It is an UnifiedPush distributor, so it can replace FCM for applications supporting it. Here are most of the applications supporting UnifiedPush right now: https://unifiedpush.org/users/apps/
This is the way. UnifiedPush is sllooowly becoming more popular. Element (Matrix chat app) just added official support for it, which is super cool. And you can use ntfy as a distributor.
Yes, in the same way that you need to trust Whatsapp not to MITM you. What's your perceived difference between these trust levels, other than one is something you pay for with money, and the other doesn't require money?