Newsletter February 2025
The FMUS podcast is out! From Trump’s scandalous attacks on USAID and U.S. foreign assistance, to the work of courageous physicians and activists ensuring access to abortion pills in restrictive US states – the conversations are lit
The FMUS podcast is here! I’ve been planning it for a while, and I’m delighted it’s now launched, with the support from the great folks at Körnelius and Spkr Studio in Montreal. It felt important at this time to reach out to you in a more direct way, and build a stronger sense of community. The Famous Feminist Newsletter will continue to be published once a month, but you can now enjoy (hopefully!) insightful and urgent conversations throughout the month with some of the most inspiring feminist activists, researchers and policy-makers. You will feel less alone—I know I did!The first three episodes are up at https://www.fmus.org/fmus-podcast.In the first episode, I discussed the impact of Trump’s ongoing dismantling of U.S. foreign assistance and of USAID, the United States Agency for International Development, with Beth Schlachter, Senior Director of U.S. External Relations at MSI Reproductive Choices, an international organization that provides reproductive health services including abortion in 36 countries in the global South. Schlachter was previously a diplomat at the U.S. Department of State, where she participated in multilateral UN negotiations on sexual and reproductive health.https://www.youtube.com/watch?v=2tQBdm6UyY0
In our conversation, Schlachter noted that U.S. foreign aid is not even 1% of the total federal budget, and that gutting it will therefore not yield any great savings. But it has provided lifesaving healthcare to millions of people in the developing world, notably via PEPFAR, the U.S. signature program to prevent and treat HIV and AIDS. Cutting funding for anti-retrovirals overnight will cause drug-resistant HIV strains to develop and spread around the world, said Schlachter: “By suddenly stopping access to HIV drugs, we’ve both made it possible for the pandemic to be accelerated again, and we’ve threatened the lives of those 20 million people who are counting us to provide the drugs to them.”
“The U.S. is also the largest funder of contraception as a development investment,” explained Schlachter. “70% of the contraceptive commodities, the implants, the IUDs, the condoms, the birth control pills that go to Africa are provided through USAID and the UN Population Fund (UNFPA) in partnership. So when you rip that partnership apart, you make it difficult for everybody to have their services. And now, we at MSI cannot count on that fact that those commodities will be on the shelves when women show up to receive them. It’s a break in faith. And for anybody who’s used contraception, just imagine, going to your provider expecting to get something and then be turned away and told: “I don’t know when you can come back.” That doesn’t work! That’s how you get pregnant!”
The shock of the Trump/Musk cuts to fragile health systems that rely on U.S. aid is profound, noted Schlachter: “All of those countries are in a state of chaos around what is going to be predictable, how can we continue to provide services when we don’t know what’s happening. Supply chains have been cut off, stop work orders have been sent, people have been sent home … that means nurses aren’t showing up in health centers, doctors aren’t allowed to work either, so a lot of these health systems are grinding to a halt.”
When I asked her about Secretary of State Marco Rubio’s claim that funding had to be stopped to investigate whether USAID was funding “DEI” (diversity, equity and inclusion) programs, Schlachter replied that it is impossible to isolate DEI from “the full range of humanity” addressed by development assistance. “People are whatever gender they identify with, whatever race they come from, whatever culture they live in. We all show up with that full range of diversity and complexity. We don’t ask each other to park one aspect of our identity at the door while we’re coming in for food aid, or wanting to use a safe road, or send our children to school. It’s this false construct that they’ve used for political purposes, and we know that they don’t care what the impact is, what the truth is. They’ve found a convenient story they can tell to stoke fear… if you want to pull people apart, you pull them apart culturally with things that are closest to their own identity, and you separate us into camps and then are able to take power. And in the last week, we’ve seen exactly that.”
I’ll add that we’re seeing more of the tactic Schlachter described as the weeks go on, with the Trump Administration doubling down on its illegal and discriminatory attacks on vulnerable people to justify its spending freezes and cuts and its mass firing of federal civil servants. Trans persons have been particularly victimized, with the Administration firing them en masse from the military, seeking to deny them the right to participate in collegiate sports or barring them from obtaining a visa to travel to the U.S. By the way, trans persons make up 1% of the population, and an estimated ten trans girls were members of college sports teams before Trump signed his Keeping Men Out of Women’s Sports executive order on February 5, 2025. And no, there is literally no evidence that trans girls have a physical advantage over cis girls in sports.
In the second episode, I interviewed Jodi Jacobson, founder and executive director of Healthcare Across Borders, an organization that seeks to ensure that people can access lifesaving care no matter where they live in the U.S. Jacobson was previously the founder and editor-in-chief of Rewire News, an online news service on sexual and reproductive health and rights. Jacobson and I discussed abortion with pills via telemedicine as a lifeline for pregnant persons in U.S. states that restrict access to abortion.
https://www.youtube.com/watch?v=0kuU1EGpcy4
At the outset, Jacobson noted how those of us who worked on abortion access in the global South have known for years the deadly consequences of abortion restrictions, but that this is only now becoming obvious once again to people in the U.S. following the Dobbs decision: “Working on that globally, you know the dire situation that occurs when there is no access to abortion which has knock-on effects on families, on infant health, on child health, that really creates a public health crisis.” While Roe was an imperfect framework, it did ensure access to abortion care for many.
Jacobson explained the growing role of telemedicine in all manner of healthcare in the U.S., a role that was turbocharged by the COVID pandemic, when the Biden Administration allowed medical personnel to use it to deliver many health services, including abortion care. “We have 16 states with total or six week bans [on abortion], so we are able to use telemedicine when needed to get care to people. Similarly, with gender-affirming care.”
More than 60% of all abortions in the U.S. are currently thought to be performed with pills, but Jacobson believes that is an undercount, since there are many ways people access pills, not all of which are tracked easily.
Telemedicine has been embraced in all states, restrictive or not. “There is a large number of people offering abortion via telemedicine in states where abortion is still legal,” noted Jacobson. Telemedicine abortion is simply much more convenient than having to drive to a clinic. But there are also a few brave providers, explained Jacobson, who rely on the protection offered by shield laws in their progressive state to provide abortion pills by telemedicine to patients located in restrictive states. Shield laws, such as those passed by California, Colorado, New York or Massachusetts, protect these providers from extradition requests or the attempted seizure of their records by restrictive states.
This work is not without risk, noted Jacobson; for example, these providers cannot safely travel to restrictive states or even change planes there. From sixteen providers willing to do this across the entire U.S., the number fell to only ten after the November 2024 elections. Collectively and with the help of volunteers, they help 10,000 people a month, a mind-boggling number. Healthcare Across Borders subsidizes these providers financially as best they can, since not all patients can pay the $150 cost of providing pills and associated insurance and other costs.
Jacobson emphasized the long trajectory of the anti-rights, anti-abortion movement, and how those who supported choice never took measures that were forceful enough to block their actions: “To be honest with you, from all we know from history from the AIDS movement to our own experience with restrictions on abortion care, this has been a long-time plan that they’ve been very happy to implement incrementally till they got where they wanted to go. (FRANCOISE: you mean the anti-abortion folks…) JODI: The anti-health movement, the forced birth movement, that really is at base a pro-natalist movement that is saying we want more white babies, we want to get rid of people of color. If we had been more proactive, and if people in Congress who said they were pro-choice had understood and believed us, we might have done things in advance that were more protective.” Such as passing a federal law to codify abortion rights nationally when Democrats controlled Congress.
I also had the pleasure of speaking with Angel Foster, MD, PhD, who is a professor at the Faculty of Health Sciences at the University of Ottawa and longtime abortion researcher. Dr Foster founded the MAP (Massachusetts Medication Abortion Project) in 2023 to ensure that folks in restrictive U.S. settings have access to abortion pills. The MAP is integrated in the formal health system of Massachusetts, abides by its regulations and policies, and benefits from the protection of Massachusetts’ shield law.
https://www.youtube.com/watch?v=YEPmKNX-cPQ
Dr Foster described the learnings she and her team had previously gained from conducting research on abortion with pills in settings such as Pakistan and Thailand, lessons they applied to the MAP: “The most important [lesson] is about trust. We can trust women and other pregnancy-capable people to determine for themselves if they are pregnant and they don’t want to be. We can trust [them] to determine whether they are eligible for medication abortion based on gestational age. We can trust them to follow up, if they need another intervention or need any kind of emergency care. We can trust them without having to do ultra-sounds or blood work, or some kind of in-person clinical interaction.”
These lessons apply to telemedicine but also to community provision of abortion pills in all kinds of settings, noted Dr Foster. De-medicalized approaches to abortion are safe and effective. Bringing that knowledge back to the U.S., Dr Foster’s team took into account the additional advantages the U.S. has, such as a functioning postal system and a high level of literacy, in designing and setting up the MAP.
Dr Foster explained that the MAP can be found online via consolidator sites such as Plan C. Prospective users fill out a form to determine their eligibility (for example, Massachusetts only allows them to serve patients who are 16 and over), and then intake and consent forms. Once a clinician has reviewed these, whatever payment the patient can afford is made, and pills are shipped via priority mail along with instructions for use. Follow-up care is available should the patient have any questions or concerns.
The MAP currently serves 3,000 patients a month. With the MAP’s pay-what-you-can approach, patients pay on average $55 of the $75 that the package costs, but Dr Foster and her team felt strongly that their “trust women and trust pregnancy-capable people” philosophy also had to apply to payment for the care. Many of the patients are poor and some are homeless, noted Dr Foster, and the MAP will not turn anyone away. “We had many patients who paid $5, and two months later made a $5 donation, and some try to pay it forward as well, and that’s really heartening.” Individual donations and foundation support make up the difference.
The MAP also provides abortion pills to those who are not pregnant but might need them in the future. Demand has gone up significantly since November 2024: “Until the election, less than one percent of our patients were requesting pills in advance of need. And now we are seeing closer to six or seven percent of our patients requesting pills in advance, and that changed almost overnight once the results of the election were announced.” Folks definitely feel the threat to their bodily autonomy.
When asked about managing their legal risk in the face of hostile attorneys-general in restrictive states, Dr Foster pointed to Massachusetts’ comprehensive shield law (which protects providers but also funders and helpers), but also explained that she and her team “designed the MAP on a distributed risk model, with the intention of making it harder to identify a particular person who is implicated in a particular patient’s abortion care. The person who orders the pills is different from the person who prescribes the pills, is different from the person who mails the pills, is different from the person who’s processing the payment. Patients do not know which individual was involved with their care, they only know that the practice was involved. We did that to protect those who are working with the MAP. And we also think of that as potentially protective for patients.” (And indeed, several restrictive states have recently considered charging pregnant persons with murder if they abort, something they had shied away from until now). The MAP relies extensively on volunteers, who meet regularly for “packing parties” to prepare the packages for patients; they even include a hand written note of support for each patient. Dr Foster feels strongly about the importance of creating community around the service. I agree with her wholeheartedly.
Still, it’s incredible to think that a safe, effective, lifesaving health service must be offered in 2025 in the U.S. with all of these safeguards and precautions. Dr Foster also noted that, in a paradoxical way, convincing patients in restrictive states that the MAP and other shield law providers are above board is a major problem, given the constant drumbeat of bad news about abortion: “One of the things that limits our ability to meet the incredible demand for abortion in ban and restrictive states, is that people wonder: is this is a legitimate service? We get this question every day. Think of a 23-year old woman in Texas who has heard post-SB 8 [one of the Texas laws restricting abortion] and post-Dobbs for the last three years that abortion is illegal in Texas. She’s not in college, she’s not tied to reproductive justice or feminist networks. But she goes online and she finds out that there’s this group in Massachusetts that will send her FDA-approved medications for $5, that will come to her house within five days. That sounds bananas!”
That being said, Dr Foster is sure that even if a federal abortion ban were ever enacted, “even if shield providers had to close, medication abortion access will just continue in the United States. There will be international providers that can send pills, there will be new, innovative strategies. These pills are NOT going away. That ship has sailed.”
A luta continua! In podcast solidarity,
FG