U.S. Aid Cuts and Their Global Impact on Reproductive Health and Rights

Global reproductive rights and investment in the agencies and organizations that support reproductive rights have often been used as a political football. The bodies of women, girls, and LGBTQI+ persons have been used to push and pull power for decades—and this anti-rights, anti-choice framework has become increasingly exported around the world. Beth Schlachter, Senior Director for U.S. and External Engagement for MSI Reproductive Choices, talks to us about how attacks to human rights frameworks and funding will further endanger global reproductive health and rights.

Some apparatuses the U.S. have been using to redefine human rights, and therefore, redefine access to sexual and reproductive healthcare services, include the Commission on Unalienable Rights, the International Ministerial Conference on Freedom of Religion or Belief, and the Geneva Consensus Declaration. These frameworks and tools then get internationally exported. MSI has a host of programs around the world that will be impacted by these tools, frameworks, and funding attacks. MSI’s programs support maternal health and access to other reproductive health services. In addition, these attacks will likely and broadly impact child marriage programs, the PEPFAR program, the Sustainable Development Goals, and more.

Links from this episode

MSI Reproductive Choices
MSI on Instagram
MSI on X
MSI on Facebook
Beyond the Chaos, a New World is Emerging: Making Sense of the Trump Administration’s Impact on Reproductive Rights and Gender Equality
Alliance Defending Freedom: Last Week Tonight with John Oliver
The dismantling of US international aid has already had a profound impact on women’s reproductive health around the world.  
Defending reproductive rights in the face of aid cuts

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie Hi rePROs. How's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/her. So y'all, there has been so much happening in the last week or so. First, Congress is in the midst of budget reconciliation, and there's a lot of really bad things that are coming out in that process. We're only going to talk about one today, but just know there are a lot of them, so keep an eye on it. One of them is that they are threatening to defund Planned Parenthood, and y'all, that is said with the biggest of scare air quotes. There is no defund Planned Parenthood. There is not a line item that says this money goes to Planned Parenthood. Planned Parenthood is a grantee in a number of states providing Title X services. We talked about that last week with Claire Coleman, with NFPRHA. If you want to hear more about what is happening with the Title X network, go back and check out that episode if you haven't already. It is attacking who can access care. Defunding Planned Parenthood would also mean that people who are on Medicaid would no longer be able to go see Planned Parenthood as a provider. And this is huge. Not all providers accept Medicaid funds and Planned Parenthood does. And so, they play a really big role in making sure that people access sexual and reproductive health services when they're on Medicaid. And often that is people's only contact with the medical system. They often don't have a primary care provider, but they do go into Planned Parenthood and make sure that they're able to get family planning or sexual and reproductive health care. So, this would be really devastating if Planned Parenthood were to be defunded because they play a huge role in the social safety net. And we need to make sure that they are still able to provide services to all the people who need them. So, make sure to call your Congresspeople and let them know that you support Planned Parenthood and want to make sure that they continue to be funded. Also recently, the administration issued a Kemp-Kasten ruling saying that they are no longer going to fund the work of the United Nations Population Fund. This comes on top of all the grants that had been frozen due to basically the dismantling of the foreign aid system. And this is going to have devastating implications around the world. UNFPA plays really an important role in providing sexual and reproductive health service to people all around the world, particularly those in humanitarian settings where UNFPA is often the only people there providing those services. And just to read a little bit from UNFPA's release that they put out about this determination, just so you have a broader understanding of what this means: "This comes in addition to a termination notices UNFPA has already received for more than 40 existing humanitarian projects, amounting to some $335 million in funding. Following the abrupt termination of development assistance grants, this move will further add strain to the already stretched global public health system. It will cut essential support for millions of people living in humanitarian crises and for midwives preventing mothers from dying in childbirth, work that is a best buy in development, a cost-effective investment that generates positive returns over generations. UNFPA's decades-long partnership with the United States, a founding partner, has made the world safer, stronger, and more prosperous. Together, we have strengthened health systems, saved millions of lives, improved the economic prospects of families and communities worldwide. Over the past four years alone, with the U.S. government's lifesaving investments, we have prevented more than 17,000 maternal deaths, 9 million unintended pregnancies and nearly 3 million unsafe abortions by expanding access to voluntary family planning." It's going to be a huge loss, y'all. It is going to be a huge loss that UNFPA is going to have a hard time making up for that shortfall. That means people are not going to get access to life-saving services that they need, be that in humanitarian settings or in other settings. It's just further fueling this global crisis that the administration has kicked off by basically dismantling U.S. foreign assistance, which I guess takes me right into this week's interview because we're gonna talk a little bit about some the fallout we are seeing and how we got here for U.S. attacks on foreign assistance, particularly around reproductive health. And I could not think of a better person to have on to talk about that than Beth Schlachter with MSI. We're going to talk about basically how we got from Trump 1 to where we are now. What are some of the things that MSI is already seeing and what this is going to mean for things like maternal health and other ripple effects that we are going to see. So with that, let's go to my interview with Beth.

Jennie: Hi, Beth. Thank you so much for being here

Beth: Thanks, Jennie. I'm really pleased to be here today. Thank you for inviting me and for including MSI Reproductive Choices. We're thrilled.

Jennie: So excited to have you on. Before we dig into our conversation, would you like to take a second and introduce yourself and include your pronouns? Sure.

Beth: My name is Beth Schlachter. My pronouns are she/her. And I am the Senior Director for US and External Engagement for MSI Reproductive Choices. The organization is based in the UK and has service delivery programs in 36 countries around the world. Where we operate, we're the largest providers of reproductive healthcare, including contraception and abortion. So, really proud to be a part of this team. Going way back, I used to be a diplomat with the State Department. And one of my roles was as the Senior Advisor for what we then called population policy. So, I covered reproductive health as a foreign policy issue and managed our relationship with UNFPA, which meant that things that came up like U.S. legislation, Kemp-Kasten, global gag rule, defunding of UNFPA and the Helms Amendment—all those things were my policy issues as a State Department official. And I left there to become the Executive Director of FP 2020, FP 2020 for a number of years and then transitioned that to FP 2030. And then I also had a little stint with IPPF. So, I feel like I've had the glorious benefit of being in government, in a global partnership and then with some pretty amazing NGOs that have been global. So, I've gotten a view of things from multiple sides that I find I'm just very, I feel very fortunate to have.

Jennie: It feels like a lifetime ago that you were at State's apartment. Looking back, I was so early in my career at PI when I remember working with you at State.

Beth: It's definitely a world apart now in terms Especially, even the end of the Bush administration when I first started working on these issues was such a different environment than where we are now, which is pure chaos and cruelty, but we'll get into that.

Jennie: Yeah, and I thought it would be good, you know, often I do, like, a background on how we got to where we're at, and I was thinking we would start like... talking about what has happened since the new admin took office, but that doesn't feel quite right. Like, I think we need to step back further and go back to the first four years they were in office and talk about what they did then and how they used various sexual and reproductive health restrictions then and how that relates to what we're seeing now.

Beth: Yeah. I think Americans in particular—and global folks probably know this better than Americans do—[know] how reproductive rights as a foreign policy issue, as what had been a USAID priority investment, have been a political football, where we've used the bodies of women and girls and LGBTQI persons as a way of pulling and pushing power for decades now; since 1984, in particular, when Ronald Reagan first introduced the global gag rule. But it had been a sort of predictable kind of back and forth. Republicans come in, they defund UNFPA, and they apply the global gag rule. Democrats come back in, they reverse those things. And we kept trying to grow the investment past 2010. We really couldn't get anywhere with that. But it had just sort of this predictable, somewhat predictable kind of nature to it. And then that radically escalated under the first Trump administration. In a lot of ways, I guess what I'd ask our audience to hold in their minds as we talk today is both what happens in the U.S., what the U.S. funds and drives, and then what's also happening in other countries around the world, both for their own purposes and because there's this really extremist, right-wing, nationalist in many ways, anti-democratic sort of effort to use, again, the bodies of women, girls, and LGBTQI persons to create wedges in societies around the world and pull us apart. It worked very effectively in the United States. And one thing we're really great at is exporting things that we feel are cut from America that can be useful somewhere else. So a lot of U.S. effort was built up during that first Trump administration to create a sort of normalized framework around an anti-rights, anti-choice, anti-LGBTQI sort of worldview. And it took a little while to get there because, first of all, they never thought they were going to win. None of us thought they were going to win. Unfortunately, they did, and then they did again. But once they got their feet under them, they started using the tools of state to sort of push against progress and progressive values around the world. And I would start with Mike Pompeo, who was then the Secretary of State. And his first big move in this direction was to create something called the Commission on Unalienable Rights. And what that commission did was bring together a number of conservative academics, legal scholars, foreign policy experts, and those who are human rights experts to review the US posture on human rights. And this commission issued a report that said a lot of things, but for our purposes, it boiled down and said that the US posture on human rights was over-implementing, and that in fact, "God's law," or what they refer to as "natural law," supersedes human rights law, and that human rights needed to be recalibrated as a US foreign policy initiative beneath God's law, so that we would start to recalibrate our positioning at the Human Rights Council, from which we'd already withdrawn, and other bilateral and multilateral negotiations, ensuring that God's law was always our primary foreign policy objective. And then to implement this worldview, they created something called the Ministerial Conference on Freedom of Religion and Belief. And this brought together ministers from around the world, again at the State Department, hosted by Mike Pompeo. In a lot of ways, this is an issue where many people agree that there should be religious freedom around the world. But this conference, one of the primary objectives of it was also to ensure that they gave cover to anti-LGBTQI bigotry by saying that any religion should have the authority to determine how it receives, condemns, appreciates, does not allow for issues related to gender identity and sexuality. And so it gave cover to anti-LGBTQI bigotry under the guise of freedom of religion and belief. And then the last thing they did was to create something called the Geneva Consensus Declaration. And what this tried to do was to use, again, the pretense of UN frameworks to launch their own document that repositions reproductive rights under the Commission on Unalienable Rights sort of framework, saying that human rights, again, are secondary to God's law. And under God's law, the only appropriate relationships are heteronormative relationships There should not be sex outside of marriage. And there is certainly nothing called abortion. So, it's a very simple, clear document. It's a great public relations document in terms of spreading your message. And the US launched it in Geneva, which is where the Human Rights Council is, to give it this look of authenticity. And you could pretend that it actually sort of exists within a UN framework, right? And they convinced 36 countries to sign on to this Geneva Consensus Declaration. Then shortly after this happens, Trump loses. And so all of these things are still standing. The Freedom of Religion and Belief Conference happens again in the UK under the auspices of the UK government, some of them knowing it was going to happen in the framework that it did and others not. So that created its own dust up in the UK. But the people who had been working for the Trump administration to create these documents, particularly a woman named Valerie Huber, who had been in charge of global health from the Health and Human Services offices here in the United States, she continued to sell the Geneva Consensus Declaration even when Trump was out of power and in fact created her own health system framework that she convinced a number of governments to sign on to, including Honduras and Uganda, importantly, and basically saying, if Trump is out of power right now, but if he comes back in, we're coming back in with these frameworks, and one way you can show fealty to us is to continue your engagement with us and to sign on to this sort of Protego framework. So, a lot of this ended up in Project 2025. It was a continuation of that work where they articulated they were going to continue to do these things, and they have done that. What we've seen, though, by taking down all of USAID and pulling most of the money out, though, is really taking out the key part of that transaction that brings value, which is the cash. So, what we haven't seen yet is with this new skinny budget that the Trump administration has proposed and with this larger big budget that they're trying to work on, what money will be left for foreign assistance? How much of that will go to global health? And then again, how much will go to reproductive health? And what will be the framework of the deal that they offer countries? Because there's been such a profound damage caused by the defunding of USAID, where many governments were hugely dependent on U.S. foreign assistance for their own just day to day health systems. Again, you can argue whether that was right or wrong. It was what it was and should have been addressed in a very thoughtful, collaborative way, which of course is not what happened. So let's see what they come back with when they do come back in with whatever funding they may or may not come back with and see what sort of policy demands they make alongside funding agreements.

Jennie: Yeah, I remember all of this happening and particularly the Commission on Unalienable Rights because it was...shocking doesn't feel like the right word. Cause it shouldn't be surprising at all, any of the things they did. But I do remember just being really shocked when they came up with their hierarchy of, like, one, that there is a hierarchy in human rights, which there's not, but two, that at the top was religion and property rights.

Beth: Property rights, I didn't think of that one.

Jennie: Right? Like, religion wasn't, like, obviously I could see that one coming and the way they were going to interpret it and how that was going to attack all the other rights that we support, but the property rights one really threw me that they were going to actually argue that that came as one of the top.

Beth: Yeah, yeah. You know, who owns what, right?

Jennie: Right. Wild. So, that's a lot about what the previous Trump administration did and thinking ahead of what they were doing. But this anti-rights agenda you have talked about, we've really seen it spreading globally.

Beth: Absolutely.

Jennie: So, how are we seeing this play out kind of around the world right now?

Beth: Well, first, I want to point everybody to a couple of really great reports, one by a group called the European Parliamentary Forum, where the director, Neil Datta, has been tracking money flows for about 15 years now. And so, he goes way back and looking at not just money that comes from the U.S., but money that also comes from Europe and Russian oligarchs. And that's important because we've seen a real convergence of not just money, but also policy and groups that are willing to work together to advance the sort of anti-rights, anti-democratic framework. The way the U.S. has also contributed is groups like the ADF, who we know out of Arizona have been the real machine churning out the Dobbs scandal. sort of frameworks and all of the laws in the United States that make it more difficult bit by bit to get an abortion in the clinic, even where it is allowed. The ADF have been providing these sort of draft legal frameworks for countries around the world as well that codify anti-abortion perspectives and legislation that make it harder for people to get care and really limit things in the ways that they've been limited here in the United States. So, the U.S. contributes both money and thought and then just sort of advocacy effort as well and the real energy that comes from that and some of the ways that it's just easier as well to connect the dots from that side is that they often do so through international church and religious kinds of networks which have their own authority, moral authority in communities as well so when new policies are introduced and they start first with conversations that are based through church networks, they already have a pathway of trust and linkage to people's moral and emotional lives. So, it's a different pathway of introducing anti-rights legislation that's pretty effective. So, that's sort of one way that we've seen that happening, but there really has been this burgeoning both of authoritarianism in countries around the world, not just the ones we immediately think of in terms of Russia and Hungary and Turkey, but also places like the Philippines that have gone back and forth in terms of really extreme authoritarian behaviors, like with Duterte, who's now out of power. But this has been on the rise, and others are better at measuring that than I am. What we're seeing, though, is over and over that it's reproductive health and issues around sexuality that are often that wedge issue. They get in and help to drive people apart because it feels as if that organically is just something that people are resisting within their own communities because we have allowed this sort of shroud of shame around anything to do with women's bodies or with sexuality. So, it's been pretty easy pickings on their part in order to take these issues And then through a nationalized or international sort of process, bring them down to very local communities in ways that have been profoundly damaging.

Jennie: I'm just going to put a flag in for the audience when we're recording this on May 12th. But just to point out, as I was Coming online this morning, I saw that last night's episode of Last Week Tonight with John Oliver is talking about the Alliance Defending Freedom. So, I am very excited to go learn more about a group that I already know more than I would like about, but to see what all he has had to say, because I'm sure it's going to touch on a number of the issues that you brought up. But anyway, y'all make sure to check that out.

Beth: That sounds great.

Jennie: Yeah. So, we're just like seeing all of this coming together. And now with this withdrawal of U.S. funding, particularly in foreign assistance and seeing we've talked on the podcast before about how this is going to impact programs around the world. MSI has a lot of programs that were getting U.S. funding. Maybe we should turn a little bit and talk about some of the impacts that we are seeing or expect to see. And maybe one of the places to start right now is maternal health, because we are already starting to see some of those numbers. So, what are some of the impacts we're seeing on maternal health?

Beth: Yeah, so for MSI, we... I say only, but our funding from USAID was at $14 million when Trump came in. So, we were able to walk away from that money. I think on the third day of the Trump administration, when we saw the executive order around DEI and realized that they were going to push that into the system and make it so that the global gag rule was applicable much earlier than it had in previous iterations. So, we walked away from that money and were able to sort of make up that difference with our own resources, which means for us, we are one of the few NGOs that's fully operating in many countries. According to government data in Ethiopia, 85% of NGOs have stopped their programming in Ethiopia. That's a profound loss of services, right? And in Kenya, there have been 54,000 jobs lost in the health sector so far. According to my MSI colleagues who are still operating in countries, part of what they've said is that there's a bit of a tail to help people lose their jobs when the funding goes away. So, some of that loss is still playing out, and it'll be in the next three to six months where we see the real impact, what the actual impact has been. So, when you extrapolate from that—and it's really Guttmacher and others who've done some fabulous research on the data of what that's going to mean in terms of maternal health loss—right now, or in 2024, the US had allocated a little over $600 million for family planning, including 32 million for UNFPA. But on top of that, UNFPA had over $200 million because the Refugee Bureau had provided so much assistance in addition to that for humanitarian settings as well. So, not having that money will result in over 47 million women and girls losing access to contraception. And that means there's likely to be 17 million unintended pregnancies. And unfortunately, we know that when there are pregnancies, even with good health, it's still dangerous for people to be pregnant and to give birth. But in low-resource settings, it's even more dangerous. So unfortunately, we estimate that there will be 34,000 pregnancy-related deaths just per year from the loss of USAID funding. And another statistic that really stuck with me, Jenny, is that Every day, every single day without this assistance, over 130,000 women will lose their access to contraceptive services. So that's just, I mean, you can just imagine from there, that's 130,000 women or girls every day who then can't control whether or not they get pregnant, which ultimately means they can't control whether or not they stay in school, whether or not they are able to continue to function and keep their business, keep their families together. So, the cascade, that ripple effect, we've spent years talking about the sort of virtuous cycle of good created by access to reproductive healthcare and contraception. Now we have to imagine that virtuous cycle in reverse and the damage that it then causes as well. And just the real crisis and the real sadness is that these are gonna affect women and girls that you and I will never meet. And that our government took an obligation to, when we committed this funding, we committed to people, that the American people would stand with people in other countries who were struggling with so many factors to increase their livelihoods. And so, this is just a profound betrayal. We'll never be forgiven for this, and we don't deserve to be, quite frankly. So yeah, the maternal health impact is going to be profound. It already is.

Jennie: And it's one of those things, like, this has been a big global commitment for, I mean, honestly, I think almost my entire career that I've been working on reproductive health , maternal health has been part of it, and we had made such great globally to reduce the maternal mortality rate. You know, we hadn't seen it come up a little bit with COVID and other things, but this is going to be a major setback, not just on maternal health, but I can only imagine on any number of issues that we care about.

Beth: Yeah.

Jennie: Like, all of the Millennium Development Goals, the Sustainable Development Goals. I think we're just going to see huge steps back. I'm thinking about like the child marriage programs and how that's going to impact maternal mortality. I think that's also an important part to think about is: all of this is interconnected and will have impacts on other things. And you mentioned ripple effects. What else are you kind of thinking about?

Beth: There's legitimate criticism for the family planning reproductive health program at USAID over the decades that we can absolutely go into. But one of the really important things that they did was, and a lot of this was lessons that were learned during PEPFAR in the early days of trying to build up a program that was an emergency crisis program, but that brought a way of working to government systems that didn't align. It was square peg, round hole. So, PEPFAR spent a lot of time learning how to craft a program that worked on both sides. And a big piece of that was the data piece in terms of what is the data we need and what are the systems that governments need to gather in order to make data and scientific informed decisions, and then how to help work with governments to build up that system. So, a lot of what goes away are the things that most people aren't going to think about because we don't even think about it when we go to get healthcare in the UK or in the US or anywhere around the world is: who's measuring what and how does this actually affect decision-making? So, the folks who had worked on those systems, many of them got together and wrote a paper that was recently published in The Lancet just this last week on the discontinuing of USAID's global health program. And I'll just... rattle off a couple of the numbers that they just put out last week. Their numbers are based on the next 15 years. So, this is more of that ripple effect. And without the USAID Global Program, they estimate that 15 million, there will be 15 million additional AIDS-related deaths. So, it's 15 million families that are going to lose an important person who's no longer there: emotionally, financially, part of their community. Those people will no longer live, no longer be there. There'll be 2 million TB related deaths. There will be 7.9 million child deaths from other causes and 55 million additional unplanned pregnancies and all the other effects that we talked about a minute ago. So, this is a profound undermining of the stability of families, communities, and countries. And so, you know, one of the reasons like Congress was never in the business of appropriating global health assistance because You know, you could take that moment and feel good about it. But the reason that the U.S. government invested in it was because it was part of that three-pronged system of diplomacy, defense, and development. And we always, one of our biggest defenders of the development budget was the DOD, because they understood that the thing that drives people toward violent extremism anywhere in the world, whether it's Western Idaho or Somalia, is a loss of hope. And the most profound thing that drives hopelessness in families is the loss of a mother or the loss of a loved one. And so, the investment in global health was an investment in global stability. And we don't yet know. It's going to take time for that to play out, right? That doesn't happen overnight in terms of how that sort of plays out in people's lives. But the fact that Congress, who knows better, have allowed people this issue to be so profoundly politicized and they're so afraid to stand up to Trump that they're willing to fund the greatest moment of violent extremism ever to come from the US. And I say that after all of the other horrible things that we've done. In addition to many good things, I like to be even keeled on that, but this is just very bad for global stability and it's very bad for Americans' safety in the world. And as we saw with 9/11, we are not impervious to attacks from others who are unhappy with us for whatever reason. This is just a gift. So, it's just really the most short-sighted decision-making imaginable, especially from people who should or do know better.

Jennie: I think the other thing I think about hearing those numbers and thinking of all of the lives that are going to be impacted are already being impacted is something we try to talk about on the podcast when we talk about these issues, but I think the average person may not understand fully is: let's say a miracle happens and the administration sees that they're doing terrible things and decides to restart funding. So, all the programs magically come back and everything's fine, right?

Beth: [chuckles] Yeah. They thought they did that when they realized, you know, the U.S. had made a commitment when it came to HIV, right? Especially in Africa. It's a build-out of PEPFAR. And for folks who don't know, that's the President's Emergency Plan for AIDS Relief, mostly in Africa, but it also included Haiti, and I think Vietnam at one point. But it was the response to the global AIDS crisis in the early aughts, and it has saved millions and millions of people's lives. Our commitment until three months ago was that we were providing the antiretroviral drugs for over 20 million people. We pulled the plug on that, or let's say Elon Musk and his Doge boys pulled the plug on that. They said that when they found that out, they tried to turn it back on. But even now, when you talk to many of the providers of healthcare, that has not been turned back on. They said that they turned on lifesaving care. But they did not turn it on, again, for programs that prevent mother-to-child transmission for HIV. Our programs were actively supporting providing antiretroviral drugs to 40,000 women who were pregnant, who may have given birth by now, in Southern Africa alone. We stopped providing them antiretroviral drugs, and we never turned that back on. Doge decided that those lives were not worth saving, even though there was an active pregnancy. So, to have religious conservatives in the United States say that they're all about the baby, they're all about preserving life, and to do nothing, nothing to provide... healthcare to actually currently pregnant women who want to have these babies is just the most glaring hypocrisy that you could imagine. Plus, what's more evil than that? I can't think of something more cruel and more evil than that. And yet here we are.

Jennie: Yeah. And I just think about the people who went to access services and couldn't get services. They may never come back, even if the clinics can reopen because they don't trust them.

Beth: Exactly.

Jennie: So, it is not that simple as thinking funding could restart and things will get back to the way they were. Clinics may have closed. Physicians may have left. Nurses may have left. Like it is not just, as we talk about with global gag rule, it's not just flipping a switch and everything comes back. So much is lost and would have to be rebuilt so this is, like, damage that has been done and cannot easily be undone and the longer it goes the harder it will be to bring any of it back.

Beth: Absolutely, and you know it's so crazy just to look at those DOGE receipts and say that the only way that you calculate money saved is by programs turned off. What about all the money invested into building those programs and those very personal relationships that you just mentioned, Jennie? All of that is money and investment. But then that need doesn't go away. Just because you stopped paying a bill or you cut off a commitment to other people, that's not money saved. There's a cost on the other side of that. And I want to see the receipts for those and to know that we'll be gathering that information in the weeks and months and years ahead because the damage is just going to be so profound. Already is.

Jennie: Okay. So, we've talked a little bit about maternal health and some of the ripple effects that we are expecting to see or have already seen. What is MSI already seeing?

Beth: Yeah. It's pretty tricky out there. And I just talked about this with our regional director last week, and she said that we're still, again, some places, things are unfolding still. So the whole story isn't fully visible because there were still commodities in some places that are being spent down or being allocated. So, those commodity shortfalls haven't fully happened yet. So again, we're still a little bit early in that phase, but we are seeing that there is that sort of falling out of other partners at the local level. And that some partners are turning to MSI to shift over health care from clients as they can no longer serve. But there was a lot of chaos in the system as well in terms of what it all meant. Like, women in Uganda, there are reports that they immediately wanted to get their implants taken out because they thought that they were going to be illegal because suddenly USAID was no longer able to provide it. So, there was a lot of panic at the personal level and going to healthcare clinics, like you said, that were closed, feeling as if they were stuck with a commodity, feeling as if they were going to be in trouble. So, we've seen some of that. We also saw that or continue to see that USAID wasn't just money. A lot of the impact that they had was on training and quality of care services, things like the high impact practices, which codify the kinds of things you can do to have the highest impact and how to do those things carefully and thoughtfully and safely. USAID also convened a lot of the technical working groups between government and civil society implementers in countries. And what MSI is seeing is that a lot of those tech working groups no longer meet. And if they do go to a meeting, there's only one or two people there. So the system itself has ground to a halt in a lot of ways that are less about whether there's a commodity on the shelf or not, and more about that sort of quality kind of processes that are a little bit more behind the curtain that are gradually, incrementally increasing, or they were, program quality and reach of over time. So, a lot of that has gone away. And then there are a lot of conversations around the commodities themselves in some places where commodities are stuck in transit. I think there's like $35 million in commodities that were somewhere in the transit process of either stuck in ports or stuck. I think nothing's on the ocean anymore. It must certainly have gone somewhere by now. And then there were other contracts as well that were just cut off with the pharmaceutical providers and The last thing I'll say about that is there are a lot of the work that USAID and other partners, Gates Foundation, UK government as well, UNFPA, have done a lot of these compacts, SIF is another big player, to make volume guarantees to contraceptive product manufacturers. You don't make a lot of money. off contraceptives, particularly if you sell them at a really reduced rate in countries across Africa, Asia, and Latin America, right? So, they've gone in together in a consortium in a lot of ways to give volume guarantees so that the pharmaceutical producers would agree to maybe even build a new factory to produce more contraception. You can't grow contraceptive use if you don't have the products that people want. So that whole system is now under threat. What's going to happen if we no longer have the guarantees for purchase and production. Will that go away? Will implants, which have been the largest, they've seen the most rapid increase of any type of contraception across Africa, they've been very popular. What happens if you can't get more in? What happens if there isn't money for training about contraception? putting them in and then taking them back out again because women need to come on and off contraception over the course of their reproductive lives. So, it's this whole bigger system that's really facing a lot of damage too. And so, we're starting to see those threads, either stress on them or things that aren't working at all, like with contraceptives coming that USAID had paid for. And the last thing I'll say as well is that UNFPA Supplies, their program had a meeting last week as well, and they're facing an additional 30% increase reduction to the funding they have for commodities as well. Because remember, there's a lot of intermingled financing. So, when the US pulls out, every other country has to reprioritize what their investments are as well. And there's a lot of pressure in Europe to reduce overseas development assistance too. So, there's less money, there's more need, there's more pressure on all of that. And so, what we're seeing is really an internal collapse of the commodity system that had been dependent in Africa on donated commodities. Between USAID and UNFPA, I think at the high point, they were providing 70% of the contraceptives to go to Africa, and most of those were donated. So, what happens to your health budget, your health system, an organization like MSI, who is dependent on donated commodities in many countries, if those donated commodities are no longer there? So, a lot of those things have yet to play out.

Jennie: Yeah, and again, back to the patient level, right? The trust in your healthcare provider, but if you go to your provider and they don't have the method you want, or don't have any methods, or only have condoms, this becomes a problem of people not wanting to go back to that provider because they don't have what they need, maybe there's not alternatives, like, where people are going to turn to access for care.

Beth: That's right.

Jennie: And it becomes a real problem and it really, again, back to the trust in the system, it really breaks that trust between patients and providers. And when that trust is broken, it can be really hard to get back, and sometimes even impossible.

Beth: Yeah. Yeah, you know, we're seeing in Kenya, Nigeria, and Ethiopia, we've had reports that our outreach services to young people, remote communities, and key populations, and for folks who don't know what key populations are, they can often be folks that are... without resources that don't have financing. They can be LGBTQI persons. They can be sex workers, just folks who are most in need. So, we've seen that they've been paused or that they've had to scale back and that health facilities are having to switch from individual counseling sessions now to group counseling sessions. So just imagine if you went into a clinic and you needed counseling, but you had to do it with five other people that you might not even know, and that that's the best that people can offer.

Jennie: Or if you're a young person and, like, want to ensure privacy like that...

Beth: And you're embarrassed, or you don't know what to ask.

Jennie: Or your spouse is unsupportive or your partner's unsupportive, like, so many factors are hidden in that.

Beth: That's right, or we're operating on reduced hours or we're certain we're closing certain days of the week or not operating on weekends so like you said you know people show up to get health care and no one's there and then in Zambia we're working with community mobilizers who were trained through USAID funded projects to raise awareness about contraceptive through community level awareness campaigns. And as turnover happens, that means that there are fewer and fewer people who are trained to do that work. There's just no replacement. So, there's this immediate need and then there's this longer-term sort of system degradation that's definitely taking place.

Jennie: Okay, that's all really depressing. Let's turn to action, because I don't like to leave people on a sad note. Let's talk about how they can get involved. What can our audience do to take action to ensure that people are able to get this care?

Beth: Yeah, you know, one of the things, and I've spent more time in the last year since I've been with MSI talking to Americans than I ever have before, and it's really quite shocking how little Americans know about foreign affairs, much less that the U.S. invests in any of the things and why they invested in it. So, I think something that all of us can do is to not just talk to our immediate family and friends, but to make an effort to get out there and talk to more people. So, help them understand both why this was an important investment for the U.S. and what the damage is going to be when this doesn't happen, now that this money has gone away. So, each of us can make a commitment over some period of time to reach more people. I think people are really interested in this. They just don't know about it. So, I think that's one thing that we can all do. And just help others to connect these dots as well, that what we're seeing in terms of Elon Musk and the incredible sort of cesspool of what X has now become under Twitter. But that is the conversation that we're fighting against, and that's global. That's a really hard thing to accept. But understanding what's happening in the world, even though it's hard to look at, so that we can figure out what to do together, it's really important that all of us continue to track this, even though it's hard stuff to look at. And then what else can we do? just take care of your own mental health and well-being because those who've been working, like Grace, you and me and Jennie, you know, we're all values-driven folks, right? That's why we're in this sector, which means we take this moment very personally. It's really hard. And yet the only way we're going to come through it is in partnership with one another and in that sort of greater solidarity and realizing, as they did, that they played a long game and that rights... clearly are in flux around the world and that we have to gird ourselves as well. We were on that sort of long arc of progress, you know, bends towards justice kind of a thing. And I still believe in that, but clearly, it's a longer arc than many of us were emotionally prepared for. And so, I do think we have to accept that this is the work of many lifetimes. It's not going to be resolved in ours, certainly not in the United States and not in many other countries. And to mitigate the damage done by the United States in this moment and in the years to come, we're just gonna have to take care of ourselves and stay strong as a community. And in that sense, I think maybe we have to give each other a little more grace because this community has really high standards and we have a way of taking each other down on an individual and on an institutional level. And maybe we need to have a little bit more room because it's going to take all of us and many, many more in order to build whatever comes next, not to build back, but build whatever's next. So, I hope that we can be a little bit more open and gracious with one another as well, because there's a lot on us in that.

Jennie: Beth, thank you so much for being here. I had such a wonderful time talking to you about everything that's been going on.

Beth: Thanks, Jennie. It's a pleasure to be here and always so lovely to see you. So, thank you for inviting me.

Jennie: Okay, y'all. I hope you enjoyed my conversation with Beth. It was a really wonderful conversation to talk about all of the things that are happening right now and kind of how we got here by backtracking to the first Trump administration, which was a really important conversation to have. Next week, we will have our next in the series on abortion later in pregnancy. I'm really excited about it. We're going to be talking about a book that is coming out next month, Beyond Limits by Dr. Shelley Sella. And I am very excited for y'all to hear our conversation. Okay, with that, I will see everybody next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!