Our next witness is Dr. Carl Tyler, Chief, Family Planning Evaluation Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Ga.

Dr. Tyler, we appreciate your being with us.

STATEMENT OF DR. CARL TYLER, CHIEF, FAMILY PLANNING PLANNING EVALUATION DIVISION, BUREAU OF EPIDEMIOLOGY, CENTER FOR DISEASE CONTROL, ATLANTA, GA.

Dr. TYLER. Thank you, Mr. Chairman. I am pleased to testify before you with regard to these resolutions, and I would like to point out that although I am an employee of the Department of Health, Education and Welfare, I am not appearing here as a policy representative of the Department. I understand that the Department has taken no position on the resolutions pending before this subcommittee. Rather, I am appearing because of my special professional interest in abortion and other methods of fertility control. In addition to my Federal position with the Center for Disease Control, I am a Board Certified Obstetrician-Gynecologist, a Fellow of the American College of

Obstetricians and Gynecologists, and a member of the American Public Health Association.

Abortion has been used as a method of fertility control for more than 2,000 years. In the United States, it has been an issue of public concern at least since the time it was first made illegal in the State of Connecticut in 1821. As recently as 1930, abortion was the certified cause of death for almost 2,700 women in a single year, and it was not until after 1940 that the number of such deaths reached a level of less than 1,000 per year. At the Arden House Conference on Abortion held in 1955, one expert group estimated that no fewer than 200,000 abortions were induced illegally each year. This group set an upper estimate of 1.2 million illegal abortions performed annually. Subsequent survey information indicated there might be as many as 800,000. In 1955, 255 women died from causes related to abortion.

The medical and legal aspects of abortion have, therefore, posed problems for public health professionals in this country for many years. In the remainder of my testimony, I shall briefly review the information currently available on the practice of abortion, I will describe current trends in abortion mortality and in diseases related to abortion, and I will discuss some of the current issues that are of concern to public health professionals with regard to the increasing practice of abortion. Finally, I will conclude by stating my personal views concerning the effects which the resolutions before this committee are likely to have on the health of the American people.

Although the Department takes no position on the resolutions before this committee, the center has collected information on the practice of abortion for almost 5 years. Recent revisions of State statutes began in Colorado in 1967. In 1969 10 States voluntarily reported more than 22,000 legal abortions to CDC. The following year, 1970, 24 States voluntarily reported more than 190,000 abortions, and in 1971, the number of abortions reported to CDC as having been done legally was in excess of 485,000, even though the number of cooperating States increased by only 1, to 25. In 1972, the most recent year for which we have complete data available, more than 586,000 legal abortions were reported to CDC. More detailed information on these statistics is available in the center's abortion surveillance report and with your permission, I would like to enter the most recent issue of that report into the record, and along with it a supplementary statement which will provide fuller detail and more specific documentation for some of the statements I will make in the rest of my testimony.

Senator BAYH. Without objection, so ordered.

[The information referred to follows:]

SUPPLEMENT TO THE STATEMENT OF CARL W. TYLER, JR., M.D., F.A.C.O.G.

This supplement to the statement I have made concerning Senate Joint Resolutions 119 and 130 is provided for two purposes. First, it gives more detailed information on the topics discussed briefly in verbal testimony. And second, it documents the sources of information referred to in that testimony.

This supplement gives information on five subjects: (1) the status of abortion laws, (2) estimates of the number of abortions performed, (3) trends in the health of women undergoing abortion, (4) changes in other areas of public health related to abortion, and (5) current health problems related to abortion. The discussion of each of these subjects is confined largely to facts concerning the United States, and deals with three time periods. The first period starts in the times of colonial America and goes to the end of 1966. The second time

period covers the years 1967 through 1972, and the third period begins with the Supreme Court Decision of January 22, 1973, and goes to the present. This supplement ends with a statement about the effects which I believe Senate Joint Resolutions 119 and 130 are to have on the health of the American people.

THE STATUTES OF ABORTION LAWS

Abortion has been used as a method of fertility control for more than 2,000 years. (1) In the United States, abortion has been an issue of public concern at least since the time it was first made illegal in the state of Connecticut in 1821. (2) By 1840, 8 states had enacted laws dealing with abortion. By the time the War Between the States was over, legislative action made abortion illegal in practically every state in the United States. Even though abortion was banned unless performed to save or preserve the life of the mother in all but a few states by the end of the 1950's, the American Law Institute published its Model Penal Code in 1962, which recommended important changes in the state abortion laws. (3) This Model Penal Code permitted abortion if continuing the pregnancy would adversely affect the physical or mental health of the mother, if there was an increased risk of the birth of a deformed fetus, or if pregnancy resulted from rape or incest. Five years elapsed before any state adopted this model law.

In April 1967, Colorado became the first state to follow the American Law Institute's recommendation. Between the beginning of 1967 and the end of 1972, however, 17 states revised their abortion laws. Most followed the recommendations of the American Law Institute, but in 1969 one, the state of Oregon, went a step farther and stated "in determining whether or not there is substantial risk (to the woman's physical or mental health), account may be taken of the mother's total environment, actual or reasonably foreseeable." (4) In 1970, four of these 17 states, Alaska, Hawaii, New York, and Washington, enacted laws which permitted induced abortion if a pregnant woman requested that the procedure be done and a licensed physician agreed to do it. In the state of Washington, the legal change was brought about by a referendum which permitted abortion to be performed legally by or under the supervision of a licensed physician.

may

On January 22, 1973, the United States Supreme Court handed down decisions in the cases of Roe vs. Wade and Doe vs. Bolton which invalidated abortion statutes in Texas and Georgia. (5) Specifically, these decisions stated that "(a) For the stage (of pregnancy) prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman's attending physician. (b) For the stage subsequent to approximately the end of the first trimester, the state *** may *** regulate the abortion procedures in ways that are reasonably related to maternal health. (c) For the stage subsequent to viability, the state *** regulate and even proscribe abortion, except where it is necessary for the preservation of the life or health of the mother." (6) The Court also permitted the state to proscribe abortion by any person who is not defined by the state as a physician. (7) The Supreme Court went on to invalidate legal requirements of accreditation by the Joint Commission for the Accreditation of Hospitals, the requirement of approval by a Hospital Abortion Committee, the confirmation of the need for abortion by 2 independent physicians, and the requirement of proof of residency in the state where the abortion is to be performed. (8)

ESTIMATES OF THE NUMBER OF ABORTIONS PERFORMED

Although abortion has been an issue of public concern in the United States at least since the time it was first made illegal in the state of Connecticut in 1821, no scientifically credible estimate of the number of illegal abortions performed in a given year was published until 1955. That year, an expert group at the Arden House Conference on Abortion in the United States stated that **** a plausible estimate of the frequency of induced abortion in the United States could be as low as 200,000 and as high as one million two hundred thousand ***." (9) Their statement went on to say "there is no objective basis for the selection of a particular figure between these two estimates as an approximation of the actual frequency." This information was based, in large part, on data collected by Dr. Alfred Kinsey and his colleagues at the Institute

Obstetricians and Gynecologists, and a member of the American Public Health Association.

Abortion has been used as a method of fertility control for more than 2,000 years. In the United States, it has been an issue of public concern at least since the time it was first made illegal in the State of Connecticut in 1821. As recently as 1930, abortion was the certified cause of death for almost 2,700 women in a single year, and it was not until after 1940 that the number of such deaths reached a level of less than 1,000 per year. At the Arden House Conference on Abortion held in 1955, one expert group estimated that no fewer than 200,000 abortions were induced illegally each year. This group set an upper estimate of 1.2 million illegal abortions performed annually. Subsequent survey information indicated there might be as many as 800,000. In 1955, 255 women died from causes related to abortion.

The medical and legal aspects of abortion have, therefore, posed problems for public health professionals in this country for many years. In the remainder of my testimony, I shall briefly review the information currently available on the practice of abortion, I will describe current trends in abortion mortality and in diseases related to abortion, and I will discuss some of the current issues that are of concern to public health professionals with regard to the increasing practice of abortion. Finally, I will conclude by stating my personal views concerning the effects which the resolutions before this committee are likely to have on the health of the American people.

Although the Department takes no position on the resolutions before this committee, the center has collected information on the practice of abortion for almost 5 years. Recent revisions of State statutes began in Colorado in 1967. In 1969 10 States voluntarily reported more than 22,000 legal abortions to CDC. The following year, 1970, 24 States voluntarily reported more than 190,000 abortions, and in 1971, the number of abortions reported to CDC as having been done legally was in excess of 485,000, even though the number of cooperating States increased by only 1, to 25. In 1972, the most recent year for which we have complete data available, more than 586,000 legal abortions were reported to CDC. More detailed information on these statistics is available in the center's abortion surveillance report and with your permission, I would like to enter the most recent issue of that report into the record, and along with it a supplementary statement which will provide fuller detail and more specific documentation for some of the statements I will make in the rest of my testimony.

Senator BAYH. Without objection, so ordered.

[The information referred to follows:]

SUPPLEMENT TO THE STATEMENT OF CARL W. TYLER, JR., M.D., F.A.C.O.G.

This supplement to the statement I have made concerning Senate Joint Resolutions 119 and 130 is provided for two purposes. First, it gives more detailed information on the topics discussed briefly in verbal testimony. And second, it documents the sources of information referred to in that testimony.

This supplement gives information on five subjects: (1) the status of abortion laws, (2) estimates of the number of abortions performed, (3) trends in the health of women undergoing abortion, (4) changes in other areas of public health related to abortion, and (5) current health problems related to abortion. The discussion of each of these subjects is confined largely to facts concerning the United States, and deals with three time periods. The first period starts in the times of colonial America and goes to the end of 1966. The second time