The Art of the Deal in Foreign Aid

| alexandersanger

April 3, 2026

By Alexander Sanger

The Trump Administration today issued its budget proposal for the next fiscal year. It eliminates funding for family planning and other vital programs. Some background first:

Just when I thought that the Trump administration hit bottom in cruelty, depravity and disregard of the humanity beyond our borders, the administration recently had USAID destroy millions of dollars of contraceptives that had previously been bought by USAID for African countries. The contraceptives have been sitting in limbo in Belgium since the Trump administration in 2025 had dismantled the American foreign aid program. They were literally left to rot rather than be distributed to health systems and providers in Africa for whom they had been purchased. There will be forthcoming, I am sure, a report of the health impact of this callous act on women who have been denied family planning through increased and unwanted pregnancies, children spaced too close together and thus infant mortality, and pregnant women resorting to unsafe abortions.

Fos Feminista has issued a report, When Aid Becomes Empire: The Silent Recolonization of Global Health, which analyzes the detrimental effects of the America First Global Health Strategy (AFGHS) that has been issued by the Trump administration. https://fosfeminista.org/wp-content/uploads/2026/01/Recolonising-Global-Health_V3.pdf

The new US foreign aid strategy is focused on 1) addressing and preventing future outbreaks and epidemics that affect American health and security; 2) developing bilateral agreements with nations rather than multilateral agreements with intermediary NGOs; and 3) exporting American technology to advance global health outcomes. In addition, the strategy envisions recipient countries giving favorable consideration to the US purchasing “key minerals and rare earth elements” within their countries. All the above in service of fighting “Islamic Extremism”. The AFGHS’s rationale prioritizes Africa, which it describes as “a continent of strategic importance to U.S. national interests,” citing amongst other advantages, its deposits of “key minerals and rare earth elements needed as inputs into advanced technologies that fuel critical military and commercial applications.” The competition with China for resources is clear.

The Fos report accurately uses the word “recolonization” to describe the new foreign aid program.

Foreign aid as practiced by many countries has been around a long time. Some historians even have discovered it employed in ancient Greece and Rome. Perhaps the most egregious example of foreign aid by colonial powers being used to pillage and pirate natural resources from colonies was Spain looting the New World of gold and silver – the 15thcentury equivalent of “key minerals and rare earth elements”.  

One of the beneficial examples of foreign aid in our history was when France, before Liberité, Égalité and Fraternité, gave arms and advisors to the fledgling American Revolution in 1776 in order to bloody the nose of the British Empire. This example could be called de-colonizing.

Geo-political interests have been omnipresent in modern foreign aid. When our turn came in the Marshall Plan, our main goal was to stop the incursion of communism in Europe. And when foreign aid in the 50s and 60s and beyond became a regular part of the US budget, the goal similarly was to fight the spread of communism abroad. 

President Kennedy said in a message on foreign aid: “Is a foreign aid program really necessary? Why should we not lay down this burden which our nation has now carried for some fifteen years? The answer is that there is no escaping our obligations: our moral obligations as a wise leader and good neighbor in the interdependent community of free nations—our economic obligations as the wealthiest people in a world of largely poor people … and our political obligations as the single largest counter to the adversaries of freedom.

“To fail to meet those obligations now would be disastrous…. For widespread poverty and chaos lead to a collapse of existing political and social structures which would inevitably invite the advance of totalitarianism into every weak and unstable area. Thus our own security would be endangered and our prosperity imperiled….”

https://www.americanforeignrelations.com/E-N/Foreign-Aid-John-f-kennedy-s-special-message-to-the-congress-on-foreign-aid.html#google_vignette

The West is not alone in political uses of foreign aid. China props up North Korea to prevent the expansion of the West near their borders. 

There are plenty of studies about the effectiveness, or not, of foreign aid, but the world has developed economically and healthwise since the advent of the Marshall Plan and US foreign aid, as well as foreign aid from other Western European powers. Multinational aid organizations with staff on the ground and effective accounting mechanisms have been developed over the decades to distribute aid effectively in cooperation with local authorities and institutions and to monitor effectiveness and prevent waste. 

And one of the most effective aid programs has been in maternal and child health and family planning. Life expectancy has grown, birth rates have been reduced and child mortality drastically reduced. All this is due largely to family planning and maternal and child health funding for pregnancy prevention and for safe delivery services. Childhood vaccines have been an integral part of the success. The status of women has risen as a result. 

All this is gone in the new US policy – no intermediate organizations (those hotbeds of Woke leftists!) and no family planning with maternal and child health and childhood vaccines not mentioned. What better way to attack Planned Parenthood and similar international organizations than eliminate them from funding. Also, no gender or DEI programs permitted. And the expanded Gag Rule is back. No discussion of abortion and more. No climate work. Faith-based organizations (i.e. Christian ones) are to be favored. There is, however, a focus on HIV/AIDS funding, from a prevention of epidemic viewpoint rather than humanitarian. Now we have US policies and products being a cornerstone of local health systems which will become markets for US innovation and product testing. Sounds like the Tuskegee experiments brought into the modern age. Products will have to comply with US standards, not those of the WHO – another multilateral organization tossed aside. This an excuse to ban mifepristone abroad which the Trump administration is maneuvering to get discredited by the FDA. 

There are more questions than answers, especially about how this new system will work and whether governments can use their own funds for their own projects and priorities. But what is clear is that the Trump administration sees Africa as a takeover target, where the US comes in with much needed financing and structures the deal to give it voting control over the nation’s health and natural resource systems, no matter that it doesn’t have a clue how the country works. Some art of the deal. 

The one thing we do know is that the new U.S. budget proposal has a vastly reduced amount for foreign aid from the United States. Unfortunately, other countries are following suit, including the UK.

The Administration’s new budget proposal unveiled today provides $18 Billion combined for targeted investments overseas and securing critical minerals. Humanitarian assistance is cut $2 Billion, Food for Peace is cut $1.2 Billion and Global Health is cut $4.3 Billion, leaving $5.1 Billion for Global Health. There are no disease specific accounts, leaving the administration the power to allocate “across HIV and other infectious diseases, such as malaria, tuberculosis and polio to strengthen global health, security and protect Americans from disease.”

There is “no funding that supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and Lesbian, Gay, Bisexual, Transgender, and Queer services to better focus funds on life-saving assistance. The United States should not pay for the world’s birth control and therapy.” 

Examples of programs eliminated:

“Promoting reproductive health education and access to birth control and other harmful programs

couched under ‘family planning’ in Ghana;

…

Promoting health equity and providing condoms and contraception in Kenya.”

So, birth control is out. This and destroying contraceptives are deliberate slaps at women. The anti-family planning agenda of the Trump administration is clear. This is a fight over who controls reproduction – the administration wants men to. 

The fight is now in Congress which in the past has supported family planning programs.

The need for international family planning assistance remains. See: https://www.guttmacher.org/adding-it-up?utm_source=Guttmacher+Email+Alerts&utm_campaign=922864ee96-EMAIL_CAMPAIGN_2026_03_26_12_19&utm_medium=email&utm_term=0_-922864ee96-260655221

The battle is on.

The New Eugenics – Heritage Foundation Project 2025 for Marriage and Increased Childbearing 

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Reading the opening lines of the Heritage Foundation Report – Saving America by Saving the Family: A Foundation for the Next 250 Years – I was struck by a deja vue. Not just because the Report warms over the usual right-wing attacks on the 20th Century including reproductive rights, women’s rights and sexual rights, but some of the language about the rights of children were oddly reminiscent of statements made by my grandmother 100 years ago. I suspect the authors of this report were totally ignorant of this, so it’s worth a reminder.

The opening paragraph of the Report states: The first (truth) is that all children have a right to the affection and protection of the man and woman who created them. The second is that the ideal environment in which to exercise this right is in a loving and stable home with their married biological parents.

In 1926, my grandmother wrote an article for Holland’s Magazine entitled “Passports for Babies.” As reported by the Margaret Sanger Papers Project, “Sanger fantasizes about parents being subjected to an interview by a prospective baby. The demanding child inquires whether the parents have paid for their last baby, how many other children they have, and whether or not the parents can supply a happy home, proper food, a sunny nursery, and love and affection. Summarizing the prospective parents’ responses, the baby exclaims: ‘Five children already? Two dark rooms in the slums? No! Thank you! I don’t care to be born at all if I cannot be well born. Good-bye!’”

God forbid that the Heritage Foundation would ever quote Margaret Sanger in support of its thesis, but their arguments are oddly similar … as far as they go. 

The Heritage Foundation chastizes much of modernity, global population trends, real world economic factors and the resulting changing social, cultural and mating environment where human reproductive strategies have been adapted for success. These adaptations include: more female education, fewer and later marriages, and fewer children. 

Women are decried as selfish: the opening paragraph of the Report continues: In contrast, the default in American culture today is to put the desires of adults over the needs of children. Children are too often called to sacrifice what is due to them—the presence of their mom and dad under the same roof for the entirety of their childhood.

The body of the Report goes on to cite the Founding Fathers who signed the Declaration of Independence who were, quite literally, fathers: Fifty-four of the 56 signers of the Declaration of Independence married and had a total of 337 children among them—an average of six each.   

Available figures indicate that the average American woman in 1800 had over 7 children (there are no figures for 1776), so the Signers were apparently on the low side of the average (perhaps they weren’t finished, or rather their wives weren’t, having children). 

The Report somehow fails to cite what the Declaration of Independence actually said: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are Life, Liberty and the Pursuit of happiness.”

Alas, we all know that the Founding Fathers didn’t “Remember the Ladies,” but not even the authors of the Heritage Report could bring themselves to assert that women have no right to Life, Liberty and Pursuit of happiness. Nor did the Framers talk of any children’s rights. 

For me and my grandmother, Women’s Rights and Feminism are included in the right to Life, Liberty and the Pursuit of Happiness. My grandmother said, “No woman can call herself free who does not own and control her body. No woman can call herself free until she can choose consciously whether she will or will not be a mother.”

She added: “A woman’s body belongs to herself alone. It is her body. It does not belong to the Church. It does not belong to the United States of America or to any other government on the face of the Earth. The first step toward getting life, liberty, and the pursuit of happiness for any woman the serve decision whether or not she shall become a mother. Enforced motherhood is the most complete denial of a woman’s right to life and liberty.”

The Heritage Report fails to analyze why a declining birthrate is a worldwide phenomenon, including in so-called first world countries, and I would include Russia and China in them, in addition to Europe, Latin America and Asia. Much of the world now has a TFR less than 2.1, which is the replacement rate. The US is no outlier.

Contrary to the Heritage Report attacks on the lack of morality and the alleged disfavoring of religion in the US as drivers of reduced birthrates, smaller families also occurs in countries with a strong state religion and strict sexual morality and with no or little “Feminism”. For instance, Iran has 1.7, about the same as ours.

Fertility rates have been falling in some countries since the 18th Century – long before modern birth control or abortion, before “Feminism” and “Gender”, before the sexual revolution (there are arguments that the sexual revolution began with the advent of the automobile, not the Pill), before welfare and before internet pornography and dating. Analysts have looked at such factors as: the Industrial Revolution, medical advances for child survival, costs of raising a child – all this before much female education and women’s entry into the modern workforce and feminism.

Single motherhood proliferates worldwide but varies from culture to culture. It is higher than the United States in many countries in Western Europe and Scandinavia and in Latin America; it is far lower in East Asian countries. 

Wailing about smaller families is often a disguise about exactly who is having smaller families and who larger. In many countries there is concern with immigrants having a higher birth rate than those native born. This Great Replacement argument occurs not only in the United States, but in other western countries as well, hence Reports like the Heritage’s calling in coded language for greater native birthrates. 

The Heritage Foundation’s call for a Manhattan Project for babies uses an unfortunate metaphor – the population bomb was an inept metaphor used in the early 1970s for what was thought to be unbridled population growth. It seems that the Heritage Foundation wants unbridled baby growth.

There are the expected attacks on Lyndon Johnson’s Great Society and its welfare programs and on the Pill and the sexual revolution and feminism and gender. The ideal country in the Heritage view for a Baby Boom is Israel, which is quite different from the US and the rest of the Western World with its religiosity, uniform language and culture, not to mention a history of real and immediate threats from its neighbors. The authors fail to mention that Israel has available sex ed, birth control and abortion. Nor did it mention that Israel allegedly once gave long-acting birth control to immigrant Ethiopian Jews without their consent.

Some of the Heritage solutions for the US: a large family tax credit, home childcare tax credit, reducing education levels and establishing church-societal marital boot camps, discouraging on-line dating, promoting family education in schools, making divorce harder (they do not realize that doing so is a disincentive to marriage), and mandating a day of rest, i.e. Blue laws (I am writing this on Super Bowl Sunday) and reducing welfare and head start programs. The list goes on and on.

In contrast to the research cited in the Heritage Report about the single parent homes destroying children, the Annie E Casey Foundation, which has decades of research on the family, states: “Com­pared to kids in mar­ried-par­ent house­holds, chil­dren in sin­gle-par­ent fam­i­lies are more like­ly to expe­ri­ence poor out­comes. Research indi­cates that these dif­fer­ences in child well-being tend to be small, though, and can dis­ap­pear when adjust­ing for key fac­tors like pover­ty.  While the research is com­plex, some­times con­tra­dic­to­ry and evolv­ing, mount­ing evi­dence indi­cates that under­ly­ing fac­tors — such as strong and sta­ble rela­tion­ships, parental men­tal health, socioe­co­nom­ic sta­tus and access to resources — have a greater impact on child suc­cess than does fam­i­ly struc­ture itself.

Chil­dren thrive when they have safe, sta­ble and nur­tur­ing envi­ron­ments and rela­tion­ships, and these con­di­tions and con­nec­tions can exist in any type of family.”

There has been much discussion of our modern mating system, if it can be called that. In the modern economy, with modern contraception, women are getting the education they need to survive and thrive on their own without relying on a husband. They have their children when they are ready and when their children have the best chance of survival and thriving. The Report calling for women to get less education and to be stay at home moms flies in the face of that reality. That genie isn’t going back in the bottle. 

What to do about men deserves more serious addressing than the Report does. The American male is not in great shape physically or educationally. My grandmother noted that during World War I 56% of American men were found unfit for military service. A recent study by the Defense Department found 77% of men unfit for service. Is it stricter guidelines or declining male health? Men attend college less then women. Antisocial behaviors are exhibited more by men than women. They are of declining marriageable material; hence women aren’t marrying them.

The Report’s proposals for family formation are targeted to benefit taxpayers, not those who don’t earn enough to pay taxes. The incentives are for the relatively well-to-do not the poor. Childbearing is to be encouraged for those who have, not those who have not. 

Finally, one of the drivers of infertility is undiagnosed sexually transmitted infections. The more well-to-do get reproductive health care from private physicians or clinics. The less well-to-do from Planned Parenthood. And what has the current administration done? Defunded Planned Parenthood, thereby leading to more undiagnosed STDs and thus infertility among the less well off, as well as more unintended pregnancies and more abortion, legal or illegal (illegal abortions can increase infertility). 

Eugenics by any other name. 

Site Visit to Guatemala – Dec 8-10, 2025

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On Dec 8-10, 2025, I went to Antigua, Guatemala to visit two Fos Feminista partner organizations and to attend a Fos board meeting. Antigua is surrounded by 4 volcanoes, one of which was smoking. The nation’s capital was once in Antigua but multiple earthquakes in the 1700s led the Spanish authorities to move the capital.

Guatemala is the most populous country in Central America with over 18 million people. The country struggles with persistent inequality. The population is primarily Mestizo, but Indigenous Maya communities make up about 35 percent—the highest proportion in the region. Guatemala is home to 22 Mayan languages, which makes delivering health care challenging. Poverty is widespread. In 2023, 56 percent of Guatemalans lived in poverty, with 16 percent in extreme poverty. Rural communities and Indigenous peoples are disproportionately affected, with poverty rates exceeding 80 percent in some areas. Malnutrition among children is alarmingly high: 46.5 percent of children under five suffer chronic malnutrition, one of the highest rates globally. 

Guatemala faces a critical sexual and reproductive rights crisis. Adolescent pregnancy rates, particularly in rural and Indigenous communities, are among the highest in Latin America. Many of these pregnancies result from sexual violence, highlighting deep gaps in child protection and support systems. Early pregnancy often forces girls to leave school, limiting their opportunities and perpetuating cycles of poverty. 1 in 3 Indigenous women have no access to health and family planning services. 25% of teen girls are pregnant or parenting. The birthrate is 2.4. 

Challenges in the country have been further exacerbated by the recent US funding cuts to USAID and UNFPA which brought $605.5M in support for global family planning and reproductive health programming and services to an abrupt end. Guatemala was among the largest losers of funds. Birth control pills are currently out of stock in government clinics. 

The country has some of the most restrictive abortion laws in the world, permitting the procedure only when the life of the pregnant person is at risk. In practice, even these cases are difficult to access. Medical professionals often interpret the law narrowly, and social stigma further discourages care. As a result, many girls and women are forced to continue pregnancies, even in cases of rape or when their health is at risk. Illegal abortions proliferate. 

The two Fos partners there are: 

Founded in 1964, APROFAM (Asociación P r o B i e n e s t a r d e l a Fa m i l i a de Guatemala) is a long-standing partner of Fòs Feminista and one of the largest providers of sexual and reproductive health care in Guatemala and within the Fòs Feminista Alliance. In 2024, APROFAM provided more than 2.7M sexual and reproductive health services, including nearly 975,000 contraceptive services. APROFAM provides subsidized SRH services primarily through its clinics and occasionally through mobile clinics in collaboration with the Ministry of Health. It also offers general medical care including pediatrics.

And 

WINGS (Women’s International Network for Guatemala Solutions) has been a Fòs Feminista partner since 2019. Founded in 2001, WINGS provides quality, free or subsidized reproductive health education and services to low-income, rural, and Indigenous populations, reaching around 25,000 individuals annually. Their model is complementary to APROFAM in that WINGS focuses predominantly on rural, Indigenous, and underserved provinces in Guatemala that are not reached either by APROFAM or the public sector. In 2025, WINGS reached an important milestone in expanding their mobile health outreach to every department in the country.

On Day 1 we visited an APROFAM clinic visit 2 hours away from Antigua. It was a public health clinic that APROFAM was borrowing for the day. It was spotless. They provided good quality compassionate care. 

It was vasectomy day. I scrubbed up and observed one procedure. The patient was a man about age 35 or 40 with a few children (exact number undisclosed to me). Lively music was playing in the operating theater. A doctor, nurse and orderly did the procedure. It was very quick, 7 minutes, with lots of chatter with the patient who said he didn’t feel a thing. My high school Spanish being limited, I couldn’t understand what they were talking about – maybe football. All was very professional and relaxed. Patient was at ease and hopped off the table at the end. 10 more patients were done that morning. An 11th got a call from his office and left before his procedure. 

The clinic also does tubal ligations for women but not today.

Below — ACS in scrubs

ACS with clinic and Fos staff and volunteers. 

We next visited a health promoter’s house. She is part of the WINGS network. She is a nurse who does counseling and also inserts implants and IUDs in her home as well as providing injections and pills. Her 9-year-old daughter and family cat sat in, as well as an adult patient. There was also a teenaged male sex educator who spoke of his speaking to teens in schools. In the living room/consulting room was a chapel so that the patients can pray as they get care and feel absolved.

ACS with the WINGS nurse-educator.

These organizations are doing life saving work in very difficult circumstances.

Sharon Camp

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Sharon Camp was determined. Determined to get out from behind the policy desk, from behind the research desk, from behind the lobbying desk and to do something concrete for women. She did.

We met numerous times in the mid and late 1990s to discuss financing for Plan B and its use at PPNYC clinics. The latter was easier than the former, as we were already offering the morning after pill to our clients, just not under the Plan B label. Alas we were in our usual financial straits and could not be an investor in Women’s Capital Corp. But we cheered her on and lobbied on Plan B’s behalf with medical, legal and regulatory authorities.

Plan B moved women’s health from relying on off label use to FDA sanctioned use of birth control pills for the morning after.

Well done, Sharon!

Victory in BraZil

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This past Friday, Supreme Court Justice Luís Roberto Barroso issued landmark decisions in three major cases led by Fos Feminista partners — ADPF 442, ADPF 989, and ADPF 1207 — marking a transformative moment for sexual and reproductive rights in the country. In one of the cases, Justice Barroso reaffirmed the unconstitutionality of criminalizing abortion up to 12 weeks of pregnancy, strengthening the path for decriminalizing abortion in the country. In the other two cases, his decisions pave the way for expanding access for those seeking abortion under the current exceptions (rape, risk to life and anencephaly) allowed in Brazil.

There is much work ahead, but this is a great first step for the women of Brazil to reproductive Justice.

Birth rates, Fertility and What To Do

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The CDC reported last week that births increased by just 1 percent in 2024 with the fertility rate (TFR) remaining level at about 1.6, well below the 2.1 level needed to maintain the population level through births alone (i.e. without immigration). 

At the same time, the Guttmacher Institute estimated that clinician-provided abortions in 2024 in states without a total abortion ban increased also by slightly less than 1 percent from 2023. There were additional abortions of an undetermined number that were not clinician provided. 

The Trump Administration is considering ideas to increase the birth rate, among them a $5,000 baby bonus, tax credits for children, increasing the availability of IVF, and awarding medals to mothers of a certain number of children. Worldwide incentives of this sort have been largely money wasted. My October 16, 2024 post talks about Norway and Hungary’s futile efforts to increase their birthrates. At most, incentives have speeded up childbearing but not increased the number of desired children. Russia awards an Order of Parental Glory to parents of large families. It hasn’t stopped the decline in the Russian TFR. A similar award in France has had no effect either.

The Administration’s cutting of Title X funding for family planning and threatened cuts to Medicaid program (as well as criminalizing abortion if they seek a nationwide ban) will perhaps serve to increase unintended childbearing, especially among teens. The decrease in the national TFR has come because of a reduction in teen pregnancy over the years largely due to better and longer-lasting contraception. Teens and young adults are also reporting having less sex. Criminalizing abortion further and reducing access to contraception may serve as further deterrents to sex and hence pregnancy, but I suspect the pregnancy and childbearing rates will rise among those without access to private family planning services, i.e. the poor and minorities, exactly the groups that the conservative White Replacement Theory folks don’t want to reproduce. 

The issues around infertility and IVF are tying the Administration in knots given the sway of absolutist anti-abortion people in policy circles. The imperatives of couples wanting a child by any means often outweigh their beliefs on abortion. 

The causes of infertility in males and females are debated, but one thing is sure: sexually transmitted infections can cause infertility. And the Administration by cutting reproductive health care programs will be increasing STIs and hence infertility. 

Who ever said politics makes sense. 

The Forest obscuring the Trees

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In the midst of the tariff forest, or conflagration to switch the metaphor, we cannot lose sight of the trees – Administration’s devastating attack on reproductive, and general, health of people here and abroad. And the attacks are just beginning.

The Administration has suspended Title X funding for family planning clinics in this country but also USAID grants for reproductive and other health around the world. Title X supports the provision of reproductive healthcare, including family planning and the treatment and prevention of sexually transmitted diseases in family planning clinics in this country. Many of those clinics are operated by Planned Parenthood. None of the funds can be used for abortion services. A total of $66 Million in Title X funding has been suspended, including $21M for Planned Parenthood clinics. These programs have been audited repeatedly to make sure that this does not happen, yet this administration under the guise of fiscal probity has suspended the funds to do yet another investigation. The effect of this suspension will be that clinics will be turning away low-income patients who will have nowhere else to go and will lead to increases in sexually transmitted infections, cervical cancer and pregnancy rates, and therefore abortion rates.

The next shoe to drop is probably Medicaid funding going to Planned Parenthood and other reproductive healthcare clinics. Medicaid funding reimburses clinics for reproductive healthcare visits, including family planning and sexually transmitted disease provision for clients who are eligible for Medicaid. If and when these cuts are enacted, and there are sure to be challenges because these funds are budgetary provisions, enacted by Congress, and it will lead to the closure of many family planning clinics nationwide. Patients will have nowhere else to go. On top of this, the Supreme Court this week heard arguments about whether or not states can prohibit Medicaid recipients from using clinics which also provide abortion services, i.e Planned Parenthoods. Planned Parenthood receives about one-third of its revenue from Medicaid and Title X.

Planned Parenthoods nationwide are facing huge budgetary pressures, as are many healthcare providers, with rising costs, especially salaries for nurses, doctors and other trained personnel. My old affiliate, Planned Parenthood of Greater New York (PPGNY), recently announced that they were putting up for sale the building that houses its Manhattan clinic and would be closing the clinic. They said they hoped to open in Manhattan clinic at another site, but there are no definite plans. The affiliate, along with many other Planned Parenthood affiliates nationwide, have been closing under-performing clinics because they cannot be subsidized in the current climate. PPGNY and PP Illinois have recently closed four clinics each. This has led to greater travel, and other costs, being imposed on rural patients, as well as delay and forgoing of health care.

Planned Parenthoods around the country that provide abortion services are inundated by patients from states where abortion has been criminalized. The resulting subsidy that patients need, including travel costs and accommodations, as well as the fees that they are unable to pay are devastating the finances of Planned Parenthood. This is a human and public health crisis, and states that keep abortion legal must do more to make abortion as safe and accessible as possible. Women are going to resort to do-it-yourself abortion and not under a doctor’s care which could lead to injury and death. Those doctors who are mailing abortion pills internationally and across state lines are not reaching every woman who needs an abortion. About half of women coming to Planned Parenthoods nationwide are using abortion pills, but many are opting for surgery because the procedure can be done in the same day and the woman can return home without delay or risk of needed a followup visit in a state where abortion is criminal.

There is a curious intersection, and disconnect I believe, with much of the conservative ideology about white supremacy. The attacks on Planned Parenthood will reduce reproductive healthcare as well as abortion services in areas with large white populations. If the conservatives hope as a result the white birth rates will go up, that might happen (preliminary data shows an increase in births in criminalized states – the abortion rate has also gone up!). But these attacks will also end up resulting in the closure of clinics serving minority populations, so those birth rates will also go up. In all cases, there will be an increase in sexually transmitted diseases (and illegal abortions), which in many cases cause infertility, thereby decreasing the nation’s ability to increase the birth rate. Talk about counterproductive.

The middle of all this chaos, families have to sort out whether and when to have children. One of the factors that men and women will take into account is how they view the future. Certainly the tariff chaos will give financial pause to many in every state and of every political persuasion. People are now poorer than they were a month ago, and one can question whether they see any light at the end of the Trump tunnel. Some conservatives are beginning to see that they should offer incentives for married couples to have children, though incentives offered in various countries around the world have done little or nothing to increase birth rates.

The intersection of the tariff policy with the anti-immigration policy gives political concern. Many areas of this country have seen population growth and economic vitality from immigration. If these areas are depopulated through deportations, the economies there will stagnate and decline. One US study called it, “Depopulation, Deaths, Diversity and Deprivation: the Four D’s of Rural Population Change.” This scenario played out in the former East Germany recently, an area where people of ability left for greater opportunity in the former West Germany, leaving behind people with fewer opportunities and social services, who were full of resentment, and therefore voted for far right political parties. This would naturally buoy the Trump party even though he was the cause of it all.

Nita Lowey and Alan Simpson

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What a force Nita Lowey was. Tenacious supporter of women’s and reproductive rights, she was at our side, and leading, in every major Congressional battle over women’s access to reproductive health services here and abroad. Her office was the first we would call when some new threat would emerge from the Neolithic swamps of the Reactionary Right. Nita would pick up the phone herself and lead the counter strategy. She was solid, and we knew she would never waver.

As for Alan Simpson, Republican Senator from Wyoming, I give credit where credit is due. He was a steadfast supporter of reproductive rights when that stand was growing increasingly unpopular in his Republican Party. I met him in Cairo when he attended the 1994 UN Conference on Population and Development, lending the US delegation bipartisan support for an agenda that included expanded family planning efforts. He voted against ban on late term abortions but was not supportive of Federal funding for abortions except in limited circumstances.

Irony indeed that Nita Lowey and Alan Simpson clashed heatedly over Anita Hill and Clarence Thomas, a clash that Simpson later regretted. He voted to put anti-Roe Justices on the Supreme Court, saying, “I wanted people on the court regardless of ideologies. I wanted credible public servants with brains.” I don’t think he got them.