AJR  Features
From AJR,   June 1999

Embracing the Complexities   

Alix Freedman's powerful story on a controversial sterilization drug had instant and global impact. But it was the ambiguities that drew her in.

By Mark Lisheron
Senior Contributing Writer Mark Lisheron (mark@texaswatchdog.org) is Austin bureau chief for Texas Watchdog, a government accountability news Web site.      

THE VIETNAMESE SECURITY POLICE who had thrown Alix M. Freedman off the Hoa Binh Rubber Plantation were not prepared to treat her second visit so lightly.
The Wall Street Journal reporter had first come in early 1998 while pursuing a tip that 107 women workers at Hoa Binh had been sterilized without their knowledge with quinacrine, a drug Freedman had spent months reporting on before coming to Vietnam. Before the police sent her away, Freedman had gleaned enough to know she must come back to do interviews and take pictures.
When she returned, the police took her notes and detained her. Through her translator and colleague, the Journal's Hanoi bureau chief, Freedman somehow persuaded them not to lock her up.
"Obviously, I was taking some calculated risks, and, for a time, I had thought I might go to jail," Freedman says. "But if you become too focused on the risks and calculating the dangers, you can become paralyzed. When I'm reporting, I'm not thinking of the risks. I'm thinking of getting to the bottom of things."
It was Assistant Managing Editor Stephen Adler who was assessing her risks and dangers from an office 3,500 miles away in New York City. For all of her prowess, Freedman had never done any international reporting. "She called me every night, and I was more terrified during those calls than she was," says Adler, who works closely with Freedman on all of her projects. "There is a fearlessness about Alix. She has gone places you wouldn't think that someone with her background might go. She has gone places I'd be scared to go. She has dealt with a lot of not very nice people. But she had heard there was a story in that commune, and she was determined to get it."
It was just one of dozens of stories Freedman collected over eight months of reporting. She wove them into a single, nearly 5,000-word account that ran on the front page of the June 18, 1998, Wall Street Journal under the headline, "Population Bomb; Two Americans Export Chemical Sterilization To the Third World."
The story of the impassioned efforts of Stephen Mumford and Elton Kessel to control population through quinacrine sterilization exploded with the impact of a bomb. Freedman wrote that quinacrine sterilizations, which are not permitted in the United States, may cause cancer. She wrote that the operations are frequently painful, sometimes causing women to faint, and can be followed by such side effects as abnormal menstrual bleeding, lower abdominal pain and fever. And she wrote that, in some cases, women were sterilized without their knowledge, even against their will.
After the article appeared, India, where Mumford and Kessel had concentrated much of their effort, banned quinacrine sterilizations. Chile, where the method was developed, also banned the drug. The lone company manufacturing quinacrine stopped doing so, announcing it had a "moral obligation" to desist. The U.S. Food and Drug Administration threatened Mumford and Kessel with criminal prosecution.
The Society of Professional Journalists gave its award for excellence in investigative reporting in 1998 to Freedman. She won the Polk Award for international reporting. The National Headliner Awards named "Population Bomb" the Best of Show. Freedman just missed winning her second Pulitzer Prize in four years, finishing as a finalist in the investigative reporting category, and the story also was the runner-up for the Selden Ring Award.
Journal Managing Editor Paul Steiger says Freedman's work did nothing less than transform international health policy. Of Freedman, he says, "Alix is the best reporter I've ever encountered, one of the very best reporters in the world."
Freedman, 41, a senior special writer, has wide latitude in choosing her subjects. Although Steiger has rarely had to remind her, he says he wants Freedman to focus on projects that are meaningful, projects that carry a "moral force."
"Should you apply a Stradivarius to the playing of `The Farmer in the Dell?' " Steiger asks. "I want her tackling serious stuff, about something that really matters. I tell her, `Something that is worthy of your Stradivarius.' "
Freedman, a 1979 Harvard graduate whose father, Emanuel Freedman, was a New York Times editor, spent five years working her way to the Wall Street Journal, which she joined in 1984. From the Philadelphia bureau she moved very quickly to New York, showing great tenacity in covering beats and exhibiting an unerring feel for writing large and complex stories, Adler says.
Freedman's coverage of the tobacco industry in 1995, including accounts of the collusion of cigarette makers to addict smokers, won her the Pulitzer Prize in 1996. Her work contributed to the tobacco industry's decision to settle for $368.5 billion a class action lawsuit initiated by state governments over damages caused by smoking.
She has done award-winning front-page stories on companies that make Saturday Night Specials, sell fortified wines, and market televisions, stereos and furniture on rent-to-own plans. Her moral force has been directed to "the nexus between business and poverty, an intersection that is not thought about much," she says. "I think it's a story when some element of capitalism has gone awry, or a person's moral compass is not pointing strictly due north."

ADHERING TO THE JOURNAL'S policy, Freedman, Adler and Steiger will not discuss the genesis of "Population Bomb." Adler is uncomfortable recounting how the story evolved. But Steiger says he knew early on "the story of two men working on the cheap, quite successfully sterilizing women and putting them at risk, was pretty simple, a no-brainer, a green light." A violin concerto.
And Adler says the subject was tailor-made for the reporter. "I really respect her conceptualization ability, her ability to step back and say, `What do we take away from this?' " Adler says. "Quinacrine was so complicated, and she embraced the complications."
Freedman is tightly coiled. Over lunch and in an interview in her office in the Journal's Manhattan newsroom, she seems truly surprised anyone is interested in her and fears an account of her answers will somehow contribute to the hated trend toward celebrity journalism. But she gradually warms to the retelling of her work.
As it unfolded, the story became a good many things: a story of overpopulation and poverty, a story of science and regulation, a story of the sometimes jolting differences in attitudes toward and perceptions of women in the First and Third Worlds. Freedman embraced the complexities by simplifying. This, she says, was the story of Mumford, Kessel and their unstinting commitment to quinacrine.
"I never had this, `Eureka, this is a blockbuster,' " Freedman says. "But I had done enough of the reporting, and I had asked myself, `Does the story need to be in the Wall Street Journal?' and I concluded that the answer was yes."
Mumford says Freedman left a message for him one day late in the fall of 1997 at his home in suburban Chapel Hill, North Carolina. The home doubles as the headquarters of the not-for-profit Center for Research on Population and Security. His basement is the storeroom for one of the world's largest supplies of quinacrine.
Researchers during World War II had developed quinacrine from a synthetic compound to fight malaria. During a particularly active period of contraceptive research in the early 1970s, Kessel and Mumford learned that Chilean researcher Jaime Zipper had adapted the drug for use in sterilization. Quinacrine does its work in the uterus by scarring the tissue, thereby blocking the fallopian tubes.
As Freedman embarked on the story, it was with the understanding that there were health concerns about using quinacrine for sterilization. When she raised the question with federal regulators and World Health Organization officials, she was told quinacrine causes cells to mutate. More often than not, mutagens also cause cancer, although conclusive research on quinacrine has not been done. Mumford and Kessel dispute the view that quinacrine is a carcinogen.
In Mumford, Freedman certainly had a willing interviewee. Mumford recalls that he was so eager to talk to Freedman about quinacrine that he returned her call from an outdoor telephone in Beijing, China. After toiling for years in relative anonymity, Mumford says Freedman's was an irresistible offer to carry the message of quinacrine through one of the largest, most respected newspapers in the world.
"It is a sterilization method that I believed deserved a lot more attention than it had gotten," Mumford says. "It appeared to be the opportunity we were looking for to get our message out to large numbers of people. She literally told me that if I gave her what she needed for the story, she would give me a fair and honest assessment of the method."
Mumford and Kessel had over the past decade raised and spent roughly $1 million traversing the globe distributing quinacrine for free to doctors and clinics that have performed more than 100,000 sterilizations, Freedman learned. The men had taken a vow of relative poverty while carrying out their crusade. Mumford pays himself but $37,500 a year out of the donations he receives to run his research center; Kessel, who heads the International Federation for Family Health in Carlton, Oregon, lives on Social Security and income from a few small investments.
"Their primary goal, they emphasize, is to improve the lives and protect the health of Third World women, almost 600,000 of whom die each year from pregnancy related complications," Freedman wrote. "The World Health Organization, which advises the United Nations and its members, reports that the incidence of such deaths is 18 times as high in the developing world as it is in industrialized countries."
The underlying motivation for Mumford, Freedman went on to report, was alarm over the "chaos and anarchy" that would be created by untrammeled population growth worldwide and resulting immigration to the United States. Financial support for Mumford and Kessel's work has come largely from anti-immigration groups such as the Federation for American Immigration Reform as well as the conservative Scaife Family Foundation.
For almost 30 years, Mumford has maintained that the Roman Catholic Church is behind much of the opposition to family planning, birth control and sterilization internationally. The entire 600-page text of his 1996 book, detailing what he portrays as the perilous reach of the Vatican, is posted at population-security.org, one of Mumford's two Web sites.
The situation was rife with the ambiguities to which Freedman says she has always been drawn.
"These are not the devils incarnate," she says of Mumford and Kessel. "In some places where they work, they are considered well-meaning saviors whose work has not been given its due. Mr. Mumford is a very bright man, coming to this from a very particular ideology. Illuminating people's motivations for doing what they're doing is more worthwhile, I think, than condemning evil."

FREEDMAN HAD PUT IN AT LEAST three months of reporting before the question was broached of traveling to the places where Mumford and Kessel did most of their work. Without seeing women being treated with quinacrine firsthand, she says, what she had was "an arid discourse between talking heads decrying quinacrine and its supporters."
Mumford says he volunteered to serve as Freedman's guide. "I may very well have suggested this," he says. "I may have even pleaded with her to do this, so that she could see for herself the success we were having. This was entirely to give her the opportunity to discuss with women and clinicians what this procedure was all about."
Freedman accepted Mumford's offer. Together they planned a 23-day tour that took them first to Indonesia, then to Vietnam, to Bangladesh and, finally, to India. Before leaving, Freedman says she did what any cub reporter would have done, calling sources suggested by Mumford to arrange for interviews in advance.
While her editors speak of her fearlessness, Freedman isn't sure that's the best way to sum up her approach to her foray deep into the Third World. "I would call it a blithe suspension of disbelief," she says. "It was foolhardy to believe that everything would go as I had planned it. It was clear I'd be living by my wits."
In Dacca, Bangladesh, where quinacrine already had been banned, Freedman met Naseem Rahman, a gynecologist who has performed 3,000 sterilizations with the drug. Rahman invited her to witness the sterilization of Ambia Khatoon, a maid.
"Mrs. Khatoon moans softly as Dr. Rahman briskly thrusts an IUD inserter filled with 12 quinacrine pellets deep into the patient's uterus," Freedman reported. "Moments later, the doctor instructs an assistant to mop up a small pool of blood that has dripped onto the floor." "You see the cartons of quinacrine packets in the basement of Mumford's home, and you have this antiseptic view of what is going on, and then you see the procedure, with the blood dripping," she says. "I almost fainted."
This dramatic eyewitness account does not lead her story, but serves as an introduction to its dŽnouement. Freedman was unwilling to write a simple morality play. Much earlier in the story, she introduces Rahman as an unabashed proponent of Mumford, Kessel and their methods. Doctors in countries with booming populations and precarious economies have embraced quinacrine sterilization for its inexpensive effectiveness, Rahman and others told Freedman. How can the remote chance of cancer be weighed against infant mortality rates more than 15 times higher and maternal mortality rates as much as 80 times higher in some countries than that of the United States?
"First let these women be accepted as humans, and then let's talk about human rights," Rahman told Freedman. "As it is, they're going to die, so what do the long-term complications of quinacrine matter?"
Mumford, who wrote a letter to the editor decrying "Population Bomb," says Freedman seems to have ignored much of what she saw overseas. Otherwise, how could she not have become convinced of the value of quinacrine? "Here we were riding around through some of the worst poverty you can imagine, and it appeared that she didn't want to look out her window," Mumford says. "It was like she didn't want to see it."
What she saw and reported were at stark variance with Mumford's assessment. Freedman followed Mrs. Khatoon into the street and to the rickshaw bicycle that will carry her home and learned that the woman's trip to the gynecologist will cost her family vegetables for a week. At the Hoa Binh Rubber Plantation, a woman tells Freedman she and other workers were beaten by their husbands after they found out their wives had been sterilized.
The trip to Hoa Binh was not part of Mumford's itinerary. Confirmation of sterilization without knowledge or consent was necessary, so important that it made her possible arrest a secondary consideration, Freedman says.
"In Vietnam I was accompanied by the Hanoi bureau chief, and so I wasn't exactly flying blind," she says. "But to report the story to its fullest, I knew I had to get as close to its grass roots as I could. All I know is that I wanted to get to that rubber plantation."
And yet for every vignette damning to Mumford and Kessel, Freedman provided countervailing opinion. Freedman and Adler say they agreed early on that this was not simply going to be a story about villains and victims.
"You don't need to sacrifice ambiguity, contradictions and denials to get where you are going," she says. Freedman is no more interested in revealing how these interviews and these scenes made her feel than she is in taking sides in her story. If everything that should be in a story is in a story, she says, the deciding can be left to the reader.
"I don't believe you should be a hostage to your own views," she adds. "When I was younger, with more passionate convictions, I wanted to sort of drop neutron bombs. But as I have matured, I have tried illuminating people's motivations for doing what they're doing. I really don't like stories that cry out, `Dear reader, this is what you should think.' What I'm talking about here is less investigative journalism and more meditation on how the world we live in works with all its complexities and nuances."

DESPITE ITS AMBIGUITIES, "Population Bomb" was a story that had a powerful impact, both instant and global. Until Freedman's story ran, Sipharm Sesseln AG of Switzerland manufactured quinacrine, solely for Mumford and Kessel. "If there was absolute clinical evidence that the pellets were toxic and dangerous, we would refuse to make them," company President Fritz Schneiter told Freedman. "But it isn't our role to check if this is safe or not. We aren't the conscience of the world."
A week after the story appeared, the company released a statement saying it had a "moral obligation not to support a project that is now so controversial."
The U.S. Food and Drug Administration sent letters to Kessel and Mumford requesting that they stop distribution of quinacrine and voluntarily destroy the roughly 300,000 little yellow pellets stored in Mumford's basement. The FDA also raised the possibility of legal action. The two have not complied with the request and challenge many of the FDA's conclusions about quinacrine, Mumford says.
Freedman has also earned the never-ending enmity of Mumford, who cannot believe the community of journalism could laud such a story. Mumford says "Population Bomb" is "a very skillfully written piece of propaganda crap." On one of his Web sites, quinacrine.com, he provides a paragraph-by-paragraph rebuttal side by side with the entire text of Freedman's story under the headline, "Wall Street Journal creates a Docudrama on the Front Page News complete with Villains, Victims and the Reporter as Hero."
Through all sorts of misrepresentation, Freedman "did everything she could to paint us as two lone kooks," Mumford says. "We come across as anti-immigrant, racist, Nazi types." Of helping Freedman report on quinacrine, he says, "It was the worst mistake in judgment of a human being that I have ever made."
Freedman apologizes for nothing in the story; Mumford's role as evangelist for quinacrine is much different from her role as a journalist, she points out. She also thinks it is a mistake for journalists to become preoccupied with the changes their stories bring about. "Measuring everything against impact is not the way we should be doing things," Freedman says. "Reporters become too impact-centric, I think, because of this preoccupation with winning prizes....
"A newspaper has many missions," she continues. "We want to change the world sometimes, and sometimes we just want to tell a good story. I would have done quinacrine anyway, because it was a good story."