’t help. Neither does the country’s long history of medical neglect, experimentation, and dismissal that taught communities of color, Black ones in particular, to fear medical institutions.

Concern compounds when you consider that a meaningful share of these influencers are selling supplements that have never been independently tested, hawking lab panels designed to find a problem that justifies the next thing they promote, or otherwise pushing people toward the darker side of the MAHA Matrix.

Still, influencers are doing something many healthcare providers are not. They’re making people feel seen and understood, which is what care is supposed to do. That many of those influencers are selling supplements and shame is the wellness industry’s crime. That they got the opening is medicine’s.

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Dave Chappelle1 has a bit about how, in the days after 9/11, he turned on MTV, and there was Ja Rule giving his opinion about the attacks. Chappelle, with a sharp note of disdain tinged with disbelief, asked a question that has since become shorthand for a specific kind of media pathology: Who gives a fuck what Ja Rule thinks at a time like this?

I’ve been thinking about that bit for weeks now, about the media’s instinct to reach for the nearest available mouthpiece during a moment that demands something, anything, else.

We are currently living through a news cycle in which one recurring figure is a 20-year-old named Braden Peters. You likely know him as Clavicular, a looksmaxxer adjacent to the manosphere. For those of you blessed enough not to know what looksmaxxing is…I’m jealous, but, in short, it is Gen Z’s version of eugenics, like millennials were quantifying ourselves. He’s publicly claimed to have injected enough testosterone to render himself infertile, has discussed how to smash your own cheekbones with a hammer to achieve “facial harmony,” and was hospitalized after overdosing during a livestream a few weeks ago. He has become, by some collective decision, someone the serious press has determined is worth airtime. Over the past several months, he has been the subject of a New York Times profile, an equally lenient follow-up on The Daily from the same reporter, a Piers Morgan sit-down (Two racists walk onto a set…), and a steady churn of interviews across outlets, all chasing the same clicks. He is, by every visible measure, trying to become a celebrity—because that is one of the machines through which ideology enters the mainstream in this country. Once he’s asked about something other than his dogma, he abruptly ends the interview, which is another reason the press should stop talking to him.

Around this, the usual swirl of questions has coalesced. Is looksmaxxing a fleeting teenage subculture or something more sinister? What do we do about youth radicalization, about the boys who are reaching for him, about the parents who don’t know what their sons are watching, about the platforms that amplify him, about whether we should be platforming him at all? These are legitimate questions. But the way they are being asked—in a recursive spectator’s loop that keeps circling back to him—is, to borrow a line I wrote in a different decade about a different man pushing an adjacent ideology: an exhausting, pointless conversation that serves no true function.

I wrote that sentence in 2019, for HuffPost, about the press’s inability to call Donald Trump a racist. At the time, the media was consumed by a meta-debate about whether it was a journalistically appropriate word to apply to a sitting president who had just told four congresswomen of color to go back where they came from. I was, like a lot of Black journalists then, over it. The argument I ended up making was not, in truth, my argument. I borrowed it from Toni Morrison.

Seven years later, I find myself reaching for her again.

In her 1975 keynote at Portland State University, Morrison described what she called the “very serious function of racism”:

Where racism exists as an idea, it was always a confidence game that sucked all the strength of the victim. It really is the red flag that the toreador dances before the head of a bull. Its purpose is only to distract, to keep the bull’s mind away from his power and his energy, to keep his mind focused on anything but his own business…

It’s important, therefore, to know who the real enemy is, and to know the function, the very serious function of racism, which is distraction. It keeps you from doing your work. It keeps you explaining over and over again, your reason for being. Somebody says you have no language and so you spend 20 years proving that you do. Somebody says your head isn’t shaped properly, so you have scientists working on the fact that it is. Somebody says that you have no art so you dredge that up. Somebody says that you have no kingdoms, and so you dredge that up. None of that is necessary. There will always be one more thing.

Instead of pinning this spectacularly dangerous figure to the center of the umpteenth rebranding of eugenics, the interview circuit around Clavicular is channeling our finite energy toward the inner world of a young man who is mutilating himself in public. It is a red flag. It is being waved. We are the bull.

Potential disciples are being introduced to some deeply racist, misogynistic, weird shit by prestige media organizations through reporters who, no shade, don’t have the range to write about these topics critically or in a way that serves those who would be integral in preventing young men from getting swept up in the storm. If you think this is an overstatement, consider how, on The Daily, the reporter who profiled Clavicular was asked about his documented, incessant use of the n-word. The answer? That these guys don’t really understand the impact of what they’re doing.

Meanwhile, we are being taken from. On April 7, Trump threatened to level “a whole civilization” if Iran didn’t agree to a ceasefire. One was announced the following day, and hours later, Israel dishonored it and killed at least 357 people in Lebanon. At least 75,200 Palestinians died violent deaths between October 2023 and January 2025 alone, according to research published in April, an estimate that is likely more on the conservative side. The UN has projected that at least 101,000 Gazan children under five will suffer acute malnutrition through October, more than 31,000 of them severely.

The 9/11’s happening on American soil are more domestic. Men continue to murder their families, most often the women, the children, or both. Children are being detained by ICE. In the first four months of 2026, the CDC has confirmed 1,748 measles cases—on pace to surpass 2025, which was already the worst year in three decades. The collective net worth of the 12 richest billionaires has more than quadrupled since 2020. Nearly half of American adults cannot cover a $1,000 emergency.

Who gives a fuck what Clavicular thinks at a time like this?

Since Chappelle’s bit—which was, at its core, about celebrity worship—the awe captured by mouthpieces with millions of followers has only metastasized. Now is the time to do the disciplined work of channeling your attention with purpose. The attention economy is engineered to exhaust, fragment, and keep us reactive, overstimulated, and proving the shape of our own heads. The interview circuit around Clavicular is one small expression of that machinery. Knowing about him does not make us more informed.

It is a red flag. It is being waved. We are the bull.

Do what the bull cannot: look away.

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Early next month, I’m moving back to North Carolina. The reason why is unnerving, but relatively straightforward. I’m out of money, I’m still unemployed, and I got that dreaded eviction notice taped to my door last week. Even if I could come up with the back rent, it would only delay the inevitable, so I figured I’d call it before a “Scarlet E” was attached to my rental record. This is the culmination of an ugly year, one marred by rejection and instability.

Still, for some reason, I feel at peace. It’s a blessing that I’ll be closer to my family—closer than I was in college, even—and I have a place to live while I get back on my feet. D.C. has been my home for 11 years. I moved here in 2015 on an unseasonably cold day. The wind chill was below zero, and I’d never been that cold before. I came in on a Megabus with my best friend and $600 to my name. In May, that same friend will drive the U-Haul containing what’s left of my life here back to North Carolina. It’s all very circular. My time here feels complete, even though I will miss my adopted home.

A few months after 9/11, Colson Whitehead wrote that we can never appropriately say goodbye to a city. Your last metro ride to Gallery Place happened without fanfare. At some unknown point, you were closer to your last chicken box from Yum’s than you were to the first. That essay was later adapted and evolved from a requiem into an atlas of the place that made Whitehead who he is. Mine will do both at once.

Before I go, I’ll have to walk past my first house in the city, a shit hole with bugs and rats and roommates I loved anyway. I’ll go by my second solo apartment, where I was sitting when I found out my essay was going to be in The Best American Science and Nature Writing. That same apartment is where my seven-year relationship ended a week before I moved out. I tossed my mattress before I left. I could only think of him when I tried to sleep on it, and keeping it felt too on the nose. I’ll venture to the former HuffPost office on Pennsylvania Avenue, the building where I started my career, before I run my old route—down 17th, onto Constitution, all the way to the reflecting pool at the foot of the Washington Monument. On a different day, I’ll get out the door to Stanton Park, sit on the bench where I read for 30 minutes at a time, and then walk the mile back. I’ll sit down at Pluma to order the avocado toast and the oat milk latte with vanilla, the way I used to before the pandemic locked us indoors for a year. I’ll pop into Baker’s Daughter for the bacon, egg, and cheese burrito—two, actually—and Red Derby, which is the best dive bar in this city, and I will fight anyone who says otherwise.

There are a few rooftops to visit and, of course, one more night at the Bullpen—which will always be famous and I’ll never forget the night I fell at Everyday People before me and my homegirl left to use a clean bathroom and smiled at the security guard to get back in. I have to go one more time to the Blacksonian, because I was here when it opened, and I’ve been more times than I can count.

These are the places. There are more. There are dozens.

Whitehead mentions that our old homes would gossip about us if they got the chance. Mine would have a lot to say. #218 would tell #314 about the year I pretty much stopped answering my mama’s calls and communicated almost exclusively through my dad. The same unit would tell the house I lived in uptown that I became someone who slept through the night and woke up before 1 P.M. My current place would join and share how I wailed like an injured child when my dad died, then again 10 months later when it was my uncle.

This is the city where I quit smoking. Where I started lifting, which has given me a kind of peace I didn’t know my body was capable of. Where I grew from a reporter into a writer and an editor. Where I met almost every person I now consider close. Where I cried watching Beyoncé sing Dangerously in Love. Where I got pushed into the stage barriers at Echostage during a Gucci Mane concert because of all the fights in the crowd, but I also got to see Playboi Carti and Dreezy before they blew up. Where I went apple picking with the homies and down to the cherry blossoms every spring, and into every museum. Northeast holds the most of me. I have lived there for the bulk of my 11 years, and it remains my favorite side of the city.

I won’t be here for the kickoff of Jazz in the Garden, but as I walk barefoot through my friend’s yard, I’ll think of every summer Friday I spent in the Sculpture Garden, lying out on a blanket or dipping my feet in the fountain while drinking sangria. On my last night here, I’ll pour one off the balcony for everything politics, gentrification, the pandemic, or some combination has taken from this beautiful city. Sweet Mango Café, where I had my first authentic beef patty and ate it sitting next to Laz Alonso. Marvin, where my first year in D.C. I got drunk and fell asleep at the bar. Tropicalia, where I’d wind my hips on reggae night. Dodge City, where I threw ass until my knees ached and my thighs hurt. The Kennedy Center, where I saw Kendrick Lamar perform his one-night-only show of To Pimp A Butterfly with The National Symphony. American Son, where I ate the best burger I’ve ever had. Stadium, where my friend introduced me to thee best wings, omfg.

There is no place in this city that I won’t miss—except every single Target and CVS.

D.C. has been the only continuous witness to 11 years of a life that has turned over at least three times—probably more. Friends and lovers and employers have come and gone. The man I thought I’d marry left me for another woman. I changed what I eat, what I read, who I answer the phone for, and what I tolerate from people in my life. Despite it all, D.C. has been here. It’s seen me grow from a wide-eyed 22-year-old to a discerning 33-year-old woman who has done things the girl who moved here never dreamed of. That’s what a city, a home is, in the end—the archive of the parts we’ve shed, stored on our behalf by streets that don’t ask anything of us.

And still, I have missed the South. I am ready to hear the cicadas chirping on balmy summer evenings, to feel the thick cushion of tall fescue under my feet, to mush my toes into the ochre colored earth. Maybe this transition is the South’s way of saying it has missed me, too.

At an actual homegoing, this is when the pastor says the deceased has completed their journey. They’d assure you that this is not a sad occasion, but a joyous one, even if we feel grief, because the person, the thing we loved, is now eternal, immortalized. The congregation would nod, a weepy “yes, pastor” would escape a few mouths.

I will say I love you, and I’m going to miss you. And then I will go back South.

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It was 90 degrees outside, and I was incredibly late. My first attempt at doing my makeup was a major fail. My foundation oxidized on me, and I ended up looking like an Oompa Loompa if it had black hair and a nose ring. Redoing it took longer than expected, and I anxiously texted my date to let them know I’d be late—how late, I didn’t know, but at least 15 minutes.

I walked into the bar an unknown amount of time later, but the cool air was almost as refreshing as his demeanor. He really wasn’t bothered that I was late, and he was still happy to meet me and get to know me. After a trip to the bathroom to blot the sweat off my face and make sure I wasn’t musty—listen, D.C. gets humid in the summer and that moisture sticks to you—I was glad I’d shown up.

Yes, I considered canceling even though he was already waiting for me at the bar.

Conversation felt effortless, and when the servers mistakenly brought a free birthday treat to our table, we both leaned into pretending it was actually my birthday. Drinks were the pregame to the concert he’d invited me to after learning that I enjoyed seeing indie artists on the verge of blowing up, and that, generally, I loved music, and I was willing to listen to any genre. During the middle of the set, I realized I’d never put on the necklace I’d brought with me. I asked him if he could, since my nails were too long and the lights were too low for me to fumble with it. Feeling his fingers touch my neck sent a knowing jolt down my spine, as if I’d swallowed a firecracker. The night wrapped up with a kiss, or 20, and so began a wonderful thing.

We spent late summer and the fall roaming our way through the city—spending nights in bars, playing mini-golf, going ax-throwing, and talking a lot. I enjoyed his company, and I enjoyed being understood and accepted. I didn’t have to mask around him. Our thing ended before the year did, sitting on my rooftop, watching the sunset. He removed my shades and said, “I want to look at you.”

Indeed, I’d never been looked at like that before. He saw me the way you approach the sociopolitical complexities present between the brush strokes of a Basquiat or the way you angle your head to get a better sense of whether the Mona Lisa is indeed smiling at you. Curiously. In a way comparable to seeing a baby laugh for the first time, at what you don’t know, but it kicks up a sense of wonder we lose as we age, and become entrenched in the mundane, and the muck of responsibility that comes with it.

Experiencing romance in this way reshaped how I saw myself. Respect and understanding are complex neurobiological processes, as far as how we, as complicated beings, land on what deserves our neural energy, but the effects they have on us are pretty straightforward. We feel less lonely, more empowered, and validated in who we are. I started holding my head higher. I laughed louder. I felt like I had permission to be myself after leaving a relationship where every choice I made was an audition to keep my role in my ex-boyfriend’s life. In our current social ecosystem—which includes IRL and online communities—finding validation outside of yourself is depicted as a weakness, despite it being a normal part of human behavior and socialization. It’s important to reach inward for tenacity, self-worth, and self-concept. I’ll never argue with that, but people don’t exist in silos; we live in community with each other. How can we be totally individualistic? How can we find everything we need in ourselves? We can’t even find everything we need in one other person! How are we not supposed to care what other people think, especially when we care about them? How are we not supposed to consider those opinions as we create ourselves? It doesn’t make sense, and I’m not interested in continuing to conflate a desire to be seen with dependency on external validation.

Ever since that summer, I’ve been enthralled with how to bring seeing someone without flinching into other areas of my life. I believe it can be done through tenderness. As my dear friend Maya Cade said in 2023: “Tenderness is spent moments of affection, whether familial, romantic, or among confidants. Tenderness can show up as a warm embrace, a gesture of understanding, whether that’s a head nod or a glance that you get from your family when you’re across the room and they just understand. I think that can be a tender moment. Tenderness is warmth, understanding. Of course, love is a part of it, but it’s not all of it.”

A frame of tenderness holds space for the fact that me and him weren’t in love with one another. When romance is identified as the vehicle for radical transformation, it’s often reduced to nothing more than fervent passion or promoted as love when it’s not—but tenderness can hold the weight of any connection. A tender bond won’t demand a performance; it just asks you to show up because that is enough. Tenderness, in practice, looks like the people by whom I’m surrounded pouring into me when my sense of self runs dry. It also looks like me doing the same for them when, inevitably, they experience drought. It’s the willingness to see someone without flinching and remain in community with them.

I think about him removing my sunglasses on the roof more than I should.

I want to look at you.

I look the same as I always do.

I wish I could remember what he said about me against the backdrop of the sunset.

I’m sure it was beautiful.

I’m sure it was tender.

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The constant vomiting and nausea began early during Tonya Abari’s first pregnancy in 2014.

It was far beyond the typical morning sickness, which happens once or twice daily, most commonly during the first trimester. Abari was throwing up multiple times—sometimes, she took as many as 20 trips to the nearest receptacle. “There was not one day that I didn't have five or more episodes of vomiting throughout the entire [10 months of] pregnancy,” Abari, now 42, said. “I was very weak and lost a lot of nutrients, and the only thing that made me feel better was eating bread. I ate a lot of bread.”

While the bread soothed her stomach, it also caused her to gain weight, which led the midwives and obstetrician she was working with in Nashville, Tennessee, to question if the vomiting and nausea were due to her size, even though her illness predated the jump on the scale. She wasn’t offered nutrition counseling or blood tests to determine what was wrong. Toward the end of her pregnancy, her blood pressure began to fluctuate, eventually ticking upward to hypertensive levels. She doesn’t remember how high, but she knows it was well above her pre-pregnancy average of 115/65. She believes she had preeclampsia, a disorder characterized by high blood pressure and the leading cause of death in the pre- and postpartum periods for Black women, but she was never officially diagnosed. (She later found out from her doctor that her vomiting was hyperemesis gravidarum, a severe form of pregnancy-related nausea and vomiting that can lead to dehydration, weight loss, and nutritional deficiencies.)

Another complication arose once it was time to deliver her daughter. Abari went to the hospital because her amniotic sac was damaged. It wasn’t wholly ruptured, or, as is more commonly said, her water hadn’t broken. The sac was torn and slowly leaking—a complication that can potentially lead to infection if not treated. She was admitted and told she’d need an emergency C-section due to her weight. “I refused because my weight is not a determinant of whether I need a C-section or not,” she recalls. “Let me walk around. Let me see if we can move the needle. I was zero centimeters dilated. Let me do what we've been talking about according to my birth plan.”

After 56 hours of labor, Abari got the C-section. Her heart rate dropped after, another potential sign of preeclampsia, and so did her newborn daughter’s. Abari’s first pregnancy and birthing experience were a nightmare.

“I felt like I was not heard. I felt like there was a lot of bias during the entire process,” said Abari. “The first birth was so traumatic that I felt that I didn't want to have any more children after that.”

Six years later, Abari and her husband decided to have another child. While planning the baby’s birth, they were adamant about having a birth team that could actually see and hear them, people who could navigate the complex relationship Black birthing people have with clinicians who often disregard and ignore Black patients. She also wanted to reclaim her autonomy and power within the birthing experience.

Abari met Tanzye Hill, a doula and owner of Birth Manifesta, an organization that offers full-spectrum doula support to birthing people and focuses on reducing rates of Black maternal and infant mortality, in Nashville, and they became friends. When Abari found out she was pregnant, Hill was the first person she went to, and she helped Abari by looking for a Black care team that would respect her wishes, and adding a doula was key.

What differentiates doulas professionally from obstetricians, nurses, or midwives is that they don’t have clinical duties or give medical advice. Instead, doulas fill in gaps that overworked clinicians often can’t or won’t in the birthing person's care. This includes emotional and physical well-being support to their patients during pregnancy, labor, birth, and postpartum. They supplement knowledge gaps between clinicians who don’t explain complicated medical knowledge well to patients and the birthing parent.

Across all causes of maternal mortality, Black birthing persons experienced 49.5 deaths per 100,000 live births in 2022—nearly three times the rate for their white (19) and Hispanic (16.9) counterparts, respectively, and almost four times as often as birthing persons of Asian descent (13.2). Sixty-five percent of pregnancy-related deaths happen in the 365 days after delivery, according to a report from the Centers for Disease Control (CDC). Death by suicide is the leading cause. Between 29 and 44 percent of Black women exhibit symptoms of postpartum depression, but many are not diagnosed or directed to mental health care. The CDC estimates that 80 percent of these deaths were preventable.

Doulas also catch other complications in the early stages and encourage the birthing person to receive life-saving care. They teach parents the skills needed to care for a newborn, like changing diapers and soothing, and they assist with housework and other chores to take the burden off new parents. Despite evidence showing that doula care could significantly reduce the U.S. maternal mortality rate, doula care is underutilized. A study in the American Journal of Managed Care found that Black women are more likely to desire doula care than their white counterparts.

‘The Buck Doesn’t Stop with Giving Birth’

Community-based doulas are especially adept at providing culturally competent care, which is what Abari was seeking, to those most susceptible to adverse birthing outcomes. Think of a doula as a birthing parent’s caregiver, helping parents, their children, and their communities thrive by reshaping the birthing experience and empowering parents to take control.

“In our history, communities have always had what we call now doulas,” said Myriam Webb, a longtime doula. “They didn't have a formal title. They were community members who would come by and drop off food, or help you with the baby, or they would attend the birth and help you with the labor.”

While many people think of doulas as additions to the birthing process, they play a crucial role during postpartum, providing vital emotional, physical, and informational support to new parents. Doulas can offer new moms a safe space to navigate their postpartum emotional ups and downs and alleviate the feelings of overwhelm and isolation new parents often feel. They’re also trained to recognize when postpartum depression has taken root and can refer families to critical mental health services.

After attending her first couple of births, Takeallah Rivera, a longtime doula based in Memphis, realized that the postpartum period needed more attention.

“I saw that the birth aspect as it pertains to being a doula was very saturated,” she said. “And I noticed the very critical postpartum period was being neglected, which is where Black women tend to suffer even more. [But] the buck doesn't stop with giving birth.”

“Usually, with a postpartum client, I'm there maybe a night or two to help mom prepare meals, making tea, tending to the other children she may have,” said Rivera, who also works as a postpartum counselor with the National Maternal Mental Health hotline. “I also focus heavily on the mental health aspect, so getting moms connected to resources for postpartum mental health supports, therapists, psychologists, online support groups, anything that would foster their wellbeing during the postpartum period.”

Covering Doula Care Under Medicaid and Private Insurance Could Expand Access

In December 2023, De Ajanae Gunn contacted Black Infant Health, a health equity program that provides resources to pre- and postpartum Black birthing persons toward the end of her pregnancy. She wanted to know what resources were available to her as she approached her due date. They pointed her to United and Guided, a Sacramento, California-based organization offering various services, including doula care. “My baby, during birth, his heart rate kept dropping, so I had to have an emergency C-section,” said Gunn, a 36-year-old child care provider. “It was very tough because I wanted to have a very holistic birth. I wanted to have a water birth, but it just didn't work out.”

Although her doula wasn’t there in person for the birth—she was sick and attended via Zoom—she helped Gunn navigate the postpartum period mood swings, offered breastfeeding support, and was an active listening ear.

Accessing the doulas who helped Gunn through a challenging birth and postpartum period would not have been possible were it not for Medi-Cal, California’s Medicaid program, which offers doula services to any pregnant person who wants one up to one year after pregnancy. As of June 2025, 24 states and the District of Columbia actively cover doula services for people on Medicaid, according to data from the National Health Law Program’s Doula Medicaid Project. Eight additional states are implementing doula coverage under Medicaid, and 15 others have programs adjacent to Medicaid coverage for doulas, such as pilot programs or exploratory efforts. But research shows that Medicaid expansion, even when it doesn’t include doula care, is crucial to reducing Black maternal mortality.

“Having a support person is very important, especially while you're going through pregnancy,” said Gunn. “With everything going on in healthcare and how systems are already not for us, it is important that we do have that support.”

Nearly 40 percent of births are covered by Medicaid, with this figure rising to 65 percent for Black birthing people. Disruptions in postpartum health coverage, particularly among Medicaid enrollees, are a persistent issue in preventing access to necessary care during this critical time, which is why expansion is associated with lower rates of maternal mortality. The American Rescue Plan Act of 2021 introduced a provision that allows states to extend Medicaid postpartum coverage from 60 days to 12 months through a state plan amendment. As of January 2025, 49 states and the District of Columbia have implemented 12-month Medicaid postpartum coverage, and Wisconsin has implemented limited coverage for up to 90 days.

Private insurance plays a role, too. The risk of maternal mortality for Black birthing persons is not bound by socioeconomic lines—wealthy Black mothers and their infants are still more likely to have an adverse outcome during the perinatal period. The coverage of doula services by private insurance varies across the country, depending on state regulations and individual insurance plans. Rhode Island became the first state to mandate that private health insurance plans cover doula services in 2021. Elsewhere, it’s less direct. California is encouraging private insurers to cover doula care. Lawmakers in Indiana introduced a bill in 2021 requiring state employee health plans to cover doula care, but it failed. Massachusetts and New York lawmakers are considering bills that would mandate all health plans to cover doulas. A bill in Virginia failed.

Research suggests doctors may be more likely to recommend doulas to their patients if Medicaid and private insurance cover their services. A doula in Rhode Island told the Women’s Bureau of the U.S. Department of Labor that since Medicaid and private insurance started covering their services, they’ve seen increased requests, especially from high-risk clients, because doctors are encouraging these patients to work with a doula.

However, following the 2024 election, the ability of millions to keep this critical coverage could depend on politics.

In May, House Republicans pushed through a budget reconciliation bill that would cut Medicaid by more than $800 billion over the next decade. Black women across the country would be left more vulnerable if Medicaid funding is slashed. Fewer providers amid an ongoing shortage, hospital closures, and the erosion of essential programs—like home visiting services—would exacerbate already staggering disparities in maternal and infant health.

Insurance isn’t a perfect solution. Medicaid doesn’t have the best reputation for paying providers. Plus, the payment rates are low and may not include the entire scope of a doula’s services. There’s also a significant administrative burden associated with insurance reimbursement—hours of paperwork, thoroughly logging hours, and filing precise claims to avoid an expensive medical audit. But having no option for people to afford doula care isn’t ideal or sustainable, either.

In Memphis, where Rivera practices, the demand for doulas is high, but so is poverty. Nearly 25 percent of Black residents in the city live below the poverty line. “I was pregnant with my son in Memphis, and there were virtually no doulas available to me,” Rivera recalls. “The doulas that were available to me were charging anywhere from $1,000 to $1,500 for support, and I recently left a pretty abusive relationship, so I was low-income. I could not afford that.”

Now, Rivera charges a sliding scale for her services, especially within the Memphis City limits. And, usually, she won’t charge Memphis residents at all. “Within the city limits is the highest rate of poverty and infant mortality, and I often do those for free,” she said.

“I have been thinking a lot recently about the future of doulas, especially Black doulas, because it's emotionally taxing, it's physically taxing—especially if you are in a red state like I am, and you're a proponent for reproductive justice as a whole,” Rivera continued. “We have a hell of a fight ahead of us for reproductive rights.”

(Editor’s note: Rivera told me in March 2025 that she has since stopped practicing as a doula in an effort to focus on taking care of herself.)

Despite GOP Desires to Slash Family-Supportive Policy, the Effort to Diversify the Perinatal Workforce Remains

That fight includes efforts to provide financial access for doula services and ensure the demographic makeup of doulas reflects the diversity of their patients. Few remedies to address the U.S. Black maternal health crisis are as directly impactful as getting more Black people into the perinatal workforce, research shows. Black patients live longer when they are cared for by Black care providers due to the reduction of implicit biases and a boost in trust, communication, and the chance that patients will adhere to medical advice when the person providing it looks like them. Currently, only 5.7 percent of physicians, 6.3 percent of nurses, eight percent of nurse practitioners, and 10 percent of doulas are Black—all of which are disproportionately low compared to the 13.7 percent of the U.S. population identifying as Black.

When Antonia Mead began overseeing Johnson C. Smith University’s (JCSU) doula and lactation program in 2017, its capacity to diversify North Carolina’s perinatal workforce was limited. Black maternal mortality was being discussed more in the news and online, and more people were discussing the benefits of doula support to birthing people. Interest in the program peaked as national conversations picked up more steam following the death of Shalon Irving, an epidemiologist at the Centers for Disease Control, from postpartum complications, becoming the focus of an in-depth ProPublica report. The story quickly went viral, shedding unprecedented national light on a crisis that has plagued Black birthing people for generations. But Mead was in a bind. She was the only full-time staff member for the program, tasked with scheduling courses, promoting them, and finding a doula to teach the students.

Mead’s reality shifted in January 2023 when the school became one of 75 projects in Mecklenburg County, North Carolina, to receive funding from the American Rescue Plan. JCSU, a historically Black college and university, was granted $943,000 to flesh out its Lactation and Doula Program. She used the funds to hire staff, invest in marketing, and increase the frequency with which the university offers the training.

“I was like a one-woman band with too many instruments—as the department chair, as the point person who would try to coordinate with our facilitator. It was all on me,” she said. “Those two things have been a blessing before God with everything I'm juggling.”

Even before receiving the funding, the course was open to anyone who wanted to take it—whether a student or a community member—with the primary target being North Carolinians. However, the school could only offer the course once or twice a year, depending on the schedule of the contracted trainers, one of whom lives in Raleigh. (Charlotte, where the university is located, is a roughly two-and-a-half hour drive one way with the usual traffic. Hitting rush hour in both cities can easily tack another hour or more onto the trip.) Marketing was also very “low budget,” Mead said, with the school depending heavily on social media.

Now, the program can appear at events and train students three times a year or once a semester, including the summer term. Funding from the American Rescue Plan has also allowed the university to fully cover the training cost and financially assist students with a portion of their total certification costs.

According to Mead, 75 students have graduated from the program, the most thus far.

That’s just step one. Becoming a certified doula is a multipronged and expensive process—and many states have some type of certification or training requirements. (They vary state-by-state and, in some states, they’re as simple as registering for a vague “certification course.”) Several organizations offer this distinction, but DONA International is the most popular. The nuts and bolts of DONA’s process begin with participating in a birth doula workshop. If a student is lucky enough to join a program like the one offered at Johnson C. Smith, the workshop will fulfill the childbirth and lactation support education requirements. If not, the student has to find additional classes. Next, the student completes two research papers and reads four books before completing a self-assessment, compiling a referral list of doulas in their community, and attending three births. The last step is submitting all materials in an application packet and uploading them to DONA International’s site, for a fee. Students have three years after participating in the training to complete all requisites.

While DONA International estimates this process costs prospective certified doulas anywhere between $600 and $1,000, Mead said $1,000 is closer to the low end. “If someone tried to do this program without our assistance, it could range anywhere from $1,200 to $3,000 for them to get their [full] training,” said Mead. “We removed that barrier, and we're able to help them move the needle closer to that certification.” JCSU’s facilitators also offer one-year mentorships to interested students working to get their certification—the university partners with local organizations to help students attend live childbirths.

JCSU, being an HBCU, is crucial to this effort and to increasing and diversifying the perinatal workforce. In June 2023, the Supreme Court effectively eliminated race-conscious affirmative action in higher education, which is expected to lead to declines in the number of Black students attending college.

The effect of that expected decline on the health and well-being of Black communities is currently unknown, but history offers up a grim possibility. In 1910, Abraham Flexner released a report that led to the closure of 75 percent of U.S. medical schools. Commissioned by the Carnegie Foundation to evaluate and standardize medical education, Flexner's investigation included six Black medical schools, four of which were shut down by 1923. Although the goal was to enhance the quality of medical care—and due to a lack of access to quality secondary school education, Black students arrived at medical schools unprepared—the consequences were particularly harsh for Black communities. Researchers estimate that, had those schools not closed, 30,000 to 35,000 Black doctors would have received a medical degree in the past century. With limited acceptance of Black students into predominantly white institutions, the number of healthcare providers willing to serve Black populations significantly decreased.

Of the Black doctors currently practicing, 80 percent were educated at Meharry Medical College or Howard Medical School, the only two Black medical schools left.

“Advocacy is the thread throughout this; that's key. That's the beauty of why we're doing it. History and advocacy are connected to the history of HBCUs,” said Mead. “HBCUs existed to educate us when nobody else would. Even if we didn't attend an HBCU, we were likely educated by someone who did. So, the legacy of HBCUs and that connection of advocacy and empowerment ties into what we're doing now.”

Doula Care Saves Black Lives

Tonya Abari’s second pregnancy was much different than the first.

Abari planned to have a vaginal birth at home—a decision that turned off many potential care providers due to her age and past complications. Abari and her husband decided that their six-year-old daughter would be as active in the birthing process as a small child could be. Their care team jumped on board, including the six-year-old in appointments, giving her homework—like keeping her mom’s food journal and writing down her blood pressure readings—sharing affirmations, and bringing her coloring books. It was a stark shift from her first pregnancy already. Her former OB didn’t even allow children in the office, which Abari found nonsensical.

“We needed a care team that was understanding of us needing to have her in the room—and I mean in the room literally while I'm giving birth,” she said. “A prerequisite for us in choosing was that you have to understand that we do things as a family.”

For centuries, Black birthing traditions have included a communal element. Abari’s doula arrived on the morning of labor and delivery with an apprentice, a birth photographer to document the process, and a therapist to provide mental health support, considering the trauma experienced during her first birth experience. Her care team held her hands during contractions, sang, made a playlist of her favorite songs, and recited affirmations with her. I am strong. I am magnificent. I am capable. They decorated her bedroom with photos of her family and art. More coloring books showed up for her six-year-old daughter, and they cooked for her family.

Labor and delivery went smoothly. In November 2021, Abari and her family welcomed a healthy baby girl.

Two weeks after giving birth, Abari had excruciating leg pain. But, suffering from postpartum depression, she kept that to herself. Late one night, she shared a photo of her swollen legs with her doula and midwife. They told her to get to the hospital. There, a kind-hearted Black woman OB told Abari that she had a blood clot and was having a light stroke. She was rushed into surgery to remove the clot. Her Black OB prayed with her alongside a few nurses.

Of Abari’s care team, her doula was the one who made it to the hospital. While there, she noticed Abari had been left to “sit in her own dirt.” She went to the managerial team and the doctors, demanding they clean Abari up. She was also able to help Abari pump so that she could continue feeding her daughter, who refused formula.

At this point, when sharing her story, Abari breaks down.

“I don't know how I pumped milk, but I pumped milk in the hospital, and my doula was there picking up the milk and delivering the milk. My baby would not drink anything other than my milk,” Abari said once she had collected herself. “She made runs. She was there. She did so much, so much, so much. And, honestly, it was lifesaving.”

“The most important time was postpartum because I didn't know things could fall apart that fast,” Abari continues. “I didn't know that I needed that extra help and that extra care after I had the baby—and what helped to save my life was their care.”

Everything you just read is free, and I want it to stay that way! But the research behind Healthy Futures—the clinical reviews, the sourcing, and the hours spent making sure every claim holds up—isn’t. If this issue earned your trust, a tip or a paid subscription helps me keep earning it.

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The gap between wellness as a product and wellness as a right has gotten obscene. The state forced Black women to receive C-sections. A Georgia woman was charged with murder for taking abortion pills. A Black town in Illinois has E. coli in its drinking water and has just lost federal funds that could be used to address the issue. Meanwhile, the wellness industry pushed nicotine patches and cold plunges in Norwegian fjords.

March made it very clear that, under capitalism, whether your body belongs to you still depends on who you are and what you can afford.

They Didn’t Want to Have C-Sections. A Judge Would Decide How They Gave Birth. | ProPublica

They’re forcing birth and forcing how those births play out. ProPublica found that Florida hospitals sought emergency court hearings—mid-labor—to override two Black women’s refusal of C-sections. One woman, a professional doula who understood the risks and made an informed decision, had a judge convened on a tablet at her bedside while she contracted. She had no lawyer or advocate present, and she was the only Black person involved in the proceeding. The judge told her race had nothing to do with it. ACOG has deemed court-ordered C-sections “ethically impermissible,” but, apparently, Florida doesn’t care.

We’ve yet another example of what fetal personhood looks like in practice. A laboring woman’s bodily autonomy will be weighed against an unborn child’s rights, and she will most likely lose.

And all this in a state that champions “medical freedom” for vaccine refusal. Tuh.

Georgia Woman Charged With Murder for Taking Abortion Pills | WSB-TV / AP

In December, Alexia Moore went to a hospital emergency room with severe abdominal pain. She told medical workers she’d taken misoprostol, one of the drugs used in medication abortions—and that became the basis for a murder charge, one of the first of its kind in Georgia since the state’s six-week abortion ban took effect.

I want y’all to read this again. A woman sought emergency medical care, and the information she disclosed to her healthcare providers was used to charge her with murder.

The judge who heard her bond case called the charge “extremely problematic” and set bond at $1. The DA said local police filed the charges without his office’s support. But the charge exists because these backward-ass laws allow it to. Pregnancy Justice found that more than 400 women have been charged with pregnancy-related crimes since the Dobbs ruling. Pair this with the ProPublica piece above, and it becomes crystal clear that the state is expanding its authority over pregnant bodies in ways that disproportionately criminalize Black women and women without resources—which anyone who pays attention to U.S. history knew was coming.

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If my wellness journey were a situationship, it would be the one where I ignored a man’s every red flag because the [redacted] was immaculate. The aesthetics of wellness are just like that man—gorgeous, and how it makes you feel distracts from the larger issues it presents. In 2017, when my journey began in earnest, I loved the matching sets, the farmers market hauls, and the sunrise yoga sessions—I still do, because, well, it’s complicated. But, soon, this love story morphed into a capitalistic pursuit I was too invested in to admit that looking well and being well had nothing to do with each other.

By 2019, my chase had matured into two intense routines. The morning went exactly like this:

• Wake up at 6 AM

• Make ginger tea

• Take AM supplements

• 30 minutes of power yoga

• Shower

• Coffee

• Commute to work

• Hop off the train at Gallery Place to walk a mile to the office

And the evenings:

• Leave work at 6 PM

• Hit the Crunch Fitness in downtown DC for 45-60 minutes to workout

• Walk five blocks back up 12th to Eaton for about an hour in an infrared sauna—only a few days a week though. I’m not made of money.

• Walk to the metro station—another five or six blocks—to head home

I was heavily inspired by the rising wellness influencers just beginning to take over Instagram with their very aesthetic depictions of their lives.1 Such a mirage is why I’d built my daily life off their Pinterest boards. It was perfect looking, majestic, aspirational, and it gave me the same high I got from the Marlboros I’d put down three years prior.

It also gave me the same temporary relief from my anxiety. I’m a highly functioning anxious person, according to my therapist, so, naturally, I was drawn to systematized presentations of wellness. Being “that girl”—the rigidity, the optimization, the relentless self-monitoring it requires—is how an impending anxiety attack pregames for women like me. I couldn’t see at the time that building my life around aesthetics wouldn’t make me well. It would only manage my unhappiness and feed my perfectionism (read: anxiety). It would only do that for so long before the oasis fizzled against the horizon of my discontent with myself.

Once I worked through the personal aspects of all this—years of therapy, y’all—I started noticing the same pattern everywhere. I saw it in the 5 AM girlies, the women with the “non-negotiable” morning routines, and the women filming themselves hitting 10,000 steps before sunrise.

This rigidity is often our nervous system trying to build a cage it can control because everything outside of it is ungovernable.

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I’ve been working on this for a while, and it’s finally ready!

The Shelf is a curated shortlist of health, wellness, and beauty products I actually use, with discount codes and free trials for Healthy Futures paid subscribers.

It now lives as its own section of this newsletter. You can browse it anytime. New additions will land here as their own posts, so you’ll get an email each time something earns a spot.

The bar for landing on The Shelf is simple: Despite whatever the science says (which I always check), would I recommend this to a friend, unprompted? If the answer isn’t an immediate yes, it doesn’t make the list.

Some of these products were sent to me by brands; some of those brands are affiliate partners with Healthy Futures. Other items I purchased myself. Either way, the standard is the same, and every listing includes a disclosure denoting which is which.

How The Shelf works

The beauty of The Shelf is how slim the pickings are; I mean it when I say a spot here is earned—and I’m a tough sale. The section will grow over time, but I’m not trying to build a long list. I’m trying to build one that prioritizes quality over quantity. When a new product is added, you’ll get a dedicated post.

If even one code saves you $10–15 a month, your subscription has already paid for itself. If you’re not yet a paid subscriber, this is a good time to sign up!

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What’s on The Shelf right now

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MDSolarSciences sent me these products to test and, as always, any assessment of them is my own. This post also has affiliate links, which earn me a small commission if you buy through them.

Welcome back to Well-Spent, the series where I test health and wellness products and tell you whether they’re worth the hype. If you missed the last editions, I reviewed Prequel Skin and Quince. Go check them out.

This time, I’m testing three SPF beauty products from MDSolarSciences: a BB cream, a cream blush, and a lip balm. The thinking behind all three is the same. If you fold sun protection into the makeup you’re already wearing, it’ll be easy to use, so you don’t have to think about it. I tested all three products for over a month.

Let’s get into it.

About the Brand

MDSolarSciences was founded by Dr. Robert J. Friedman, a dermatologic oncologist. The brand prioritizes mineral-based formulations across its lineup and has expanded from straightforward sunscreens to tinted SPF products. More recently, they’ve begun selling full-color cosmetics with built-in sun protection.

Green flags: Dermatologist-founded and developed, mineral and chemical-based formulas, transparent ingredient lists, wide-ranging HSA/FSA eligibility across the line (which is a real money saver), and a price point that sits around industry averages.

Yellow flags: The shade ranges across their tinted products are still narrow. The BB cream offers four shades, versus, say, Tarte’s 15 or Colorscience’s six. The cheek crème and lip balm offer more variety, but I’m not fond of seeing only four shades of a complexion product in 2026.

About the Reviewer

I have persistent post-inflammatory hyperpigmentation, which makes me exactly the kind of person who benefits most from daily SPF. I’ve also been wearing tinted sunscreens and makeup for years. For your reference, my complexion is medium-deep with neutral peach undertones, or the shade Syracuse in the NARS Natural Radiant Longwear Full Coverage Foundation.

Why SPF Matters for Black People

Yes, we need to wear sunscreen. We also need to get annual skin checks to make sure our moles and any other skin spots aren’t cancerous. Mostly, the sunscreen conversation focuses on skin cancer—specifically melanoma—but the relationship between melanated skin, various skin cancers, and UV exposure is a bit complicated, and different than it is for lighter skin.

For starters, UV exposure isn’t the primary cause of melanoma in skin of color. A 2021 systematic review of 13 studies covering more than 7,700 melanoma cases among people with skin of color found that 11 of them showed no association between UV exposure and melanoma risk. When Black people do develop melanoma, it’s overwhelmingly the acral subtype, which is the kind that shows up on the palms, soles, and nail beds, not the sun-exposed areas dermatology has historically fixated on. As Dr. Jenna Lester, an associate professor of dermatology at UCSF, put it to NPR: dermatology’s focus on skin cancer sometimes takes people of color out of the conversation entirely because we’re less likely to develop the types associated with sun exposure.

All of this speaks to a need for heightened skin cancer surveillance and a more nuanced understanding of how skin cancers develop for Black folks and other people of color. That doesn’t mean that we shouldn’t protect our skin from the sun, though.

While melanin offers some protection from the sun, visible light damage is cumulative, and overexposure to UVA/UVB rays can cause DNA changes to our cells—even if those changes aren’t necessarily cancerous.

There’s also hyperpigmentation, which is very annoying, even if it isn’t harmful to your skin’s health. Dark spots from acne, eczema flares, or even a scratch that healed months ago but left a mark that won’t quit are one of the most stubborn skin concerns for people with melanin-rich skin. A widely cited study published in the Journal of Clinical and Aesthetic Dermatology found that around 65 percent of Black patients with acne developed post-inflammatory hyperpigmentation (that study is from 2002, but the figure has been confirmed in more recent research). Once those spots show up, they can stick around for months or years—far longer and more intensely than they do for lighter skin tones—because our melanocytes respond to inflammation more aggressively and produce more pigment in the process. If you want to nerd out with me for a second, this happens because melanocytes in darker skin types form a specific protein complex that sustains pigment production long after the initial trigger has cleared. That’s why your dark spots seem to have their own lease agreement with your body.

Now, here’s where it gets interesting and why I’m recommending tinted sunscreen usage. A few paragraphs ago, I mentioned visible light. Well, standard sunscreens, even the mineral ones, don’t protect against it, which can cause worsened hyperpigmentation in melanated skin—but tinted sunscreens containing iron oxides do. Those formulations significantly outperform non-tinted sunscreens at preventing visible light-induced pigmentation.

Despite offering a layer of protection that non-tinted formulas don’t, tinted sunscreen products matching darker skin tones have only become widely available in the last few years. This is very similar to the Band-Aid problem. Iron oxide containing tinted sunscreens still don’t cover the full range of darker skin tones, and there are no regulatory standards requiring companies to substantiate their visible-light protection claims. A lot of brands are playing catch-up, and some of them aren’t running fast enough.

Product 1: Cheek Crème SPF 30 in Heat Wave

$36 · Two shades · Broad-spectrum SPF 30

What They Say

MDSolarSciences describes this as “a cream blush that does more than provide a beautiful flush, it protects your delicate cheeks.” The formula includes jojoba oil, shea butter, squalane, and Vitamins C and E alongside broad-spectrum SPF 30 (chemical). It’s buildable, non-comedogenic, and fragrance-free.

What I Found

This is the product I’d hand to a friend and say, “Just trust me.” I applied it with a brush, layered it over my usual makeup products, and it blended beautifully. The color payoff in Heat Wave is warm and natural—like I’m just slightly flushed—and the buildable formula means I could go from “barely there” to “blushed down baddie” depending on the day. It reminded me a bit of Rhode Toasted Teddy and Glossier’s Cloud Paint in Plume.

The real win here is the SPF placement. Your cheeks are one of the most sun-exposed areas on your face. They’re where hyperpigmentation and sun damage love to set up shop. A product that puts broad-spectrum SPF 30 directly on the spot that needs it most without you having to think about it is doing exactly what this category should be doing.

The Science

The formulation checks several boxes. Zinc oxide provides mineral-based broad-spectrum protection. Jojoba oil and shea butter offer hydration without clogging pores, which is important for anyone with acne-prone skin. Squalane supports the skin’s moisture barrier. Vitamins C and E are antioxidants that may help with the appearance of existing hyperpigmentation while protecting against further oxidative damage. I love the straightforwardness of this product. There’s nothing groundbreaking here, but it’s well-formulated and well-suited to the product’s purpose.

Who This Serves (And Who It Doesn’t)

Serves: Anyone who wants effortless sun protection on their cheeks. Tinted SPF users who want something more fun and wearable. Anyone who’s HSA/FSA-eligible and wants to put their benefits to work on products they’ll actually use.

Doesn’t serve: People looking for intense, full-coverage blush. This is sheer and buildable, but you’re not going to get the same coverage you would from, say, Juvia’s Place.

The Verdict

Worth it. At $36, this is a smart investment. I’ll be repurchasing this one with my own coin.

Product 2: Mineral BB Crème SPF 50 in Dark

$43 · 4 shades (Light, Medium, Dark, Deep) · Broad-spectrum SPF 50 · HSA/FSA eligible

What They Say

The BB Crème is described as a “sunscreen-makeup-hybrid” that blurs, smooths, and brightens skin while providing SPF 50 mineral protection. The formula includes niacinamide and caffeine to reduce the appearance of redness and discoloration, as well as zinc oxide at 17% and titanium dioxide at 2%. They market it for all skin types, including sensitive, rosacea-prone, and acne-prone skin.

What I Found

On paper, this should be the star of the lineup. SPF 50 in a BB cream with niacinamide? For $43? From a derm-founded brand? I wanted this to work.

It didn’t.

The formula goes on nicely. It’s smooth, not chalky, and the initial color match in Dark was actually decent.

For about an hour, then it oxidized, and the shade shifted noticeably warmer and orangey. By mid-morning, I looked like I was wearing a different BB cream than the one I’d applied. This happened consistently over weeks of testing. Oxidation is a known formulation challenge, and it disproportionately affects deeper shades because the color-correcting pigments interact differently with our skin.

At $43, though, I need it to look right for more than one Zoom call. Brands can combat this issue by adjusting their formulas or packaging. That, of course, affects pricing, but I would be willing to pay more for this. I really liked it, and I found it easy to apply and blend with a sponge or a brush. But I can’t be walking around giving you Donald Trump; that’s just not going to work for me.

The Science

The active ingredients—17% zinc oxide and 2% titanium dioxide—provide legitimate broad-spectrum mineral protection. SPF 50 is robust. The niacinamide is a welcome addition; it’s well-documented for managing acne, reducing hyperpigmentation, and strengthening the skin barrier. Caffeine has anti-inflammatory properties and can temporarily reduce puffiness.

All good here.

Who This Serves (And Who It Doesn’t)

Serves: People who want a mineral BB cream with serious SPF. Sensitive and rosacea-prone skin types who need a gentle, zinc-based formula. People who enjoy wearing any Fenty complexion product. Don’t boo me; they’re orange! But the formulation? Outstanding. The same goes here.

Doesn’t serve: People who are counting on the shade staying accurate for more than a couple of hours.

The Verdict

I’ll pass. The ingredients are impressive. The SPF protection is excellent. But the oxidation loses me and, likely, a good chunk of consumers who are already underserved by this category.

Product 3: Hydrating Sheer Lip Balm SPF 30 in Shimmer

$26 · 7 shades · Broad-spectrum SPF 30 · HSA/FSA eligible

What They Say

This is marketed as a hydrating, tinted lip balm with SPF 30 protection, packed with shea butter, jojoba, avocado oil, and olive oil. The formula includes Vitamin C to support collagen and promote firmness. Seven sheer, buildable shades. Vegan, hypoallergenic, gluten-free.

What I Found

It’s fine! The Shimmer shade is exactly what you’d expect—a sheer, slightly iridescent wash that doesn’t commit to a color. The texture is smooth and non-sticky, which is better than many SPF lip products that feel like you smeared a stick of sunscreen across your mouth. It hydrates adequately. The SPF 30 is a legitimate benefit.

At $26 for a lip balm—even a nice one—I need it to do something that makes me choose it over the dozen other options at that price point or lower. And it just... doesn’t.

The Science

SPF on lips is genuinely underrated. Lip cancers, while relatively rare, are disproportionately aggressive when they occur, and chronic sun exposure on the lips contributes to premature aging and dryness in that area. Shea butter and jojoba oil are well-established emollients. Vitamin C is a proven antioxidant. The formulation is sound. Still, I don’t think the product is exceptional enough to justify the price in a crowded category.

Who This Serves (And Who It Doesn’t)

Serves: People who want a daily lip balm with built-in SPF and a barely-there tint. Folks who are already MDSolarSciences fans.

Doesn’t serve: Anyone looking for noticeable lip color. People who can get similar SPF lip protection at a lower price point.

The Verdict

It depends. Worth it if you’re already within the MDSolarSciences ecosystem and want the convenience of matching SPF lip protection. Not worth it as a standalone purchase when competitors offer comparable formulas for less.

Final Thoughts

MDSolarSciences is building sun protection into the products people actually reach for every day. While I’m usually quite skeptical, I don’t think it’s a marketing gimmick. SPF cosmetics that work are a real public health win for everyone.

Still, it’s a brand and many of them have a long way to go when it comes to properly serving a diverse consumer base. Having only four shades for a BB cream is not robust enough, given that competitors offer more options. The gap between marketing inclusivity and formulation performance is where the beauty and skincare industry keeps falling short, and it’s especially frustrating for a brand built on science. If any brand should understand that sun protection needs to work for everyone, it’s this one.

Everything you just read is free, and I want it to stay that way! But the research behind Healthy Futures—the clinical reviews, the sourcing, and the hours spent making sure every claim holds up—isn’t. If this issue earned your trust, a tip or a paid subscription helps me keep earning it.

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Healthy Futures is free to read and always will be. Paid subscribers get Wellness Debrief, The Shelf (launching soon), and a few paid essays per month. If you’re not ready for that but want to support the work, you can also leave a tip via PayPal. Now, let’s get into it.

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You’ve seen the trajectory. Someone gets a gym membership, starts a few supplements, and maybe listens to the Huberman Lab podcast. They drop some body fat and get better sleep—no big deal. But for a sliver of those people, it goes further: skepticism about seed oils is first, then beef tallow on the skin instead of a moisturizer, then raw milk, then a full embrace of a broader conservative politic, which is now codified in federal policy due to MAHA.

Many of us have spent years watching this happen online or IRL. At some point, a person who just wanted to be healthier begins parroting talking points from a deregulatory political project with ties to white nationalism.

This has been percolating in my head for a while now, so I built what I’m calling The MAHA Matrix: an interactive scatter plot that visualizes the line between normal self-improvement practices and conservatism. The result is a visualization of how capital and ideology move people from “I just want to look and feel better” to “processed foods are poisoning you,” and how the evidence thins out as the journey becomes more extreme.

The matrix maps a system, not individuals, running through content creation, consumer products, and policy infrastructure.

Well, this embed is interactive for anyone reading in the Substack App or on a web browser. Hover over a point to briefly learn more. Click on it to view any sourcing.

What The Axes Mean

The X-axis runs from bodily autonomy to ideological project. The former refers to “decisions about your own body,” such as getting a gym membership, getting lip filler, and weight training. On the right, you have things like MAHA policy, looksmaxxing, the anti-vax movement, and the manosphere—ideological projects that require you to adopt a worldview to participate. These go beyond buying a product or service; you’re being recruited into a belief system that has a specific political valence.

The Y-axis runs from desirability at the top to purity and nostalgia at the bottom. Desirability is longing aimed forward. It’s aspirational. You want to look good, feel strong, be attractive, and perform well. It’s fairly honest about what it is.

Purity and nostalgia is longing aimed backward. It’s the fantasy of life before whatever modernity you’ve been taught to fear. It manifests as consumer behavior and belief, but the engine underneath is always a lie about the past in service of a present political project.

Why I’m Highlighting Evidence

Every item on the matrix is color-coded by the strength of its evidence base:

Green items are supported by decades of research and clinical data. Yellow means that real studies exist, but the claims made for these inclusions in the wellness/self-improvement ecosystem far exceed what the research shows.

Red is where the chart gets crowded. These practices and movements are either unsupported or actively contradicted by the available science.

The pattern that emerges is stark, making the pipeline quite visible. Evidence thins as you move right and down. Almost everything green sits on the bodily autonomy side of the chart, while everything red clusters toward ideological project and purity/nostalgia.

The Most Interesting Thing

It was shocking to see that the bottom-left quadrant ended up being almost completely empty. The MAHA matrix shows that you cannot exercise bodily autonomy within a framework of purity and nostalgia because these are ideologies.

Bodily autonomy can realistically be paired with desirability. Here are some examples of decisions a person makes about their own body that do not require conservative ideology as a foundation:

“I want to look a certain way, so I’m getting this procedure.”

“I want to be stronger, so I’m lifting weights.”

“I want clear skin, so I’m using retinoids.”

And some that operate within a framework of conservatism:

“I drink raw milk because I don’t trust what’s in pasteurized milk.”

“Vaccines cause autism.”

“Eat real food.”

Purity and nostalgia require a theory of contamination: the belief that something, someone, or, in the most extreme instances, a group of people is a corrupting force. The “us versus them” dichotomy, hidden beneath sometimes benign language, is what makes the pipeline seen in the matrix so effective. It doesn’t announce itself, and each step feels like a personal choice.

The MAHA Matrix is my attempt to make that pipeline visible in a single image because the first step to not getting played is seeing the game.

Everything you just read is free, and I want it to stay that way! But the research behind Healthy Futures—the clinical reviews, the sourcing, and the hours spent making sure every claim holds up—isn’t. If this issue earned your trust, a tip or a paid subscription helps me keep earning it.

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“What do you want?”

“For all of this to be over,” I said.

I felt the tears welling up in my eyes, my chest tightening. I paused. Looked up at the ceiling to avoid making eye contact with her or myself in the camera.

“What does that mean?”

I took a deep breath.

This year has been challenging. I’ve been out of work since April 2025. I’ve barely freelanced because my pitches are, I assume, lost in a sea of other pitches sent by jobless writers who need the money just as much as I do. Or, maybe, no publication cares about what I want to write about, which tracks, and has, ultimately, been what pushed me out of the newsroom anyway, so my resistance to acquiesce bites me in the ass once again. Healthy Futures isn’t profitable—mostly because I refuse to put the stuff people would pay for behind a paywall since the point of my access is to give it to people who don’t have it. A holdover from my time in journalism and nonprofits that makes me feel like a mule, but is also simply the right thing to do when you’re working with marginalized groups in mind.

Applying for jobs is a humiliation ritual I can’t participate in in good faith. I do it because I feel like I’m supposed to, but somehow, I also feel like it’s a massive waste of my time because, hundreds of applications later, I’m still unemployed, and I’m really starting to take that personally.

No, I am taking that personally.

Of course, this isn’t only happening to me; it’s happening to too many of us. But I feel it so acutely that I can’t really think about anybody else or anything outside of the dwindling number in my bank account and the fact that there is no money coming in.

I’ve been thinking, or I guess this all makes me think about a question I ask every person I interview for my newsletter: “What does a healthy future look like to you?” The sameness of the responses is what I like most. It’s always some combination of healthcare for all, safe housing, economic security, nutritious foods, limited stress, and real choice—not the false ones presented to us at every turn. Every expert reiterates that, to thrive, we all need these basic human rights. No argument from me on that. But we focus on the conditions of a healthy future, we don’t stop to imagine, even for a second, what it feels like.

What does a Tuesday feel like when you’re not in survival mode? What do you want out of life when the wanting isn’t shaped by fear or instability?

That is an answer I’m not sure I know, but damn it, I want to. I’ve spent so long cataloguing what’s broken that I haven’t spent enough time figuring out what whole looks like for me on a random morning when nothing is on fire. I’ve come close to it, though, once before, in 2019, on a trip to Aruba. I think about this moment often, even though it involves my ex (lol). We were floating just offshore in warm, crystal blue Caribbean water. We were in that still moment before it starts to rain, when the clouds shield most of the sun, but you can still see it peeking from behind the cover. The beach was empty and quiet. My body was fully relaxed; my brow wasn’t furrowed for once. I’ve never felt more at peace.

That version of myself, the one who isn’t in crisis, feels fictitious because I’ve been in crisis for so long. But I’m trying to see her. I’m trying to do it on the pages of my journal, in here with you, on are.na and Pinterest boards, in my TikTok and Instagram folders, and, at times, in public. Either way, it’s really tough, and I often do not know what, if anything, I can feasibly do.

“I just want two weeks where I’m not scared all the time,” I finally respond. “I know that life isn’t perfect and there will always be a mountain to climb, but can I have a break? I want a break. Really, it’s been hit after hit since 2020. So I don’t care how this wraps up. I don’t care what’s on the other side of it. I’ll either be happy, miserable, or I won’t give a fuck. And I don’t give a fuck about how I’ll feel once this chapter of my life is done. I just need it to be done.”

My therapist’s face falls, and so do my tears.

Everything you just read is free, and I want it to stay that way! But the research behind Healthy Futures—the clinical reviews, the sourcing, and the hours spent making sure every claim holds up—isn’t. If this issue earned your trust, a tip or a paid subscription helps me keep earning it.

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Cycle syncing—which is the practice of adjusting your workouts and diet to match where you are in your menstrual cycle—is one of those wellness trends that sounds like it could either have scientific evidence behind it or be another internet wellness culture scam. The hashtag has racked up hundreds of millions of views on TikTok, influencers talk about it like it’s a settled fact, and skeptics maintain that saying women are limited by their cycle sets a bad precedent in our increasingly conservative society.1

But what does the data say?

In this case, not much. Clinical research on cycle syncing is inconclusive. A 2020 analysis of nearly 80 studies involving around 1,000 participants found that any performance differences across menstrual cycle phases were too small to warrant sweeping recommendations. The researchers also noted that the majority of included studies were of low or very low quality, indicating that even small findings come with caveats. More recently, a 2025 study found that exercising at various points in the cycle had no impact on muscle growth. That study was small, which isn’t great. But it did use a rigorous methodology to verify cycle phases, something many earlier studies didn’t bother with, which is great. Currently, the Apple Women’s Health Study, which Harvard’s School of Public Health oversees, is researching the correlation between exercise and the menstrual cycle—particularly the amount of time spent working out and the number of steps taken on bleeding versus non-bleeding days.

While there are certainly people who have periods who feel different during the various stages of the menstrual cycle (Hi! It's me! I'm people!), this is one of those trends where generic advice could go left fast. The evidence base is still too thin—and the population-level experiences are too varied—to make blanket recommendations for all period havers. Every person is different and, I’d argue, every menstrual cycle is, too.

I wanted to talk to someone who could hold the real things we feel in our bodies during our menstrual cycles with the limits of the evidence. Dr. Kerry Krauss is a board-certified OB-GYN and senior medical advisor at Natural Cycles, a hormone-free birth control and fertility tracking app. The first to receive FDA clearance as a digital contraceptive in the U.S., it uses basal body temperature data to predict ovulation and identify fertile windows, and reports 93 percent effectiveness with typical use. Dr. Krauss was drawn to reproductive health work in part by her own experiences with infertility and PCOS.

We talked about how hormone fluctuations can affect your workouts, why the 28-day cycle is a myth for most women, and what’s worth trying even when the science isn’t definitive. Below is our conversation, edited for length and clarity.

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Julia Craven: Let’s just get right to it. There’s some debate in the health and wellness community about whether cycle syncing is evidence-based or just wellness industry hype. What does the science say? Is the practice rooted in any quantitative data, or is it more qualitative?

Dr. Kerry Krauss: While there is limited research that supports cycle syncing as having any proven benefits, we do know that hormone levels can vary throughout the menstrual cycle in ways that do impact energy, mood, and libido, among other things.

I don’t think anyone should expect incredible benefits from the practice, and I don’t think there is anything wrong with trying it out and seeing if it works for you. We all do this to some degree in many facets of our lives. For instance, when I’m on call overnight at the hospital, I try to take it easy the next day and don’t schedule any rigorous activity on those days. If syncing your workouts to your cycle works well in your life, then I say go for it.

Can you explain the science behind how hormone fluctuations throughout the menstrual cycle impact exercise performance, recovery, and nutritional needs?

I do want to stress that everyone is different, and while I can speak to general trends, I think everyone should learn to listen to their own body and notice how they feel at different phases of their menstrual cycle. This is what makes tracking so important.

In general, we know that at various points in the cycle, there can be changes to the way we experience energy, stamina, recovery, hunger, and mood. For example, many people report feeling stronger or more energetic in the follicular phase after menstruation, when estrogen levels are rising. That’s because estrogen helps to boost metabolism, increase serotonin and dopamine, which can improve mood and motivation, and can elevate cortisol and testosterone, which helps to enhance physical strength and endurance. The luteal phase, which is dominated by progesterone, can be associated with increased fatigue and increased recovery needs because of how progesterone metabolizes and increases gamma-aminobutyric acid (GABA) activity in the brain. GABA is a neurotransmitter that promotes relaxation, sedation, and better sleep by reducing brain activity, and that can be responsible for increased fatigue and drowsiness. But at the same time, many will notice that they sleep much better during this time in their cycle.

Similarly, when it comes to nutrition, those changes in estrogen and progesterone can impact how you eat. Estrogen can act as an appetite suppressant, so people in their follicular phase may notice they’re not eating as much or having as many cravings post menstruation. That changes during their luteal phase, when estrogen is lower, and progesterone is higher, because progesterone can increase hunger and cravings.

What types of exercise and nutritional adjustments would you recommend for each phase of the menstrual cycle?

This is highly individual, and I encourage everyone to determine for themselves what feels right. It may also depend on what type of exercise they like to do, and I would always encourage sticking with an activity that you like, or that feels good at any stage of the menstrual cycle. But if you do notice very large shifts in your exercise capacity and appetite during your menstrual cycle and want to start planning around that, here’s what I would recommend:

During the menstrual phase, estrogen and progesterone levels are at their lowest, and we may experience pain or cramps, so our bodies can benefit from more gentle, restorative movement. For women who experience symptoms such as cramps or back aches, low-impact activities like yoga, walking, Pilates, or stretching can help promote circulation and ease tension.

As energy begins to increase in the late follicular phase and ovulation phase, start adding in cardio-based workouts, such as running, swimming, spinning, kickboxing, or group fitness classes. Ovulation, in particular, is a great time to schedule a longer or more intense effort, like a race. As energy begins to dip in the luteal phase, slow things down again with strength training or medium-intensity cardio.

In terms of nutrition, again, this is highly individual, and none of these recommendations have proven evidence-based benefits. But that being said, I don’t think there’s any harm in it, and it could be helpful to eat iron-rich foods during the menstrual phase to replace any iron stores lost through bleeding. During the follicular phase, choosing lean proteins and complex carbohydrates can help fuel more intense workouts. When you’re luteal, complex carbohydrates, high-fiber, and magnesium-rich foods can promote rest and recovery.

Also, it’s important to remember that everyone experiences their cycle differently, and exercise and nutrition should be tailored to what makes them feel their best throughout their cycle.

For women who’ve been following traditional fitness programs designed without considering hormonal cycles, what changes might they notice when they start syncing their workouts to their cycle? How long does it typically take to see benefits?

It’s tricky to make broad promises about how someone will feel when they start cycle syncing their workouts. In my experience, the impact depends largely on the type of exercise routine someone is currently following and the regularity of their menstrual cycle.

For women with predictable cycles who have been following traditional fitness programs designed without hormonal fluctuations in mind, cycle syncing may give a better sense of what to expect from any given workout. Some notice improved energy, better recovery, or less frustration around workouts that suddenly feel harder at certain times of the month. Others report feeling less inclined to “push through” fatigue if they know they’re in their luteal phase.

That said, I wouldn’t expect cycle syncing to offer the same level of benefit for everyone. Women with irregular cycles, PCOS, or other ovulatory disorders don’t experience the same predictable hormonal patterns, which makes rigid phase-based recommendations less applicable. This is exactly why awareness and tracking matter more than following a one-size-fits-all plan.

Before changing your workouts, I always encourage women first to observe their own patterns. Using a cycle-tracking tool, like the Natural Cycles app, can help you identify whether you consistently experience certain symptoms—like higher energy, better strength, or increased fatigue—at specific points in your cycle. Your menstrual cycle provides valuable insight into what’s happening physiologically, but those signals can look very different from one woman to the next.

This personalized approach is also why I’m such a strong advocate for tracking beyond just period dates. When women log exercise, nutrition, sleep, and symptoms over time, they’re better able to notice meaningful trends and make adjustments that actually support their bodies, rather than working against them.

As for timing, the benefits of cycle syncing don’t follow a strict timeline. Some women notice changes within a few weeks, especially if they were previously overtraining or ignoring recovery. For others, it can take a few months to gather enough data, experiment with adjustments, and settle into a rhythm that truly feels sustainable. Ultimately, the goal isn’t perfection. It’s building awareness and flexibility so your fitness routine works with your physiology, not against it.

For athletes training for specific events or women with demanding fitness goals, how do you balance cycle syncing with the structured training plans needed for performance gains?

Structured and performance driven training plans don’t have to be at odds with cycle syncing. In fact, they can complement each other. The goal isn’t to reduce ambition, but to strategically place intensity, recovery, and skill work in phases where the body may be better equipped to handle them.

Recognizing that capacity and perceived exertion can fluctuate across the cycles allows athletes to adjust load, volume, or recovery without losing momentum. This approach can help reduce the risk of overtraining and injury, supporting more consistent long-term progress towards performance goals.

For example, prioritizing strength and high-intensity sessions during phases when energy and recovery tend to be higher, and placing mobility, technique, or active recovery work in lower-energy phases can make demanding programs feel both more sustainable and more productive without compromising results.

Some critics worry that cycle syncing could reinforce outdated ideas that women can’t perform consistently. How do you respond to concerns that this approach might be limiting rather than empowering?

Concerns are understandable, especially given the long history of women’s performance being misunderstood or underestimated down to “that time of the month.” The intention behind cycle syncing isn’t to place limits on what women can do, but to expand the information available to them so they can make more strategic, informed choices about how they train.

Hormonal fluctuations do not mean women are incapable of training consistently or performing at a higher level. Rather, they offer context for why energy, recovery, or perceived effort may feel different at certain points in the cycle. With that understanding, adjustments become tools for optimization.

In practice, that might mean keeping the same training goals, but being more intentional about how sessions are approached. For example, emphasizing mobility and recovery during menstruation while maintaining strength or performance work.2 The aim is greater knowledge, autonomy, and resilience, not limitation.

Not all cycles are 28 days, and many women experience irregular cycles, PCOS, perimenopause, or are on hormonal birth control. How adaptable is cycle syncing for women whose hormonal patterns don’t follow the “textbook?”

One of the most important things to recognize is that there is no “standard” cycle. Data from our survey shows that only 13 percent of women have a 28-day cycle, and that there’s a huge variation in both overall cycle length and length of each phase. That variability is even more pronounced for women with conditions such as PCOS, endometriosis, those in perimenopause, or transitioning on or off hormonal birth control, breastfeeding, or postpartum.

Because of that, cycle syncing is best approached as a personalized, adaptive framework rather than a fixed calendar. Instead of following textbook timelines, the focus shifts to understanding individual patterns, such as changes in basal body temperature, energy, mood, and recovery, and using those signals to guide training, rest, and nutrition. Again, this is why it’s so helpful to use a tool like the Natural Cycles app, which analyzes your biomarker data to provide personalized insights into your cycle. When you can see these shifts in your body over time, you can better understand what approach works best for you.

I’d also stress that while cycle syncing can be a helpful framework, it’s often the day-to-day habits that matter most for hormonal and metabolic health. Consistent, sustainable behaviors tend to have a far greater impact than perfectly aligning workouts to a specific cycle phase.

Regular, moderate movement supports blood-sugar regulation and insulin sensitivity. Prioritizing sleep, since disrupted or insufficient sleep is closely linked to increased stress, poor glucose control, and decreased exercise performance. Eating a nutrient-dense, whole-food diet that emphasizes healthy fats, fiber, quality protein, and cruciferous vegetables to support gut and hormone health. And reducing added stressors such as excess sugar intake, smoking, and vaping, all of which can place additional strain on hormonal and metabolic systems.

When these foundations are in place, cycle syncing becomes less about rigid rules and more about fine-tuning and helping women respond to their bodies with greater awareness rather than chasing perfection.

How should women who are just starting to track their cycles approach this? Should they wait several months to establish patterns before adjusting workouts?

When women first begin tracking their cycles, the most valuable first step is to observe rather than make immediate adjustments. It takes time for patterns to emerge, such as cycle length, phase timing, and recurring symptoms. In general, tracking cycles and symptoms for at least three cycles can provide a more reliable baseline to understand what’s typical for your body, and continuing to track over time can provide even deeper insight into patterns and changes.

Since cycle length and phase duration can vary significantly from person to person, a personalized view is more useful than following a standard model. Once those individual patterns become clearer, it’s easier to make informed, gradual changes to training intensity, recovery, and nutrition.

While there are common trends across cycles, each body still has its own journey, and that often changes over time. Approaching the process with patience and self-compassion helps create a sustainable, long-term relationship with both training and overall well-being, rather than chasing quick fixes.

Everything you just read is free, and I want it to stay that way! But the research behind it—the clinical reviews, the sourcing, and the hours spent making sure every claim holds up—isn’t. If this issue earned your trust, a tip helps me keep earning it.

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The Louisiana Cup Cure involves placing a glass of cold water upside down on the head, with a towel in between, to treat heat exposure and headaches. I’d never heard of it until I saw a video on Twitter in December, but I understood the principle as someone who’s had migraines since I was seven. When you feel like you’ve just been punched in the face by Thanos, a cool rag over your head, however it’s cooled, is akin to a forehead kiss from God. Still, my curiosity about Black ancestral healing practices got the better of me, so I went and found the original TikTok video.

@anitrapowell4A tradition in these parts of Louisiana my son being treated for the SUN #ifyouknowthenyouknow😌

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Users in the comments said their elders did the same for them in Brazil, Mississippi, Texas, and elsewhere across the American South. Then, a few follow-up searches on the platform led me to several creators who pretty much confirmed this is an old hoodoo practice, which is what I figured.

That’s why the reactions to the cup cure I saw on X were so disappointing.

I’m always let down when people call Black ancestral knowledge “stupid.” But this moment bothered me more so than usual because the denigration was rooted in seeing a Black woman practicing a Black folk remedy, and that was enough for a significant portion of the internet to dismiss it as superstition, at best, and idiocy, at worst. Writing Black folk medicine practices off as “superstitious” has never been a neutral observation. It was used to dehumanize enslaved Africans, suppress their religious practices and the cultural offspring that arose from them in the Americas, and frame complex systems of knowledge as primitive.

Besides, the gag is that the cup cure isn’t bunk, scientifically speaking.

Before I get into the research, we need to note the difference between a migraine and a headache since the majority of the data I found focuses on migraine, which is more severe. I’m going to let this cool graphic from Tandem Clinical Research do it for me:

Migraines almost always require medication in addition to any home remedies. Now, the data!

Mechanically, the cup cure is doing two things at once. First, it’s providing a localized cold compress—a method for treating headaches that has been documented for at least 150 years—that lowers skin temperature and constricts blood vessels, reducing the transmission of pain signals to the brain. Second, there’s a mild suction element, since the inverted glass creates a partial vacuum against the towel and scalp, a principle shared with cupping. There are two types of cupping: dry and wet. The former involves creating suction between the cup and the skin using heat or by sucking air out of it, while the latter is the same process, except that small incisions are made in the skin beforehand, and the recipient bleeds.

A 2024 analysis found an 83 percent improvement in migraine symptoms among patients who received cupping therapy, with wet cupping alone showing the strongest results. Still, the research in this area is limited, more rigorous trials are needed, and pain medication offers the best relief for a migraine. As for the other half of what the cup cure is likely doing, cold therapy for head pain has stronger evidence behind it. Frozen neck wraps targeting the carotid arteries reduced migraine pain by nearly 32 percent within 30 minutes, according to a 2013 study, and the short-term benefits of cold therapy were further confirmed by a 2023 meta-analysis.

But, as I said, if you’re a migraine patient or if you have frequent headaches, you already know about the additional relief provided by cold therapy, cupping, or other tension-relieving practices. What you may not have known is that there’s a strong ancestral history behind the mechanics of the cup cure, too.

I couldn’t find documentation of cold therapy being practiced by Black folks in the American South. That likely says more about what got recorded and by whom, and the limitations of online research into historical documents, than about what was actually practiced, since there is strong evidence that cold therapy was used on the continent and may have survived the Middle Passage.

The Edwin Smith Papyrus, the oldest known medical text, mentions hydrotherapy, and an article indexed in PubMed lists the practice as a core component of African traditional medicine. Research published in the Journal of Advanced Research in Humanities and Social Sciences explains that practitioners used cold and hot baths, as well as steam, to treat fever, headache, and pain.

While the provenance is debated, and some research attributes it to European colonists, “cooling” the practice of drawing excess heat from the body to restore balance, is a foundational principle of traditional medicine across the Caribbean. In Brazil, the Candomblé tradition, brought over by enslaved Yoruba people, includes herbal baths and head treatments used to address what practitioners call “doenças da cabeça” (illnesses of the head). One such practice, borí, involves applying preparations directly to the head to care for the ori, the seat of consciousness. The “cooling” is spiritual as much as physical, but the principle is familiar: when the head is disturbed, you restore balance by drawing the heat out.

There’s also plenty in the literature about cupping.

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Though in the mainstream it’s often directly correlated with Traditional Chinese Medicine (TCM), applying suction to the skin is cross-cultural and among the oldest documented medical practices in the world. It appears in the Egyptian Ebers Papyrus from 1550 BC, in TCM texts dating to the Jin dynasty, in Islamic medical tradition as hijama, and throughout Africa, where practitioners used animal horns.

These practices didn’t stay on the other side of the Atlantic either. In Medicine and Healing in the Age of Slavery, historian Mary Hicks documents how Black barber-surgeons in Brazil adapted West African healing traditions of bleeding and cupping. In the American South, the practice was used by white doctors and enslaved Black folks. Historian Sharla M. Fett in Working Cures: Healing, Health, and Power on Southern Slave Plantations mentions it briefly: “If a client was bedridden, the conjurer performed curing rituals at the bedside, using cupping horns, songs, and massage to withdraw the offending snakes, lizards, or other reptiles from the sick person’s body.”

I wanted more information than that, though. After a short dive through the narratives of formerly enslaved people from the Federal Writers’ Project1, I found Lucy Key’s recollection healing her rheumatism by cupping. It was also the most direct correlation to the Louisiana cup cure I found:

In another narrative, where Morris Sheppard mentioned that the plantation where he was enslaved didn’t allow the practice:

It’s worth noting that, generally, cupping, especially if it involved bloodletting, wasn’t preferred by most Southerners, according to historian Lindsey Stewart’s research in The Conjuring of America: Mojos, Mermaids, Medicine, and 400 Years of Black Women’s Magic. Still, the Louisiana Cup Cure sits in this lineage and is rooted in knowledge that predates the country in which it was practiced.

This brings us back to the reactions online.

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Cupping has been steadily gaining mainstream Western credibility for years. Gwyneth Paltrow is often credited with the practice’s original ascension in 2004, when she was photographed on a red carpet with the distinctive round bruises on her back. Twelve years later, Michael Phelps threw it back into the mainstream when he showed up to the 2016 Olympics covered in cupping marks. Some insurance plans now cover acupuncture, and TCM practitioners are licensed in most states.

Cold therapy has followed a similar trajectory. Cryotherapy chambers, where you stand in subzero temperatures for two to three minutes, have become a staple of elite athletic recovery and high-end wellness spas. Ice baths went from niche biohacking to mainstream wellness content after figures like Wim Hof and Andrew Huberman popularized a practice that is also indigenous. The basics of the science are the same as those behind a grandmother in Louisiana placing a glass of cold water on her grandson’s head.

Black ancestral medicine didn’t fail to produce knowledge. It was failed by the institutions that decide what counts as knowledge. The Louisiana Cup Cure works the way a cold compress works, the way cupping works, the way generations of Black grandmothers knew their methods worked before anyone with grant funding started to ask why.

The difference isn’t the evidence. It’s whose hands are holding the cup.

Everything you just read is free, and I want it to stay that way! But the research behind it—the clinical reviews, the sourcing, and the hours spent making sure every claim holds up—isn’t. If this issue earned your trust, a tip helps me keep earning it.

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The one-day sexual education class I took in 8^th grade is barely memorable. We saw an anatomical model of the female reproductive system. We didn’t see one for males because the class was segregated. The boys went into a different room. For the girls, abstinence was the main talking point—and, as I’d hear later over a giggly lunch, it was for the boys, too. We were told that, if we weren’t going to abstain from sex, be sure to use a condom. We were shown how to put it on properly, so we’d know if a guy had done so. (Speaking as an adult, many of them do not.) Birth control was mentioned, reluctantly, as a third option. Still, the instructor immediately pivoted back to: Don’t have sex at all, then you won’t have to worry about getting pregnant. Abortion wasn’t discussed, which isn’t at all shocking in the Bible Belt.

Accurate and comprehensive sex education is not easy to access. Only 29 states and D.C. require public school students to take a sex ed course, and, of those, only 20 require the information taught to be medically accurate, according to a 2025 factsheet by the Guttmacher Institute. Forty-three states plus D.C. require programs to stress abstinence, despite a slew of evidence that the method is ineffective and harmful to adolescents. There’s also no cohesion on how to discuss gender identity or sexual orientation, which means 10 states either ban talking about it or restrict the conversation based on age. The hodgepodge landscape leaves teens with inconsistent and often inaccurate information. They’re also ill-equipped to make informed decisions about their bodies and well-being—an attribute that continues into adulthood.

The things you weren’t taught at 13 become the things you’re left to figure out when you’re in your 20s and 30s, usually when something goes wrong. Black women are three times as likely to develop uterine fibroids, and most of us aren’t told to screen for them until the symptoms are already severe. Perimenopause can start in your 30s, but because the earliest signs are anxiety and brain fog rather than hot flashes, many women and their providers chalk it up to stress. Endometriosis operates with a biological severity that researchers are now comparing to cancer at the molecular level—and the average wait for diagnosis is still 7 to 10 years. The system that was supposed to teach us about our bodies never started, and nothing since has caught up.

The March Living A Better Life Resources is an attempt to close some of that distance. Everything below is focused on reproductive health—the science, the context, and the practical information that should have been part of the conversation a long time ago.

Let’s get into it.

Sexual health isn’t just about having sex

It includes understanding your anatomy, maintaining reproductive wellness, navigating contraception, managing menstruation, getting screened for cancers and infections, and having the language to communicate about your body with partners and providers. The World Health Organization defines sexual health as “a state of physical, emotional, mental, and social well-being in relation to sexuality”—not merely the absence of disease or dysfunction. When sex ed reduces the conversation to pregnancy prevention and STI avoidance, it leaves out a chunk of what people actually need to know to take care of themselves.

Your period is a vital sign

In 2006, the American College of Obstetricians and Gynecologists formally recommended that clinicians treat the menstrual cycle as a vital sign—on par with blood pressure, heart rate, and respiratory rate—when evaluating adolescent health. The logic was that abnormal menstrual patterns in adolescence could flag conditions like PCOS, thyroid disease, eating disorders, and even early indicators of liver failure. That was nearly 20 years ago, and the recommendation, reaffirmed in 2025, still only applies to adolescents.

A 2025 comprehensive research review argues that this is a mistake, since the menstrual cycle functions like any other vital sign. It can signal when something is wrong, track how a condition is progressing, guide treatment decisions, and confirm when things are working as they should.

Ongoing issues with your cycle could be an indicator that you have a health problem that needs to be addressed. Long and irregular cycles are associated with increased risk of premature mortality. A 2024 study investigating the association between PCOS and cardiometabolic conditions found that, regardless of a PCOS diagnosis, irregular menstrual cycles were associated with higher rates of obesity, prediabetes, type 2 diabetes, high cholesterol, hypertension, metabolic syndrome, and other cardiovascular issues.

Think of your period like a monthly briefing from your body. When things are going smoothly, it usually arrives in a predictable rhythm—not necessarily every 28 days, but in a pattern you recognize. When your cycle starts to show up late, disappear for months, or brings heavier bleeding or new pain, it’s often a signal that something in your body or environment needs attention.

Contracting an STI doesn’t mean you’re dirty

Sexually transmitted infections are extraordinarily common health conditions, not character assessments. The CDC estimates that roughly 1 in 5 people in the U.S. has an STI at any given time, according to the most recent data available. The moral stigma attached to STIs—which is this idea that they reflect carelessness or promiscuity—is a cultural issue that stands in the way of improving public health by discouraging people from getting tested, seeking treatment, or disclosing their status to partners.

Further reading: It Might Not Be Too Late to Protect Yourself From Cervical Cancer

There are only about six days per cycle when pregnancy is possible

The fertile window refers to the five days before ovulation and the day of ovulation itself. Sperm can survive in the reproductive tract for up to five days, while an egg is viable for about 12 to 24 hours after release. Outside of this window, conception is biologically unlikely.

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The female reproductive tract actively selects sperm

The idea that fertilization is a race where the fastest sperm wins is one of the most persistent oversimplifications in reproductive biology. Recent research has found that eggs aren’t passive participants in fertilization. The fluid around the egg releases chemical signals that preferentially attract sperm from certain men over others—meaning your egg has its own preferences about which sperm gets chosen. It’s an evolutionary advantage science is only beginning to understand, but it’s so fascinating!

You can have a safe pregnancy after 40

The panic around “advanced maternal age”—a clinical term applied at 35—deserves context. Fertility does decline with age, and specific risks (chromosomal abnormalities, gestational diabetes, preeclampsia, and miscarriage) do increase. But more birthing persons are having babies in their late 30s and into their 40s due to meaningful advances in medical care, such as prenatal screenings for genetic disorders and scheduling more ultrasounds to look for congenital disabilities.

Further reading: Thinking About Having a Baby in Your Late 30s or 40s? Here’s What I Tell My Patients.

Your medical history determines which birth control is best for you

Birth control is not one-size-fits-all, and the conversations from our adolescent years don’t go far beyond “condoms and the pill.” In practice, your health history significantly shapes which methods are safest. Take combination birth control, for instance. If you’re a smoker, over the age of 35, have migraines with aura, or a history of blood clots, this form of birth control—which contains estrogen and progestin—could increase your risk of having an adverse medical event. Plus, there’s the bloating, which sucks.

Thankfully, other forms of birth control exist, including progestin-only and non-hormonal options.

Non-hormonal birth control for men is on the way

For decades, male contraception has been limited to condoms and vasectomy. But, as of February 2026, multiple non-hormonal male contraceptive candidates are in Phase II clinical trials, and men are actively enrolling with many citing the 2022 Dobbs decision as a motivating factor. Phase II trials evaluate efficacy and safety, and regulatory approval, so public availability is still years away, but the pipeline is more active and closer to market than ever.

If you want to nerd out for a second …

NEXT Life Sciences has two: a long-acting reversible hydrogel injected into the vas deferens called Plan A (lol), and a daily pill designed to provide 24 hours of protection. Contraline’s ADAM hydrogel reached a 24-month efficacy milestone in 2025, with trial participants achieving azoospermia (zero sperm count), and received Phase II approval in Australia. YourChoice Therapeutics is also advancing YCT-529, a non-hormonal pill that blocks a vitamin-A-dependent protein involved in sperm production.

Uterine fibroids disproportionately affect Black women, and most of us aren’t told about them

Black women are three times as likely to be diagnosed with these noncancerous growths in the uterus that can cause heavy bleeding, pelvic pain, and pregnancy complications. Almost 25 percent of Black women ages 18–30 have fibroids, compared to about 6 percent of their white counterparts. By age 35, the rate among Black women reaches 60 percent. By age 50, it hits 90 percent.

In addition to developing fibroids at younger ages, Black women experience larger and more numerous growths, report more severe symptoms, and wait longer before seeking treatment. We are also two to three times more likely to undergo a hysterectomy as a first-line treatment. Research emphasizes that these disparities are due to structural racism, provider bias, higher levels of chronic stress, environmental exposures, and barriers to healthcare access.

Perimenopause can start in your 30s, and the first symptoms aren’t what you’d expect

This transitional phase, when hormone levels begin shifting, can start as early as the mid-30s and last four to eight years before menopause. A 2025 study found that more than half of women in their 30s experience moderate to severe perimenopause symptoms. Many don’t seek treatment, most likely because they don’t even consider that they could be perimenopausal.

The earliest symptoms are often anxiety, depression, irritability, and brain fog, not the hot flashes and night sweats people expect. These psychological symptoms tend to emerge before physical ones and peak between ages 41 and 45.

Because the symptoms don’t match the popular image of menopause, many women and their providers dismiss what’s happening as stress, aging, or mental illness. Understanding that perimenopause can begin much earlier, and that its first signals are often emotional, could change how millions of women interpret their own experience.

Further reading: I Didn’t Expect Perimenopause to Start With My Teeth

Endometriosis is a cancer-mimicking disease

Keyword: mimicking!

Endometriosis is usually talked about in terms of pain and diagnostic delay. That framing isn’t wrong, but it could be underselling the biology. A 2025 review documents how endometriosis mimics cancers at the molecular, imaging, and biomarker levels. The paper catalogs 35 cases where endo was clinically mistaken for malignancy, which include elevated tumor markers triggering oncology workups, imaging findings indistinguishable from tumors, and more. The researchers also investigated symptom overlap between endo and cancers—such as bleeding or bowel obstruction—as another way endo mimics. The parallel to cancer has resulted in women undergoing major surgeries or other aggressive medical interventions that weren’t necessary, and could lead to morbidity, due to the imitation.

None of this means endometriosis is cancer. It isn’t. It means the condition operates in a way that the current clinical framework isn’t well equipped to address. For the 190-plus million people living with it, the language we use to describe what it actually does to the body matters—and “benign gynecologic disorder” ain’t cutting it.

Further reading: My Disease Is Not Benign In Any Sense of the Word

Your pelvic floor is a muscle group that needs care like any other in your body

The pelvic floor is a group of muscles at the base of the pelvis that support the bladder, uterus, and rectum and play a role in controlling bladder and bowel function, sexual sensation, and core stability. When those muscles are weakened, tightened, or injured—from pregnancy, childbirth, chronic straining, high-impact exercise, or simply aging—the result can be urinary incontinence, pelvic organ prolapse, chronic pelvic pain, or pain during sex. And yet, a systematic review of the research found that the majority of women have significant knowledge gaps about pelvic floor health.

Some good strengthening exercises include bird dogs, squats, kegels, and hip extension movements—like a bridge pose, pelvic tilts, or a hip thrust.

Everything you just read is free, and I want it to stay that way! But the research behind it—the clinical reviews, the sourcing, and the hours spent making sure every claim holds up—isn’t. If this issue earned your trust, a tip helps me keep earning it.

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