Episode 5 – Abigail Aiken

[0:00:00 Speaker 1] This’ll is Policy on Purpose, a podcast produced by the LBJ School of Public Affairs at the University of Texas at Austin. Way take you behind the scenes of policy with the people who help shape it. For more. Visit LBJ dot utexas Study.

[0:00:18 Speaker 0] Teoh Welcome

[0:00:22 Speaker 2] to Policy on Purpose My name is Angela Evans, and I’m the dean of the LBJ School of Public Affairs at the University of Texas at Austin. My guest today is one very special person to me. Her name is Abigail Hagen. She is an assistant professor of public affairs here at the LBJ School and has dedicated her career to researching factors that affect sexual and reproductive health, including one of the most highly charged issues in society. Access to abortion. Abigail comes at this issue from a rich background and biomedical sciences, public policy, democracy, demography, scudi and public health and democracy to in terms of equal access to this. In addition to her PhD in public policy, Abigail holds an M. D from the University of Cambridge and the masters of public health from Harvard. So you can see this rich background has just come to fruition at a time where the LBJ School can make a difference in the world

[0:01:14 Speaker 3] working on a very complex, controversial problem where Abigail could bring some really great fax and her expertise and background So information can be used in making really difficult decisions.

[0:01:26 Speaker 2] So her research is not Onley impactful in terms of Texas, it’s been impactful around the world. Last year, she testified before the Irish Parliamentary Committee, responsible for deciding the scope of the 2018 referendum to legalize abortion in Ireland. At a time when women’s issues are so in the forefront of our national conversation, I want to bring Abigail and to talk about her research and how she uses it to inform policy. Welcome. And two gals, Thank

[0:01:53 Speaker 4] you very much. Glad to be here,

[0:01:55 Speaker 2] Abigail. Tell everybody what inspired you to jump from clinical your clinical perspective and health to the policy focus? Well, I think

[0:02:04 Speaker 5] that clinical medicine brought two things toe life for me. One waas how often we make decisions without really any good evidence at all, and that could be at a legislative policy level. Or it could be at the clinical level that I was at looking at some of the guidelines that we hade and asking the question of Wait, what’s the evidence behind this? And sometimes we find ourselves in the clinical setting, really working in the dark. And I think that’s not that different somehow to how people often work in the legislative environment tube. So that was something I cared about throughout my entire time. A clinical school. The second thing I think that you get from clinical medicine is the really experience that people go through. So when you’re interacting with patients, one on one, when you see them come through clinics when you’re responsible for their care, you also understand the human piece off the stories that the things people go through and when you think about policy, that’s always something I think is really important to have in mind.

[0:03:02 Speaker 3] I think that’s really important. You’re talking about the clinical perspective, not only the knowing the medicine and the discipline of that, but also looking at from the client perspective from the patient perspective. So

[0:03:12 Speaker 2] talk to us a little about you’ve been moving

[0:03:14 Speaker 3] through these policy communities, even though you’re young and new in your career, relatively new in your career. You’ve worked at the very high levels. You’re talking about the Irish Parliament. You’re talking about serving on central health here in ah, in

[0:03:26 Speaker 2] Texas. What have you

[0:03:27 Speaker 3] seen as some of the obstacles to the policy makers in terms of their ability to understand and go know who to go to to get this kind of information that’s based on fact and data and research.

[0:03:40 Speaker 2] That’s very

[0:03:40 Speaker 5] interesting. And it’s something that I actually have thought quite a bit about because sometimes when you see people operating in the legislative space, you wonder if they have a sense for the fact that you could basis evidence, his policy on evidence. You you could actually go and ask an expert, and you could see what the evidence based looks like.

[0:04:01 Speaker 2] And I think sometimes

[0:04:02 Speaker 5] when you’re dealing with issues, particularly these very sensitive issues like abortion, people are not necessarily thinking off them as having an evidence base. We’re not thinking about that as an aspect of medical care. They’re not thinking about that as really a a service that you might provide to someone. They’re thinking of it as a very moral or ethical issue only, and not to say it doesn’t have that component to it. But by taking your very one dimensional view

[0:04:26 Speaker 2] to it, the idea that

[0:04:28 Speaker 5] there could be some evidence you might ask for or look for maybe doesn’t occur to them. And one of the interesting experiences about talking with the Irish Parliament was that moment of recognition for some of the people in the room. That weight there actually is an evidence base that we can explore here, and one of the really cool things about that experience was people’s willingness to do that.

[0:04:50 Speaker 3] You know, I think that that is just an example of how our work in public policy schools could be used by people just

[0:04:56 Speaker 2] to make

[0:04:56 Speaker 3] a determination to you making an informed decision, which is, Ah, lot of us use that phrase. But we don’t always go behind what the phrase means.

[0:05:04 Speaker 2] The other thing. I want

[0:05:04 Speaker 3] you to talk to us a little about

[0:05:05 Speaker 2] you are very comfortable with

[0:05:07 Speaker 3] in engaged with a lot of different disciplines.

[0:05:10 Speaker 2] So when you’re in the field

[0:05:11 Speaker 3] of public policy, it’s really important for us to go out and seek the input and advice and counsel of other other disciplines.

[0:05:18 Speaker 2] You’ve worked with statisticians clinicians, economists, sociologists and talk to us a little bit about if you can give us a magic recipe of how you work with a lot of disciplines bringing their focus, their

[0:05:31 Speaker 3] methodology and together so you can have a cogent kind of approach to a policy. So we’re not confusing people with complexity.

[0:05:39 Speaker 2] Yes, I think. To me, it’s a very

[0:05:41 Speaker 5] natural thing in policy toe. Want to do that to bring these different lenses to a problem? Because when you think about any issue of public policy, it’s really hard to pin it down into one particular area. Very, very rarely is some policy issue Justin issue of economics or just an issue off culture or just an issue of medicine. Right? And so to me, it’s very natural to go looking for all those different pieces of the puzzle on. I enjoy putting them together to kind of bring ah, holistic view to a policy issue. I think you get a better solution that way when you search outside of your own particularly narrow track. I also think that it’s very important to know what you don’t know, and when you’re thinking about an issue and you’re thinking about from someone else’s perspective. You want to ask yourself, You know, am I analyzing these data in the very best way possible? Or am I leaving out a certain piece of the puzzle here that could really make this better? And so for me, because I think part of the reason I’m sensitive to this is that I have been through many different disciplines on my own kind of meandering track to get to where I am now. So I think it’s often having awareness in my mind off. I want to consult with that person. I want to bring them on board. I want to find a solution that works for the most people possible, and you do that by making thes cross disciplinary collaborations. Plus, they’re also really fun. You know, you get to meet a lot of interesting and very smart people by doing this, and they don’t even often know much about the policy world. But they love the idea that their research could be applied. Teoh the problems of the society and trying to make life better for people.

[0:07:07 Speaker 3] And your answer is wonderful because what it does if he has two sides to it. One side is if you are going to be informing policy in a very high stake level, that is gonna affect a lot of people. Wouldn’t you want the best information? And the best information doesn’t always reside in one discipline. So bringing the other disciplines that’s important and the other is a different methodologies in the different ways of thinking about it. So the problem could be attacked from a lot of different angles, and I think that’s really important. But

[0:07:33 Speaker 2] some people are just not comfortable doing that. So can you

[0:07:36 Speaker 3] say, Can you give any kind of helpful hints for People are a little nervous about that because I think what you’ve he had is you could success and people wanting to work with you. So part of it is your openness, and part of it is your ability to collaborate. Are there other tools or other helpful hints that you can give to? People are a little nervous about taking on other disciplines in terms of their research. You

[0:07:58 Speaker 5] know, I think it’s important to sort of dip the toe in, go over and see what people are doing in other departments. You know, 10. Some talks. I know it’s always hard to find the time to do this, but also when you go down to the Legislature, when you go to wherever it is, that policy gets made and you

[0:08:11 Speaker 2] see who else is there. Part of that

[0:08:14 Speaker 5] helps you to understand who’s not there, right, and maybe you can go and help bring them into the fold.

[0:08:18 Speaker 2] And then sometimes you,

[0:08:19 Speaker 5] on the other people who are just dying to get a, you know, toe in the water. But they don’t know how to go about it themselves, and you can help them to do that. So I think that a lot of it is about sort of being brave and thinking that you can get a better solution if you go do this. So

[0:08:33 Speaker 2] just being aware of

[0:08:34 Speaker 5] what’s out there, and you’d be surprised how many people one that you talk about, the policy relevance they go. I wish we had that in my field, and you can say you do. You just gotta and I could help you do that because I’ve been connected to that world. So I think it’s partly three awareness and then also the willingness to just to go forth and talk to people.

[0:08:52 Speaker 3] You are what you are because of your past and the fact that you had that clinical experience when you actually could see patients and folks who were supposed to be helping either through our policy through our application of medicine really adds a dimension that we’re trying to do with our students, which is tell the students to go out and actually meet and talk to the people that they think they’re helping. And I think that’s an important part of what’s grounded you and made you, as you say, courageous or a little fearless and going outward because you see the end, you see the patient.

[0:09:23 Speaker 2] Can you

[0:09:23 Speaker 3] embellish on the had a little bit about what it meant to you to have that clinical background before you went into the policy perspectives in the arena. In your

[0:09:31 Speaker 2] work? Yeah, I can’t. And I think for me

[0:09:33 Speaker 5] it started almost even before that. You know, I grew up in Northern Ireland and Northern Ireland is an interesting place. It’s a lovely place. It’s very close to my heart, but it’s one of the few places in Europe where we still have laws that govern sex. Reproductive health, dating to Victorian times 18 61 is for abortion.

[0:09:50 Speaker 7] Law in Northern Ireland

[0:09:52 Speaker 5] dates to So I grew up with a sense of the human experience of what it’s like to be an individual who might be marginalized, who might have a difficult time. You know, being a female in an environment where being a female is a tough thing to be S O. That put me into clinical medicine in the first place. I wanted to be able to connect with people who needed healthcare and try to understand from their own life experience what it’s like to go through that even if you don’t go through it yourself, you can still have empathy, and you can have understanding off the experiences of others. And when you get into clinical medicine, that’s the place where you really see that because you see people come through the system. You also see not just what happens to them once they’re there. But if you take the time, you also see how they got there while with barriers to getting here today, what have you gone through? Um, and you know often you’ll find it with conversations in the clinical sphere. Ah, lot of what people talk about is that they talk about the experience of the illness and not just the solution to the illness or or the condition or whatever they’re dealing with. On I found that inspiring that made me think about how could we have kept you out of hospital in the first place? And how could we have made these services more accessible for you? So that was something that I really drew from my clinical experience. I think it’s a wonderful thing to be a clinician and to treat people and help them and treat disease. But for me, the direction it made me movin was, Let’s see how we can look at this from a sort of a bigger picture and try to make these services better and more accessible and more responsive to the needs of the person. Thank you. Great

[0:11:22 Speaker 2] answer. We know that you’re

[0:11:23 Speaker 3] doing some really important work in Ireland to support, you know, the Irish Parliament and the people moving for with legalization of abortion.

[0:11:31 Speaker 2] But what should

[0:11:31 Speaker 3] Americans know about the state of reproductive health here when we think about women and women’s health in a major part of women’s physical health is defected, their childbearing. So we have the pregnancy, the pre pregnancy, the pregnancy and then, you know we have Our record is not very good in terms of post partum, you know, health.

[0:11:50 Speaker 2] So tell me a little bit

[0:11:52 Speaker 3] about what you see. The dimensions of the policy, uh, the policy debates that are coming along that might be a little bit different than they were in the past.

[0:12:01 Speaker 2] Yeah, there’s

[0:12:02 Speaker 5] several big ones and you know, I’ll tell Use Texas is an example, goes. This is something we haven’t talked about much yet, which is the maternal mortality issue. And so we’ve heard a lot. We’ve seen a lot about maternal mortality rates rising in Texas on drily now being they were already unacceptably high, but now really high.

[0:12:20 Speaker 2] And there’s a lot

[0:12:22 Speaker 5] to investigate on that issue coming at it from a scientists perspective, the first thing you want to know is, let’s look at the consistency of those data over time. We want to know, Are we seeing a real increase? Are are we seeing a difference and say how records were collected or how gesture reported or what we now count is a death in Texas. That’s the first question that a scientist is gonna ask right then, after having done the analysis, if we still find that these increases are riel than were worried, and we want to figure out what are all the moving pieces that might have contributed to that? That’s incredibly complex. You know, when we think about all the different contributors, you’ve got the fact that people don’t have good access to care you If you qualify for Medicaid, you have that during your pregnancy. You have it for six weeks afterwards. Then it goes away and any other problem you have you’re still postpartum, by the way, is then going to be your own problem. You don’t have the insurance to cover anymore. That’s something we think about A lot in my role in central health as well is how do we then step in to try to cover that gap. Then you’ve got to think about issues like mental health. So not all the things people are experiencing post pregnancy that might contribute to maternal mortality or physical things. Some of those will also be postpartum depression, which could be really very serious, say postpartum substance use and those things we don’t really have. Sometimes the capacity to first of all, identify all of those people and second of all, understand what to do with them to help them. We really need a robust service that could do that. So I think that that’s going to one of the big issues that is not going away in Texas anytime soon. It’s got to be addressed. We also know that it particularly affects different communities. We know that even if maternal deaths have started to be reported differently, they were higher. Are still higher among women of color, an African American woman in particular. And that is an issue of equity and something that we really have to think hard about. So I would say that’s something coming up for the next Legislature kind of thinking ahead another year. We also have to think about the fact that you know, I’ve been working in Ireland. We talked about that and how you’re looking there at a situation where apportions not available. It’s not a right you’re looking in the United States where you’ve got a completely different environment. It’s legal here. And yet many, many people, especially in our state here struggle to access it for financial reasons, for the reasons of having to travel a long way for reasons of having to go through medically unnecessary obstacles before they can have an abortion. And so what happens to people in that environment is a question that I’m actively researching right now. Um, what happens to someone who can’t get to an abortion clinic in Texas or in Ohio or in Alabama or any of the states in America where Clint Cox has gotten harder and harder? That’s something that we need to start grappling with. It’s a very difficult thing to research. It’s a difficult thing for us all to come to terms with, but it’s going. Teoh, I think, become a really important policy issue. Moving forward.

[0:15:10 Speaker 3] I think you’ve hit another important message here about the role of public policy in terms of its not only it is a driver of debate and legislative consideration and deliberation, but the fact that is grounded. It has to be grounded in fact and has to be grounded in research and like you said earlier in an answer a good thing to tell us what we know and what we don’t know. And if we don’t know what, what are we gonna do about collecting it so that we don’t continue not to know this? So this is a very important part of our work here at the LBJ School, both in terms of the research, but also instilling in our students the need to understand this important aspect of their careers. When they leave, they leave us.

[0:15:51 Speaker 2] So you knew huge

[0:15:52 Speaker 3] on so much in terms of your research. Your your well published your scholar, you’ve done a lot of work in terms of being on boards and involved in the

[0:16:02 Speaker 2] community. So tell me a little bit about some of the specific impacts you’ve been able

[0:16:07 Speaker 3] to make in the area of reproductive health.

[0:16:09 Speaker 2] And we know I don’t know if we’ve actually told people

[0:16:12 Speaker 3] about what you’ve done with the Irish Parliament, but we can start there and then you can talk about other issues. But I’d like people to really see the impact of research on from your perspective.

[0:16:22 Speaker 2] Certainly I think that one

[0:16:23 Speaker 5] off the, um I don’t know if it will always be the most surprising and yet satisfying part of my career that may now have already happened. I

[0:16:33 Speaker 2] may not be able to ever adopt this. But having gone to the

[0:16:36 Speaker 5] Irish Parliament and to give the background there, you know the situation in Ireland with abortion is that it is governed by what’s called the Eighth Amendment, and that is a constitutional amendment. Ah, that gives fetuses equal rights to pregnant people. And that means that when someone is pregnant and they suffer, ah, threat to their health, that may also be a threat to their life. But you’ve got a fetus that has a beating heart. There’s nothing a doctor could do. You really are in a situation where your hands are tied and because of the Constitution, there wasn’t a terrible incident where city to help out of our. She was a 35 year old woman who died in Ireland because doctors felt they couldn’t intervene. And so the law has changed a little since then. In 1995 the introduced a clause saying, OK, you know, if death is imminent, you may do something to help the woman, but that’s as far as the law has gone. Now that constitutional amendment was enacted in 83. That’s the year that I was born. So if you think about that, Ah, there’s a generation of women in Ireland who have never had to say over their own reproductive rights. And there was a movement basically in Ireland to change this. So this this this this policy debate really grew out of, ah, lot of on the ground sort of advocacy and speaking out, You know, when I was growing up in Ireland, no one could mention the word abortion. It’s very much now something that people are in the streets demonstrating about. So there’s been a really big just in your lifetime. Yes, exactly. So it’s been kind of interesting to see that.

[0:17:57 Speaker 2] So the reaction to

[0:17:58 Speaker 5] this in Ireland is okay, let’s take this up as a policy issue. Let’s decide should be left. The Irish people vote on whether they want to keep the Eighth Amendment or not. And if not, what would you like to replace it with? And

[0:18:08 Speaker 2] the way that Ireland

[0:18:08 Speaker 5] went about this to me is the policies. Color is fascinating, they decided. Let’s get 99 our citizens in a room that’s randomly select a 99 99. So they came from all over Ireland. They came into this with all kinds of different opinions and life experiences about all kinds of things, not just abortion. And they put

[0:18:25 Speaker 2] them in a room

[0:18:26 Speaker 5] for five weekends, and they had experts see no doctors. Researchers come to testify to them and tell them a bit about forces in Ireland about abortion in the world, on abortion in general.

[0:18:36 Speaker 2] At the end of this process,

[0:18:38 Speaker 5] those 99 people made a recommendation to what’s called the Iraq Pissed Committee. And that’s the Irish Parliamentary Committee that was responsible for deciding what to do about the commitment. And the Parliament said, OK, the citizens assembly. These 99 people have recommended repeal, so go ahead and allow the referendum and replace it with abortion on request up to 12 weeks. We now as the Iraqis committee, have got to decide what to do with that recommendation. So they also called in experts. They called in doctors, researchers and luckily we were very fortunate our research team to be asked to come and testify, and we were asked because what we’ve been doing is looking at the impacts of the law. You got a law that basically says no abortion in Ireland. But is that the reality? Are people in Ireland finding ways to have abortion even though it’s not allowed on? The answer from our research is absolutely. They do two things. They either travel abroad to England usually, or they use what’s called online telemedicine, and that’s a service where they can purchase the medications they need to do a medication. Abortion at home Up to 12 weeks using online service called Women on Web and we partnered With Women on Web there are non profit organization Ah, they allowed us to use anonymous data from their clients, and we were able to actually track what was happening with abortion. Over time in Ireland, we found that the number of people traveling declined, and the number of people turning to the online service increased to the point where you’re have you have more than 2000 women a year doing their own abortions at home in Ireland, despite a law that says there’s no abortion in Ireland. So we came to the Rockies committee. We presented these findings we did not know what their reaction was going to be. But the reason I say this and the reason I wanted to talk about it is because the reaction the room that a lot

[0:20:22 Speaker 2] of these politicians, they have very strong

[0:20:25 Speaker 5] opinions. Some of them are already very supportive of abortion. Some of them were very, very non supportive of abortion. They believed it was very wrong. But everybody in the room was interested in the fact that it’s happening and they wanted to confront the fact that, okay, if the law is not having its intended impact, what does that really mean? And what are we going to do about the fact that people are doing this? They may be doing it safely in the service. We’ve looked at the numbers. It’s pretty effective. It’s pretty safe, but they can’t get the follow up care that they need all the time. They don’t feel safe going to a doctor. They don’t feel they get anyone to talk to you about the decision, and they feel like the whole thing has got to be completely covert because it’s technically against the law. So the committee were interested in asking the question off. What is someone’s experience in Ireland when they go through this? And do we really think we can support a law that allows this to happen or should be changed to be left? There’s people decide what to dio, um, And so, after having heard a lot of different testimony, they decided to go ahead with the referendum, and it will be

[0:21:25 Speaker 7] happening in May of this year.

[0:21:27 Speaker 3] So we’ll see what happens with that decision, which will be a major decision for the Irish people, for sure. Yeah,

[0:21:35 Speaker 2] we talk

[0:21:36 Speaker 3] about, you know, President Johnson, and you know his legacy of getting in the middle of the most complex public policy problems and working across the Isles and talking to people and compromising and finding areas where people agree.

[0:21:51 Speaker 2] But this year you’re confronting

[0:21:52 Speaker 3] a policy on your working in a policy that has a lot of emotion around. It’s an emotionally charged issue.

[0:21:59 Speaker 2] How do you deal

[0:22:00 Speaker 3] with it when your work and how do you keep your eye on the ball? Ah, and not be just, you know, distracted as a researcher from that and keep keep study on the course of trying to find information that would. That’s a foundational source for people on both sides of these issues.

[0:22:18 Speaker 2] It’s interesting. I think one thing

[0:22:20 Speaker 5] that helps me is my training as a scientist. You know, I started life as a medical scientist. I went to medical school than and for me. No, I recognized that I’m not a neutral being. You know, I obviously have opinions about the stuff that I’m researching, but that’s very different. I know the research questions I pick, I pick them cause they’re interesting to me. But I never assume that I know what the data are going to tell me. So I remain neutral when it comes to the analysis of the data on the interpretation of it. Even though I know that in my own life, I’m not intruding the subject. I don’t feel like I have to be. I think a lot of times people come into policy, they work on an issue because they really care about it. But it doesn’t mean that you know what you’re gonna find. You always want to keep your mind open and your methods scientific

[0:23:00 Speaker 2] on the question

[0:23:01 Speaker 5] off. Talking to people, it’s very interesting, you know, I know people. I’m close to people. I love people who don’t agree with me. They are very, very, very opposed to abortion. They think it’s a morally very problematic thing, and I think that when you are close to someone or know someone that doesn’t agree with

[0:23:20 Speaker 2] you, it’s It’s a very different

[0:23:23 Speaker 5] ballgame than thinking off. Oh, the others that are out there that don’t agree with me. It’s very easy to demonize people who don’t agree with you when you don’t know any of them and when you do, you are forced to reckon with the fact Here’s a person that I love and respect. They don’t agree with me on something that you know I might feel strongly about. And I think that being respectful and tolerant of those opinions is incredibly important. You are more likely to get somewhere with someone who doesn’t agree with you. If you can try to understand what you’re coming from, rather than simply disagree, you can disagree but disagree without respect and without tolerance for their viewpoints. So I find that’s one way of, you know, reaching

[0:23:59 Speaker 2] compromise sometimes in a policy arena, but also even if you don’t get

[0:24:03 Speaker 5] to a place of compromise. You learn something, you learn something about how other people work, and I think it’s always worth doing that.

[0:24:09 Speaker 3] I think that’s the key of this. What we’re talking about right now in terms of discourse, the ability to talk and understand, you said, Not demonised. But it becomes, I think it becomes a challenge because people want, yes, no black, white and often in these kinds of situations Number one, their complex and number

[0:24:25 Speaker 2] two. It’s almost

[0:24:26 Speaker 3] like you have to say, I accept this, but I don’t accept this. It comes almost to a gut after you have a lot

[0:24:31 Speaker 2] of information. But the other important point you made is to seek out because he’s a real people,

[0:24:36 Speaker 3] you know. It’s very easy, Seo them. But all of them came to a conclusion about an issue and either started the issue that you’re on. So what drove them to their conclusion? What are they thinking about? What were their life experiences?

[0:24:48 Speaker 2] So why you might

[0:24:49 Speaker 3] come out on the side that you thought you were, you gonna be much more informed about the other.

[0:24:53 Speaker 2] It’s one of the things at the LBJ school That we try to do, too is ensured that students have the ability to understand the bottom foundational analytic pin ings off issues because once you have that set, then you can advocate. But if you can’t

[0:25:09 Speaker 3] get that an analytic approach that analytic was the word as a keystone of any kind of decision, then it’s very hard to advocate cause then you become the risk of becoming an echo chamber. And I think you’ve maneuvered through that. You know very well cause this is again a very highly charged policy. So Abigail, I want to thank you so much for joining me today. And I’m hope everyone can really see how articulate and thoughtful you are. And we’re so proud that you’re here at the LBJ School. Thank you for joining me. Pleasure. Thank

[0:25:41 Speaker 1] you so much. This is Policy on Purpose, a podcast produced by the LBJ School of Public Affairs at the University of Texas at Austin. We take you behind the scenes of policy with the people who help shape it. To learn more, visit LBJ dot utexas dot edu and follow us on Twitter or Facebook at the LBJ School. Thank you for listening