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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 judg. ment, 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 There is no way of finding out, because as I said, the illegal abortionists do not publish their figures.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 Bays. 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 Bays. 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 i8 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?

Dr. BARNO. These were the suicides in pregnancy and in the 3 months post-partum state of every woman in Minnesota that we could find.

Senator Bayh. The argument as I try to envision it now, is if you are forced to have a child you do not want, you are liable to commit suicide. Now, it seems to me for that to be relevant we have to confine the suicide rate to that group who are then forced to go ahead and have an unwanted child and not commingle all of those mothers in the whole State, most of whom have wanted children.

Dr. BARNO. Yes, sir. Of those 22 suicide deaths, 20 of those people were married, only 2 were out-of-wedlock pregnancies where you could suppose that maybe they wanted to commit suicide because they could not get an abortion. But from all of the details that we could get from all of our careful analysis, not a single one of those women asked for an abortion.

Senator Bayh. Doctor, with your expertise, could you help us in onr search to find the answer to the problem of when a life specifically is created, when a human being first starts to become a human being.

What is your definition of that moment?

Dr. BARNO. Yes, sir. I think that life begins at the beginning and it ends at the end.

Senator BAYH. I cannot argue with you on that. Dr. BARNO. It begins with the fertilization when the sperm unites with the egg and a whole new human life is created, and then it is a continuum. It goes all the way on through; the embryologists have all documented this, and then it comes out in a nice little package. It is called a human being.

Senator Bays. And you feel that the moment that you would describe as the beginning would be the fertilization process, the joining of the egg and the sperm? Dr. BARNO. Yes, sir.

Senator BayH. Would you care to give us you thoughts as to how you believe an intrauterine device operates to prevent pregnancy.

Dr. BARNO. Senator, there has been quite a bit written about this. Margulies, the man who reincarnated or brought forth the IUD that was used in Europe long before it was popularized here, states he does not know the mechanism.

There is a tremendous monograph by Dr. Moyer who is professor of obstetrics and gynecology and experimental pathology at the University of Southern California. He gives all sorts of theories. The theories vary from destruction of the sperm, incapacitation of the sperm, variability with regard to tubal motility, even inhibition of ovulation.

There are all sorts of theories, and I can only say to you, Senator, that it is unknown, the mechanism as we know it now is unknown. The great Dr. Allan Barnes, former professor at Johns Hopkins has written a nice treatise on the IUD's, and he himself says it is not an abortifacient. I myself am convinced it is not an abortifacient, if it were, I would not use it.

Senator Bays. What about what is commonly known as a morning after pill? How does that function?

Dr. BARNO. Well, here again, the man who popularized the morning after pill is Dr. Morris at Yale who did his preliminary work in monkeys and followed through in human beings. Again, he states he does not know the mechanism of the morning after pill. It is pregnancy prevention.

So all I can say is that we do not know the answer to that. We do not know the full mechanism.

Senator Baył. Do you have any personal thoughts on that? You say you do not know how it works? Dr. BARNO. No, sir; I do not know how it works.

Senator BAYH. Thank you, Doctor, I think we have inconvenienced you enough. We appreciate your adding to our efforts here.

Dr. BARNO. I thank you for the opportunity for being here, Senator.

Senator Bayh. Thank you very much.

Our next hearings will be May 7 at 2 p.m. and we will recess until that time.

[Whereupon, at 1:10 p.m., the hearings were recessed to reconvene Tuesday, May 7, 1974, at 2 p.m.]

ABORTION: PART II

TUESDAY, MAY 7, 1974

U.S. SENATE,
SUBCOMMITTEE ON CONSTITUTIONAL AMENDMENTS

OF THE COMMITTEE ON TW ashington, D.O. The subcommittee met, pursuant to recess, at 2:15 o'clock p.m., in room 1202, Dirksen Senate Office Building, Senator Birch Bayh (chairman of the subcommittee) presiding.

Present: Senators Bayh (presiding), Burdick, Fong, and Cook.

Also present: J. William Heckman, Jr., chief counsel; and Abby Brezina, chief clerk.

Senator Bayh. May we come to order, please?

Our first witnesses today, we could say, comprise an international panel. I ask that they consent to appear together to give us a comprehensive discussion of their point of view on this issue: Dr. Albert W. Liley, Post Graduate School of Obstetrics and Gynecology, the University of Auckland, National Women's Hospital, Auckland, New Zealand; and Prof. Jerome Lejeune, professor of fundamental genetics, Medical College of Paris, in Paris, France.

The witnesses will be introduced by Dr. Watson A. Bowes, the Division of Perinatal Medicine, the University of Colorado.

Dr. Bowes, would you please proceed?

STATEMENT OF DR. WATSON A. BOWES, DIVISION OF PERINATAL

MEDICINE, UNIVERSITY OF COLORADO, BOULDER, COLO. Dr. Bowes. Thank you, Senator Bayh. Distinguished members of the committee, as an American physician deeply concerned about the abortion issue and its effect on the lives of the unborn, it is a great privilege to welcome to this country and to introduce to this committee two of the most prominent scientists in the field of reproductive medicine.

Early in my training as an obstetrician-gynecologist at the University of Colorado Medical Center, I was called upon to perform a number of abortions on women suspected of having rubella in early pregnancy. It was in the performance of these abortions that I was faced with the realization that as a physician I was treating a disease by killing the patient with the disease.

It required only minimal reflection to be reminded of the enormous accumulation of unassailable scientific evidence that testifies to the humanity of the fetus in utero. For at precisely the same time

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