As the long, angry fight over abortion roars on, Tracy Weitz, a researcher in California, has quietly worked to gather reliable facts about the procedure and the women who choose to have it. A ProPublica Q&A
For the last decade or so, Tracy Weitz has been one of the most prominent abortion researchers in the United States.
As director of the University of California at San Francisco’s Advancing New Standards in Reproductive Health (ANSIRH), part of the Bixby Center for Global Reproductive Health, she has co-authored seven studies in major journals in the past year alone, on topics ranging from how low-income women pay for abortions to why some women who want an abortion delay until it is too late.
This summer, one of the studies she oversaw persuaded California lawmakers to allow trained non-doctors (nurse practitioners, certified midwives, physician assistants) to perform first-trimester abortions, possibly the biggest expansion of abortion access since the Food and Drug Administration (FDA) approved the morning-after pill in 2000.
Now, just as some of ANSIRH’s most ground-breaking work is starting to see the light of day, Weitz is leaving the world of clinical research. She has taken a job at an organization she declined to name but where she hopes her impact on women’s reproductive health issues will be broader and deeper.
Weitz recently spoke with ProPublica’s Nina Martin. This conversation has been edited and amended for clarity and brevity.
NM: How did abortion become the main focus of your work? What is your background?
TW: I’m a medical sociologist by training. I started off trying to figure out how to deliver health care services. I did that for many years as an administrator and was frustrated that we seemed to just be rearranging the deck chairs on the Titanic. I also have a real interest in policy and politics. Abortion for me has always been the natural place in which all of those things come together. It is a political issue. It is a social issue. It is a health care issue. It is a feminist issue.
NM: What are some of the main challenges to doing abortion research in this country?
TW: The federal government has a prohibition on funding any research that involves abortion care. You cannot get funding from the National Institutes of Health to study, say, abortion techniques — how to make it safer. But this ban has been interpreted very, very broadly to preclude funding anything involving abortion, even a topic like women’s emotional responses. That has left the funding of research on abortion to the philanthropic community.
Now, it’s very unusual for foundations to fund clinical research. It’s not historically what they do — research is the domain of government. But in the last 10 years, there’s been recognition in the philanthropic community that in order to make progress [on reproductive rights], whether culturally or politically or in the service-delivery arena, there are research questions that we need to answer.
This [private funding] has opened up an enormous avenue for researchers who are interested in questions about abortion care, abortion policy, and abortion in American culture. But it comes with its own downside, which is that people are very suspect of research that is funded by organizations that have particular ideological agendas.
NM: As researchers, what kind of hurdles and antagonism do you face?
TW: There’s definitely a difference between the social scientists who do the research and the MDs who actually do abortions. Abortion doctors have had assassinations, barricades and constant protesters. As researchers, our safety hasn’t really been in question.
Most of the harassment comes at the level of trying to discount our academic reputation— suggesting that anyone who does abortion-related research who believes that abortion should be legal shouldn’t be trusted. That somehow our science is tainted, that we haven’t used good methods. That’s why we have a strong interest in being published in the peer-reviewed literature. We think that the science should be open to scrutiny. It should be put through the same kind of rigor that other clinical or social research is.
NM: Let’s talk about the study that has probably had the greatest impact so far: the one looking at whether trained non-doctors — nurses, midwives, physicians assistants — can safely perform vacuum-aspiration abortions in the first trimester. That study included nearly 20,000 patients throughout California — one of the largest studies on abortion ever done in the United States. The study had two key findings. First, it found almost no difference in complication rates in abortions done by doctors versus non-doctors. Second, the overall rate of complications for both groups was very low — much lower than abortion opponents claim. Has the study shed light on other abortion-related issues as well?
TW: Yes. One has to do with hospital transfers [patients who require hospital care after having an abortion]. We were interested in this topic, of course, because it’s a category of complication, and you want to track it. But it wasn’t something we intended to focus on.
Then states [including Texas] started passing new laws that require physicians who offer abortion care to have admitting privileges to hospitals. And we realized that, thanks to [the non-doctor] study, we had very good data showing that complications requiring transfers to hospitals are actually exceedingly rare.
Of about 20,000 patients over several years, only four were directly transferred.
NW: There’s a second study I want to talk about, which is known as the Turnaway Study. It’s a long-term study looking at what happens when women who want an abortion can’t get one. They show up at a clinic too late and are turned away.
TW: First some background. At the Bixby Center and ANSIRH, we are driven by three sets of issues and concerns. One is: How can care be best delivered? That’s the question underlying the non-physician study. We’re very interested in safety in general. Do you need to be in an ambulatory surgery center? Do you need to have a nurse who administers anesthesia? Which kinds of cervical preparations are safe and do the least damage to the cervix?
Two, we care a lot about women’s experiences. We know that 1 in 3 women are going to have an abortion in their lifetime. And choosing to be a parent or not is a big decision. Whatever a woman decides, we want to know what can improve their outcomes. What do they need from their social networks and their friends? What are the long-term effects of silence and secrecy?
The third area of interest is social inequities. Where is there uneven distribution of services, uneven distribution of economic outcomes?
The Turnaway Study arose out of the second and third set of concerns. Abortion opponents have been pushing the idea that abortion hurts women, that they feel regret. With 1.3 million women having an abortion every year, it’s likely that a certain number do feel regret. That’s the natural curve of any kind of big decision. What we want to know is: Who are those women and what do they need?
But another of our questions was: what happens to women who wanted an abortion but couldn’t get one? What happens to her economically, what happens to her psychologically, what happens to her other kids? That was the underlying question behind the Turnaway Study.
NM: Can you summarize the findings so far?
TW: The take-home from that study is that most women are having an abortion because they say they can’t afford to have a child. And it turns out that they’re right: Two years later, women who had a baby they weren’t expecting to have, compared to the women who had the abortion they wanted, are three times more likely to be living in poverty. They knew they couldn’t afford a kid and it turns out they were correct.
NM: Can you give some specifics about how the study was designed?
TW: The principal investigator is Diana Greene Foster, who was trained as a demographer. It is an eight-year study and includes about 30 abortion facilities in every region of the country. The sole criteria was that the clinic had to be isolated — it had to be the only one within 150 miles that was willing to do abortions up to whatever it set as its gestational limit [the latest point at which it will terminate a pregnancy]. So if a woman was turned away from that facility, she really had no other option. She probably was going to have that baby.
We recruited about 1,000 women — that alone took us three years. About a quarter were women who had been turned away and had a baby they weren’t expecting.
Approximately 500 were women who happened to be just under the gestational limit when they arrived at the clinic so were able to get the abortion they wanted. They were the comparison group.
We also wanted to know if women receiving earlier abortions were somehow different. So the remaining participants — about 250 — are women who received first-trimester abortions.
We followed the women every six months for five years — a phone interview with a very lengthy survey that includes every question we could think of about their mental health, their economic circumstances, using routine and standardized tools, so we have some basis for comparison. Everyone in the study has finished at least two years, and some women have completed their five years and are rolling off.
NM: What has been your most eye-opening finding?
TW: The study has really exposed how hard it is to be a parent in this country. It is a huge economic investment. And if you don’t have the economic resources to be a parent, there’s nothing to help you.
Data from the study is also helping to answer other questions for which we have no good research until now — for example, how women feel about mandatory ultrasounds before an abortion and what factors contribute to some women feeling regret afterwards.
NM: Finally, I want to talk about some preliminary research you presented at a conference last fall, looking at how state and federal courts view the kind of research you are working on.
TW: ANSIRH was started specifically to ensure that health policy is grounded in evidence. Because many laws aimed at restricting abortion were ending up in the courts, I became interested in how judges were interpreting the science in their legal decisions. We focused on four abortion-related issues where the science is pretty clear — whether women are at risk for suicide after abortion, gestational bans based on the presumption that the fetus feels pain, ultrasound-viewing mandates, and medical abortion regimens.
We looked through over a thousand documents — including lawsuits, briefs, rulings by courts at every level, the scientific studies that are referenced, the CVs of the medical experts whose work was cited. We analyzed not just the court decisions, but their language about the scientific claims, how expert knowledge is referenced, the quality of the research, whether the studies appeared in peer-reviewed journals — that kind of thing. We’ve really just scratched the surface — we had no idea how much there would be out there.
NM: What have you found?
TW: There is no consistent standard for how science is or is not incorporated into the legal decisions. Across the decisions, the same scientific studies are adjudicated very differently. Overwhelmingly what we do see is political ideology substituted for objective standards in adjudicating scientific claims. We were very disheartened to find that many of the judicial decisions were discounting the science altogether. I think I was a little naive. I had this idea that the courts were more objective.
Since I started this work, I’ve been intrigued to discover that there’s a whole body of criticism —a lot of it around climate change — over whether courts should have anything to do with science. When the D.C. federal court was set up, all the patent cases went there. There was a recognition that these issues were really complicated —more science-y — and you needed to have judges who had specific expertise to decide them. Now, whether they’re about environmental science or, in our case, health-related science, these cases are being spread out across multiple courts, and judges with absolutely no scientific training are being asked to make adjudications about science. Should we be training judges to review science? Should we be thinking about specialty courts with scientific expertise?
One of the more troubling findings is the way that controversy has become a reason to discount science. There’s a great book called “Merchants of Doubt” [Naomi Oreskes and Erik Conway, Bloomsbury, 2011]. It’s about the production of scientific controversy as a way to discount legitimate scientific research and clear-cut consensus about tobacco or climate change, but it also applies to abortion. As the book points out, you don’t need to disprove science anymore. All you need to do is suggest that the science is actually in doubt. Courts will then look at and say, “It’s a controversy, so deference should go to the Legislature,” or “It’s a controversy, so we’ll do whatever we want.”
A contributing problem is that, in the legal context, medical experts and scientists who do abortion or study abortion have been seen as suspect. Lisa Harris, at the University of Michigan, has written some great stuff on what she calls “The Legitimacy Paradox.” It goes like this: By virtue of doing an abortion, you’re not a real doctor. Therefore, real doctors don’t do abortions. Therefore, you have the right to regulate them because they’re not real doctors.
NM: That brings me to the last thing I want to talk about, which is the issue of stigmatization. That’s a major thread in your research and writings. Why is this issue is so important to you?
TW: A stigma is a mark that makes you seen as morally suspect. It’s not just bad. It’s bigger than bad.
In the abortion context, stigmatization means that your position on abortion says everything about you as a human being. To do abortion means that you are morally corrupt. The fact that you would have an abortion means you’re a different kind of person. And the consequences associated with disclosure — whether it’s “I support legal abortion,” “I do abortions,” “I’ve had an abortion” — now carry huge social weight. That leads to silence.
Now, I’m a person who fundamentally believes in doing anything that I can to help women have their families when they want to have their families. If I can help her figure out how she gets the contraception she wants and she picks the partners she wants and she has the money she wants so that she never has to have an abortion, then I’ve been a success.
But if she needs an abortion, she needs an abortion. And I’m there for her with that support. I’ve never met a woman who said, “It’s on my bucket list to have an abortion.”
I want everyone to have every tool in their tool-box to be able to have a family, when and if they want to. Any of those strategies are legitimate strategies. That includes abortion.
After former world billiards champion Michael Ferreira, Boman Irani is the second celebrity against whom a complaint has been filed in the Rs425 crore QNet scam
The Economic Offences Wing (EOW) of the Mumbai Police has received a complaint against Bollywood actor Boman Irani and his son Danesh in the QNet scam. Irani is the second biggest celebrity against whom complaint has been filed in the QNet scam. Last week the EOW issued lookout notice against 10 people including QNet founder Vijay Eswaran and former billiards champion Michael Ferreira in the Rs425 crore QNet scam case.
According to sources, police have found transactions worth Rs18 crore in Danesh's bank accounts related with QNet. The actor was also present at several promotional events organised by Qnet in India. Earlier in August 2013, Moneylife had asked Boman Irani through Twitter about his ties with QNet, but the actor kept mum.
The EOW has already registered a case against directors and officers of Vihaan Direct Selling (India) Pvt Ltd, QNet, Transview Enterprises Pvt Ltd and Vanmala Hotels & Tourism Services.
Ferreira was summoned by the EOW in connection with the Rs425-crore scam allegedly committed by multi-level marketing (MLM) operator QNet. The former world champion is founder of Faith, which was started as a distributor network under the QI brand. However, the former Billiards champion did not turn up before the EOW, which resulted in police issuing a look out notice against him.
QNet operates in India through its official franchisee Vihaan Direct Selling Pvt Ltd, which carries the company's brand name in the country. Ferreira owns 80% stake in Vihaan Direct Selling with Malcolm N Desai holding the rest. Desai had already approached the Sessions Court in Mumbai for an anticipatory bail fearing that the EOW may arrest him soon.
As reported by Moneylife, QuestNet and GoldQuest, the MLM companies that had shut shop in 2009 following police action came back with a bigger bang. They now call themselves as QNet and are thriving in an environment where tens of thousands of Ponzis and MLM companies are able to lure people into believing that they have the formula to instant riches and a high growth career.
Here is the complaint filed by Gurupreet Anand against Boman Irani and his son, Danesh...
Unless the Nifty manages to close above any previous day’s high, the index may head lower
On Monday, we mentioned that the down trend is losing steam. The market opened Tuesday in the positive where it remained for a while, before plunging into the red and giving up the day’s gain. We had mentioned that the close below 6,165 will signify further downside for NSE Nifty. The index closed today below that level.
The BSE 30-share Sensex opened up at 20,846 and immediately hit a high of 20,890 while Nifty opened up at 6,204 and hit the high almost at the same level at 6,222. After about 25 minutes, the indices started sliding down and hit the low of 20,637 and 6,145. After a range bound session until 1.40 pm the indices tried recovering, but closed in the negative for the fifth consecutive session. The Sensex closed at 20,693 (down 94 points or 0.45%), while the Nifty closed 6,162 (down 29 points or 0.47%). Today’s fall has happened on a higher volume of 74.95 crore shares on the NSE.
Except for Pharma (up 0.22%) and Auto (up 0.09%) all the other indices on the NSE closed in the negative. The top five losers were Metal (1.76%); Realty (1.74%); PSU Bank (1.65%); Commodities (1.47%) and Energy (1.42%).
Of the 50 stocks on the Nifty, 15 ended in the green. The top five gainers were Maruti (2.28%); IndusInd Bank (1.60%); M & M (1.29%); Sun Pharma (1.01%) and ICICI Bank (0.94%). The bottom five losers were Tata Steel (3.75%); Bank of Baroda (3.32%); Tata Power (2.63%); Sesa Sterlite (2.51%) and BPCL (2.24%).
Of the 1,226 companies on the NSE, 492 companies closed in the green, 670 closed in the red while 64 closed flat.
Markit Economics said that the HSBC Emerging Markets Index (EMI), a monthly indicator derived from the PMI surveys, signaled overall growth of output across global emerging markets in December 2013. But, the EMI fell to 51.6, from 52.1 in November, signaling a weaker rate of expansion. Manufacturing output continued to rise at a faster pace than services activity, and the rate of growth was only fractionally weaker than November's eight-month high. Meanwhile, service sector output rose at the slowest rate in three months. New business inflows in global emerging markets rose for the fifth month running, although at the weakest rate since September. Backlogs continued to expand marginally. Inflationary pressures in emerging markets remained muted in the final month of 2013. The HSBC Emerging Markets Future Output Index fell to a six-month low in December. But, the index's average in Q4 was higher than those in the previous two quarters.
US indices closed flat on Monday however with a negative bias. The Senate on Monday approved Janet Yellen to be the first woman to run the Federal Reserve in the central bank's 100-year history. Yellen's four-year term will begin on 1 February 2014.
The Institute for Supply Management said Monday its services index for December decelerated to 53% from 53.9% in November. In a separate report, orders for goods produced in US factories jumped 1.8% in November. The increase, led by orders for durable goods, suggests the manufacturing sector enjoyed stronger growth than the services side of the economy toward the end of last year.
Among the Asian indices, four indices closed in the positive while five indices closed in the negative. Seoul Composite, was the top gainer, which rose 0.32% while Jakarta Composite was the top loser which fell 0.64%.
European indices were trading in the green and the US Futures were also trading higher.
British businesses plan to hire more staff and invest in new equipment this year, signaling the UK's economic revival is likely to gather strength through 2014. A survey of nearly 8,000 businesses by the British Chambers of Commerce, published Tuesday, said a gauge of manufacturing firms' hiring intentions reached a record high at the close of 2013, while firms in Britain's services sector reported their strongest hiring intentions since the end of 2007.
French consumer confidence rose slightly in December, although it remains at a level below its long-term average, statistics showed Tuesday. Consumer confidence measures by national statistics agency Insee rose to 85 in December from 84 in November. The long-term average reading is 100.