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STATEMENT OF DR. ALEX BARNO, CLINICAL PROFESSOR OF

OBSTETRICS AND GYNECOLOGY, UNIVERSITY OF MINNESOTA, MINNEAPOLIS, MINN.

Dr. BARNO. Mr. Chairman, my name is Alex Barno, M.D. I have been a physician for 30 years and an obstetrician and gynecologist from Minneapolis, Minn., for the past 28 years. I am a clinical professor in obstetrics and gynecology at the University of Minnesota School of Medicine, a past president of the Minnesota Obstetrical and Gynecological Society, and a member of the Central Association of Obstetricians and Gynecologists, I am chairman of the Minnesota Maternal Mortality Committee of the State Medical Association, chairman of the Committee on Obstetrics, Gynecology and Maternal Health of the State Medical Association, and I am a member of the Minnesota Cervical Cancer Mortality Committee. I am a Catholic physician. I hope not to talk too long. Some philosopher once said that the mind can only absorb what the posterior can endure.

I am here today in favor of the Human Life Amendment. These are my comments, and they do not represent in any official capacity any of the aforementioned organizations.

Mr. Chairman, I would like to submit the following items that I have for the written record: a summary report on deaths and near deaths of legal abortions by Dr. Matthew Bulfin, president of the American Association of Pro-Life Obstetricians and Gynecologists, of which I am a charter member; and second, Induced Abortion, A Documented Report of World's Literature, by Dr. Thomas Hilgers, a former resident at the Mayo Clinic; also, Abortion and Social Justice, by Hilgers and Horan, especially for chapter 4 where Dr. Hilgers summarizes the world's literature regarding medical hazards of legally induced abortions; and finally, a report by Dr. Margaret Wynn and Dr. Arthur Wynn from England entitled Some Consequences of Induced Abortion to Children Born Subsequently.

May I present that?

Senator Bays. Without objection, it will be put in the record at the appropriate place.

My presentation will be in two parts—some data from the Minnesota maternal mortality study, which I believe will be of interest to you, and some general remarks.

Santayana stated that "those who do not remember the past are condemned to repeat it." The pro-abortionists flooded the American public with scare tactics before the Supreme Court decision, claiming that there were 1,000,000 to 1,500,000 criminal abortions annually, and that 5,000 to 10,000 women were dying annually in the United States as a result of induced abortions. Statistics from Minnesota maternal mortality study suggest that these figures were grossly exaggerated. This is a clinical research study sponsored by the Minnesota State Medical Association, the Minnesota State Department of Health and the Minnesota Obstetrical and Gynecological Society. It has been continuous since 1950. I have been involved with the study since its beginning. Every maternal death in the State of Minnesota is studied in detail by an ob-Gyn specialist field worker, going to the hospital, doctor's office, etcetera, and obtaining firsthand all the information. Final decisions are then made at periodic meetings of the committee as a whole, consisting of 23 physicians.

These decisions were the determinations of the cause of death, criticism regarding prenatal care, labor and delivery and postpartum care as to whether the care was contributory or not contributory to the cause of death, evaluation of the autopsy, criticism of the death certificate and birth certificate, and finally preventability of death and responsibility for the death.

Now, I briefly want to go over this because I think it is important. It is a quality-control study. Before the study was begun, it was outlined in our state medical journal, "Minnesota Medicine. Each doctor was notified by letter. Each hospital administrator and chief of staff of every hospital in the State was also notified by letter. The cross-matching techniques has been utilized. The death certificates of all women ages 15 through 45 are cross checked against any births or stillbirths additional cases are discovered since pregnancy or the postpartum state was not mentioned on the death certificate. Additional cases were discovered through notification by physicians, nurses, social workers, medical students, hospital record room librarians and newspapers. In addition, the State Department of health issued a ruling to all hospitals that a maternal death should be reported within 3 days of occurrence. Two of every three deaths were autopsied and this added to the accuracy of the assessment as to the cause of death.

Senator BAYH. That is of abortion-related deaths ?

Dr. Barno. No; I am saying two out of three are autopsied of all maternal deaths.

Senator BayH. All maternal deaths ?
Dr. BARNO. And I will bring in the abortion deaths, sir.

I have presented to you data, tables I through IX from this study for a 24-year period, 1950 through 1973, regarding rates, a breakdown of the causes of death, the out-of-wedlock pregnancy situation, the induced abortions, and the suicides in prgenancy. During this 24year period of time 840 maternal deaths occurred in Minnesota among 1,763,702 live births. Only 31 of these deaths were induced-abortion deaths or 1.3 per year, 28 illegal, or 1.2 per year, 2 therapeutic—for medical reasons—and í legal in 1973, table IX.

Automobile accidents, 48, are killing more pregnant patients in Minnesota than induced abortions, 31, yet this does not create such a furor or emotional impact as the abortion thing has.

Senator Bays. Do you suppose we could amend the Constitution to make it illegal to have accidental automobile deaths for pregnant women?

Dr. BARNO. We could do it better if we could make people wear seat belts.

Senator Bayh. Doctor, I say amen to that.

Dr. BARNO. The pattern in our State, i.e., the abortion pattern in the State is the same as it has been, even after the latter part of the sixties when some of the States began liberalizing their abortion laws and Minnesota residents could go out of State for abortions.

Now, I have the figures and you can look at that table, table IX.

57-676 0.76 • 14

The pattern is about the same. If the figure of 5,000 to 10,000 abortions per year were true, Minnesota should have contributed at least 100 to 200 illegal abortion deaths per year, yet we had only 1.2 a year, Senator. The figure 5,000 to 10,000 then I think was picked out of a Houdini hat.

Senator Bays. Well, Doctor, could you tell me where you have seen that 5,000 or 10,000 figure, or that multi-million figure that you have mentioned? I had not heard lt.

Dr. BARNO. It was printed in all of the media. It was printed in medical periodicals, and so forth. It is in the literature time and again before the decision of the Supreme Court.

Senator Bayh. Dr. Tietze, have you seen that, sir?

Dr. TIETZE. Yes, sir, and I have in this case, I have to agree, and yet I have branded it as utter nonsense as early as I believe 1968 or 1969, and many of my friends who believe in the freedom of decision on abortion have reproached me for this statement. I can also tell you where it comes from. It comes from a paper written by Dr. Talsick, Frederick Talsick back in 1936 where he gave a figure of I believe some 5,000, and that was subsequently expanded to 10,000 because the population of the United States had increased so much. But the figure is nonsense because the total number of deaths of women of reproductive ages of all ages in the United States is on the order of 50,000, and obviously not one-tenth, let alone one-fifth of the women die as a result of abortion.

But even if only 500 women die or even 50 because a medical procedure is forced from the legal into the illegal area, it would be too many.

Senator BAYH. Well, Dr. Tietze, you expressed yourself very eloquently previously on the latter portion, and you and Dr. Barno are going to come down on opposite sides of that, but both of you will agree that that 10,000 figure is poppycock? Dr. BARNO. It is erroneous, yes, sir.

Now, legalizing abortion does not have much to do with decreasing maternal mortality rates. The rates were decreasing before liberalization of the abortion laws, as we have seen and heard. While there seems to be a decrease in the number of illegal abortion deaths in some States, such as New York, the number of legal abortion deaths seems to have replaced these. Now, there are many factors to account for the decrease in maternal mortality rate. You asked, Senator, earlier, the decrease in the birth rate, as we know, better training of physicians, better hospital organization of obstetrical care, better anaesthesia, availability of blood, antibiotics, better nurses, and so forth. Now, in our own State in Minnesota, we think the study itself was a factor, a quality control peer review mechanism. We disseminated the knowledge that we learned regarding the problems we found, and their corrections. That is, we tried to get at it by educative methods rather than by being punitive.

As our modalities of care have improved, the medical indications for therapeutic abortion have dwindled to almost nothing. Before the Supreme Court decision of January 20, 1973, the proabortionists kept parroting that if we did not abort these women, they would kill themselves. About 75 percent to 85 percent of the abortions were done on the basis of psychiatric indication, the principal criterion being the likelihood of suicide. Again, however, data from the Minnesota study indicates that this fear was unfounded. There were only 22 suicides, one per 88,168 live births, or less than one per year. Sixteen of these occurred post partum and only six with the baby in utero. Pregnant patients commit suicide about six times less frequently than nonpregnant women of the same age group. No one has ever shown that aborting a woman cures psychiatric disease. The first nine tables of data I have presented to you are an undating of a scientific paper of mine which was published in the American Journal of Obstetrics and Gynecology in 1967, the reprint I also included for your perusal.

Some pertinent data is presented to you in tables X, Xi and XII. Had we relied on death certificate information alone, we would have missed 32 percent of the total maternal deaths and 18 percent of the obstetrical deaths, where pregnancy played a causative role, since pregnancy or the post partum state was not mentioned on the death certificate. These additional deaths were discovered through committee efforts, setting up the study in a prospective fashion.

Now, analyzing the maternal death certificates with regard to the cause of death we found that 19 percent were incorrect there was no correlation between the cause of death listed and that determined by the committee.

So, Senator, with 19 percent incorrect to begin with as a cause of death and 18 percent of the obstetrical deaths missed by relying on death certificate information alone, one wonders about the reliability of some of the biometric information we are being fed today. Some of this data is inaccurate because they are making calculations regarding data which I think is inaccurate to begin with.

Now, second; the second part of my presentation, I would like to make a few statements.

The abortion issue is the most divisive issue that has ever faced medicine. It has produced a dichotomy, a schism, a polarization of a great and honorable profession on the local, State, national and international level, especially within our discipline of obstetrics and gynecology-abortionists in one camp and prolife physicians in another. Our role as physicians I think is to protect and preserve life. The physician is the guardian of life. We are doing heart transplants, kidney transplants, kidney dialysis, and so forth, in order to save lives. Only in the discipline of obstetrics and gynecology are we asked to destroy a life. This I have done three times in 28 years, and I will do it again when the life of the mother is jeopardized, but this is indicated very, very rarely in modern day medicine. The unborn child is a life, and its rights to be born should be protected. This wanton destruction of human beings by the thousands is a debasement, a prostitution of the art and science of medicine as far as I am concerned. Dr. Sigmund Freud, the eminent psychiatrists, said, “We may suppose that the final aim of the destructive instinct is to reduce living things to an inorganic state. For this reason, we call it the death instinct.” If I had to coin one word to try to express everything regarding this indecent concept, it would be this—it is a phantasmagoria.

You have been bombarded with figures that abortion on demand has decreased the infant death rate. Dr. Helleger alluded to this and I agree—what a paradox—the more that are destroyed, the less there will be available for the live birth status for the statistics for perinatal mortality. This is a schizophrenia. These destroyed babies should rightly be included in the statistics as iatrogenic deathsdoctor produced deaths.

Senator Bays. Doctor, excuse me. You have defined iatrogenic deaths as being doctor induced.

Before you go on here, I wonder if you could elucidate for the committee what is phantasmagoria ?

Dr. BARNO. Senator, phantasmagoria is apparitions in fantasyland, unreal dreams. This whole thing is an unreal dream, an apparition, incoherencies and what-nots in fantasyland. That is my coining of this whole concept of an abortion.

Senator Bayh. Thank you, and excuse me for interrupting. You just had me there.

Dr. BARNo. That is quite all right .

You have been bombarded with the concept that doctor produced abortions are much safer regarding the possibility of maternal death than the "back alley abortionists." In a recent article from the Bulletin New York Academy Medicine 49: 804, 1973, entitled “Impact of the Liberalized Abortion law in New York City on Deaths Associated with Pregnancy: A Two-Year Experience" by Pakter, O'Hare, Helpern, and Nelson, they reported 29 maternal deaths 16 associated with legal and 13 with illegal abortions. It seems that doctors kill more women than the so-called "back alley abortionists,” if I can understand the arithmetic, 16.

Senator BAYH. Well, Doctor, let us be accurate here. Before that statistic goes into the record, I want to know the total number of illegal performed operations compared to the total number of those performed legally. Just the number of deaths alone could be misleading, could it not?

Dr. BARNO. That is right, it could be misleading, sir, they have so many per thousand or 100,000 abortions, but you see, we do not have figures, Senator, for illegal abortions. Illegal abortionists do not give us any kind of figures. We do not have that available.

Seantor Bays. Well, I am going to try to pursue that with Dr. Tyler and his data collection system. He, as you heard, confessed that it was difficult to get an accurate count on that. But I would assume, in the State of New York, in light of everything else we know, that there had to be significantly more legal abortions than the New York definition of an illegal abortion.

Is that not fair?

Dr. BARNO. That is correct, sir, they did more legal abortions, certainly, but we have no figures on how many illegal abortions were done. It might have been just the same.

We do not have that figure.
Senator Bayh. How do you reasonably come to that conclusion !

Dr. Barno. No, sir, I say it might be. I cannot say that with any finality.

Senator Bays. Well, if you look at the increased rate in legal abortions in New York during that period, compared to what transpired prior to that period, I do not see how one could logically

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