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    Give birth? In this economy? US women scoff at Trump’s meager ‘baby bonuses’

    In theory, Savannah Downing would love to be a mom. At 24, the Texan actor and content creator is nearing the age at which her mother had kids. Some of her friends are starting families. But having children in the United States is wildly expensive – and so when she saw the news that the Trump administration was considering giving out $5,000 “baby bonuses” to convince women to have kids, Downing was incensed.“Maybe people will want to have children more often if we weren’t struggling to find jobs, struggling to pay our student loans, struggling to pay for food,” she said. “Five thousand dollars doesn’t even begin to even cover childcare for one month. It just seems really ridiculous.”Trump officials have made no secret of their desire to make America procreate again. In his very first address as vice-president, JD Vance said at the anti-abortion March for Life: “I want more babies in the United States of America.” Weeks later, a Department of Transportation memo directed the agency to focus on projects that “give preference to communities with marriage and birth rates higher than the national average”. Then, in late April, the New York Times reported that the administration was brainstorming policies to encourage people to get married and have kids, such as giving out those baby bonuses or awarding medals to women who have at least six children.All of these moves are evidence of the growing power of the pronatalist movement within US politics. This movement, which has won adherents among both traditional “family values” conservatives and tech-bro rightwingers such as Elon Musk, considers the falling US birthrate to be an existential threat to the country’s future and thus holds that the US government should enact policies designed to incentivize people to give birth.But many of the women who are, in theory, the targets of the pronatalist pitch have just one response: Have babies? In this economy?After the New York Times report broke, social media exploded with indignation at the proposed policies’ inadequacy. “Go ahead and tell Uncle Sam what he needs to give you to make him Daddy Sam,” a woman rasped at the camera in one TikTok with nearly 1m likes. “Universal – ?” she started to say, in a presumable reference to universal healthcare. “No. No. Where did you even hear that?”“Five thousand? That doesn’t go very far!” one 24-year-old stay-at-home mother of four complained in another TikTok, as her children babbled in the background. “It costs 200, 300 bucks just to buy a car seat for these kids. I just feel like it’s really just insulting. If you want people to have more kids, make housing more affordable. Make food more affordable.”Although the cost of raising a child in the US varies greatly depending on factors such as geography, income level and family structure, a middle-class family with dual incomes can expect to spend somewhere between $285,000 and $311,000 raising a child born in 2015, a 2022 analysis by the Brookings Institute found. That analysis doesn’t factor in the price of college tuition, which also varies but, as of last year, cost about $11,600 a year at an in-state, public university.The cost of merely giving birth is more expensive in the US than in almost any other country on the planet. An uncomplicated birth covered by private insurance. which is basically the best-case scenario for US parents, tends to cost about $3,000, according to Abigail Leonard’s new book Four Mothers.Paige Connell, a 35-year-old working mom of four who regularly posts online about motherhood, had a long list of pro-family policies she would like to see adopted. For example: lowering the cost of childcare, which runs to about $70,000 a year for Connell’s family. (An April Trump administration memo proposed eliminating Head Start, which helps low-income families obtain childcare, although the administration appears to have recently reversed course.) Or: preserving the Department of Education, as Connell has children in public school and some of them rely on specialized education plans. (Trump has signed an executive order aiming to dismantle the department, in an apparent attempt to get around the fact that only Congress can close federal departments.)“They want to incentivize people to have children. I don’t think they have a real stake in helping people raise them,” Connell said of the Trump administration. “Many women that I know – women and men – do want more kids. They actually want to have more children. They simply can’t afford it.”Lyman Stone, a demographer who in 2024 established the pronatalism initiative at the right-leaning Institute for Family Studies, argued in an interview last year that “most of missing babies in our society are first and second births” – that is, that people avoid having a second child or having kids at all. Pronatalism, he said, should focus on helping those people decide otherwise.“The misconception is this idea that pronatalism is about tradwives and giant families, when it’s really about, on some level, helping the girl boss, like, girl boss in her family life a little bit earlier and harder,” Stone said.Some Americans may indeed be having fewer children than they would like. Among adults under 50 who say they are unlikely to have children, close to 40% say that they are not doing so due to “concerns about the state of the world” or because they “can’t afford to raise a child”, according to a 2024 Pew survey. A 2025 Harris poll for the Guardian found that the state of the economy has negatively affected 65% of Americans’ plans to have a child.But to say that pronatalism is about helping the “girl boss” have one or two kids is not quite accurate, given that several prominent pronatalists are deeply interested in producing “giant families”. Malcolm and Simone Collins, who have become the avatars of the tech-right wing of pronatalism, have at least four children and show no signs of slowing down. (The Collinses were behind the medal idea reported by the Times; they called it a “National Medal of Motherhood”.) Musk, perhaps the most famous pronatalist on the planet, reportedly runs something of a harem and is believed to have fathered 14 children.Republicans are also currently exploring policies that would entice more parents to stay at home with their children, the New York Times reported on Monday, such as expanding the child tax credit from $2,000 to $5,000. While these potential policies do not specify which parent would stay at home, four out of five stay-at-home parents are moms.However, this goal is seemingly at odds with Republicans’ desire to slash the US budget by more than $1.5tn. Indeed, Republicans have proposed dramatically curtailing Medicaid – a proposal that would appear to hinder the pronatalism agenda, because Medicaid pays for more than 40% of all US births.skip past newsletter promotionafter newsletter promotionPronatalism has long been intertwined with racism, eugenics and authoritarian governments. Nazi Germany and the Stalinist Soviet Union gave out medals to women who had large numbers of children, while in the United States, interest in pronatalism has historically surged in eras, such as the early 20th century, when women and immigrants were trying to participate more in public life. Today, fears about the consequences of the near record low US birthrate are often tied to concerns about the country’s shrinking workforce. Immigration could help alleviate those concerns, but the Trump administration is deeply opposed to it.All this leads to a fundamental question: do pronatalists want everybody to have children – or just some types of people?“What I’ve seen online of the pronatalist movement, it does seem very aligned with white supremacy, because it does seem like a lot of the conversation around it is more geared towards white couples having more babies,” said Madison Block, a product marketing manager and writer who lives in New York. She’s also leery of the Trump administration’s focus on autism, which could translate into ableism: “A lot of the conversations around pronatalism, in addition to being borderline white supremacist, I think are also very ableist.”Now that she’s 28, Block said that many of her friends were starting to get married and consider having babies. But Block is afraid to do so under the current administration. And when she thinks about potentially starting a family, affordable healthcare is non-negotiable.“I personally wouldn’t want to have kids unless I know for a fact that I am financially stable enough, that I can provide them with an even better childhood than what I have,” Block said. “I think, for a lot of younger millennials and gen Z, a lot of us are not at that point yet.”View image in fullscreenPerhaps the ultimate irony of the Trump administration’s pronatalist push is that it is not clear what pronatalist policies, if any, actually induce people into becoming parents.In past years, Hungary has poured 5% of its national GDP into boosting births, such as through exempting women who have four children or more children from paying taxes. This herculean effort has not worked: as of 2023, the country’s birth rate has hovered at 1.6, well below the replacement rate of 2.1. (For a country to maintain its population, women must have about two children each.) More left-leaning countries, such as those in Scandinavia, have also embarked on extensive government programs to make it easier for women to have kids and maintain careers – yet their birth rates also remain lower than the replacement rate and, in the case of Sweden, even dropped.It may be the case that, when access to technologies like birth control give people more choices over when and how to have children, they may simply choose to have fewer children. In that 2024 Pew survey, nearly 60% of respondents said that they were unlikely to have kids because they “just don’t want to”.Downing is not that concerned about pronatalism taking root among the general public. Personally, she doesn’t feel like there’s too much governmental pressure on her to have kids, particularly since she is Black and much of the pronatalism movement seems focused on pushing white women to have babies.“I feel like a lot of women are fed up. I think that’s why the birth rate is going down,” she said. “Women are realizing that they’re more than just birthing machines.”But images from The Handmaid’s Tale – the red capes, the white bonnets – haunt her.“I think $5,000 and a medal trying to coax women into having more kids is a start,” she said, “and I really am worried to see how far they will go to try to force women and have children”. More

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    Trump news at a glance: military to immediately remove trans troops and use medical records to oust more

    “No More Trans @ DoD,” Pete Hegseth, the US defense secretary, posted after the supreme court allowed the Trump administration’s ousting of transgender troops to go forward. As of Thursday, the orders have been issued to identify and involuntarily force trans people out of service.Department officials have said it is difficult to determine exactly how many transgender service members there are, but medical records will show those who have been diagnosed with gender dysphoria, show symptoms or are being treated. Those troops would then be forced out.Separately, Britain has become the first country to strike a trade agreement with Donald Trump since his announcement of global tariffs on what he called “liberation day”.Here are the key stories at a glance:Up to 1,000 trans troops to be removed The Pentagon will immediately begin moving as many as 1,000 service members who identify as transgender out of the military and give others 30 days to self-identify, under a new directive issued on Thursday.Buoyed up by Tuesday’s supreme court decision allowing the Trump administration to enforce a ban on transgender individuals in the military, the defense department will then begin going through medical records to identify others who have not come forward.Read the full storyUS and UK agree ‘breakthrough’ trade dealThe UK and US have agreed a “breakthrough” trade agreement slashing some of Donald Trump’s tariffs on cars, aluminium and steel. The UK prime minister said the deal would save thousands of British jobs.Keir Starmer said it was a “fantastic, historic day” as he announced the agreement, the first by the White House since Trump announced sweeping global tariffs last month.Read the full storyVance says Kashmir crisis ‘none of our business’JD Vance has said that the US will not intervene in the conflict between Pakistan and India, calling fighting between the two nuclear powers “fundamentally none of our business”.The remarks came during an interview with Fox News, where the US vice-president said that the US would seek to de-escalate the conflict but could force neither side to “lay down their arms”.“Our hope and our expectation is that this is not going to spiral into a broader regional war or, God forbid, a nuclear conflict,” Vance said. “Right now, we don’t think that’s going to happen.”Read the full storyTrump names Fox host to replace pick for DC’s top prosecutorDonald Trump on Thursday said he would look for a new candidate for the role of top federal prosecutor in Washington DC, after a key Republican senator said he would not support the loyalist initially selected for the job.He then named Fox News host and former judge Jeanine Pirro for the job.Read the full storyUS House approves Trump’s renaming of Gulf of MexicoRepublicans in the House of Representatives on Thursday approved legislation to codify Donald Trump’s policy of renaming the Gulf of Mexico to the “Gulf of America”. The measure was sponsored by rightwing Georgia lawmaker Marjorie Taylor Greene and passed nearly along party lines, with all Democrats opposed and almost every Republican, with the exception of Nebraska representative Don Bacon, voting in favour.Read the full storyTrump invokes state secrets in case of wrongly deported manThe Trump administration is invoking the “state secrets privilege” in an apparent attempt to avoid answering a judge’s questions about its erroneous deportation of Kilmar Ábrego García to El Salvador.Read the full storyWhat else happened today:

    Trump’s top trade adviser Peter Navarro told reporters that British consumers will like chicken and beef imported from the US despite the use of chlorine and hormones. “Let’s see what the market decides,” Navarro said, adding: “We don’t believe that once they taste American beef and chicken that they would prefer not to have it.”

    The National Oceanic and Atmospheric Administration (Noaa) will no longer track the cost of climate crisis-fuelled weather disasters, including floods, heatwaves, wildfires and more. It is the latest example of changes to the agency and the Trump administration limiting federal government resources on climate change.
    Catching up? Here’s what happened on 7 May. More

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    Vance says Russia asking ‘too much’ in ceasefire talks with Ukraine

    JD Vance has said that Russia is asking for “too much” in its negotiations with Ukraine in the latest sign of growing frustration from Washington with ceasefire talks to end the war between the two countries.Speaking at a security conference of senior military and diplomatic leaders in Washington, the US vice-president said that the White House is focused on getting the two sides to hold direct talks and is ready to walk away if certain benchmarks are not reached.“I wouldn’t say that the Russians are uninterested in bringing this thing to a resolution,” Vance said during an onstage interview with the Munich security council president, Wolfgang Ischinger.“What I would say is, right now, the Russians are asking for a certain set of requirements, a certain set of concessions in order to end the conflict. We think they’re asking for too much. OK?”Asked about those comments later on Wednesday, Donald Trump said: “It’s possible that’s right.”“We are getting to a point where some decisions are going to have to be made,” said the US president. “I’m not happy about it … I’m not happy about it.”Senior administration officials, including Vance and the US secretary of state, Marco Rubio, are said to be growing more frustrated over Russia’s inflexibility in discussions to end the war. Steve Witkoff, Trump’s envoy, has held four rounds of direct talks with Putin, but those have not yielded concrete concessions from the Russian side.During his remarks, Vance reiterated the threat that the White House would “walk away if [Trump] thinks he’s not making progress”.“In particular, the step that we would like to make right now is we would like both the Russians and the Ukrainians to actually agree on some basic guidelines for sitting down and talking to one another,” he said. “Obviously, the United States is happy to participate in those conversations, but it’s very important for the Russians and the Ukrainians to start talking to one another. We think that is the next big step that we would like to take.”After meeting with Volodymyr Zelenskyy at the Vatican last month, Trump threatened Russia with secondary sanctions over the continued bombardments of Kyiv and other major Ukrainian cities despite talks to reach a permanent ceasefire.“There was no reason for Putin to be shooting missiles into civilian areas, cities and towns, over the last few days,” Trump wrote then. “It makes me think that maybe he doesn’t want to stop the war, he’s just tapping me along, and has to be dealt with differently.”Senior Russian officials have maintained a hardline position, demanding both a rollback of Nato as well as limits on Ukraine’s security and a degree of control over its internal politics.“Marco Rubio expressed yesterday, I think, also the assessment that they had the American team now is getting a better understanding of the Russian position and of the root causes of this situation,” said Sergei Lavrov, the foreign minister, during an interview on Meet the Press last week. “One of this root causes, apart from Nato and creation of direct military threats to Russia just on our borders, another one is the rights of the national minorities in Ukraine.”Joe Biden in his first interview since leaving office accused Trump of “modern-day appeasement”, saying the expectations that Ukraine ceding territory to Russia would end the war was “foolish”. More

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    ‘The universities are the enemy’: why the right detests the American campus | Lauren Lassabe Shepherd

    In 2021, JD Vance, then a candidate for Ohio senate, gave a provocative keynote address at the National Conservatism Conference. Vance’s lecture was an indictment of American higher education: a “hostile institution” that “gives credibility to some of the most ridiculous ideas that exist in this country”. The aspiring politician did not mince words before his receptive rightwing audience: “If any of us wants to do the things we want to do … We have to honestly and aggressively attack the universities.” The title of Vance’s keynote was inspired by a quote from Richard Nixon: “The universities are the enemy.”The Maga movement, of which Vance, the vice-president, is now at the forefront, has been unabashedly on the attack against campuses, professors and students. Donald Trump characterizes colleges as “dominated by Marxist maniacs and lunatics”, and student protesters as “radicals”, “savages” and “jihadists” who have been indoctrinated by faculty “communists and terrorists”. He has already delivered swift vengeance against campus protesters and non-protesters alike with visa terminations and deportations. This administration has gleefully withheld hundreds of millions of dollars in federal funding to force colleges to crack down on student dissent.While Vance paid homage to Nixon and other forebears on the right, he failed to acknowledge that his political lineage had been fighting the university as an enemy for more than 100 years. In fact, reactionary backlash is a feature of two main milestones in the academy’s history: the democratization of admissions and the diversification of curriculum. Trump and Vance’s attacks are part of a longer history of rightwing backlash that follows each time college becomes more democratic.Before the universities were the enemyFor the first 300 years of US higher education, starting with the founding of Harvard College in the 1630s, the academy was a realm exclusive to the Christian elite. Only an extreme few attended the colonial and antebellum colleges, which were meant as sectarian educational clubs for the sons of the landed gentry. Boys of the Protestant ruling class attended college to socialize, form lifelong friendships and business partnerships, and even link their families legally through intermarriage of their sisters. Young men were exposed to the liberal arts and Christian theology, to be sure, but college was just as much a place to meet other boys like themselves and to be steeped in the cultural norms of their religious denomination and social class. This three-century tradition has been slow to change, and when it has, colleges have met fierce opposition from those who have benefited from the status quo.Throughout this time, the only people of color or women who appeared on campus were the wives and daughters of the faculty, maids, cooks, laundry workers, servants and enslaved people. By the 1830s and through the end of the century, segregated colleges were established for white women, and free men of color (until the founding of Bennett College and Spelman College, women of color had to “pass” as white to attend women’s colleges), but these institutions were not meant to rival or even resemble the standard colleges. The curriculums were vastly different from the liberal arts instruction of Harvard and Princeton – for girls, lessons were about homemaking and Christian motherhood; for children and adults of color, the practical vocations. Still, college-going by anyone was a privilege. Even at the turn of the 20th century, less than 5% of Americans went to college, and many fewer completed a degree.Backlash against who gets inThe right’s first rumblings about the college as enemy occurred during the 20th century, as the nature of the campus began to change for the modern era. The right’s grievance at the time was focused on who was admitted. By the 1920s, European immigrant students were starting to matriculate in east coast campuses, particularly in New York and Pennsylvania. The oldest and most prestigious colleges, such as Harvard, Yale and Princeton, sought to severely limit enrollment of the “socially undesirable”, especially Jews, to preserve the campus for old-stock Protestants. A combination of antisemitism and reactionary backlash to the era’s progressivism led rightwingers to cast a suspicious eye on the campus, where all of the decade’s new social science seemed to be emanating. Christian fundamentalists, terrified by the science of evolution, also decried the sinister academic classroom.By the 1930s, wealthy industrialists joined the chorus of college skeptics. The Franklin Roosevelt administration had assembled its famous “brain trust” of academics whose calculus was needed to pull the nation out of the Great Depression. But industry titans who refused to tolerate Roosevelt’s planned economy responded by creating free-market thinktanks such as the American Enterprise Institute (AEI) that produced rival economic white papers in defense of capitalism. Academic departments, AEI’s existence proved, were not the only place where experts could create knowledge. In fact, the right’s thinktanks would become their signature tool for churning out partisan disinformation such as climate crisis denial and race pseudoscience throughout the 20th century.By the time the second world war ended, Congress needed a way to ensure a smooth economic transition as a mass of veterans returned to the job market. The Servicemen’s Readjustment Act of 1944, AKA the GI Bill, allowed more than 1 million returning soldiers to delay workforce re-entry by a few years as they entered the classroom. To the horror of many free-marketeers and social elites, the GI Bill in effect doubled the national population of college students, thus diversifying the campus by class, age and in the case of wounded veterans, physical ability (though not by race or gender).Backlash against what gets taughtOn the heels of the democratizing GI Bill, the McCarthyite purge of more than 100 academics for their prewar affiliations with the Communist party has become legend. At the same time, Joseph McCarthy’s young admirer William F Buckley Jr produced his 1951 opus, God and Man at Yale: The Superstitions of Academic Freedom, arguing that socialist professors had run roughshod over the campus, indoctrinating students in Keynesian economics and atheism. The academy, to McCarthy, Buckley and their followers, had transformed into a hotbed of anti-Americanism. The right’s understanding that higher education could not be trusted was now well developed: too many people were entering college and learning the wrong lessons.Following the McCarthy attacks came the storied 1960s, when the campus continued democratizing its admissions and curriculum. Lyndon Johnson’s Higher Education Act of 1965 allowed for greater access to student loans and work-study programs. This allowed additional generations of working-class students to matriculate, especially more people of color, who demanded to see themselves in their lessons. The creation of Black studies, women’s studies, Chicano studies and similar disciplines throughout the 1970s followed militant strikes by student protesters. At the same time, anti-Vietnam war unrest challenged their institutions’ commitments to cold war weapons development. For the right, this was but more evidence of the college as a radicalizing institution.Increasingly, the liberal center began to agree with the notion that the campus had radicalizing potential. The 1980s and the 1990s marked the bipartisan obsession with culture wars, with the campus as its apparent locus. To the benefit of the right, popular debates about political correctness and identity politics in effect drew attention from austerity measures that had sucked resources away from higher education since the Reagan years. Through the 2000s and 2010, the right revved up its offensives against campus antiwar movements, attacking faculty and students who spoke out against the “war on terror” and protests to boycott, divest from and sanction Israel. By the 2010s, in the aftermath of the Great Recession’s deep cuts to higher education, conservative attacks shifted back to campus social crusades as the right railed against the Occupy Wall Street, Black Lives Matter and #MeToo movements, and ginned up moral panics over safe spaces, trigger warnings and cancel culture.Throughout the 20th century and into the 21st, conservative rhetoric cast colleges and universities as deeply politicized, inefficient and anti-American. From the 1920s to the 1980s, this generated popular notions that the college should be reformed back to its previous role as a selective space for class reproduction. Since the 1980s, the purpose has been to delegitimize the academy to get mass buy-in to defund, privatize and eventually abolish public higher education. The goal is to return colleges to a carefully constructed environment not to educate all, but to reproduce hierarchy (especially if it can be done for profit).This has not been an exclusively American process. Autocrats around the world have cracked down on the academy, journalism and venues of arts and culture for the last 100 years. These are places where ideas are shared and traditional conventions are challenged. Crushing them is central to consolidating authoritarian power. Today’s international rightwing leaders want to control higher education, just as they want dominion over all other social, cultural and political institutions. For the first time, a US president is finally willing to deliver the right’s century-old goal.

    Lauren Lassabe Shepherd, PhD, is a historian of US colleges and universities. She is the author of Resistance from the Right: Conservatives and the Campus Wars in Modern America and host of the weekly American Campus Podcast More

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    My rare disease was getting closer to a cure. RFK Jr could undermine that | Jameson Rich

    Since Robert F Kennedy Jr assumed control of the US health department in February, with a mandate to “[lower] chronic disease rates and [end] childhood chronic disease”, he has moved quickly to remake the US’s federal health infrastructure. But the Trump administration’s actions on medical research are already threatening that goal – and could end medical progress in this country for good.Kennedy’s office oversees the National Institutes of Health, the control center of disease research in the United States. Kennedy’s agency has killed almost 800 active projects, according to Nature, affecting medical research into HIV/Aids, diabetes, women’s health, heart disease, cancer, Alzheimer’s and more. The administration wants to cut the NIH’s budget up to 40% while consolidating its 27 agencies – separated by disease area – into just eight. Elon Musk’s Doge has been reviewing previously awarded grant funding, reportedly requiring researchers to explain how they are using their grants to advance the Trump administration’s political goals. (Audio obtained by the Washington Post suggests this “Defend the Spend” initiative may be a smokescreen, with one NIH official admitting: “All funding is on hold.”) Separately, Donald Trump has aggressively targeted universities such as Harvard and Columbia over alleged antisemitism and diversity initiatives, using federal contracts that fund research as leverage. And just recently, the NIH passed a new rule banning any university from receiving future federal grants if the universities use DEI programs or boycott Israeli firms.Medical research is a wonkish issue usually kept far away from political discussions. Even popular initiatives like former presidents Barack Obama and Joe Biden’s cancer moonshot require long-term vision in a political landscape rarely concerned with anything beyond the day’s news. But in recent years, public and private investments in medical research have seeded a wave of potential cures across major disease areas. Now, just as that wave is about to crest, RFK Jr and the Trump administration’s incursion against the NIH threatens to ensure these cures are never finished.For me, the promise of those cures is personal. At three days old, I was diagnosed with a rare version of the most common type of birth defect: congenital heart disease. CHD affects one in every 100 babies born in the US and is the leading cause of birth defect-related deaths. Congenital heart problems can range from a small hole in the heart to being born with only one ventricle. Many defects are underdiagnosed, and chances are good that you know somebody who lives with one. Even JD Vance does: his relative was born with Ebstein’s anomaly, a deformity of the tricuspid valve that has resulted in her now needing a heart transplant at the age of 12.When I was six weeks old, doctors performed the first in a series of three surgeries aimed at correcting the circulation of blood within my heart and between the other organs of my body. The final surgery in that sequence had first been described in medical journals in 1971, and crucial refinements had been made only a few years before I was brought under the knife.Before the surgery’s advent, the prognosis was grim. Many children like me died before their first birthday. Of congenital patients in the 1950s, “half died before the age of twenty”, writes cardiologist Sandeep Jauhar in his book Heart: A History. “In short, they were cardiac cripples, their existence doomed.” But after the surgery, more of us started living into adulthood. Today, most of these patients live at least another 30 years after the operation. My survival past infancy was an accident of history, the product of being born at the right moment in the lifespan of medical research. “Don’t worry,” my first surgeon told my parents when I was a child. “He’s going to long outlive you both.”But my future and the future of others like me is not guaranteed. As I grew up, my doctors acknowledged that the surgery was merely palliative, not curative – a stopgap, medicine’s way of buying me some time. With medicine advancing so quickly, though, we could hope that new solutions would be brought into existence by the time I needed them. In the decades since, we have come to understand the surgery’s long-term consequences: likely progressive damage across organ systems, leading to the need for heart or multi-organ transplants in most patients by the age of 40. Last year, shortly after turning 31, I was formally diagnosed with cardiac cirrhosis and informed that I will need a combined heart-liver transplant within the decade. The time that those early developments bought me seems to be running out.In recent years, as the patient population has grown, more of us have been able to advocate for the need for new solutions. Private foundations have started pouring tens of millions of dollars into research aimed at discovering new treatments and identifying the root causes of birth heart defects so they can be prevented. These foundations have also begun correcting an imbalance in funding – historically, pediatric cancer has received five times the amount of funding that CHD does, despite similar prevalence and mortality rates.I volunteer on the patient board of one such organization, a privately funded non-profit aimed at curing heart defects like mine. With the help of researchers and hospital systems across the country, the organization has been making remarkable progress in a short period of time. But this work relies on the infrastructure of university labs. Even before Kennedy took office, the Trump administration ordered that the NIH change how grant funding is allocated by limiting what are known as “indirect costs”, which go beyond the direct needs of a given study. But often, these costs go into funds that help universities keep their labs running: things like building operations and upgrades, legal compliance and paying researchers. Even with this support, university labs struggle to keep the lights on, and researchers are constantly fighting to secure and retain funding. (The order has since been paused by a federal judge and is the subject of continuing litigation.)Some insist the US shouldn’t be funding research with taxpayer dollars at all. Instead, they would leave the task to pharmaceutical companies and biotech firms. But this fundamentally misunderstands the reality: in the decade leading up to 2020, researchers found, government funding played a role in the development of every new pharmaceutical drug; these drugs are then sold back to patients at a premium. The research that for-profit companies do fund is narrowly focused on things that are guaranteed to make money, or to advance discoveries begun in the public sector. For example, the new blockbuster medication category of GLP-1s – Ozempic, Wegovy, Mounjaro – would not exist without a discovery that was first made by an NIH scientist. When people debate the American healthcare system, they often point to the innovations and cutting-edge treatments we’ve pioneered to support the idea that our system, while flawed, is the best in the world. That impression of a world-class system is due almost entirely to the quality and breadth of our university research infrastructure and our medical schools.Private non-profits, like the one I volunteer with, already fund a large amount of medical research. If more university labs start closing, there will be nowhere for this money to go or for this research to be performed. As Dr Kimryn Rathmell, former director of the National Cancer Institute, told the AP: “Discoveries are going to be delayed, if they ever happen.” The result will be both patients and the government spending even more money on emergency and palliative healthcare. That will only benefit the healthcare profiteers Kennedy claims to be going after: pharmaceutical companies, hospital systems and healthcare entrepreneurs such as Brad Smith, who, by some accounts, has been leading Doge’s firings within HHS.My disease isn’t the only one that will be affected by these cuts. Ongoing research has indicated that targeted mRNA vaccines may show promise in preventing or treating Aids and certain types of cancers. The technology is also being studied for its ability to treat cystic fibrosis, heart failure, sickle cell anemia and other genetic birth defects. But scientists working in these areas through the NIH have already been instructed to strike mention of mRNA vaccines from grant applications and materials, perhaps owing to Kennedy’s hostility towards vaccines and his repeated lies about mRNA technology.If the proposed funding cuts and changes at the NIH are allowed to proceed, Kennedy’s mandate to lower chronic disease rates will fail, and his failure will be obvious. We will see it in rising rates of cancer, birth defects, diabetes and other chronic illnesses. We will see it in the exodus of medical experts to other countries, and the collapse of the researcher pipeline in US universities. We will see the quality of our supposed world-class medical system crash as treatments stagnate. We will pay for this cruelty in blood and lives and lost generations.In truth, today’s congenital heart research has arrived too late to save my own life. My future is at the whim of our broken transplant system, itself already showing signs of strain under Kennedy. But I continue championing the work being done because of the hope that future children won’t be consigned to the same fate. The only thing that will have made the suffering I’ve faced worth it is if I’m a part of the last generation to do so.

    Jameson Rich is a writer and film-maker from Massachusetts who covers healthcare and culture More

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    Trump 100 days: ‘unpredictable’ US alienates allies and disrupts global trade

    For US foreign policy, Donald Trump’s first 100 days in office were the weeks when decades happened.In just over three months, the US president has frayed alliances that stood since the second world war and alienated the US’s closest friends, cut off aid to Ukrainians on the frontlines against Vladimir Putin, emboldened US rivals around the world, brokered and then lost a crucial ceasefire in Gaza, launched strikes on the Houthis in Yemen and seesawed on key foreign policy and economic questions to the point where the US has been termed the “unpredictable ally”.The tariffs Trump has unleashed will, if effected, disrupt global trade and lead to supply chain shocks in the United States, with China’s Xi Jinping seeking to recruit US trade allies in the region.The pace of the developments in the past 100 days makes them difficult to list. Operating mainly through executive action, the Trump administration has affected nearly all facets of US foreign policy: from military might to soft power, from trade to immigration, reimagining the US’s place in the world according to an isolationist America First program.“The shake-up has been revolutionary, extraordinary. It’s upended 80-some years of American foreign policy,” said Ivo Daalder, president of the Chicago Council on Global Affairs and a former ambassador to Nato.The Trump presidency has ended the relative peace in the western hemisphere since the end of the second world war underwritten by US economic, military and diplomatic influence, Daalder said.“The foundation of the Pax Americana was trust, and once you break trust, it’s extraordinarily difficult to restore,” he said. “And restoring trust – trust in America, trust in American institutions, trust in American voters – it takes a long time to rebuild.”The US’s key foreign policy and national security making institutions are in crisis. The Pentagon is mid-meltdown under the leadership of Pete Hegseth, whose erratic and unsteady leadership has been reflected in score-settling among his senior staff, while a leaked Signal chat embroiled the national security adviser, Mike Waltz, and others in scandal. The state department under Marco Rubio is undergoing a vast shake-up, and the US’s diplomats are being sidelined in favour of envoys such as Steve Witkoff with little background in foreign policy. Critics say the gutting of USAID will cut back on US soft power for generations.“There’s no better way to get us into a war, perhaps a catastrophic war, than essentially poking out your eyes and numbing your brain, and you’re left with Donald Trump and a few people sitting in the White House winging it, and they’re not competent to wing it,” said Steven Cash, a former intelligence officer for the CIA and Department of Homeland Security, and the executive director of the Steady State, an advocacy group of former national security professionals. “And so we’ve seen that with the tariffs. We’ve seen that with Nato. We’ve seen that with Ukraine, and we’re gonna see a lot more of it.”After assuming office in 2021, Joe Biden declared: “America is back.”“The world now knows America is not back,” Daalder said. “America is gone again.”In a recent interview with the Zeit newspaper, Ursula von der Leyen, president of the European Commission, expressed similar sentiments, saying: “The west as we knew it no longer exists.”View image in fullscreenIn Munich, JD Vance delivered a landmark speech openly pandering to Europe’s far right, accusing European leaders of “running from their own voters” and saying: “America can do nothing to help you.”A backlash has begun. Last month the EU presented an €800bn ($913bn) plan on the future of European defense, a putative step in what would be a herculean task to overcome internal divisions and onshore European defense manufacturing. The UK and other US allies have considered other efforts, such as limiting intelligence-sharing with the US. “We still need America now, but there is a vision [of a time] when we won’t any more,” said one European diplomat.Meanwhile, the Trump effect is beginning to sway elections as well – though not as he might hope.In the western hemisphere, Trump has terrorised US neighbours and tacitly declared what some have compared to a new Monroe doctrine, saying the White House planned to “take back” the Panama canal and annex Greenland, while regularly calling Canada the future 51st state.In an extraordinary bit of election-day meddling, Trump wrote a social media post suggesting that he was on the ballot in Canada’s vote, repeating that Canada should become the 51st state in order to avoid tariffs and reap economic awards.Canadians responded by duly electing the liberal candidate Mark Carney, completing a 30% swing in polling that has largely been explained by opposition to Trump’s tariff war and territorial menaces.In Europe, populist parties seen as Trump’s ideological allies are also on the defensive. While Trump was popular in terms of his ideological and anti-woke agenda, the trade war has made him “quite toxic, just in the last month or two, with a lot of the populist voting bases”, said Jeremy Shapiro, the research director of the European Council on Foreign Relations and a former special adviser to the assistant secretary of state for Europe and Eurasia.Nowhere has the shift in US foreign policy been felt more acutely than in Ukraine, where the sudden cutoff in US military and intelligence sharing confirmed the Trump administration’s goals of pressuring Ukraine to accept a deal with the Kremlin, rather than the other way around. Those frustrations boiled over into an Oval Office meltdown fueled by Vice-President JD Vance that one former US official close to the talks called “disgraceful”.Trump has swung wildly on the war, on certain days targeting Volodymyr Zelenskyy as a “dictator” and then quickly pivoting to call out Putin for continuing to rain down missiles on Ukrainian cities. His theatrics have produced symbolic moments, including a sudden recognition that “maybe [Putin] doesn’t want to stop the war” after speaking with Zelenskyy this weekend in the baptistry of St Peter’s Basilica. But in terms of hard results, Trump has not fulfilled a promise to end the war within 24 hours or produced a clear path to peace many months later.View image in fullscreenThe Russians have said they largely tune out what he says in public.“We hear many things coming from President Trump,” said Sergey Lavrov, the Russian foreign minister, during a television appearance this weekend. “We concentrate, as I said, on the real negotiations which President Trump supports and instructed his people to continue to engage in these negotiations.”Key among those people is Witkoff, a neophyte diplomat who has spent hours in conversation with Putin, often with no other adviser present. One person close to the Kremlin said that Witkoff was viewed as a reliable negotiator in Moscow with “a chance to make an agreement”, but added: “There is a chance it will pass by.”Much of the burden of international diplomacy now rests on Witkoff, who is also running point on other key negotiations. Trump has tasked him with reaching a deal to prevent Iran from obtaining a nuclear weapon, in effect renegotiating the Joint Comprehensive Plan of Action that he scuttled in 2018. Both the US and Iran have played up the talks, although “differences still exist both on major issues and on the details”, the Iranian foreign minister, Abbas Araghchi, told state television this week.And then there is the Middle East, where the Trump administration scored its greatest early success by negotiating a ceasefire in Gaza but then failed to prevent its collapse, with Israel cutting off new aid to Gaza as the fighting continues.“There now seems to be less focus on ending the devastating conflict,” wrote Stefanie Hausheer Ali, a non-resident fellow at the Atlantic Council’s Rafik Hariri Center and Middle East Programs. “Trump’s threat in February to Hamas to release the hostages or ‘all hell is going to break out’ has, in practice, meant Israel restarting the war and blocking humanitarian aid from entering Gaza. Without an alternative to Hamas rule, the militant group may hang on and continue to fight as an insurgency, replenishing its ranks by recruiting desperate people.”Trump’s most extreme remarks have turned out to be bluster: he stunned the world when he claimed that he would turn the Gaza Strip into beachfront condos and said that the local Palestinian population would be forcibly removed. Months later, the initiative is largely forgotten.While attempting to close three landmark negotiations at once, the Trump administration has also launched a trade war with the entire world, establishing sweeping tariffs on all foreign imports before abruptly reversing course and cutting tariffs to 10% save for those against China.With so many major efforts ongoing, observers say that the government is largely paralysed to deal with smaller but still crucial issues in foreign policy and national security. As part of a blanket ban on refugees, tens of thousands of Afghans who assisted US troops against the Taliban are left waiting for relocation to the United States, a promise that was extended by previous administrations.“The lack of clarity and the chaos are the things that are causing so much pain,” said Shawn VanDiver, the founder and president of #AfghanEvac, a group that works with the state department to help resettle Afghans.He said he was critical of both the Biden and Trump administrations for failing to relocate the tens of thousands of Afghans who were far enough along in the vetting program to be relocated before Trump came into office.“The truth is, is that when America makes a promise, you should be able to trust our word,” he said. “If our flag waving over an embassy in Tunisia or Baghdad or Kabul, or Kyiv doesn’t mean this is the place where there’s truth, where there’s justice … well, then what are we even doing here?” More

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    What did Pope Francis think of JD Vance? His view was more than clear | Jan-Werner Mueller

    We might never quite know what Pope Francis said to the US vice-president during their very brief meeting on Sunday. In the widely shared video clip, it was hardly audible. The morning after, Francis died, and Vance jetted to visit India, finding time to tweet that his heart went out to the millions of Christians who loved Francis (implying, I suppose, that not all Catholics loved him) and patronizing the dead pontiff by calling one of his homilies “really quite beautiful”).Francis had been as outspoken as could be without naming names, when he criticized Vance in his February letter to US bishops; but he was not just registering his rebuke of Trump and Vance’s cruel treatment of refugees and migrants; he was reacting to a broader trend of instrumentalizing religion for nationalist and authoritarian populism.In February, Vance had an online “close-quarters street fight” with Rory Stewart, the former UK Conservative minister, diplomat and now professor in the practice of grand strategy at the very university from which Vance obtained his law degree. At issue was what to most of us wouldn’t seem an obvious source of social media outrage: the correct reading of St Augustine’s notion of ordo amoris, the right ordering of love.In January, Vance had alluded to the concept in an interview with the Trump courtier Sean Hannity; according to the Catholic convert, it was a “Christian concept” that love and compassion start with family, then extend to neighbors, then nation, and, last and least, reach fellow human beings as such.Stewart had registered skepticism, observing that Vance’s stance was “a bizarre take on John 15:12-13 – less Christian and more pagan tribal. We should start worrying when politicians become theologians, assume to speak for Jesus, and tell us in which order to love.” The infamously very online Vance hit back with: “Just google ‘ordo amoris’.” In typically snarky fashion, Vance then questioned Stewart’s IQ and added that “false arrogance” of the Stewart type “drives so much elite failure over the last 40 years” (never mind what would constitute appropriate or correct arrogance).As plenty of learned observers remarked at the time, complex theological questions will not have bumper-sticker-size answers. But eventually a figure not entirely irrelevant for Catholics weighed in with a view that perhaps carries indeed more weight than those of others. Francis, in a letter to US bishops, instructed the flock that “Christian love is not a concentric expansion of interests that little by little extend to other persons and groups. In other words: the human person is not a mere individual, relatively expansive, with some philanthropic feelings!”He added, driving home the rebuke without naming names, that “the true ordo amoris that must be promoted is that which we discover by meditating constantly on the parable of the ‘Good Samaritan’ … that is, by meditating on the love that builds a fraternity open to all, without exception.” Apparently, Cardinal Pietro Parolin was dispatched on Saturday to explain all this to Vance again.Vance is not the only far-right populist who has smuggled nationalism into what he touts as the correct notion of Christianity. Viktor Orbán, a great model for Vance and other self-declared US “post-liberals” (meaning: anti-liberals), has been declaring for years that a proper understanding of “Christian Democracy” is not only “illiberal”, but nationalist.That would have been news to the many Catholics who experienced nation-building projects in Germany and Italy during the 19th century as outright oppressive. After all, Catholics were suspected of putting loyalty to Rome ahead of civic duties (a suspicion still very much alive in the US when JFK ran for office). Bismarck started the Kulturkampf (the original meaning of culture war) against Catholics in the 1870s; the Vatican forbade the faithful to participate in the political life of unified Italy.Far-right populists claim that only they represent what they call “the real people”. Of course, they have to explain who “the real people” are (and, who by contrast, does not truly belong). Many have instrumentalized Christianity for that purpose. Giorgia Meloni, in her autobiography, states: “The Christian identity can be secular rather than religious.” What matters is not believing (let alone actual Christian conduct), but only belonging. It’s what the social scientist Rogers Brubaker has called “Christianism”, in contrast with actual Christianity.Some far-right populists have tried to square their Catholicism with their populism by criticizing the hierarchy as a somehow illegitimate, or at least hypocritical, elite. Italy’s Matteo Salvini, who likes to flaunt the Bible and a rosary when riling up the masses of “real” Italians, pioneered this move; Vance copied it when he insinuated that there was something corrupt about church leadership; concretely he had accused US bishops of resettling “illegal immigrants” in order to obtain federal funds (an accusation deemed “very nasty” by Cardinal Timothy Dolan).The point is not that the correct understanding of Catholicism (or Christian Democratic political parties, as they have existed in Europe and Chile) has always been liberal; that’s hardly plausible. The point is that Francis reaffirmed that Catholicism is not compatible with the “America first” (and humanity last) view of the Trumpists.

    Jan-Werner Müller is a Guardian US columnist and a professor of politics at Princeton University More

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    JD Vance had ‘exchange of opinions’ with senior cardinal, Vatican says

    The US vice-president, JD Vance, had “an exchange of opinions” with the Vatican’s secretary of state over current international conflicts and immigration when they met on Saturday, the Vatican has said.The Vatican issued a statement after Vance, a Catholic convert, met Cardinal Pietro Parolin and the foreign minister, Archbishop Paul Gallagher. There was no indication he met Pope Francis, who has resumed some official duties during his recovery from pneumonia.The Holy See has responded cautiously to the Trump administration, in keeping with its tradition of diplomatic neutrality.It has expressed alarm over Donald Trump’s crackdown on immigration and cuts in international aid, and has called for peaceful resolutions to the wars in Ukraine and Gaza.Those concerns were reflected in the Vatican statement, which said the talks were cordial and that the Vatican expressed satisfaction with the administration’s commitment to protecting freedom of religion and conscience.“There was an exchange of opinions on the international situation, especially regarding countries affected by war, political tensions and difficult humanitarian situations, with particular attention to migrants, refugees, and prisoners,” the statement said.“Finally, hope was expressed for serene collaboration between the state and the Catholic church in the United States, whose valuable service to the most vulnerable people was acknowledged.”The reference to “serene collaboration” appeared to refer to Vance’s accusation that the US conference of Catholic bishops was resettling “illegal immigrants” in order to obtain federal funding. Top US cardinals have pushed back strongly against the claim.Parolin told La Repubblica on the eve of Vance’s visit: “It is clear that the approach of the current US administration is very different from what we are used to and, especially in the west, from what we have relied on for many years,.”As the US pushes to end the war in Ukraine, Parolin reaffirmed Kyiv’s right to its territorial integrity and insisted that any peace deal must not be “imposed” on Ukraine but “built patiently, day by day, with dialogue and mutual respect”.Vance was spending Easter weekend in Rome with his family and attended Good Friday services in St Peter’s Basilica after meeting Italy’s prime minister, Giorgia Meloni. On Saturday, after the Vance family’s introduction to Parolin, they had a private tour of the Sistine Chapel.It was not immediately clear where they would celebrate Easter. Pope Francis, for his part, according to official liturgical plans released on Saturday, indicated he hoped to attend Easter mass on Sunday, which usually draws thousands to St Peter’s Square.The pope and Vance have tangled over immigration and the Trump administration’s plans to deport people en masse. Francis has made caring for those who migrate a hallmark of his papacy and his progressive views on social justice issues have often put him at odds with members of the more conservative US Catholic church.The pope also changed church teaching to say that capital punishment was inadmissible in all cases. After a public appeal from Francis just weeks before Trump took office, Joe Biden commuted the sentences of 37 of the 40 people on federal death row. Trump is an outspoken proponent of expanding capital punishment.skip past newsletter promotionafter newsletter promotionVance, who converted to Catholicism in 2019, identifies with a small Catholic intellectual movement that is viewed by some critics as having reactionary or authoritarian leanings and often described as “post-liberal”.Post-liberals share some longstanding Catholic conservative views, such as opposition to abortion and LGBTQ+ rights. They envision a counter-revolution in which they take over government bureaucracy and institutions such as universities from within, replacing entrenched “elites” with their own and acting upon their vision of the “common good”.Just days before the pope was admitted to hospital in February, Francis criticised the Trump administration’s deportation plans, warning that they would deprive people of their inherent dignity. In a letter to US bishops, he also appeared to respond to Vance directly for having claimed that Catholic doctrine justified such policies.Vance had defended the administration’s America-first crackdown by citing a concept from medieval Catholic theology known in Latin as ordo amoris. He said the concept delineated a hierarchy of care – to family first, followed by neighbour, community, fellow citizens and, last, those elsewhere.In his 10 February letter, Francis appeared to correct Vance’s understanding of the concept.“Christian love is not a concentric expansion of interests that little by little extends to other persons and groups,” he wrote. “The true ordo amoris that must be promoted is that which we discover by meditating constantly on the parable of the good Samaritan, that is, by meditating on the love that builds a fraternity open to all, without exception.”Vance has acknowledged Francis’ criticism but has said he will continue to defend his views. During an appearance on 28 February at the National Catholic Prayer Breakfast in Washington, Vance did not address the issue specifically but called himself a “baby Catholic” and acknowledged there are “things about the faith that I don’t know”. More