There is a direct relationship between poverty and high birth rates. If we are to declare war on poverty, we must assist people so they can plan for their families. Much of the attention has been focused on Appalachia because of its large unemployed population and poverty. Traditionally, the Appalachian region has experienced phenomenally high fertility. The report of the National Resources Committee, published in 1938, noted that the highest fertility in the United States is found among the women of the southern Appalachians* * *. The population would increase 21⁄2 times in about 30 years without emigration ***. Conditions have improved, but the problem is still acute. We are all familiar with the problems caused by the needy families who have too many unwanted children. Our welfare departments are plagued with the poor who continue to have children when they can't even afford to feed the ones they have. And many of these, unfortunately, are born out of wedlock. ONE CHILD IN TWENTY-FIVE RECEIVES WELFARE AID The cost of maintaining children of the poor has climbed to more than a billion dollars a year in welfare funds. One child in every twenty-five receives welfare aid, and the number may double in the next 10 years. These youngsters, because of family poverty and lack of education and lack of love, have little chance of rising above the culture of despair. Birth control does not solve all the problems of poverty. But it does help the poor regulate the growth of their families. Expenses are cut. The health of the mother improves because she is not having too many children too quickly. The fear of bearing another child, who might mean increased poverty, diminishes. The costs of unwanted and unplanned children are immeasurable. The human suffering caused by and to them and the financial strain on the family and community are more than we realize. Among low-income, low-educated parents surveyed recently, 54 percent of their children were unplanned and unwanted. For every 100 patients visiting a "planned parenthood center" in 1962 66 have incomes of $74 or less per week, 33 are on welfare or have incomes of less than $50 a week, 78 are less than 30 years old, 21 are less than 20 years old, and 69 have 3 children or less. ECONOMIC ASPECTS OF INCREASED POPULATION What are the economic aspects of increased population in the United States? 1. Increasingly, we may expect our rapid increase in numbers to burden, rather than accelerate, our economy. 2. Increased expenditures mostly public funds needed to supply schools and colleges, health facilities, housing, water supplies, transportation, power, et cetera, for the expanding population will mean a substantially higher tax burden and bigger government. 3. This year 4 million new babies will be born in the United States, and between 15 and 20 percent of all tax revenues will have to be spent simply to give them basic services. 54-459-66-pt. 3A- -2 4. The U.S. Office of Education estimates that Americans spent $32 billion last year on schooling-three-fourths of it from tax funds. MEETING THE CHALLENGE OF INCREASED POPULATION What must be done to meet this challenge? 1. Research on a far larger scale must be supported on the biological and medical aspects of human reproduction so improved methods of fertility control are developed. 2. The American people must be informed of the enormous problems inherent in unchecked population growth here as well as abroad. 3. A sense of responsibility must be developed concerning marriage and parenthood, including the responsibility of bringing into the world only those children whom parents want and are prepared adequately to care for and educate. 4. Existing knowledge about birth control at low or no cost must be made available to those who need and wish such information and guidance. The Federal Government has spent millions of dollars in research so that the health of the world could be improved. The effectiveness of our federally financed research in cooperation with private enterprise has been so effective that we have now virtually eliminated many of the "killer diseases" and our death rate is now very low. Now our public health officials must concern themselves with the increase in population which threatens the health and well-being of many millions of people. WHAT CAN BE DONE? SOME SUGGESTIONS In my judgment, action is required. I suggest: 1. Public health organizations at all levels of government should give increased attention to the impact of population change on health. 2. Scientific research should be greatly expanded on (a) all aspects of human fertility; and (b) the interplay of biological, psychological, and socioeconomic factors influencing population change. 3. Public and private programs concerned with population growth and family size should be integral parts of the health program and should include medical advice and services which are acceptable to the individuals concerned. 4. Full freedom should be extended to all population groups for the selection and use of such methods for the regulation of family size as are consistent with the creed and mores of the individuals concerned. Recognizing that the population problem, nationally and internationally, has become a serious crisis, we must determine a course of action. I recognize that a greal deal of work has already been done by the drug firms throughout America and other interested organizations. Nothing should be done to detract from their achievements. In fact, we should complement their efforts. U.S. OFFICIALS "MUST FACE UP TO THEIR RESPONSIBILITIES" Our public health officials should fully utilize the devices and information that are now available. It is my understanding that even though our law provides that money can be used for family-planning services, few agencies use it. Our officials must face up to their responsibilities. We must mount an educational program that will inform the American public of the wisdom and advisability of planning parenthood. There has been substantial information and know-how collected. It must now be used. Mr. Chairman, the meetings that we have held have been most informative and most valuable. I am hopeful that the great reservoir of knowledge that has been pulled together will be used by the Federal Government and State governments in their efforts to meet these population problems and the problems experienced by our individual citizens who must concern themselves with the need for planning their families. I have appreciated serving on this committee and am grateful for the opportunity of presenting this statement. Senator GRUENING. Senator Simpson, thank you very much for a most comprehensive, constructive, and valuable statement. Of many good statements that we have had before this committee, none have summarized the arguments more effectively and more cogently than you have. This is a great contribution for the record. I direct that the Look magazine article to which you referred on the solution to the problem which was found in Mecklenburg County, N.C., be made a part of the hearing record. (The article follows:) EXHIBIT 159 "BIRTH CONTROL AND THE POOR: A SOLUTION-MECKLENBURG COUNTY, N.C., CHALLENGES THE BELIEF THAT BIRTH CONTROL IS FOR THE RICH AND NOT THE POOR. HERE IS THE MECKLENBURG CHALLENGE" (By Jack Shepherd, Look staff writer) [Look magazine, Apr. 7, 1964, pp. 63–67] A Gallup poll asks: Should birth control information be available Red Nancy P. is 22. Her husband is 26. He works as a plasterer for $45 a week. They have six children, aged 8, 7, 6, 5, 4, and 21⁄2 years. Nancy began taking birth-control pills in 1961. She still takes them. The family pays $8 a week for a five-room pine-board shack. Their living room is small, dark, and dirty. clay earth shows through cracked floorboards. The stench of urine and kerosene is everywhere. Down the hallway is a bathroom; the landlord has removed the toilet and sink, and the room is used for storage. The kitchen has a hot water heater, but no water. Nancy must walk up the block and carry water back for baths, cooking, and washing. An outhouse sits on the kitchen porch. Nancy P. considers herself lucky. After her last baby was born, she went to a Mecklenburg County, N.C., birth control clinic. A doctor offered her a choice of devices. She selected the pill. Birth control won't patch the cracked floor of her home, or bring running water to her family. But it will help Nancy stop the yearly progression of pregnancies that drained her health. Most important: It offers Nancy the hope that her children can move up from poverty. Elsewhere in the United States today, an affluent society denies birth control information to those who need it most-the poor. Because they can't afford the luxury of a private physician, the poor face a problem the well-to-do avoid-having more children than they want or can adequately support. This situation was long ago immortalized in the phrase: "The rich get richer and the poor get children.' Many of the poor must depend upon public hospitals, health clinics, and welfare departments for help. Yet, in dozens of U.S. cities, they cannot get birth control information from these agencies. "The plain fact is," says Dr. Alan Guttmacher, president of the Planned Parenthood Federation of America, "that most welfare departments and most public hospitals in our Nation do not make familyplanning service available to clients, and many actually prohibit caseworkers and physicians from even discussing the matter." Dr. Philip Hauser, a University of Chicago sociologist, argues: "The time is long past when society at large, and especially social workers, can ignore the problem. To do so is to favor the perpetuation of poverty and ignorance and large relief rolls." The U.S. Public Welfare Law of 1962 provides money that can be used for family-planning services. Few agencies use it. As a result, says a Federal report, the cost of maintaining the children of the poor has climbed to more than a billion dollars a year in welfare funds. The human cost is greater. For all the prosperity of the last 10 years, the number of children on welfare rolls has doubled. Today, nearly 3 million of them—1 child in every 25—receive aid, and the number may double again in the next 10 years. These youngsters, because of family poverty and lack of education, have little chance of rising above the culture of despair. "They help form," says Dr. Hauser, "third-generation relief families in many of our States.' What can be done? Science is quickly producing better methods of contracep tion. But while research moves ahead, a way must be found to teach present methods to women like Nancy P., who want and need them. Chicago's poor, for for example, have a birth rate on a par with India's. U.S. mothers, rich and poor, give birth to more than 300 babies every hour. At this rate, our population will double in the next 36 years. The National Academy of Science warns: "Other than the search for lasting peace, no problem is more urgent." Mecklenburg County has one solution to this problem. Its public health clinics, in Charlotte and the nearby rural area of Cornelius, dispense birth control information and devices to indigent women who ask for them. Since 1960, the health and welfare departments have combined forces to supply an oral contraceptive through the clinics. Welfare buys the drug-a synthetic compound akin to the hormone progesterone-with money from its medicine budget. The pills are a highly effective addition to the list of contraceptive devices. To Catholic women, doctors offer instruction in the rhythm method. "It's not just a matter of giving someone pills and saying, 'Here, take these,' explains Wallace Kuralt, county welfare director. "We are involved in a medical and social endeavor that is trying to help these families understand what is happening to them." Alice C. is 25. Her husband is 27. He works for the city. He earns $57 a week. They have eight children, aged 10, 9, 8, 6, 5, 4, 3, and 2 years. Alice began taking the pill after her last baby was born. The family lives in a twoand-a-half-room clapboard house and pays $7 a week rent. There is no heat. Burlap covers the windows to shut out the cold. A double bed, small dresser, and three backless wooden chairs crowd for space in the front room. A broken mirror tilts against one wall. In the back are another double bed and a cot. A neat stack of dirty clothes lies in the fireplace. Sunday clothes are carefully hung on nails in the walls. There are no closets. In the kitchen, there is the kerosene smell of poverty. Out in the yard sits an outhouse, next to a well. Alice C. is one of 732 women who have received birth control information from the clinics since 1960. Indigent mothers-married or unmarried--are treated if they have had at least one pregnancy. Mecklenburg's standards are unusual. Most birth control programs in other counties and cities are limited to wives who actually live with their husbands-or only one mother in five on relief. "If we worked with unmarried women with no pregnancies,' says Kuralt, "this would enable the public to argue that we are contributing to immorality. But by limiting the program to women with one pregnancy, we are defeating this argument." Of the 732 women who are enrolled in Mecklenburg's program, 75 percent are still taking the pill. No pregnancies have been reported. Previously, these same women had a total of 3,440 pregnancies. This record raises serious doubts about the myth that women on relief keep having children to get more money. The pill is necessary for such women. "They have a hit-and-run sex life," explains Dr. Elizabeth Corkey, assistant public health director, who heads the clinics. "Few can plan to use the diaphragm.' The pill requires no planning or privacy. Sanitation facilities aren't needed. "We always think that people in Puerto Rico or Pakistan don't have toilets," says Dr. Maurice Kamp, county public health director, "but people right here in Charlotte don't have them." About 10 new women enter the Charlotte clinic each week. Most hear of it from social workers or public health nurses. Doctors in the Charlotte Community and Memorial Hospitals also make referrals. When a woman comes to the clinic, she has a half hour interview with a nurse. Here, for the first time, the patient may learn the facts of life. It is one of the astonishing paradoxes of poverty that the poor may bear many children and not know how a child is conceived. A doctor examines the patient. If she is healthy and wants the pill, he prescribes it for her. (Otherwise, he will teach her the rhythm method or fit her for a diaphragm.) A nurse describes how the pill works and how to mark the calendar it requires. This is a drawback of the pill: Marking a calendar is simply too complex for some women. Mecklenburg couples an excellent health program with its birth control work. The doctor gives each patient a pelvic examination and Papanicolaou (Pap) smear test for cancer. Both are important, for the poor get sick more frequently than the well-to-do. They also die younger. Occasionally, a Pap smear turns up positive, indicating a possible malignancy. With luck, the clinic detects the cancer early, when it is comparatively easy to treat. But if the tumor has spread before detection, an operation on an indigent woman may cost the county up to $1,000. Worse, if not found, it may cost the woman her life. The clinic shares the expense of its devices with the women who go there. The pills are free. "One nurse told me," says Dr. Kamp, "that the cost of the diaphragm is a dollar. But many families can't raise 15 cents. If we waited for them to raise a dollar, they might raise another baby instead." Not everyone is in this position. Some of the women come to the clinic when family problems begin, when they can still raise the money. The clinic is able to help them stay off welfare rolls. As Kuralt puts it, "Being able to plan the size of their families has kept some people from needing assistance." Elizabeth W. is 21. Her husband is 23. They have four children, aged 7, 5, 4, and 1 year. They live in a cramped three-room frame house. They have no hot water, no heat. Both were unemployed when Elizabeth went to the welfare department. They couldn't afford the expense of another baby. Elizabeth asked for no assistance, only referral to the clinic. She bought a diaphragm and has used it a year. Now her husband has a job. They have saved a little money and hope to move to a larger house. Others cannot. They are caught in the downward spiral of poverty. Their families are too large for public housing, so they move to a slum. Or the children are farmed out to relatives. Sometimes the pressure is too great; the husband deserts. "I am convinced," says Kuralt, "that the majority of desertions take place when a man gets discouraged with the monetary problems of raising a large family, puts on his hat and walks out." Birth control is not a panacea for these problems. But it does help the poor regulate the growth of their families. Expenses are cut. A little money accumulates. The health of the mother improves because she isn't having too many children too quickly. The fear of bearing another child, who might mean increased poverty, diminishes. Sexual relations may improve. The husband may stay home. Barbara P. is 24. Her husband is 26. They have six children, aged 11, 10, 9, 7, 6, and 2 years. They live in a four-room house in a rural area. There is no water. There are no screens on the windows, and flies fill the house in summer. After the baby was born, Barbara's husband took to deserting. She received aid to dependent children grants, which stopped when her husband took a job as a house painter at $60 a week. In 1962, Barbara went to the clinic and bought a diaphragm. She had used one before to space the two youngest children. they get a little extra money, she and her husband shingle and paint the house. Half the front and one side are done. They plan to nail screens on the windows this spring. As For economic and humanitarian reasons, the people of Charlotte are behind the clinics. Last year, Kuralt received a Community Service Award from the Junior Women's Club, honoring his work in the pill program. When the second clinic opened at Cornelius, Charlotte churchwomen donated $500 for pills. Other North Carolina counties are adding oral contraceptive programs to their public health work. Birth control clinics patterned after Mecklenburg's are operating in 2 South Carolina counties, and inquiries have come to Kuralt from more than 25 States. Opposition to the Mecklenburg program has been negligible. Roman Catholics, who might oppose the clinics on religious grounds, number only 10,000 in a county of 300,000. More importantly, Catholics in general don't oppose the regulation of family size. Dr. Kamp explains, "I don't think it's emphasized enough that birth control is not a religious question. No group is opposed to family planning. If a clinic makes all methods available, it is certainly meeting the needs of its people within the boundary of any belief." |