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    Trump administration eviscerates maternal and child health programs

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    Multiple maternal and child health programs have been eliminated or hollowed out as part of the Department of Health and Human Services (HHS) layoffs, prompting alarm and disbelief among advocates working to make Americans healthier.The fear and anxiety come as a full accounting of the cuts remains elusive. Federal health officials have released only broad descriptions of changes to be made, rather than a detailed accounting of the programs and departments being eviscerated.“Pediatricians, myself included, are losing sleep at night – worried about the health of the nation’s children,” said Dr Sue Kressly, president of the American Academy of Pediatrics.“The one that stands out to me is the Maternal and Child Health Bureau. There is no way to make our country healthier by eliminating expertise where it all starts, and it all starts at maternal and child health.”The health secretary, Robert F Kennedy Jr, announced HHS would eliminate 10,000 jobs as part of a restructuring plan. Together with cuts already made by Elon Musk’s unofficial “department of government efficiency”, HHS is likely to lose 20,000 workers – roughly one-quarter of its workforce.“We aren’t just reducing bureaucratic sprawl,” Kennedy said. “We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic.”Piecemeal and crowd-sourced information, which has filled the vacuum left by a lack of information from the health department, appears to show maternal health programs slated for elimination, many without an indication of whether they will be reassigned. The Guardian asked HHS to comment on the cuts but did not receive a response.The picture of cuts was further muddied on Thursday when Kennedy told reporters, according to Politico: “We’re going to do 80% cuts, but 20% of those are going to have to be reinstalled, because we’ll make mistakes.”In the aftermath of the height of the Covid-19 pandemic, there’s been much conservative criticism of public health agencies, particularly the Centers for Disease Control and Prevention (CDC). Pandemic policy continues to be an animating force within the Republican party, whose supporters are cynical about the value of federal public health programs following federal vaccine mandates.The cuts to maternal health programs may serve a second purpose for Republicans.Such programs have come under fire in some conservative states, in part because the experts involved investigate deaths that could have been prevented with abortion services – now illegal or severely restricted in nearly two dozen conservative states.As part of the restructuring, the administration announced 28 divisions would be folded into 15, including the creation of a new division, called the “Administration for a Healthy America”, or “AHA”.The administration argued the “centralization” would “improve coordination of health resources for low-income Americans and will focus on areas including, primary care, maternal and child Health, mental health, environmental health, HIV/Aids and workforce development”.Meanwhile, experts in HIV/Aids, worker health and safety, healthcare for society’s most vulnerable, and experts in maternal and child health have received “reduction in force” notices, a federal term for layoffs, or have been placed on administrative leave with the expectation of being eliminated.“It certainly appears there was a particular focus on parts of HHS that dealt with women’s or reproductive health,” said Sean Tipton, chief policy officer at the American Society for Reproductive Medicine, about the cuts.He added: “How in the world you can justify the CDC eliminating the division of maternal mortality is beyond me.”Among the divisions hard-hit was the Health Resources and Services Administration (HRSA), an operating division of HHS like the CDC, which housed the the Maternal and Child Health Bureau. HRSA lost as many as 600 workers.The CDC’s division of reproductive health, which studies maternal health, appeared to have been nearly eliminated, according to multiple reports, with some of the division’s portfolio also expected to be folded into AHA.skip past newsletter promotionafter newsletter promotionThe entire staff of a gold-standard maternal mortality survey, a program that was called the Pregnancy Risk Assessment Monitoring System, was also put on leave, Stat reported. The epidemiologist in charge of the CDC survey, Jennifer Bombard, wrote to colleagues on Tuesday: “[T]he entire CDC PRAMS team, including myself, has received the Reduction in Force (RIF) notice from HHS today.”A HRSA hotline that had fielded calls from new moms seeking mental health support was also cut, Stat reported. Layoffs at the Administration for Children and Families have jolted providers of federally backed high-quality childcare for low-income families, a program called Head Start.The CDC’s only experts on infertility were laid off, just days after Trump described himself as the “fertilization president” at an event marking Women’s History Month. The team had collected congressionally mandated statistics on fertility clinics’ success rates. Without the workers, it is unclear who at the department will help fertility clinics comply with the law.“I’m astounded, sad, perplexed,” said Barbara Collura, president of Resolve: The National Infertility Association. “Infertility impacts one in six people globally, and now we don’t have anybody at the CDC who knows anything about infertility and IVF?”A division of the CDC called the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention also appeared to be gutted, with the director Jonathan Mermin placed on administrative leave. Among the center’s many tasks, it worked to curb the spread of congenital syphilis, a debilitating disease that is on the rise in the US.The March of Dimes, an influential non-profit whose mission is to improve the health of mothers and babies, said the cuts “raise serious concerns” at a time when maternal mortality rates remain “alarmingly high”.“As an OB-GYN and public health leader, I can’t overstate the value these resources and programs – and our partners across CDC, HRSA, and NIH – have brought to families and frontline providers,” said Dr Amanda Williams, the interim chief medical Officer at the March of Dimes.“We rely on the data, research, clinical tools and partnerships built by the Division of Reproductive Health (DRH) and HRSA to protect maternal and infant health – especially in communities hit hardest.”Heads of National Institutes of Health (NIH) centers were also forced out – and, apparently, offered reassignment to the Indian Health Service to be stationed in Alaska, Montana or Oklahoma, the journal Nature reported. Such large-scale reassignments are unprecedented, according to Stat.Among those to be placed on leave was one of the federal government’s pre-eminent leaders of research, the director of the National Institute of Allergy and Infectious Diseases (NIAID) Dr Jeanne Marrazzo. Marrazzo had expertise in sexually transmitted infections and women’s reproductive tract infections – a background that gave health advocates hope of curbing the US’s sky-high STD rates. Dr Diana Bianchi, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, was also forced out.“These cuts are significant,” Kressly said. “And the policy and program changes that are made because the cuts impact real people in real communities, and I’m not just talking about the people who lost their jobs.” More

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      US health secretary on Alabama’s IVF ruling: ‘Pandora’s box was opened’ after fall of Roe

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      The health and human services secretary, Xavier Becerra, said the US must provide federal protections for reproductive rights if Americans hope to avoid further restrictions on in vitro fertilization, contraception and abortion in an exclusive interview with the Guardian.Becerra’s comments come in the wake of an Alabama supreme court decision that gave embryos the rights of “extrauterine children” and forced three of the state’s largest fertility clinics to stop services for fear of litigation and prosecution. The fallout from the decision prompted the Alabama legislature to hastily sign new legislation that will give IVF providers with immunity from civil and criminal suits, which the governor signed into law on Wednesday night.He said the events in Alabama were linked directly to the “take-down” of Roe v Wade, a decision that provided a constitutional right to abortion grounded in privacy and was overturned by conservative US supreme court justices in 2022.“It wasn’t until this new court came in” – that is, that three new supreme court justices were confirmed by former President Trump – “that we saw the attacks on Roe v Wade take hold, and today without Roe v Wade there are women who are trying to have babies in Alabama who are facing the consequences,” said Becerra.He continued: “None of this would be happening in Alabama on IVF if Roe v Wade was still the law of the land, and no one should try to deny that.”Becerra’s comments come ahead of Joe Biden addressing the nation in the State of the Union on Thursday night. Although the White House has not released the speech, a large number of Democratic guests suggest reproductive rights may feature heavily.Among the guests of high-ranking Democrats are Elizabeth Carr, the first person in the US to be born via IVF; Amanda Zurawski, a Texas woman who nearly died of septic shock when she was denied a medically necessary abortion; and Kate Cox, who had to flee Texas for an abortion after she learned her fetus had a fatal chromosomal condition.View image in fullscreenAlso, sitting alongside First Lady Jill Biden as a guest of the president will be Latorya Beasley, from Birmingham, Alabama.She and her husband had their first child, via IVF, in 2022. They were trying to have another child through IVF but Beasley’s embryo transfer was suddenly canceled because of the Alabama court decision.Beasley’s “recent experience is yet another example of how the overturning of Roe v Wade has disrupted access to reproductive health care for women and families across the country,” the White House said on Thursday.More guests include reproductive endocrinologists, an Indiana doctor who provided an abortion to a 10-year-old rape victim, and leaders of reproductive rights groups.Becerra’s comments emphasizing the importance of reproductive rights, Democrats’ guest list for the State of the Union and a recent administration officials’ trips to states with abortion restrictions are the most recent evidence of Democrat’s election bet: that when Republicans married the motivated minority of voters who support the anti-abortion movement, they also divorced themselves from the broader American public, broad margins of whom support IVF, contraception and legal abortion.“As a result of the fall of Roe v Wade – or actually the take-down of Roe v Wade – my daughters have fewer rights in America than their mom did,” said Becerra. “And that happens only when you have a supreme court that acts to overturn a constitutional protection.”While Becerra said his agency would continue to enforce federal laws in Alabama, including laws that provide medical patients a right to privacy and the right to stabilizing emergency care, including emergency abortions, it is ultimately the courts in and politicians of Alabama who need to fix the upheaval their policies caused.“The supreme court in Alabama is the one that has to undo its wrongful decision,” said Becerra. “The state legislature in Alabama should move to provide protections to families that rely on IVF – and serious comprehensive protections, not short-term, piecemeal protections that threaten anyone going through the process or any provider who wishes to provide quality IVF services.”Although Alabama politicians have passed a bill to give IVF providers immunity from civil and criminal suits, national associations of fertility doctors have said the law does not go far enough to address the core problem – the supreme court “conflating fertilized eggs with children”.“Clearly, this goes way beyond abortion,” said Becerra. “It would not surprise me if we also begin to see actions which undermine the ability of women to get basic family planning services,” including contraception.While doctors and patients have reacted with astonishment, anger and sorrow at the Alabama supreme court’s decision, the anti-abortion movement has cheered the decision. “Fetal personhood” has long been the ultimate aim of the movement.For years, Republicans have abetted this aim. As recently as 2023, 124 Republicans co-sponsored the federal Life at Conception Act, which would give embryos the rights of people “at the moment of fertilization, cloning, or other moment when the individual comes into being”. This week, Kentucky Republicans advanced a bill to allow people to claim fetuses as dependents on their taxes.They have also blocked federal legislation to protect IVF – twice. In late February, Senator Tammy Duckworth of Illinois introduced an IVF protection bill. Most recently, its expedited passage was blocked by Republican Senator Cindy Hyde-Smith of Mississippi (a state which, like Alabama, has a near-total abortion ban).Nevertheless, the Alabama decision has been palpably uncomfortable for many members of the party. Former president Donald Trump has said he supports IVF, and views anti-abortion policies as a threat to his campaign. Republicans such as Tommy Tuberville of Alabama and Joni Ernst of Iowa have issued awkward, noncommittal statements about the decision. Ernst supported federal fetal personhood statutes in the past.“When Roe v Wade was struck down by the Dobbs decision the Pandora’s box was opened,” said Becerra. “Now, we see the consequences and how far the loss the protections of Roe go beyond abortion.” More

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      ‘We did it in cattle’: Alabama Republicans’ bungled response to IVF patients

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      On Wednesday morning, some 200 Alabama in vitro fertilization (IVF) patients, doctors and advocates descended on the Alabama state house. Wearing orange and pink shirts for infertility awareness, they carried a variety of handmade signs: “You can’t cuddle an embryo”. “I just want to be a mom”.For these people and thousands of others in the state, the last two weeks have been tumultuous.Following the Alabama supreme court’s recent ruling that frozen embryos are considered “children”, IVF clinics in the state have paused their services, leaving people who were in the process of treatment in limbo. Embryo shipping companies have also stopped servicing the state, which means that patients who want to transfer their frozen embryos out of Alabama are unable to do so.The rally concluded with some direct conversations between advocates and lawmakers. In one such interaction, the Republican state representative Ben Harrison told families that a “solution” would be to freeze the sperm and egg separately, instead of freezing embryos, likening the former procedure to a process used on cows.“My personal opinion is that we keep them apart and only bring them together for what you need and what you’re willing to implant,” Harrison said. “We did it in cattle all the time.”The interaction pointed to the disconnect between families who are undergoing the IVF process, doctors who provide IVF services and lawmakers who may not understand the intricacies of and science behind IVF, but who ultimately can decide whether or not it remains legal.Dr Mamie McLean of Alabama Fertility in Birmingham has become one of the most vocal opponents of the supreme court decision. Flanked by other doctors and IVF patients, she spoke to those attending the rally before they headed into the state house.“As an infertility physician, I am used to difficult conversations, but these last two weeks have been absolutely heartbreaking,” she said. “Due to the uncertainty posed by the supreme court ruling, we have had to cancel embryo transfers for patients who are longing and praying for a child. We call on the state of Alabama to provide immediate, complete and permanent access to IVF care for the women and families of Alabama.”Resolve, the national infertility group that helped organize the rally, provided pamphlets and advised attendees on how to speak to legislators. “What happens here today in these offices will be looked at by the rest of the country,” said Barbara Collura, the group’s president and CEO. “This potentially could be a roadmap for other states to restrict access to IVF or a roadmap for how to protect access to IVF and family building. Please use your voice.”Collura said that some desperate families were leaving the state for treatment.“You’re on these medications for weeks and they cost a lot of money. It’s not covered by insurance for most of these people,” she said of the drugs used during IVF treatment. “You can’t just stop and start up next week, plus we don’t know when this will get fixed.”‘It could end my journey’Elizabeth Goldman, who stood with McLean and other advocates during the rally, was diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome when she was 14. The rare disorder means that she was born without a uterus; doctors told her she would never be able to carry her own child. When the University of Alabama launched a uterus transplant program in 2020, Goldman applied, moving with her husband from Mobile to Birmingham (near the school’s campus) in the hope of being able to have a child. After receiving the uterus transplant and undergoing several rounds of IVF treatment and transfers, Goldman was able to conceive. Her daughter, who was with her at the rally, was born in October 2023.Transplant patients are able to keep the uterus for just one or two deliveries, because of the volatility of a foreign organ, Goldman said. She estimates that she has taken about 20,000 pills since her transplant 22 months ago to keep her body from rejecting the uterus.Her medical team cleared her to carry a second child, and had planned to proceed with her transfer this March. But the supreme court decision has put that at a standstill. Goldman was on her way to a transfer appointment when she found out through a notification that her clinic had closed.“With all of the transplant meds I take, it can start to cause kidney damage and other health problems,” she said. “It’s not a life-saving transplant, but a life-giving transplant. So basically, right now I’m healthy. My kidneys are good. But if it continues to drag on, it could end my journey.”Jamie Heard and Deidra Smith drove to the rally from Birmingham hoping to speak to legislators face to face. Heard used IVF to give birth to her now two-year-old son. She had already started her cycle for a second child when the news of the supreme court’s decision broke. Her clinic cancelled her appointments in the middle of treatment.“It was heartbreaking,” Heard said. “The emotions for the past few days – I feel like I’ve been grieving a loved one, that’s how heavy my emotions have been.”Brittany Pettaway and her husband Byron, of Montgomery, currently have eight frozen embryos. She said that this was their only chance of becoming parents. They attended the rally hoping that legislators would make things go “back to literally how it was two weeks ago”.“We’re just trying to protect that right, and what should be a natural, God-given ability to do,” she said. “It’s surreal, I feel like I’m waiting for someone to say it was a joke, a really horrible emotional nightmare.”‘I don’t know what the answer is’After the rally ended, advocates queued outside to make their way into the state house to speak to legislators directly. The floors with offices for senators and representatives were full of people dressed in orange and pink.Outside one office, a group of families engaged the Alabama state auditor, Andrew Sorrell, in a conversation about their struggles. As auditor, Sorrell reports the state’s receipts, claims and payments, taxes and revenues to the governor.“I don’t know exactly what the answer is, but we’ve got to find some way to protect the IVF industry while also maintaining our pro-life stance,” he said.Sorrell suggested women only make as many embryos as they want to use. The advocates explained “the numbers game”, in which a family may produce dozens of eggs, but ultimately only have one or two viable, healthy embryos. Sorrell also suggested the state pay to make it easier for people to adopt frozen embryos.Following the near immediate backlash to the court’s decision, Republicans across the country initially were mum on the issue. But as clinics across Alabama began to close, they turned heel, speaking out in support of IVF. Alabama’s attorney general promised not to prosecute IVF clinics or patients, while the former president Trump also spoke in support of the procedure. On Wednesday, several bills that would preserve IVF moved forward in the Alabama legislature. One bill, which will progress to the Alabama senate after it received a vote of 94-6 on Thursday, would protect clinics from lawsuits.But there is no comprehensive solution to preserving IVF in the state and, in the meantime, patients and families, even those mid-treatment, are left waiting. More

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      Senate Democrats to force vote on protecting IVF access across the US

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      Senate Democrats are moving to push through a bill that would protect Americans’ access to in vitro fertilization (IVF) treatment, after an Alabama supreme court ruling that frozen embryos are children led to the closure of a number of infertility clinics in the state.The Democratic Illinois senator Tammy Duckworth said she would try to force a vote on the legislation on Wednesday which would establish a federal right to IVF and other fertility treatments that are at risk in the post-Roe era. Duckworth’s two children were conceived through IVF.“I’m headed to the Senate floor to call on my colleagues to pass via unanimous consent my Access to Family Building Act, which would ensure that every American’s right to become a parent via treatments like IVF is fully protected, regardless of what state they live in – guaranteeing that no hopeful parent or doctor is punished,” Duckworth said at a news conference on Tuesday.Duckworth’s move comes as Democrats vow to make IVF a campaign issue as they look to squeeze Republicans and highlight the continuing fallout of the overturning of Roe v Wade.“I warned that red states would come for IVF. Now they have. But they aren’t going to stop in Alabama. Mark my words: if we don’t act now, it will only get worse,” Duckworth added.The bill would require unanimous consent in order for it to pass, meaning that any one senator can block its passage. Senator Richard Blumenthal, a Connecticut Democrat, said it was unlikely to receive unanimous consent from the chamber to rush the bill through.skip past newsletter promotionafter newsletter promotionWhile many Republican lawmakers registered disappointment over the Alabama ruling, at least one conservative senator was expected to object.Blumenthal said Democrats would not be deterred. He would not say what the next legislative steps would be, but he said Democrats, who control the Senate, would look for other ways to protect IVF and reproductive healthcare.“The IVF dilemma for Republicans is they are down a path that is not only unpopular, it’s untenable as a matter of constitutional law and basic moral imperative, and we’re going to pursue it vigorously,” Blumenthal said.“Today’s vote, the effort to seek a unanimous consent, we know is unlikely to be successful. Failing today is only the prelude to a fight ahead on women’s reproductive care centered on IVF and other steps that have to be taken to protect basic rights.” More

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      Florida delays ‘fetal personhood’ bill after fallout from Alabama IVF ruling

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      Florida lawmakers have postponed a bill that would give fetuses civil rights after a similar ruling in Alabama has halted in vitro fertilization treatment at several clinics in the state.The “fetal personhood” bill had been gaining support amid Florida’s mostly Republican lawmakers. The legislation attempts to define a fetus as an “unborn child”, allowing parents to collect financial damages in the case of wrongful death, the Tampa Bay Times reported.But the bill has largely stalled after Democrats argued that the legislation could affect in vitro fertilization (IVF) treatments, as seen in Alabama after the state’s supreme court ruled earlier this month that embryos created through IVF are considered “extrauterine children”. Since the ruling, several Alabama IVF clinics have paused services.The Florida state representative Dotie Joseph, a Democrat, told the Washington Post that the bill’s language did not protect IVF treatment from being affected.“We are exposing the healthcare provider to liability if something goes wrong,” Joseph said. “You have a situation where you are creating a chilling effect for people who are proactively trying to have a baby.”Florida Democrats have also warned that the new law could further affect abortion access, as fetuses gain additional civil rights rights under law.The Republican state senator Erin Grall, who sponsored the bill, said in a statement that she requested the legislation be postponed amid concerns.“Although I have worked diligently to respond to questions and concerns, I understand there is still work that needs to be done,” Grall said, the Bay Times reported. “It is important we get the policy right with an issue of this significance.”Other co-sponsors of the bill, such as the Republican state representative Jenna Persons-Mulicka, have reiterated that the bill is about the “value of the life of an unborn child”, the Post reported.It is unlikely that the bill will be passed in the current legislative session, which ends on 8 March, the Post reported.Following the Alabama ruling, other states have weighed similar bills that would grant fetuses rights, NBC News reported.At least 14 states legislatures have introduced similar “fetal personhood” bills, NBC reported, citing data from the Center for Reproductive Rights and the Guttmacher Institute. The surge is the largest increase of such bills since the overturning of Roe v Wade in 2022. More

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      Why are there so few Black sperm donors in the US? – podcast

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      When Angela Stepancic decided to have a baby with her wife, the couple were full of hope. Her partner was keen to carry their child, so the pair began looking for potential sperm donors to help them conceive. But they soon hit a problem: at the four main cryobanks in the US, there were only a dozen Black sperm donors. The reporter and assistant professor of journalism Lisa Armstrong explains to Hannah Moore that Black women in the US are twice as likely to face infertility, and half as likely to seek help for it. The lack of donors is one more barrier Black people can face when trying to start a family. There is too little research into the reasons for the shortage, explains Armstrong, but a complicated application system and invasive questioning are thought to be part of the problem, as well as a history of systematic racism. In the end, says Stepancic, she was so frustrated by the lack of black donors and the industry’s lacklustre attempts to combat it that she set up her own cryobank for Black, Brown and Indigenous people. She realised, she says, that ‘we need to do this for ourselves’. More