Senator BAYH. I forget the figures, but we do have that and we will dig it out. I remember that now.

Give us your experience in the rape field now, Doctor?

Dr. LAUFE. I had a very unusual experience, in that I was invited by Dr. Malcolm Potts, then medical director of International Planned Parenthood Federation, to go into Bangladesh immediately following the war when the word came out that 200,000 women had been raped, and those were the Bangladesh government figures. Of those, 20.000 were pregnant. Now, that is a high incidence of pregnancy resulting from rape, and we do know that the incidence in this country is much lower.

There are good reasons for that. Many of the American women who unfortunately are raped may already have been on a contraceptive; and second, for many it may have been a singular experience. Many of these Bengali youngsters were taken into barracks and camp towns by the Pakistani soldiers and kept for weeks and months at a time and literally rationed out to a certain number of officers or soldiers, so they had continuous sexual exposure. The results of this, as I said, were approximately 20,000 pregnancies.

What happened to these girls is most interesting, because the Moslem religion and Bangladesh is a Moslem country-is very rigid about sexual behavior with anyone other than your husband. So even a mother of two, three, or four children who was raped became a social outcast from her family and was not allowed to come back into the home. And for the youngsters-and the average age of these children was 14-became social outcasts. And so rather intensive rehabilitation program was instituted by the government of Bangladesh, and Sheik Bujib Rahman, the President of Bangladesh, went on public record saying, despite the fact that Moslems have never believed in this, abortion is a good thing for my country. And so, a team was invited in, a very small team. We stayed a relatively short period of time.

We established a clinic and trained the local doctors in what we felt was the best technology available. The week before we arrived in Bangladesh, 300 new-born baby bodies were found floating down the Ganges River. Infanticide. Innumerable suicides occurred. These young girls let their hair grow long, and we say many, many of them whose hair was cut short because they had been hanging themselves while they were prisoners of these various officer or soldier groups. We know of at least 250 suicides in this young group within the 2 weeks before I arrived, and we are aware of literally thousands of criminal abortions that were performed by midwives out in the vil lages in which breen branches or sticks from trees were cut, inserted through the cervix as a foreign object, and we saw many who came in with these sticks protruding out of their abdominal wall, so that the sights were not nice, I assure you. But you see, the Sheik, is a very bright man, and he said something very important. He said, the freedom fighters, they are the heroes of our country. The violatedand he used the word violated rather than raped-Bengali women are the heroines. The only sin they committeed was that they were Bengali, they were there. That was their sin. And they felt that they had to be rehabilitated, and the program was a total rehabilitation

one, and I can tell you after going back twice since that war, 90 percent of those youngsters have been rehabilitated in their homes.

Senator BAYH. Well, what has been the experience that you or the other doctors here have had ar far as the incidence of rape and pregnancy in the United States?

Dr. LAUFE. I would think that any responsible physician to whom a woman came to and said, I have been raped the night before, the day before, would do something to make sure that there was no appropriate bed in that uterus for a nidation to occur. He would not debate the issue, are you or are you not, or wait to get the appropriate tests. He would offer her immediate relief for her anxiety, and her anxiety would be great. This can be accomplished by immediately performing a currettage or D. & C., or by giving as what has been spoken to here as the morning-after pill.

Now, let us remember, and our colleagues this morning admitted, that definitions do change. Progress does occur. Conception is worthless without nidation, without implantation. And so, if you eliminate the bed of the uterus, the intrauterine lining where nidation would occur, then it cannot occur. To put the woman through the anxiety of even going through the problem of finding out whether or not she is pregnant seems ludicrous to me when you have such simple therapeutic measures to avoid the whole issue and give her the relief that she asks for.

Senator BAYH. Let me ask all or any of you gentlemen about the contraception situation and how it might be affected with an amendment. Dr. Hilgers has submitted some information for the record which I have not yet read. But apparently, you accept his assessment that the intrauterine device is not that efficient in the way it acts. Could you give me your houghts relative to whether the morningafter pill or intrauterine device are abortifacient and thus would be outlawed?

What does one then say to doctors who want to counsel mothers and families about birth control, contraception? What alternatives are available and what ancillary health hazards are then brought into the picture?

Dr. GREENE. To me it is very fascinating to attend meetings of one of our organizations called the American Fertility Society in which the experts, the investigators working in the field of reproductive biology, will argue and discuss just as to what is the mechanism of action of the intrauterine contraceptive device. There is not universal agreement, sir, on how it works, whether it has effects on tubal motility, whether it has effects on implantation, does it cause a chronic endometritis, interfering with myometrial contractility, all of which can induce abortion or prevent pregnancy.

One of the things that has impeded greatly research in these areas is the ability to do research in humans. Likewise, it is fascinating to me to have a panel such as this of experts that have devoted their life to the study of the contraceptive pill. They can list you five or more mechanisms by which the pill works. Does it work on the hypothalamus, does it work on the ovary, does it affect the tube, the nidation site or the cervical mucus? People can introduce evidence that ovulation occurs with people on the contraceptive pill but because of

other mechanisms involved in the physiology of the human female, conception or nidation does not take place. Now, conception might take place, but nidation might be impossible, or cervical factors are such that the cervical mucus will not allow the sperm to implant it. So we have so much more to learn about the human because you must do this experimentation in humans since there are many things that occur in lower animals that you cannot use as a model for human experimentation. The rabbit is one animal that has been used extensively, but rabbits are not the same as women, so that the experts do not agree on how the intrauterine contraceptive device prevents pregnancy. The experts do not agree on how the pill actually operates to prevent nidation, although the pill is practically 100 percent effective in preventing pregnancy. The intrauterine device is not 100 percent effective.

Dr. LAUFE. Senator Bayh, I would like to support Dr. Greene's statement. I have had the privilege of sitting on some medical advisory committees regarding IUDs. We really do not know how it works, and I would like to differ intensely with Dr. Hilgers presumptions that it is a very simple mechanism. It is ultracomplex. We do know there are bioactive IUDs which change the milieu of the environment, change the setting. We do not know whether the inflammatory response established destroys the sperm long before they ever reach the egg, or vice versa. It is a very complex subject. I wish it was simple.

I would like to speak about contraception in this country and also throughout the world. Basically we have two kinds, those contraceptives which are related to the coital experience, the diaphragm, the condom, the foam, the jelly, and those contraceptives unrelated to the coital experience, the IUD and the pill.

Now, it takes a much more motivated patient to use the type of contraception that must be used individually per experience. The convenience of a non-coital-related contraceptive, one which she can in essence forget about, her husband can forget about, that it is there and doing a job, is very, very important for a large segment of our society. To eliminate that service for people who want to plan their families would be a great tragedy. There is a great need for further research and investigation in contraception. We do not have the perfect contraceptive.

Many of us are trying very hard to improve what we have or look for new things. But to diminish the limited services which are now available would be a travesty to our society. The services are unequal in their distribution. There are many places in this country where you cannot get family planning services, and we need dissemination of services for everybody. This is the best public health, along with cancer control such as pap smears and breast examinations, available for every woman. In this way we will improve the quality of reproductive health in our society.

Dr. JOHNSON. I wanted to say, if you eliminate the IUD, the number of teenaged pregnant girls I showed you probably would double because you are in a group of patients now that you cannot depend on to take a pill or using a condom because the habits around their sexual function. Usually it is not in a convenient spot, at home, where

everything—it is usually at the movie or some other kind of place. So the IUD turns out to be a very acceptable kind of thing.

The other part is that you make a lot of happy mothers, usually, with the IUD. Mothers are a particular kind of people who always come in with a complaint that the young lady is having trouble with the bleeding, and you play the game between the daughter and the mother in getting the daughter what she needs, at the same time belaying the mother's anxiety. And I do not know how many 13-yearolders I have IUD's in and the 13-year-old does not know she has the IUD in. That may be good or bad. The whole point is that it is a method which can be used, and those persons who could do it, who would not follow another form of contraception.

The cost factor in terms of the patient carrying the IUD is markedly decreased over say a pack of pills each month where there may be other kinds of side effects and whether she is going to take them, whether she is going to take them very dependably. So in the girls that we have seen at the pregnant teenage schools-these are schools for girls to continue school while they are pregnant without losing time out of school-we have had less than a 5 percent repregnancy rate in looking at our girls now over a 5-year period. We have had less than a 5 percent dropout rate of kids out of school who went through this particular school, and we have had about a 90 percent increase in one grade level, and about a 50 percent increase of two grade levels in the girls who have gone to these schools. They understand and begin to understand their bodies. They begin to understand contraception, and they do use the contraception. However, they do have some difficulty with remembering each morning to take a pill or what have you.

One other thought, there have been some good studies done in terms of the IUD where in some animals where they put an IUD in one horn of an animal with a double uterus, in the recovery studies, in recovering the sperm from the horn where the IUD was located, that you are sometimes only able to recover 50 percent of the sperm from that one, and the question is, what happened to the other 50 percent of the sperm, and there they found that many of the tails had been. broken off the sperm, many of them had been absorbed by various other kinds of cells.

And I would like to echo the feelings of my friends that we are in disagreement that the whole process of how the IUD works is not a simple one, and it certainly is more complicated than presented this morning.

Dr. LEVI. Senator, may I voice my opinion? I would like to follow Dr. Greene, Dr. Laufe, and Dr. Johnson on the issue of intrauterine device being an abortifacient. I think that to really promote that idea as of today is not correct. It is not proven that it is an abortifacient, and obviously in the opinion of my colleagues sitting here, and many more obstetricians and gynecologists, the action of the intrauterine device definitely to prevent a pregnancy is not yet clearly known. Therefore, to make the statement one way or another it would be inappropriate, unjust, and untimely.

Second, to address myself to the aspect of contraception, I think that we are here also dealing with concepts of minors and pregnancy.

57-676 O-76-38

I think as physicians we have noticed the importance and the necessity of counseling, educating minors, in order not to become pregnant, and for this one has needed counseling in contraception. I might be personally happy to see that there is more and more of that, but I think there is a difficulty concerning the law, counseling in contraception of minors, which has not been made yet clear, at least in New York State.

I think as a final point that if there was a law passed that would forbid a woman to decide to have a contraceptive, not only would that be a crime, an unconstitutional law in my personal opinion, but it also would forbid a woman to have her own course, deciding on various aspects known to her, how she should control her size of family. I think that contraception in the broad sense with education and availability of that education, I hope to more and more women, would contribute to just that. It is her decision, and therefore, eliminating that right to her would be a catastrophe, and I think I am objective in saying that. I think the best answer for those things, besides the professionals on any side of the issue, would come from

women.

Thank you.

Senator BAYH. Well gentlemen, I think we have inconvenienced all of you long enough. I appreciate your patience, and I am sorry it has taken so long. I do appreciate the effort you have made to contribute to our record here. Thank you on behalf of all of the committee.

Dr. JOHNSON. Senator Bayh, may I correct this one last thing? Some one brought to my attention the comment I made about Planned Parenthood. For the record, Planned Parenthood does not do abortions. It is a referral agency. I do not know when I made the mistake, but I wanted to clear that up if I did.

Senator BAYH. All right.

Thank you very much.

We will recess pending the call of the Chair.

[Whereupon, at 4:10 p.m., the subcommittee was recessed, subject to call of the Chair.]

[Before the Senate Subcommittee on Constitutional Amendment, The Honorable Birch Bayh, Chairman. 1974.]

STATEMENT OF PROFESSOR GARRETT HARDIN, UNIVERSITY OF CALIFORNIA, SANTA

BARBARA

My name is Garrett Hardin. I hold a Ph.D. degree in Biology, and I am Professor of Human Ecology at the University of California in Santa Barbara. Human Ecology, as I define it, is a discipline concerned with synthesizing the principles of ecology, economics, and ethics. Some ways of achieving such a synthesis are described in my recent book, Exploring New Ethics for Survival (New York: Viking, 1972). My most important articles on abortion, beginning in 1963, are reprinted in another book, Stalking the Wild Taboo (Los Altos, Calif. William Kauffman, 1973).

Your committee has expressed an interest in the question, "When does life begin?" I have had an active interest in problems of the beginning of life for more than a quarter of a century. The problem of the origin of life is an active field of research and controversy in biology. My principal publication in this area is a historical and analytical note in which I contributed the name "heterotroph hypothesis" as the label for the principal theory. This name is now standard in the literature, and the theory is still the leading one.