Replacing an abortion clinic with a site that mourns the pregnancies lost in abortion is emblematic of the abortion debates in the United States. For decades, these debates have set up a false dichotomy: You either focus entirely on the pregnant person and avoid discussing the concept of loss and death or you emphasize the loss of a baby while ignoring the needs of the pregnant person. In other words, we exist in a “clump of cells vs. baby” dichotomy. 

What would it look like to marry these two ideas? 

In 2018, this time in the state’s capital of Nashville, Tennesseans once again pushed the idea of eclipsing abortion access and rights through the grieving of aborted fetuses. After heated debate, the state’s House voted to use private funds to erect a “” on state capitol grounds. (Of note, this vote turned out to be primarily political theater. Years later, the monument has .) 

Through this vote, the state’s legislators succeeded in communicating its values loud and clear. Even before the Dobbs decision overturned Roe v. Wade, Tennessee has long been one of the most hostile states for abortion rights with a pre-existing trigger law that made abortion illegal from conception onward. After much controversy, a subsequent lawsuit, and a demand for a recount, to change the state’s constitution to specifically declare that the right to abortion is not protected. 

So why did lawmakers once more deem it necessary to put forth the idea of memorializing aborted fetuses? As an abortion researcher, I view these political moves as one piece of a larger issue in our abortion conversations. We discuss abortion in the U.S. in black-and-white binaries, ceding nuance to national political messaging. Much like pregnancies, abortion exists on a spectrum and shades of gray. 

While the majority of abortions occur early on in pregnancy, they are not all “clumps of cells,” and pro-life groups routinely utilize fully grown—and already birthed—babies in anti-abortion messaging. For instance, ProLife Across America has placed more than 12,000 anti-abortion billboards across 46 states that . Anti-choice protestors have often held ground in front of abortion clinics and used gruesome images to shame, scare, or dissuade patients from seeking care. While pro-choice circles shy away, the anti-abortion movement holds a monopoly on the imagery of abortion.��

One very rare exception is a 2022 article published in that featured a series of photos of petri dishes holding early pregnancies—though clearly after being and transformed into fluffy white blobs. While the cleaning process allowed the tissues to be more visible, it also created a sanitized image of abortion.

This false binary has also been weaponized in anti-abortion legislation. Across the country, namely Wisconsin, Kentucky, Louisiana, and Texas, legislators codified mandatory ultrasound viewing into their state’s abortion policy. explicitly mandated that medical providers place the ultrasound image in the patient’s line of sight, even if the patient did not wish to view the ultrasound. 

Legislators presumed that pregnant people seeking abortions would cancel the procedure if they simply saw the contents of their uteruses. Research disproved this assumption: The vast majority of continued on with their abortion decision after viewing the ultrasound, with only 2% of people changing their minds. In other words, thousands of people saw an embryo or fetus and still felt confident in their decision to terminate a pregnancy they did not desire or feel ready for. 

In a practice public health researcher Lena Hann calls “” some people even want to see the fetus, embryo, or pregnancy tissues after the abortion. In the research Hann and I conducted, we found that abortion providers habitually have to navigate this patient’s desire. Oftentimes, providers are wary of this practice because they do not want the patient to be upset or surprised by what they will see, but it can grant patients a sense of closure, agency, and knowledge about their bodies and pregnancies. 

Despite the benefits for patients, this practice is quite taboo; many clinics lack written policy around it or prohibit it all together. Some of this taboo stems from a fear of departing from the clump of cells vs. baby binary. Allowing abortion patients to see and feel complicated feelings about their abortion is also contradictory to national abortion messaging.��

But other countries offer cultural practices that acknowledge the fetus (and its death) without stigmatizing abortion, particularly if we don’t treat abortion loss as fundamentally distinct from miscarriage and stillbirth. In Japan, temples, graveyards, and roadsides are dotted with stone babies dressed in tiny red bibs. This practice, which is called , represents and honors unborn children who died from stillbirth, miscarriage, or abortion. Mizuko Kuyo is meant to provide solace to would-be parents and grant a space to grieve.

In New Zealand, Maori abortion patients are often allowed to take their fetal remains home and have a cultural burial. Rather than memorializing only aborted babies while vilifying the people who terminated them, these practices allow us to imagine a reality in which people in the U.S. can also respectfully acknowledge and have all sorts of complicated feelings about abortions.

If the U.S. were to depart from this “clump of cells” messaging, it could provide the nuance needed to acknowledge and normalize the fetus and��defang anti-choice messaging. Pregnancy is a spectrum, and pregnant people often like to visualize their pregnancies as they develop, including using apps that use a fruit or other common object to indicate the size of the pregnancy based on weeks of gestation. What if we were able to likewise acknowledge the facts of the fetus within abortion care?

“There is something infantilizing about denying the fact that embryos die when we scrape them out of the bodies of which they are a part,” writes Sophie Lewis in . “It sentimentalizes pregnant or potentially pregnant humans as fundamentally nonviolent creatures to imply that we can’t handle the truth about what we are up to when we opt out.”

Indeed, the notion that all women are inherently nurturing and feel an innate connection to their pregnancies is . To choose an abortion, amid abortion stigma, symbolically denotes rejecting these alleged truths about what it means to be a woman. By denying the loss involved in abortion, are we inadvertently perpetuating abortion stigma?

Abortion in a world where reproductive justice is realized means allowing each person full autonomy over their pregnancy decision. This means freedom to choose the type of abortion, full ability to access abortion without barriers or shame, and, critically, freedom to feel complicated feelings about one’s abortion. For some, an abortion is a clerical, non-emotional health decision that will . For others, an abortion is a loss. Freedom to choose means freedom to feel a full range of emotions—even if these feelings contradict the political messaging we have long clinged to.

LGBTQ+ history is filled with powerful stories of queer and trans people advocating for our rights by using every tool available, whether it’s seeking justice through the legal system or pushing back against police violence—yes at Stonewall, but also at and the hundreds of other, lesser-known protests that came before.

Yet boycotts haven’t played as central a role in LGBTQ+ liberation as they did during the civil rights movement. “W��’re ultimately a fairly small group,” says Eli Erlick, activist and author of . And since companies haven’t historically valued queer consumers, the impact of a boycott is diluted.��

Still, boycotts have been an important tool for liberation. “Queer communities have used boycotts to amplify voices when mainstream media and politics ignored them,” says Jay Santana, an LGBTQ+ historian and activist. “These actions created not just pressure, but visibility.” 

LGBTQ+ Boycotts Build Coalitions and Acceptance

In the 1970s, the to protest discriminatory labor practices at Coors, where employees were disqualified from being hired if they were gay or pro-union. At that time, homophobia was widespread in , but labor leaders also recognized��the organizing power within the LGBTQ+ community, and the organizing talents of Harvey Milk and other LGBTQ+ leaders. Bay Area gay bars refused to stock Coors—to this day, many still don’t carry it—and bartenders ceremoniously poured out beer in the streets. The Coors boycott helped broker an alliance between LGBTQ+ people and union workers.

In 1977, Miami-Dade County, Florida, passed an ordinance that prohibited discrimination against LGBTQ+ people. Christian singer , who was a spokesperson for the Florida Citrus Commission, instantly began campaigning for its repeal by claiming that LGBTQ+ people groomed children. 

In response, LGBTQ+ leaders organized a and orange juice. Bartenders poured orange juice out in the streets. Protestors wore . The boycott earned more than and made gay rights a mainstream conversation topic.

Though Bryant won the battle and the nondiscrimination ordinance was repealed, she lost the war. “The universal anger directed at Anita Bryant was so strong that others joined the struggle and Anita was fired and the LGBTQ+ community had an important victory post Stonewall,” says Robert Kesten, president and CEO of Stonewall National Museum, Archives & Library.

In the years after the Florida orange juice boycott, HIV/AIDS spread through the gay community. We spent our collective energy caring for one another and organizing to demand the callously indifferent respond to the public health crisis. Things were pretty quiet until the same-sex marriage debates. 

When Chick-fil-A’s CEO spoke out against same-sex marriage in 2012, public outrage was swift. College students protested Chick-fil-A opening locations on their campuses. Local officials in , , and vowed to prevent Chick-fil-A from opening or expanding in their market.��

In the short term, sales increased as sympathetic conservatives bought chicken sandwiches in droves. However, the backlash forced Chick-fil-A to . While the company in 2019, they’re still perceived as anti-queer, which has cost Chick-fil-A .��

When North Carolina passed the first anti-trans bathroom bill in the U.S. in 2016, the ensuing mass boycott felt like a sea change. PayPal and Deutsche Bank nixed plans to expand into North Carolina, costing the state . Musicians including Bruce Springsteen, Pearl Jam, and Demi Lovato canceled appearances. The and relocated events to more inclusive states. 

The anti-trans bill cost North Carolina between $450 million and $630 million, according to . Though that was only around 0.1% of the state’s overall GDP, it was enough for the state’s politicians to nix HB2 in 2017. 

In its place, the state’s legislators passed , which kept many of the anti-LGBTQ+ elements of the hated bathroom bill. Most crucially, HB142 prevented local communities from passing LGBTQ+ non-discrimination ordinances for three years. These subtleties were seemingly overlooked as public opinion celebrated what seemed to be a victory. 

I traveled to Asheville, North Carolina, when HB2 was in effect. While Asheville is a progressive city, I dreaded using public restrooms and being misgendered. The broad support for the boycott was comforting. It was one of a few times I’ve felt like my country was on my side. 

Boycotts Document Our Refusal to Be Erased

Anti-trans measures have only grown in the years since HB2’s repeal. “It’s alarming when [anti-trans sentiment] is so widespread that it becomes normalized and impossible to enact boycotts,” says Erlick.

With Donald Trump back in office and committed to using executive orders to erase trans rights—not to mention the very word “transgender”—a collective fury has spurred a resurgence of calls to boycott corporations that abandoned DEI. 

Take Target, which in market value earlier this year, as consumers have used an economic boycott to protest the company’s decision to cancel DEI initiatives. Jamal H. Bryant, the senior pastor at New Birth Missionary Baptist Church, subsequently called for a that was timed to coincide with Lent. LGBTQ+ consumers, still angry about the retailer’s prior waffling on whether to , joined in. Now , foot traffic hasn’t recovered, and Target’s reputation is in tatters.��

“Target could have made a very different decision,” says Santana, pointing to the success of retailers like Costco, which stood by DEI and saw in response. Erlick agrees, noting, “Corporations are ultimately not that supportive of our communities outside of superficial initiatives.” 

The hollowness of brand promises can be painful to realize. But once we come to terms with the shallowness of corporate pledges, queer and trans people can seek ways to leverage our collective power. Santana points to the , a series of decentralized protests held at Tesla dealerships nationwide earlier this year, as Americans registered their discontent with government cuts proposed by Tesla CEO Elon Musk in his role as adviser to Trump, as an example of what’s possible now. 

Tesla Takedown protests have brought joy and hope in dark times and, more crucially, caused a leadership crisis and for Tesla. When claims of homophobia or transphobia are dismissed as individual sensitivity or snowflake behavior, or minimized with labels like “culture war,” Santana says boycotts name the harm, which helps LGBTQ+ people to heal. 

Increasingly, travelers to the United States—and entire countries—are also refusing to cosign our nation’s bigotry with their tourist dollars. The most vocal critic has been Canada, whose citizens are seemingly furious with the U.S. over tariffs, broad anti-immigrant and anti-LGBTQ+ sentiment, and calls to annex Canada and make it the 51st state. In response, Canadians have begun canceling their vacations to the U.S. and dumping bourbon and other imported products. 

Close allies like , , and have warned LGBTQ+ citizens against visiting the U.S., amplifying the persecution of trans Americans and validating our outrage. U.S.-based trans journalist Erin Reed maintains a for trans Americans, color-coded to reflect threat levels. Reed has flagged Texas and Florida as “Do Not Travel” states for the severity of their anti-trans laws, and she warns foreign citizens who are trans against traveling to the U.S. at all.��

The pressure comes with a hefty price tag: Goldman Sachs estimated from decreased travel and trade. 

“Boycotts document our refusal to fund our own erasure,” says Santana. So while the government publicly ’ from the Stonewall National Monument’s website and replaces LGBTQ+ with “LGB,” boycotts remain an effective means of tapping into our collective power and recommitting to queer liberation.

Hysterectomy also often indicates a tragedy inflicted by external, malignant forces. Yet one in five people who are born with a uterus will have it removed by the time they are in their 60s, a statistic that was one in three when I began this project and one that never ceases to shock the person who asks why I study hysterectomy.

Hysterectomy is at once highly common and yet primarily discussed—if at all—as a devastating event that happens to you. While we rarely read about this in news headlines, many people want a hysterectomy, choose a hysterectomy, and are happy to have had a hysterectomy. People might want a hysterectomy for a number of reasons, whether to find freedom from one of the many illnesses that affect the uterus and ovaries or to affirm their gender. These stories contradict fundamental assumptions we hold not only about hysterectomy but about gender, bodies, and reproduction.

A pervasive idea within culture and medicine alike is that all people with uteruses will inevitably want to become pregnant and be mothers. Following this logic, choosing hysterectomy will almost certainly spark regret. And yet, as I found, a hysterectomy can elicit various emotional responses, ranging from delight to grief to something in between. 

While the assumption is that hysterectomy invariably causes grief, it is not the procedure itself that brings on this grief but rather the degree of agency afforded and the social context in which the hysterectomy is situated—the degree to which a hysterectomy feels choosable.

Hysterectomy stories lay bare the dangers of viewing “women’s bodies” as perpetually pre-pregnant, or as existing in the zero trimester of pregnancy, as the sociologist Miranda Waggoner aptly named it. As it turns out, this ideology can be used within medicine to prevent people from making informed decisions about their bodies, both in the realm of hysterectomy and far beyond.

Even opting out of one pregnancy, as in the case of abortion, contradicts central truths we hold about gender in general and women specifically. The abortion scholar Anuradha Kumar and colleagues theorized that abortion is so widely stigmatized because it violates cherished feminine virtues: perpetual fecundity, the inevitability of motherhood, and instinctive nurturing.

As myself, the more I delved into the puzzle of hysterectomy, the more I realized the notion of choosing hysterectomy likewise causes fissures in how our culture understands gender and bodies, perhaps even to a magnified extent. If women are valued for being perpetually fertile, one-day mothers who are born to be nurturing, how could they ever be happy about removing the organ that is purportedly the source of these fundamental attributes?��

How could it be that some people would willingly have this organ removed to achieve happier, healthier, more self-actualized lives? Hysterectomy seekers must confront these questions and assumptions in their quest toward a hysterectomy. Ironically, the overemphasis on fertility promotion within health care simultaneously leads people to desire a hysterectomy while also making this surgery difficult to access for many.

The emphasis on fertility is even found in the way we refer to the uterus and ovaries (“reproductive organs”) and to the illnesses that affect them (“reproductive illness”), which erases the other functions these organs hold for bodily well-being. This emphasis is reflected in the financialization of health care.

Only 2% of the National Institutes of Health research budget is allocated toward understanding the various illnesses that impact these organs, many of which lead to a hysterectomy. Accordingly, despite how common these conditions are, patients often require seeing a specialist to receive proper diagnosis and treatment after years of neglect—that is, of course, unless the illness is causing fertility issues, in which case, time to diagnosis typically shrinks.

Within this system, people whose uterus is causing suffering might eventually come to desire a hysterectomy for themselves as a mode of self-care. Yet, these same people who wish to choose hysterectomy might then be told they are not sick enough, are too young, or haven’t had enough babies to warrant a hysterectomy. To have a uterus in a medical system built for cis women having babies often means being pushed to want hysterectomy and then being told to wait.

The freedom to choose hysterectomy is endlessly complicated by gendered reproductive politics as well as a health care system that does not invest in understanding and treating the uterus beyond its capacity for pregnancy. Hysterectomy access is stratified by race and gender, and more specifically by a proximity to white womanhood. Those who embody white womanhood are often paternalistically barred from choosing sterilization, typically due to a physician’s concern about anticipatory regret. Simultaneously, women of color—particularly Black women—are often pushed toward hysterectomy and are told it is the only option for relief from their symptoms.

Meanwhile, the reproduction of trans and nonbinary patients is often clerically forgotten altogether during clinical conversations about hysterectomy. Trans men as young as 19 are recommended a hysterectomy as part of their gender-affirming medical journey (often without counseling on fertility-preserving methods like egg freezing), while a white cis woman might be told she’s too young to choose such a “drastic” procedure at the age of 35. Of note, a wanted hysterectomy as part of gender-affirming care is considered essential health care, and is associated with improved psychological well-being, while a hysterectomy for a cis woman in chronic pain is often deemed elective.��

Across race and gender lines, the meaning of “medical necessity” for the same procedure shifts, as do concerns around fertility, age, and regret. While individual doctors might not be consciously acting out of malice—and some might even be motivated by a genuine desire to protect their patients—these individual encounters ultimately make up the fibers of stratified reproduction based on race, gender, and class.

To move forward toward a world where hysterectomy is choosable, then, requires viewing all reproductive health choices through the analytical framework afforded by this study of hysterectomy. This analytical framework is rooted in reproductive justice, is trans-inclusive, and accounts for the complex ways race, gender, history, and politics come together to stratify choice. It is imperative to examine not only who is being barred from the right to choose to parent and why but also who is being barred from the right to opt out of parenting—and thus to opt into infertility. These two infringements are inextricable and together form the bedrock of stratified reproduction and reproductive injustice.

As we wade into a second Trump presidency, and the looming possibility of a national abortion ban, understanding these reproductive politics becomes more dire. 

In the process, a deep dive on hysterectomy sheds light on broader inequalities faced by people with chronic illness, gender-expansive people, and racialized communities. By imagining a world in which hysterectomy is truly choosable, we imagine a world where all people have more freedom to live self-determined lives.

This excerpt, adapted from by Andréa Becker (NYU Press, 2025), appears by permission of the publisher.

In 1939, the sleepy British town of Great Yarmouth rumbled awake. National media picked up the story of two brothers, Mark and David Ferrow. The trans teens recently returned to their hometown after spending four years transitioning in nearby Maidstone. 

The siblings were far from extraordinary. Mark, the outgoing older brother, loved fine arts and literature. David, the shy younger brother, joined his father’s book-selling business upon his return. The two grew more comfortable with themselves as they received overwhelming love and support from their small community. 

Mark and David found a way to thrive decades before the first trans kids were supposed to exist. 17-year-old Mark and 15-year-old David did not have our modern language to describe themselves in 1939. The term “gender” only came into common usage around 1955. Yet the trans siblings were far from alone. They were only a tiny part of the blossoming community defying gender norms.

Transgender people are nothing new. What is new, however, is the moral panic around gender identity. After opening up about my own trans identity at 8 years old in 2003, I know firsthand that trans people have existed for more than just a few years.

Calling us “new” erases our history. But exactly how much of our transgender past has been lost, forgotten, and destroyed? Who were the first documented children to transition? What means did activists have to resist society’s extreme discomfort in discussing gender before our language developed? How did trans people live their everyday lives before they had terms to describe themselves? Which trans athletes participated in sports before sex testing? 

I started researching lost trans stories and what we can learn from them after a friend asked me the name of the first minor to medically transition. Amid the 2020s panic over trans youth health care, I realized there was no historical documentation to answer their question. Even historical experts argue that trans teens did not begin medically transitioning until the 1950s. However, what I found was an entirely new history of transgender people.

I located Mark and David’s full story after digging through British news and government archives. The teens are not only among the first known minors to transition, but they also invented creative and whimsical ways to label themselves.

Mark told the Daily Mirror in 1939, “I feel I have worn these clothes all my life. I have always been a man at heart, and I am glad to be in trouser.” He used remarkably modern phrases to tell the public about his transition. “I am glad to be through with it all. I don’t think I could have faced up to it if there had not been some of the woman’s power of endurance in me, though really, I suppose, I have always been a man.”

Testosterone was rarely prescribed before 1939. With a mixture of surprise and excitement, I realized Mark’s story represents the earliest known case of a minor transitioning with hormones.

After I shared Mark and David’s narrative online, millions of people read their history, saw their photos, and heard their story for the first time in more than 80 years. I began sharing more stories of forgotten figures from trans history: a Black trans church leader whose segregated Florida town came together to mourn her death, an Indian snake charmer who hid her trans identity from the California press in the 1940s, and a trans boy who gained the support of his large family in 1862.

Each of these stories inspired feelings of hope and familiarity for readers. Some showed their parents stories of familial support in the face of backlash and confusion. Others were excited for figures who once lived in the same cities or towns as them. I knew this moment was a rare opportunity to share trans narratives that never made it into the history books.

The period from 1850 to 1950 is a unique era sandwiched between the explosion of mass media (newspapers, radio, and photographs) and the term gender (as opposed to sex) becoming popular in the 1950s. The division between the terms gender, sex, and sexuality represents the turning point when trans people became a related but ultimately separate population from those called “homosexuals” at the time.

Sexologist Magnus Hirschfeld coined the German term transsexualismus (transsexualism) in 1923, although the term did not gain widespread usage until decades later. It was only when David Oliver Cauldwell translated the word into transsexual in 1949 that we had an English name for the category describing the people I have researched and shared.

The terms “transgender” and “trans” did not come into common usage until the 1990s. From 1850 to 1950, there was not a common language to describe trans struggles, yet trans people still existed—everywhere from the largest cities to the most remote villages.

What do we gain from the stories of trans people who have not been sufficiently studied? Trans narratives that were lost, forgotten, or destroyed can still describe breakthroughs, adventures, and influential moments in transgender history.  After years of research, it is clear we need to change our cultural appreciation of queer, trans, and gender history. We can use lost histories to foster this understanding—and change—for future trans generations.

While writing , I located what may be the first mass queer and trans uprising, a riot against police in 1930 Berlin involving hundreds of people that was later erased from history by Nazis. Then there’s a formerly enslaved Black trans woman, Sally-Tom, who is possibly the first trans person to have her sex legally changed in the U.S. in the 1860s. One of Europe’s greatest athletes, Stefan Pekar, transitioned in 1936, only for conservative bureaucrats to remove him from the record books. These are just a few of the lost stories that help us grasp the true depth of transgender history..

The archive may not save us, but it will illuminate a path forward. We cannot challenge bad-faith arguments with history and rhetoric. The arguers do not intend to change their minds. However, those who bear witness to the vastness of history may be moved to fight for a better future—and to learn lessons from those who came before us. 

As Martinican author Aimé Césaire writes, “The shortest route to the future is always the one that involves the deepened understanding of the past.”

This excerpt, adapted from by Eli Erlick (Beacon Press, 2025), appears by permission of the publisher.

In a quiet residential neighborhood near downtown Bogotá, Pinzon enters a graffiti-scrawled building, where he’s led into a room outfitted with a small lab. A mural on the hallway reads: “End the War on Drugs.” A lab technician takes Pinzon’s paper square of LSD and douses a small sample with a reactant. It turns a dark copper color, a sign the drug is not what it appears to be.

“There’s no presence of LSD,” Christian Gordillo, the lab technician at Échele Cabeza, the drug-checking site, tells him. “So we don’t recommend taking it.”

With drugs banned around the world, substances are manufactured and sold without regulation, putting the health of consumers at risk. Drug checking is a way to protect consumers by testing the makeup of drugs and providing recommendations that help them to make safer choices. 

Drug checking originates in the ’90s European club scene, where the service was commonly used to test synthetic drugs like MDMA during electronic music concerts. But in Colombia, a country at the epicenter of the war on drugs, drug checking has transformed drug users and those most affected by prohibitionist policies into activists, championing harm-reduction strategies and drug legalization. 

“Drug checking started as a strategy to care for people’s health and has ended up becoming a social movement that is demanding rights, but also proposing actions to change drug policy,” says Julián Quintero, founder of Échele Cabeza.

From Prohibition to Harm Reduction

For decades, Colombia, the world’s largest producer of cocaine, has persecuted drug traffickers and targeted the farming of coca plants, the natural ingredient used in cocaine. Colombia has also used its police force to crack down on drug users, who are often labeled by society as criminals or vagrants.

But Quintero, who began using cocaine, alcohol, and other drugs as a sociology student in the mid-aughts, questioned conventional drug policy. By the time he was in college, the Medellín and Cali Cartel, Colombia’s infamous drug cartels, had been dismantled, but the drug business still flourished. Other armed groups filled the void left by the cartels and took control of the trade. Despite numerous efforts to eliminate the trade, Quintero knew drugs were here to stay.

“The war on drugs had failed, so it was time to start proposing other strategies,” says Quintero.

In 2010, Quintero launched , a nonprofit that strives to make drug use safer instead of trying to eliminate it outright. At first, he focused on spreading information on drug use, with the aim of preventing overdoses. Two years later, Quintero opened a drug-checking booth in Bogotá’s underground raves, using reactants sent by Energy Control, a Spain-based harm-reduction program.

While Colombia has never faced an opioid crisis to the same degree the U.S. has, the growing popularity of synthetic drugs and their alterations posed a risk to Colombians. Échele Cabeza aims to catch the dangerous alterations before they are consumed. But nearly immediately, Quintero said Colombia’s media and politicians accused the organization of promoting drug use.

The nonprofit eventually won over some of its detractors by publishing reports about the adulterated drugs they detected. Their reports attracted the attention of Colombia’s Justice Ministry, which reached out to Échele Cabeza to request leftover drug samples in an effort to help identify new substances on the market. 

In 2013, the government granted the nonprofit a permit to operate legally in return for regular samples. Échele Cabeza became the first drug-checking organization in Latin America to have a government permit. “W��’re located in the Global South, so no one found out, but we were the first to operate with a permit, before anyone in England or in the United States,” Quintero says.

That permit allowed them to foray into renown music festivals and exclusive clubs, where their services suddenly reached a wider audience. Concert goers were not only finding their services valuable, but also demanded that they be available at festivals. As demand grew beyond the festival circuit, Échele Cabeza opened its first permanent drug-checking office in 2023, where it currently offers services three times per week. That same year, Échele Cabeza also opened the first supervised drug-consumption site in South America.

Drug Checking Goes Mainstream

At the drug-checking site, youth carrying drugs stored in plastic bags file into the lab, where drug checking costs 20,000 pesos, or about $5 per substance. In another room, a psychologist is available for clients who wish to discuss problematic relationships with drugs or to ask for advice on how to speak to children about drug use. 

On a recent afternoon, Esteban Pinzón, the 36-year-old public school teacher, wondered aloud what to do with the drug that had been misrepresented as LSD. Gordillo, the lab technician, said there was no way to find out exactly what the drug is. In this case, the reactants only determined whether the sample included LSD or not. But he said that it was likely 251-NBOMe, a psychedelic Pinzón had taken before. 

Pinzón hesitated before saying whether he would use the drug or not. “The analysis created a lot of distrust,” Pinzón explains. “I’d rather take it easy.”

Between 2013 and April 2024, Échele Cabeza analyzed 39,982 substances. Of those substances, about 13% were adulterated. A 2023 study published by graduate students at Bogotá’s Andes University examined whether Échele Cabeza’s services changed the behavior of its users. The study found that there was a significant increase in self-care practices adopted by service users when compared to those who didn’t use the service and that negative effects associated with drug use increased among those who hadn’t used the services. 

Quintero said the impact of their services and their regular reports on Instagram, which currently has more than 220,000 followers, has earned them credibility. They are now commonly cited in news reports and consulted by magistrates from the Constitutional Court, Colombia’s top judicial body. Their influence has also reached the highest levels of government. 

When President Gustavo Petro took office in 2022, he called the war on drugs a “failure” and vowed to end it. While his actual drug policies have not been as far reaching, his administration consulted Quintero as well as a number of other experts in the development of a new national drug plan, which included harm reduction strategies, such as improving access to naloxone, a drug used to reverse an opioid overdose, and strengthening drug-checking organizations. 

According to the Justice Ministry, there are currently 13 groups operating across the country. Quintero said the Petro administration is tapping Échele Cabeza to provide training to these groups and to create a national network. “The government wants to bring together all these youth-led projects from all over the country and train them to do the same thing we did, which we think is amazing,” Quintero says.

The rise of new drug-checking initiatives are an indication that attitudes toward drug policy are changing, Quintero said. He hopes this momentum will give way to drug legalization that includes cocaine, which he said would make drug use safer. 

While he acknowledges drug legalization is still far off, he trusts the next generation might actually achieve this far-reaching goal. “I’m not in a rush now because I know it’s going to happen,” says Quintero. “All we have to do is to continue to work and to allow the next generation to take over.” 

Truthfully, I just wanted to see their art. All of the Black art. They had busts, sculptures, and paintings on almost every wall, and I would gaze for hours at every item. There was a particular piece that captivated me each time I laid my eyes on it. The painting, which I found out later was a poster, had a melancholy-faced Black woman sitting in what looked to be a bathroom or subway terminal because of the white-tiled walls behind her.

There was a phrase written next to the woman’s despondent face, etched in exquisite rainbow lettering. It read: “for colored girls who considered suicide when the rainbow is enuf.” It wrecked me every time I read it. I would wonder, Why was this beautiful Black woman contemplating suicide? And why was she referring to herself as ‘colored’ when it was 1988 and most Black people I knew called themselves ‘Black American’ or ‘African American’?

Prior to seeing the poster, I had never heard of suicide in reference to Black women before. The only knowledge I had of suicide was when it was uttered during a Lifetime movie my mama made me watch during one of our weekend movie marathons. Even then, there weren’t any Black women in that film, or in any Lifetime movie in the 1980s that we watched. 

Even though I had all of these silent contemplations about my aunt and uncle’s magnificent poster, I never posed these questions to them or my mama. Instead, I would just stare at it in awe anytime I visited. 

I wasn’t introduced to Ntozake Shange’s work and didn’t learn about the political and cultural significance of until I was a graduate student and had the opportunity to read her 1975 choreopoem. for colored girls is a Black girl’s song, an ancient yet contemporary tune that allows a Black girl like me to begin to know herself, see herself. It allows Black girls to become familiar with their own voices, souls, and genders.

Shange’s work enlightened me to the complexities of living within the intersection of gender and race, and how those complexities related to the life chances and choices for me as a Black lesbian woman. Although I had been living within this identity all of my life, I had not yet thought about my existence theoretically: how my reality was interconnected with those who came before me and with those who would come after me.

Shange’s work showed me how my sociopolitical embodiment directly affected my ability to even dream about something as universal as love. Like Shange’s characters, I would have to navigate a racist, homophobic, and sexist world that chose not to recognize my humanity, nor my fragility as a sentient being in ways it did for others. Through its words I realized that I wasn’t the only Black girl, now woman, grappling with these realities.

Shange’s work, love, and now ancestral light for Black girls has remained a great influence on my work. Her metaphorical use of the rainbow as a symbol of the multifaceted and complex lived experiences of Black women struggling with and surviving racial and gendered oppression, within and outside of Black communities, is a brilliant illustration of the difficulty of unearthing and unraveling the complex and intricate nature of a people who represent multiple axes of difference.

Her metaphorical use of the rainbow as a symbol of the multifaceted and complex lived experiences of Black women struggling with and surviving racial and gendered oppression, within and outside of Black communities, is a brilliant illustration of the difficulty of unearthing and unraveling the complex and intricate nature of a people who represent multiple axes of difference.

The rainbow is a longstanding image for queer and trans communities. In fact, it was a tiny rainbow in the corner of a shop located in Ann Arbor, Michigan’s that drew me in. I was still a gayby at the time, and the rainbow represented a pathway into a new queer world. The shop turned out to be an LGBTQ+ bookstore that housed documentaries, films, and books about LGBTQ+ history, politics, and life.

I would spend hours after school devouring the anthologies dedicated to coming-out stories, watching what happened at Stonewall, and flipping through the photography books that showed our community members in beautiful and resilient ways. It was also in this bookstore that I learned that in 1978, artist and peace and AIDS activist was commissioned by the openly gay politician Harvey Milk to create the rainbow flag to represent the multidimensional nature and pride of LGBTQ+ people.

Each color of the rainbow was intended to represent the diversity and solidarity of our communities, visually capturing our nuances, our differences and sameness, and our complex identities. The flag was created as a symbol to not only spread love and inclusivity but also to counter sexual and gendered regulation within mainstream society. Leaders, community change makers, and inclusive businesses display the flag in stores, offices, and schools as a symbol of solidarity with LGBTQ+ folks and to express their support and welcome of people belonging to such communities.

However, throughout time, some of the most vulnerable yet resilient people within our communities have not found the rainbow marker to symbolize diversity, inclusion, or solidarity. For many, it has symbolized terror—racialized and gendered terror to be specific—causing many to disidentify from the flag’s symbolism, use, and consumption.

For example, in 1973 when Sylvia Rivera took the stage at one of the first gay Pride parades and celebrations in New York, she was booed, told to “shut up,” misgendered, and subjected to objects being thrown at her by the mostly white, mostly cis, and strikingly racist audience. She repeatedly stated, “.”

As an activist, Rivera, along with , founded the (STAR) shortly after the Stonewall rebellion in 1969, and both she and Johnson worked tirelessly to protect transgender and street youth whose needs and identities weren’t being recognized by early gay groups. Desiring to untether the Mafia’s control over LGBTQ+ bars and night life, Johnson and Rivera created the first LGBTQ+ shelter in the U.S., the first sex worker labor organization, and the first trans women of color organization.

They expanded their mission and goals to other cities until the organization’s collapse in the mid-1970s. Marsha “Pay It No Mind” Johnson stood at for nearly 25 years, serving as a central figure and activist, not only for queer and trans rights but also an advocate on behalf of sex workers, prisoners, and victims of police brutality.

She became a resounding voice for those living with HIV/AIDS, and for those Black and Latinx LGBTQ+ folks who had to navigate and suffer through gay racism. As a political agitator who lived at the intersections of racism, homophobia, and transphobia, Johnson, along with Rivera, helped to transform public consciousness when it came to queer liberation. Yet, in 1992, Johnson’s body was found floating in the Hudson River, and the circumstances surrounding her death remain a mystery to this day. Rivera died in a homeless shelter of liver cancer in 2002.

Thus, even before Baker’s creation of the Pride flag, many Black and Latinx queer and trans folks dealt with antagonism, violence, ridicule, disregard, and neglect by members of their own communities, despite the mainstream perception of unity.

So, I wasn’t surprised to learn that in 2017 the office of LGBT Affairs in Philadelphia was met with backlash when they unveiled a of the Pride flag with the addition of the colors black and brown to the bottom of the rainbow. Many people that I was in community with saw the gesture as moving in the right direction, finally illuminating the need to confront issues of racism, sexism, and transphobia.

The office’s More Colors, More Pride campaign seemed to feel similarly. Their press release read, “In 1978, artist Gilbert Baker designed the original rainbow flag. So much has happened since then. . . . Especially when it comes to recognizing people of color in the LGBTQ+ community. . . .To fuel this important conversation, we’ve expanded the colors of the flag to include black and brown.”

While marginalized folks saw this move as one that spoke to their everyday experiences, many white cis gays and lesbians felt that the revised version of the flag was racist and unfair, and some even felt that the color white should also be added in the interest of keeping things equal. Some took to Twitter to express their anger and frustration with the new flag, while others wrote op-eds to express their discontent.

In the years that followed, other cities, countries, and Pride festivals began to adopt the new version of the Pride flag to show solidarity with those of the LGBTQ+ community who don’t feel represented by the original flag. A London volunteer who leads the LGBTQ+ social and support group Rainbow Noir wrote an op-ed for the U.K. news outlet Gay Star News in response to the anger about the modified flag, following Manchester Pride’s announcement to adopt it for their festival.

“W�� are worn out; physically sick and tired from having to defend our right to be seen, both individually and as queer, trans, and intersex people of color (QTIPOC) collectively.” They argued throughout their essay that the rainbow flag for many Black and Brown queer and trans folks has never felt like it was created for them, and that the “racism and silencing that has ensued since Pride’s announcement is a painfully clear example of why the stripes were included in the first place.”

On June 27, 2018, Stonewall, the United Kingdom’s leading charity for the equality of LGBTQ+ people, released a report about the extensive and longstanding discrimination and . They reported: “Half of Black, Asian and minority ethnic (BAME) LGBT people (51%) faced discrimination or poor treatment from the wider LGBT community.” They further stated that the “situation is particularly acute for Black LGBT people: Three in five (61%) have experienced discrimination from other LGBT people.”

The study, which was based on 5,000 participants, revealed the longstanding problem that queer and trans communities are also plagued by racism, sexism, cisnormativity, and even homonormativity. Before I came out, I wasn’t aware of this fact, either. I neither recognized nor thought about the fact that LGBTQ+ communities, like Black communities, weren’t monoliths or communities made up of unmitigated unity. I never thought about how intricate, nuanced, complex, and diverse they were. 

After I came out, my experiences began to reflect the respondents’ voices, not only those in the Stonewall study but also sentiments voiced by the activist collective Rainbow Noir. When I came into my own grown Black queerness, I finally understood that some white queer and trans folks would never cede their own racial privilege over creating the necessary solidarity with queer and trans people of color. 

It was and is this reality that has led me to interrogate my own relationship to the rainbow flag, trouble the contention that LGBTQ+ communities have always been and are harmonious, borrow from the genius and nuance of Shange’s use of the rainbow, and assert that whiteness, cis-ness, wealth, and the like aren’t the only signifiers or representations of queer and trans identities.

This excerpt, adapted from by Kaila Adia Story (Beacon Press, 2025), appears by permission of the publisher.

When Juliaticia, who asked to be referred to by first name only, arrives, a nurse directs her to sit in a green plastic chair situated in front of a pale yellow building with a rusting corrugated iron roof. Within 30 minutes, more than two dozen women have gathered outside the inconspicuous building to wait for a comprehensive educational demonstration on female reproductive health and a potentially life-saving, free cervical cancer screening.

In Guatemala, cervical cancer is a stealth predator. It is the primary cause of cancer deaths among Guatemalan women, and silently and disproportionately claims lives in low-income rural communities, where access to basic health care ranges from limited to nonexistent.

The World Health Organization’s 2021 cervical cancer country profile for Guatemala reported 872 cervical cancer deaths in 2019 and suggested that this number has remained relatively stable in recent years. However, with more than 60% of Guatemala’s population living in rural areas where there’s a chronic lack of access to health care, there’s a high likelihood that causes of death aren’t properly attributed.

“With so much of Guatemala’s population living in poverty or extreme poverty, the cost of traditional [pap smear] cervical cancer screenings is maddeningly out of reach,” says Andrew Raphael, executive director of , an Antigua-based grassroots nonprofit aiming to address this issue. 

“Assuming [there’s an opportunity for a pap smear] at all, it could be months before test results are returned from the lab, at which point it might be near impossible to communicate them to the patient and her family,” he continues. “Even if the results come back [positive] and make it to the patient, the financial and personal cost for treatment in the case of a positive result can be insurmountable.”

But there is an alternative: The visual inspection with acetic acid (VIA) is a simple, low-cost, and straightforward screening method that uses vinegar, halogen lights, and a microscope to identify abnormal cervical cells—and lower some of the world’s highest rates of premature female deaths due to cervical cancer.��

The VIA procedure is currently the only viable alternative to pap smears—the standardized cervical cancer screening method in the West—for the majority of staggeringly under-resourced communities in rural and urban Guatemala.“With this VIA procedure, we can detect abnormal or cancerous cells right there, right now, and take action straight away,” says Raphael.

Detection in a Matter of Seconds

Since 2011, Nursing Heart has used VIA to perform more than 4,000 mobile cervical cancer screenings in more than 40 rural communities in the Chimaltenango, Sacatepéquez, and Sololá departments that lack basic health infrastructure.��

Nursing Heart’s rolling mobile clinic program is composed of a team of advanced nursing students; local VIA-accredited Guatemalan practitioners; and Faith in Practice’s Dr. Patty de Baiza, one of Guatemala’s foremost experts on both cervical cancer and the VIA procedure.��

The team collaboratively operates several mobile reproductive health and cervical cancer screening clinics in rural, underserved Guatemala communities every year. Patients who attend Nursing Heart’s mobile clinics are assessed by the nursing students under the supervision of and in tandem with local VIA-accredited Guatemalan practitioners.

So far, hundreds of women who have tested positive for abnormal or cancerous cells have received immediate referral and free life-saving treatment on the spot. If cervical cancer is detected, patients can choose between two treatment options: the cryotherapy technique, which uses liquid nitrogen to remove abnormal or cancerous cells on the cervix in roughly 20 minutes, or thermocoagulation, a process that takes just 30 seconds. 

Patients, some of whom wait hours to be seen and are anxious to return to their workplace or families, tend to prefer the latter procedure due to time pressures. However some patients report that thermocoagulation is a more painful procedure, which can be a deterrent. But while the treatments can be painful, they work. And with around 4% of women tested at Nursing Heart clinics showing abnormal or cancerous cells, Raphael says it’s already saved “hundreds of women’s lives.”

“In Guatemala, the mother is the pillar of the family; she takes care of everybody. But nobody takes care of her,” explains Blanca López, better known as Blanqui, a VIA-certified cervical cancer technician and pharmacist who works on Nursing Heart’s mobile clinics. “It’s a tragedy when a mom or young woman dies of a preventable form of cancer and leaves her family to fend for themselves, when it’s a really simple and straightforward procedure that can save their life.”

It’s not just women’s lives at stake when it comes to early detection of cervical cancer. Early detection and treatment of cervical cancer, which is sometimes caused by the common human papilloma virus (HPV), is a crucial lifeline for families in remote, underserved communities that don’t have access to the preventative HPV vaccine that’s available in the West. 

Put simply, more women being tested and educated about their reproductive health means fewer preventable deaths. “At the most fundamental level, the VIA procedure is portable, cheap, produces immediate and clear results, and promises isolated and marginalized women something that is horrifyingly rare in Guatemala: knowledge of their bodies and how to prevent an otherwise avoidable death,” says Raphael. “[These women] deserve so much more, but this is a crucial and promising first step in that process.”

Rural Access Riddled With Roadblocks

Dr. de Baiza, Guatemala’s leading VIA practitioner, has personally treated thousands of women in Guatemala’s most underserved communities with Nursing Heart and Faith in Practice. However, it is still complicated for women in these rural communities to access these mobile clinics, with de Baiza attributing this disparity to lack of availability of quality services, lack of sex education and overall lack of knowledge about cervical cancer, and patriarchal attitudes about women’s sexual and reproductive health. 

“Women often require permission from their partners [to attend the clinics],” says de Baiza. “And often, due to ignorance [and cultural and religious stigmas], their sexual partners don’t allow them to undergo such exams.” Guatemala is one of Latin America’s most conservative countries; not only are women often required to get permission from their spouses or caregivers to undergo the cervical cancer detection screening, Raphael says “the woman often ‘needs to be accompanied,’ which means the male ‘caregiver’ might need to take the day off of work to accompany his partner or wife to a facility where cervical cancer screening services are available.”

To put this into perspective, at Nursing Heart’s last mobile cervical cancer clinic in Candeleria, three women tested positive for abnormal or cancerous cells. Three of the women with positive diagnoses were treated by Dr. de Baiza. However, one woman who tested positive disappeared before she could be treated. Nursing Heart staff were unable to confirm why the woman left before receiving treatment but suspect she may not have received permission from her husband, succumbed to negative stigmas about the treatment process, or simply needed to return to work.

“For some of our partner communities, that’s a two-hour ride on the one public bus per day that makes that trip: a rough journey over dangerous roads that implies lost wages and out-of-pocket expenses for something that could be deemed a luxury, as it’s not addressing an acute illness rather checking for something quiet and insidious,” says Raphael. 

That’s one of the reasons the mobile clinics also offer comprehensive sex education lessons, which Raphael says is “virtually unheard of in some of Guatemala’s most rural communities, where machismo attitudes, along with social and religious stigmas, can prevent women from understanding their reproductive health and well-being.”��

“It’s not just about the exclusion of women from conversations that affect their bodily autonomy and their right to ask questions about their bodies,” he continues. “It’s also about geography and the broken infrastructure that isolates already marginalized communities and families.”

For women like Juliaticia, the VIA screening and reproductive health workshops Nursing Heart teams provide are a lifeline. “W��’re so grateful that the Nursing Heart clinic has come to visit us here,” she says. “W�� wouldn’t have an opportunity for a health check like this without them.”

How to Practically Scale VIA 

Though Nursing Heart coordinates mobile clinics, brick-and-mortar clinics devoted to reproductive health rarely exist or are only open a few times per month. The nurses who staff the latter have to cover wide swaths of land and multiple communities, often using their personal vehicles for little to no remuneration.

“Then, the facilities are usually devoid of medications, sometimes lacking even a fridge to keep supplies at the appropriate temperature,” says Raphael. “All these factors create a culture of distrust and disdain for government services, which understandably are viewed as unreliable, dysfunctional, and sometimes demeaning to communities that may not speak Spanish.” There are 24 officially recognized Indigenous languages in Guatemala. 

Blanqui believes building relationships with women leaders in rural communities is a crucial first step to creating awareness and beginning to dismantle the stigmas, shame, and fear around women’s reproductive health. “[If we don’t], women won’t take advantage of these kinds of services,” Blanqui says. “The key is gaining their trust so that they understand the procedure, the risks and benefits, and what’s happening to their bodies because women’s health isn’t talked about in the family home.” 

Dr. de Baiza says a solid next step could be educating medical practitioners on a local level. “Training a greater number of people who can offer this service, with efficient and adequate training is key,” says de Baiza.

However, with the current state of Guatemala’s chronically underinvested public health care system, where less than 3% of the country’s GDP is allocated to health—one of the lowest in Latin America—such extensive training would require significant funding from private donors. Raphael says there’s “widespread, systemic corruption in Guatemala,” so the country “invests so very little in its public health and education systems while enriching politicians and business leaders who abscond with the resources that should be going to those systems of care. Preventative health care shouldn’t be a luxury.”

In order to meaningfully scale cervical cancer screening training, Raphael says that this��systemic corruption, which has historically deprived rural communities of basic health care services, must also be addressed.

“Guatemala has one of the lowest nurse-patient ratios in the world, and the public health care system is chronically underfunded and understaffed,” he says. “Few have the facilities that can assure patients of dignified screenings, a major issue in a country where more than half the population belongs to historically marginalized ethnic and linguistic communities, and for whom a visit to a medical professional happens seldomly, if ever.”��

But despite Nursing Heart’s promising data, some research questions the efficacy of the VIA technique. A published in the Asian Pacific Journal of Cancer Prevention found that though VIA is treated as an alternative to pap smears, “Its effectiveness in terms of reducing invasive cancer and mortality is uncertain.” Instead, “Some trials have shown that there is a significant reduction in mortality after VIA screening while others have failed to prove this.”

But ​Dr. Stephen Holtzclaw, the CEO of the U.S. Orthopaedic Partners who previously educated and mentored future medical practitioners at Johns Hopkins University and attended the Nursing Heart’s clinic in Candeleria, vehemently disagrees with this finding. 

“As they say, ‘The enemy of good is great,’” he says. “The procedure doesn’t have to be perfect to save a ton of lives. You literally can wipe out cervical cancer in a matter of seconds.”

As the VIA gains traction, there’s another looming challenge that might limit access to preventative care: the global phasing out of halogen lights.

In August 2023, the United States implemented a ban on the manufacture and sale of most halogen light bulbs due to their low energy efficiency. But while certain specialty bulbs, such as those used for medical purposes, are technically exempt from the regulation, their availability has significantly decreased.

The phase out has made it difficult for Nursing Heart and other nonprofit organizations using the VIA method to procure halogen lights. “It’s been a major weakness/vulnerability for us,” Raphael says. “Even the products we used to purchase on Amazon are no longer listed on the website. For all intents and purposes, we’re about to face a major shortage.”

Additionally, it is unclear what the impact of the Trump administration’s foreign aid cuts will have on Nursing Heart’s mobile cervical cancer screening clinics. But should the clinic’s funding be impacted, Raphael says, the chain of care that would be needed for them to benefit from a more formal type of screening would not be feasible and would eradicate the limited opportunities women have to find and treat cervical cancer.

“These women live several hours from proper laboratories, and even if they were able to get to those labs, the cost of that service is often well beyond their economic means,” he says. “The roads that take them there, the medical devices that provide that information, and the technicians to operate them… all are deficient in terms of the investment required to make them accessible to the people who most need them.”

That would be devastating for women like Juliaticia. “It’s so important they keep coming back, for all of us,” she says. In places where access to health care is scarce, these clinics offer something invaluable: care that comes to them.

Radical change meant organizing. Jay joined a meeting with the Gay Liberation Front, which would become the����for the����and proliferate in chapters across the country. At those meetings, she remembers discussing what freedom could look like. Holding hands with a lover while walking down the street without fear of getting beaten up, one person said. Another said they’d like to get married. At the time, those dreams seemed impossible.��

Jay, now 78, is worried that history will repeat itself. She’s worried that LGBTQ+ people will be put in the dark again by the draconian policies of a second Trump administration. 

“Are things worse than they were before Stonewall? Not yet,” she said. “It’s certainly possible that people will have to go back to underground lives, that trans people will have to flee to Canada, but it’s not worse yet.” 

The 19th spoke with several LGBTQ+ elders, including Jay, about what survival looks like under a hostile political regime and what advice they would give to young LGBTQ+ people right now. 

Many states protect LGBTQ+ people through����that ensure fair access to housing, public accommodations, and employment. Supreme Court precedent does the same through��. Other states have passed����for trans people.��But to Jay, a cisgender lesbian, it all still feels precarious. The Trump administration is trying to make it����to live openly and safely, and lawmakers in����want to undermine marriage equality.��

“W�� have forgotten that the laws are written to protect property and not to protect people. They’re written to protect white men and their property, and historically, women and children were their property,” she said. “To expect justice from people who write laws to protect themselves has been a fundamental error of the lesbian, gay, bisexual, trans community.”��

To fight back, LGBTQ+ Americans need to organize, Jay said. That starts with thinking locally—supporting local artists, independent stores, and small presses, as well as LGBTQ+ organizations taking demonstrable political action and protecting queer culture. 

“See what you can do without going crazy. If you can focus on one thing, and you can spend one hour a week, or you can spend one day a week, that’s much better than being depressed and doing nothing,” she said. “Because the person you’re going to help is yourself. This is the time for all of us to step up.”��

To fight back, LGBTQ+ Americans need to organize. That starts with thinking locally—supporting local artists, independent stores, and small presses, as well as LGBTQ+ organizations taking demonstrable political action and protecting queer culture.”��

Renata Ramos feels obligated to share her experiences with young people. As a 63-year-old trans Latina, she wants young people to know that so many of their elders have already been through hard times—which means that they can make it, too, including during this moment. 

“I’m not scared in the least. Because we have fought so many battles—the elders. We have fought so many battles, with medicine, with HIV, with marching on Washington, with watching our friends die,” she said. “It’s been one war after another in our community that we have always won. We have always been resilient. We have always stood strong. We have always fought for our truth, and we’re still here. They haven’t been able to erase us.” 

As Ramos watches the Trump administration use the����to target transgender Americans and erase LGBTQ+ history, she’s not afraid for herself. She’s afraid for young LGBTQ+ people, especially young trans people who now find themselves at the center of a growing political and cultural war. If someone transitioned six months ago, she said, they now have a target on their back—and little to no experience with what that feels like.��

“They don’t know what it is like to be a soldier going into war, as far as social issues. So I fear for them,” she said. “Who wouldn’t be scared?” 

Criss Christoff Smith has seen firsthand what that fear can look like. On Jan. 28, at 3 a.m., he received a phone call from an LGBTQ+ person who was considering taking their own life. This was a stranger—someone who admired from afar Smith’s advocacy as a Black trans man and Jamaican immigrant. This was someone who had been considering a gender transition for years, Smith said, who was now feeling broken. He spoke with them for two hours. 

“It’s been quite dark,” Smith said. The onslaught of policies targeting marginalized people and the turbocharged news cycle are working to keep Black and trans people in a constant state of fear and uncertainty, he said.  

“I tell everyone in my community, you have to stop responding to those alerts and just try to go inward,” he said. “Find a space of peace and spirituality.”

To Smith, who is 64, looking inward can mean reflecting on what’s still here. Although the Trump administration is going to make daily life harder for LGBTQ+ people, he said, laws can’t be undone with the stroke of a pen on an executive order. LGBTQ+ Americans need to find whatever source of strength and peace they can find right now—and try to remove themselves from the daily fray as much as possible—while still finding ways to take action.  

“This is the time when we really have to find community, where we really have to hone in on our spiritual feelings and try to talk to someone. Don’t keep it to yourself,” he said. Joining protests or lobbying days at state capitols are great ways to find community in-person, Smith said—to be around like-minded people and to not feel so alone. 

“That’s the best space to be in, not home alone and in your feelings and in your mind, because we can get lost there thinking negatively. So we have to stay positive and stay with like-minded people, and have those people constantly around you to reassure you and just hold you tight in that space,” he said. 

“It’s been one war after another in our community that we have always won. We have always been resilient. We have always stood strong. We have always fought for our truth, and we’re still here. They haven’t been able to erase us.” 

Protests against the administration’s hostile LGBTQ+ policies have been ongoing—including outside the Stonewall National Monument. In at least one way, history is already repeating itself. 

The National Park Service deleted all references to transgender and queer people from its web page honoring the 1969 Stonewall uprising—the most well-known moment from LGBTQ+ history in the country—leaving references to only lesbian, gay and bisexual people.  to protest. Among them was Renee Imperato, a 76-year-old trans woman and New York native. 

“Protests like this are our survival,” she told The 19th over email. “The rhetoric of this administration is driving a violent onslaught against our community. The Stonewall Rebellion is not over. We are at war, and we are still fighting back. What other choice do we have?”

Jay, herself an old hand at joining protests and demonstrations, said that she’s been afraid before every one of them. She’s lost sleep the night before and feared for her safety—but she did it anyway. 

“I’m afraid I’ll be beaten. I’m afraid I’ll be arrested. But if you don’t do something even though you’re afraid, they win,” she said.

This story originally appeared in .

This stance reflects widespread stigma and misconceptions about what people with disabilities can and do accomplish.

Negative stereotypes and exclusionary practices persist despite the fact that people with disabilities are the  in the United States, representing nearly . Whether or not you identify as disabled, most people  to others with a disability.

For years I have researched how people with disabilities have been kept out of efforts to guarantee equal access for everybody, particularly in higher education. This exclusion is often due to unfounded , and the false premise that disability inclusion requires lowering standards.

However, studies demonstrate that including people with disabilities is , not just disabled people. Schools and workplaces are more collaborative and responsive when people with disabilities are included at all levels of the organization. In other words, disability inclusion isn’t about charity; it’s about making organizations work better.

Rolling Back Protections

President Donald Trump issued executive orders the day he took office for a second time that aimed to end government and private-sector efforts to make U.S. workplaces and schools more . In addition to affecting LGBTQ communities and people of color, these measures could  toward protecting the rights of people with disabilities to earn a living.

Between 40 million and 80 million Americans . Even the higher end of this range underestimates the actual number of people with disabilities, because some individuals choose not to identify that way or even realize they qualify as such. That includes people with impairments from chemical and pesticide exposure, as well as many older people and those who are living with HIV and AIDS, to name some examples.

Only 15% of people with disabilities , so most individuals become disabled over their lifetime.

Tracing Historical Precedents

Blaming failures on people with disabilities and people of color echoes the , an attempt to scientifically prove genetic inferiority of disabled, LGBTQ, Indigenous, and Black people.

Eugenics led to the institutionalization and forced sterilization of, and the coercive experimentation on, people with disabilities, immigrants, and  Even the  the concept in the early 20th century.

These studies began to fade after World War II, but their legacy persists. Even today, forced  in U.S jurisdictions in 31 states and in Washington.

Due to widespread activism and the advent of new legal protections, many states finally  in the late 1970s. But eugenics-era experiments provided foundations for contemporary medical research, standardized testing, and segregated school placements.

People with disabilities have far-reaching legal guarantees of civil rights and access today due to the . The statute, which was enacted in 1990 and strengthened in 2008, provided protections in the workplace, educational settings, transportation, and places of recreation and commerce, among others. It also guarded against negative perceptions of disability.

For example, if an employer perceived someone as disabled and denied them consideration in the hiring process because of that, the candidate would be protected from discrimination under the ADA—whether or not they had a disability.

While these advances are significant, many people with disabilities still do not have access to their basic civil rights. This is particularly true of Black people with disabilities, as they are disproportionately , , , and marginalized in .

Gaining Workplace Accommodations

Critics of inclusion efforts sometimes wrongly argue that employing people with disabilities is too costly due to the accommodations they may require. But the  in the Department of Labor’s Office of Disability Employment Policy found in 2023 that nearly 60% of these accommodations cost nothing.

What’s more, many  are available to cover these costs. Disability civil rights law does not mandate hiring people who are not qualified or lowering standards to include the disabled. The law requires that candidates meet the “” of the job in order to be hired.

According to a , the employment rate for working-age people with disabilities was 38% compared with 75% for nondisabled people. Though there are countless reasons for this disparity, many people with disabilities can and want to work, but employers don’t give them the opportunity.

Providing Benefits for Everyone

Many accommodations designed for people with disabilities also benefit others.

Captioning on videos and movies was originally meant to benefit the deaf community, but it also helps multilingual speakers and people who simply . Similarly, visual or written instructions assist people with depression, Down syndrome, or attention-deficit/hyperactivity disorder, but they can also make tasks more accessible for everyone, along with breaking assignments into smaller components.

 benefit people with autism and post-traumatic stress disorder, while also providing a reprieve in a noisy work environment and minimizing distractions. Remote work options can make it easier for people with chronic illnesses to be employed, and they similarly benefit others who may have caregiving responsibilities—helping attract and retain talented employees. Text-to-speech software provides people with cerebral palsy and nonspeaking individuals with options for communication, similar to options that many people already use on their phones.

A  demonstrates the broad benefits of making jobs and schools more accessible to people with disabilities, which is ultimately an advantage for everyone.

Studies on diversity in educational and workplace settings also demonstrate positive outcomes. In a study of 10 public universities, researchers found that students who reported  had higher scores on measures of more complex thinking, a concern for the public good and an interest in poverty issues, and were more likely to vote and develop strong leadership skills.

In a national survey of human resources managers conducted in 2019, 92% of the respondents who were aware that one or more of their employees had a disability said  than their peers who did not.

Research published by Harvard Business Review  to hiring people with disabilities.

For one thing, people with disabilities can have unique insights that contribute to the workplace culture. The presence of employees with disabilities can make the environment of entire companies and organizations more collaborative. Earning a reputation for inclusiveness and social responsibility can improve customer relations and can give businesses an edge when they seek funding and recruit talented new employees.

Ultimately, I believe it’s important to create conditions where anyone can thrive, including people with disabilities. Doing so benefits everyone.

This article is republished from  under a Creative Commons license. .

In the United States, with legal protections for LGBTQ people in jeopardy and violent incidents of racism, xenophobia, transphobia, and homophobia on the rise, it has become clear that the world we currently inhabit is broken and deeply unjust.

We now see the world before us more clearly. And this new clarity brings with it an urgent longing to deconstruct and reconstruct the world, to try again, to experiment with radically alternate ways of being, to build the world otherwise.

Before we can build the world in alternate ways, however, we need to be able to envision alternate worlds. Works of science fiction and other forms of speculative art have long been at the forefront of efforts to build new worlds through imagination. Worldbuilding of this sort is never a neutral endeavor; designing the world anew always entails resisting or reinforcing (sometimes simultaneously) existing structures of power.

The cultural stakes inherent in worldbuilding have been made particularly clear through creative and scholarly work around Afrofuturism and Black speculative worldbuilding. As performance studies scholar Jayna Brown argues in her writing about Black mystics and musicians, structures of white supremacy have placed Black communities into a “bleak and bloody dimension we are taught to call reality.” In response, Brown calls for “build[ing] alternative worlds, in this dimension and in others,” as a way to “practice alternative ways of being alive.”

In addition to turning to fiction, art, and music to find the speculative worlds that inspire us, there is another media form we should be taking closely into consideration when we look for these “alternative ways of being live”: video games. Video games have often been derided or dismissed precisely because they seem disconnected from the “real world.” Yet, in truth, the relationship between video games and the world around us is much more complex than these critiques would suggest.

As many game studies scholars have argued, video games are intimately bound up with the real world; they shape and are shaped by the conditions of their production and reception. At the same time, video games offer opportunities to inhabit worlds that differ from our own. Indeed, we can understand video games themselves as alternate worlds.

In their own ways, they are each models for other ways that the world might operate. They offer us opportunities to “question the order of things,” as the disability studies scholar Robert McRuer writes in , to ask how this order has been “constructed and naturalized . . . and how it might be changed.”

Certainly, not all video game worlds offer visions of empowerment for those who are pushed to the margins. Video games are a vast and varied medium, and games culture is still marred by , sexuality, and gender. At the same time, games themselves offer powerful opportunities to experiment with strategies for rebuilding the world we currently live in, one where many forms of oppression currently reign.

Yet, through games, we can see that building (or unbuilding and rebuilding) the world necessitates a revolutionary redesign of the foundational logics and underlying operations of the world we inhabit.

Through video games, I theorize a practice that I term queer worldbuilding. Queer worldbuilding is not the same thing as building worlds that feature queer stories or communities, though such worlds themselves have immense value. Instead, queer worldbuilding describes the practice of constructing new worlds through methods, frameworks, and tools that can themselves be understood as queer.��

In this spirit, I analyze video games to offer as examples of building worlds through a process that itself challenges or rewrites norms around sexuality, gender, identity, and desire. In them, we find tools for both building queer worlds and queering the world around us.

Every Video Game Is a World

This alternate vision of worldbuilding is premised on understanding video games themselves as worlds. When we think of video games and worldbuilding together, it is common to think of large-scale, expansive, story-focused games with extensively developed narratives. These games, certainly, are worlds. But so are all video games, regardless of their content. Small games are worlds. Abstract games are worlds. Puzzle games, mobile games, experimental games, absurdist games, games with no characters: All of these video games are worlds, in their own right.

Video games do sometimes contain games, but what they are, above all, is worlds: universes in miniature. Reframing video games as worlds opens up new opportunities for making sense of the cultural meaning that games contain. 

If games are worlds, then the importance of competition, achievements, and technological prowess fades into the background. In its place, what comes to hold meaning in a video game is its qualities as a space for existing. In this game world, who has power? Who is afforded freedom, and who is placed under constraint? How do beings connect with one another?

The spirit of video game worldbuilding has much in common with the spirit of queerness. Both describe a mode of imagining alternate ways of being in the world. As I and my fellow queer game studies scholars have argued elsewhere, video games are rich sites for locating and expressing queerness. While some video games (whether mainstream or independent) contain the presentation of LGBTQ identities, a great many more contain queer meaning—offering themselves as opportunities for exploring queer play, engaging with queer design, or undertaking queer analysis.

Insisting on the queerness of video games, in its many forms, is a way to reclaim a medium that has long been exclusionary to queer people. To say that video games can model queer worlds is to expand on this reclamation, to move beyond making a place for queer people in the world of video games by insisting that video games can aid us in making the world itself more queer.

There are many ways in which queer worlds manifest themselves in video games. Multiple AAA games of the sort that engage in elaborate narrative worldbuilding now prominently feature queer characters. One high-profile example is The Last of Us Part II (Naughty Dog, 2020), which includes a lesbian protagonist and a transgender side character and was the recipient of a 2021 GLAAD Award for Outstanding Video Game. 

Beyond the sphere of mainstream video games, the rise of queer avant-garde game makers has brought with it an explosion of indie video games whose worlds are directly structured around queer experience. Mattie Brice has noted that white designers were centered in the early days of the queer games avant-garde, which began to take form at the start of the 2010s. Today, a growing number of these games are being made by, about, and for queer people of color. 

These range from The Black Trans Archive (Danielle Brathwaite-Shirley, 2021), which wrestles with the erasure of Black trans people from documented histories, to the upbeat roller derby “rhythm ga(y)me” Skate & Date (Geneva Hayward, 2020). In Skate & Date, players skate to a musical beat in the role of Maggie, a Black femme roller derby team captain with a crush on a woman from a rival team. A game like Skate & Date creates its own vision of a queer world: a world where femmes are, as a matter of course, powerful physical competitors who romance other femmes.

Queer Video Game Worlds

Queer video game worlds also manifest themselves as queer communities. Many queer and transgender people have shared stories about using online role-playing games to explore their identities and connect with others who share similar experiences: a way of forming queer games worlds while using game worlds to understand oneself as queer. Beginning in 2012 and 2013, events like GaymerX and the Queerness and Games Conference built temporary worlds where queer people who made, studied, or simply loved video games could come together to play.

At the same time, many video game worlds that do not appear queer can be understood queerly. These worlds are places where the norms that we often mistake for universal truths—our unquestioned beliefs about how the world works, both socially and physically—are sidestepped, rewritten, or overturned. Indeed, the relationship between video games and queer worldbuilding goes deeper than the queerness of any individual game world.

Video games serve as opportunities to transform queer world-making into something concrete. They offer us playgrounds where we can reach out and touch, as trans studies scholar Susan Stryker writes in describing the process of transing, “the material truth of a potential for worlding otherwise.” They show us world-making in action.

Certainly, the queer worlds we find in video games offer us a critical entry point into imagining how we might queer the world around us. Like all queer works of art and ways of living, they are messy. Queer video game worlds are often silly, improbable, or impossible, ecstatic and joyful but also broken or mournful, posthuman and nonhuman, postapocalyptic, counterhegemonic in some ways and complicit with dominant structures of power in others.

Queer video game worlds balance the longing to fix worlds and the hunger to destroy them. These worlds are many things at once. They are an invitation to remake the world through play. They are whole universes, shrunk down to the scale of tiny dioramas, galaxies under glass. Video game worlds challenge us to question how the universe—our universe, any universe—functions.

Games will not fix a broken world. They will not save a world on the brink of collapse. But they will inspire us to explore new ways of rebuilding our world. And, when necessary, they will remind us that some worlds cannot be saved.

This excerpt, adapted from by Bo Ruberg (New York University, 2025), appears by permission of the publisher.

Medicaid—the state and federally funded program that provides health coverage for almost and about half of the state’s children—could face billions of dollars in federal cuts under a budget proposal from House Republicans. That’s alarmed families like the Pequeños, who rely on Medicaid, called Medi-Cal in California, to pay for medical care and other support for their children with chronic conditions.

Pequeño’s 11-year-old son, Xavier, has a rare, genetic immune disorder that undermines his body’s ability to fight disease. Thanks to Medi-Cal, Xavier receives medications that keep him alive and would otherwise cost his family around $100,000 a month. The program also pays for Xavier’s medical equipment such as a wheelchair and portable oxygen tank, antibody and respiratory treatments, and hospital stays when he gets sick.

“It’s allowed him to go to school. It’s allowed him to be home and not living in a hospital 24 hours a day,” says Pequeño, who cares for Xavier while her husband works as a forklift driver. “There’s no way right now we can afford his monthly medications, his treatments or his hospitalizations. Without Medi-Cal it would essentially be a death sentence for him.” 

Parents of children with special health care needs aren’t the only ones alarmed about the potential cuts—disability advocates, health care providers, budget analysts, and state lawmakers have also expressed concern. Although the House proposal, passed Feb. 25, doesn’t specifically call for Medicaid cuts, it does direct the House Energy and Commerce Committee, which oversees Medicaid, to come up with $880 billion in savings over the next 10 years. Achieving that amount of savings would be difficult without making cuts to Medicaid, experts said. 

The requested budget cuts still need to be adopted by the Senate, written into legislation, and passed by Congress. But Aaron Carruthers, executive director of the California State Council on Developmental Disabilities, said he doesn’t see how cuts to Medicaid can be avoided under the Republican plan. The council is an independent state body that advises the governor and legislature on policies related to adults and children with developmental challenges.

“This is a four-alarm fire, this is all-hands-on-deck, there is no messing around,” Carruthers says. “The cuts are so big that it’s going to [impact] everyone in the program, there’s no way around it.”

President Donald Trump and House Speaker Mike Johnson have said Republicans—who have sought to cut Medicaid in the past—won’t touch it this time, but will look to reduce fraud, waste, and abuse. But information from the Congressional Budget Office shows that there is no way to reduce the budget by the proposed $880 billion without making cuts to Medicaid (the only other option is cutting Medicare—the health insurance program for people over 65—and Republicans have ruled that out too). 

Republicans have also floated proposals aimed at reducing spending on the program such as through work requirements (although most people with Medicaid already work), capping the amount of Medicaid funding sent to states, and making it harder for people to enroll and renew coverage. 

“W�� don’t really have specific proposals to react to yet. It’s kind of a list of ideas, and most of them are bad ideas,” says Mike Odeh, senior director of health policy at Children Now, a children’s research and advocacy organization. “For kids with special health care needs, thinking about their access to specialty care, to medical equipment, to prescription drugs—all of that could be jeopardized, as well as the care and coverage of their family members.”

Medi-Cal is especially important for children with disabilities because they often need more specialized and expensive care than children without special health care needs. The program recognizes this and allows some of these children to qualify for Medi-Cal even if their families earn too much to make them eligible under standard rules, or if a parent already has insurance through an employer. 

Private insurance typically doesn’t cover the full cost of care for people with severe disabilities, and copays and coinsurance add up when someone needs a lot of medical care. In these instances, Medi-Cal covers the costs that private insurance doesn’t. 

Anita Morris, who is based in Fresno, California, relies on Medi-Cal to cover costs for her daughter, Jayline, that her employer insurance won’t cover. These include daily nursing care, diapers, and a wheelchair. Previously, Jayline also received physical and occupational therapy. Jayline, 26, has severe epilepsy and autism due to a genetic disorder. She can’t talk, walk, or eat by herself. Without the nursing that Medi-Cal provides, Morris said she’d have to quit her job as a clinical social worker to take care of her. 

“I’m not freaking out yet, but it does cause me concern,” Morris says. “If they need to look at abuse and fraud, do that, but don’t take away the services in that process because the services aren’t causing the abuse and fraud.”

Cuts would also impact children with special health care needs who aren’t enrolled in Medi-Cal, said Ann-Louise Kuhns, executive director of the Children’s Hospital Association. That’s because, for most hospitals and providers of specialty care to children, about two-thirds of their income comes from Medi-Cal patients, she explained.��

“If you start reducing support for that network, you jeopardize access to care for all of the children that rely on those services, not just the ones on Medi-Cal,” she says. “The whole system is knitted together.”

Beyond Medi-Cal health insurance, Medicaid dollars support other important programs and services for children and youth with disabilities, including Regional Centers, early intervention programs for children with developmental delays, California Children’s Services, in-home nursing, and special education services such as speech therapy and school health aides.

Fernando Gomez, who lives in West Los Angeles, has two sons who receive Medicaid-funded services through their local regional center. Oscar Antonio, who is 18 and has Down syndrome, has a physical therapist who works with him to navigate daily life and build independence. He’s also received speech therapy to help him learn to talk. As a result, a dream that once seemed impossible—attending college—has become feasible, Gomez said.��

Meanwhile, Gomez’s other son, Diego, 15, who has autism, is receiving educational support. Gomez, who’s retired, said it would be impossible for him and his wife to afford those services themselves. He also worries that Medicaid cuts could destabilize the lives of other Latinx families and their children and undermine progress he believes California has made toward reducing disparities in access to regional center services.

“I call it a death blow because it will be, it literally will be,” he says. “It will kill many of our family members’ ability to have a productive and engaged … life.”

While California contributes state funds to Medi-Cal, more than half of the funding—$98 billion out of $161 billion in Medi-Cal spending—comes from the federal government. That makes it difficult for the state to backfill any large federal cuts to the program, health policy advocates and budget experts said.

For now, many organizations and advocacy groups are focused on trying to avoid cuts to the program. Some groups are offering guidance and trainings for parents of children with special health care needs on how to share their concerns and Medi-Cal stories with their congressional representatives. Others said they are connecting directly with those representatives to urge against cuts.

Nevertheless, some said California could do more to prepare for potential changes to Medicaid. The California Budget and Policy Center has suggested the state raise corporate tax rates, eliminate certain tax loopholes, and reduce tax breaks for the wealthy.

“State leaders really could proactively develop contingency plans and explore solutions to safeguard health care coverage,” says Adriana Ramos-Yamamoto, a senior policy analyst with the center. “W�� know that there are actions that state leaders can take to raise additional revenue equitably, making sure that profitable corporations pay their fair share in order to support critical health care programs like Medi-Cal.”

Aides for the chairs of California’s Assembly and Senate health committees, Assemblymember Mia Bonta and Senator Caroline Menjivar, respectively, said they were both unavailable for interviews. However, Assemblymember Bonta’s office sent a written response that said she is “committed to ensuring our communities can continue to access the care they need.”

Pequeño said she’d like to see more evidence that the California legislature is trying to keep the cuts from happening, and wants to know what the state will do to protect children like Xavier if cuts do go ahead. 

“What is the backup plan?” she says. “What are they doing, and what can they legally do to help protect families like ours that are going through these things and are wondering, ‘What’s next?’”��

In the meantime, she and her family are trying to come up with their own backup plan. Pequeño said she’s even considering taking Xavier to another country, such as Canada, so he can get care.

“The thought of losing benefits that keep him alive and the possibility of having to watch things get cut and watch his quality of life deteriorate … watch him essentially die because of a choice the government made, it’s terrifying,” she says. “No one’s life should be cut short because of the government’s choices.”

This story was produced in collaboration with the.

However, when considering the concept of marriage equality, there has been one population overlooked and excluded: disabled people. , a “documentary rom-com” streaming on Hulu, takes up this problem, bringing a siloed issue to the forefront in a nation that believes the fight for marriage equality has already been won. But, as the documentary aims to explain, there’s no true marriage equality if disabled people are grossly penalized for falling in love.

Patrice follows a mixed-race disabled couple, Patrice and Garry, who desire to get married. But there’s one pesky problem: the marriage penalty. When disabled people who receive Social Security benefits such as Supplemental Security Income (SSI) get married, they are and their healthcare coverage, the latter of which is typically provided through Medicaid.

That’s the predicament Patrice and Garry find themselves in. Though they love one another, they are unable to live together or legalize their union or they will no longer have access to the critical lifelines of support that allow them to live independently. Unfortunately, the Social Security Administration (SSA) doesn’t know how many disabled people lose their SSI benefits when they marry—they don’t keep track, an SSA spokesperson told in 2024.��

Patrice’s desire to live on her own stems mostly from her upbringing: She came of age in the 1970s and ’80s when our understanding and societal inclusion of disabled people were vastly different. Patrice endured stigma for being intellectually disabled in school before she was placed in an accessible education setting that better suited her learning and social needs. As a young adult, she was institutionalized and was harmed by those responsible for her care in the facility. She then faced discrimination once out of the institution while trying to find employment to live on her own as a disabled adult.����

Despite the hurdles she’s faced, Patrice innately knew she had a right to create the life she envisioned for herself—and that she did. Though Patrice is unable to wed without significant risk, the film still spotlights how she has been able to build a supportive community. From her relationship with Garry and her friendships to her eclectic hobbies and her job as a crossing guard, the film fully humanizes Patrice without leaning into the stereotypes and tropes that often plague disabled people. That community steps in when Patrice needs to replace an essential lifeline—a modified van large enough to accommodate a wheelchair.

The average person may be unaware at how costly these modified vehicles are. Used vans, for instance, can cost as much as a modest luxury-brand car. Patrice’s struggle is familiar; as someone who was once on benefits, acquiring a car was out of my financial grasp. I didn’t want to take out a loan because of my limited financial means, and I knew that crowdfunding could jeopardize my benefits.

We see this conundrum when Patrice shares how fundraising efforts for her first van impacted her benefits. In order to acquire this new van, she has to use other means that allow her to purchase a replacement van without directly accessing the funds. Once again, Patrice, like many other disabled people, has to jump through unbelievable hoops to get the basic tools she needs to thrive in society. 

Currently, SSI limits in savings and assets. Since 1989, the limit has been $2,000 for an individual and $3,000 for a couple, with an exception made for a single car and a single home. Not only should that number have increased to $10,000 for an individual and $17,000 for a couple to accommodate inflation, but it should also consider how expensive it is to provide in-home care for disabled people. 

“There’s anger, there’s a feeling of betrayal sometimes,” attorney Ayesha Elaine Lewis . Lewis is leading a national campaign to secure marriage equality for disabled people by ending this marital assets clause. “Because the [Americans with Disabilities Act] has a beautiful promise of full integration into society, of people with disabilities being able to live their destinies and make their life what they want of it. But with these rules still in place, it’s obvious that the full promise of the ADA hasn’t been implemented.”

At the end of the film, Patrice and her community raise enough money for the new wheelchair van. It was a beautiful ending that filled me with joy, especially now that I am on a journey to acquire my first set of wheels as a disabled adult who uses a wheelchair. Since I am several years removed from receiving benefits and I now have secure employment, I now have the financial ability to purchase a car and learn more about installing a wheelchair rack on the roof of the car I choose.

Financial freedom and the ability to take care of one’s needs or even purchase simple wants or luxuries of life shouldn’t feel out of grasp because one is receiving governmental assistance. We all deserve to be able to take care of ourselves and have the resources to do so without outdated strings attached.

It was refreshing to watch Patrice possess and display joy and wins while navigating antiquated systems that harshly impact the quality of life for disabled people. Often, storytelling surrounding disabled people can be heavily negative, and the light moments are downplayed or rarely seen; the documentary did a fair job in displaying the highs and lows with balance and nuance.  

Of course, since Patrice is a documentary rom-com, the ending is pleasant: Patrice and Garry are able to have a commitment ceremony during a protest to raise awareness about the fight for marriage equality for disabled people. Though they are unable to legally marry, Patrice and Garry still secure a “happily ever after” for themselves on their terms. From the beginning of the documentary until the end, Patrice is fighting for a better world for not just herself, but for all those impacted by the rules and regulations that intrude on aspects of our lives that should be our choice.

Patrice’s activism—from talking to legislators to demonstrating during the day of action for marriage equality—are a testament to her understanding that these issues are not isolated; marriage equality matters to the health and sustainability of the fabric of our society. Patrice: The Movie was captivating, led with so much care and intention, and showed us that the work to ensure that every American can live and marry whoever they want is a fundamental right, even for people with disabilities. 

To myself, I rationalized,
“I know this toxic narrative is wrong about us.”
“My partner and I have a loving, supportive relationship.”
“The kids are alright.”
“Other people have it way worse.”
“W��’ve been through this before.” 
“W�� know how to survive.”

It’s true. We do know how to survive…
When your rights are stripped away on repeat 
When the walls keep closing in tighter 
When they destroyed
because they can. 
When it feels more possible to disappear than earn a doctorate degree, survival becomes the primary goal.

We know how to survive. A lot of us have been surviving our entire lives.
And I’m not just talking about raw survival against street and institutional violence. 
It’s the way the hypervigilance we carry in our bodies impacts our nervous system. 

It’s the increased prevalence of autoimmune diseases, cardiovascular issues, depression, and PTSD among trans people, particularly those who have also experienced racialized trauma.
It’s also the economic barriers to health care and discrimination within the medical-industrial complex. 
Being trans is beautiful, but the world makes it exhausting.

Path to Liberation

Trans people have saved my life time and time again. I came out in 1998. I was 14 and living in a town along the so-called U.S.–Mexico border. All we had was each other. In a time with few legal protections and next to no resources, we had to organize deep systems of care for ourselves. Over the past two decades, there have been many political and cultural changes, thanks to the labor of advocates (trans and otherwise) who have pushed tirelessly to implement pathways to better protect folks.

However, it is risky to become dependent upon incremental policy change. As important as these kinds of wins are, what is granted by colonial law can also be revoked by colonial law. When we become comfortable within the bounds of what is “given” to us (often crumbs), we settle for less than what we know we really need: real solutions to the root causes of the political and ecological crisis we are facing. 

False “solutions” and concepts like individual upward mobility or assimilation (when even possible) often distract us with temporary comfort and take us away from building up the collective care and self-governance muscle that will actually protect us. We need that are rooted in values like radical care, collective governance, and mutuality.��

When we are not organized, the impacts of backlashes, such as the one we are experiencing now, are far more detrimental because when they come for us, what and who do we fall back on?  

Our autonomy is our power. Our long-built systems of survival and community defense are our power. There is so much to draw from in our collective DNA to guide us through this time. We know how to do this.

Trans people: Brown, Black, Indigenous, working class. 
So many beautiful stories. 
So much cultural wealth and lived wisdom rooted in the will to survive like hell against all odds.

From street economies to the people’s pharmacies
From houses for disowned youth to adopted queer parents
From Stonewall to
From our own designs of family to fierce love and solidarity
From prisons walls to asylum halls

Trans people have navigated a million plot twists—many steeped in violence—based upon a perception of us:��
How we exist in the eyes of others.
Be it the state, religion, our families of origin, or neighborhoods.��
And still they have no idea who we really are.��
Nonetheless, we remain.��
Our most prominent hxstorical rebellions powerfully led by Black and Brown trans women.

It Means Home…

I kept trying to understand why I was questioning my existence last month.
It might have had something to do with the right’s violent campaign to erase us while simultaneously hyper-visibilizing us, spending $215 million on anti-trans ads, to create another common enemy and boost votes.

“Take America back from pronouns and immigrants!”
Come on, we know they’re full of….

But it worked. Across our backs.
Not even 0.5% of the population posed a supposed threat so big it gave the right (and moveable center) a perfect point of unity: 
“Protect our kids.”

Protect them from what exactly?
Learning and embracing that all different kinds of people exist?��
A culture that teaches to not harm people for being different from yourself?
It is no surprise that those who see our Mother Earth and her life sources as nothing more than a dollar sign would despise a worldview in which we respect and revere life in all of its complex and beautiful intelligence.��

We will never understand all there is to this planet, but you don’t have to understand it to respect it. 

If we are speaking ecologically: Diversity is our best defense in the face of crisis. 
If we are speaking like my old timers: “Everything in its place.”  
Eradicating one thread in an ecosystem disrupts the entire ecosystem. 
Global traditional knowledge has carried that teaching since time immemorial. Everything is connected.

Humans are but one expression of nature. And yes, we are human.
Never mind the dehumanizing, ableist narrative that we are “imposing mental illness” by advocating for a right to a dignified life and basic respect.

Despite the long-overused weaponization of “nature” against queer and trans people (“Its not natural!”), sex and gender variance is reflected all across the natural world.��

From birthing male seahorses��
to split-gill mushrooms’ 28,000 different sexes��
to the female swallowtail butterfly’s “doublesex” genes that provide wing pattern camouflage from predators—
Biodiversity is a part of nature.
Adaptation is a part of nature.
Trans, gender-expansive, and two-spirit people are a part of nature.
Honor it.����

My comrade asked me: “What are your wildest dreams for trans relatives?”��
My dream is not just for us to survive, but that we come to know belonging.��
That we remember the truth of who we really are in a mess of endless projections and attacks.��
I pray that as we endure a war on our right to exist—we hold the deep knowing that we are not alone.��
The Earth and so many others, human and non-human, are also enduring profoundly violent disruptions.��
We struggle in solidarity with all those who persist on the side of justice, the side of life.��
Now more than ever, our interconnection mandates us to protect the living world. Yes, we have a right to be here, but more than that, we need to be here.

Building on the decades-long fights for reproductive justice and LGBTQIA+ rights, we marched in the autumn sun and chanted about collective power outside the Capitol and Supreme Court buildings. Our route ended with a rally elevating intersectional themes and a defiant dance party outside the headquarters of the Heritage Foundation, a key architect of .

At the time, we were among a minority of Americans who took that agenda’s promise of societal regression seriously. We hoped our effort would serve as an antidote during an uncertain election cycle. By then, the course charted by leaders across the political spectrum had proven dismal.

Democratic candidate that myopically focused on cisgender women and girls accessing abortion care with sparing mentions of access to in vitro fertilization. In contrast, Republican candidate Donald Trump danced around whether he would enact a . At the same time, his vice presidential pick opined about “,” insinuating that women who couldn’t or didn’t bear children were of lesser societal value than their counterparts.

Due to countless threads missing from the larger political discourse around care, things worsened for people on the margins by the time we made it to the ballot box. The chief conservative demonized Haitian immigrants, planned to “,” and orchestrated a rally that drew similarities to the historic Nazi regime. He also dealt a heavy blow to our burgeoning movement, spending on ads denouncing the idea that transgender people, especially migrants and those who are incarcerated, deserve holistic health care.

Now, less than four months after Trump’s inauguration, there are more profound threats toward the universal right to bodily autonomy—and it is essential to understand the connective tissue and how they impact everyone, trans and cis alike.

On Inauguration Day, Trump signed an claiming to collapse sex and gender into a single identity category defined by a binary. He asserts that people assigned male at birth must identify as a man, and people assigned female at birth must identify as a woman. But the deeper aim, as has been the goal of the Republican party for nearly a decade, was to eliminate the acknowledgement and discussion of trans people in all corners of society. 

While the presidential action wasn’t legally binding, it set a precedent for continued attacks against the community. Within days, trans and nonbinary people reported that requests to change were being denied. The administration also struck down the option for an “X” marker for more nuanced gender identities. This order, however, goes far beyond attacking trans and nonbinary people. It also erases the experiences of intersex people, whose sex often isn’t adequately defined by binary ideas of male and female. 

Then came an executive order calling for an end to gender-affirming care for anyone under the age of 19. The Trump administration elevated the conservative lie that affirming trans and nonbinary youth is detrimental, ignoring that shows the opposite. Further, anti-trans advocates never discuss cis youth who may have to access similar care to have a more normative bodily experience. They also ignore that intersex youth regularly face to make their bodies conform to a sex binary. We must also understand the widespread practice of nonconsensual youth circumcision as incompatible with bodily autonomy, regardless of the cultural or religious implications.

Many, like the majority of , regard these attacks on trans and intersex people as inconsequential because each group is estimated to make up just of the total U.S. and global populations, respectively. But Trump’s directives also reveal a malicious desire to define personhood as beginning at conception and to reduce people to their reproductive capabilities.

This has far-ranging influence on the fight for abortion access and resurfaces an outdated notion of child-bearing as a defining factor, which has historically limited opportunities for those assigned female at birth, particularly in education and employment.

Conservatives are obsessed with telling people who they are and what they can and can’t do with their bodies. Their current platform blends Christian religious dogma, the goals of the science-fiction-inflected , and the so-called . All of these, in their own ways, urge conformity and uniformity at all costs. In essence, you and your body are for serving a particular version of god and an authoritarian executive while upholding a white supremacist, capitalist patriarchy. Otherwise, those on the margins (including LGBTQIA+ people, women, migrants, people of color, and those who are poor) will fully wrest control and destroy society.

Over the last two months, it seems like those forces are winning, but there are historical sources of inspiration that believers in bodily autonomy can look toward. The concept of reproductive justice provides a sturdy foundation to expand how we think about access and the care that we deserve.

The framework was coined in a placed by the Women of African Descent for Reproductive Justice collective to demand that Congress center Black women’s barriers to the U.S. health care system and to comprehensively reform it. They specified their ideal outcomes, including universal coverage, physician choice, equal access to services, and protection from discrimination. 

The “reproductive justice” framework moved beyond the limited focus on that dominated mainstream feminist discourse and organizing and shifted toward overall reproductive care. But unfortunately, three decades later, many of the initial aims and subsequent wins of the abortion rights and reproductive justice movements are in peril. In 2022, the Supreme Court overturned Roe v. Wade, ending a near half-century of constitutional protection of abortion rights. 

Since then, the conservative push for statewide abortion bans has accelerated, with access at risk of being severely limited or prohibited in 26 states and three territories, according to the . While the language, promise, and organizing power of reproductive justice endure, this restrictive political landscape is demanding a retrenched focus on abortion access to the detriment of other goals.

In the last few years, for trans people, particularly youth, have increased alongside abortion bans. A year before Roe v. Wade was overturned, Arkansas became the first state to ban gender-affirming care for trans minors. That number has since increased to 27. Now, the trans rights movement has taken up the mantle to defend the right to gender-affirming care to varying degrees of success.��

Unfortunately, the movement has been plagued by widespread cis ignorance about what the care entails and whether youth deserve access to it. If people moved beyond salacious headlines and hateful rhetoric, they’d learn that “encompasses a range of social, psychological, behavioral, and medical interventions.” They’d also realize that plenty of cis people access similar treatment for a variety of reasons. Unfortunately, this endless discourse often ignores that other health care decisions for minors are often trusted to be handled by physicians, parents, and the minors in question.

While conservatives regularly claim that banning gender-affirming care will defend and protect youth, the Trump administration’s order tries to ban gender-affirming care for people in the first year of legal adulthood as well. It reveals a larger conservative hope to , as was tried in Florida in 2023. This is all the more reason why we must build a broader movement that intertwines the fight for reproductive rights, gender-affirming care, intersex rights, and bodily autonomy writ large.

Every day in this Trumpian hell has been chaotic and demoralizing. These stressful times encourage us to turn inward and pull away from the collective. However, now is the time for us to expand and tap into collaboration and solidarity. We must begin to think beyond the silos of queer, trans, feminist, or reproductive justice movements, but as a broader fleet of gender liberationists. After a decade of discussions about trans visibility that have proved largely ineffectual, I’m invested in moving away from having my experiences simply being seen. They need to be understood as just one thread of a larger collective tapestry that includes everyone understanding their right to gender liberation.

In 2018, she discovered the childfree subreddit, an online forum on Reddit for people who do not have children and do not want them. In that forum, she learned about , a procedure that removes both fallopian tubes and permanently prevents pregnancy.

“I was 19 or 20, and I knew I probably wouldn’t be able to get it,” says Young, who didn’t meet the minimum age requirement to have a at the time. “But it was something that was kind of in my back pocket.” 

In 2022, when a document suggesting the U.S. Supreme Court was likely going to overturn Roe v. Wade was leaked, Young, who now met the minimum age requirement, immediately made an appointment with her gynecologist for a bilateral salpingectomy. 

After observing the mandatory one-month waiting period, Young received the procedure. “[I had felt like] an animal in a trap,” she says. “But when I woke up from that surgery, it was just … indescribable peace.” 

Young is one of many people of reproductive age whose health care decisions have been influenced by the overturning of Roe v. Wade, the fundamental ruling protecting the right to abortion in the United States.

In the years since, for people between 18 and 30 has jumped, particularly among female-born people. During the 2024 election, abortion rights were a key ballot issue and several states, including Maryland and Colorado, enshrined the right to abortion into their state constitutions. 

Political promises to legalize abortion—a critical issue, but one topic in the much larger ecosystem of reproductive health care—have overlooked some of the discussions the country must have to improve reproductive rights for the millions of reproducing people in America. When we take a closer look at the quality of reproductive health care that most people receive, it’s clear that simply restoring Roe v. Wade isn’t enough.

“The populations with the best reproductive health care outcomes … have all of [their] basic and human life needs met,” says Dr. Regina Davis Moss, president and CEO of , a group that amplifies Black voices to advocate for reproductive equity. “That is why we have some of the worst outcomes when we compare ourselves to other industrialized countries.” 

Pregnant people in the United States are more likely to die during pregnancy, childbirth, or postpartum than any other high-income nation, even though are preventable. The , who statistically are less likely to have access to high-quality medical care. On average, giving birth in the U.S. can . 

Cost is a leading prohibitive factor for those who most need to access birth control, abortion, and other reproductive health care. But there are legal barriers to subsidizing reproductive health care services—such as the Hyde Amendment, which bans the use of federal funds for abortion with few exceptions—and in many counties, no one to provide them. An estimated , for example, do not have a single birthing facility or obstetric clinician to deliver maternal care. 

So, what might reproductive health care look like in a reimagined America that puts equity first? There’s already a framework for it: , a critical feminist framework that advocates for the right to have children, the right not to have them, and the right to raise children in a safe environment.

A Quest for Overall Well-Being 

In 1994, a group of Black women activists coined the term “reproductive justice” to achieve, as , “the complete physical, mental, spiritual, political, social, and economic well-being of women and girls, based on the full achievement and protection of women’s human rights.”

While reproductive justice promotes equitable reproductive health care for everyone, the idea was born out of the struggles that people of color—particularly Black women—have faced in the United States since slavery, when they were forced to bear children to work on plantations.

The framework acknowledges that Black women face poorer reproductive health outcomes—and aims to do something about it. “The reproductive justice framework analyzes how the ability of any woman to determine her own reproductive destiny is linked directly to the conditions in her community—and these conditions are not just a matter of individual choice and access,” Ross writes. “Reproductive justice addresses the social reality of inequality—specifically, the inequality of opportunities that we have to control our reproductive destiny.” 

There is a modern-day implicit bias in health care, says Davis Moss, that women as a whole can’t be trusted to make their own decisions about their bodies. For example, Black women commonly report that health care providers are not offering them the full range of contraceptive options.

“The subjugation, the control, all that has happened ever since the country was born,” says Davis Moss. “W��’ve seen that happen over the years in our health care system, in segregated hospitals, all the way up to modern day in clinical care encounters.” 

Though Young’s bilateral salpingectomy, which can cost thousands of dollars without insurance, was fully covered by Ohio Medicaid, cost remains a prohibitive factor for many people accessing reproductive health care in the United States. 

Take contraception, for example. A , which interviewed more than 5,000 female-born participants, looked at how cost influences contraceptive choice. Researchers found that a quarter of those surveyed with insurance had to pay at least part of their birth control costs out of pocket. “Any time you have to make a choice about day-to-day expenses and a copay… you know, living expenses, keeping food on the table… that is going to have an impact [on health],” says Davis Moss. 

The survey also found that of those who were in their reproductive years, one in five women who were uninsured had to stop using a contraceptive method because they couldn’t afford it. That data is supported by a Commonwealth Fund survey of women in several high-income nations, which found that women of reproductive age in the U.S. were the most likely to due to cost.

Solutions for the Future

In 2023, In Our Own Voice and more than 50 other Black women’s organizations published the , a playbook on how to improve reproductive justice for birthing people at the policy level. 

The report makes more than a dozen policy recommendations that Davis Moss calls “proactive, comprehensive, and life-saving.” Among them are , requiring states to provide maternity and newborn care for at least one year (the time frame in which ), and increasing access to doulas and midwives who advocate for patients.

Passing acts like the would require the federal government to provide funding for abortion services. “That in and of itself directly impacts a large percentage of Black women of child-bearing age [who] are on Medicaid and Medicare,” says Davis Moss.

For people struggling to pay for contraception, with or without health insurance, the cost of an in-person abortion—the median price is $600—is somewhat unthinkable. Medication abortion, however, can be cheaper and more accessible. Such is the promise of telehealth abortion, a virtual way to connect with a doctor, receive a prescription, and take abortion pills in a supportive environment.

Increasingly more women in the United States are finding themselves living in maternity care and —areas where there is limited or nonexistent access to prenatal, postnatal, maternity, contraceptive, or abortion services. Telemedicine can provide a range of services for people living in these areas at a fraction of the cost—the median price of a telehealth medication abortion is $150.

“Telehealth does a lot to remove barriers to access to health care,” says Dr. Ushma Upadhyay, a public health scientist at UC San Francisco who researches the impacts of telehealth abortion. “People who live in rural areas, young people, people who report facing food insecurity… in our research, they are the most likely to have said that telehealth enabled them to have an abortion.” 

But even with the advent of telehealth, both Upadhyay and Davis Moss say addressing racism is essential to establishing an equitable reproductive future. That’s one of the reasons the Black Reproductive Policy Agenda recommends funding anti-Black racism programs as a part of its agenda. 

“This is the reason those 12 Black women 30 years ago said ‘You can’t only focus on abortion,’” says Davis Moss. “It’s impossible to have one without the other.”

After getting a bilateral salpingectomy, Young feels relieved. Yet she still worries about what will happen with Medicaid and the Affordable Care Act—the resources she relies on to help her afford care for chronic health issues—under the Trump administration, and what that means for others seeking care.

“Thinking about if other women don’t have access, that breaks my heart, and from the abortion side […] it’s too much to bear,” she says, emotion tugging at her voice.  “I feel relieved I got [the procedure] done when I did. I feel safe.”

The frog appears to be calmly responding, or at least thinking, “Bro, relax, I am literally just attractive.” Underneath this image and text is a scene from the gay cowboy movie Brokeback Mountain, showing Heath Ledger’s character, Ennis, hugging Jake Gyllenhaal’s character, Jack, from behind.

Mediatized panic over the specter of gay frogs, including queer mockery of this panic, has a more traceable history. Beginning in the 1990s, scientists began sounding the alarm over synthetic substances called endocrine-disrupting chemicals (EDCs), which interfere with naturally occurring hormones and thus interfere with all kinds of bodily functions and organ development, including but not limited to reproductive organs. 

While these environmental health scientists meant well, and hormone-interfering chemicals do appear to cause serious health issues, including cancer and diabetes, the science and advocacy around these chemicals almost exclusively focused on their reportedly feminizing effects, in terms of reproductive organs as well as what’s understood as sexual behavior.

One 2008 documentary lamented the “disappearing male,” for instance, and a , publicly endorsed by famed environmental activist Erin Brockovich, despaired over the threats that “plummeting sperm counts” and “shrinking penises” posed to humanity.

Frogs, meanwhile, have been a model organism for laboratory science for as long as laboratory science has existed. And frogs make sense to study in the context of toxic environmental exposures because they spend so much of their lives in the water, where so much chemical pollution circulates.

Scientists studying the effects of EDCs on frogs widely reported that individual frogs exposed to these chemicals displayed same-sex sexual behavior, exhibited both female- and male-marked phenotypes, and tadpoles changed sex during development, resulting in what researchers and journalists variously called “gay,” “intersex,” or “transgender” frogs (with “sad sex lives” to boot). Queerness was thus characterized as a bad outcome of toxic exposure, and media outlets—both mainstream and fringe—were quick to jump directly from frog to human bodies and behaviors.

Framing same-sex sexual behavior, transness, or intersex conditions as both unnatural and undesirable has a long and ugly history that continues to rear its head, as demonstrated by recent and proliferating statewide bans on gender-affirming care and sexuality education. But labeling frogs as harmed by toxicants because toxicants “make them gay” is not only socially wrong, it’s also biologically wrong.

Frogs, among many other animal species, engage in same-sex sexual behaviors in the wild all the time. And tadpoles, it turns out, change sex all the time, irrespective of chemical exposure. Intersex frogs, meanwhile, can still successfully mate to produce offspring.

Scientists overwhelmingly assumed that intersex frogs and male-male frog sex—nobody seemed concerned about female-female frog sex—demonstrated evidence of chemical harm because that’s what biological sciences like toxicology have taught them. I hope my work helps correct this scientific and popular miseducation, for the sake of stamping out stigma as well as injustice.

Toxic environmental pollution, as environmental researchers and activists have amply documented, is indeed demonstrably harmful, while its demonstrable harms are vastly and unevenly deployed. The challenge I offer—and rise to—is how to organize effective political action against the poisoners without stigmatizing the poisoned. I am pushing people to ask not simply what makes a poison, but rather who?

Toward Critical Toxicity Studies

The scientific elites who codified toxicology occupied particular gender-, race-, and class-privileged social locations, positions that empowered them to grant themselves the authority to define what makes a toxicant safe (and measurable), what chemical risks are acceptable (and to whom), and how much of an exposure is tolerable (where, for whom, and for what). 

I show that despite toxicologists’ best intentions, toxicology’s inherent biases undermine the usefulness of toxicological findings for environmental justice struggles by focusing on the environmental toxicology and ecotoxicology of EDCs, which is the sub-field fretting about feminized frogs.

The challenge for critical feminists and EDC toxicologists, including those who identify as both, is to communicate the urgency of reducing toxic pollution—by both better regulating chemicals and reining in corporate power—without resorting to eugenicist and masculinist tropes of deformity, low intelligence, queerness, or weakness.

I do not mean to sound flippant; EDCs are a class of toxicants that have become ubiquitous throughout our environments, being constitutive components of such commonplace objects as plastic bottles, receipt paper, or body lotion, among many other items. EDCs are particularly alarming to scientists and other environmental health advocates because they have been shown to interfere with our bodies’ hormonal processes via the endocrine system. 

Hormonal disturbances, in turn, can adversely affect fundamental aspects of physiological development and function, leading to a range of serious health issues, including different cancers and cardiovascular and metabolic failures. Moreover, because EDCs either mimic or override bodies’ naturally occurring hormone signals and hormone receptors, these particular toxicants may be more harmful at lower doses than at higher doses, upending the core tenet of toxicology: “The dose makes the poison.” 

My work does not question the urgency of attending to EDC contamination, but rather how EDC toxicology inadvertently—or by design—reviles the poisoned more than the poisoner.

As mentioned, decades of EDC research on frogs in particular has been built on the homophobic and ableist assumptions that same-sex sexual behavior is abnormal, that frog sex changes are unnatural, and that intersex frogs cannot produce offspring.

The violent histories that EDC research unwittingly recites by deploying such terms as “demasculinization” and “chemical castration” is a form of violence in and of itself. By assuming and perpetuating the white supremacist and heteropatriarchal ideologies that queer, transgender, intersex, neurodivergent, and disabled bodies are somehow aberrant (read: abhorrent), the work of prominent EDC researchers and anti-toxics advocates reinforces social stigma as well as judicial, material, and biomedical inequity.

Social science scholars and activists have well documented the unjust ways that people who are marked as queer, trans, disabled, nonwhite, and foreign struggle disproportionately more to receive the medical care they need, safely access transportation and public restrooms, survive bullying and other forms of violence in schools and sports, and so on.

Put another way, feminist critique of EDC research and advocacy is not simply about problematic language or social stigma on a conceptual level, it’s about how scientific theories can be complicit in prejudicial mistreatment on an undeniably material, visceral level—and sometimes fatally so.

Critical Toxicity Studies calls for a queer, ecofeminist study of toxicants that explicitly, carefully situates toxicants in their sociohistorical contexts, while simultaneously prefiguring a world where all bodies and identities—whether female, male, trans, intersex, disabled, queer, melanated, more-than-human, microbial, weedy, fungal, fishy, fat, young, old, sick, and so on—are fiercely, generously, handled with care.

This excerpt, adapted from by Melina Packer (New York University Press, 2025), appears by permission of the publisher.

However, as the movie progressed, I shockingly began relating more to Elphaba (Cynthia Erivo) than Nessarose, though I am also a wheelchair user. While Elphaba and Nessarose have the same mother, Elphaba was conceived when their mother has an extramarital affair with a man who gives her a green elixir to drink. 

From the moment Elphaba is born with green skin, her father, Frexspar (Andy Nyman), rejects her and begins treating her like an outsider. He even delegates her child-rearing to an anthropomorphic bear named Dulcibear. At the same time, Frexspar dotes relentlessly on Nessarose, his biological daughter, and discourages Elphaba from using magic in public.

Elphaba is treated as an outcast because of her green skin, which the film regards as a disability. Whenever Elphaba encounters a person for the first time, they often visibly gasp because her skin is so different from theirs. “Fine, let’s get this over with,” she always retorts. “No, I am not seasick; no, I did not eat grass as a child; and yes, I’ve always been green.” 

When Elphaba first meets Glinda (Ariana Grande-Butera) and offers this spiel, Glinda says: “W��ll I, for one, am so sorry that you have been forced to live with … this.” She then offers to fix Elphaba’s “ailment,” saying, “It is my intention to major in sorcery. So if at some point, you wanted to address the, um, problem, perhaps I could help.”

Elphaba’s green skin, which , is treated by the people around her as a liability or something worthy of being pitied. The inability of Elphaba’s father and classmates to connect with her because of her exterior difference made me recall the many times over the course of my life where I have been pre-judged because I use a wheelchair.��

The hesitation to acknowledge Elphaba’s existence is something I’ve experienced as a Black woman with a physical disability. People have judged and misjudged me before they even learned my name or heard me speak; the world isn’t kind or thoughtful to people whose physical presentations are different. 

It’s painfully familiar for me to be ridiculed before being embraced. I’m always in a cycle of wondering what others think and if they’re being genuine. That’s a sadness that never leaves, even as I’ve grown immune to what others think about me. Throughout the film, Elphaba is isolated, which fuels loneliness—another emotion that’s particularly resonant. Being the “only” in your family and community with such a striking difference is a bold act of existing in a world that demands conformity.  

And yet, despite the fact that Elphaba’s stepfather treats her as if she’s a burden, she’s still incredibly protective of Nessarose. When the sisters first arrive at Shiz University, where Nessarose is enrolled, an overbearing teacher attempts to push Nessarose’s wheelchair before she even asks for assistance. When Elphaba sees this transpire, she becomes upset about her sister being infantilized and conjures powerful magic that gains her impromptu admission into Shiz and gets the immediate attention of Madame Morrible (Michelle Yeoh), a professor who begins mentoring her.

Elphaba respects Nessarose’s autonomy, though other people in their lives fail to do so. It’s an example of what I call “The Good Samaritan Gone Wrong” factor, wherein people overextend themselves to help a disabled person without pausing to interrogate why. I am often forced to ask: Did the disabled person ask for help, or are you projecting a sense of helplessness onto them simply because they’re disabled? 

The latter is incredibly ableist, and a disabled person has a right to rebuff that projection. But seeing Nessarose deal with ableism in a whimsical film about magic reminded me that ableism is always lurking, even in Oz.  

But Nessarose doesn’t reciprocate Elphaba’s protective impulse. When Elphaba begins sounding the alarm about anthropomorphic animals losing their ability to speak, she’s disregarded and then silenced, an all-too-familiar reality for Black women in our real world who are constantly attempting to save our society from itself and its cruelty. Since Elphaba is also an outlier who’s isolated and disbelieved, she’s able to easily make the connection between how she’s been treated and how these animals are being treated. She understands that the push for conformity is closer than anyone recognizes. 

This parallel is even more relevant during our current political climate. During the 2024 presidential election, Black voters, especially Black women voters, considered harm reduction while some other voters leaned into—and even relished—the harm. It can be isolating to point out injustice, especially when others can’t see or don’t believe it’s happening.

As a disabled activist, I know that the people—including your fellow comrades, who should understand the misgivings of the world—will choose a less friction-laden route rather than directly addressing the injustice. When I began speaking out against , I realized that people with privilege can be severely conflict avoidant and would rather “play nice” than hold people accountable.

Glinda, who has built a friendship with Elphaba, knows the animals in Oz are losing their ability to speak. And yet, we see her internal conflict around making noise about the issue because she’s worried it could negatively impact her social status as the most popular student at Shiz. Like Glinda, people don’t confront injustice because they still want access to the resources, money, and connections of those who cause harm. It reflects a scarcity mindset in which one believes an oppressor is worth keeping around because of potential gain. 

When Elphaba tries to bring attention to the issues occurring in Oz, she’s first scrutinized, then disbelieved, and eventually betrayed by the Wizard (Jeff Goldblum) and Madame Morrible. She’s coerced into using her magic to further discriminate against the animals in Oz—and neither Glinda nor Nessarose come to her defense. Instead, she’s forced to go it alone, even as Madame Morrible calls her a “wicked witch” across Oz’s radio waves.

Elphaba is villainized simply because she’s attempting to stop powerful people from causing more harm. There’s a deep “know your place” tone when Elphaba bucks against the Wizard and Madame Morrible—it costs her deeply and shifts the public narrative of who she is. In this moment, we see Elphaba’s undesirability in a new light; it’s no longer just the micro (her interpersonal relationships). It’s now on a macro level, as she’s being treated as a political enemy of the state. 

The parallels in Wicked regarding the ways disability, disabled people, and overall differences among people (and other species) mirror the hardships people who cannot (and do not) conform endure in our society. I left the theater better understanding that the people we view as villains may not be the true or only villain in their story. Erivo breathtakingly embodied Elphaba through every emotion and every moment of rejection and frustration, a commitment that will hopefully continue in Wicked: For Good when it’s released in November. Ultimately, I hope that our collective understanding of Elphaba expands as we uncover what happens to her—and how her story is further shaped by those who failed to view her with care.