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information must be initiated by the recipient. However, we encourage or we certainly authorize the dissemination of information generally to recipients. This can be in the form of notices enclosed with the checks that such family planning information and referrals are available; it can be in the form of general notices that are posted in waiting rooms of the department. In other words, it is a general form of information about the availability and not a one-to-one advice or counseling on the part of the social worker.

Now, we believe first of all that this is necessary by reason of the Penal Code sections that I referred to earlier, and secondly, I think that there is a real hazard in the implied, if not actual, coercion of persons who are completely dependent upon a public assistance check. They may have the idea that they are going to get along better with their social worker if they follow his or her advice to go to the nearest family planning clinic and to get this service. I think freedom of choice is essential here, and particularly so with this dependent group. At the same time, I do not think there should be any barrier or any policy or procedure that would prevent people who are sincerely desirous of obtaining information and counseling and advice from getting it.

CLINICS UNDER AUSPICES OF CATHOLIC CHURCH IN BUFFALO, LONG ISLAND

I might say one other thing that I think should be of interest to the committee. There has been a great deal of talk about the opposition of the adherents to Catholic belief to this kind of program. In the State of New York, I assume there is a very substantial number of such adherents in the population-a third or maybe 35 or 40 percent of the residents of that State are believers in the church and its concepts and precepts. But very interestingly, in the Archdiocese of Buffalo and on Long Island, in the diocese there, family planning clinics have been established under church auspices and in hospitals operated by the diocese, voluntary hospitals. These are staffed by physicians who are members of the Catholic faith and they advise the person seeking such information as to the appropriate rhythm method, advice and counseling insofar as family planning is concerned. While the Catholic Welfare Conference of New York was not enthusiastic about the adoption of the policy which I have referred to, I think it is fair to say that, in general, the operation of it has met with the approval of the religious, of the people who are members of that faith; and I would say that, generally speaking, it has worked out very effectively.

I have referred to this policy saying that it is limited in the sense that only those persons who are married or who are the head of a household are referred for family planning advice. This does not mean that those who initiate a direct contract with a physician or a hospital clinic are denied any service or that we do not pay for that. We do. We will pay for the services of a physician or any devices, materials, or other articles that he prescribes, regardless of whether the person has first come to the welfare department for this referral or whether the recipient has gone directly to the physician, wherever he may be.

Senator GRUENING. In these clinics that are conducted in Catholic hospitals, do they prescribe only the rhythm method?

Mr. WYMAN. So far as I know, yes, sir. And we will pay for the physician's services if a charge is made for such advice and time or service.

Senator GRUENING. Are there any statistics that you are aware of as to the effectiveness of the rhythm method?

Mr. WYMAN. No, sir. I have heard that some have been provided, but I do not have them at hand and I am not competent to express an opinion.

HOW EFFECTIVE IS RHYTHM METHOD?

Senator GRUENING. Well, the previous witness, who as to the welfare clinics in Mecklenburg, N.C., testified that since they have been using the pill devised by Dr. Rock, there were no instances of failure, that where this pill had been used consistently, mothers no longer had children while they are using the pill. Of course, that is very interesting and important testimony and it would be useful to be able to ascertain how effective the rhythm method is where it is used consistently. Do you know whether it is possible to get any statistics from these hospitals where it is being used?

Mr. WYMAN. I am sure it would be, Senator. I just do not happen to have that information.

Senator GRUENING. I think we should try to get it.

Mr. WYMAN. If you care to, we shall be glad to assist the committee in getting this information.

Senator GRUENING. I think it would be useful if you could get that information.1

Please proceed.

A CAVEAT

Mr. WYMAN. I have concluded my comments, sir. I only wish to emphasize again this one aspect. That is that I think it would be a serious error to leave solely in the discretion of the caseworker the decision as to when and who should be referred for these services. I realize that a great deal of discretion is given the social workers for referrals for other kinds of medical services, for the provision of special budgets of one kind or another, and things of this nature. But it seems to me that at our stage of development and policy and program with respect to family planning, and in the level of competency, frankly, of many of the social workers throughout the country who are not completely trained, who are not fully experienced, that to give this complete discretion in their hands, I think, would be a mistake and be an error. It is very difficult, it seems to me, to make proper distinctions in a spectrum that runs from suggestion, counseling, advice, over to implication or even coercion, you know.

1 The information concerning the efficacy of the rhythm method in family planning was forwarded to the subcommittee at Commissioner Wyman's request by C. Carlyle Nuckols, Jr., M.D., deputy commissioner, Division for Medical Services, Department of Social Welfare. New York State. The information forwarded by Dr. Nuckols follows:

The fertility clinic at one Catholic hospital in New York City "has been engaged in a study of the rhythm method for the past 3 years. During this time, approximately 1,000 couples have been involved, and of this number 600 are still on the active rolls. The results so far have been successful in all but 13 cases, utilizing the rhythm method alone and control of body temperature on the part of the wife. These latter represent failure with no demonstrable cause. I would interpret the results as being quite encouraging." The doctor, "who is director of the clinic, emphasized to me that these figures are from unpublished reports, and he would prefer that the clinic be unidentified. I can, however, attest to its excellence and reliability of the work performed therein."

Where do you draw this line between counseling with good will and best of intentions and moving over to the other side that could even be coercion on the part of someone who might feel that this is the solution to all the problems of the world by having poor people not have children? I think it could be a very dangerous weapon in the wrong hands.

Senator GRUENING. Well, thank you very much, Mr. Wyman. We are very happy that you came. Your testimony has been very helpful. Mr. WYMAN. Thank you, Senator.

Senator GRUENING. Yesterday an article by Rasa Gusteitis appeared in the New York Herald Tribune concerning a statement by James R. Dumpson, who recently resigned as New York City's welfare commissioner, on the birth control program of the New York City Welfare Department. Mr. Dumpson, who is at present associate dean of Hunter College School of Social Work, urged that the welfare department take the initiative in informing all adult welfare recipients that family planning help is available if they desire it. I direct that the article be made part of the hearing record at this point. (The article follows:)

EXHIBIT 209

"DUMPSON: GIVE DATA ON BIRTHS TO POOR"

(By Rasa Gusteitis of the Herald Tribune staff)

[From the Herald Tribune, Sept. 14, 1965]

James R. Dumpson, who recently resigned as the city's welfare commissioner, yesterday criticized his own administration for providing birth control information in "a halfhearted way."

He also called for consideration of a guaranteed minimum income and chided public welfare workers for "carping and snide remarks" about the Federal antipoverty program. Public welfare has shared in the Nation's failure to reduce poverty substantially, he said.

"We have done almost nothing to tell the poor of the availability of (birth control) services," Mr. Dumpson said, after addressing the Northeast Regional Conference of the American Public Welfare Association in the Statler Hilton Hotel here.

"We have to find additional ways to let them know, without stigma or coercion," he said.

INITIATIVE

In January 1964, when Mr. Dumpson, a Catholic, annouced that free birth control information would be provided at 17 hospitals for some welfare clients, he made it clear that the initiative would have to come from them. He also required that the clients be married and living with their spouses.

Yesterday, he said the welfare department should take the initiative in making sure all adult welfare recipients understand they can have family planning help if they want it. He did not exclude unmarried women, adding only: "I question whether we should repeatedly make this information available to unmarried mothers.

"I believe people on public assistance should have made available to them all services available to other parts of the population," Mr. Dumpson said.

He said he was led to believe that people on relief did not have adequate access to birth control by the steady increase of births among them in comparison to total births. In 1960, 5.5 percent of all births were to people on relief, he said. In 1964, the figure was 8.6 percent.

INCOME

In his speech, he urged "serious and detailed consideration" by economists of ways to provide a minimum income for all citizens. This becomes necessary "as one views the growing impact of technological automation on economically

productive employment possibilities in the future and the humanistic goals of our society," he said. One way to implement such a program might be a reverse income tax, he suggested. If a person made less than the minimum judged needed for a decent subsistence, the Government would pay him the needed amount.

Mr. Dumpson, who is now associate dean at Hunter College School of Social Work, said public welfare and volunteer agency people who grumble about the Federal antipoverty program should abandon their "dog-in-the-manger attitude" and learn from the Office of Economic Opportunity.

He suggested they follow the OEO's lead in organizing people on relief and letting them have a say about welfare programs.

Senator GRUENING. Earlier this month an address was given by Mrs. Katherine Brownell Oettinger before the Fall Conference on Public Family Planning Clinics in New York City which is of great interest to us today. Mrs. Oettinger is the Chief of the Children's Bureau in the Welfare Administration of the Department of Health, Education, and Welfare. During her speech, she declared that the Children's Bureau

is in a key position in the Department of Health, Education, and Welfare in its involvement in helping to support service programs of family planning. Our basic concern has been, and will always be

Mrs. Oettinger continued:

to improve the social and physical health of mothers and children throughout the country. Our obligation under the Social Security Act is to assist the States in promoting these health services.

She then goes on to explain what the Children's Bureau has been doing in this field. It is an extremely interesting speech, and I will direct that it be made part of the hearing record.

In another address delivered last July in Tennessee before the Institute on Health Education, Mrs. Oettinger discussed family planning services, as well as other "challenges that lie before us" in the fields of health and welfare. I direct that the July 12 address also be made a part of the hearing record. In addition, two other presentations by Mrs. Oettinger, both made before the House and Senate Appropriations Committee earlier this year, are of interest because they give further information on activities ongoing and projected for the Children's Bureau. All four of these addresses will be made a part of the hearing record at this point. (The four addresses follow :)

EXHIBIT 210

"THIS MOST PROFOUND CHALLENGE"

(By Mrs. Katherine Brownell Oettinger, Chief of the Children's Bureau, Welfare Administration, Department of Health, Education, and Welfare)

(An address before the Fall Conference on Public Family Planning Clinics, Hotel Roosevelt, New York, N.Y., September 9, 1965)

I am indeed happy to be here with you tonight for it seems to me that this meeting is the symbol of our national response to one of the most crucial questions confronting the future of this Nation and of the world.

The rapidity of this response can be measured by the rising chorus of our national dialog as all segments of our society seek to make a contribution to the most appropriate national solution of the problem confronting us the population explosion and its allied problems of health and welfare.

What has been produced, in the short span of 3 years, has been a series of policy expressions from powerful national groups and individuals which repre

sent a convergence of conviction like beams of light melded together in a prismatic reflection.

Let us consider some of these expressions:

Late last year, the trustees of the American Medical Association urged it to update its stand to "conform to changes in society" and to cooperate with nonprofessional birth control groups which had "adequate medical direction" in dispensing information about family planning.

The AMA trustees asserted: "An intelligent recognition of the problems that relate to human reproduction, including the need for population control, is more than a matter of responsible parenthood; it is a matter of responsible medical practice."

Similarly, last year the American Public Health Association not only reaffirmed its 1959 position "that public and private programs concerned with population growth and family size should be integral parts of the health program but urged that Federal, State, and local governments in the United States include family planning as an integral part of their health programs, make sufficient funds and personnel available for this purpose, and insure such freedom of choice of methods that persons of all faiths have equal opportunities to exercise their choice in accordance with their conscientious beliefs."

In 1962, the National Association of Social Workers called upon social workers everywhere to give attention to the need for family planning services.

In 1964, the American Public Welfare Association's board of directors stressed the "importance of family planning to assist families to attain the highest potential" and stated that welfare clients should be referred for this kind of assistance if they requested it. "Family planning," the APWA said, "is an individual decision *** and a fundamental human right."

This spring, the chorus from practitioners in various disciplines was swelled by the scientific findings of the National Academy of Sciences, National Research Council, as it reported on the growth of the U.S. population.

"The freedom to limit family size to the number of children wanted when they are wanted is, in our view, a basic human right. *** Most Americans of higher income and better education exercise this right as a matter of course, but many of the poor and uneducated are in effect deprived of the right. No family should be fated through poverty or ignorance to have children they do not want and cannot properly care for. Responsible parenthood requires that couples of all social strata have the ability and means to limit births when they wish to do so, in accordance with their personal convictions. In short, this basic freedom for the individual family should be made effective throughout American society." The continuing thread running through this dialog has been respect for the conscience of individuals from all faiths to determine freely if they wish to space their families by methods morally acceptable to them.

In his state of the Union message last January, President Johnson said, “I will seek new ways to use our knowledge to help deal with the explosion in the world population and the growing scarcity in world resources."

This summer, he was even more specific in asking us to "face forthrightly the multiplying problems of our multiplying populations and seek the answers to this most profound challenge to the future of the world."

Former President Eisenhower mounted a further thrust by vigorously reversing his previous position and stating unequivocally, “I cannot help believe that the prevention of human degradation and starvation is * * * a moral-as well as a material-obligation resting upon every enlightened government.

If we now ignore the plight of these unborn generations which, because of our unreadiness to take corrective action in controlling population growth, will be denied any expectations beyond abject poverty and suffering, then history will rightly condemn us."

Let us look at the current role of the Federal Government in meeting this “most profound challenge to the future of the world."

Secretary of the Interior Stewart Udall has launched a program making contraceptive advice and services available, where desired, to American Indians, Eskimos, and natives of the islands the United States hold in trust in the Pacific.

This action prompted the New England Journal of Medicine to comment editorially:

"Now that Secretary of Interior Udall has announced (this program) perhaps the time is nearing when natives of Massachusetts will share in the new freedom."

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