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    ‘We are failing’: doctors and students in the US look to Mexico for basic abortion training

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    On paper, it should not be difficult for Dr Sebastian Ramos to learn to perform abortions. As a family medicine doctor, Ramos works in a specialty that frequently provides the procedure. He lives in deep-blue California, where it is still allowed. And the administrators running Ramos’s residency program – a kind of apprenticeship that US doctors must undergo to become full-fledged physicians – support Ramos’s desire to learn how to do it.But over the course of his three-year-long residency, Ramos is guaranteed just three days’ worth of training at Planned Parenthood. Residents get to participate in only a handful of abortions.“That’s just not enough if you want to practice abortion care,” said Ramos, who asked to go by a shortened version of his last name to protect his privacy. “I knew that if I wanted to do this, I needed more experience.”That’s why, earlier this month, Ramos traveled to a clinic in Mexico City for two weeks’ worth of training in abortion provision. During his first week at the clinic, which is run by the global organization MSI Reproductive Choices and its Mexican arm Fundación MSI, Ramos performed roughly 60 abortions.In the years since the US supreme court overturned Roe v Wade, paving the way for more than a dozen states to ban virtually all abortions, a small but growing number of would-be abortion providers have begun to leave the country in search of an education. In 2023, MSI trained nine American doctors to perform abortions at clinics in Mexico. In 2024, it trained 27. So far this year, it is on track to double that number.View image in fullscreen“On one hand, it’s a tremendous relief to know that medical students and residents aren’t going to have to forego this very important part of their training in their education,” said Pamela Merritt, executive director of Medical Students for Choice. Last year, Merritt’s organization helped eight medical students and residents receive abortion training in Mexico and the UK.Merritt continued: “It’s also incredibly sad that in the United States, we are failing to train people even to the standard of care indicated by abortion bans.”Every abortion ban in the US permits abortions to save a patient’s life. But without adequate training, doctors may not be skilled enough to perform abortions even in those dire circumstances.‘It’s a shame’Medical schools and residency programs are run by massive hospitals that are heavily dependent on public funding; such institutions tend to be, by nature, leery of anything as controversial as abortion. The Accreditation Council for Graduate Medical Education (ACGME) has required OB-GYN residencies to teach doctors how to perform abortions since the 1990s, but rather than offer training in-house, hospitals have often farmed their residents out to freestanding abortion clinics for training.Even before Roe fell, this system was faulty: a 2019 study found that, despite the ACGME requirement, just 64% of OB-GYN residency programs offered “routine training with dedicated time” for abortions. Family medicine residents who want to learn to perform abortions face a greater disadvantage, since the ACGME does not require their residency programs to offer any kind of abortion training.View image in fullscreenEven most OB-GYN residents, program directors reported in the 2019 study, did not achieve what doctors call “competency” when it came to abortion. Without competency – a qualification that’s measured through a melange of doctors’ knowledge, skills and attitudes – doctors may not be able to safely perform abortions on their own.Abortion training and competency is now even harder to come by. Since Roe’s collapse, more than 100 abortion clinics have closed. Those that are left are often besieged by patients fleeing abortion bans, leaving them without the time and space to teach everybody who wants to learn.If an OB-GYN residency program is located in a state that bans abortion, ACGME rules currently dictate that the residency “must provide access to this clinical experience in a different jurisdiction where it is lawful”. The ACGME declined to respond to a request for information about how many residency programs are currently compliant with its abortion-training requirement, although records show that no OB-GYN programs have lost their accreditation status in the last year. Patricia Lohr serves as the director of research and innovation for the British Pregnancy Advisory Service (Bpas), a UK non-profit that provides abortions up until about 24 weeks of pregnancy. Lohr trained to become an OB-GYN in the US. “Having been a resident and a medical student in the United States, I could really see the importance of having access to abortion education that wasn’t entirely reliant on what was being delivered within academic training programs,” Lohr said. “Because often, abortions weren’t being provided in those academic hospitals.”View image in fullscreenWhen Lohr moved to the UK, she quickly moved to create a two-week training program at Bpas where medical students could learn about abortions and observe – but not perform – the procedure. In the years since Roe fell, that training program has received a surge of applications from American medical students and residents.“It’s a shame that people would have to travel to learn a basic part of women’s health care,” Lohr said. “There are many trainees out there at the moment who would like to obtain abortion skills, but cannot get it locally, and so they get diverted into doing something else.”Lauren Wiener, a New Jersey medical student, had originally planned to travel to Arizona in summer 2022 to learn how to provide abortions. But when Roe’s fall led Arizona abortion providers to temporarily stop working, Wiener had to cancel her trip. Instead, she ended up undergoing a week-long training at Bpas last fall.“It is something that you need to know how to do, because there are emergency situations,” Wiener said of abortions. “You might not want to electively perform an abortion at 24 weeks, but if someone comes in and they’re miscarrying, you need to know how to evacuate that uterus. It’s a skill you need to have to save a life.”‘We will be there’While training in the US dwindles, the country’s increasingly conservative approach to abortion has also put it at odds with much of the rest of the world. Only four countries – including the US – have tightened their abortion laws over the last 30 years, while more than 60 countries and territories have loosened theirs, according to a tally by the Center for Reproductive Rights.Mexico is one of them. In 2023, its supreme court decriminalized abortion nationwide; the procedure is now available in about half of all Mexican states. And providers aren’t the only people taking advantage of Mexico’s liberalized abortion laws: last year, Fundación MSI provided first-trimester abortions to 62 women from the United States.“Training, training, training – it is key, to have less danger for actual patients,” said Araceli López-Nava, managing director of MSI Latin America. “We understand how difficult the situation is becoming in the US, so we’re happy to help.”The organization has the capacity to train up to 300 doctors a year to perform abortions, López-Nava estimated.View image in fullscreenMSI is not, however, a solution for everybody. Would-be trainees need to speak Spanish. And although the organization has in past years trained medical students, MSI’s Mexico clinics have started focusing on teaching residents who have already performed 20 abortions. Because residents have already chosen their specialties and secured berths in residency programs – which can be highly competitive – they are more likely to become abortion providers.Training in Mexico can also be pricey, especially since the program does not pay for travel and lodging. Ramos’s entire trip cost about $5,000, although a scholarship helped him cover most of the costs.“It’s a way, at least for me, to be exposed to a different medical system, learn from different providers from a different country, exchange knowledge,” Ramos said. “I feel like I’m being adequately prepared to meet the needs of my patients in the US.” More

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      Melania Trump’s secret to getting through hard times? Love (actually)

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      Melania’s guide to getting through hard timesLet’s take a quick break from the increasingly dreadful news for a little check-in, shall we? So … how are you holding up right now? How are those stress levels?Mine aren’t great, to be honest. I’m pickling in my own cortisol as I write this. But I’m not here to moan. I am here to share some helpful advice, courtesy of our inspiring first lady Melania Trump, about how to get through these challenging times.Now, I know what you may be thinking: what on earth does Melania Trump know about adversity? The woman divides her time between a gold penthouse in Manhattan and a mansion in Florida, occasionally dropping into the White House to wave at commoners. She’s not exactly worrying about the price of eggs or the balance of her 401(k).But let’s not be too quick to judge. Money doesn’t insulate you from everything, and I’m sure Melania has her own problems. I mean, the poor woman is probably forced to regularly socialize with Elon Musk – which would drain the lifeblood from anyone. Then there’s the fact her husband has taken to using the stomach-turning nickname the “fertilization president”.Melania’s also not just lounging around in luxury: I am sure she is working extremely hard for the millions of dollars Amazon has thrown at her for the privilege of making a sycophantic documentary about her life. And then there’s all the annoying first lady admin; her office has just had to reschedule the White House spring garden tours – which Melania is not expected to actually attend – because of some pesky protesters.So how does our first lady navigate these very stressful challenges? While presenting the state department’s 19th International Women of Courage awards, which honored eight women from around the world, Melania shared her secret trick for getting through hard times. It’s … wait for it … love.“Throughout my life, I have harnessed the power of love as a source of strength during challenging times,” Melania said. “Love has inspired me to embrace forgiveness, nurture empathy and exhibit bravery in the face of unforeseen obstacles.”Melania noted that the award recipients – which included women from Yemen, South Sudan, Israel and the Philippines – “came from diverse backgrounds and regions, yet love transcends boundaries and territories”. She further added that she was inspired by “the women who are driven to speak out for justice, even though their voices are trembling”.The first lady deserves an award of her own for that speech because I have absolutely no idea how she managed to say all that with a straight face. I mean, seriously, is she trolling us? How can she talk about love while her husband’s hate-filled administration is deporting everyone they can? Having the wrong tattoo – or just a stroke of bad luck – can now get you sent to a prison in El Salvador. (The secretary of state Marco Rubio, by the way, who is presiding proudly over these deportations, also made a speech at the International Women of Courage awards.)How can Melania talk about justice when the Trump administration is currently doing their best to deport or imprison anyone who speaks out for justice for Palestinians? And how dare she talk about diversity and women’s rights, when the Trump administration is erasing women from government websites as part of their crackdown on diversity, equity and inclusion.But, look, I don’t want to completely dismiss Melania’s advice. Perhaps she has a point. Perhaps, in these challenging times, we should all just channel Melania and reach for the power of love. So: if you happen to get into trouble with any US border guards because you’ve indulged in a little wrongthink online, just remind them of Melania’s words. Remind them that love transcends borders and territories. And then sit back, and enjoy your free trip to El Salvador.Katy Perry says she is ‘going to put the “ass” in astronaut’Please don’t, Katy. For more cringeworthy quotes on how “space is finally going to be glam”, read this feature in Elle. It profiles the all-women crew that has been chosen to joyride around space on Jeff Bezos’s Blue Origin rocket. They’re all going to be glammed up with lash extensions, folks! It’s gonna be one giant leap for womankind.Women in the US are dying preventable deaths because of abortion bansNew research details how three critically ill patients in the US could have survived if they’d been able to access abortions.How Taliban male-escort rules are killing mothers and babiesEven before the Taliban took power, Afghanistan had a maternal mortality rate three times higher than the global average. Now draconian policies, including guardianship rules that mean a woman can’t travel to hospital without being accompanied by a man, are contributing to an increase in maternal deaths in Afghanistan.House revolts over Republican bid to stop new parents from voting by proxyA small group of Republicans joined forces with Democrats to stop the GOP from blocking consideration of a measure that would allow new parents to temporarily designate someone else to vote in their place. “I think that today is a pretty historical day for the entire conference. It’s showing that the body has decided that parents deserve a voice in Washington,” the Republican Anna Paulina Luna said.The US woman with the world’s longest tongueImagine people screaming in shock every time you stick your tongue out. Such is the life of Chanel Tapper, a California woman who holds the Guinness World Record for woman with the globe’s longest tongue.US anti-abortion group expands campaign in UKA rightwing US group has been trying to export abortion extremism to the UK, lobbying heavily against the introduction of buffer zones around reproductive health clinics.Russell Brand charged with rape and sexual assault“Nation Could Have Sworn Russell Brand Was Already Convicted Sex Offender”, reads an Onion headline from 2023.At least 322 children killed since Israel’s new Gaza offensive, Unicef saysUnicef said “relentless and indiscriminate bombardments” had resulted in 100 children killed or maimed every day in the 10 days to 31 March.How Gina Rinehart is pushing the Maga message in AustraliaSome fascinating details in this Guardian series about Rinehart, who has been described as a “female Donald Trump” and is Australia’s richest person. Money clearly can’t buy taste because Rinehart is renovating her company headquarters to include a sculpture of Peanut the squirrel, Maga’s favourite rodent, and etchings of inspirational Elon Musk quotes.The week in pawtriarchyTrump’s tariffs are so far-reaching that they’ve even been imposed on the Heard and McDonald islands near Antarctica, inhabited only by penguins. (And a few seals.) I am sure the penguins, already suited up for an emergency meeting on the tariffs, are not too happy about this development – but the rest of us have been gifted some brrrrilliant memes. More

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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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      ‘A slap in the face’: activists reel as Trump administration removes crucial missing Indigenous peoples report

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      Since January, Donald Trump’s presidency has been marked by a series of radical changes. Of note is the way troves of previously publicly available information on government websites such as the Centers for Disease Control and Prevention (CDC) or National Institutes of Health (NIH) have quietly gone dark.One such page is the Not Invisible Act Commission’s final report from November 2023. The Not Invisible Act Commission was mandated by bipartisan legislation and signed into law by Trump himself. The report was a collaboration between the justice department and the interior department to address, document and respond to the missing and murdered Indigenous peoples (MMIP) crisis, in which Indigenous communities experience disproportionate rates of abduction, assault and murder. Accurate statistics about the MMIP and missing and murdered Indigenous women (MMIW) crises can be limited and dated, but, as of 2019, homicide was the third most common cause of death for Indigenous girls aged 15 to 19 and Indigenous women aged 20 to 24.The Not Invisible Act Commission’s final report was a culmination of seven in-person field hearings held across the country and a one-day virtual national hearing. Nearly 600 people attended the hearings and 260 people, including survivors, victims, family members, advocates and law enforcement gave testimony to the commission. As a result of those hearings, the commission issued its final report of recommendations to address the crisis.Having a resource like the Not Invisible Act Commission’s final report provided Indigenous people and governments, as well as federal, state and local branches of the US government, with data and suggestions on how to reduce the crises. The act itself was historic, not only because it shed light on an issue that Indian Country has faced for decades, but also because it was the first bill that was introduced and passed by four Indigenous US congressional members.Despite the report no longer being available online, advocates say the fight to bring light to and end the MMIP and MMIW crises continues.Tracking numbersCharolette Gonzales, the policy and advocacy director of the Coalition to Stop Violence Against Native Women (CSVANW) said that she and other staffers were shocked when the Not Invisible Act Commission’s report was removed from the federal website.“They were like, ‘What does this mean for the future of other information that supports our work?’” said Gonzales, who is Diné and San Ildefonso Pueblo. “[We] make sure that our communities are informed. What does that mean for them?”The coalition focuses on preventive work, or trying to stop violence against Indigenous women before it happens.“When doing this education, we are better able to equip them with the ability to advocate for themselves, and that work is really important as we move forward, especially with these unprecedented times of this current presidential administration,” she said.Karrisa Newkirk, of the Oklahoma-based MMIW Chahta, an organization that supports affected families through financial assistance, provides training opportunities for law enforcement agencies, and works with victims to help them heal after experiencing violence, said that the work doesn’t stop just because of a decision made in Washington.“When it comes to our work and what we do, I don’t feel like we’ve missed a step,” she said. “We’re going to continue to serve our families exactly how we should and always have. When it comes to other MMIWs across the United States, I truly feel like it kind of puts us back in time a little bit, where people aren’t going to see what a real crisis it is.”Newkirk said that after the commission collected the data, it should have been used to make tangible changes. Still, having a national database that tracked MMIW cases was vital.“Even though there were great strides in the last couple years, them removing that was like a slap in the face. It was a huge step back.” she said. “It felt like we were being heard and recognized, and then all of a sudden it felt like that was no longer what it was any more … When you think about that as someone that’s in the work and you know how many people already don’t know about it, and then it’s removed from the United States website, it’s definitely disheartening.”The CSVANW has begun discussing creating a database of its own, one built with information that the organization has collected over the years, including documents and reports that the Department of Justice previously issued. This method of ensuring that vital documents and resources are stored somewhere other than on government agencies’ websites is something that some advocates have been pushing for since the website purges began.The National Indigenous Women’s Resource Center, Inc (NIWRC), a non-profit organization that works to end violence against Native women, children and communities, for example, has a version of the Not Invisible Act Commission’s report that is still accessible.skip past newsletter promotionafter newsletter promotion“We’re taking it upon ourselves to collect as much information as we can as it slowly becomes unavailable to us on purpose,” Gonzales said. “I think the censorship is a really hard hit to our communities, especially to our work. We already have limited resources as not only just a Native organization and survivor-led organization, but also as tribal people who live in these pueblos and work with our people.”MMIW Chahta also tracks its own numbers, and is trying to overcome racial misclassification by law enforcement.Tribal communities are also concerned about whether treaties, agreements made between sovereign nations, will be upheld by the US government, Gonzales said. The US has had a long history of violating treaties even before Trump’s election.Since he was sworn in, Trump and Elon Musk have called on the General Services Administration to terminate the leases of roughly 7,500 federal offices, including 25 regional offices of the Bureau of Indian Affairs. On Friday, Trump rescinded a Biden-era executive order, which aimed to strengthen tribal sovereignty for the 574 federally recognized tribes in the nation.Following the removal of the Not Invisible Act Commission’s final report page, federal agencies have flagged hundreds of words to limit or avoid, including, “indigenous community”, “tribal”, and “Native American”. Defense department websites removed pages about Indigenous code talkers, whose usage of Choctaw and Navajo languages to communicate messages were vital for winning the first and second world wars.Of the extreme changes being made by the administration and their implications for Indigenous people, Gonzales said: “A lot of community members, along with our staff, are emotionally exhausted every day we hear about new executive orders coming out.“Our survivors and our resources truly help decrease the violence that happens in our communities … And so, once we heard this, I think our mind instantly went to the fact that Native women will die if we don’t have federal funding. That’s just a fact.” More

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      The rise of pronatalism: why Musk, Vance and the right want women to have more babies

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      In his first address to the United States after becoming vice-president, JD Vance stood on stage and proclaimed: “I want more babies in the United States of America.” Weeks later, Donald Trump signed an executive order pledging support for in vitro fertilization, recognizing “the importance of family formation and that our nation’s public policy must make it easier for loving and longing mothers and fathers to have children”.In late January, a Department of Transportation memo directed the agency to prioritize projects that “give preference to communities with marriage and birth rates higher than the national average”. And last week, it was reported that Elon Musk, the unelected head of the government-demolishing “department of governmental efficiency” and a man who has said that the “collapsing birth rate is the biggest danger civilization faces by far”, had become a father of 14.Republicans have long heralded the importance of “family values”. But in these developments, many see mounting signs of a controversial ideology at work: pronatalism.Pronatalism is so contentious that people often struggle to agree on a definition. Pronatalism could be defined as the belief that having children is good. It could also be defined as the belief that having children is important to the greater good and that people should have babies on behalf of the state, because declining birth rates are a threat to its future. Perhaps most importantly, pronatalism could be defined as the belief that government policy should incentivize people to give birth.While people on the left might agree with some pronatalist priorities, pronatalism in the US is today ascendant on the right. It has become a key ideological plank in the bridge between tech bro rightwingers like Musk and more traditional, religious conservatives, like the speaker of the House, Mike Johnson – who once said in a House hearing that abortions were harming the economy by eliminating would-be workers.But there are plenty of widening cracks in that bridge and, by extension, Trump’s incoherent coalition.‘Hipster eugenicists’In the US, interest in pronatalism has historically coincided with growing anxiety over changing gender norms and demographics, according to Laura Lovett, a University of Pittsburgh history professor and the author of the book Conceiving the Future: Pronatalism, Reproduction, and the Family in the United States, 1890-1930. In the 1920s, pronatalism’s prominence grew after women gained the right to vote, as people worried about women working and wielding power outside the home.“When Theodore Roosevelt uses the term ‘race suicide’, he actually blames women who are going to college for the first time for that eventual suicide of the right, white race. There’s this linkage between women’s educational and aspirational futures and the declining birth rate,” Lovett said. “There was this anxiety that white, native-born, middle-class women were having smaller families.”Historically, US pronatalism was also tied to an interest in eugenics – and some of the more tech-minded, modern-day pronatalists do want to use breeding to fashion a better human race. Malcolm and Simone Collins, parents of four who have become standard-bearers for the burgeoning popularity of pronatalism among Silicon Valley venture capitalists, have championed “no-holds-barred” medical research to engineer the “mass production of genetically selected humans”. They have joked to Business Insider about making business cards declaring themselves “hipster eugenicists” – although they have also rejected the idea that they are performing eugenics, stressing that they think racism is “so dumb” and that the only bloodlines they are altering are their own.The Collinses, who support Trump, have spent hundreds of thousands of dollars on in vitro fertilization (IVF) and screening their embryos for IQ, risk of depression and other markers. (Scientists aren’t convinced that it is possible to screen embryos for IQ.) These kinds of practices – which the Collins have called “polygenics” – draw a wedge between the Silicon Valley pronatalists who back Trump and his more traditional pronatalist supporters. The anti-abortion movement, which was critical to getting Trump elected in 2016, has long opposed IVF, largely because it can lead to unused or discarded embryos.In signing his pro-IVF executive order, Trump appears to be siding with the “tech right” (and the broader electorate, among which IVF remains extremely popular). When Musk recently brought his son X Æ A-Xii to the Oval Office, Trump called the four-year-old a “high-IQ individual”.View image in fullscreen‘Restructuring society’While the Collinses are avatars for the emerging pronatalist tech right, Lyman Stone is one of the highest-profile pronatalists from a more traditionally conservative background.“Pronatalism has to be disciplined by a commitment to human liberty and human flourishing – and this is coming out of work on reproductive justice, basically. People have a right to have the families they want to have, and for some people, that means no family,” said Stone, a demographer who in 2024 established the Pronatalism Initiative at the right-leaning Institute for Family Studies. “The focus of pronatalism, in my view, generally is not and certainly should not be on family gigantism, and instead should be on helping young people overcome the barriers and obstacles to romantic and family success in their life.”In practice, Stone said, pronatalists should help people get married earlier in life so that they can start having children younger. That could mean, he said, everything from improving mental health services to creating better childcare programs. Stone’s frequent collaborator, Brad Wilcox – a University of Virginia sociology professor and author of the book Get Married: Why Americans Should Defy the Elites, Forge Strong Families and Save Civilization – pointed to several policies that he thinks would help strengthen “family formation”, such as expanding the child tax credit and converting federal land into affordable housing.“Pronatalism is not just a fiscal program. It’s a program of restructuring society in a way that treats family goals as worthy, worth supporting and socially important,” Stone said.Asked if he supports abortion rights, Stone clarified: “No, I would draw the line at destruction of human life.”Many of these policy proposals could comfortably fit into a left-leaning political platform – in fact, they may be more at home on such a platform than within today’s Republican party. Although Vance said on the campaign trail that he would like to expand the child tax credit, a move that could cost trillions of dollars in federal spending, Republicans have instead committed to slashing the government budget by at least $1.5tn.Instead, elected Republicans have tended to invoke pronatalist rhetoric in support of their top culture-war causes.They have repeatedly condemned gender-affirming healthcare for allegedly “sterilizing” people; in 2022, as Idaho weighed whether to ban kids from accessing the care, one Republican state legislator said: “We are not talking about the life of the child, but we are talking about the potential to give life to another generation.” When a Republican lawmaker from Michigan introduced a resolution to condemn same-sex marriage, he told reporters: “This is a biological necessity to preserve and grow our human race.” And last year, in a lawsuit to cut access to a common abortion pill, the Republican attorneys general of Idaho, Kansas and Missouri argued that access to the pill had “lowered birth rates for teen mothers”, leading to a falling state populations, “diminishment of political representation and loss of federal funds”.In practice, pronatalism – especially when paired with anti-abortion policy – often overlooks the disproportionate effect that having more babies has on women, according to Elizabeth Gregory, director of women’s gender and sexuality studies at the University of Houston. Childbearing can reshape a woman’s entire future.“This idea that the child is the only person in the dyad loses a real understanding of how embedded and dependent children are on their mothers,” Gregory said. “Fertility affects many, many parts of culture and talking about it can’t be reduced to just a few soundbites.”Falling birth ratesBirth rates are, indeed, on the decline. To remain stable, populations must reproduce at a “replacement rate” of 2.1; in other words, each mother must have 2.1 babies. The US currently averages closer to 1.6. (South Korea, which maintains the world’s lowest fertility rate, had a rate of just 0.75 in 2024.)Experts are split over how to address this problem. The world’s population is at a record high, and immigration to rich countries could offset declines in fertility – but, as the medical journal the Lancet warned in a 2024 issue, “this approach will only work if there is a shift in current public and political attitudes towards immigration in many lower-fertility countries”. If countries remain hostile to immigration while their birth rates fall, they will probably end up with a shrunken labor force that is unable to support an ageing population.There is evidence that Americans would like to have more children. A 2023 Gallup poll found that 47% of Americans think an ideal family has one or two children, while only 2% said families should have zero. At the same time, a Pew poll that same year found that 47% of American adults under 50 say they are unlikely to ever have children. Of those, nearly 60% say they just don’t want kids. Nearly 40% said they couldn’t afford to have kids or that the “state of the world” had convinced them not to.“We’re living in a moment where – I would say, unfortunately – marriage and parenthood have become ideologically polarized,” Wilcox said. More

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      The pink protest at Trump’s speech shows the Democrats aren’t coming to save us

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      Pretty (pathetic) in pinkHappy International Women’s Day (IWD), everyone! I’ve got some good news and some bad news to mark the occasion.The bad news is that a legally defined sexual predator is leading the most powerful country on earth and we’re seeing a global backlash against women’s rights. “[I]nstead of mainstreaming equal rights, we are seeing the mainstreaming of misogyny,” the UN secretary-general, António Guterres, said in his IWD message.The good news, for those of us in the US at least, is that the Democrats have a plan to deal with all this. Or rather, they have wardrobe concepts of a plan. On Tuesday night, Donald Trump addressed a joint session of Congress at the US Capitol. Some members from the Democratic Women’s Caucus (DWC), including Nancy Pelosi, decided to protest by … wait for it … wearing pink.“Pink is a color of power and protest,” the New Mexico representative Teresa Leger Fernández, chair of the DWC, told Time. “It’s time to rev up the opposition and come at Trump loud and clear.”The pink outfits may have been loud but the message the Democrats were sending was far from clear. They couldn’t even coordinate their colour-coordinating protest: some lawmakers turned up wearing pink while others wore blue and yellow to support Ukraine and others wore black because it was a somber occasion.Still, I’ll give the DWC their due: their embarrassing stunt seems to have garnered at least one – possibly two – fans. One MSNBC columnist, for example, wrote that the “embrace of such a traditionally feminine color [pink] by women with considerable political power makes a stunning example of subversive dressing”.For the most part, however, the general reaction appears to have been that this was yet another stunning example of how spineless and performative the Democrats are. Forget bringing a knife to a gunfight – these people are bringing pink blazers to a fight for democracy. To be fair, there were a few other attempts at protest beyond a pink palette: the Texas representative Al Green heckled the president (and was later censured by some of his colleagues for doing so) and a few Democrats left the room during Trump’s speech. Still, if this is the “opposition”, then we are all doomed.Not to mention: even the pink blazers seemed a little too extreme for certain factions of the Democratic party. House Democratic leadership reportedly urged members not to mount protests and to show restraint during Trump’s address. They also chose the Michigan senator Elissa Slotkin to give the Democratic response to Trump’s speech. While Slotkin tends to be described as a sensible centrist voice by a lot of the media, she’s very Trump-adjacent. Slotkin is one of the Democratic senators who has voted with Trump the most often and, last June, was one of the 42 Democrats to vote with the GOP to sanction the international criminal court (ICC) over its seeking of arrest warrants for Benjamin Netanyahu and other Israeli leaders for destroying Gaza. Human rights advocacy groups have warned that attacking the ICC like this undermines international law and the ability to prosecute or prevent human rights violations across the world. It speaks volumes about the US media and political class that a senator standing against international law can be called a centrist.This whole episode also speaks volumes about the Democrats’ plan for the future: it’s growing increasingly clear that, instead of actually growing a spine and fighting to improve people’s lives, the Democratic party seems to think the smartest thing to do is quietly move to the right and do nothing while the Trump administration implodes. I won’t caution against this strategy myself. Instead, I’ll let Harry Truman do it. Back in 1952, Truman said: “The people don’t want a phony Democrat. If it’s a choice between a genuine Republican, and a Republican in Democratic clothing, the people will choose the genuine article, every time.”Anyway, the upshot of all of this is that the Democrats are not coming to save us. We must save ourselves. That means organizing within our local communities and learning lessons from activists outside our communities. It means being careful not to normalize creeping authoritarianism and it means recognizing the urgency of the moment. The warning signs are flashing red: we need to respond with a hell of a lot more than a pink wardrobe.Make atomic bombings straight again!DEI Derangement Syndrome has reached such a fever-pitch in the US that a picture of the Enola Gay aircraft that dropped an atomic bomb on Japan has been flagged for deletion at the Pentagon. Apparently, it only got the job because it was Gay.Can a clitoris be trained to read braille?The Vagina Museum addressed this very important question on Bluesky.One in eight women killed by men in the UK are over 70A landmark report by the Femicide Census looks at the deaths of 2,000 women killed by men in the UK over the last 15 years and found that the abuse of older women hasn’t had as much attention as it should. “We have to ask why we see the use of sexual and sustained violence against elderly women who are unknown to the much younger men who kill them,” the co-founder of the Femicide Census told the Guardian. “The misogynistic intent in these killings is clear.”Bacterial vaginosis (BV) may be sexually transmitted, research findsWhile this new study is small, its findings are a big deal because BV is super common – affecting up to a third of reproductive-aged women – and has long been considered as a “woman’s issue”. Treating a male partner for it, however, may reduce its recurrence.How astronaut Amanda Nguyen survived rape to fight for other victimsAfter being assaulted at age 22, Nguyen got a hospital bill for $4,863.79 for her rape kit and all the tests and medication that went along with it. She was also informed that it was standard practice for her rape kit to be destroyed after six months. “The statute of limitations is 15 years because it recognises that trauma takes time to process,” Nguyen told the Guardian in an interview. “It allows a victim to revisit that justice. But destroying the rape kit after six months prevents a survivor from being able to access vital evidence.” After her traumatic experience, Nguyen successfully fought for the right not to have your rape kit destroyed until the statute of limitations has expired, and the right not to have to pay for it to be carried out.Female doctors outnumber male peers in UK for first timeIt’s a significant milestone in what has traditionally been a male-dominated profession.There’s an Israeli TikTok trend mocking the suffering of Palestinian childrenThis is one of those things that would be front page of the New York Times if it were directed at Israelis but is getting relatively little attention because of how normalized the dehumanization of Palestinians is. It’s also just the latest in a series of social media trends mocking Palestinian suffering.Florida opens criminal investigation into Tate brothers“These guys have themselves publicly admitted to participating in what very much appears to be soliciting, trafficking, preying upon women around the world,” the state attorney general said.The week in pawtriarchyJane Fonda, a committed activist, has always fought the good fight. But she’s also apparently fought wildlife. The actor’s son recently told a Netflix podcast that Fonda once “pushed a bear out of her bedroom”. While that phrase may mean different things to different people, in this instance it was quite literal. Fonda apparently scared off a bear who had entered her grandson’s room and was sniffing the crib. Too bad nobody was there to snap a photo of the escapade – it would have been a real Kodiak moment. More

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      ‘Musk? He’s horrendous’: Martha Lane Fox on diversity, tech bros and International Women’s Day

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      As Elon Musk grinned in the Oval Office, one of Britain’s most influential tech investors looked on in horror. “He is absolutely horrendous. I have said it multiple times: I think it is horrifying what is happening,” says Martha Lane Fox.For the British peer and ex-Twitter board member, the sight of Musk holding forth from the bully pulpit of Donald Trump’s White House shows the Silicon Valley dream has gone sour.“The richest man in the world, who can stand there alongside the president, and kind of carte blanche make jokes about how he’s carving up people’s jobs in the government. Then he can be there with a chainsaw laughing on stage…“It is really, really alarming, and I find it extremely unpleasant at a values-based level – but also, just how can we be watching this in plain sight? It makes me feel very anxious. I think it is gross.”In an interview with the Observer to mark International Women’s Day, the president of the British Chambers of Commerce (BCC) warned the diversity pushback orchestrated by Trump and his tech bro acolytes will not only damage society, but also the economy at large.Since his return to the White House, the US president has shut down all federal diversity, equity and inclusion (DEI) initiatives, while Musk’s “department of government efficiency” (Doge) is ripping up funding schemes.Some of the world’s biggest companies are following suit. Amid a wider pushback against everything from environmental targets to sustainable development, among the most prominent taking part are US finance and tech companies, including Goldman Sachs, Accenture and Amazon, while UK businesses such as GSK have also fallen in line.“He needs to be contained,” Lady Lane Fox says of Musk’s role in the rollback. “I find it extraordinary that the richest man in the world is trampling all over these things and that we still have kind of fanboying from the tech sector. It’s already been corrosive for society, and I would argue it is going to continue to be.”For businesses, she says the bottom line is that companies that take diversity seriously appeal to the widest possible employee talent pool and are better placed to target a broad range of customers. This, she adds, is about profit as much as social justice. However, she has a broader concern about the future.“The first thing, it’s financial. But the second thing, it’s about power and money – like everything, right?“If you’re looking at a sector like the digital sector, where there’s the growth in jobs, growth in opportunity – it is the growth sector in the economy. Yet you are not including a whole bunch of people in that. Then you are going to be creating inequality. Full stop. So it’s financial and it’s a question of social justice.”Given the close ties between Britain and the US, there is a view that where corporate America treads, the UK naturally follows. But there are signs that some UK businesses – and even the British operations of some US companies – are prepared to stand apart.The accountancy firm Deloitte instructed staff working on contracts for the US government to remove pronouns from their emails, while also announcing the end of its DEI programme. But its UK boss told staff its British operations remained “committed to [its] diversity goals”.“It feels as though global companies rooted in the US are making a politically motivated slight shift in emphasis and tilt, through to rowing back everything. And it does feel a bit more tempered here,” says Lane Fox.UK businesses have an opportunity to do something different, she says, which could bring financial benefits. “I think we’ll build more robust companies, attract talent and have a much better shot at building the most resilient companies of the future.”For almost three decades, Lane Fox has built a career – and multimillion-pound fortune – in tech. She made her first big money floating Lastminute.com, the online travel site co-founded alongside fellow Oxford graduate Brent Hoberman in 1998.View image in fullscreenShe joined the board of Twitter – now X – in 2016, landing herself a huge payday in Musk’s $44bn hostile takeover in 2022, before he dissolved the board and appointed himself the sole director.Seeing Musk in the Oval Office, parading his son X on his shoulders, made her question the gender divide. “Can you imagine if that was a woman? Can you imagine what that would look like? I mean, I just think the whole thing is really gross.”But while railing against Musk in a personal capacity, the BCC president does not suggest this approach is for everyone. “It is really tricky to navigate. You have a responsibility to your customers and your employees that might be different to our personal view sometimes.”Government regulation to enshrine diversity targets is also a bad idea, she says, preferring instead that companies report their progress. “Keeping it in the light, keeping up the reporting, is important – keeping up good investors, looking at the right metrics and investing in the right companies all helps.”However, not enough progress is being made. Analysis this week showed that worsening unemployment and workforce participation for women has pushed the UK behind Canada to its lowest global ranking for workplace equality among large economies in a decade.The gender pay gap has been declining slowly over time, but average pay is still 7% less for women than for men. It is a challenge Lane Fox is all too aware of. “Look at the data and it is really freaking depressing – and it is not moving,” she says.“What worries me is that it’s far too easy to find numbers that I thought we were moving on from.“In this week of International Women’s Day, we see representation at the executive level has gone back. I see progress on boards is still good at the FTSE 100 level, but bad at FTSE 250 and 350 level.“I know there will be people in the sector thinking: ‘Oh, here she goes again.’ That’s true of many women [that people think that]. But it is so important to keep making these arguments.” More

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      Trans women transferred to men’s prisons despite rulings against Trump’s order

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      Transgender women incarcerated in the US prison system have been transferred to men’s facilities under Donald Trump’s executive order, despite multiple court rulings blocking the president’s policy, according to civil rights lawyers and accounts from behind bars.Trump’s day-one “gender ideology” order, one of several sweeping attacks on trans rights, said the attorney general “shall ensure that males are not detained in women’s prisons or housed in women’s detention centers” and that no federal funds go to gender-affirming treatment or procedures for people in custody.The executive order was quickly challenged in court. In three lawsuits filed on behalf of trans women housed in women’s prisons, federal judges have ruled that the US Bureau of Prisons (BOP) cannot withhold their medical treatment and was barred from moving them to men’s facilities. One judge said the plaintiffs had “straightforwardly demonstrated that irreparable harm will follow”.Lawyers fighting Trump’s directive say the court rulings prevented the transfers of 17 trans women who are plaintiffs in the cases, but others not included in the litigation are now facing placements in men’s facilities.“I’m just continuing to be punished for existing,” said Whitney, a 31-year-old trans woman who was transferred from a women’s facility to a men’s prison this week. The BOP changed her records from “female” to “male”, records show. In messages before her transfer, she said she felt like a “pawn in others’ political games”. The Guardian is not using her full name due to concerns about retaliation.Kara Janssen, an attorney representing trans women in litigation, said she learned of another trans woman not included in the lawsuits who was recently transferred to a facility that houses men, and also had the gender marker in her records changed. Janssen also learned of a trans woman newly entering the BOP system who had gender-affirming surgeries before her incarceration, but was placed in a men’s facility.Prisons are required under the Prison Rape Elimination Act (Prea), a longstanding federal law, to screen incarcerated people for sexual assault risk and consider LGBTQ+ status when making housing decisions. Legal experts say Trump’s blanket policy of housing trans women in men’s facilities clearly violates Prea.“This is incredibly unnecessary and cruel,” said Janssen. “Our clients are desperate and scared.”The BOP did not respond to requests for comment.Trans people have long faced high levels of sexual violence and discrimination behind bars, and the implementation of Trump’s order has unleashed chaos, panic and significant violations of their rights beyond the threats of housing transfers, attorneys said.Internal BOP memos seen by the Guardian show that officials are now requiring staff to refer to trans residents by their legal names and incorrect pronouns, as well as deny requests for gender-appropriate clothing accommodations. The BOP has also rescinded policies that allowed trans women to have their pat-down searches conducted by female guards.Susan Beaty, a senior attorney for the California Collaborative for Immigrant Justice, who represents roughly 20 trans people in federal prisons, said they have received reports that some trans people were forced under threat of discipline to hand over their underwear, including bras and boxers, as if they were contraband. They said they’ve also heard accounts of male guards searching trans women in encounters several of the women described as “groping”. Some staff have been emboldened to harass and taunt trans people, Beaty said.“It is already so difficult to be a trans person in prison in this country, and now this administration’s measures are intentionally terrorizing and traumatizing incarcerated trans people even further,” Beaty said.“It is essentially sanctioning sexual assault in some instances,” added Janssen, of the male pat-downs of trans women. Some trans people had told her they were suffering suicidal thoughts and daily nightmares.Whitney, who was recently transferred, said in interviews prior to her move that staff for weeks gave her conflicting information. In mid-February, she and another trans woman were placed into a form of isolation called a “special housing unit” and told they could be there for months, she said. The other woman attempted suicide out of fear of being transferred, she said.Days later, the women were moved back to the general population. Whitney’s doctor, however, then told her that her hormone therapy medications would start to be tapered down. Whitney said going off those medications would wreak havoc on her body and mind, describing it “like a slow death”. The doctor also said staff would start using male pronouns for her, though she said that had not happened yet. She said she was also told she would be allowed to keep women’s underwear she already owns, but would not be issued new garments.Last week, medical staff told Whitney her medications would not be changed after all, she said, but then days later, she was told to pack because she was being transferred to a men’s facility.skip past newsletter promotionafter newsletter promotion“I’m nervous. Worried. Apprehensive. Anxious. Scared. You name it,” Whitney said before her transfer. “One moment I am feeling relief, and the next I am growing gray hairs. That’s probably one of the most stressful things about all this. Are you safe or are you not?”The litigation is ongoing and is most immediately focused on maintaining trans people’s housing and medical care, attorneys said. But Janssen said lawyers would also be fighting for trans women who have long been housed in male facilities and were in the pipeline to be transferred, and advocating against the rollback of basic accommodations across the system. “It’s cruel and unusual punishment because you’re punishing this group for no reason other than you don’t think they should exist.”One judge criticized the US government for failing to address plaintiffs’ concerns that their gender dysphoria would be exacerbated in men’s prisons “whether because they will be subject to searches by male correctional officers, made to shower in the company of men, referred to as men, forced to dress as men, or simply because the mere homogenous presence of men will cause uncomfortable dissonance”.Alix McLearen, who was the acting director of the National Institute of Corrections (NIC) in 2022 before she retired in 2024, said Trump’s order endangers trans people and staff. The NIC is part of the BOP and does training and policy development for corrections officials. McLearen led the drafting and implementation of the “transgender offender manual” when she oversaw women and special populations at BOP. That manual has recently been rescinded.“If you yank this away, no one knows what to do,” McLearen said. “If you are going to change a policy, you [should] do it slowly and thoughtfully.”Confusion in a prison setting increases stress levels and the potential for conflict among staff and incarcerated people, McLearen said.Trump’s order also increases the already high risk of sexual and physical assault of trans people in prison, said Julie Abbate, the national advocacy director of Just Detention International, a human rights group focused on sexual abuse in prisons and jails.Putting a target on trans people in prison only increases their risk of assault, which in turn also puts staff in the dangerous position of intervening in violent situations, said Abbate, who spent 15 years at the civil rights division of the US justice department and helped draft national Prea standards.Trump’s policy has no benefit, McLearen said. The order purports to “defend women” in prisons, but McLearen said it addresses a problem that does not exist.“This is fake – this whole executive order is false on its face,” McLearen said. “It’s scapegoating. Trans people are easy to scapegoat.” More

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      Trump is tearing up the rights of women. The message from your sisters in the Arab world? Don’t give up: resistance works | Hibaaq Osman

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      From outside the US looking in, those of us who have experienced the tumultuous years since the Arab revolutions feel a strange sense of familiarity: the chaos of the Trump-Musk administration, the attacks on minority groups, the elevation of men – a number of whom have been accused of violence against women – to cabinet positions.Trump seems to have started his second term with the same ferocity, callousness, violence and ignominy in which his first term so notoriously ended. Amid the shock of the past few weeks, a sense of panic can be immobilising. But that is exactly what such a strategy is designed to do.For women in the US who now feel under attack like never before, who sense their rights, even their bodily autonomy, slipping through their fingers, I bid a weary but warm welcome to the club. You must know that you do not need to look far for solidarity. There are women in the US who have had to fight every step of the way to have their humanity recognised by a bigoted and over-mighty state. African American women, Indigenous American women, Latin American women – their civil rights struggles have been extraordinary and hugely influential across the world.But if I may, there are many examples to be shared of women in the Arab world who have taken on the laws, institutions and cultures of oppression that mired their daily lives – and won.With some US politicians now looking to bar women from seeking an abortion beyond state lines, you can take inspiration from the women of Libya. Twice now, the Libyan authorities have declared their intention to ban women from independent travel without a male “guardian”. Female activists met these proposals with campaigns that raised global attention and condemnation, exerting political and diplomatic pressure that resulted in the proposals being rescinded.That this is possible in a country in which decades of dictatorship and conflict have prevented the establishment of a democratic culture shows the power of women organising together in grassroots advocacy. Even when the levers of power are not accessible directly, there is still huge power in working together strategically.When women in Jordan and Lebanon started work on addressing colonial-era laws that meant convicted rapists could escape punishment by agreeing to marry their victim, there were not many female parliamentarians they could find to champion their cause in the corridors of power. So they found other means. On social media, they developed hugely creative campaigns. Through this activism, women’s groups built coalitions that put the issue on the political agenda, with the laws abolished in both countries within days of each other.Such laws – which could still be found on the statute book in France as late as the 1990s – are based on an all-too-common belief that it is more shameful to be the victim of rape than it is to be the perpetrator. The work in Jordan and Lebanon then finds a haunting echo in the amazing courage shown last year by Gisèle Pelicot. Her case emphasises that while legal or constitutional changes are vital, the more difficult but fundamental task is to change a culture that allows such violence and discrimination to be conceived and committed at all.It makes me think of the incredible work going on in Egypt led by my colleagues reaching out to religious leaders. Over years, these activists have brought imams to engage with a study on women’s rights, gradually overcoming resistance and demonstrating compatibility with their faith.Some leaders went further, using the study in sermons and advocating for policies such as criminalising early marriage. That work has required incredible patience, persistence and compassion. It takes a lot to understand where people are coming from and to build a platform for respectful conversation, all without ceding ground or your own principles. But it can be done.Such a task of dealing with, and challenging, deeply held beliefs faces women in the US.American women did not suddenly wake up one morning to find sexual abusers in the White House. The path to this point has been long and ignominious. If things are to change for the better, the road ahead is equally long and challenging – but women can lead the way. There will be missteps, there will be failures. But nothing at all will be achieved if those disgusted and enraged by this state of affairs choose to sit back.The triumphs I have witnessed have been the fruit of years of hard work, of determination, of people being prepared to take risks. The stakes in the US show the time for playing it safe is long gone. This is a time to make noise, to find strength in solidarity and being part of a movement.The Trump administration threatens not only the health and rights of women within the US, but the progress that women have made globally. His cuts to American development, humanitarian and medical aid overseas are already having devastating consequences for women and girls facing violence, armed conflict, disaster and disease. And by cosying up to regimes notorious for perpetrating organised gender-based violence, he threatens decades of work to address the impact of conflict on women and girls.In this fight, women across the world are with our US sisters. Our cause is one – it has always been. To stand up against the injustice and inequality you see is an awesome challenge, but it is not one you are facing alone. More