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California is now 17 years and under, and in 1971, 16,345 abortions (14%) were performed on patients in this category.

When related to live births, the legal abortion ratio reached a high of 286.7 per 1,000 live births in 1971. The highest age-specific ratio was at ages 10–14, and decreased with increasing age, until ages 35-44, where the ratio increased. The fact that there were 1,166 legal abortions in 1971 in the 10–14 age group is surprising, but the proportion of total abortions in this age group has actually decreased from 2.3 percent in 1969 to 1.1 percent in 1971.

REGIONAL COMPARISONS

In 1971 there was an increase of 51,380 abortions from that of 1970, and nearly 67 percent (34,165) of this was produced by the increase in the Los Angeles Víetropolitan Area. As seen in Table 3, every Statistical Area except Santa Barbara-Ventura experienced increases between 1970 and 1971 ranging from 26 to 342 percent.

Regional data given here do not necessarily reflect the actual abortion experience of the women residing in these areas. This results from women leaving their state or county of residence to obtain the procedure. The reasons for this may be economic or simply a lack of available services locally. For example, the 1971 decrease of abortions in Santa Barbara-Ventura might well be due to women seeking services in Los Angeles.

HOSPITAL PRACTICES

In 1970, 17 hospitals, each performing over 1,000 abortions, accounted for over 27,000, or 42 percent of the total 65,369 procedures. In 1971 the number of institutions performing more than 1,000 abortions each, increased to 22 and they did more than half (51 percent) of the 116,749 abortions that year. The 22 hospitals doing over 1,000 abortions in 1971 did not include all 17 from this category in 1970. Six hospitals doing over 1,000 abortions in 1970 reported fewer than this in 1971 and 11 other hospitals reported over 1,000 abortions for the first time in 1971.

MATERNAL MORTALITY DUE TO ABORTION

Hospital therapeutic abortion reports and death certificates have identified 4 maternal deaths due to legal abortion in 1970 and 5 such deaths in 1971. However, the death certificates for 1971, which were available for review, were not complete at the time this report was prepared, so the 1971 count is preliminary.

The medical findings and patient history pertinent to the 5 fatal outcomes in 1971 are as follows:

Case 1.-Cardiac arrest following dilatation and curretage of the uterus (D&C). The coroner's report attributes the underlying cause of death to be a sickle cell disorder. The attending physician suggests a possible reaction to the anesthetic drug administered.

Case 2.—Hemorrhage following D&C. The underlying cause of death was a perforation of the uterus and laceration of the uterine artery.

Case 3.-Cardiac arrest following D&C. This patient had a history of taking amphetamines, LSD and mescaline.

Case 4.-Ruptured left ectopic pregnancy with hemoperitoneum following D&C.

Case 5.-Septicemia following D&C.

The mortality rate for induced abortions performed in hospitals was 6 per 100,000 in 1970 and 4.3 per 100,000 in 1971. A death rate of 3–4 per 100,000 legal abortions is reported in Hungary, Czechoslovakia, Japan and New York State, where large numbers of legal abortions are performed.

For comparison, the maternal mortality rate in 1970, excluding spontaneous and therapeutic abortion, was about 18 per 100,000 total births. The ratio of deaths from legal abortion (1971) to California women of reproductive age (1970) was approximately 1 per 857,000 women.

There is evidence that deaths due to illegal and self-induced abortion have declined since the California Therapeutic Abortion Act became effective. As reported on death certificates, the number of such deaths are as follows: 1966—15, 1967—20, 1968—14, 1969—8, 1970—6, and 1971–3 (preliminary count).

PREGNANCY COUNSELING

One result of the 1967 therapeutic abortion law has been a remarkable growth in pregnancy counseling services. Such services are generally intended to help women with problem pregnancies to evaluate the options open to them. The agencies offering counseling have met patient needs during the rapidly changing and uncertain scene following the law's enactment. They continue to provide counseling as well as referral to community resources concerning family and social problems—services which most private physicians' practices or medical clinics are not usually organized to provide.

A survey was made in December, 1971 to obtain a general description of these agencies: The 94 agencies were contacted through a mail questionnaire that asked about the number of women served, the characteristics of their caseloads, the nature of the counseling and the existence of other services. Because many organizations do not keep such statistics, respondents were asked to give the figures of their July, 1971 caseload or to make estimates if such figures were not available.

The proportion responding varied from 92 percent by adoption agencies, 85 percent from Planned Parenthood affiliates, 87 percent from hospitals and county health or welfare departments, and 70 percent from other counseling agencies. The relatively low response rate from the last group may be explained by the inclusion of new agencies not a part of the long-established organizations for example, Women's Liberation and counseling services offered by individuals.

Based on projections from the July, 1971 caseloads, an estimated 100,400 preg. nant and nonpregnant women received services during the year from the 67 agencies reporting size of monthly caseload. This figure includes Some 63,000 women who chose abortion which is more than half of the 116,749 women undergoing the procedure in 1971. It should be noted that these figures are an under. statement of the true number because some agencies did not report this information.

Compared with all women having therapeutic abortions, the women using counseling services include more teen-agers (40 percent compared with 31 percent of all abortions), more first pregnancies (55 percent compared with 48 percent), and more who have never been married (64 percent to 51 percent). Adoption agencies in particular serve teen-agers (59 percent), primiparae (64 percent) and women never married (87 percent).

Of the women served in the July sample, 18 percent were not pregnant, 19 percent chose to continue the pregnancy, and 63 percent chose an abortion. Of all the pregnant women counseled, about three-fourths chose abortion. These proportions vary according to the service focus of the agency which results in pa. tient selection. For example, a program with emphasis on family plamning results in more contacts with nonpregnant women, while adoption agencies see fewer nonpregnant women or women choosing abortion.

About 48 percent (32) of all agencies reported a monthly caseload of less than 50 : over 40 percent (28) served 50 to 300, and only 2 served 1,000 or more. Adoption agencies and “other” counseling services typically had small caseloads: 82 percent of adoption agencies served fewer than 100. In comparison, 50 percent of hospitals and county or welfare departments and 57 percent of Planned Parenthood units served fewer than 100.

DEMOGRAPHIC EFFECTS

It is frequently asked whether the rise in abortions in California has resulted in a decline in illegitimate births (numbers, ratios and rates). A definitive answer to the question cannot be given for several reasons. One is that birth data for 1971 is not yet available, and it will not be until the first half of 1971 that the impact on births of abortions performed in the second half of 1970 will be seen. There is some evidence that rates of illegitimacy started to decline in Califoruia about the middle of 1970. However, this finding is being reviewed in the light of better denominator data that are just now becoming available from the 1970 Census. A further consideration is that even when better data are available, it will be extremely difficult to separate the influence of unfavorable economic conditions from the influence of increased availability of abortion.

Although statements about cause and effect cannot be made at this time, the numbers and types of women having abortions and having babies can be reviewed, see Table 4. From this, it is clear that abortion has had a larger relative impact on illegitimate than on legitimate fertility. Three-fourths of the women having

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abortions are unmarried. The rapid rise in abortion in 1970 resulted in there being more abortions for unmarried women than illegitimate births (46,316 extramarital pregnancies legally aborted compared to 45,593 illegitimate births).

TABLE 1.- PERCENT DISTRIBUTION OF SELECTED CHARACTERISTIC OF WOMEN HAVING ABORTION, CALIFORNIA

1968-71

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1 Number of therapeutic abortions adjusted for late reports.
Note: Percents calculated independently and may not add to 100.

Source: State of California, Department of Public Health, Bureau of Maternal and Child Health, Therapeutic Abortion
Reports.

TABLE 2-THERAPEUTIC ABORTIONS, AGE-SPECIFIC ABORTION RATES, AND RATIOS OF ABORTIONS PER 1,000

LIVE BIRTHS, CALIFORNIA, 1969-71

[By place of residence]

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1 Number of therapeutic abortions adjusted for late reports and for California residents.
2 Rates based on 1970 population.
3 1971 live birth data not available; therefore, 1971 ratios based on 1970 live births.

Source: State of California, Department of Public Health, 1970 Census Data for Health Planning, vol. 2, table 9, Birth
Records and Therapeutic Abortion Reports.

TABLE 3,-NUMBER OF THERAPEUTIC ABORTIONS PERFORMED AND PERCENT ANNUAL INCREASE BY

STATISTICAL AREA-CALIFORNIA, 1968-71

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I Number of therapeutic abortions adjusted for late reports.
Source: State of California, Department of Public Health, Bureau of Maternal and Child Health, Report of Therapeutic
Abortions.

TABLE 4.-THERAPEUTIC ABORTIONS AND LIVE BIRTHS BY AGE AND MARITAL

STATUSOF WOMEN, CALIFORNIA, 1969, 1970

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I Women reported not currently married.
2 Denominator is women of known marital status.
3 Birth classified as illegitimate by an inferential method.
Note: Totals include women with marital status or age unknown.
Source: State of California, Department of Public Health, birth records and abortion reports.

PRESS RELEASE OF SENATOR ANTHONY C. BEILENSON Senator Anthony C. Beilenson (D-Beverly Hills) today said that last month's U.S. Supreme Court decision barring restrictions on most abortions will have "profound and highly beneficial effects on our society”.

Speaking at a University of California Symposium on Population and Planning at Berkeley, Beilenson said: “We already have sufficient data from California and New York—where abortions have been widely available during the past 2 or 3 years—to predict with some confidence what the results of this decision will be nationwide".

Because American women “for the first time will be able to choose not to bear unwanted children”, Beilenson forecast a number of specific results, including:

Lower costs of welfare and public education;
Better economic and physical health for low and middle income families;
Greater family stability;

Decreased divorce and illegitimacy rates;

Eventually, a lower incidence of crime, violence and mental illness. In measuring the impact of the California Therapeutic Abortion Act, which he authorized in 1967, the lawmaker pointed out that the state's fertility rate fell 12% in 1971, about twice the average decrease nationwide.

Beilenson also noted that illegitimate births, which had dramatically increased in recent years, decreased in 1971 by 16%. He said a study for the State Department of Public Health concluded that the sudden reversal in illegitimacy rates was mainly due to unmarried women obtaining three-fourths of all legal abortions in the state.

State budget estimates for education have dropped $130 million for the current and coming fiscal years, he said, because the decline in fertility has forced revisions of average school attendance predictions.

Welfare rolls have diminished, too, largely because of the reduced birth rate, according to Beilenson. "If today's average welfare family has as many children as the average welfare family of just two years ago, there would be 76,000 more recipients than we actually have,” he explained, “at a minimum extra cost to taxpayers of $41 million".

Beilenson also noted similar results in New York, where unrestricted abortion has been available for two years. In that state maternal mortality rates have decreased almost 50%, the infant mortality rate has reached “an all-time low", and the number of illegitimate births declined for the first time in 17 years.

In both states, he said, “fewer girls have been forced by pregnancies to drop out of high school ; fewer young women have entered into the cycle of poverty and welfare dependency that is so often initiated by the birth of a first illegitimate child; and fewer young people are marrying to legitimize conception, thus leading to a reduction in teenage marriages, which are twice as likely to end in divorce as in those of older couples”.

Beilenson concluded that “these and many other indications of better health and well-being of so many of our young people are bound to augur well for our state and nation in the years to come.”

Senator Cook. Thank you, Congressman. I must say to you, I have some aversion toward this concept that everyone has this right without the responsibility of the whole concept of the rights that are extended to him under the Constitution in society that we live in. The fact that this society is going to continue, and I wonder that if somehow or other there is going to be a new listing on my Blue Cross-Blue Shield card that is going to say how much I will pay a doctor, and how much medical expenses I can be entitled to if I am entitled to an abortion in the first trimester.

I am going to have to get used to that idea, and I am not sure I am at that stage of the game, Congressman.

Thank you very much, Mr. Chairman.
Mr. Rees. Thank you.
Senator Bayu. Thank you, Congressman, for being with us.

I would like to put in the record at this time statements from two very distinguished colleagues, without objection, Senator Percy and Senator Brooke.

[The prepared statements of Senator Charles Perey and Senator Edward Brooke follow:

STATEMENT OF SENATOR CHARLES H. PERCY

Mr. Chairman, the 1973 Supreme Court ruling on the issue of abortion has brought forth a momentous national response. I have listened to the points of view of people who support that ruling and of people who denounce that ruling. Recognizing and respecting strong arguments on both sides of this highly controversial issue, I believe that the Supreme Court ruling on abortion is correct and proper under existing circumstances.

The Supreme Court based its decision on the individual's right to privacy, which is founded primarily in the Fourteenth Amendment's concept of personal liberty

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