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 BAYH. 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 deaths-doctor produced deaths.

Senator BAYH. 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 BAYH. 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 BAYH. 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

assume that there might have been as many illegal abortions during that period as there were legal abortions.

I am looking for facts, and everybody can make their own judgment, but I want as much of this phantasmagoria eliminated as is possible.

Dr. BARNO. Yes, sir, yes, sir, I would agree with that, but I still say we do not have those figures on how many illegal abortions were done. We were bombarded earlier before the Supreme Court decision that there were a million to a million and a half. There is no way of finding out, because as I said, the illegal abortionists do not publish their figures.

Senator BAYH. Well, please proceed, sir. I did not mean to interrupt, I just thought we were stretching the obvious conclusion.

Dr. BARNO. No, sir, making the abortions available to the individual does not eliminate illegal abortions. This has been shown to be true in Sweden, I think Dr. Tietze alluded to that, in a paper in the American Journal of Public Health, it has been shown to be true in Norway, Denmark, Czechoslovakia and Hungary. It would seem to me, Senator, that the answer to this whole abortion controversy as pregnancy prevention instead of pregnancy destruction-there is an old saying that an ounce of prevention is worth a pound of cure.

Senator BAYH. Excuse me, Doctor, I just want to narrow this down. Before we go on, I would like to keep the record as consistent as we can here, and relevant from page to page.

The statement, "this has been shown to be true in Norway, Denmark, Czechoslovakia and Hungary," is that based on the same premise that you used to reach the conclusion of the facts in the United States?

Dr. BARNO. I would say so. We have so many legal abortions, we have so many illegal abortions. I cannot say that we have the accurate amount, the exact number of illegal abortions done, but from what we can read, it has not eliminated illegal abortions by legalizing abortions.

Senator BAYH. All right. But prior to that time you made the statement, that doctors kill more women than the so-called "back alley abortionists," then you go ahead and talk about the same being true in Sweden, Norway, Denmark, Czechoslovakia and Hungary.

Dr. BARNO. Yes, sir, I think we are going to see as the thing unfolds that doctor produced abortions are going to be a big figure. It has just been in effect here, Senator, only since January, since the Supreme Court decision.

We do not have the final figures about how many there are, but I can predict it will be quite a few.

Birth control is a reality in today's world-we have the pill, the intrauterine device, the diaphragm that we all know of, the vasectomy in the male and tubal ligation in the female, as is desired.

In closing I would like to quote Camus. This is from a publication by Dr. G. A. Gehred from Rochester, N.Y. Camus said in "Letters to a German Friend":

I continue to believe that the world has no ultimate meaning. But I know that something in it has meaning, and that is man, because he is the only creature to insist on having one. This world has at least the truth of man, and our task is to provide its justification against fate itself.

And it has no justification but man; hence he must be saved if we want to save the idea we have of life. With your scornful smile, you will ask me, what do you mean by saving man? And with all my being, I shout to you that I mean not mutilating him.

If life has any intrinsic value, then I think, Senator, abortion is just such mutilation.

Now, if I might comment regarding two things. First, I want to comment regarding Dr. Tietze's figures of 1 to 4 deaths per 100,000 abortions versus 18 deaths per 100,000 life births, that is in the first trimester how safe abortion is.

Now in the first place, the 1 to 4 deaths per 100,000 abortions is not the same comparison as 18 deaths per 100,000 live births that is usually given now. He cleaned out the abortion-related deaths since most people quote these, because this latter figure includes the number of abortion-related deaths, and then they are including the statistic with which they are trying to compare it with.

Now, second, the figure of 1 to 4 per 100,000 abortions is mostly from the Communist countries under regimented control, highly efficient, robot, automated production lines. Now this is not the same as is happening in New York, California, Minnesota, or Colorado where these abortions are done by various doctors in various settings, in various milieu and some of the settings are not so good, I do not think.

Finally or third-I quote you an article from Yugoslavia, from Skopje University by Jurokowskij "Complications Following Legal Abortions," Proceedings of the Royal Society of Medicine, 1969, and abortion mortality in the first trimester of 25 per 100,000 abortions or 6 to 25 times the rate quoted by Dr. Tietze. I am certainly not questioning Dr. Tietze's integrity in any way.

I would also like to coment regarding Dr. Tyler. He said legal abortions would continue to reduce the maternal mortality rate. Well, the maternal mortality rate, as I alluded to earlier, was declining even before abortion was legalized, and he said that there were no studies on abortion-related deaths.

We published this before and this is brought up to date now. His abortion-related figures were quite high, and our Minnesota quality control study show these figures to be low. I would just like to briefly quote these to you, Senator. In 1972, we had 18 maternal deaths and we had no abortion deaths. In 1971, we had 19 maternal deaths and 5 of these 19 were in the abortion category, 26 percent. Two of the 19 were in the obstetrical category or this is where they belong, 10 percent in the obstetrical category.

In the 1970 study, 2 of 17, or 12 percent are in the abortionrelated category as far as the production of maternal deaths. Thank you very much for this opportunity.

Senator BAYH. Thank you very much, Doctor.

You mentioned the suicide situation.

Dr. BARNO. Yes sir.

Senator BAYH. Your statistics were the suicide rate of all births,

were they not?