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there is a logical provision for post-fertilization, pre-implantation termination of pregnancy. During this stage, the zygote is in the colonial and organal stages, not the ultimate stage of “organismal livingness.” Prevention of implantation after rape or by IU D's is no more homicidal than accepting the inevitable eroding away of all life in a person already legally dead.

So, let us not forget that the primary alternative to abortion is preventing fertilization and implantation by the full range of birth control methods under normal circumstances and in the case of rape, immediate termination of the fertilized zygote by a simple medical procedure.

For birth control to be a genuine alternative to abortion, there must be a more effective and energetic program of training in the facts of childbirth and sexuality, According to one study, 30% of the women seeking abortion used no birth control method at all, and half were not using one at the time of conception. At the same time, many of those persons are well-educated and undoubtedly knowledgeable about the "facts of life." We don't need to devote effort to explain to people that sexual intercourse may result in pregnancy, but we do need a much more adequate program of developing the motivation for avoiding unwanted pregnancies. Let us direct many of the pro-abortion arguments to people before they allow the pregnancies to occur. Let us tell them about the population problem, the food scarcity, the cost of rearing a child, the physical dangers and unpleasantness of childbirth, and the tremendous challenge of raising a child. The pro-abortionists say all of these things very well, but only to justify terminating a pregnancy at any stage. These things need to be said in the home, the school, the church and synagogue, the community center, in the public media, and in the counselling programs, so people will develop the motivation to use the methods available to avoid pregnancy.

There are those who have developed strong hostilities to sex education, particularly as undertaken in the public schools. Apparently, this concern reflects a commitment to a Judeo-Christian ethic of sexual abstinence apart from marriage. While I personally accept that ethical standard and see compelling social reasons for its observance, we need to be careful at this point. Realistically, we cannot pretend that sexual abstinence outside of marriage is being observed in our society, even by the majority. Given this social reality, we must decide whether we want a full and effecitve sex education program or a situation which pushes us toward liberal abortion laws. The California State Senate recently approved a bill which would authorize birth control advice and aid to any person under age 18. Perhaps this is the realistic approach to take.

Moreover, a sound program of counselling and instruction in sexuality need not contribute to promiscuity. On the contrary, the emphasis should be on experiencing sex at its best-a beautiful expression of the commitment and devotion of two persons, not the fleeting and shallow coupling of counterfeit sex. This training should also avoid the prevalent exaggeration of the importance of sex in human experience. It is a meaningful experience, but not the end of all human life.

Even if we are successful in developing effective training programs such as these, we must also go the second mile and provide viable alternatives to those who have problem pregnancies in spite of anything done to prevent this. Here again, the pro-abortionists have failed to look beyond the relatively cheap and easy solution of abortion.

Some of the steps in dealing with problem pregnancies will require fundamental changes in attitude. First of all, society will need to set aside the punitive approach toward the unmarried, pregnant woman. Nothing in the various religious and ethical systems justifies a lack of compassion toward the unintentionally pregnant woman. Even if the woman has failed to use birth control methods and has taken a very poor approach to sex, there must be compassion and acceptance toward her. On the other hand, the pregnant woman may need to adjust her attitude as well. Hopefully, the father of the unborn child will face the responsibilities and decisions with her, but, even if not, there must be an acceptance of the fact that a new life has come into being and cannot be wished away or destroyed with no emotional or moral scars.

A number of specific and practical alternatives are available to help the woman with the problem pregnancy.

1. ADOPTION When the hundreds of babies were being evacuated from Vietnam, a great many people interested in adopting a child made inquiries to my office and to other officials. Nevertheless, there are numerous "difficult” cases of children with handicaps or mixed ancestry whom no one will adopt. Perhaps our adoption agencies should provide special grants for the medical and counselling costs associated with adopting these children. Senator Inouye has introduced a bill, S. 108, which would allow an income tax deduction for social agency, legal and related adoption expenses. I support such a bill, since natural parents are permitted to deduct the medical expenses incurred in childbirth. Senator Inouye's bill would set a $1000.00 limit on such a deduction, which would be sufficient, particularly if there could be additional assistance for the "hard to adopt” cases.

Some counseling services explain sufficiently to the pregnant woman what is involved in adoption, from her point of view. In other cases, there is a strong bias toward abortion, so the emotional cost of abortion is underestimated and psychological cost of adoption is exaggerated. We should not talk of “giving up" a child, but of "giving over” the responsibility and privilege of nurturing the child to those in a better position for this role. The pregnant woman should meet some adopted children and parents and realize the potential happiness in such a family setting. Of course, provision should be made for the costs to the woman during her pregnancy, just as public funding has been provided for abortion.

2. CHILD AND FAMILY SERVICES

An unmarried, pregnant woman must not be forced to choose between abortion or adoption. In many cases, as the woman comes to understand and accept her situation more fully, she will decide to raise the child herself. In some cases, this may eventuate in marrying the father of the child or some other man who accepts the situation and agrees to be the adoptive father. In other cases, the woman will be able to successfully provide a family enviornment herself. There has been a favorable trend toward accepting such families, even to the extent of allowing a single person to adopt a child.

Senator Mondale, chairman of the Subcommittee on Children and Youth, has been_holding hearings, in conjunction with the House, on the important Child and Family Services Act, S. 626. The statement of purpose within this bill reminds us that the family is the primary and most fundamental influence on children, and must be strengthened by more effective services. As a co-sponsor of this bill, I fully agree and would point out the relevance to the discussion of alternatives to abortion. If anyone needs child care programs and the full range of counselling services, it is the woman who chooses to raise her child instead of aborting it. She will need a monthly income during the early years of the child's development, then a provision for child care if she is able to work.

While the federal government has given extensive assistance to child care programs, the Mondale bill takes the laudable approach of providing broad family services. A favorite pro-abortion argument is that a problem pregnancy produces an unwanted, neglected child, subject to emotional neglect, if not physical abuse. Child abuse is a serious problem, but we need not accept the inevitability of a previously unwanted child being abused. People change their attitudes toward children and, with counselling and guidance, can accept a child and provide an excellent home for it. This happens repeatedly among couples who at first did not expect to have another child. I trust the Congress will pass the Mondale bill and thus allow the strengthening of child and family services.

While, in some cases, present social service agencies can adequately deliver the needed services, in other cases there need to be more visible and accessible delivery methods. Certain areas would benefit from mobile clinics, offering information, counselling, and basic medical services both to prevent and to deal with problem pregnancies and the gamut of related social and physical needs. Another approach would be the development of “child life centers” as visible and accessible adjuncts of existing social service agencies.

3. OTHER ALTERNATIVES

Federal and state legislative adjustments are needed in cases which still reflect outmoded and punitive social views. An example is insurance policies which exclude unmarried mothers from maternity benefits.

Public school programs in family life training could benefit from in-service training for present teachers and more effective training in the colleges of education, to assure that teachers have adequate preparation in the biological and social aspects of their course content. This should result in public school classes which expose students to the full range of alternatives to abortion.

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In some cases, problem pregnancies of the past have resulted in neglected children, for whom foster care may be a solution. More attractive incentives may be needed for potential foster parents, both financial and social.

Mr. Chairman, I appreciate the opportunity to present this statement. The Subcommittee has been providing ample opportunity for interested persons and organizations to be heard and has been most fair in conducting the hearings. My best wishes to you as you conclude the hearings and face the difficult task of developing an amendment acceptable to your Subcommittee. I would only add that the process of amending the Constitution is deliberately difficult and time consuming. The Senate must act responsibly in proposing amendments, but has the assurance of full consideration in the state legislatures before ratification takes place.

Senator BURDICK. A word may be in order about the purpose of today's hearing.

On several occasions in our earlier hearings on the proposed resolutions the question has arisen to the effect of the language of the amendment on drugs and devices which are generally regarded as contraceptive. Senate Joint Resolution 6 of Senator Helms would apply all the constitutional protections to the fetus "from the moment of fertilization.”

Senate Joint Resolutions 10 and 11 by Senator Buckley uses the term “at every stage of biological development.'

In testifying on these amendments, Senator Buckley further clarified this and wished to indicate that he intended full legal protection from the moment of conception.

Our two distinguished witnesses, Dr. Philip Corfman and Dr. Gordon Douglas will offer expert testimony on the current state of medical and biological knowledge as we attempt to answer the question if whether we were to adopt the amendment we would also be outlawing certain kinds of contraceptive devices.

Welcome to the committee, doctors.
You may proceed in any way you wish.

Dr. CORFMAN. We both have prepared statements. Would you like us to read them?

Senator BURDICK. First of all your prepared statements will be put in the record in that form, and you may proceed in any way you wish.

[The statements referred to follow :) MECHANISM OF ACTION OF CONTRACEPTIVES IN USE: INTRODUCTORY REMARKS AND DISCUSSION OF BARRIER METHODS, Rhythm, AND INTRAUTERINE DEVICES

Mr. Chairman and members of the Subcommittee, I am pleased to be asked to speak on this topic of much medical importance and am honored to appear with Dr. Gordon Douglas who is Professor and Chairman of Obstetrics and Gynecology at New York University. He is also a former member of the Secretary's Committee on Population Affairs of the Department of Health, Education, and Welfare and is uniquely qualified to discuss this subject.

In order to use the time efficiently and to permit adequate discussion of the various issues, Dr. Douglas and I divided the discussion into five classes of contraceptive methods. I have taken three and he has taken two. Our statements are our own and are not submitted as a single document but taken together they are designed to cover the principal topics.

We have been asked to discuss the mechanisms of action of the various contraceptives in use in the United States today. Some methods function in very simple and obvious ways but the functions of others are not well known. We certainly require more research to understand these processes but it may never be possible to be completely certain about the mechanism of actions in humans of some methods.

Normal reproduction involves the deposition of sperm at the opening of the uterus, the ascent of the sperm into the oviducts where, given the proper time of the month, an ovum will be present and fertilization will take place. Fertilization is a process which requires several hours for completion. The fertilized ovum is transported down the oviduct into the uterus where it implants after about 6 days. Considerable development of the fertilized ovum takes place during this transport period. Due to ethical restraints and technological problems we shall probably never be exactly certain of all steps in the reproductive process in humans. Much of our understanding is drawn from extensive animal work.

We shall discuss contraceptives in the five classes listed in the table. All of these methods interfere in some way with the reproductive process I have just described. We have listed the methods according to their frequency of use in the United States. These data are taken from research supported by the NIH and are based on surveys of contraceptive practices by married women in 1970. These are our most recent definitive data but we have reason to believe that since 1970 there have been some changes, particularly an increase in use of IUDs and sterilization. Also it should be noted that these data were obtained from married women and differ somewhat from the contraceptive practices of other women.

The first class of contraceptives are various barrier methods, all of which are designed to prevent access of the sperm to the uterus. All of these methods prevent fertilization. In 1970 approximately 28.3% of couples used these methods which include withdrawal (2.1%), douche (3.2%), diaphragm (5.7%), vaginal jellies and foam (6.1%), and the condom (14.2%). Withdrawal involves the deposition of sperm outside the vagina and the other methods involve the use of a physical barrier or some fluid substance to immobilize sperm or wash them from the vagina. It should be noted the douche is not considered to be a good contraceptive.

The second class of contraceptives is rhythm or periodic continence. There are a variety of rhythm methods but all are based on attempts to avoid coitus at the time when fertilization is thought likely to occur. No devices or drugs are used and coitus is normal but it is restricted to periods in the menstrual cycle during which conception is thought not likely to occur. In 1970 6.4% of couples used this method.

The third class of methods includes the intrauterine devices of which a large variety are in use including tvpes developed quite recently which contain drugs, such as copper or hormones. In 1970, 7.4% of couples used this method but there probably has been an increase in their use since then.

Little is known with absolute certainty about the mechanism of action of IU Ds in humans but we know much of their mode of action in various experimental animals. The effect varies considerably from species to species, ranging from sheep in which IU Ds prevent access of the sperm to the uterus to rabbits where devices interrupt the reproductive process after implantation. In most animals, however, IU Ds appear to be effective before implantation has occurred. This is the case in rodents, hamsters and non-human primates.

IUDs alter the environment of the uterus so that it is inhospitable to sperm, the ovum or the fertilized ovum, depending on which is most sensitive. The most sensitive element in sheep is sperm, but in most others it is the ovum.

We know much less about the mechanism of action in humans. We cannot state with certainty how IU Ds work but many scientists believe that they prevent implantation. Our doubt is confounded by the fact that IUDs are not always effective and approximately 2 or 3% of women with IUDs in place become pregnant within the first year.

Thank you for the opportunity to review these important topics. I shall be glad to join Dr. Douglas in responding to any technical questions you may have.

STATEMENT OF PHILIP A. CORFMAN, M.D., DIRECTOR, CENTER FOR POPULATION RESEARCH, NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Dr. CORFMAN. I am Doctor Philip Corfman, Director of the Center for Population Research at the National Institutes of Health.

Mr. Chairman and members of the subcommittee, I am pleased to be asked to speak on this topic of much medical importance and am honored to appear with Dr. Gordon Douglas who is professor and

chairman of obstetrics and gynecology at New York University. He is also a former member of the Secretary's Committee on Population Affairs of the Department of Health, Education, and Welfare, and is uniquely qualified to discuss this subiect.

In order to use the time efficiently and to permit adequate discussion of the various issues, Dr. Douglas and I divided the discussion into five classes of contraceptive methods. I have taken three and he has taken two. Our statements are our own and are not submitted as a single document, but taken together they are designed to cover the principal topics.

We have been asked to discuss the mechanisms of action of the various contraceptives in use in the United States today. Some methods function in very simple and obvious ways, but the functions of others are not well known. We certainly require more research to understand these processes, but it may never be possible to be completely certain about the mechanism of actions in humans of some methods.

Normal reproduction involves the deposition of sperm at the opening of the uterus, the ascent of the sperm into the oviducts where, given the proper time of the month, an ovum will be present and fertilization will take place. Fertilization is a process which requires several hours for completion. The fertilized ovum is transported down the oviduct into the uterus where it implants after about 6 days. Considerable development of the fertilized ovum takes place during this transport period. Due to ethical restraints and technological problems, we shall probably never be exactly certain of all steps in the reproductive process in humans. Much of our understanding is inferred from extensive animal work.

We shall discuss contraceptives in the five classes listed in the table which is part of my submission.

Methods of contraception used by American married couples--1970
Methods

Percentage 1. Barrier methods

28. 3 Withdrawal.

(2. 1) Douche..

(3. 2) Diaphragm

(5. 7) Foam.

(6. 1) Condoms

(14. 2) 2. Rhythm.

6. 4 3. IUD's.

7.4 4. Sterilization..

16. 3 Wife sterilized.

(8.5) Husband sterilized.

(7. 8) 5. Oral contraceptives-

34. 2 From Westoff, C. F. “The Modernization of U.S. Contraceptive Practice," Perspectives 4: 9-12, 1972.

All of these methods interfere in some way with the reproductive process I have just described. We have listed the methods according to their frequency of use in the United States. These data are taken from research supported by the NIH and are based on surveys of contraceptive practices by married women in 1970. These are our most recent definitive data, but we have reason to believe that since 1970, there have been some changes, particularly an increase in use

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