PREGNANCY COUNSELING

One result of the 1967 therapeutic abortion law has been a remarkable growth in pregnancy counseling services. Such services are generally intended to help women with problem pregnancies to evaluate the options open to them. The agencies offering counseling have met patient needs during the rapidly changing and uncertain scene following the law's enactment. They continue to provide counseling as well as referral to community resources concerning family and social problems-services which most private physicians' practices or medical clinics are not usually organized to provide.

A survey was made in December, 1971 to obtain a general description of these agencies: The 94 agencies were contacted through a mail questionnaire that asked about the number of women served, the characteristics of their caseloads, the nature of the counseling and the existence of other services. Because many organizations do not keep such statistics, respondents were asked to give the figures of their July, 1971 caseload or to make estimates if such figures were not available.

The proportion responding varied from 92 percent by adoption agencies, 85 percent from Planned Parenthood affiliates, 87 percent from hospitals and county health or welfare departments, and 70 percent from other counseling agencies. The relatively low response rate from the last group may be explained by the inclusion of new agencies not a part of the long-established organizations-for example, Women's Liberation and counseling services offered by individuals.

Based on projections from the July, 1971 caseloads, an estimated 100,400 pregnant and nonpregnant women received services during the year from the 67 agencies reporting size of monthly caseload. This figure includes some 63,000 women who chose abortion which is more than half of the 116,749 women undergoing the procedure in 1971. It should be noted that these figures are an understatement of the true number because some agencies did not report this information.

Compared with all women having therapeutic abortions, the women using counseling services include more teen-agers (40 percent compared with 31 percent of all abortions), more first pregnancies (55 percent compared with 48 percent), and more who have never been married (64 percent to 51 percent). Adoption agencies in particular serve teen-agers (59 percent), primiparae (64 percent) and women never married (87 percent).

Of the women served in the July sample, 18 percent were not pregnant, 19 percent chose to continue the pregnancy, and 63 percent chose an abortion. Of all the pregnant women counseled, about three-fourths chose abortion. These proportions vary according to the service focus of the agency which results in patient selection. For example, a program with emphasis on family planning results in more contacts with nonpregnant women, while adoption agencies see fewer nonpregnant women or women choosing abortion.

About 48 percent (32) of all agencies reported a monthly caseload of less than 50 over 40 percent (28) served 50 to 300, and only 2 served 1,000 or more. Adoption agencies and "other" counseling services typically had small caseloads: 82 percent of adoption agencies served fewer than 100. In comparison, 56 percent of hospitals and county or welfare departments and 57 percent of Planned Parenthood units served fewer than 100.

DEMOGRAPHIC EFFECTS

It is frequently asked whether the rise in abortions in California has resulted in a decline in illegitimate births (numbers, ratios and rates). A definitive answer to the question cannot be given for several reasons. One is that birth data for 1971 is not yet available, and it will not be until the first half of 1971 that the impact on births of abortions performed in the second half of 1970 will be seen. There is some evidence that rates of illegitimacy started to decline in California about the middle of 1970. However, this finding is being reviewed in the light of better denominator data that are just now becoming available from the 1970 Census. A further consideration is that even when better data are available, it will be extremely difficult to separate the influence of unfavorable economic conditions from the influence of increased availability of abortion.

Although statements about cause and effect cannot be made at this time, the numbers and types of women having abortions and having babies can be reviewed, see Table 4. From this, it is clear that abortion has had a larger relative impact on illegitimate than on legitimate fertility. Three-fourths of the women having

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abortions are unmarried. The rapid rise in abortion in 1970 resulted in there being more abortions for unmarried women than illegitimate births (46,316 extramarital pregnancies legally aborted compared to 45,593 illegitimate births).

TABLE 1. PERCENT DISTRIBUTION OF SELECTED CHARACTERISTIC OF WOMEN HAVING ABORTION, CALIFORNIA 1968-71

Source: State of California, Department of Public Health, Bureau of Maternal and Child Health, Therapeutic Abortion Reports.

TABLE 2.-THERAPEUTIC ABORTIONS, AGE-SPECIFIC ABORTION RATES, AND RATIOS OF ABORTIONS PER 1,000 LIVE BIRTHS, CALIFORNIA, 1969-71

1 Number of therapeutic abortions adjusted for late reports and for California residents. 2 Rates based on 1970 population.

* 1971 live birth data not available; therefore, 1971 ratios based on 1970 live births.

Source: State of California, Department of Public Health, 1970 Census Data for Health Planning, vol. 2, table 9, Birth Records and Therapeutic Abortion Reports.

TABLE 3,-NUMBER OF THERAPEUTIC ABORTIONS PERFORMED AND PERCENT ANNUAL INCREASE BY

Source: State of California, Department of Public Health, Bureau of Maternal and Child Health, Report of Therapeutic Abortions.

TABLE 4.-THERAPEUTIC ABORTIONS AND LIVE BIRTHS BY AGE AND MARITAL
STATUSOF WOMEN, CALIFORNIA, 1969, 1970

Note: Totals include women with marital status or age unknown.

Source: State of California, Department of Public Health, birth records and abortion reports.

PRESS RELEASE OF SENATOR ANTHONY C. BEILENSON

Senator Anthony C. Beilenson (D-Beverly Hills) today said that last month's U.S. Supreme Court decision barring restrictions on most abortions will have "profound and highly beneficial effects on our society".

Speaking at a University of California Symposium on Population and Planning at Berkeley, Beilenson said: "We already have sufficient data from California and New York-where abortions have been widely available during the past 2 or 3 years to predict with some confidence what the results of this decision will be nationwide".

Because American women "for the first time will be able to choose not to bear unwanted children", Beilenson forecast a number of specific results, including: Lower costs of welfare and public education;

Better economic and physical health for low and middle income families;
Greater family stability;

Decreased divorce and illegitimacy rates;

Eventually, a lower incidence of crime, violence and mental illness.

In measuring the impact of the California Therapeutic Abortion Act, which he authorized in 1967, the lawmaker pointed out that the state's fertility rate fell 12% in 1971, about twice the average decrease nationwide.

Beilenson also noted that illegitimate births, which had dramatically increased in recent years, decreased in 1971 by 16%. He said a study for the State Department of Public Health concluded that the sudden reversal in illegitimacy rates was mainly due to unmarried women obtaining three-fourths of all legal abortions in the state.

State budget estimates for education have dropped $130 million for the current and coming fiscal years, he said, because the decline in fertility has forced revisions of average school attendance predictions.

Welfare rolls have diminished, too, largely because of the reduced birth rate, according to Beilenson. "If today's average welfare family has as many children as the average welfare family of just two years ago, there would be 76,000 more recipients than we actually have," he explained, “at a minimum extra cost to taxpayers of $41 million".

Beilenson also noted similar results in New York, where unrestricted abortion has been available for two years. In that state maternal mortality rates have decreased almost 50%, the infant mortality rate has reached “an all-time low", and the number of illegitimate births declined for the first time in 17 years.

In both states, he said, "fewer girls have been forced by pregnancies to drop out of high school; fewer young women have entered into the cycle of poverty and welfare dependency that is so often initiated by the birth of a first illegiti mate child; and fewer young people are marrying to legitimize conception, thus leading to a reduction in teenage marriages, which are twice as likely to end in divorce as in those of older couples".

Beilenson concluded that "these and many other indications of better health and well-being of so many of our young people are bound to augur well for our state and nation in the years to come."

Senator Cook. Thank you, Congressman. I must say to you, I have some aversion toward this concept that everyone has this right without the responsibility of the whole concept of the rights that are extended to him under the Constitution in society that we live in. The fact that this society is going to continue, and I wonder that if somehow or other there is going to be a new listing on my Blue Cross-Blue Shield card that is going to say how much I will pay a doctor, and how much medical expenses I can be entitled to if I am entitled to an abortion in the first trimester.

I am going to have to get used to that idea, and I am not sure I am at that stage of the game, Congressman.

Thank you very much, Mr. Chairman.

Mr. REES. Thank you.

Senator BAYH. Thank you, Congressman, for being with us.

I would like to put in the record at this time statements from two very distinguished colleagues, without objection, Senator Percy and Senator Brooke.

[The prepared statements of Senator Charles Percy and Senator Edward Brooke follow:]

STATEMENT OF SENATOR CHARLES H. PERCY

Mr. Chairman, the 1973 Supreme Court ruling on the issue of abortion has brought forth a momentous national response. I have listened to the points of view of people who support that ruling and of people who denounce that ruling. Recognizing and respecting strong arguments on both sides of this highly con troversial issue, I believe that the Supreme Court ruling on abortion is correct and proper under existing circumstances.

The Supreme Court based its decision on the individual's right to privacy, which is founded primarily in the Fourteenth Amendment's concept of personal liberty

and restrictions upon State action. The Justices determined that the right of privacy "is broad enough to encompass a woman's decision whether or not to terminate her pregnancy."

Many with whom I have talked even recently still do not understand that the Court decision prohibits State regulation of abortions only during the first three months of pregnancy. Beyond the first trimester, the State may regulate abortion procedures to preserve and protect maternal health; and beyond the second trimester, the State may prohibit abortion in all cases except those where the life or health of the mother is endangered.

The question as I view it is not an absolute one of pro-Court-decision versus anti-Court-decision, or of concern for human life versus lack of concern. The fact that women do desire abortions and will seek them out even under illegal and dangerous circumstances cannot be ignored or denied. Whether individuals, groups, or governments approve or not, this is the nature of the real world we live in. Rather, the question is whether the government will force those women who desire abortions, and whose personal moral and religious views do not prohibit them, to seek abortions under illegal and potentially abominable surgical conditions.

Furthermore, legalized abortion allows for a far greater amount of personal counseling than was possible before the Supreme Court ruling. We know that prior to that decision, about one million abortions were performed annually in the United States. We also know that an illegal abortionist will seldom counsel a woman against abortion. If an expectant mother feels free to consult her family physician, however, that doctor might well counsel against abortion although the abortion would be legal.

The Court's ruling does not require any woman to undergo an abortion if she does not so choose; the ruling allows a woman a personal choice. The same cannot be said by laws prohibiting abortion; such laws deny freedom of choice. Although I view abortion as the least desirable means of birth or population control, and although I wish that no abortions were ever desired or performed, I cannot in good conscience work to overturn the Supreme Court ruling.

I am well aware that many people are in strong disagreement with me on this issue, and I believe that the individual rights of those people should be protected as well. Consequently, I have supported and will continue to support legislation to protect the rights of those who because of religious belief or moral conviction oppose abortion. I do not believe that any medical personnel should be required to perform abortions if personal or religious beliefs are in conflict.

The decision to terminate a pregnancy, at least in its earliest stages, should remain between a woman and her physician, and the government should interfere as little as possible. This has been my position consistently during my years of public office, and it remains my position now.

Although I personally view the central issue in the abortion controversy to be the right of each woman to control her own reproductive life, there are a number of peripheral issues which indicate that the Supreme Court ruling of January 1973 has resulted in other types of social benefits. Improvements to our society with respect to health, child welfare, equal rights, and economy are evidence by available information.

Because abortion has been legal nationally for only one year and information on the national impact of the new law is not yet available, existing statistics are mainly from New York and California, where new abortion laws took effect in 1968 and 1970 respectively. Although we cannot assume that the experiences of two States will be duplicated nationally, changing trends are apparent.

The number of women admitted to hospitals for post-abortion treatment has declined. In one San Francisco hospital, such cases decreased by 68 percent in two years following abortion reform. Abortion complication cases in one Los Angeles facility declined by 88 percent in one year. And statistics from ten New York City hospitals indicate a 52 percent drop in abortion complications in the first three years of legalized abortion.

In my home State, the Illinois General Assembly 1969 Family Study Commission Report showed that the Cook County Hospital alone admitted approximately 4.000 women annually from 1962 to 1968 for medical care following criminal abortions; in April and May of 1973, however, the Chicago Board of Health found less than five such cases per month at the same facility.

Abortion-caused maternal deaths have declined as a result of legalized abortion. In California in 1967, there were 20 such deaths per 100,000 live births. In 1971, after liberalization of the law, there were only two abortion-caused maternal