accepted contraceptives have come from a widening circle around the city, and almost all of these women have chosen the new devices. This is presumably what happens when word of the method reaches women who are ready for family planning but want an easier and "better" way than they have heard of before. Family planning does not, of course, diffuse evenly among the different kinds of people in a community. Acceptance varies with education and age and—in Taichung at least-above all with number of children and number of sons. When couples in Taiwan have four children, they have all they want and they are ready to do something about it—if there is something available that is reasonably effective, inexpensive and easy to use. The evidence here is that whereas the slow long-term "natural" speed of contraception through a population reaches the better educated people first, a deliberate and accelerated effort like the Taichung program can quickly have a major impact on the families that already have large numbers of childern,

Taiwan is one of many low-income countries where rapid increases in population thwart economic development and threaten to slow further improvements in the standard of living. In the long run, to be sure, it seems likely that economic and social pressures combined with personal aspirations will lead individuals to limit their families. The underdeveloped countries, however, cannot wait for a long-term solution to their present crisis. The program in Taichung suggests that fertility control can be spread by a planned effort—not so easily or so fast as death control, but nevertheless substantially, in a short period of time and economically. (The cost of each acceptance was between $4 and $8, far below the eventual economic value of each prevented birth, which has been estimated as being between one and two times the annual per capita income.) A good deal of the story in Taiwan remains to be told, of course, including the results of the sample survey and the critical check of official birth statistics over the next months and years. Health agencies in Taiwan are now extending the program to a larger segment of the population, testing the Taichung results and trying out new approaches in the slum areas of cities and in poor fishing and mining villages. At this point one can at least say that fertility in Taiwan is changing and can be changed-changing over the long run as the result of unplanned social processes but, most significantly, changeable in the short run as the result of a planned effort to help people have the number of children they really want.'

ABORTION IN CHILE: "PAINFUL PLEA FOR HELP"

Dr. LIPPES. If anyone doubts the motivation of modern women to limit the size of their families, let them look to Latin America, where induced criminal abortion has reached epidemic proportions. These women risk their lives not to have another child. In some hospitals, complicated abortions occupied as much as 70 percent of the beds. For every 100 Chilean live births occurring in hospitals, there were 31 hospitalizations due to induced abortions. Out of every 100 liters of blood for transfusion, 27 were expended on abortion cases. duced abortions occurred in 35 to 40 percent of all pregnancies in Chile. In 1 year alone, there were 54,000 hospital admissions just for the complications secondary to criminal abortion. This is an exquisitely painful plea for help for family planning and contraception. Contraception is obviously an urgent need in Latin America.

In

It is interesting that in Chile both the political left and the political right are in agreement about the implementation of birth control. The conservatives see that birth control will save tax money by reducing the state welfare costs and state medical costs by preventing abortions. On the other hand, the liberals see that the new Chilean birth control

See illustration, p. 37, op. cit.

program will help equalize treatment for all classes of people. Why should the rich Chileans have contraceptives available to them to limit family size while the poor must resort only to abortion? Such unity of opposite political polarity is historically unique.

INDIA: 14.2 MILLION LOOPS TO BE INSERTED IN 3 YEARS

Because of the popularity of this new method of contraception, large national programs are now going forward in many countries. They have been enumerated earlier this morning. The Indian Council of Medical Research this year declared intrauterine contraception safe and effective after a review of 50 pilot studies involving 3,667 women. In summarizing their results, pregnancies or contraceptive failures had occurred once in every 161 women in the 2-year project. The plan now is to insert 1 million loops this year and a projected 14.2 million within 3 years.

100 DOCTORS COULD CARE FOR 1 MILLION WOMEN A YEAR

It is possible that intrauterine contraception will provide a solution or contribute to a solution of the urgent problem of fertility control? Is it practical? To insert an intrauterine takes 5 to 10 minutes. I know that in my own clinic and observing other clinics around the world. It is reasonable to expect a doctor, with one nurse helping him, to insert 40 of these intrauterine devices per day. This works out to 200 per week, or 10,000 in 1 year. Simple arithmetic tells us that 100 doctors could service a million women in 1 year, or 1,000 doctors could service 10 million women in 1 year. This is, of course, an oversimplification because problems of education and communication would have to be resolved before these devices could be inserted.

LIPPES QUOTES FREUD

But, please, bear in mind that when a woman is wearing an intrauterine device, parenthood becomes an act of deliberation. This is an entirely new sociologic phenomena. For when she wants a baby, she must say to herself and to her husband, "If we want a child, I must go to the doctor and have my device removed." Then she must actually have the device removed. Let me quote Sigmund Freud from the year 1898:

It cannot be denied that contraceptive measures become a necessity in married life at some time or other and theoretically, it would be one of the greatest triumphs of mankind, one of the most tangible liberations from the bondage to nature to which we are subject, were it possible to raise the responsible act of procreation to the level of a voluntary and intentional act and to free it from its entanglement with an indispensable satisfaction of a natural desire. We can only reflect at this man's great and prophetic genius. Perhaps it is not unfair to say that intrauterine contraception represents a sociologic revolution in enhancing the dignity of mankind.

Some of my friends in economics estimate that the private foundations and Planned Parenthood Federations have enough money to

perhaps reach 2 percent of those women desiring contraception. How soon this method becomes available to all women everywhere could depend in some measure on the action of this committee.

Senator GRUENING. Thank you very much, Dr. Lippes, for a most informative paper.

Have you some photographs of this intrauterine device that could be included in the record?

Dr. LIPPES. Yes, I have.

Senator GRUENING. I notice that Life magazine recently had pictures of various intrauterine devices and it seems to me that it would illuminate your testimony very much if we could have a photograph of yours that we could put into the record.

Dr. LIPPES. I will be happy to mail you one, Senator.

Senator GRUENING. And any other thing to illustrate this process I think would be very helpful. Thank you very much. (Pictures of intrauterine devices and an inserter follow :)

INTRAUTERINE DEVICES: "ON THE FRONTIERS OF MEDICINE: CONTROL OF LIFE" [Photograph which appeared in Life magazine, Sept. 10, 1965, reprinted with permission.-Copyright Time Inc.]

Senator GRUENING. It is appropriate to place in the hearing record today a rather startling report from Belgrade by Edward P. Morgan, who is a well-known radio and television commentator. Mr. Morgan went to Belgrade to cover the United Nations World Population Conference and his radio broadcast of August 31 is alarming. He quotes Prof. Ronald Freedman, who is head of the population study center at the University of Michigan, as telling delegates to the conference that: "The most accepted method of population control in the world today is abortion." The full text of Mr. Morgan's broadcast will appear in the hearing record at this point. (The broadcast referred to follows:)

EXHIBIT 227

EDWARD P. MORGAN AND THE NEWS, AUGUST 31, 1965

(Sponsored by the AFL-CIO, American Broadcasting Co. Radio Network) BELGRADE. "The most accepted method of population control in the world today is abortion."

That stunning statement was made yesterday by the U.N. World Population Conference here by Prof. Ronald Freedman, sociologist, demographer, and head of the population studies center at the University of Michigan. There is something downright savage about that fact, but the very ugliness of it, reflecting as it does a kind of hypocrisy in the approach to the wonder of human life, is beginning to shock an increasing number of nations and the effect, paradoxically enough, may be beneficial.

It goads the conscience of civilization, which faced with the prospect of not so slowly choking itself to death by breeding more babies than national economies can sustain in decency, is obliged to search for sounder, safer, and more ethical means of bringing the world's population growth rate under control.

A massive struggle is developing over the very personal and intimate function of human reproduction. Time was and quite recently too when organized groups from chambers of commerce to churches and the highest councils of government extolled the multiplication of citizens as a civic virtue, a moral exercise and a patriotic duty. Now we know or are rapidly learning that such growth may defeat the very development a country needs, especially the emerging nationstates. If people are produced faster than food to sustain them, only trouble can lie ahead and this is the prospect many governments face.

The universal use of abortion, in varying frequency, indicates that individuals have been ahead of many of their leaders in sensing the need to limit family numbers to avoid compounding the burdens of poverty. Yet this method of limitation assails the stability, health, and moral values of the family. This is a large reason why the hierarchy of the Roman Catholic Church in Latin America, for example, is more realistic and flexible on the issue of birth control than the Catholic hierarchy in the United States.

Given an incidence of illegitimate births as high as 80 percent in some Latin American countries and given, too, the fact that 40 percent of the hospital beds in Chile are occupied by women with postabortion infections, and it doesn't take long for a conscientious priest in Santiago or Montevideo, or Lima or wherever to realize that such conditions dangerously corrode the institution of the family, the foundation of the church's power, influence, and not incidentally income.

No wonder Latin American cardinals and bishops stand on far less ceremony than their colleagues in the United States on the need for aggressive and more effective approaches to family planning. Ironically, clerics and other critics in the United States might be more liberal on the issue if the shockingly high incidence of illegal abortions in the United States itself were more widely known.

But religious scruples and/or prejudices are deeply imbedded in the problem and it does no good-indeed, it only makes matters worse to try to brush them rudely aside. At the same time diplomatic doubletalk on the subject may be the worst sin of all.