A Gospel from Clay and Dust

Raegan McDonald-Mosley, MD’04, MPH, found her calling during medical school to fight a “needless form of mortality” facing women. During her time as the first chief medical officer of Planned Parenthood, that struggle put her in the national spotlight.

By S.I. Rosenbaum

Photos by Peggy Peterson

Raegan McDonald-Mosley, MD’04, MPH, closes her eyes and prays.

God, she thinks, as she does on every day she spends in the clinic: God, please let me adequately support these women. Let them all do well and go home healthy in mind, body, and spirit.

She opens her eyes. It’s 6:45 a.m., her last moment of calm before she heads to the Planned Parenthood health center in Baltimore. All the patients she will encounter today, including those who have come to the center for abortions, come to her at a crucial point in their own stories, and while McDonald-Mosley may never know their whole story, she’ll observe each woman closely to see how she can best serve her. Some of them will need her warmth, her compassion; others will merely need her professionalism. In rare cases, when the occasion is just right, she has been known to sing to them.

This is the part of her work she looks forward to most: the place she gets to do what she knows best, to help people most directly. She has had many days like this when she has needed to stop what she’s doing, duck into a counseling room and hold a press conference by phone with journalists all over the country. It was a day like this when the Trump administration moved to strike the birth control mandate from the Affordable Care Act. McDonald Mosley was in demand that day because she is more than just a doctor—she was the first person to serve as chief medical officer of Planned Parenthood Federation of America (PPFA), a role that made her one of its primary spokespeople at a time when Planned Parenthood has been fighting for its life.

“I recognize that abortion is a real polarizing issue,” she said. “Yet I feel that anyone who has lived my life, and had the experiences I have had, would see the issue the same way I see it.”

To understand what powers McDonald-Mosley, what shapes her, you have to know about a dusty basement in Tanzania. You have to know about a rural church in Massachusetts. And you have to know about an unspeakable crime committed in the red clay country of North Carolina, in the days of Jim Crow.

Blank Spaces

When Raegan McDonald was born, the nurses who filled out her birth certificate left the space marked “race” blank—they could see that her mother was black, but weren’t sure what to make of her father’s light skin and blue eyes. Among the nine children in the blended McDonald family, baby Raegan was the lightest. Her sisters used to tease her, telling her that she was adopted, that she was really Italian, that she wasn’t really black.

It was enough to make her want to overcompensate a little. “Subconsciously, I dress ethnically and gravitate to an Afrocentric aesthetic,” McDonald-Mosley said.

So in college, at the University of North Carolina at Chapel Hill—not that far from her father’s birthplace—she grew out her hair, styled it into locs, and became an African Studies major. And in 1999, her senior year, she was off to do a research project in Moshi, Tanzania, the first of two trips she would make to Africa as a young woman.

Her research project was to find out what was killing pregnant women at the Kilimanjaro Christian Medical Center. It was one of only two hospitals in the area that kept records, and they kept them in the basement. It was hot down there, and dusty. She spent hours there poring over documents, reading reports. She’d thought, going in, that the pregnant women were probably dying of AIDS complications, or lack of transfusions, or hypertension. It was none of those things.

In Tanzania, abortion is punishable by up to 14 years in prison. And again and again, the reports told her, dying women came to the hospital after attempting to abort a pregnancy by themselves or with help from healers. It was the leading cause of death for pregnant women.

At times, the heat grew too much and the dust irritated her eyes and nose. One of these times, she wandered up from the basement to take a break. The hospital’s wards were open, and she saw a woman who looked very sick. Internal bleeding, multiple organ failure, the doctors told her. The woman couldn’t care for another child, so she’d gone to a healer.

“You can imagine this dichotomy of experience, where I’m poring over these hospital records, reading these stories of women who come in near death, the severe morbidity related to unsafe abortion,” McDonald-Mosley said, remembering. “Then I pivot to being on the ward and actually seeing it.”

As a kid, her parents had thought she might become a minister. In college, she’d leaned toward becoming an academic. Instead, when she came home from Tanzania, she was on a different path.

When she returned to Africa, it was as a medical student at the University of Pennsylvania. This time she traveled with a young culinary student, Damian Mosley, who would soon become her husband. While he studied West African cuisine, she worked in a hospital in Dakar. In Senegal, abortion is legal but highly restricted, and once again Raegan McDonald saw women who had been horribly injured by amateur procedures. One had a punctured colon, but swore she hadn’t tried to abort the pregnancy. To admit so much would be to admit to a crime.

At night, after her shift, she would tell her fiancé about the women she was treating in the hospital. He was a good listener. It was something she loved about him.

She didn’t tell him then, but she was becoming surer and surer that this was her calling—her ministry, as her mother would put it years later—to fight what seemed like a “needless form of mortality” for women.

“I would dedicate my life to reducing that in any capacity I could,” she said.

Path to a Calling

The idea of having a calling—of being used for a purpose by something bigger than herself—was something she’d learned at Calvary Baptist Church in Haverhill, Massachusetts.

The church has a domed white ceiling held aloft by honey-colored wooden beams. It’s a place where folks lay on hands; a place where they sing. Growing up, whenever McDonald-Mosley and her sisters weren’t traipsing through her family’s three-acre patch of woods, they were here: Wednesdays for Bible study, Saturdays for choir practice. This is where McDonald-Mosley first deployed the mezzo-soprano that would someday soothe her patients. “I lived at church,” she said.

Out of her sisters, she was the one who seemed most interested in the Bible and the lessons it described. “Her father and I thought she was going to go into ministry,” recalled her mother, Miriam McDonald. “She always had a penchant for the underdog or making sure the right thing was done, that people were properly represented. That was part of her DNA.”

Church was where McDonald-Mosley learned to think in terms of justice. She didn’t hear all that much about the wages of sin from the pulpit there, she said. Instead, in the tradition of African-American church activism, it was, “How do we fill the needs of community, how do we get food to people who are hungry, how do we enrich our youth so people get on the right track and go to college?”

After graduating from medical school at Penn in 2004 and completing a residency in obstetrics and gynecology at New York University Medical Center—and having two children— McDonald-Mosley took a fellowship at Johns Hopkins University School of Medicine and earned a master’s of public health at the Bloomberg School of Public Health. She still thought she might end up as a teacher. But when Planned Parenthood of Maryland asked her to be their medical director, she saw a greater opportunity.

“Where else can you work where, regardless of whether the patient has insurance, it doesn’t matter—we’re here to take care of them and give them what they need, no matter what?” she said. “It was a way to be a physician and also be a justice advocate.”

She didn’t talk about her new job much when she went home to Calvary Baptist, though. “I think I was a little worried they would judge me, even though I didn’t hear any anti-abortion rhetoric there,” she said. In the end, neither her family in Christ nor by blood took her to task—except for one.

“I did have one cousin who said to me—and this really stung—‘It made sense when you became an OB/GYN, because you’re so compassionate and care about women and babies. But it doesn’t make sense to me you’d specifically [perform abortions].’ That didn’t go along with her view of how she saw me, as a super empathetic loving person,” she said.

“I wish I’d had the clarity of mind to say to her, in that moment: That’s exactly why I’m so interested in this work. That’s exactly why I do this work.”

She worried at first that she would miss teaching. But it turned out there was plenty of teaching to do. As medical director, McDonald-Mosley instituted regular Skype training sessions with clinicians at Planned Parenthood clinics all over the state, so they could coordinate their standards of care. She also loved working with midwives, nurse practitioners, and young doctors. “Every time I had a question, she had an answer,” said Gretchen Nettle, a Planned Parenthood clinician who became one of McDonald-Mosley’s many protégés. “And she never makes me feel less for not knowing the answer or needing an answer.”

“She was always helping us, guiding us,” said another clinician, Sharon Reith. “She makes you feel like you’re the only person in the world when she’s talking to you.”

There were other initiatives she was proud of, too—like making it easier for patients to access long-term birth control, and making sure all women who came to the centers for abortions got access to birth control as a matter of routine. Before, these patients weren’t offered long-term birth control methods before leaving the clinic; now, McDonald-Mosley made sure they could get an IUD the same day, if they wanted, at any Planned Parenthood clinic in the state. “The patients were so grateful,” she recalled.

Still, after five years, when the position of chief medical officer for the national Planned Parenthood organization was created, McDonald-Mosley didn’t think at first that she should apply. The listing asked for ten years of experience, which was more than she had. “When they invited me to apply, I didn’t think I was going to be a top candidate or a serious candidate,” she recalled. “But the more I learned about the position, the more I realized it was doing what I was doing at Planned Parenthood of Maryland—but on a national scope.”

The position was a new one, designed as a spokesperson who could draw on a knowledge of both hands-on clinical experience and a familiarity with women’s-health policy and best practices. In a way it was tailor-made for her. Besides, it was 2014, and the organization was in an optimistic mood: Abortions and teen pregnancies were down nationwide, health care access had just expanded through the ACA, Obama was in the White House. ”It seemed like the tide was turning,” McDonald-Mosley said, “that we could move toward more access and innovation and decreasing inequity. The ACA had been in place a couple of years, we were making good progress. It seemed like this is a good opportunity to jump on board and be part of something really positive.”

When they offered her the job, she took it.

Turn of the Political Tide

On July 14, 2015, McDonald-Mosley had just dropped her kids off with their grandmother in Massachusetts and was driving back to Baltimore when her cell phone buzzed. She ignored it. It buzzed again. And again.

“My phone was just blowing up,” she said.

A group of anti-abortion activists, posing as a medical research supply company, had managed to film a meeting with a Planned Parenthood executive. The footage they released—Planned Parenthood officials say it was heavily edited—showed a physician appearing to discuss the sale of organs from aborted fetuses. In reality, the doctor was discussing how much it cost to process and transport fetal tissue that patients have donated to scientific research; Planned Parenthood says it makes no profit from these donations. But for many viewers, the footage would seem damning.

As she watched the video, McDonald-Mosley felt her stomach drop. She had been chief medical officer for exactly 14 days.

At that moment, she said, “I knew everything was going to be different.”

The response was immediate: Conservative politicians called for investigations of Planned Parenthood and talked about possibly defunding the organization. Donald Trump—who had recently announced his run for president, but wasn’t yet considered a serious candidate—quickly worked the video into his talking points. “I mean these people, what they say and the way they, it’s like you are selling parts to an automobile or something,” he told conservative radio host Laura Ingraham not long after the video’s debut.

McDonald-Mosley led the briefing team, but in the weeks and months to come strove to balance the video’s negative message with a positive one on many aspects of sexuality, speaking to outlets such as Cosmopolitan, Glamour and Teen Vogue about how to use condoms or overcome obstacles to sexual pleasure. She had become a public face of Planned Parenthood. It was a time she recalls as “traumatic,” and her husband remembers her being “under tremendous stress and a tremendous burden,” to a degree he hadn’t seen since she was pregnant during her medical residency.

Others at the organization were unaware of her private doubts. “All I could tell from the outside was that it was pretty amazing that she was able to join and jump in and handle what was obviously a difficult situation,” said Julia Kohn, Planned Parenthood’s national director of research. “I think she maintains a calm presence, and even in the face of adversity she really understands the importance of speaking to audiences in a way they can hear it.”

In Baltimore, McDonald-Mosley had worked closely with the city government and state health department. It was a liberal city and state, and she had felt valued by the community. Now, on the national field, that was no longer true.

The election of Donald Trump with a conservative tide in federal and state legislatures in 2016 next took the country, and the organization, by surprise. In the year that followed, a series of legislative and regulatory moves changed the backdrop for their work. Across the country, numerous movements emerged in state legislatures and the federal government to restrict access to both abortion and birth control. The Trump administration loosened the interpretation of Obamacare requirements mandating all health insurance include contraception coverage without a co-pay, so it is now easier for employers to deny this coverage to employees. Each narrowly defeated attempt to “repeal and replace” the Affordable Care Act has included a measure to block Planned Parenthood from receiving government funding for non-abortion health care to low-income patients in the form of Medicaid reimbursements and Title X federal grants for family planning services.

“I have lots of moments of personal doubt,” McDonald-Mosley said in an interview in September 2017. “I’ve really been stressed in the last two years, and wondered if I’m the right person to do this job. But I never have doubt in the movement or organization.”

That month, the Lasker Foundation honored Planned Parenthood with the Lasker-Bloomberg Public Service Award, a selection noted by the New York Times as an entry into “more political territory” than usual for the humanitarian and scientifically focused prize. The foundation cited Planned Parenthood’s provision of essential health services, including comprehensive reproductive health care, for more than a century, serving 2.5 million people just in 2015.

In her work as the organization’s chief medical officer, McDonald-Mosley continued to issue statements, go on TV, write op-eds, and see patients. She appeared on the Daily Show and published perspectives in the New York Times. She talked about everything from her personal experiences learning about sex from her mother, who had been a teenage parent, to the vital role of Planned Parenthood’s preventive care services, such as cancer screenings. It would be daunting for anyone, but people who know McDonald-Mosley say she’s relentlessly dedicated. “Raegan manages to combine the first-hand experience of delivering care to our patients every week in Baltimore while working to address the most important health care delivery issues across the country,” said PPFA President Cecile Richards. “Her commitment as a health care provider and her passion for our movement have made her a heroine to patients, colleagues, and women everywhere.”

In December 2017, McDonald-Mosley reassessed her position and the hardship caused by travel that brought her from Baltimore to New York and Washington over the span of every week. She stepped back to her previous role as medical director of Planned Parenthood of Maryland, where she remains committed to her patients, to her calling to provide the care her patients need.

Born with this History

When people ask her to justify her work, McDonald-Mosley often reaches back to her experiences as a college and medical student in Tanzania and Senegal. “I provide abortions because I have seen firsthand the devastating consequences for people who do not have access to safe, legal abortion by trained providers.” That’s a quote from her in an official Planned Parenthood tweet.

But there’s more to it than that. There is a story McDonald-Mosley doesn’t remember being told; she pieced it together, she says, from murmurings in her family as she was growing up. The story goes like this:

In 1936, a girl was raped in the red clay farming country outside Charlotte, North Carolina.

She was black. The man who assaulted her was white, and he owned the land her family farmed. Abortion was completely illegal then, not just in North Carolina but everywhere, and there was no question of pressing charges in the Jim Crow South. So nine months later, the girl gave birth to a boy she named Robert. She was not yet 14.

She raised him as best she could until he was about 7, when she gave him up to foster care. It didn’t stick. He kept running away, running back to the woman who birthed him, until he was old enough to join the Navy. Robert McDonald told his recruiter that he was white so that he could learn a skill while he was in the Navy. He was light enough to pass.

He served in Korea, and afterwards he eventually wound up in Boston, where he hung around in jazz clubs and met the beautiful daughter of a jazz pianist. Her name was Miriam. They named their youngest Raegan.

“I don’t think she’s ever far removed from remembering how she got here,” said Damian Mosley, the man that child would later marry. “The burden she carries, it’s a burden connected to where you come from; it’s a burden that’s connected to freedom and ideas of freedom, and I think that’s something that maybe not every single one, but most black people in America have some experience of.”

“It’s hard, as a person whose literal existence comes out of a history of racism and violence, for me not to think about it all the time,” McDonald-Mosley said. “My literal DNA, my self.” Her own experiences are inextricable from the history that came before her. If she hadn’t been teased by her siblings for inheriting her father’s light skin, would she have insisted so hard on claiming an Afrocentric identity, gone to Tanzania? To Senegal? Would she have seen what she saw, become the person she became?

“I am who I am,” she said. “I was born with this history. All I can do is make something constructive of all of it.”

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