Roger Rochat oral history interview, 2013-10-24

ALEX MCGEE: The following interview was conducted as part of Georgia State University's Activist Women Oral History Project. I am Alex McGee and I am interviewing Roger Rochat. It's Rochat right?

ROGER ROCHAT: Correct

MCGEE: Yes, like the candy. It is October 24, 2013 and we are at Georgia State University. So I want to start with your childhood. Can you please tell me where you were born and when?

ROCHAT: Sure. I was born in Pasco, Washington on November 20, 1940.

MCGEE: Oh, so you got a birthday coming up. Did you have any brothers or sisters?

ROCHAT: I have one sister about a year older than I and I had three younger siblings, two sisters and one brother who's ten years younger.

MCGEE: Okay. Can you tell me about your parents? Where did they come from and what did they do?

ROCHAT: Sure. So my father was born in a house on the prairie, small area 00:01:00called St. Joe Valley in northern Idaho. And my mother was born in Sierra Madre, California. She was the daughter of a physician. My father's father was a -- he came from Switzerland and he was -- his family was in the watchmaking and raising cows. So I would say those are the main things, but the area where they settled in northern Idaho was in Paul Bunyan country with very large trees. And so much of the money that some of the family members had made was really from logging, forestry. So they come from very different backgrounds. My dad was about 11 years older than my mother. The year that he courted her, he was teaching school is Louisville, Montana and lived in a tent all winter and wrote some of the most incredible love letters, which we still have some of.

MCGEE: Well it's good that you kept them.

ROCHAT: Yeah, my sister has them.

MCGEE: Yeah. That's awesome.

ROCHAT: Yeah, and my mother basically ran away from home to get married.

MCGEE: How old were they when they got married?

ROCHAT: So dad was about 31 I think -- 32 and she was about 21.

MCGEE: Okay, that's sweet. Can you tell me about your relationship with your parents?

ROCHAT: Hmmm. I spoke with my mother yesterday, so she's still alive and well very much. And my dad died about 1996, so -- an amicable relationship throughout life certainly. I mean it was a strict, conservative Christian home in a rural western state, in terms of -- very family centered, not church centered at all, but very family centered. And because we grew up poor, we all learned to work very early. I got my first job earning money at age five rolling bales of hay for a neighbor. He paid me 25 cents for the day, but it 00:03:00meant a lot to me. And I pretty much worked ever since. Part of the value of working was getting out of chores in the home.

MCGEE: It's okay if you're not doing work for free, right? It's getting paid. So you said your family -- it wasn't church centered, it was like -- were they spiritual?

ROCHAT: Yes, yeah so we had Bible readings morning and evening and prayer before meals and very conservative Christian faith of a particular belief group called Plymouth Brethren, which you may or may not know about and that's fine. But if you would tie it to Amish or Mennonite in your thinking, it would be close in terms of I would say the family and relationship between people. So, very not of this world group.

MCGEE: Can you tell me about your childhood friends and hobbies?

ROCHAT: Childhood friends I had almost none because I worked and we lived in a very isolated area. So we lived in a farmhouse with no immediate neighbors and I went to a one room schoolhouse for the first four years. I had two classmates whom I don't remember at all except that they were girls. And then we moved to a small mining town in northern Idaho where we lived on the highest street on the hillside and I used to run home for lunch and run back to school and so, again, I was very family focused and I pedaled newspapers in the morning beginning at 5:30, seventh and eighth and ninth grade. And so again I was employed doing that shoveling snow. And working and schoolwork was life. I mean -- so there wasn't much friendships. And I would have to say that I don't think I socialized hardly at all until my senior year of high school and 00:05:00even then it was painful. So we moved to another town, Kennewick, when I was in the ninth grade. I got my first salaried job working at the library. I worked for three years at the library. And my last year of high school I worked as orderly in the hospital so I was prepping men for surgery. I shaved my dad before his groin surgery, [finagled?] hernia. And I was allowed by the principal to watch the surgery. So I had more hands on patient care my last year of high school than I had probably in my four years of medical school. And so it's sort of an unusual up-growing experience. But I never played sports because I was working. By the time I finished high school I had paid for four years into Social Security. I had saved $3,000 which in today's money would be about $20,000.

MCGEE: Right. That's really impressive.

ROCHAT: It was a very work focused life but part of that was because we were poor and I wanted to go to college. And then I was given a full scholarship 3,000 miles from home from the University of Rochester in New York and tuition, room, and board. And so I hitchhiked back and forth, part of another saga of my life.

MCGEE: Yeah, I'm sure.

ROCHAT: I'm probably getting ahead of your questions.

MCGEE: It's okay, it's totally fine. So you told me where you attended school. What subjects interested you?

ROCHAT: Well I would have to say I probably loved education generally, probably maybe science a little more than others. So I founded a science high school club called Molecules Associated and because I worked in the hospital I met someone who gave a telescope to us. So there is a lot of interesting things on the science side. And then in 1957 Russia put the Sputnik into space and my chemistry teacher said, "Even if you want to go into medicine, you ought to go into science." And so I started out my college career in chemistry. And I 00:07:00don't – you know, it's interesting trying to reflect back because I'm so biased by everything that's happened since them. But I was able to arrange with my university to spend a year studying in Germany on scholarship again. And taking my physical chemistry and my comparative anatomy and my pre-med stuff, my science stuff in German in Munich, Germany was quite an education for me.

MCGEE: I'm sure yeah.

ROCHAT: And the physical chemistry was a three semester course. I started the second semester of it. And so I hired a tutor to try to catch up, but my final exam was an oral exam in German. And along with which I was taking European history, German drama and theater, German as a language. So it was intense, but because of it I changed my professional interests. The world was opening up to 00:08:00me, this little farm kid from out west. And so I enjoyed opera which I had never heard of before. I mean I enjoyed a lot of the arts. I hitchhiked intending to get to Greece, I got as far as Italy and fell in love. I spent six week hitchhiking around Italy mostly looking at museums and ruins, but just enjoying the place. I went back to Rochester and opted out of the BS program and the BA program and took a year of French and a year of Russian instead of taking more advanced chemistry.

MCGEE: So what was your degree ultimately in?

ROCHAT: Bachelor of arts in chemistry. But looking back, if I had known more of what the world was like, I might've taken a liberal arts program rather than a science program. But I think the combination of the science and the liberal arts made it easy to get into medical school. And so I went to the University of Washington for medical school. But again, I was interested in international work and in getting through without debt and so I lived in the bowels of the 00:09:00veteran's hospital and did lab work at nighttime for room and board and had a tuition free scholarship so and then managed to get a tropical medicine fellowship with Louisiana State University to go to Costa Rica for two months, but to get there I hitchhiked around the United States again looking at internships and came to Emory. And they said, "You ought to go visit CDC while you're here." So I went to visit CDC, met Alex Langer, Lyle Conrad. Alex Langer who was head of epidemiology and they said, "If you stay interested in international health write us a letter once a month." And I did and two and a half years later they called and offered me a job as an EIS officer.

MCGEE: And what does EIS stand for?

ROCHAT: Epidemic Intelligent Service. So when people ask how I got to Atlanta and CDC I just raise my thumb. It was literally hitchhiking, very unusual, 00:10:00serendipitous sequence of events. Well I've tried to summarize the history quickly.

MCGEE: No, that's fine.

ROCHAT: You're welcome to ask questions if you want me to focus on anything.

MCGEE: What were your parents' aspirations for you?

ROCHAT: My dad's primary aspiration was that I have good character. He did not care if I was a street sweeper or a physician or whatever. He wanted good character. That's what he cared most about. I don't remember any professional aspirations as such. I spent the summer of my tenth year in southern California with my mother's father, a general practitioner. So I had some exposure early on to at least one physician. I think they would've liked most if I'd been a Christian missionary to be honest with you. It never was stated, but that would be consistent with their values. Yesterday I spoke at CDC about my life history at their request and then my wife rose up to give her 00:11:00rebuttal at the end and one of her comments was I thought he was going to be a missionary and he ended up being a family planning missionary.

MCGEE: Still kind of close, certainly there's that international aspect. Yeah.

ROCHAT: That's right.

MCGEE: So since you have spent a great deal of your adult life advocating for sound sex practices, so like contraception, safe abortions, can you tell me about the kind of sex education you received when you were younger?

ROCHAT: Absent to terrible. I remember in high school, maybe ninth grade in that mining town, Wallace, northern Idaho, something of a one session in physical education related to health, sexuality -- but I can't remember 00:12:00anything of the content of it. I do remember my father once making a comment to me that he had heard that masturbation might make the penis fall off. Those are the two things I remember of my sex education, not much. On the other hand, I grew up on a farm. I knew what happened when I put a male rabbit with a female rabbit or a bull with a cow. I knew about sexuality and about pregnancy as a result. But I knew it in animal situation, not in a human relationship situation.

MCGEE: Right. Sounds good.

ROCHAT: I thought I had good sex education, but it was all about animals. And certainly never anything about contraception. I can't remember that contraception or abortion was ever mentioned in my childhood or my home relationship. Now I talked to my mother many times about her lack of contraception in recent years since my dad's been passed. And I know that she 00:13:00used the diaphragm for a time, but I know that when she got married in 1937 despite having a physician father that she knew nothing about contraception or about condoms. And I found that naturally astonishing because certainly the birth rate in the US had bottomed out in the 1930s before she got married. So I think she grew up in a very conservative household where again the issue of sexuality, contraception, abortion would never have been mentioned.

MCGEE: Right. So when you were at the University of Washington's School of Medicine, what kind of work were you doing while you were there?

ROCHAT: Well I did the lab work at night time in the veteran's hospital for room and board. And I did a couple of externships during the summer time. One was a physician in private practice and another one with the doctor's hospital doing surgery of a variety of sorts and enjoyed them very much. That was the 00:14:00primary work. The only thing notable in the context of family planning is that IUDs had just come into common use. I carried an IUD in my wallet to pull out to show to patients. So that was in the mid-1960s, '65 time period. And I had two people of influence that are relevant. One was someone who had been an EIS officer at CDC, Ray Ravenholt. He was professor of public health. And he lectured on Saturdays. Public health didn't get high priority in medical school. But there were two issues that were really important to him in this world and one was population explosion as an issue and the other was tobacco, the two most important public health issues. So he was recruited from that position to be head of population for USAID. And he developed an incredible 00:15:00reputation, shouting matches with his staff, both ways. And that's how they argued through issues. But he developed an incredible program for USAID in terms of population assistance around the world. That's another story.

MCGEE: I'd like to talk about your family, like your marriage and your children. So how did you meet your wife?

ROCHAT: Oh my. So I say Sleepless in Seattle. So we were both -- I was a medical student and she was a nurse working night shifts, a graveyard shift in the hospital. And that's how I met her.

MCGEE: She was just there?

ROCHAT: She was a nurse on the ward, the ward of urology and orthopedics.

MCGEE: Was that in --

ROCHAT: In the University of Washington Hospital.

MCGEE: And what year was that?

ROCHAT: That would've been 1966 early spring. I courted her for one week, I proposed, she accepted and then she told me she had chosen me even before I first dated here. I wondered if I wasted a week of my life. Anyway, so then I went to my internship in New Orleans, Charity Hospital and she went back to Peoria. And she came to visit me once in August and we got married in December. So we saw each other about once between June and the time we got married in December. And I had not met her parents until the week before we got married. So it was -- we've had 47 wonderful years together, but I would never recommend the sequence of events that we had to anyway. It just happened to work for us.

MCGEE: And okay, so do you have any children?

ROCHAT: We have three children, four grandchildren. So the first two children are adopted and we have one biologic offspring.

MCGEE: Okay. And what are their names?

ROCHAT: So the oldest is Melanie and the second is David and the youngest is Suzette.

MCGEE: And did you enjoy fatherhood?

ROCHAT: I had a lot of fun with the kids when they were young, a lot of fun with the grandkids now and mixed relationships with the adult children. But we love the grandkids.

MCGEE: What were your aspirations for your children?

ROCHAT: I suppose my most strong aspiration was that they would at least all complete college and one did. So I'm pleased that we at least have an amicable working relationship with all of them. That doesn't always happen in life.

MCGEE: Certainly. Okay. Following your graduation from medical school, you eventually went to CDC EIS, the epidemic --

ROCHAT: I had two years at Charity Hospital in New Orleans and then I went to CDC -- correct -- to EIS.

MCGEE: All right. And you already told me how you got there. What kind of work did they have you doing while you were there?

ROCHAT: So my first year in EIS, I was assigned to the state of Oregon. And I think I was either the first or second EIS officer to be assigned to that state. And because I was interested in international health, I was offered the opportunity to go to East Pakistan and do cholera research about two months after I got to Oregon. So the assignment there was really to care for patients in a rural hospital setting with oral fluids, that is forcing people who were dying of acute diarrhea to drink fluids to replace the water and salt losses and to see how well that could be managed outside of a formal hospital setting. And in the course of the four months and a sequence of two pairs of us, we treated 00:19:00about 1,000 patients with cholera. And I think we had one or two deaths during that time period. So I remember a nine-year-old whose dad brought him in. He hadn't been breathing for 20 minutes. We did artificial resuscitation and brought him back to life or at least breathing and heartbeat again. And then six hours later he died. And that was it. But a very poignant situation. The father with a long, white flowing beard. The next morning as I was walking through the mud to the hospital, prostrated himself on the ground and wrapped his arms around my legs and begged me to bring his son back to life again in a language with which I couldn't communicate, but that was the translation. So anyway, that experience working there, observing the population issues that made 00:20:00a change in my career. So at that point -- I didn't make the final decision then, but it certainly influenced me a lot. When I got back to Oregon I took a family planning evaluation course here at Brady, a CDC sponsored course.

MCGEE: What year was that?

ROCHAT: That would've been 1969. I'm trying to think '68 or '69. But I went in at '68, it had to be '69 or maybe February -- March of that year. And then I took a leprosy course, a valence course, in Carsa, Louisiana, and then I got a phone call asking me if I wanted to do something important with my life. And that kind of a question. And so I made a decision to change to family planning and was transferred to the state of Georgia. So that was my first year in working in the Georgia Health Department, working on developing the family planning program. I was the third EIS officer -- let's see Nick 00:21:00Bright, Ronald Clark, Dave Allen -- the fourth EIS officer of CDC assigned for that purpose to the state of Georgia. And do you want me to just continue to talk?

MCGEE: Yeah, you're right on track so yeah we're good. So you can keep talking about I guess your time with Georgia -- the Georgia State Health Department.

ROCHAT: Right, right. So my supervisor was Al Shonebacher or nicknamed Bud, a retired military official, Roman Catholic, but just a wonderful supportive person. And when CDC asked me to do two studies, asked me, one, to evaluate the whether the family planning program was having any impact on fertility and I did that study and presented it and demonstrated that it did have. And I tell this story more because of the political time period and the consequences. So I presented it at the Planned Parenthood meeting in Boston and an obstetrician 00:22:00from San Francisco came to the microphone and charged me with racism and genocidal behavior for reducing the fertility among African Americans. Alex Langyer who was head of epidemiology also went to that meeting because he was on the national board of Planned Parenthood. That's why I saw politics, very different time period when you have a leading official in CDC actively engaged in Planned Parenthood as an organization. I mean today it would be harder for Planned Parenthood even to visit CDC. It's really a very different time period. But Alex defended me the next day and stood up and said how much Planned Parenthood needed these kind of evaluations to determine the effect that they were having on health and population. So it's an interesting story. Alex was also the person who hired Judith Rooks after she was fired at Georgia State and brought her into our program. The other study I did had even more 00:23:00impact and that was a study of whether or not the so-called liberalized law of Georgia on abortion passed in April of '68 had any impact on maternal mortality. And you know the study. It basically concluded that it was not having an impact. But the definition of what was liberal at that time was something we would've viewed today as incredibly conservative. But what was important out of that wasn't in a sense that I had done the study, but that a lawyer, Margie Pitt Hames, took that data along with other CDC studies and other information and appealed Georgia's law to the Supreme Court and that led to the Doe v. Bolton decision. So that was, in a sense, that's one of the most memorable events of my professional career. I mean a lot of other good things along the way too, but to have -- with a small amount of data really have been 00:24:00able to contribute to such a momentous decision was just extraordinary.

MCGEE: So I have that you were trained to do early abortions in Washington DC in 1972. Can you tell me about that experience and how that impacted your future research?

ROCHAT: So I was offered career development by CDC. Career development means that they pay you full salary and all of your school expenses. It's a phenomenal opportunity. One, two, or three people get it each year. But it's part of CDC developing its seed corn, if you will, investment for the future. And at that time, we could not hire demographers at CDC. We were public healths and demographers viewed us, I would say from our perspective, as beneath their interest area. Today there are many demographers and social scientists at CDC, but the way we got them then was by sending people off for career development. 00:25:00So Lyle Morris preceded me. He went for a PhD at Michigan and then I went to Princeton for a year with the office of population research. But because I was a physician and wanted to do abortion surveillance work, I wanted experience with first trimester abortions and had the incredible opportunity of being assigned to learn to do abortions at a pre-term clinic in Washington DC. I spent the first week sitting in counselling sessions with permission of the patient and the counselor just observing. And that has influenced my feelings about counseling ever since. And I've never found another set of counseling sessions that I thought were as good as what I saw then. But I'll have to say that they were so adamant that the woman would leave there with a method of contraception that she was not encouraged to have much choice not to have contraception. And in that I differed a little bit them with them because I felt that one ought to view abortion neutrally and not in a sense view abortion 00:26:00as a failure of the system or a failure of contraception. On the other hand, I think that today both because of the cost of getting contraception and because of the incredible apathy of the public and politicians in providing contraception to women post-abortion that we have a huge gap in what ought to be done in this country. And I would expect the people who are opposed to abortion to be the ones clamoring to provide them with contraception, but in fact they don't. And the family planning community I would have to fault as having focused very little attention over a long time period, several decades, on whether or not women are getting contraception after abortion. So there is fault on both sides in terms of really engaging the issue as a policy issue. It's still a problem today. So Medicaid will pay for family planning services 00:27:00after delivery, not after abortion. It seems crazy. So then I spent a year studying demography at Princeton. And demography at Princeton is different from studying at many other places. We had six hours a week in the classroom that was all one afternoon. The rest of the week was free to learn to do research. But you had to find your mentors. They weren't assigned to you. So it was an interesting experience in my own maturation and development I think of learning how to try to get help to do research. The experience doing abortions was probably as valuable to me as anything in my medical career in terms of influencing what I did subsequently, my ability to deal comfortably with the subject of abortion. And I must say, I never -- I can't say that I changed my feelings about abortion by doing abortions except that I certainly got to know some women and their reasons for having an abortion even though in a sense I was 00:28:00a technical person, not the counselor. I still learned something from each one about why they were there. And the experience of many other abortion providers that a woman might well believe that it's an absolute evil, but for me it's an exception for whatever reason. So there's very diverse feeling. But I do remember at least one who did not want to use contraception and was willing to accept that abortion might be the method that she ended up using regularly. But when you're having sex infrequently and unexpectedly, the hassle of using contraception may well leave one to feel more comfortable with either abortion or withdrawal plus abortion as practical options.

MCGEE: Okay, so now we're going to talk about Roe v. Wade and Doe v. Bolton. So I know you've already kind of mentioned your involvement with Doe v. Bolton. So during this time both of those were making headlines because they 00:29:00were moving through the courts. Reflecting back on your experiences and family planning and evaluation, what were your thoughts and experiences with illegal abortion?

ROCHAT: With illegal abortions?

MCGEE: Right.

ROCHAT: Well there weren't many illegal abortions taking place certainly in my first few years. And we set up -- I remember a special monitoring, for example, at the time that the federal government stopped providing Medicaid funding support for abortions. We weren't able to find any adverse consequences of that to speak of in our monitoring system. So I never had to deal much with it in the US context except later in life in 1994 when I was working again with the state health department and learned of the death of a Morehouse student, a third year student who had been using condoms. And they failed and she made an appointment at an abortion facility. She was deterred by protesters and went 00:30:00home and inserted a coat hanger and subsequently died as a result. But I did go to Bangladesh in 1974 to do an assessment of contraceptive distribution within the country for USAID. And I asked questions about maternal mortality in the different places I visited and learned of abortion deaths virtually everything. And this astonished me. I had not had that sense when I was doing cholera research there. And I reporting that to the USAID mission and they were not interested. They hadn't asked me to ask that question. And Ford Foundation two years later invited me back to do a national survey. And I worked with them and the Institute for Statistical Research and Training. And we had statistical statisticians go to something like 800 maternal and child health facilities in the country, including hospitals, and ask about maternal deaths and abortion 00:31:00deaths. And we learned of 1,933 maternal deaths. About 500 of them were due to abortion. And the most common technique was inserting a stick or a tree root into the cervix and leaving it there until the woman either dies or aborts. And we didn't know at that time what the death to case rate -- how many would die out of this. We later funded a small study that showed that about one out of 30 would die. So never mind the complication rate, it was pretty serious situation for a woman desperate to end her pregnancy. Most of these were married women. They were poor women. And they had all the children they knew they could afford, maybe more already. And so it was always an act of desperation. But from what I've read I think that abortion has been in that cultural setting for centuries. I don't think it's a new phenomenon. It may be more common, but there's also more people.

MCGEE: But I guess like before Roe v. Wade and Doe v. Bolton, did you ever find instances of illegal abortions here in Georgia when you were with the state health department?

ROCHAT: Only that study I did on abortion mortality. No, I never dealt with illegal abortions per say or illegal abortion deaths on a personal level.

MCGEE: What did you know about the local activist community, like what they were doing to address the fact that abortion was illegal or so difficult to obtain like in the state of Georgia.

ROCHAT: I think I knew almost nothing. I was just a little farm kid from Washington who'd passed through some interesting phases in life and ended up working for CDC and being asked to look at some data. I was still very green in many ways in terms of what was going on around me.

MCGEE: So what were your feelings among your colleagues about abortion? What were the feelings among your colleagues about abortion possibly being legalized, like at the CDC?

ROCHAT: It's hard to reflect back well, but I would say that they were -- many of them from other parts of the country, pro-choice in terms of sentiment, but eager to be absolutely, unscrupulously solid scientists in terms of what they were doing with data in putting it together and ensuring that it was subjected to peer review.

MCGEE: Certainly not letting their personal --

ROCHAT: So they were not activists at all, any of them, I don't think. I mean Judith Rooks because of her history was more of an activist coming in than I think anyone else in the group. And I think the CDC director was more of an activist than we were, David [Sensor?], in that he encouraged CDC to let its 00:34:00staff go to Mississippi to encourage supporting voting. I remember those kinds of I would say very liberal political aspects that he had that again would not -- in my mind -- possibly happen today. But he always said that what came out of our group was based on evidence and that's why he valued it so highly. Today that evidence would not be put together.

MCGEE: Right, there wouldn't be funding for it. So how did your work come to be used by Margie Pitts Hames I know you said she called you and asked you.

ROCHAT: Well I presented at the American Public Health Association meeting. How she learned about it, I can't really know. I think I was in Guatemala when she phoned me. I was helping develop a national family planning record system in Guatemala and I got this strange phone call from a -- who later became our 00:35:00personal lawyer for a time period also. But I don't think it was my personal relationship at all. I think it was the first time I'd heard from her. So it wouldn't surprise me if she knew of my work through Judith Rooks or through somebody else who was working at CDC.

MCGEE: So she called you though and asked you?

ROCHAT: If she could use it, of course I said yes. What an honor.

MCGEE: Did you follow the case after that once she called you?

ROCHAT: I don't think I did. I don't think I was into legal issues or court issues. I was doing my job in life.

MCGEE: That's so interesting.

ROCHAT: I mean it's kind of amazing when you think the advocacy position people see me in today and where did it come from? Did I have a girlfriend who had an abortion? None of that, I mean nothing.

MCGEE: You were still figuring it out.

ROCHAT: That's right. And I don't think of myself as an activist today. Others view me that way, but I still view myself as how do I get students to engage in research which is what I support on the topic and to get people to even talk about abortion in a rational way. So that's an activist today.

MCGEE: It is. Maybe the definition has broadened.

ROCHAT: Being a scientist on the topic is being an activist.

MCGEE: So did you ever get to meet Margie Pitts Hames or Sarah Weddington?

ROCHAT: Margie Pitts Hames certainly because she was our lawyer and Sarah Weddington for the first time -- no I've met her twice, but the last time was last January when she was at Emory at the fortieth anniversary of Roe v. Wade. So I have a picture of the two of us sitting together. Yeah I find it very 00:37:00interesting that Emory Law School would celebrate Roe v. Wade, Georgia State would celebrate Doe v. Bolton. It's fascinating.

MCGEE: Yeah and Emory has Margie's papers.

ROCHAT: Correct and I reviewed all of them.

MCGEE: We want them. We wish we could have them.

ROCHAT: Why don't you get copies of them? Can you do that?

MCGEE: You have to have permission. She was convinced by someone to give them to Emory and so they have them and take care of them, but I can go over and look at them and I have copies of stuff.

ROCHAT: I mean there's not much there in truth.

MCGEE: I know. You go there and you just wish there was more.

ROCHAT: I know. It's like looking at a piece of a skeleton.

MCGEE: But, you know, you just have to put the pieces together. So did you -- I guess even though you said you didn't really -- you weren't total aware of Roe and Doe, you knew they were going on.

ROCHAT: Oh absolutely. Sure.

MCGEE: And did you think they were going to be successful or did you hope they were?

ROCHAT: I sort of want to say I must have, but I don't remember.

MCGEE: So can you describe how --

ROCHAT: So let's see. In 1972 I went to [pre-term?] and then to Princeton. So I was at Princeton at the time of the decision making. So I had my head deep trying to understand demography as a student at the time that was happening. So in a way I was really out of that world, even of the CDC world during that time period.

MCGEE: Right. Do you remember when they announced the decisions? No? Okay. But when you found out, how did you feel?

ROCHAT: You know I've had a lot more feelings about them since then than at that time. Honestly I just can't remember. It's not like the day 00:39:00Kennedy was shot. I know exactly where I was and what I was doing that day. So there are some events in history I can remember, but I honestly don't remember that.

MCGEE: But when you heard that they had come down, I guess, favorably, were you pleased by that?

ROCHAT: I'm sure I was. But it is interesting. I was more interested in my three-year-old daughter than I was in the politics of the time.

MCGEE: Okay. Do you think the decisions affected the work you were doing?

ROCHAT: So I was again into demography, into trying to learn methodology to study the effectiveness of family planning programs, trying to understand something about the history of the world. I was doing a research paper on female sterilization at the time. I wasn't really engaged in abortion per 00:40:00say. And I certainly wasn't on the activist side of things. I was also still a member of that very conservative church group of my youth of which I was evicted a year or two later as they learned I was doing abortion epidemiology and suggested I should either quit my job or quit the church. And so I stayed with my job. But that had a lot of impact on my life in terms of family relationships. Yeah, I think for me abortion was more of an intellectual than an emotional thing. It became more emotional when I saw so much opposition to it. It was such a fundamental social justice issue to me. I mean I think I've always approached it more as public health and social justice than I have from a woman's rights point of view. Although I absolutely believe that you 00:41:00can't achieve social justice without women having the right to choose. But I come to it as secondary. If there were no abortion deaths in the world, would I care about the right to choose? Probably a lot less. So I'm more dedicated to solving the public health problem and the inequities between rich and poor, that rich can always buy and poor can't. I think it's extraordinarily unfair. Sadly, it typifies this country to a great extent.

MCGEE: That's totally fair.

ROCHAT: You're probing my inner thinking here, but that's good. That's quite appropriate.

MCGEE: At the time that all of this was going on, did you expect the challenges that were going to come in the future in terms of abortion rights.

ROCHAT: I could never have anticipated that, never. And I would say the same is true for family planning, the eagerness and drive we had to develop the family planning program in the state of Georgia, the eagerness to try to see whether or not it works or doesn't work makes a difference, doesn't make a difference. That disappeared. It just disappeared. It's starting to come back a little bit.

MCGEE: When would you say it disappeared?

ROCHAT: Two things that I can remember, around 1980 the establishment of the block grants for maternal and child health, prevention block grants. Before that Congress had categorical grants to states to work on a variety of different things and the states said, "We really want to make that decision making, how we allocate those resources." And so the block grants were established. Family planning state categorical, but relatively isolated from maternal and child health as a result I think. And then the second thing I remember was 1985 00:43:00at which time I was the director of the division of reproductive health and Surgeon General Koop came to Atlanta and told us in advance he was coming to challenge us to look at the mental health problems from abortion. And I was invited to the CDC director's conference table. The CDC director, Jim Mason, sat at one end, Koop across from me, and Koop said Ronald Reagan is going to be reelected. This was the end of his first time. Roe v. Wade is going to be overthrown. And wouldn't it be a shame if we documented all of the problems related to abortion. And I knew he was interested in mental health and so my response was we've been looking at deaths following abortion for X time period, 15 years, and we had two deaths or three deaths from suicide and what we would've expected would be about 125. I said we can do better research, but 00:44:00maybe that the findings will come out that abortion is protective from mental health issues. There have been lots of studies since and I would say nothing truly definitive on this issue. And the wonderful studies being done out of UCSF, now the [turn away?] study.

MCGEE: What's UCSF?

ROCHAT: University of California San Francisco, the ANSIRH study. And I can't tell you what A-N-S-I-R-H stands for exactly. But that research study is just phenomenal in terms of a prospective study with a good comparison group to look at the consequences of being turned away from getting a person, usually because of gestational age. So there's been a couple of reports out from that. But that kind of research is what's needed to know whether or not there are mental health consequences among those seeking abortions who get turned away. I feel like I've skipped something that was important too. 1981 when I became 00:45:00division director, my deputy director Ward Gates who had previously been head of abortion surveillance branch was quoted in the Washington paper as saying that abortion was safer for the woman than following the pregnancy to term which was a factual epidemiologic statement. But it led to the wrath of the president's staff at least and in fact we've been told that he was on a list of ten people to be removed from his position when Reagan was elected. And in any case, I was in Washington D.C. at the farewell of the National Family Planning Director's Retirement and got a phone call from Ward saying he was -- had been offered the opportunity to change jobs overnight essentially. And he became director of the STD division. It wasn't a bad thing to have happened except that it was clearly politically driven, motivated. So that time period, Ronald Reagan's 00:46:00ascendency, clearly was the time period that I remember some radical changes of suppression, of family planning, and abortion issues. And we renamed our division from family planning evaluation to reproductive health. Well, what is reproductive health? Family planning, we knew a little bit about. It's interesting, the word abortion has been around for hundreds of years, birth control since Margaret Sanger, 1918, family planning since the late 1930s. Reproductive health's been around a few years and you still won't find it in the dictionary. It's variously defined and has different meanings to different people. So maybe having a vague term is a good thing, but it also means that you don't really know your mission, your vision, quite as sharply.

MCGEE: And you think that definitely was the motivation when they changed the name?

ROCHAT: I'm fairly certain of it. I remember -- because I was the director at that time, during that change time period, and I was one of the more resistant persons probably to its changing. Not that I objected to working on reproductive health issues. We had done maternal mortality studies. We had engaged other than just family planning issues. But we also had a consciousness about unintended pregnancy and of population issues that I would say have markedly diminished relative to other reproductive health issues over time. And I was going to say -- I mean there's a success story with family planning in lots of countries also, due in part to family planning, due in part to just the development of countries. So we have many countries with exceedingly low fertility today where the problem isn't family planning, it's the inability 00:48:00to produce enough people to serve in the army, President Putin's observation.

MCGEE: Yeah, is it Russia where they were doing the love benches in parks? Did you ever hear about that?

ROCHAT: I don't know that, no. I just remember President Putin once saying that his number one national problem was low birth rate. I mean, wow, what a statement.

MCGEE: I can't remember what country it was, but I remember hearing an associate in class that they were putting love benches in so couples could sit and hopefully get in the mood and I thought what a weird problem to have, what a crazy problem to have.

ROCHAT: That's right, so very different.

MCGEE: Yeah. Okay. So you returned to CDC family planning. I'm going back again.

ROCHAT: That's fine.

MCGEE: Okay -- and evaluation in 1974. Is that about right?

ROCHAT: '72, '73, so I would've returned in '73, but I returned to Dave Sencer to the CDC director's office to work in the office of program planning 00:49:00and evaluation for one year, during which time I was the medical reviewer for the medical claims of Tuskegee syphilis survivors. So that was another interesting period of life. But I was also in Dr. Sencer's absence the acting director for CDC on paper at least, for signing things. But it was the intent of that year as for others who went through it, Don Hopkins and Jeff Colquin and others, was to develop people who had a broad perspective of CDC probably hoping that we would go into leadership positions different than what I did because I went back to family planning rather than going on into higher level positions.

MCGEE: And so you returned to family planning and is that where you worked with US --

ROCHAT: USAID, right.

MCGEE: And that's where you went to Bangladesh?

ROCHAT: That's correct.

MCGEE: Okay, and what did you think were your greatest challenges during that 00:50:00period of time?

ROCHAT: The toughest challenge was that I was given responsibility not for abortion surveillance which I viewed as relatively interesting and easy and not for contraceptive safety studies where I really didn't have the competence, but rather for family planning program evaluate which I view as still the toughest challenge, evaluating a program to determine what impact they have on health. I mean there have been many studies of family planning which are difficult to demonstrate health benefits of family planning. It's a tough area. There's no randomized control studies. There's no -- and I wouldn't want them, but there's no even good observational studies that demonstrate a benefit to health. There's associations with intimate partner 00:51:00violence and other -- lack of prenatal care and so forth. And the challenge for that is that then we think of family planning as a human right and we think of it as a rights issue, but CDC doesn't deal with rights issues by and large. It deals with public health. So if you don't have a health benefit from it, then do you have a legitimate program in a CDC context? I'm delighted there's still family planning work going on there. And its good work. I'm really proud of it. I think it's the -- again, it's sort of the philosophic -- what's the mandate of CDC? It's more prevention on the mobility mortality side than it is prevention on the unwanted fertility side.

MCGEE: And so we kind of already talked a little bit about this, but how was your work at the CDC affected under like more conservative administrations like 00:52:00Reagan? Like you said Koop came in --

ROCHAT: Well he certainly changed things. I think that CDC was burned on the abortion issue and at the time of Reagan's arrival and no subsequent president ever reversed that. So under Bush Sr. when he was president when we did work on abortion we knew that our papers had to go to the White House for clearance, that they were always cleared. Under Clinton, we could never get our papers out of CDC. No one wanted to move them forward. And I think the same thing is true under Obama where we've got an incredibly supportive president of Planned Parenthood. You couldn't ask for stronger support. But I don't think that it's led yet to any opening that I can see, any overt opening in a public way 00:53:00of the importance of family planning and certainly not of enhanced abortion surveillance activities. And I think it's because we've got this strong opposition to Obama. I mean there's good reasons CDC as a professional scientific organization is not going to stick its neck out just to be chopped off. So I respect the situation that they're in from the director on down and delighted I can do things at Emory I could not have done at CDC.

MCGEE: Okay, well perfect transition. Let's talk about when you left CDC. And so you went to Emory and Rollins School of Public Health.

ROCHAT: Sure but let me step back to when I left India in -- I was in India for two years, in '97. So I came over from CDC when I stepped down as division director. So a year after that meeting with Koop, I was offered a different job. Mostly I was offered to get out. And it was pretty clear that was the 00:54:00message. And so I was offered the opportunity to go to what was then the masters in public health program, not yet a school of public health and set up the international health track. And so I did that for two years which was wonderful. I got a little exposure to teaching and academic setting. And then I was given the opportunity to go to India for two years as head of health population nutrition for the USAID mission there. That was another interesting experience because I was recruited by Owen Cylke, a forward thinking, as I thought, director of the mission who wanted a professional in the job who would help relate to professionals in the US and in India. He was replaced the month I arrived who felt that everything that he had done was illegal and set about reversing them, not just me but the head of agriculture and the other organizational units. It was easier for him to get rid of the EID staff than it 00:55:00was a CDC assignee. So I was there for two years. But in the ordinary course of events, it would've been renewed for another two years, but because of his position I returned to the US. So I had an opportunity to go to IPPF London and be head of research for them as a CDC detail, but CDC wouldn't approve it. So then I was offered a position to go to Oregon to work on maternal and child health, but I had in-laws in Gainesville, Georgia at that point. So I wanted to come back to Atlanta. And somewhat reluctantly I think I was allowed the opportunity to work in the Georgia health department again. So I was detailed as perinatal epidemiologist at the state health department and spent five and a half years working there mostly on child's health issues, but I also dealt with maternal mortality on the state maternal mortality committee. And the one abortion case that I described came out during that time period. And during 00:56:00that time period I was also given the chance to go to Romania for USAID to determine whether or not USAID should provide oral contraceptives to a country with high cardiovascular disease and high levels of abortion. And the main message I brought back was we should provide oral contraceptives. The main problem they had was tobacco smoking affecting their disease and our exportation of American cigarettes was exacerbating that problem. And that was not a message they really wanted to hear at the Department of State. But anyway, USAID did go in and was extremely helpful in helping to increase contraceptive use and reduce the abortion rate in Romania as they have in Russia as well. So two very sort of novel experiences to come out of a time period in the state health department. The other thing that happened while I was in the state department was that I was asked again to return to Bangladesh to redo the same study that we had done 18 years earlier. And it happened that at the time I had 00:57:00a Bangladeshi physician assigned to me from CDC as a preventive medicine resident. And his sister abruptly died in Dhaka and he went back to Dhaka. And I got the message about the invitation while he was in Dhaka. And I encouraged Ford Foundation to contact him and ask him if he would develop a protocol, which he did. And so we repeated the study. This time we went to about 5,000 health facilities and we learned that about -- I'd say the proportion of pregnancy related deaths due to abortion had dropped from 26% to 16%, that kind of a shift. So a huge improvement. So I know you didn't want me to talk about this, but this is part of the story that you don't know about. The other thing that happened during that interim of 16 years is that instead of one infectious disease hospital, they now had five infectious disease hospitals. And in the first study, we had found a maternal tetanus death due to abortion. 00:58:00This time we went to all five hospitals. We found like a couple hundred tetanus deaths, maternal tetanus deaths due to abortion. And we don't usually think of maternal tetanus, the focus is always on infant tetanus. But if you're putting sticks and tree roots into the cervix, sooner or later you'll introduce tetanus spores. We published that [in Lancer?] so that was an original contribution that contributed to try to think of when you need to immunize women to keep them from getting tetanus, maybe before they ever become pregnant rather than waiting until their first pregnancy ending in a live birth. I don't know whether we had any impact or not. But the science suggested something different than what was being done. So when I came back from India then Georgia Health Department and I developed thyroid cancer. Sort of an interesting personal story, I stepped out of Lake Lanier, stepped on a fish bone, got my foot infected and went to a doctor for the infection and he did a physical exam and discovered I had an enlarged thyroid, put a needle in, found 00:59:00out it was cancer, and within a month my thyroid was out. But if I hadn't had that foot infection, who knows how long it would've taken before I realized the problem I had swallowing was due to a real problem. It took a good six months to recover from that, but I had done several studies in Georgia that were really important. One of them was a really major work looking at infant mortality over a ten-year time period and risk factors for it. Another was a statewide study of cocaine metabolite in the blood of all newborn infants, a study done in collaboration with the March of Dimes and CDC. And then the third was a statewide survey of over 3,000 women that focused on fertility and family 01:00:00planning issues, but also dealt with other issues like sleeping position of infants and the like. But we learned -- I don't remember the exact proportion, but a substantial proportion of women, the last pregnancy was unwanted. And two thirds of unwanted pregnancies were terminated by abortion. I could get those exact data for you, but it's again -- did the data go anywhere? We put together reports for each of the legislators. They were handed out on maternal issues and infant and child issues. But whether it ever had any impact on legislation, I don't know. But because of my health issues in part and not having a boss with whom I had a good relationship, at one point I was abruptly given three days to pack up and get out of the health department.

MCGEE: In Georgia?

ROCHAT: In Georgia. So this is the third time in my career that I had an 01:01:00involuntary shift if you will. And fortunate that I had ties to CDC and respected there, so I went back to CDC for three years and worked with other state health departments around the country until I retired in December of '99. So that takes you to the end of my CDC career. And because I had worked at Emory for a time, I explored the possibility of employment there. And they offered me a position with no salary, but a room to sit in, and no invitation to come to faculty meetings. It was sort of a harsh and lonely setting for a time. I was able to bring in funds to cover salary from the Office of Population Affairs and different places. So I was active and engaged, but I was not really part of the epidemiology department in which I sat. And two years later I was offered a position in global health where I had been ever since. And that has been a much better situation for me in which to work. And then a year after that I was offered a position of director of graduate studies, a position that 01:02:00had never existed in any department before, but because the chairperson really wanted me to assume a lot of responsibilities so that he could do his research. At which he was superb. He was a great leader as well with that. Now I've tried to bring you up to date on what I can think --

MCGEE: No, that was perfect. That was exactly what I wanted. So shortly after arriving at Emory you established GEMMA?

ROCHAT: I established it in 2003. Well I have to tell you, I didn't talk about abortion for several years. I mean I knew it was something I cared about and I didn't put much money into it, but then my chairman and a few others put some money into it. And I finally decided maybe this can work. And so I put in enough to bring it up to the $50,000 limit at which point you can start getting interest to support students. And the support was only $500, it wasn't much.

MCGEE: What for the students?

ROCHAT: For the students to do research on abortion. So there is another -- there were other endowed funds that support students to the tune of 1,500 to 2,000 for the summer to do research internationally. I added on 500 if they could say the word abortion in that context. So I leveraged the system. And so the first summer we had two and then we had five or six each summer since then.

MCGEE: Can you really quickly just say what GEMMA stands for?

ROCHAT: Global Elimination of Maternal Mortality from Abortion. So there's about 50 million abortions a year, about 22 million unsafe abortions, about 47,000 deaths. And in this country there are 1.2 million abortions and fewer than ten deaths. So if we could take the situation we have here, the safety of abortion services and do that worldwide, we would have fewer than 100 deaths a year worldwide. And I would count that as elimination. So I think that 01:04:00technically it's feasible to do it. And I also think it's a winnable battle as CDC likes to think of winnable battles because I think there's tremendous momentum taking place worldwide both for contraception and for a shift to post-abortion care to those who have complications of abortion, for agencies like USAID that can't provide abortion services, but they can try to keep women from dying if they have a complication. And then there are many organizations engaged in comprehensive abortion services from DFID, the British international agency, Marie Stopes, a number of NGOs, Pathfinder, IPASS. And there's a lot of effort I think too in the private sector that's underground in the way of the availability of Cytotec or some medical abortifacient which 01:05:00may not lead to the successful termination of the pregnancy without complication, but then leads the woman to go into the doctor and get a DNC. So it's not the ideal method, but it markedly reduces mortality. Does that all make sense to you? Am I saying things you under --

MCGEE: Yeah. So what were the goals for -- or what are the goals for GEMMA as a program, like to eliminate maternal mortality? Is that --

ROCHAT: Absolutely, eliminate maternal mortality from abortion and people say now that you've raised it up to a couple hundred thousand, why don't you make it a scholarship. Call it the Rochat Scholarship in Reproductive Health. I said, "No, that would dilute the vision." I don't want to do that. I want to be very clear, this is about GEMMA. And I thought hell will freeze over before GEMMA succeeds. But the truth is I think GEMMA might succeed before then. I think there's a lot of things going the right direction. But I'm 01:06:00pessimistic at times too largely because of religious forces, conservative forces in this country. But also even Melinda Gates, absolutely wonderful TED Talk on contraception and family planning, but she said it's not about abortion. Well for me it is about abortion. Abortion is an important backup or an important choice for women who haven't had access to contraception. So I don't think abortion should ever go away. There will always be a need for it, not only first trimester, but later in gestation among women with medical problems or with fetal problems that give a reason for it.

MCGEE: So looking back I guess on the first ten years of GEMMA, what do you think have been the successes and challenges it's faced?

ROCHAT: So successes, I think the fact that 30 students have done research work 01:07:00in 10 or 15 different countries related to abortion and with the research ranging from what should a teenager do if she has an unintended pregnancy in your community, open ended, not mentioning the word abortion, but abortion often comes out as a result of that to focusing on what are the barriers to getting abortion services in a community in South Africa. Or another research project this last summer looking at the acceptability of multiple size condoms that fit different sized penises because we don't usually deal or talk about variation in that anatomy. We know we have different head sizes and glove sizes and shoe sizes, but there's one standard size of condom basically. And in South Africa it's called Choice. And in their research they heard back that Choice is no choice at all. And they found that sex workers would be very interested in 01:08:00having maybe ten different sizes of condoms available to them. The challenge is that sex work is illegal, so they often hide their condoms in trees and how do they -- ten different sized trees or something. So there's a lot more to work out in terms of the logistics of making it work. You may or may not know the story of the cardiologist locally who was an entrepreneur in developing 100 different sizes of condoms which he's got licensed now in 20 different European countries. He's initiated sales in London and comes and lectures in my course every year.

MCGEE: I have not heard about this person at all.

ROCHAT: So he's the guy that inspired me to say -- he's done no research at all on this. He's just an entrepreneurial guy trying to figure out if this can work. So our goal really is to figure out if it's really true that men often don't use condoms because they are too large or too tight, then how do we figure out a way to get multiple sizes out there which would be a tremendous 01:09:00logistics challenges for USAID. I mean they market one or two sizes and that's it. And it's easy. They can move them around the world as they're needed. But if you have ten different sizes you have to move around the world to meet the needs of different people, what are the logistical aspects of that and what are the cost issues because does it drive up the price to have better fitting condoms. So it's a fascinating little avenue of research. Others are now doing some research here in this community on men having sex with men on the same issue. A woman can go in and get her breast size measured and choose from 35 different sizes of bras. A man can't go in and have an erect penis measured anywhere. There's lots of differences in that analogy obviously. The breast size isn't going to change as often perhaps. But it's a 01:10:00fascinating aspect of sexuality and reproductive health that I think is, again, just being ignored forever. We've had standard condom sizes since rubber was invented in the 1940s -- 1840s rather. And it's part of mass production. Anyway, it's -- so one of the success stories anyway is getting people engaged in a variety of aspects of preventing maternal deaths from abortion, from direct abortion related studies to interventions related to barriers or contraception related studies, a study in Nepal on contraceptive counseling, a study in Nepal on pharmacist's attitudes towards young women coming in asking for abortifacients, a study in Honduras this last summer on the proportion of young women coming into public clinics who have ever had an abortion. In different settings, there's a team that wants to go to Uruguay this summer because 01:11:00abortion was just legalized there to try to understand what are the issues, the barriers to getting abortion services. We'll see. I hope it works. So another success story is that one of my students in my management course said, "Why don't we start a course on abortion?" So we set up a GEMMA seminar and we said we ought to deal with the public health aspects, the measurement issues, we ought to deal with the clinical aspects, both in treating women who have had unsafe abortions and providing safe abortion services. We have to address somehow contraception. It's not the primary focus of the course, but it should certainly be there, especially post-abortion contraception. And then we ought to deal with cultural issues. So we have values clarification exercise for one session. We have a whole session devoted to when does life begin. So just spin off of that for a minute. A biologist at Swarthmore who just recently 01:12:00retires has written a book on developmental biology and ethics related to it in which he says there are four different possible scientific reasons for thinking when life begins. I could either be conception; it could be gastrulation when there's no further opportunity for twinning. It could be when brain waves start because we say when you're braindead, life is gone. So that's 23 or 24 weeks, gestation, or it could be at the time of birth or viability. And so both at the school of public health and yesterday at CDC I asked for a show of hands choosing between those. Which do you think was the most commonly chosen response?

MCGEE: Viability?

ROCHAT: Absolutely. I was amazed. At CDC, no one chose the first two. At the school, one or two chose them. Obviously, very biased audiences. This is not the general public. But it would be interesting to take those questions to the general public and say these are the scientific possibilities, set aside the 01:13:00religion for a moment. Anyway, we also have dealt in one session with religious issues. So we dealt with Islam and Buddhist and Christian and Jewish perspectives. There's a wonderful book by an anthropologist in Japan on abortion there called Liquid Life. And I'll say it so it'll be part of your potential reading in the future, but it was very interesting. The customs they have of those who have abortions, at least according to his investigation of how they put a little statuette in the temple and go and visit it and you'll later -- I mean there's some ritual related to having had an abortion. Now I had a Japanese obstetrician, a student of mine a few years ago in our CNPH program, distance learning. And she comes to Atlanta periodically. And I asked her about this and she said, "I never heard of that." But she said, "Maybe 01:14:00that's for late abortions only. Maybe it's for some subset of those who get abortions," because she's done abortions. She's never observed it. So I'd love to learn more, but the book -- he talks about the Buddhist belief of life coming from water and how it can go back to water and come again at a more convenient time. And so there's a different way of thinking about life than our fetal development approach or our theological perspective for Christians or whomever. So that's an interesting -- then I had an obstetrician from Thailand come and do some work and her research work really was on state reporting of abortion to CDC versus on their own websites. They report different data to the two places. Why? Is it a timing issue of whatever? Something else, they'll report different demographic data on their state sites than they report to CDC. So part of my point yesterday was to say CDC it would 01:15:00be great to work with states and see what we can learn from their websites and if there's some way of standardizing them and improving surveillance at the state level. But in her setting, abortion is illegal in Thailand. It's not in Japan. It's been legal for a long time, both Buddhist countries. So just as there are two variations of Christianity and other religions, there's two variations of Buddhism too. Anyway, it makes some interesting class discussions, getting people out of their particular backgrounds, whatever they happen to be. I mean we have people saying, "I'm a liberal Jew from New York. I want to hear the conservative point of view." We had a Mormon in the class last year who was very willing to give her conservative point of view. And I recruited her to the class because I want some conservatives in the class. We need to hear from them.

MCGEE: It's good to have that discussion.

ROCHAT: That's right. And then there are those who have had abortions and they share their experience sometimes. I mean sometimes they're uncomfortable 01:16:00with it. But so those two things, the course, the experiences of students, and I would say there's a lot of spinoff acceptance in discussing abortion. But John Blevins who's trained in theology and public health teaches a course on sexuality and religion and he's added three sessions on abortion that he never used to have.

MCGEE: So you've had an impact not even in your program, but like --

ROCHAT: Well it's still within the school of public health.

MCGEE: Right, but not like a GEMMA seminar.

ROCHAT: That's correct, not something that I directly sponsor myself. And it happens that he takes the Buddhist work from Taiwan which was about ten years after the work in Japan as his textbook. So if they take both courses, they get two exposures to the same kind of thinking in two different settings. But he's a good teacher and it's great having other people dealing with it so 01:17:00that I'm not labeled the only person dealing with it. So in our course we have someone from CDC who's a Romanian obstetrician trained in population studies at Johns Hopkins who comes over and deals with measurement issues only to keep her protected in a CDC perspective. We have Eva Lathrop who's on the faculty, an OB/GYN and one of the three physicians who sued Governor Deal last December and got the injunction against House Bill 954.

MCGEE: Which was just for the -- for people watching this in the future, what was that bill?

ROCHAT: Well it's been variously called the physician-patient interference bill and fetal pain bill or commonly fetal pain bill. But it also interferes with physician's good judgment in managing patients with a variety of problems during pregnancy. And so it was great to have an injunction against it. I don't know when the final court decision will come down. So I would say the 01:18:00alliance with the department of genecology and obstetrics at Emory has also been a powerful -- not consequence because they built up to each other, but certainly having family planning -- obstetricians taking specialized training in family planning, contraception, and abortion either participating in the course or supportive with their own research work with obstetrical residents has been great. So October 10 we had our GEMMA evening that you weren't able to come to. And all of the students who had done research in the area, medical students, public health students, both gave presentations and most of them had posters around the room. So the dean of our school gave the opening remarks, generously said that when he came into public health he wanted to be like Roger Rochat. And it's true. We tried to recruit him into family planning, but he 01:19:00got diverted into HIV. He became CDC's leader in HIV research. But he had aspirations of being an obstetrician and working for Planned Parenthood in his medical school days. But then he went around and looked at all of the posters. That was probably the cheap value of having them is that he saw them and saw that we were not only passionate people, but we were providing evidence on the topic in a variety of settings internationally. The other group -- and it's not directly related to GEMMA, but the Georgia OB/GYN Society about four years ago -- the executive director, with whom I'd worked on them in the state, called up and asked for help in students in doing an assessment of rural obstetrics shortages in Georgia. And since that time about 30 medical students 01:20:00and public health students have worked on the topic. And some have done theses on it. One of the recent surveys of medical obstetric residents was that about half of them would prefer not to work in Georgia because of the fetal pain legislation bill. So that was financially supported by the March of Dimes and presented at the Georgia OB/GYN Society meeting in August with the March of Dime logo on it along with the school of public health logo. There are many other reasons they don't want to practice in rural Georgia. Women who want to get married, there are women who want to have kids, they want a family, they want good schools for their kids and there's not a lot of that in rural Georgia. So a lot of the lifestyle issues that any professional person would ordinarily feel. So now students have gone into rural Georgia, the interviewing physicians are there saying, "Why are you here? What brought you here and why do you 01:21:00stay here," to try to better understand how we might get incentives --

MCGEE: To bring people down there.

ROCHAT: And even the residents, about half of whom owe over $200,000 say if someone were to pay off their debt, they would happily work in rural Georgia. So they may have moral principles on the fetal pain bill, but they can be bought, if you will, economically at least for a time period in their lives. But we're trying to understand what are the issues, what's feasible. Is it even feasible to have obstetricians out there?

MCGEE: Do you want to take a break? Okay. So we were talking about GEMMA, the successes, and challenges. Did you have any challenges?

ROCHAT: I'm conscious that at least one faculty has said to me that she would not do what I am doing, nothing stronger than that. I had the feeling that 01:22:00others really wish I didn't focus so much on the topic. And my response is that the students are what drive me on this. The students are enthusiastic about it. And if they didn't have that enthusiasm I wouldn't be as out front on the issue. And its kind of a cyclical thing. I mean if students come, they get enthusiastic, they do something, word spreads, more come, and the school as a whole -- I mean, they write articles about it. And so it gets publicized. My alma mater, the University of Rochester, is considering setting 01:23:00up GEMMA. I have offered them some money to start if they want to because my belief is that we ought to see just as many places as possible. They may in fact do something better than we can do here because they're in a different environment than we're in. I mean you never know where it's going to make the most progress. And it's not an Emory issue, it's a global issue.

MCGEE: Right. Do you think it's made a difference though that you were able to get -- like you were able to get this off the ground because you were at Emory and it was a private school.

ROCHAT: I never thought about it because that's just where I was and I didn't think about alternatives like public schools, but it's a good point. I don't think you could do that at Georgia State, could you?

MCGEE: No, or the University of Georgia.

ROCHAT: Yeah, it never occurred to me. So I went to the University of Washington for medical school and when I was out there for one of these very episodic -- go back, it's the fiftieth or something like that -- I think it was the forty fifth. But I told them what I was doing here on GEMMA and I asked 01:24:00them if they'd like funds in that area and I did not get a positive answer. And it's a fairly I would say liberal school in some ways, but it's a state school still. And it's a liberal state. It still has a conservative rural area. So they wanted to go into maternal mortality. I said, "I'm sorry, that's not what I'm interested in." I'm very focused on this issue. It's interesting. I was at a research meeting at NIH a couple weeks ago on paternity. Who does research on dads? And I try to get the abortion issue in. I said, "You know, the main reason we have abortion in this country is because of missing fathers. They don't follow their sperm. They don't take care of women whom they impregnate." And so the women get abortions. When I think about it -- I never had thought about it that way before. If I haven't been at that conference, I wouldn't have made that connection, but it's really true. People have sex for recreation or for personal pleasure and they don't 01:25:00-- and when procreation occurs as a result, they don't want it. So how'd I get digressing on this? I don't know. Oh I know because at that meeting I met someone from the University of Rochester and she looked at me and she said, "You are Roger Rochat." And she said, "We just had a discussion about GEMMA among the faculty as to whether we would like to have it there or not." And she claimed to have been the only positive person. Well I sent her my talk on September 18 and I haven't heard back from her.

MCGEE: I definitely see that it could be a program that could be elsewhere. Like certainly there should be more people considering this issue. That's not a bad thing. But Rochester, they're a private school right?

ROCHAT: They're a private school and there's been a lot of feminist leadership in that area from the 1850s on. So I would've expected -- and I do 01:26:00expect to open this. But I have a feeling that I'm not offering them enough money. But I don't have enough that I want to offer them more either. And I started in a sense with 50,000 at Emory and I observed that I could make it work there. I don't know whether someone at another school could make it work. You'd have to have something pretty passionate about the issue like I am because I provide a lot of technical guidance to the students. I draw students in. I encourage them to work on it, teach a course on the topic. It's a visible issue. This year I'm trying to have a GEMMA event every month of some sort.

MCGEE: Oh then Lauren and I will have a really great chance of making some of those.

ROCHAT: We'll look forward to it, absolutely. I don't know what the next one will be -- but challenges. The challenge is that it takes a lot of my time. 01:27:00I hadn't expected that. I didn't expect it to evolve. And so many other things take my time and increasingly also that I am overworked and when you get overworked you start cutting corners some place and so you start not doing as well in some areas. And teaching unfortunately is the area that often gets cut short. And I feel badly about that.

MCGEE: Are you teaching a class this semester?

ROCHAT: I'm teaching two courses this semester. I'm co-teaching one and teaching the other one, I'll say alone, but I'm getting help. So I went down to the state health department and offered last summer -- I said, "Is there any way we can work with you." And they came back and said, "Yes, we'd like some help. We're staff short. So we're doing a Title 10 needs assessment." And they're coming out and teaching and reviewing the students' papers and its real life stuff that they need at the state. And it's wonderful. The students love it. I mean they're doing something that's real.

MCGEE: Yeah, that practical application. In grad school, that's like what you dream of getting.

ROCHAT: Exactly, yeah. And the other course is on technology of fertility control. So in both that and in my work with CDC, in all three courses, I'm dealing with family planning issues.

MCGEE: So it sounds like you've been pretty fortunate though that your challenges really are overworked, but that's because you're probably so passionate about it that you put so much --

ROCHAT: And because I keep an open door. I tell students they can come any time, call me any time day or night. My wife doesn't love it, but I want to die with my boots on and these are the boots that I want to have on.

MCGEE: So what do you think the impact has been teaching the GEMMA seminar 01:29:00though? Like do you think --

ROCHAT: Well I think that the Mormon became more of a feminist than she was and I would love to have a good feminist in the Mormon Church. I can't think of anything better. And the other person of strong Christian values I think was the best student in the course and the most eloquent in stating her point of view. But I think all of us learn from others in a course like that. So I think the more people are educated about different perspectives as well as the clinical -- it's interesting -- we don't do it for that course, but for our contraception course we take all the students to attend a women's health center. That tour leads people to sometimes say things. Like they always have to write a reflection paper. One of them said, "I was brought up in a Baptist home and I marched with my mother pro-life and now I'm seeing the other 01:30:00side." So you see some of these, I won't say conversion, but there are changes that take place in people's attitudes when they have these exposures. And I think we're a very unique school in being able to provide those.

MCGEE: Has the experience of teaching these courses changed your own thinking or approach at all?

ROCHAT: Well I love learning about the Buddhist perspective in Japan for example. And I wouldn't have learned that if I hadn't been teaching this course. So I think the other perspective is the passion of the students in the area is just amazing. And you listen to that presentation and you heard the standing ovation. That's never happened in that room before. And I sent out a message that I'd love to have a few friends there. Well I had a few friends there. The room was packed, standing room only. I didn't expect that. I mean usually there's 30 to 50 people in the room. It's a fourth full at best.

MCGEE: So that's definitely an impact then. You're reaching for --

ROCHAT: It's incredible feedback to me too that they care enough about me and/or the topic, it's both.

MCGEE: What, if ever, do you think GEMMA's work -- or when, if ever, do you think GEMMA's work will be accomplished? What is the end game I guess?

ROCHAT: Well my message to the development office is when hell freezes over. It just won't happen. That's when they stopped asking me to change the name. I mean clearly the work is accomplished when it's been achieved, when we have fewer than 100 deaths worldwide. But what's required to get there? Well among other things, we need a surveillance system. We need to know how many are 01:32:00happening. We don't know. The data is terrible. WHO sites the same 13% of maternal deaths are due to abortion. They did that when they estimated there were half a million deaths, now they estimated a quarter of a million deaths and they still use the 13% figure because I don't think there's any better data. And so the ultimate challenge is probably documenting progress, real progress, genuine progress. WHO shows that the proportion of unsafe abortions that are associated with death has gone down. So they make that claim. So I think there is progress taking place. I really believe that. But when it gets down to measuring the last one, I don't think it's like small pox eradication where people will be so eager to invest top dollar in verifying that it's been 01:33:00eradicated. So it'll be a soft landing in that sense. We won't really know probably when we get there or if we get there. And I think that some countries will obscure the information, China, Russia, totalitarian regime. But I guess from my lifetime, a continuation of the current process of engaging students. And I would love to have it not just in our school, but other schools. And I would love to have a court course. I'd love ultimately to have enough funds at Emory that we could hire a post-doc or someone at a higher level of research capacity to help students develop good research projects and maybe to bring in funds to do research directly, funded research. It's amazing. One person, 01:34:00one idea, and a small amount of money and it's just mushroomed.

MCGEE: So you said they were first given -- your first students were given $500. What is it now?

ROCHAT: It's still four or five hundred, that's it. So it's got to be on top of something else. Now I have a PhD nursing student who is going to Togo in the spring and wants to do her PhD dissertation on abortion in Togo. And I've offered her and someone else $1,000 each if they needed it at that point in time. But they're an exceptional situation and it's still not much money in the big picture of things.

MCGEE: But that's still pretty amazing that you could have such a response.

ROCHAT: It's token money.

MCGEE: What do you see as central traits in people who work in this field?

ROCHAT: Let me come back to the other question first and say I would love to somehow expand our funding source, so either from the Anonymous Foundation in Nebraska or some source to find a mechanism to get outside monies at a larger level for some specific purpose that that foundation or organization also believes in. I'm not sure how that'll evolve, but that would be another real measure of success to me that it's not primarily my money that's making stuff happen, but somebody else who cares enough about it to move it forward also. Anyway, next question again.

MCGEE: What do you see as essential traits in the people who work in this field?

ROCHAT: In public health?

MCGEE: Public health, abortion.

ROCHAT: Well public health, the underlying philosophical value is clearly social 01:36:00justice. It's equity. And that can be measured in so many different ways. But I think that's been touted as the underlying philosophy and I think it's the value system that most of the people I work with strongly believe in. And I think that passion goes along with that for most people in the field. I certainly know some extraordinary competent public health officials who are interested primarily in the science and aren't passionate about family planning or abortion but care about doing good epidemiology, finding out which is sort of the philosophical value of academic institutions is what's the truth. Does that make sense? And I think it's a lot easier for young women 01:37:00to be passionate about family planning and abortion because of their age and stage of sexuality and just as passionate about dealing with obesity or chronic disease. So I think that's why I draw a lot of interest even though the other problems are viewed by many as much greater. So that's another problem I face is that if you ask what's important in public health? How do you set priorities? People may turn to the global burden of disease study which measures the mortality and morbidity. Where does sexuality fit into that or reproductive health or women's choice issues? I mean they will think more about the pregnancy outcomes than -- in terms of live birth prematurity -- than they will the choice of whether to terminate the pregnancy or not. So intentions doesn't fit well into that. So I think there's a major challenge in terms of what's important within public health and where sexual 01:38:00reproductive health fits into that when it doesn't relate to overt morbidity and mortality.

MCGEE: Can you talk about the work you've done regarding abortion nationally and internationally, specifically like how do you view our rights in the United States compared to elsewhere in the world?

ROCHAT: I think we're probably pretty good compared to most of the world with a lot of diversity within the country, but there's still the freedom of going across state lines. I mean it's a money issue, but there's a freedom issue. And we talk a lot about European countries as being better than we and they may be in terms of maternal mortality or something, but some of them are extraordinarily conservative on abortion as an issue. And they still have the 01:39:00same urban and rural divide issues. So small town and rural areas make much more conservative than major city areas. As it compares with Latin America, we're lightyears ahead. The diversity we see here is no different than the diversity within Italy, north-south divide on abortion as an issue.

MCGEE: Are there countries that you see as positive models?

ROCHAT: Well I certainly think of -- no; I don't know that I do. I think Japan for example has had abortion legal, but they've only recently made oral contraceptives available, perhaps in part because the condom companies may not want oral contraceptives available. So I'm trying to think if there's any really positive model. A positive model to me would be defined as a country 01:40:00with good diversity of contraceptive methods readily available and with abortion readily available, preferably with government funding or at least resolving the problems of poor people who seek abortions. So where would you find a country like that? I mean a lot of countries have skewness in contraception where either female sterilization or IUDs or pills or condoms are the dominant mode and there's not the diversity of options available. Even in this country, we have huge diversity of let's say on vasectomy with western states being 15% or greater and southern states being less than 5%. I'm generalizing in terms of region because some of the northern states also have a high rate of vasectomy. But there is huge geographic variation. I wonder if Great Britain might be at 01:41:00least comparable in terms of -- but I would expect, again, variation within the country even if I don't know. I mean we know Ireland is off on the conservative side. New England? I mean you might find regional areas in the US that would be very good. And of those I would think west coast, New England, geographic areas with large urban areas, even Miami in Florida versus northern Florida for example or Chicago. With the urban areas, they might have the diversity.

MCGEE: Have you ever had to hide the fact that your career has focused largely on abortion?

ROCHAT: I don't know that I've ever had to do it, but I've chosen to do it. So during the time that I worked in the Georgia health department, '89 to '96 --

MCGEE: The later stint.

ROCHAT: The second stint, yeah. I remember going through my CV and taking all abortion articles out and then I had to find them later on and put them back in. But I'm a little embarrassed to have done that, but I was trying to focus on perinatal epidemiology, largely infant health issues. And I didn't want it to be an obstacle to getting my job done. I mean no one told me to do it.

MCGEE: Were there any times you felt like giving up and if so what kept you going?

ROCHAT: Giving up on --

MCGEE: Your mission?

ROCHAT: Nothing. The mission on abortion is probably varied in terms of strength. I mean it certainly is more public now. It's much stronger now. I don't know that I ever felt that I was giving up on it as an issue. It's 01:43:00just [one time?] I more successfully engage the issue. And I couldn't be doing this, like you say, if I were here or at the state health department. The amazing thing is that I went down to the state health department last June and met with the director of MCH and I told her about GEMMA and I told her about my passion in the area. And I said you got to know the baggage I carry if you want to work together with me. And it was not an obstacle obviously because they come to us for help and I don't want to make it an obstacle either, but I also want to be open about it.

MCGEE: Right, don't want it to crop up later.

ROCHAT: It's like coming out.

MCGEE: What advice would you give to someone who is planning to work in this field?

ROCHAT: Probably the same kind of advice I'd give to most public health 01:44:00professionals that -- in NPH I would say -- because those are the people I talk with mostly -- and that is working on this during your NPH years does not impede you doing work on other topics later on. So you can work on abortion for your thesis or your practicum, but you can go on and do infectious disease epidemiology in a local health department. You have a general NPH degree. You got broad training with some specialized topical areas. And I think always encouraging people to be flexible as I've had to be in life in working on different topics in different organizational areas. On the other hand, I'm thrilled that I think two or three each year of the people that I've engaged with are going on to provide abortion services. So they're going on as a nurse midwifery, they're going on into OB/GYN, but they are -- or they are 01:45:00doing research that supports going on and the opening up of abortion services as in California to non-physicians. So it's possible to use this as a channel to a career but --

MCGEE: It doesn't have to be.

ROCHAT: It doesn't have to be. There's lots of other good things to do in this world. And my daughter is passionately committed to preventing obesity among kids. She works for the American Heart Association in Dallas. I'm just as happy about her career as I am about my own, lots of very important public health work to be done.

MCGEE: Are there any other issues that have concerned you throughout your life?

ROCHAT: I love public health so I've been as interested in cholera research or 01:46:00tropical diseases. My two months working at a children's hospital in Costa Rica when I was in medical school dealing with snake bites and a variety of tropical ailments I really enjoyed immensely. So I could be passionate about all of public health.

MCGEE: Have you ever been involved in any other organizations like as an adult that's outside of your career?

ROCHAT: Outside of professional organizations, no. I can't think of any. I mean I'm a member of the local Presbyterian church down the street, but that's --

MCGEE: Are there any individuals or events that have been influential or inspirational in your adult life?

ROCHAT: Lots. Probably lots of people, I mean from Alex Lang, Carl Tyler, I can think of a whole host of people who worked in the early days, the '70s. So when we were putting up this new school of public health building we had the 01:47:00chance of paying $250 to honor people on seats. So I got about 15 seats that are labeled -- identified for GEMMA related people. So David Grimes and Eva Lathrop and Phil Darvey and Judith Rooks, they all have the names on seats.

MCGEE: Is that the theater that we were in -- no wait.

ROCHAT: That's on the -- when you walk into the building on the parking level, that theater on the left. And it's the left side of the -- there's several seats honoring me and -- honoring me and my wife too. And I don't know how many ever pay attention except when we give tours there to --

MCGEE: You point them out.

ROCHAT: -- to people who are interested, we point them out. People to honor?

MCGEE: Or even events.

ROCHAT: Mostly the people probably related to GEMMA come to mind and that's probably unfair. It's just fairly recent in my life and included my mother's been really important to me and my grandkids, my wife above all. But I've known a lot of really great people, [Chris Tetsy?] early on, population council guy who was Jewish, left Austria in time, one of the first persons who really did good work on maternal mortality and abortion research in the US, ending up transferring his research program to CDC. We ran it for a few years, 01:49:00pre-Reagan. But it was on the most important research in terms of changing abortion methodology in this country. It is one of the reasons that I have said that the abortion work that CDC has done has been the most influential work CDC has done in the area of maternal and child health. I published a paper saying that, co-authored by people at CDC that went through CDC clearance a few years ago. I've met a lot of good people at CDC certainly.

MCGEE: Has your work affected your family life in any way?

ROCHAT: Well I mentioned being evicted from my church group and the consequences that for family relationships. I was, for example, a few years ago invited to a niece's wedding in Denver and disinvited from the reception. It led to my daughter and my brother getting into a strong argument with the father of the 01:50:00bride about how they could possibly put me out. I was willing to walk.

MCGEE: How do you feel your work has impacted your own life?

ROCHAT: And you're asking specific about abortion related work? But certainly public health is -- I mean I am who I am largely because of my career at CDC. I don't think that in medical school social justice was part of my value system or a term that I can recall or having it heard used. And so going down the trail of public health has hugely affected me.

MCGEE: Do you consider yourself a feminist?

ROCHAT: Yes and no. Ordinarily, I would say no. But then the feminists defines what feminists is and I say, "Did that just make sense? That's not feminism, that's just what's right." And in that sense I'm a feminist because I [lie?] a lot in values, but -- Elise would call me a feminist, but I 01:51:00wouldn't -- and I don't have the theory. I don't have the education. So there's a lot of feminist work that I know nothing about. But I have been on committees -- dissertation committees for women getting a doctorate in women's health at Emory a couple of times. And each time that issue comes up and I say, "Why do you call it feminism? That's just justice. That's just what's right." But that's partly coming from a public health background and a social justice background. And in fact having worked most of my life in women's health, reproductive health issues.

MCGEE: Certainly I can see how people would call you that.

ROCHAT: They probably call me lots of things. I'm comfortable being called that, but I don't know that I would ever call myself that because I don't know that I understand all of what it means from those who are well educated in 01:52:00feminist thinking.

MCGEE: Right, like the theory I guess. I don't know. I think you certainly could -- you don't have to have the theory to be a feminist.

ROCHAT: I would say I'm more on the practitioner's side of public health, the practitioner's side of feminism. I'm not good at theory of epidemiology or biostatistics or any of this.

MCGEE: Are there any other further experiences you would like to share that we haven't discussed, anything that you hate that we didn't get to?

ROCHAT: So my wife was offered a few minutes' rebuttal yesterday at CDC. And she read the poem that she sang at my retirement from CDC. And it's just a reminder that I'm still a farm boy at heart and that in the last 30 years for our property up on Lake Lanier, I've hauled about 500 loads of horse manure which I get free of charge from a neighbor. And so she says, "My Roger, 01:53:00he's a gardener for sure and he has this mistress who we'll call Miss Manure." And the whole poem was about my love affair with horse manure and I said only to say there's another side of me that we haven't talked about. So in 1970 -- I want to tell a little bit about the history of CDC's work in family planning in Georgia. It started in 1964 when Alex Lang, director of the Bureau of Epidemiology assigned an EIS officer whom he was transferring in from another state because of problems there. Nick Wright was the name, to the state of Georgia. And he worked mostly on the relationship of the pelvic inflammatory disease and IUD insertions. He worked with a nursing director of maternal and child health I think by the last name of Wright, W-R-I-G-H-T. And I say that in 01:54:00case anybody wants to look up publications by them. At the end of Nick's time period, Alex recruited Carl Tyler to head up the insipient family planning evaluation activity. And he was assigned half time I think to Grady Hospital and the CDC. And concurrently Bob Hatcher was recruited and assigned to Columbus, Georgia where he worked on family planning. And Scott Field -- blocking on his name -- Scott Field was assigned to Grady Hospital. And then there were a series of people assigned to the state health department. Ron O'Connor was the first. Ron was an intern when I was a medical student in Seattle and he was the one that called and asked me if I wanted to do something 01:55:00important with my life. And when Ron finished with CDC, he went to Boston and got an MPH at Harvard and a management degree at MIT and founded Management Scientists for Health which is one of the largest NGOs in the world today working on health issues, on management issues related to health in developing countries. And then David Allen came after Ron and was assigned to the state. David was very important in developing the state family planning record system and was one with whom I went to Guatemala to help Guatemala develop a family planning record system. Some other story around that was that the US ambassador had been shot and killed the previous year.

MCGEE: In Guatemala?

ROCHAT: In Guatemala. And CDC director said we couldn't go because of that. 01:56:00And the director of family planning down there flew to Atlanta to persuade the CDC director that he would make sure it was safe for us to be there. But we went down and they had people with machine guns on every street corner while we were there. I mean it was a 9:00 p.m. curfew. It was really a pretty serious situation. But I went back to Guatemala several times over the next two years developing that system. But Ron O'Connor, David Allen, and then myself all worked voluntarily in family planning clinics, maintaining the clinic in Crawford, Georgia, a monthly clinic for several years. And after I left the state, a series of people -- I don't remember the sequence exactly. Claude Burnette I think was next. I mention him because he's still district health officer in Athens. And he had been one of the champions for family planning in the state of Georgia. Jim Shelton who went on to USAID and was their senior 01:57:00technical person in population and family planning work and is now at Johns Hopkins and is editor of a new global health journal. Brian McCarthy who spent three years in the state health department did a whirlwind of many, many activities. He was a pediatrician with an engineering undergraduate degree who engaged with the infant health issues more than any of us previously had and was probably a good candidate for supporting the shift in name change from family planning to reproductive health. And he was then assigned to WHO where he went for five or six years before he came back to this country and worked for the reproductive health division for many years doing a lot of work in developing countries. But one of his papers from his work in China had to do with 01:58:00identifying new ways of looking at perinatal risk and categorizing what's now been called perinatal periods of risk, not the name that he applied to it, but it's now used in many state health departments as a way of characterizing the population at risk in terms of birth weight and mortality and comparing it with standard populations and saying there are some birth weight groups where the problem has to be related to maternal health and others where it's related to the perinatal care, to pediatric care. And in many of the populations, it's the maternal health issue that's the driving force behind infant mortality and using that way of thinking is very different from what I as an epidemiologist had done looking at causes of death of infants. So it ignores the causes of death and rather tries to say what's the antecedent problem. It's a very 01:59:00important contribution coming out of Georgia. And then George Ruben followed him and George was an internist from Australia who hiked around South America for a year, came to CDC to visit an Australian friend, and worked for us for free for several months and then we got a job for him, EIS officer, and he became a branch chief. And then he left and worked for Ford Foundation in Bangladesh and then back to Australia where he became a state health officer in Sydney. And just fascinating careers of these people that came through Georgia Health Department for a time period of their life. The last one was Allison Spitz who was a nurse. One of the nice papers that she did that I remember was to look at the abortions occurring in very late gestation and documenting that most of them were fetal death in utero. They were not abortions for fetuses that were alive. And then abruptly the state epidemiologist said he didn't 02:00:00want us to assign any more people down there and I went down and met with him. And the reason was that the birth defects division at CDC was going to pay them to do research and assign people down there. And he didn't want to manage more people. And that was the situation until I returned from India in 1989. And that epidemiologist was a retired CDC veterinarian who wanted more to play golf than he wanted to mentor and develop young people. So that's an interesting piece of history in terms of CDC's relation, at least in the reproductive health arena, with the state health department. And we don't currently -- CDC does not currently have someone assigned there in MCH or perinatal epidemiology. I mean I walked on egg shells for six months when I went down there to say, "What can I do in this incredible situation where the state is in CDC's backyard, has many CDC assignees, and yet wants to be an 02:01:00independent state health department."

MCGEE: Right, but they wouldn't want to take advantage of those resources basically.

ROCHAT: Well, they don't want to be overrun by those resources. They don't want CDC telling the state what to do. I mean the state has its own political problems. I mean I remember the state -- when I was down there, the state health officer, Jim Elly invited me to lunch once and once only and asked me if I would like to be reassigned somewhere else within the department. I was in the department of epidemiology at the time and he really wanted to assign me to what was then the center for health statistics. And my chief ally was the director of maternal and child's health. And I said I wouldn't mind going to work for Judge Floyd but he didn't go for that. But he told me a story -- because I had been publishing a lot of papers on smoking, tobacco issues, on its impact on infant health. He said that he had taken on that issue just once. And who was the powerful person from the head of the House of Representatives at 02:02:00the time until 10 years ago or so. And I can't remember his name. Anyway, he simply told him that if he wanted to pursue that, that was fine, but he would just have his entire budget cut. That was it. So there's this power of politics in Georgia that CDC can be independent of. But the state health department can't.

MCGEE: I'm trying to think -- so before -- when you were doing the research for the report that would eventually be decided in Doe, were you just looking at reports or were you --

ROCHAT: I was looking at death certificates, paper death certificates.

MCGEE: Did you -- I'm trying to formulate my questions right now. Was there anything that -- I mean obviously you saw that there was this huge inequity between who was able to obtain abortions and who was not. And it was mostly rural Georgia or was it --

ROCHAT: It wasn't that straightforward in a way. What was I think pretty straightforward was that there was a striking contrast of women dying. And in truth two thirds of the deaths, maternal deaths, were African American and two thirds of abortion deaths. It wasn't like abortion deaths were much worse than other pregnancy care. But when you took a look at who was getting the safe abortions, it was just much disproportionately white and very young women. That's what I remember of it anyway.

MCGEE: Yeah, I'm pretty sure that sounds right. I guess I'm also just interested in looking at like how rural Georgia was affected. Obviously 02:04:00services were available here in Atlanta, but one of the facts that Margie Pitts Hames cited was that there are fewer hospitals in rural Georgia or counties that didn't have abortion clinics or services. And so I would imagine that hurt rural women certainly younger women, poor women, black women, the people that you saw as not being able to obtain the legal safe abortions.

ROCHAT: Right. So two stories on that. One is a paper Jim Shelton wrote when he was in the state of Georgia and it was titled Does Travel Distance Matter. And it showed an inverse relationship between distance from Atlanta and getting an abortion.

MCGEE: Can you say that -- travel --

ROCHAT: Does Travel Distance Matter and Jim Shelton. I don't think I was a co-author on the paper, but I'm sure if one were to repeat the study today, it 02:05:00would show the same. Part of the challenge though is that we don't have reciprocal reporting of abortion data from all of our neighboring states so that in South Georgia, it will look like they're solid right Christian, no abortions and they're all going to Florida. And we don't know what the real abortion ratio is for residents of South Georgia. Another story was around 1990 when I went to Albany, Georgia to talk with public health nurses -- I don't recall about what, but in the course of the conversation I discussed the abortion issue. But what I remembered distinctly was that the white nurses were on the left facing me, the African American nurses on the right. And a white nurse spoke up and said, "We don't have a problem with abortion. If our girls get pregnant, they go to Atlanta." And an African American nurse spoke up and said, "We have a problem when our girls get pregnant, they can't afford to go to Atlanta." And the white nurse said, "I didn't know you had that problem." I'm paraphrasing I know, but that was the message I got, 02:06:00the lack of communication, the lack of discussion of the issue, and among African Americans there was a problem.

MCGEE: And that was in --

ROCHAT: 1990. So that was so consistent with what I observed during the '50s and '60s. And so they have babies. And I don't know the extent to which that's still true. But I can't help but believe the discrimination issue and the stigma issue about getting an abortion is huge in rural Georgia among both whites and African Americans. And I'd like to believe there's a lot of effective contraception out there, but I don't honestly believe that's true.

MCGEE: Well and you consider the state of sex education in the state.

ROCHAT: So that's my story for Georgia that I wanted to share. Let me just say that Dave Allen -- I talked about some of the success of careers. Dave Allen went on to be commissioner of health in the state of Kentucky until a new governor came in, he lost his job, political interference with public health.

MCGEE: That certainly seems to be a theme.

ROCHAT: He was an incredibly dynamic person, just really outstanding. And he was also a pilot and used to fly around Georgia. Oh I should tell you another story about my life when I was working in Georgia. Do you have another five minutes or not?

MCGEE: We can go for another five minutes.

ROCHAT: Okay, I'll make it short. Jane Fonda at one point wanted to have analysis of teenagers, how many births they averted by using contraception. Have you heard this story already?

MCGEE: No, but is that because of her -- for GCAPP?

ROCHAT: Well it was for GCAPP, yes. And I was asked to play a role in doing it. And actually we hired someone out in California to do the analysis. But I insisted that we include abstinence. Well the story that comes out is that 02:08:00teenagers averted about 100,000 births a year, about half through abstinence and about half through contraception. And she borrowed Ted Turner's jet. And four or five of us flew around the state for three different press stops at which I would stand up and present the data, as she would stand up and say, "See, prevention works, abstinence or contraception." And then the newspaper would talk about her as being crazy Jane. But I love the lady for what she does.

MCGEE: Yeah, when was that that you did that?

ROCHAT: Well that would've been about 1994, '95, somewhere along in there. And that data was never published. I still have a copy of the report, but Claire [Brendis?] who had done the research out in California, had done a data analysis, has published similar data, but without the abstinence piece I think for California. But I love the abstinence piece. I love saying, "You know, you can make a marginal difference in abstinence, it can really make a difference too."

MCGEE: It can be part of it.

ROCHAT: I mean the public health prevention strategy, none of the research shows that it matters to try to advocate abstinence. But for those who practice abstinence, it does make a difference. Thanks for listening.

MCGEE: No, thank you so much.