Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
24823542
label
Women and Girls Education- Teen Pregnancy
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
24823542
sourceUrl
contentType
document
title
Women and Girls Education- Teen Pregnancy
citationUrl
collections
Records of the First Lady's Office (Clinton Administration)
Noa Meyer's Files
largeImageUrl
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
24823542
levelOfDescription
fileUnit
otherTitles
42-t-18558020-20120869S-015-006-2015
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
07b80bc909873ecb
ocrText
SUMMARY
Unintended
Pregnancy
***
and the
Well-Being
of
Children
and Families
INSTITUTE OF MEDICINE
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
services are provided in a
promote better health and
Methodology
more integrated manner.
nutrition among developing
societies is a strongly held
The potential effect of a 35% cut in U.S. funding for family planning is
estimated by gathering and sometimes reconciling information from a
Reflecting American Values
American value, one that
Endangered: U.S. Aid for
wide variety of sources. ranging from national censuses and population
has driven U.S. interna-
estimates to country-specific surveys of women of reproductive age and
Making family planning
tional assistance for many
special studies of contraceptive use and of pregnancy outcomes.
services widely available to
decades. And making
Family Planning Overseas
all who want them is one of
The estimates that follow reflect the knowledge and expertise of the fol-
quality family planning
lowing organizations: The Alan Guttmacher Institute. The Futures
the surest ways to foster
services available to all
In the wake of groundbreaking
This Issues in Brief explores
new conditions on indigen-
Group. Population Action International and the Population Reference
self-sufficiency, promote
who want them has been a
international accords calling
the political climate con-
ous. private organizations
Bureau. in consultation with the Population Council. The basic steps in
preventive health care and
central tenet of American
for greater political and fi-
fronting family planning
abroad conditions that
reaching the estimation are as follows.
basic education, nurture
humanitarian aid. Clearly,
nancial attention to popula-
assistance. It describes the
could not be imposed on
The first step in estimating the impact of the funding cut begins with
strong and healthy families,
it must remain so if our
tion and development issues,
human toll that deep funding
similar U.S.-based institu-
determining how many of the couples who depend on U.S.-funded family
and enhance the quality of
efforts are to succeed in
the United States is failing to
cuts will take in the form of
tions. Under the Mexico
planning programs will lose their access to contraceptives.
life for all of us. In many
improving the lives of
fulfill its commitments.
more unplanned pregnancies
City policy, these overseas
Population censuses and estimates indicate an estimated 829 million
ways, family planning
women, supporting families
women of reproductive age are living today in developing countries other
During the last two years,
and abortions, more women
organizations would be dis-
reflects the core values that
than China (which receives no U.S. family planning program support).
worldwide and benefiting
ultraconservatives in Congress
dying during pregnancy and
qualified from receiving U.S.
Surveys of women in developing countries show that roughly 247.5
most social conservatives
our own lives here at home.
have doggedly attacked U.S.
childbirth, and more infant
family planning aid if with
million of these women and their partners use modern methods of con-
indeed, most Americans
participation in the Interna-
deaths. Finally, it discusses
their own funds and in accor-
traception to lengthen the time between the births of their children or to
hold so dearly. It is ironic
Major Sources
tional Conference on Popula-
why U.S. leadership is critical
dance with the laws of their
avoid having more children than they already have.
that the strongly held
Because of their poverty. 190.5 million. or 77%, of the couples in de-
tion and Development in Cairo
to the global family planning
own countries they provided
antiabortion views of some
The Alan Guttmacher Institute
veloping countries outside of China who are using modern contraceptive
(AGI), Hopes and Realities: Clos-
and the Fourth World Confer-
effort and why this is fully
any abortion-related infor-
methods rely on public-sector family planning programs.
conservatives have been
ing the Gap Between Women's
ence on Women in Beijing and
consonant with American
mation or services.
The United States contributes about 17% of all public funds spent on
extended into the realm of
Aspirations and Their Reproductive
have made U.S.-aided family
traditions and values.
family planning in developing countries other than China. accounting for
family planning, which has
Experiences. New York, 1995.
planning programs a favorite
The House endorsed the
32.4 million couples using modern contraceptive methods. [Of these
long enjoyed strong bipar-
couples. 12.6 million are estimated to be protected by contraceptive
target of their hostility.
sterilization or long-lasting methods including hormonal implants (such
tisan support in Congress
The United Nations Children's
Fund (UNICEF), The Progress of
Cleverly using the divisive
T
he 1994 congressional
reimposition of the Mexico
elections ushered into
City restrictions on several
as Norplant) or intrauterine devices (IUDs).]
and around the country as
Nations, New York, 1996.
issue of abortion, they have
the House of Represen-
occasions in 1995 but was
On an annual basis, 19.8 million couples depend on U.S. supported
a means to reduce the
attacked family planning
tatives a formidable bloc of
rebuffed by the Senate each
programs to obtain contraceptive supplies, such as pills. condoms or in-
incidence of abortion.
efforts as promoting abortion
antiabortion conservatives.
time. The Senate's refusal to
jectables. or to start use of a long-term method. such as voluntary steril-
This Issues in Brief. written by
ization, hormonal implant or IUDs.
by encouraging promiscuity,
Facing an electorate that is
reinstate these discrimina-
A cut in program resources of 35% means that 12.9 rather than 19.8
The American public sup-
Wendy R. Turnbull. was made
possible with the support of The
sabotaging parental authority
basically prochoice, however,
tory and imperialistic re-
million couples will be able to be served in a year's time. leaving 7 mil-
ports humanitarian assis-
Pew Charitable Trusts/Global
and threatening family life.
they had few potential targets
strictions, even after the
lion couples without access to contraceptive supplies or services.
tance family planning and
Stewardship Initiative.
within their reach. Foreign
House countered with vary-
reproductive health ser-
The second step is estimating what effect losing U.S.-supported family
Frustrated in their attempts to
assistance became an easy
ing versions, resulted in a
planning services will have on the couples who are depending on them
vices, child survival, ed-
© 1996, The Alan Guttmacher Institute
restore heavy-handed policies
mark. and the restoration of
lengthy showdown between
for contraceptive care.
ucation, environmental
The
imposed on international fam-
the so-called Mexico City
the two chambers. As a
There are few other contraceptive choices in developing countries for
protection not only as a
ily planning programs during
policy became a rallying cry.
consequence. a second but
women who lack access to modern contraceptives. A conservative esti-
necessary price for world
Alan
the Reagan years, key mem-
equally devastating - assault
mate is that of the 7 million women losing services because of U.S.
leadership but also as the
funding cuts 2.8 million will turn to traditional methods and 4.2 million
bers of the U.S. House of Re-
The Mexico City policy was
by family planning opponents
will use no contraceptive.
right thing for a wealthy
Guttmacher
presentatives set out, instead,
first enunciated by the
began to unfold: to decimate
Because pregnancy rates are so much higher among couples relying on
country to do. In a recent
Institute
to undermine these programs
Reagan administration at the
the program's funding.
no method or on a traditional method than if they use a modern contra-
nationwide poll conducted
New York and Washington
through draconian funding
1984 United Nations' pop-
ceptive. 4 million more unwanted pregnancies are expected in develop-
by the University of Mary-
A Not-for-Profit Corporation for
restrictions. They succeeded:
ulation conference in that
In January 1996, almost four
ing countries due to the drop in family planning program resources.
land, those surveyed felt
About 40% of these unintended pregnancies are likely to end in in-
Reproductive Health Research,
In 1995, while funding for
city: it was revoked by
months into the new fiscal
that 5% of the national
duced abortion. even though it is often not legal and performed in
Policy Analysis and Public
most humanitarian aid was
President Clinton nearly 10
year and under immense
unsafe conditions accounting for 1.6 million abortions among the
budget was an appropriate
Education
reduced by 20%, family plan-
years later. The policy
pressure to head off a third
expected additional unwanted pregnancies.
level for the United States
120 Wall Street
ning was singled out for extra-
deemed population growth a
governmentwide shutdown,
Some 47% of the unintended pregnancies are likely to end in un-
to spend on development
New York, NY 10005
ordinarily harsh treatment a
"neutral" phenomenon; to
both the Senate and the
wanted births with the remaining 13% resulting in spontaneous abor-
assistance. Currently, less
Telephone: 212 248-1111
far deeper cut and a compli-
the extent it could be consid-
White House were forced to
tions or miscarriages accounting for 1.9 million unwanted births
than 1% of the federal budg-
Fax: 212 248-1951
among the expected additional unwanted pregnancies.
cated allocation scheme that
E-mail: info@agi-usa
ered a problem, it would be
accept a self-described
Maternal mortality rates in developing countries are high. about 4.1
et is earmarked for interna-
reduced even further the
solved by "market forces."
"compromise" proffered by
deaths per 1.000 women giving birth. leading to an estimated 8,000
tional aid, and less than
1120 Connecticut Ave. NW
amount of funds actually
The policy also declared that,
the House leadership. As
additional deaths due to pregnancy among the women facing additional
Suite 460
half of that amount goes to
Washington, DC 20036
available. Lawmakers gave no
henceforth, the United States
the price for dropping the
unintentional pregnancies.
humanitarian assistance.
Telephone: 202 296-4012
Infant mortality rates in developing countries are high. with about
The
reprieve in 1996, as the dispro-
would no longer "promote"
Mexico City language, family
Fax: 202 223-5756
7.2% of all babies born dying before their first birthday. leading to an
E-mail: [email protected]
portionate funding cut was
abortion worldwide some-
planning would be stripped
estimated 134,000 additional infant deaths among the women facing
Contributing "our fair share"
Alan
extended for a second year.
thing that, in fact, had been
of much of its funding. First,
additional unintentional pregnancies.
to alleviate poverty and
http://www.agi-usa.org
Guttmacher
Another congressional test of
prohibited by law since 1973.
an overall funding cut of
Institute
this issue, however, is already
The latter goal would be
35% a much deeper cut
The Alan Guttmacher Institute
4
Endangered: U.S. Aid for Family Planning Overseas
New York and Washington
slated for February 1997.
achieved by imposing strict
than that sustained by
development assistance
and men make about family
countries. It is well docu-
chart /
chart 2
ber they actually have.
them. is central to the
extensive cuts to family
generally was imposed.
size will depend greatly on
mented that mortality rates
Unplanned Births
Unmet Need
Many women give birth
quality of their lives and
planning assistance inevita-
Second, to punish family
the contraceptive and re-
for women and children are
before they and their part-
the well-being of their
bly will affect other develop-
planning even further, an
productive health services
highest when births are
Many women say their last birth
..and need family planning to
ners feel they are ready to
families. And women's
ment endeavors.
unprecedented and complex
available to them, and will
was mistimed or unwanted.
spaced too close together.
postpone or end childbearing.
care for a child, and sub-
success in achieving their
set of funding rules would
help shape their futures and
when a woman has many
stantial proportions of
reproductive goals has
U.S. Leadership
be imposed. No funds
the world's thereafter.
children (more than four)
14
22
31
women more than 50%
important implications for
would be made available
Cameroon
Cameroon
and when births occur too
in some countries say
the social and economic
Currently, about three-
28
until July 1 a full nine
Moreover, given that women
early or too late in a wom-
12
Nigeria
their last birth was mis-
welfare of the communities
months into the fiscal
Nigeria
quarters of the roughly $4
are the primary caretakers
an's life. Yet the campaign
timed or unwanted
28
and nations in which they
24
billion spent to provide fam-
year and, perhaps most
and household managers
by abortion opponents to
Pakistan
Pakistan
(Chart 1).
live and, ultimately. for the
ily planning services in de-
severe of all, the funds,
throughout much of the
decimate government-
38
ASSIGN
22
future of the world.
veloping countries is borne
once released. could only
developing world, their
supported family planning
Jordan
Jordan
The use of effective contra-
by the countries' own gov-
be doled out in monthly in-
health and well-being un-
services only assures that
29
33
ceptive methods has in-
Rapid population growth
ernments and by the women
stallments over the next
deniably determines how
women and their families
Guatemala
Guatemata
creased rapidly over the
severely reduces the like-
and men who use these ser-
15 months.
their children especially
in the developing world
56
38
Kenya
Kenya
past 30 years throughout
lihood that developing
vices. The remainder is
their daughters will fare
will know more suffering
the developing world. Yet
societies can move out of
-
42
20
contributed by developed
The fiscal 1997 budget
in life. In the immediate
and death.
Egypt
Egypt
nearly 230 million women
poverty or that women can
countries. Financial support
process brought more of the
future, the relatively dismal
24
THE
19
worldwide roughly one in
contribute to development
from developed country gov-
same. Still stymied by
state of women's reproduc-
Measuring the Impact
Indonesia
Indonesia
six women of reproductive
on an equal footing with
ernments both to other
Senate and White House
tive health throughout much
51
7
19
age are still in need of
men. Providing women with
governments directly and to
opposition to the Mexico
In early 1996. a consortium
Mexico
Mexico
of the developing world can
modern contraceptive
the means to control their
indigenous nongovernmental
City restrictions, the far-
be expected to worsen as a
of expert organizations un-
47
20
Philippines
Philippines
methods to postpone or
fertility, primarily through
organizations (NGOs) work-
right demanded an exten-
direct result of the severe
dertook an effort to quan-
33
@W
11
avoid future childbearing
improved access to quality
ing in those countries -
sion of the same funding
cutback in U.S. family
tify the impact of the steep
Thailand
Thailand
(Chart 2).
family planning services,
clearly plays a pivotal role
conditions. However, an-
planning aid.
reduction in family plan-
38
the
17
is. therefore. fundamental
in meeting the rapidly in-
other test of the issue was
ning aid. Their calcula-
Colombia
Colombia
The high level of unmet
to human progress.
creasing contraceptive needs
built into the equation. The
According to a 1996 report
tions, which take into
52
17
need for family planning is
of couples in the developing
from the United Nations
Japan
new law requires Congress
account only the 35% cut
Japan
a key reason why women
In this light. it is important
world. And. it is no exag-
39
to vote by February 28.
Children's Fund (UNICEF).
to the program's overall
10
United States
have great difficulty in
United States
to recognize that the impact
geration to say that the U.S.
1997 on a presidential
almost 600,000 women die
funding level. are conser-
19
13
spacing their pregnancies
of deep cuts to U.S. family
program is the anchor of the
"finding" (itself to be de-
during pregnancy and
vative by design (see
France
France
and bearing the number of
planning aid will extend
global family planning effort
livered by February 1) as to
childbirth each year:
Methodology. page 4). Ex-
0
20
40
60
0
20
40
60
children they want. Deter-
well beyond the delivery of
on which other countries'
whether the funding lim-
75,000 of these women die
cluded from the analysis is
% of women whose last birth was:
mined to avoid an un-
% of women needing contraception to:
contraceptive and repro-
contributions depend for sta-
itations are having "a neg-
attempting to abort an
the combined effect of the
Mistimed
Unwanted
Space births
End childbearing
planned, unwanted birth,
ductive health services to
bility and direction.
ative impact on the proper
unwanted pregnancy them-
nine-month moratorium
many women in the ab-
women and couples. On-
functioning" of the interna-
selves or with the help of an
and the monthly "metering"
Source: AGI, Hopes and Realities
Source: AGI. Hopes and Realities
sence of family planning or
going U.S. efforts to im-
Should U.S. support for in-
tional family planning pro-
untrained and unsafe
of funds, which only add to
following a contraceptive
prove literacy rates and
ternational family planning
gram. Assuming the presi-
provider. All told, these
the financial hardship.
cies will end in miscar-
need for quality contra-
failure resort to unsafe
primary school education
continue to erode, it is un-
dent reports that they are,
deaths render at least one
riages):
ceptive services remains
abortion. Worldwide. more
of girls, promote good
realistic to expect that other
and both the House and
million children motherless
Based solely on the one-
8.000 more women
considerable.
than one-quarter of preg-
nutrition, improve maternal
donor countries will or
Senate agree, the fiscal
every year.
year, 35% cut, the consor-
dying during pregnancy
nancies about 52 million
and child health. and
could make up for the loss
1997 money will be re-
tium estimates that:
and childbirth, includ-
Over the last three decades,
annually end in abortion,
enhance women's partici-
of U.S. government funds.
leased on March 1 instead
UNICEF further estimates
7 million couples in
ing from unsafe abor-
the size of the average fam-
often performed clandes-
pation in the economic and
No other country, nor inter-
of July 1.
that for every woman who
developing countries who
tion; and
ily has fallen from roughly
tinely and under unsanitary
political spheres of society
national organization for that
dies, "approximately 30
would have used modern
134,000 more infant
six children to about three.
conditions.
will feel the sting as well.
matter. has the extensive
A Major Setback
more incur injuries, infec-
contraceptive methods will
deaths.
By having fewer children,
field presence nor the vast
tions and disabilities which
not have access to these
parents are in a better
Meeting the Challenges
On the ground, these
array of technical resources
Meanwhile, the impact on
are usually untreated and
methods.
Unmet Needs
position to provide for them
programs rarely operate in
and experience that the U.S.
the lives of millions of
unspoken of, and which are
As a result, 4 million more
and improve the family's
Helping women narrow the
a vacuum, independent of
family planning effort has
women who are served by
often humiliating and
women will experience
The devastating cuts to U.S.
quality of life overall.
gap between their child-
each other. Rather, over
developed over the decades.
these programs, and on their
painful, debilitating and
unintended pregnancies,
family planning assistance
However, while women are
bearing desires and what
the years. they have be-
families, will be profound.
lifelong." Improving ac-
leading in turn to:
abroad come at a time when
striving and succeeding,
they actually experience is
come increasingly inte-
Moreover, American leader-
As nations head into the
cess to quality family
1.9 million more un-
increased access to family
albeit with great difficulty
at the heart of U.S. family
grated. partly to maximize
ship has been crucial to
21st century, the largest
planning services, notes
planned births and 1.6
planning and related
to have smaller families, a
planning assistance. En-
resources but largely
forging alliances among
generation in history is just
UNICEF. is paramount to
million more abortions
reproductive health care is
gap still exists between the
abling women to have the
because such efforts natu-
governments and the private
reaching adulthood. The
improving maternal and
(the remainder of the
crucial. Although progress
number of children women
number of children they
rally complement and
sector S0 that family plan-
choices these young women
child health in developing
unintended pregnan-
has been made, the unmet
say they want and the num-
want, and when they want
reinforce one another. The
ning and related social
The Alan Guttmacher Institute
2
Endangered: U.S. Aid for Family Planning Overseas
The Alan Guttmacher Institute
3
Endangered: U.S. Aid for Family Planning Overseas
table 2
their childbearing also grows.
Sources of Data
Curable STDs
Moreover, women who prac-
The Alan Guttmacher Institute (AGI).
tice family planning are more
Hopes and Realities: Closing the Gap
Support for Family Planning
Region
New yearly
Yearly rate
likely than those who do not
Between Women's Aspirations and Their
infections
per 100
to seek other types of health
Reproductive Experiences. New York:
AGL 1995.
(millions)
adults
care services for their chil-
dren and themselves.
AGI. Preventing Pregnancy, Protecting
Improves Women's Lives
World
333
11
Health: A New Look at Birth Control
South & Southeast Asia
150
18
Choices in the United States. New York:
AGL 1991.
Sub-Saharan Africa
65
25
Taking Effective Action
Issues Brief
L
ike the use of the telephone,
High-Risk Childbearing
ly 17 million women are affect-
Latin America & Caribbean
36
15
National Academy of Sciences. Contra-
the practice of family plan-
ed with such conditions as
East Asia & Pacific
23
3
Helping women avoid high-
ception and Reproduction: Health Con-
ning is so widespread and
Every year, 585,000 women-
uterine rupture, uterine pro-
sequences for Women and Children in
Eastern Europe & Central Asia
18.
11
risk and unwanted pregnancies
SO routine in the United States
99% of them in developing
the Developing World. Washington. DC:
lapse (a displacement from the
Western Europe
16
8
remains an urgent health
National Academy Press. 1989.
that we almost take for granted
regions-die from causes relat-
normal position), hemorrhage,
North America
14
9
priority-especially where
its far-reaching benefits.
ed to pregnancy. These causes
Safe Motherhood Initiative. Causes of
vaginal damage, urinary incon-
North Africa & Middle East
10
6
include the direct health con-
access to prenatal and emer-
maternal deaths. <http://www.
Because American women
tinence, obstetric fistula (a
Australasia.
I
9
gency obstetric care is inade-
safemotherhood.org/barchart.html>.
sequences of high-risk preg-
accessed Apr. 9. 1998.
using effective modern contra-
muscle tear that allows urine to
Source: World Health Organization (WHO). An Overview of Selected Curable Sexually
Transmitted Diseases. Geneva: WHO. 1995.
quate, and nutrition and over-
nancies, unsafe abortions and
ceptives can decide when to
seep into the vagina) and pelvic
United Nations Children's Fund
all health are poor. And the
(UNICEF). The Progress of Nations.
have their children and are able
difficult deliveries, as well as
inflammatory disease (which
use of the latex condom is the
to bear only the number they
problems that arise soon after
1996, New York: UNICEF. 1996.
can lead to permanent sterility).
What is more, by reducing
Empowering Women
only effective way known to
want, they can plan their edu-
deliverv. Maternal-mortality
World Health Organization (WHO).
genital wart infections, all
Abortion: A Tabulation of Available
ratios (representing the number
The vast majority of pregnancy-
Access to family planning
prevent the transmission of
cational careers and their work,
barrier and spermicidal meth-
services is affirmed as a uni-
STDs-including HIV-
Data on the Frequency and Mortality of
Unsafe Abortion. Geneva: WHO. 1994.
family and personal lives with
of women who die every year
related complications that lead
ods offer some protection
from pregnancy-related causes
to health problems or death can
versal human right in many
among sexually active couples.
an assurance that would have
against the development of
been impossible for their
per 100,000 live births) in
be prevented in the first place,
United Nations documents.
cervical cancer. However,
What is more, in many parts
Credits
Africa, Asia and Latin America
or successfully treated, if the
More concretely, it con-
while the effects of spermici-
of the developing world, a
grandmothers.
Akinrinola Bankole and Susheela Singh
are 10-100 times the ratios in
right medical care is available.
tributes to the advancement
woman's first referral to other
dal methods on reducing the
oversmo data compilation and analyses
In the developing world, family
the industrialized world (Table
High-quality and accessible
of women and to the fuller
risk of certain STDs is clear,
important health services is
used for this publication. which was writ-
planning can bring these same
1, column 1). UNICEF points
prenatal and maternity care
development of society.
often made through her ini-
ten by Deirdre Wulf. This Issues in Brief
the evidence on their effects
benefits to women and do even
was made possible In support from the
out that "no public health
services are the major reasons
on HIV transmission remains
Women who are able to defer
tial contacts with a family
Andrew W. Mellon Foundation and the
more: By helping women pre-
problem shows greater dispari-
for the low levels of death and
planning provider, be it a
1998 Series, No.1
disability associated with preg-
inconclusive.
childbearing until their 20s
Rockefeller Foundation.
vent ill-timed or unwanted preg-
ty between rich and poor coun-
improve their chances of hav-
clinic, community-based dis-
nancies, it can also save their
tries than maternal mortality."
nancy and childbearing in
Other modern contraceptive
ing time to obtain adequate
tributor or outreach worker.
lives and protect their health.
developed countries. In the
methods also confer some
The major causes of maternal
schooling, develop work
In many developing coun-
developing world, unfortunate-
health protection. The pill
© 1998. The Alan Gultmacher Institute
And for couples everywhere,
deaths are similar throughout
skills and acquire broad life
tries, it will be difficult-and
ly, services are often of poor
helps reduce a woman's
the use of the condom and
the developing world, although
experience. And women who
will take decades-to
quality, and coverage is inade-
chance of developing endome-
some other contraceptives
the relative importance of each
bear only the number of chil-
improve overall health and
quale or, in some areas, com-
trial or ovarian cancer. and the
living conditions, and to
THE
helps protect against the
varies from one region to
dren they want have
pletely lacking.
longer it is used, the lower the
spread of sexually transmitted
increased opportunity and
GUTTMACHER
another. Overall, the leading
change deeply entrenched,
risk. What is more, among
INSTITUTE
diseases (STDs), which threat-
time to be in the labor mar-
causes are hemorrhage, or
Most women in developing
discriminatory cultural prac-
women with chlamydia and
NEW
en the well-being and some-
ket and to build competence
excessive bleeding (accounting
countries still give birth at
tices and attitudes that harm
times the survival of men and
gonorrhea, hormonal contra-
for 24% of all maternal deaths);
home, helped by a close family
and achieve personal fulfill-
women and jeopardize their
A Not-for-Profit Corporation
women worldwide.
member or' traditional birth
ceptives reduce the chance of
ment. Such participation in
preexisting conditions that are
health. While these broad
for Reproductive Health
attendant. Fewer than one in
pelvic infection, ectopic preg-
society enhances women's
Despite the many ways in which
complicated by pregnancy
goals should continue to be
Research, Policy Analysis
five women obtain assistance
nancy and infertility.
sense of self-worth and
pursued, the more wide-
family planning benefits women
(20%); sepsis, or acute infec-
and Public Education
from a trained doctor or nurse
tion with fever (15%); compli-
Family planning and repro-
improves the well-being of
spread provision of family
and their families throughout
120 Wall Street
cations of unsafe induced abor-
when they give birth in Burundi,
ductive health service
their families.
planning services is an
the world, the support of devel-
New York, NY 10005
tions (13%); eclampsia (12%);
Niger, Yemen, Bangladesh and
providers help improve and
achievable (and highly cost-
Telephone: 212 248-1111
oped countries-an essential
The relationship between
Pakistan; fewer than one-half
even save the lives of both
effective) way of improving
Fax: 212 248-1951
component of financing and
obstructed or prolonged labor
women's empowerment and
(8%); and ectopic pregnancy
receive professional medical
women and men by educat-
both women's lives and the
e-mail:[email protected]
improving access to these nec-
family planning is often
essary services in developing
and other conditions (8%).
assistance in Ghana, Kenya,
ing couples about healthy
mutually reinforcing: As
well-being of couples and
1120 Connecticut Avenue, N.W.
Mali, Nigeria, Senegal, Uganda,
women obtain more educa-
families everywhere.
countries-is often under threat
sexual behavior, the benefits
Suite 460
According to the World Health
Egypt, Morocco, India, Indone-
of condom use, and STD pre-
Washington, DC 20036
of being reduced or even elimi-
tion and gain the skills and
Organization (WHO), for every
sia, Bolivia and Guatemala.
Telephone: 202 296-4012
nated. This Issues in Brief exam-
maternal death that occurs
Even when women deliver in a
vention and treatment, and
confidence they need to go
by linking clients and their
out into the world and earn
Fax: 202 223-5756
ines the advantages for women
worldwide, an estimated 30
hospital, the equipment, sup-
e-mail:[email protected]
families to other preventive
money of their own, their
and society that family planning
additional women suffer preg-
plies, drugs, or operating rooms
and curative health services.
desire and ability to plan
http://www.agi-usa.org
services bring, and that would
nancy-related health problems
and trained staff needed to do
GUTTMACHER
be compromised if these ser-
that can be permanently debili-
INSTITUTE
cesarean sections or manage
vices were curtailed.
tating. Each year, approximate-
emergencies may be lacking.
Maternal Health
4
The Alan Guttmacher Institute
table /
Who Is Most at Risk?
pregnancy or childbirth as are
chart "
maternal morbidity might be
Southeast Asia is the worst
Maternal Health Risks
those with two or three chil-
Young Women and Mothers
Maternal Mortality
even more impressive, given
affected region. But an indi-
dren. Millions of women
that 30 women suffer preg-
vidual's risk of contracting one
over 35. The risks of dying
Country and survey year
Maternal
% of women
% of women
worldwide face this increased
30-34 with
during pregnancy or child-
Both younger and older women face an elevated
nancy-related disabilities for
of these STDs is highest (one
deaths per
20-24 with
100.000 live
at least birth
at least 4
risk, given the large family
risk of dying during pregnancy or childbirth.
every woman who dies.
in four) in Sub-Saharan Africa.
births
by age 18
live births
birth are higher for women
sizes that are typical in many
younger than 20 and for
Sub-Saharan Africa
regions. For example, the pro-
Maternal deaths per 100,000 live births
According to the WHO's
women 35 and older than for
Botswana. 1988
250
12
portion of women aged 30-34
Offering STD Protection
most recent global estimate,
26
32
80
other women (Chart A).
1,000
Burkina Faso. 1992-1993
930
who have already had four or
every year, 5.9 million indi-
1.300
Teenagers' physical growth is
Millions of men and women
Burundi. 1987
8
69
viduals become infected with
more children is especially
800
Cameroon. 1991
550
46
68
usually incomplete, and their
throughout the world suffer
Central Afr. Rep.. 1994-1995
700
38
58
high-ranging from about
HIV-an increase over pre-
Côte Ivoire. 1994
bodies have not developed
600
from STDs. In addition to the
vious estimates. The vast
810
44
69
40% to 80%-throughout
Ghana. 1993
740
25
59
sufficiently for pregnancy
discomfort and embarrass-
Africa and the Middle East
400
majority of new infections are
Kenva. 1993
650
28
68
and delivery to proceed easi-
ment these diseases cause,
44
and in some Asian countries
in Sub-Saharan Africa (four
Liberia. 1986
560
59
Iv. Chronic malnutrition-
200
some STDs greatly increase
Madagascar. 1992
490
31
67
560
38
174
which is widespread in poor
(Table I. column 3).
million) and South and
the likelihood of HIV trans-
Malawi, 1992
0
Southeast Asia (1.3 mil-
Bolivia
Mali. 1095-1996
1.200
46
75
countries-exacerbates the
For women who become
Uganda
Matlab, Bangladesh
mission during sexual inter-
lion)-the regions with the
Namibia. 1992
370
18
45
problem of insufficient or
pregnant many times, the
15-19
20-24
25-29
30-34
35-39
course, and can have other
highest STD rates.
Niger. 1992
1.200
53
81
Nigeria. 1990
1.000
35
stunted physical growth. In
problem is not just that they
Sources: Bolivia and Uganda- graphic and Health Surveys. 1993-1994 and 1996. respect
serious health consequences.
68
Next to complete sexual absti-
Rwanda. 1992
1.300
8
67
addition, very young women
are more often exposed to
tively. Bangladesh-Koenig MA et al., Maternal in ortality in Matlab. Bangladesh. 1976-1985.
Studies in Family Planning. 1988. 19(2):69-80.
Worldwide, the most common
Senegal. 1992-1993
1.200
34
70
are even less likely than
obstetric risk, but also that
nence-an impractical goal
Tanzania. 1996
770
25
64
bacterial STDs (which are
older women to obtain prena-
frequent pregnancy, child-
for most people-the most
Togo, 1988
640
30
74
Women with Unwanted Preg-
lower levels of maternal mor-
curable) are gonorrhea, tricho-
effective protection against
Uganda. 1996
1.200
39
77
tal or delivery care-espe-
birth and breastfeeding
Zambia, 1992
940
34
72
cially if they are unmarried.
deplete women's physical
nancies. Every vear, an esti-
tality and morbidity. Further-
moniasis, candidiasis, syph-
the spread of both bacterial
Zimbabwe. 1994
570
23
58
resources and stamina. This
mated 190 million women
The younger the adolescent,
more, by helping women-
ilis, genital ulcers resulting
and viral STDs is the latex
North Africa & Middle East
makes il more difficult for
throughout the world become
especially those at highest
from chancroid, and chlamy-
condom. If used correctly, this
Egypt. 1995
170
15
46
the greater her maternal risk.
dia. The most common viral
Morocco. 1992
610
7
In Jamaica and Nigeria, for
them to fight the effects of
pregnant, and many of them
risk-to space and limit their
method-while offering con-
46
Sudan. 1989-1990
660
17
59
example, women younger
heavy blood loss, infection or
did not want to conceive. In
pregnancies, it can do more.
STDs (which are incurable,
traceptive protection-can
Tunisia. 1988
170
3
56
than 15 are 4-8 times as
trauma during childbirth and
Latin America, an average of
though not necessarily
dramatically reduce the likeli-
Even in parts of the world
Asia
likely to die during pregnan-
after a delivery or abortion.
40% of women of reproduc-
untreatable) are hepatitis, her-
hood that an infected man or
where women customarily
Bangladesh. 1993-1994
850
47
60
tive age who do not want to
pes, genital warts and HIV.
woman will pass the disease
India. 1992-1993
570
28
50
cy or delivery as are women
Women with Closely Spaced
marry as adolescents, contra-
650
16
31
aged 15-19. Although preg-
Pregnancies. Maternal deple-
become pregnant for at least a
An estimated 333 million new
to a sexual partner.
Indonesia. 1994
ceptive use to postpone preg-
Pakistan. 1990-1991
340
17
62
nancies at such early ages
tion also threatens safe child-
couple of years, or ever again.
infections with curable
nancy until after the teenage
The female condom. the
Philippines. 1993
280
8
40
are common only in certain
Sri Lanka. 1987
140
5
28
bearing among women who
are not using an effective
parts of the world, many
contraceptive method: in Sub-
years would reduce maternal
STDs-or 11 for every 100
sponge, and the diaphragm or
become pregnant again before
adults-occur worldwide
Thailand. 1987
200
9
18
mortality associated with very
cervical cap used with a sper-
Turkey. 1993
180
11
30
women in all developing
they have had time to recover
Saharan Africa, the propor-
early childbearing. What is
every year (Table 2). In
micide also have the potential
regions have their first child
fully from an earlier birth.
tion is 85% (Chart B). Such
Latin America & Caribbean
more, women who wait to
absolute numbers, South and
to reduce STD transmission.
Bolivia, 1993-1994
650
19
48
by age 18. In most of Sub-
women often cannot avoid
This problem, too. is common:
220
16
18
Saharan Africa, in
Births spaced less than two
having an unplanned preg-
begin childbearing are less
Brazil. 1996
chart 1,
Colombia. 1995
100
18
21
years apart account for one in
nancy. II should come as no
likely to have a large number
Dominican Republic. 1996
110
22
30
Bangladesh and India, and in
of children than those who
Nonuse of Effective Methods
Ecuador. 1987
150
16
44
one of the poorest countries
10 of all births in developing
surprise, therefore, that many
300
47
of Latin America-
women seek abortions, and
first give birth at a young age.
El Salvador. 1985
U
countries as varied as Liberia,
Guatemala. 1995
26
And those who start practic-
Many women who do not want to become pregnant
200
56
Cuatemala-25-53% of
Mexico. 1987
110
19
45
Malawi. Senegal, Morocco,
each year approximately 20
women aged 20-24 had their
ing family planning early in
are not using effective contraceptive methods.
Paraguay. 1990
160
16
37
Sudan. India, Turkey, Bolivia,
million of them obtain abor-
their married lives are less
Peru. 1991-1992
280
12
36
first child before their 18th
tions under conditions in
% not using effective contraceptives
Brazil and Peru. They repre-
Trinidad & Tobago. 1987
90
13
30
birthday (Table 1. column 2).
which the procedure is illegal
likely than those who delay to
sent more than one in seven
100
Developed Countries
have closely spaced births.
85
Maternal risk is elevated for
births in Madagascar, Niger,
and therefore unsafe, greatly
France. 1994
13*
2
6
80
Japan. 1992
16*
I
older women in part because
Tunisia, Pakistan, the
increasing their risk of mater-
Finally, the prevention of
2
58
57
United States. 1995
13*
9
7
they frequently have had
Dominican Republic, and
nal morbidity and mortality.
unwanted pregnancies would
60
mean a reduction in the more
40
"Adjusted for underreporting: ratio based on national vital statistics would be lower. Note:
many births and have spaced
Trinidad and Tobago.
40
u=unavailable. Sources: Mortality-United Nations Development Programme, Human Development
births closely, risk factors
than 76,000 maternal deaths
Report. 1996. New York: Oxford University Press. 1996. PP- 154-155: births by age 18-The Alan
Even in developed countries.
Lowering Maternal Risk
Guttmacher Institute (ACI). Into a New World: Young Women's Sexual and Reproductive Lites. New
discussed next.
that result from unsafe abor-
20
York: AGL 1998. Appendix Table 1. col. P. 52: at least four birth-for developing countries.
a short interval between preg-
Family planning reduces the
tions each year in developing
special analysis of data from Demographic and Health Surveys: for France, Laverth Fécondité et
Women with Many Children.
nancies is a risk factor, moder-
0
calendrier de constitution des familles: Enquête Famille de 1990. INSEE Résultats 579. Paris:
total number of pregnancies
countries-almost 15% of
Sub-Saharan
Asia
North Africa &
Latin America
Institut National de la Statistique :I des Etudes Economiques. 1997: for Japan. special tabulations
Women who have had five or
ately raising levels of preterm
among women of childbear-
the total number of maternal
Africa
Middle East
of the 1992 National Fertility Survey: for the United States. special tabulations if the 1995
more children are about 2-3
delivery and intrauterine
National Survey of Family Growth.
ing age. For this reason
deaths in these countries.
Note: Percentages are regional averages. based on women aged 15-14. weighted by population
times as likely to die during
growth retardation.
size. Source: Special analysis of data from Demographic and Health Surveys.
alone. it can substantially
The associated reduction in
Maternal Health
2
The Alan Guttmacher Institute
Maternal Health
3
The Alan Guttmacher Institute
held in Cairo. Al this historic
depressed levels means that.
document/epidemio/june98/global_
gathering, policymakers
in developing countries, far
report/index.btml>. accessed July 2.
1998.
pledged to focus on individu-
fewer resources will be avail-
Sexually Transmitted Diseases
als' reproductive and sexual
able for STD care in family
World Bank. Confronting AIDS:
health needs. Such a focus,
Public Priorities in a Global
planning settings and that the
Epidemic, New York: Oxford
they agreed, would enable
burden of STDs will continue
University Press, 1997.
Hamper Development Efforts
women, men and young peo-
to fall on the primary care-
ple to lead healthier and more
givers and household man-
productive lives, and would,
Credits
agers-women.
in turn, promote sustainable
This Issues in Brief was written by
Issues Brief
mproving the health condi-
consequences, including poor
worldwide total (Chart A).
Clearly, there is a compelling
tions of individuals and fami-
maternal health, ectopic preg-
Some 9% of all persons aged
development and lower popu-
David J. Landry and Wendy
need for STD services. For
lies in the developing world
nancy, infant illness and death,
15-44 in North America con-
lation growth rales.
Turnbull. It was prepared with the
decades, U.S. lawmakers
support of the Pew Charitable
has long been a priority for
cervical cancer, infertility and
tract one of these STDs annual-
The key question facing poli-
have acknowledged the fun-
Trusts/Global Stewardship
American humanitarian aid.
increased susceptibility to HIV.
ly, but the rate rises to 25% in
cymakers is how-and, to
damental role of disease pre-
Initiative.
As a result of 30 years of U.S.
Millions of men and women
Sub-Saharan Africa. Tricho-
some extent, whether-they
vention and treatment in
assistance, maternal and infant
suffering these and other
moniasis alone has been
can fulfill their financial
social and economic develop-
death rates have dropped in
effects of STDs are hindered in
detected in more than 40% of
commitments to ensure that
ment, which remains a cor-
many regions, significantly
their ability to provide for their
women attending prenatal clin-
individuals most in need will
nerstone of American foreign
more couples are using contra-
families and contribute to their
ics in Uganda and Botswana.
have access to a full range of
assistance. To the detriment
ceptives to plan their families
society. For countries strug-
Every day, about 16,000 people
reproductive health care ser-
of millions, however, the
and more children are living
gling to develop economically,
vices. In addition to family
long-term impact of STDs
past their fifth birthday.
the health and economic costs
(or nearly six million people
each year) become infected
planning, these include STD
has gone unnoticed.
are immense.
Nevertheless, despite the
with HIV, a startling number,
screening and treatment.
maternity and postpartum
Fortunately, times are chang-
1998 Series, No.2
tremendous progress brought
The toll of STDs also hampers
given the short period of time
care, safe abortion (where the
ing. The global consensus
about by investments in mater-
U.S. international aid. American
since the virus emerged. Some
assistance aimed at improving
nations have been hit harder
procedure is legal) and rou-
that emerged in Cairo recog-
nity care, family planning,
nizes the toll of STDs on
child immunization and better
educational, health and eco-
than others. Among developing
tine gynecologic care. At the
Cairo conference, both donor
individuals and society over-
nutrition, one crucial element
nomic conditions overseas
nations. for example, the
and developing country gov-
all, but the funding to carry
of maternal and child health
becomes less effective, and
United Nations estimates that
out this new public health
has been sorely neglected: the
therefore more costly. when a
emments pledged new funds
more than 20 million people in
to fight STDs, yet that
mandate is crucial. The
prevention and treatment of
substantial proportion of recipi-
Sub-Saharan Africa are HIV-
United States was instrumen-
promise has gone largely
sexually transmitted diseases
ents are suffering from STDs.
positive, and most are unaware
unrealized, in part because
tal in shaping this enlight-
(STDs). Historically, STDs have
Thus, although this is not
of their infection. While fewer
U.S. political and financial
ened worldview and should
also been overlooked in the
always well understood by poli-
than 1% of India's adults have
© 1998. The Alan Guttmacher Institute
leadership in the reproduc-
endeavor to follow through on
global fight against infections
cymakers and the public, the
the virus, India has the largest
five health field has faltered
its political and financial
diseases; as a result, they con-
United States has a consider-
number of HIV-infected people
in recent years.
commitments to STD preven-
tinue to drain the lives of young
able stake in combating the bur-
in the world: 3-5 million, 89%
tion and treatment. The qual-
THE
and old throughout the devel-
geoning STD epidemic in devel-
of whom are younger than 45.
ity of life for individuals and
GUTTMACHER
The U.S. Challenge
INSTITUTE
oping world.
oping countries. This Issues in
families worldwide will be
Brief examines the incidence
Globally, women and children
WASHINGTON
The vast majority of STDs are
greatly enhanced.
and consequences of STDs in
represent a large proportion of
Beginning in 1995. the long-
spread through sexual inter-
those infected with HIV: In
simmering legislative feud
developing countries, and
A Not-for-Profit Corporation
course-which is perhaps the
1997, an estimated 36% of new
over domestic abortion poli-
describes why a strengthened
Sources of Data
for Reproductive Health
most important reason for the
cies spilled over to the inter-
U.S. commitment to the preven-
HIV infections occurred among
national arena, wreaking
Eng TR and Butler WT. eds., The
Research, Policy Analysis
lack of public discourse on
tion and treatment of these dis-
women; 10% were among chil-
Hidden Epidemic: Confronting
and Public Education
their impact-and women of
eases is needed.
dren younger than 15. In Latin
havoc with U.S. family plan-
Sexually Transmitted Diseases.
120 Wall Street
childbearing age (15-44) are
America, HIV infections among
ning and reproductive health
Washington DC: National Academy
New York, NY 10005
disproportionately affected. In
women and teenagers. who con-
care efforts overseas. Over
Press. 1997.
Telephone: 212 248-1111
addition, each year, millions of
STDs Are Widespread
tract the disease primarily
the past three years,
Tsui AO. Wasserheit JN and Haaga
Fax: 212 248-1951
infants begin their lives disad-
Congress has imposed deep
Worldwide, more than 400 mil-
through heterosexual inter-
JG, eds., Reproductive Health in
e-mail: [email protected]
vantaged by an STD they con-
funding cuts on the U.S.
Developing Countries: Expanding
lion adults become infected
course, have been increasing
1120 Connecticut Avenue, N.W.
tracted from their mother; STD
sharply. Throughout Africa,
Agency for International
Dimensions, Building Solutions,
with an STD every year. Four
Washington. DC: National Academy
Suite 460
infections in newborns compro-
heterosexual intercourse was
Development's population
STDs that are spread primarily
Press. 1997.
Washington, DC 20036
mise their health, both immedi-
responsible for an estimated
assistance program, effective-
through heterosexual contact
Telephone: 202 296-4012
ately and in the coming years.
85% of new HIV infections in
ly scuttling its expansion into
United Nations Joint Programme on
HIV/AIDS and World Health
Fax: 202 223-5756
are completely curable-
1997.
the provision of more com-
Organization. Report on the global
e-mail:[email protected]
THEALAN
STDs are a serious problem not
trichomoniasis, chlamydia,
prehensive STD services.
HIV/AIDS epidemic. June 1998.
GUTTMACHER
only because they are wide-
syphilis and gonorrhea. These
Because STDs strike relatively
Continued funding at these
http://www.agi-usa.org
<http://www.umaids.org/highband/
INSTITUTE
spread, but also because they
account for 333 million STD
young persons and treatment
may have delayed, long-term
infections, or about 80% of the
often is not sought or is inac-
WASHINGTON
8TDs Hamper Development Efforts
4
The Alan Guttmacher Institute
chart a
consider STD-related symp-
acquiring STDs if their hus-
What Is Needed?
public include the impor-
333 Million Infections
toms such as abdominal pain
bands have sexual encounters
tance of reducing the number
or vaginal discharge a normal
outside the marriage.
STD prevention efforts are
of sexual partners, the effec-
critical and should be of
Each year, 11 of every 100 adults worldwide are newly infected with gonorrhea, chlamydia, syphilis or trichomoniasis-all curable STDs.
condition, not realizing that
tiveness of condoms in pro-
Additionally, biological and
their suffering is caused by a
highest priority for policy-
tecting against infection and
social factors heighten the
contagious disease and can
makers, a 1997 World Bank
the benefit of dual method
Eastern Europe & Central Asia
risk for young girls and
be treated.
report declared. The sooner
use, or simultaneously using
18 million infections
leenage women. Young
developing countries act to
a condom to prevent STD
11 per 100 adults
Infants of Infected Mothers.
women contract STDs more
contain the spread of STDs,
transmission and another
Infants born to women with
easily than adults because
Western Europe
especially HIV, the more
contraceptive method to pre-
16 million infections
East Asia & Pacific
an active STD are highly like-
they have fewer protective
manageable and less severe
North America
vent unintended pregnancy.
8 per 100 adults
23 million infections
ly to be infected before, dur-
antibodies and the immaturi-
14 million infections
the problem will be in future
3 per 100 adults
per 100 adults
ing or after delivery. Globally,
ty of their cervix facilitates
years. In particular, the Bank
How and in what clinical set-
North Africa & Middle East
the probability that the moth-
the transmission of an infec-
concluded, reaching groups
tings STD-related counseling
10 million infections
South & Southeast Asia
er's HIV infection will be
tion. In some societies, sexu-
most prone to spread STDs
and medical services might
per 100 adults
150 million infections
16 per 100 adults
transmitted to the infant at
al coercion has emerged as a
(such as sex workers, their
best be offered are less clear.
birth ranges from about 20%
major risk factor for young
customers and youth) with
These questions have long
to 40%; this mode of trans-
girls; many are forced to have
bedeviled health advocates
Australasia
prevention programs will
Latin America & the Caribbean
mission accounts for 5-10%
I million infections
sex or are given gifts or
have the largest impact in
and policymakers. In the
36 million infections
9 per 100 adults
of all HIV infections world-
Sub-Saharan Africa
money in exchange for sex,
reducing infection rates
United States, for a variety of
15 per 100 adults
65 million infections
wide. The consequences of
precisely because they are
throughout a population.
reasons, largely separate net-
25 per adults
STD infection are serious for
seen as being disease-free.
works of family planning clin-
In a number of countries.
the newborn: stillbirth or pre-
ics and STD clinics have
Youth who are infected with
maturity, permanent damage
national prevention cam-
evolved. Recently, this two-
to vital organs and possibly
an incurable STD-genital
paigns, using a variety of
track system has come under
Source. World Health Organization (WH in Overview of Selected Carable Sexually Transmitted Diseases, Geneva: " HO. Clobal Programme on AIDS. 1995.
death.
warts, herpes or HIV-hear
messages targeted for specific
criticism; opponents urge that
the debilitating effects of the
audiences, have proven effec-
whenever possible, STD pre-
cessible, delayed or inade-
of healthy life among men.
Early and effective treatment
medications and douching
Should an infant manage to
disease for the rest of their
tive in helping people adopt
vention. screening and treat-
quate, the impact of these
women and children world-
of STDs. especially those that
may increase a woman's risk
escape STD infection at
lives. Many become infertile
healthier behaviors. Messages
ment services be fully inte-
infections on individuals'
wide (Chart B). Women lose a
result in genital ulcers. can
of acquiring an STD. With
birth. he or she is likely to
and are unable to have fami-
that should be promoted
grated within family planning
health is high. The impact on
disproportionate share of
reduce the incidence of HIV
the exception of HIV, STDs
feel the impact of the disease
lies of their own.
widely among the general
and primary care settings,
society also is substantial.
healthy years of life to STDs.
infection. In one Tanzanian
may have more life-threaten-
in other ways. By the end of
which are considered con-
since STDs affect primarily
largely because of PID.
community, a program that
ing consequences for women
1997, more than eight mil-
lion children had lost their
chart 1,
ducive to providing counsel-
men and women who are
allowed for the diagnosis and
(PID, ectopic pregnancy and
ing and services to help indi-
forming families and con-
treatment of STDs without
Symbiotic STDs
cervical cancer. for example)
mother or both parents as a
STDs' toll
viduals meet their pregnancy
tributing to the work force.
using expensive laboratory
than for men.
result of AIDS before they
STDs account for the loss of millions of healthy years of life.
and STD prevention needs.
The World Bank and the
A mutually reinforcing link
tests reduced HIV incidence
had reached the age of 15.
World Health Organization
exists between HIV and
by about 40%.
Married and monogamous
Further, untreated STDs can
In developing countries,
Healthy years of life lost (in millions). 1990
other. more common STDs.
women are often at higher
severely impair parents' abil-
30
where the existing formal
have led efforts to develop
measures to quantify the bur-
One of the principal reasons
risk of contracting STDs than
ity to work outside the home
health system may provide
Groups at Greatest Risk
den of disease. One of the
HIV prevalence is SO high in
might be expected. because
and provide for their family
inadequate or no STD ser-
25
vices, there is an opportunity
developing countries is that
Women. A variety of biologi-
of the high-risk behaviors
best-known measures is the
adequately. increasing the
12.8
that are relatively common
to think through these infra-
number of healthy years of
STD levels were high before
cal and social factors make
risks to their children's
20
structure issues from the
life lost as a result of illness
the epidemic. The suscepti-
women more susceptible to
among men in many coun-
health and well-being.
or premature death.
bility of people to HIV infec-
STDs than men. Women are
tries: intercourse with multi-
beginning, with an eye
ple partners and with com-
Teenagers. Sexually active
15
toward developing a more
tion is 2-9 times as high if
physiologically more vulnera-
Each year, STDs, including
they alreadv have certain
mercial sex workers.
teenagers, especially males.
integrated, comprehensive
ble than are men to contract-
HIV, account for 6% of
infections, particularly
ing STDs when they have
Moreover, in some countries,
tend to engage in riskier
123
approach to STD care.
10
healthy years of life lost
behavior than adults: They
syphilis and chancroid.
unprotected sex (i.e., without
women's low social and edu-
among women aged 15-44
cational status conspire to
have more partners, have more
Similarly, HIV facilitates the
using a condom) with an
5
The Global Response
worldwide. The annual occur-
transmission, hampers the
infected partner. Addi-
deny the majority of them the
high-risk partners and often do
1.3
0.3
not use condoms. Consequent-
diagnosis and accelerates the
3.1
3.6
The extent of STDs and their
rence of four STDs-syphilis.
tionally, STDs in women are
power and knowledge to pro-
gonorrhea, chlamydia and
progression of other STDs.
more likely to be asympto-
tect themselves against
ly, sexually active teenagers,
0
impact on families and soci-
Females
Males
For example, human papillo-
STDs. In many cultures, few
along with adults younger than
ety first received formal
HIV-along with pelvic
matic; if women are unaware
25, generally have the highest
Pelvic inflammatory disease
Chlamydia
recognition from the world
inflammatory disease (PID), a
ma virus-which is closely
of their infection, they will
women are able to negotiate
result of some STDs that often
associated with cervical can-
not seek timely care and
the conditions of their sexual
STD rates of any age-group.
HIV
Syphilis and gonorrhea
community at the 1994
Married adolescent women
United Nations-sponsored
leads to sterility among
cer-progresses at a much
hence may experience seri-
lives or the effective use of
who themselves may be
World Bank. World Development Report. 1993. New York: Oxford University Press. 1993. PP. 216
International Conference on
women, accounts for the loss
faster rate in HTV-infected
ous complications. Further.
protective measures with a
& 218.
monogamous are at risk of
Population and Development,
of more than 51 million years
women than in others.
the use of traditional vaginal
partner. In fact, many women
STDs Hamper Development Efforts
2
The Alan Guttmacher Institute
STDs Hamper Development Efforts
3
The Alan Guttmacher Institute
A Response to Concerns
About Population Assistance
Issues in Brief
T
he preference of couples
ples' desires for smaller fami-
centrality of women in the
for small families-well
lies, improving the health of
family and in society.
established in the United
women and children, and giv-
The United States played a
States, Japan and other indus-
ing women and girls a chance
major role in these delibera-
trialized countries-is now
to participate fully in the life of
tions and, even prior to the
evident throughout the world.
their communities and nations.
Cairo conference, had acted to
While average family size in
the developing world is still
This extraordinary consensus
broaden the scope of its own
very high by industrialized
was evident at the 1994 United
population program. The
countries' standards, couples
Nations-sponsored International
premise of that program, now
reflected in the worldwide con-
clearly want, and are having,
Conference on Population and
fewer children. It is a trend that
Development (ICPD), held in
sensus, is that the most effec-
transcends culture, religion,
Cairo. Some 200 governments
tive strategy to reduce unwant-
ethnicity and national origin.
from every region of the world
ed childbearing and slow rapid
The trend has been supported
affirmed the validity of demo-
population growth is one that
by the rapid dissemination of
graphic concerns, but stressed
relies on family planning at its
information and knowledge
that all population policies and
core but is closely intertwined
about contraception and by the
programs must be responsive,
and integrated with other devel-
increased availability of family
first, to meeting the needs and
opment strategies (see box).
planning services.
desires of individuals and fami-
However, just months after the
Since the 1960s, the United
lies. They also emphasized that
ICPD officially embraced the
States has played a critical role
these policies must be consid-
importance of population and
in facilitating couples' desires
ered and implemented in the
development as an issue and
for smaller families. Both the
context of overall development
outlined key strategies to
domestic family planning pro-
strategies and that, above all,
address it, Congress brought
gram, which provides subsi-
they must take into account the
the U.S. program to a halt.
dized services to the poor, and
the international population
Population Aid Program
assistance program were con-
ceived about 30 years ago, at
The U.S. Agency for International Development (USAID) adminis-
the urging of Presidents John F.
ters the U.S. population assistance program. In 1994, USAID
Kennedy, Lyndon Johnson and
reorganized and created the Center on Population, Health and
Richard Nixon and with the
Nutrition to foster a closely coordinated and integrated effort among
bipartisan support of Congress.
its existing activities in these areas. The center's priorities include
Initially, some countries in the
family planning and reproductive health; basic health information
developing world rejected the
and services for youth; maternal and child health and nutrition;
view that there was reason for
child survival; human immunodeficiency virus and AIDS prevention;
concern about the rate at which
and environmental health. These programs are mutually supportive
their population was growing.
and highly interdependent.
Many had regarded their own
The population assistance component consists mainly of preventive,
rapid population growth as a
voluntary family planning activities, but also includes prevention of
desirable or at least a neutral
sexually transmitted diseases, breastfeeding initiatives, reduction
phenomenon. Over the years,
of female genital mutilation, treatment for complications of unsafe
however, governments from the
abortion and provision of follow-up family planning. Population
developing and industrialized
aid also includes distribution of contraceptive supplies; research on
world alike have come to rec-
The
new contraceptive methods and into ways to promote greater pro-
ognize the mutually reinforcing
gram effectiveness; policy evaluation; training; and information
Alan
benefits of slowing population
and education efforts. By law, the USAID program does not include
Guttmacher
growth, supporting their peo-
support for abortion.
Institute
New York and Washington
After appropriating a record
chart "
and economic obstacles.
$547 million for population
Population Growth
A compelling indicator of the
assistance in FY 1995,
Congress slashed the pro-
From 1996 to 2000, the world will gain 319 million people.
failure to help women meet
their childbearing goals is
gram's funding by a third and
the 52 million abortions—
imposed onerous limitations
Sub-Saharan Africa
half of them illegal-that
that greatly exacerbated the
64 5 million
Near East and
funding cut: None of the
Remaining world
North Africa
occur worldwide each year,
funds appropriated in FY
7.4 million
29.0 million
according to the World
Health Organization. Another
1996 were made available
United States
Latin America and
until July 1996, nine months
10.1 million
the Caribbean
is the large number of preg-
28.6 million
nancies that women report
into the fiscal year, and once
Eastern Europe
ending as unwanted or mis-
available, the money could
and newly
independent states
timed births: about 60% in
only be allocated at the rate
China and
24 million
Taiwan
Kenya; 50% in Japan,
of 7% a month for the next
44.2 million
Mexico and the Philippines;
15 months. Essentially the
Rest of Asia
72.1 million
and 40% in Egypt, Jordan
same formula has been con-
and the United States.
tinued into FY 1997.
India
60.8 million
These indicators of a popula-
The reasons for singling out
tion problem do have solu-
this program for such harsh
Source: T. McDevitt, World Population Profile: 1996, USAID and U.S. Bureau of the Census,
Washington, D.C., 1996.
tions. Making abortion less
treatment stem from the poli-
necessary can be achieved in
tics of abortion and concerns
large part through greater
raised by skeptics of popula-
ance that countries are striv-
opposed to 20% in the devel-
access to preventive family
tion assistance in general and
ing to achieve. The ICPD's
oped world); in Sub-Saharan
planning services. And that,
family planning in particular.
Programme of Action summa-
Africa, about half of the pop-
in turn, could be expected to
This Issues in Brief identifies
rizes the issue this way:
ulation is younger than 15.
significantly lower the stag-
and attempts to respond to
"Efforts to slow down popula-
This means that even if all
gering number of maternal
concerns that have been
tion growth, to reduce pover-
couples were to have only
deaths that occur each year
raised in the course of the
ty, to achieve economic
two children (enough to
in connection with pregnancy
ongoing debate.
progress, to improve environ-
replace themselves), the
and childbirth.
mental protection, and to
world's population would
What Population Problem?
reduce unsustainable con-
continue growing for many
In addition, reducing the rate
sumption and production pat-
years to come because of the
of unintended pregnancy, and
The debate over whether
terns are mutually reinfore-
large absolute number of
therefore improving women's
there is such a condition as
people having children. As
ability to achieve their own
ing. Slower population growth
overpopulation and, if so,
has in many countries bought
Chart A indicates, the world's
childbearing goals, would not
what it means and what to do
more time to adjust to future
only benefit the lives of indi-
population is expected to
about it may continue for
population increases."
increase by 319 million peo-
viduals, but also have a sig-
decades to come. It is clear,
ple by the turn of the century.
nificant impact globally. If all
however, that dilemmas
The disconcerting fact is that
unwanted births were pre-
involving population issues
the world's current popula-
The "population problem"
vented, the annual number of
tion of almost six billion is
also can be defined in terms
confront virtually all nations.
births worldwide would drop
growing by 81 million people
of women's self-described
from 130 million to 122 mil-
Depending on the country,
each year (equivalent to
"unmet need" for high-quali-
lion-a decline of almost
these might include high
rates of teenage and unin-
about one-third the popula-
ty family planning services.
19% in the global rate of
tion of the United States), but
An estimated 230 million
tended pregnancy, migration
population growth.
economic development and
women worldwide do not have
across national borders,
the availability of renewable
access to effective contracep-
urbanization, an aging popu-
natural resources are not
tive methods and services,
Is Progress Possible?
lation (in industrialized coun-
keeping pace with this
tries) and the youth bulge (in
representing approximately
In light of the seemingly
the developing world). These,
growth. In addition, after
one in six women throughout
overwhelming size and scope
years of rapid population
among other factors, affect a
the developing world. The
of thé population problem,
key determinant of the quali-
growth, a record number of
reasons for this unmet need
ameliorating the situation
people are about to enter the
include a lack of accurate
ty of life: the balance
may appear impossible.
between population growth
childbearing years. Thirty-
information, poor-quality ser-
There are encouraging signs,
five percent of the population
vices and less than the full
however. The United Nations'
and economic development.
in the developing world is
range of contraceptive choic-
recent announcement that
Indeed, il is just such a bal-
under the age of 15 (as
es, as well as legal, cultural
the planet is growing by 81
The Alan Guttmacher Institute
2
Concerns About Population Assistance
million people annually may
dize family planning pro-
than 14% in 1993 alone,
States has been the largest
sound daunting, but the fact
grams, even if they have not
dwarfing exports to industri-
donor country; in 1994, it
that it is only 81 million
yet adopted a formal policy.
alized countries.
contributed almost 40% of
more people each year means
The combination of financial
and technical resources,
Population growth also
the approximately $1.2 bil-
that global population growth
affects the U.S. interest in
lion in population aid given
already is slowing down.
political commitment, and
encouraging political stability
collectively to developing
Between 1985 and 1990,
laws and policies that protect
countries. But the total U.S.
which was the peak period of
and respect the rights and
and building strategic
conscience of the individual
alliances. Most analysts have
per capita contribution, even
population growth in human
history, the world's popula-
and promote personal health
concluded that rapid popula-
at its peak, amounted to only
and well-being are equally
tion growth, in conjunction
$1.78-placing the United
tion grew by 87 million peo-
key to the success that world-
with poverty and scarcities of
States fifth behind Norway
ple annually. The decline in
natural resources, has been
($9.47), Denmark ($6.27),
wide efforts have seen SO far.
the growth rate that has been
linked to instances of politi-
Sweden ($5.08) and the
observed more recently has
cal upheaval all over the
Netherlands ($2.85), and on
been attributed to the intro-
U.S. Interests and Funds
a level with Finland,
world, particularly in Haiti,
duction of programs in the
In 1969, President Nixon told
Mexico, Pakistan and, most
Germany, Australia and the
1960s and 1970s that
Congress that investing in
recently, Rwanda.
United Kingdom.
enabled people to begin to
have the smaller families
international population
The international population
Put another way, the federal
they wanted by increasing
assistance is important to the
aid program is also consistent
government spent $554 mil-
United States "whether it is
access to family planning
with the fundamental
lion in FY 1994 in response
services. More recent efforts
moved by the narrowest per-
to the needs of some 15 mil-
American value of helping
to enhance women's econom-
ception of national self-inter-
lion American women for
the most vulnerable members
est or the widest vision of a
ic power and social status
of society and providing the
subsidized family planning
have also played a key role.
common humanity." Even
tools for them to help them-
services. That same year, the
then, it was becoming clear
selves in the future.
United States allocated only
The drop in the population
that stabilization of the global
Experience has shown that
$463 million toward family
growth rate to about 1.5%
population growth rate would
increased use of family plan-
planning programs overseas
per year (from 2.5% in the
be critical to creating a cli-
ning is associated with higher
in an effort to respond to the
1960s) largely reflects a
mate of economic and politi-
230 million women in the
levels of education among
decrease in the average num-
cal stability. It was also
developing world who need
women and girls. Further,
ber of children each woman
apparent from the experience
services.
according to the U.S. Census
is having. Over the last 30
of American women that
Bureau, the eight million
For this small price, the U.S.
years, average family size in
access to family planning
infant deaths that occur
population aid program over
developing countries has
would contribute significantly
annually worldwide are likely
three decades has acquired a
dropped from 6.0 children to
to the health of women and
to be cut in half by 2020 if
unique role and vast capacity
3.3. This phenomenon also
their children in developing
current programs continue,
that cannot be easily trans-
corresponds to improvements
countries, and that giving
because of improvements in
ferred or replicated by any of
in related health and social
these women more control
child survival and reductions
the existing donors without
indicators, such as lower
over their childbearing deci-
in high-risk births.
losing valuable time and
infant mortality rates and
sions would afford them
improved female literacy.
greater educational and eco-
The United States initiated
expertise. The United States
has established an extensive
Together, these results sug-
nomic opportunities.
its population assistance pro-
field presence, and it is the
gest that at both the global
gram with all of these consid-
and the individual levels,
The population assistance
only donor that works widely
erations in mind. Today, the
program has shown itself to
both with the public and pri-
there has been enormous
developing countries them-
be in the economic interest of
vate sectors and with non-
progress.
selves account for three-
the United States by laying
profit as well as for-profit
quarters of the $4 billion
Over the same period, devel-
the groundwork for export
entities-all of which are
markets. Indeed, half of the
spent worldwide each year on
oping countries gradually
integral to the success and
family planning services; it is
have begun to adopt formal
top 35 consumer countries of
ultimate self-sustainability of
impossible, however, for them
policies addressing the issue
American agricultural prod-
to absorb the full cost of this
local programs. The U.S.
of population growth. Of the
ucts are former or current
Agency for International
recipients of U.S. population
critical endeavor. Often, they
125 developing countries that
Development (USAID),
participated in the ICPD,
aid. More prosperous
must rely on outside donors
which administers the popu-
more than half reported that
economies create the possi-
for technical assistance, sup-
lation program, is widely rec-
they already have policies in
bility of more consumers:
plies, training and even
ognized for its high level of
direct services.
place. Further, virtually all
U.S. exports to the develop-
technical expertise upon
developing countries subsi-
ing world increased more
Historically, the United
which other countries rely.
The Alan Guttmacher Institute
3
Concerns About Population Assistance
Similarly, the United States is
Coercive family planning
according to extensive sur-
years after their sibling are
the only donor country that
practices are expressly pro-
veys of married women of
almost twice as likely to die
conducts research on new
hibited by U.S. law under
reproductive age. Kenyan
as those born after a longer
contraceptives and program
both the domestic and the
women in the 1980s, for
delay. This occurs because
operations, which not only
international programs. This
example, said they wanted
they are more likely to have a
are essential in guiding an
is not to say that coercion has
about seven children, but
low birth weight, making
effective family planning ser-
not occurred or will not occur
today they say they want no
them more vulnerable to ill-
vices program but also some-
in the future, either here or
more than four. The same
ness. Births too close togeth-
times directly benefit
elsewhere, but it is con-
downward trend is evident in
er frequently affect the older
American women. It was
demned as a matter of policy.
every region of the world,
children as well; premature
USAID-funded research, for
As with any law, constant
regardless of religion and cul-
discontinuation of breastfeed-
example, that led to the two
attention is required to
ture, and in such diverse
ing, for example, can lead to
most recently approved major
assure compliance. This is
places as Senegal, Egypt,
malnutrition, dehydration or
methods of birth control in
especially true since coercion
Morocco, Bangladesh,
infection. Further, illnesses
the United States: Norplant
can manifest itself directly as
Colombia and Peru. While
in a family with many young
and Depo-Provera.
well as indirectly.
overall fertility rates have also
children can spread rapidly
fallen over the same period,
Finally, to the extent that
China's one-child-per-family
and be severe, especially in
large gaps remain between
policy, for example, has been
poor countries with inade-
U.S. policymakers wish to
the number of children
have any real policy influ-
associated with instances of
quate sanitation and crowded
forced sterilization and abor-
women say they want and the
living conditions.
ence on the worldwide effort
number they actually have.
to stabilize population growth
tion that have warranted
Birthspacing is one of the
rates, the United States must
worldwide opprobrium.
Large proportions of women
main reasons cited for the
remain a major financial
Limiting the range of avail-
throughout the world report
promotion of family planning
able contraceptives, which
that their most recent birth
player. Issues of special con-
in developing countries. In
cern to the United States
occurs in some family plan-
was unplanned-either
many such countries, one in
ning programs, is a more sub-
unwanted or mistimed:
include the quality of family
five infant deaths could be
planning services, the avail-
tle form of coercion. Ensuring
25-40% in much of Asia,
averted by birthspacing
full and informed consent and
North Africa and the Middle
ability of a wide range of
alone. No one is suggesting
true choice in the decision on
East, and 50-65% in some
the abandonment of other
method choices (including
natural family planning)
whether to use family plan-
Latin American countries.
available programs known to
ning services is neither easy
The same phenomenon is
accompanied by full and
help save the lives of chil-
accurate information, an
nor simple, but is necessary
also evident in several areas
dren; rather, the data show
and of the highest priority
of Sub-Saharan Africa, even
emphasis on preventing
that further progress in child
from both the U.S. and the
though women there general-
unintended pregnancy and
survival would only be
an insistence that programs
international perspectives.
ly want larger families than
impeded if investment in
in other parts of the world.
As for the specter of cultural
such a low-cost, low-tech
are truly voluntary and free
of coercion.
imperialism, preventive vol-
strategy as family planning
Maternal and Child Health
were not sustained.
untary family planning pro-
grams are specifically
Concerns About Coercion
Given that infant mortality
If family planning's contribu-
designed with the full input
is one of the world's most
tion toward lower infant mor-
Coercion and cultural imperi-
and participation of indige-
glaring and preventable
tality and better child health
alism are real and serious
nous groups, women in par-
tragedies, it has been argued
were its only health rationale,
concerns that arise in con-
ticular. The charge that these
that increasingly scarce U.S.
that would be enough. It is
nection with family planning
women are availing them-
resources might be better
not, however. The tragedy of
programs; to protect against
selves of contraceptive ser-
spent if family planning
maternal death and disease
them requires ongoing vigi-
vices as a result of the impo-
funds were redirected toward
receives far less attention
lance. Not only are both
sition of Western values is
prenatal care, childhood
than the plight of children,
anathema from an individual
belied by worldwide survey
immunization and disease
but its impact reverberates
rights perspective, but expe-
data. Indeed, women in
control programs. The reality
throughout the developing
rience has demonstrated that
developing countries are
is that family planning is as
world. Increased access to
the most successful programs
seeking out family planning
integral to an effective mater-
family planning can go a long
are purely voluntary, promote
services and having fewer
nal and child health strategy
way toward helping women
maximum choice of family
children because they want
as these other necessary
avoid pregnancies that too
smaller families.
planning methods and are
activities. The facts show that
often and in too many coun-
provided in a culturally sen-
Over the past 30 years, what
family planning saves lives,
tries are still life-threatening.
sitive manner in response to
of women and children.
people consider ideal family
The World Health
what women say they want.
size has declined steadily,
Infants born less than two
Organization estimates that
The Alan Guttmacher Institute
4
Concerns About Population Assistance
close to 600,000 women die
abortion." Program skeptics
table /
each year of causes related to
even claim that family plan-
Russian Trends
pregnancy and childbirth;
ning causes more, not fewer,
99% of these women live in
abortions.
Measure
1990
1991
1992
1993
1994
developing countries. Among
It is indisputable that
% of women using
them, 75,000 die from unsafe,
increased reliance on effec-
contraceptives*
19
20
22
23
24
illegal abortion-often self-
tive contraception results in
Abortions per 1,000
induced-that leads to infec-
fewer abortions. Common
women
109
100
90
82
76
tion or hemorrhage.
sense leads most people to
*Data are from the Russian Ministry of Health and represent pill and IUD use only; statistics for
Furthermore, as the United
barrier methods are unavailable. and statistics for oral contraceptives understate actual prevalence,
that conclusion, and SO does
Nations Children's Fund
since the pill is also sold over the counter. Source: I... Thomas, International Planned Parenthood
the research. The only ques-
Federation, London, personal communication, 1996.
(UNICEF) points out, for each
tion is how quickly lower lev-
woman who dies, about "30
els of abortion are attained.
contrast to the situation in
ily planning programs just as
more
incur injuries, infec-
That question pertains
Brazil, where no national
tions and disabilities which
contraception is beginning to
because there are situations
family planning program
are usually untreated and
replace abortion. It is espe-
where both contraceptive
exists but desired and actual
unspoken of, and which are
cially troubling for regions
prevalence and abortion rates
family size are relatively
such as Africa, where the fer-
often humiliating and painful,
rise, creating confusion about
small. The abortion rate, now
debilitating and lifelong."
tility transition is in its earli-
cause and effect. In reality,
39 abortions per 1,000, is
est stages. As increasing
UNICEF notes that "the first
what this phenomenon
likely to remain high until
numbers of people feel more
and most obvious step
reflects is the strong desire
Brazil too makes the transi-
strongly about having fewer
towards reducing the toll of
for smaller families, which
tion to the widespread avail-
children, the absence of qual-
maternal mortality and mor-
then motivates people to seek
ability and more effective
ity family planning services
bidity is to make high-quality
out all available means to
practice of contraception.
will inevitably encourage
family planning services
achieve their desired family
The states of the former
more abortions-legal or not,
available to all who need
size. As preventive family
them.
Soviet Union present a com-
safe or not.
Meeting only the
planning programs become
existing demand for family
pelling case for how the
better established in the cul-
planning would reduce preg-
introduction of high-quality
ture, and as couples begin to
Public Support for Aid
nancies in the developing
shift to more effective contra-
contraceptive services can
reduce abortion rates dramat-
A recent survey confirms that
world by up to a fifth, bring-
ceptive methods, recourse to
ing at least an equivalent
ically. In Russia, abortion is
foreign aid is unpopular
abortion declines.
legal and has been used-in
among Americans, apparent-
reduction in maternal deaths
and injuries."
The experiences of cities in
the absence of any contra-
ly because most people think
Mexico and Colombia illus-
ceptives-as the major
the United States is spending
trate the point. For example,
method of birth control. In
far more than it actually is.
Prevention or Abortion?
as contraceptive use rose
fact, it was the only choice
Most people questioned esti-
from the mid-1970s onward
available in answer to the
mated that the United States
Family planning means preg-
in Mexico City, SO did the
prevailing desire for smaller
is spending 15% of the feder-
nancy prevention. Since
abortion rate, which peaked
families. While abortion rates
al budget on foreign aid, 15
1973, U.S. law has expressly
in the mid-1980s at 41 per
prohibited federal funds pro-
are still very high, the recent
times the actual amount of
vided under the Foreign
1,000 women aged 15-49.
introduction of family plan-
1%. When asked what they
As the culture of effective
ning has already resulted in a
thought the appropriate
Assistance Act from being
used to perform or advocate
contraceptive use has taken
significant drop in the abor-
amount should be, most
hold, however, the abortion
respondents indicated a level
abortion as a method of fami-
tion rate (see Table 1).
ly planning. Confusion per-
rate has declined to 25 per
Similarly, abortion was the
that turned out to be five
sists, nonetheless, about the
1,000 women. A similar pat-
primary means of birth con-
times the present spending
tern has been observed in
trol in Hungary until the late
level. Less than half of the
international family planning
program's relationship to
Bogotá, where the abortion
1970s, by which time contra-
1% the federal government
abortion. There is no evi-
rate has fallen from 50 per
ceptive use had risen to
spends overseas is reserved
dence, however, nor any
1,000 women to 30 per 1,000
about 50%. Once reliance on
for development aid, which
since the mid-1970s.
credible reason to suspect,
family planning became more
provides support for popula-
that U.S. funds are being
The highly organized national
the norm in Hungary, the
tion, health, nutrition and
used contrary to the dictates
family planning programs in
abortion rate dropped by
environmental programs.
more than two-thirds.
of the law. Instead, the argu-
these two countries may be
Americans cite protection of
ment has shifted to one that
credited with the current
These patterns suggest reason
the global environment as
alleges "indirect" support for
downward trend in abortion
for concern about the impact
one of the most compelling
abortion or the "promotion of
rates. This trend is in stark
of suddenly withdrawing fam-
reasons for the United States
The Alan Guttmacher Institute
5
Concerns About Population Assistance
to support development assis-
tinue to grow significantly
abortion. It is a sad irony,
Washington, D.C., 1991.
tance. And "overpopulation"
over the coming decades as
since the research shows
Singh, S., and C. Sedgh, "Trends in
is often volunteered as a sig-
the largest cohort in history
unequivocally that family
Abortion, Contraception and Fertility in
nificant factor contributing to
enters its reproductive years.
planning leads to fewer, not
Brazil, Colombia and Mexico," Inter-
environmental degradation.
The greater the degree to
more, abortions. Indeed, a
national Family Planning Perspectives.
Vol. 23, No. 1, 1997 (forthcoming).
So, international population
which women's increasingly
consortium of research orga-
aid should be, according to
prevalent and ever-stronger
nizations (including The Alan
Sollom, T., R.B. Gold and R. Saul,
"Public Funding for Contraceptive
most Americans, a central
desire for smaller families
Guttmacher Institute) con-
Sterilization and Abortion Services.
component of U.S. humani-
can be addressed today,
cluded that the recent cuts
1994." Family Planning Perspectives,
tarian programs overseas.
especially through better
imposed by Congress could
28:166-173, 1996.
Indeed, this rationale sup-
access to effective contracep-
be expected to result in 1.6
Special Programme of Research.
ports the U.S. position that
tive services, the more likely
million more abortions.
Development and Research Training in
its population program is the
that world population will
Human Reproduction, World Health
Thus, whether the motivation
cornerstone of its approach to
stabilize at fewer than 10 bil-
Organization (WHO), Reproductive Health
is reducing abortion, improv-
Activities in WHO, Geneva, 1994. P. 7.
sustainable development, a
lion people by the middle of
ing the health of women and
process whose objective is to
the next century.
Turnbull, W.R., "Endangered: U.S. Aid
children, enhancing women's
for Family Planning Overseas," Issues in
enhance the quality of life for
The United States has played
status, helping to alleviate
Brief. AGI, Nov. 1996.
people today without unduly
a major role in raising world-
world poverty, promoting eco-
compromising the resources
United Nations Population Division,
wide awareness about indi-
nomic development overseas,
"World Population Growing More Slowly
necessary to sustain future
vidual family planning needs
protecting the global environ-
but Could Still Reach 9.4 Billion by
generations.
and global population trends,
ment or pursuing the econom-
2050," press release, New York, Nov. 4.
1996.
Many public opinion surveys
and through its strong finan-
ic self-interest of the United
have shown that population
cial and policy leadership,
States, restoring a strong U.S.
USAID, The Role of Family Planning in
growth is an issue of concern
has established its promi-
commitment to international
Preventing Abortion, Washington, D.C.,
1996.
to most Americans. A 1994
nence in addressing those
population assistance will be
Time-CNN poll found that
challenges. Its relatively
essential to future progress.
This report was written by
55% of Americans view
small investment pays signif-
Susan A. Cohen. It was pre-
"overpopulation" as a "very
icant dividends in strength-
pared with the support of The
Information Sources
serious" problem; an addi-
Pew Charitable Trusts/Global
ening the global economy,
tional 31% view it as "some-
protecting the environment
Adamson. P., "A Failure of Imagination,"
Stewardship Initiative.
what serious." Four-fifths of
and saving the lives of
in The Progress of Nations: 1996. United
Nations Children's Fund (UNICEF), New
those surveyed believe this is
women and children through-
York, 1996.
© 1997. The Alan Guttmacher Institute, 1/97
a problem that will eventual-
out the developing world. As
ly affect the United States.
Alan Guttmacher Institute (AGI), Hopes
First Lady Hillary Rodham
and Realities: Closing the Gap Between
The
Perhaps for this reason, 72%
Clinton noted recently in La
Women's Aspirations and Their Repro-
Alan
of Americans support U.S.
Paz, Bolivia, in reaction to
ductive Experiences, New York. 1995.
Guttmacher
subsidies "to make birth con-
that country's extremely high
Conly, S., and J. Rosen, "International
maternal mortality rate,
Institute
trol and family planning"
Population Assistance Update: Recent
New York and Washington
more available in developing
"Family planning campaigns
Trends in Donor Contributions,"
at work in Bolivia and else-
Population Action International,
countries. Why do so many
A Not-for-Profit Corporation for
Washington. D.C., 1996.
people support family plan-
where represent sensible,
Reproductive Health Research,
ning assistance, even assis-
cost-effective and long-term
Gelbard. A., "Global Population: An
Policy Analysis
tance overseas? According to
strategies for improving
Overview," Population Reference
and Public Education
Bureau, Washington, D.C., 1996.
a 1994 survey conducted for
women's health, strengthen-
the Pew Global Stewardship
ing families and lowering the
Klitsch, M., and S. Singh, "Are Women
120 Wall Street
Achieving Their Childbearing Goals?"
rate of abortion."
New York, NY 10005
Initiative, 91% of Americans
Issues in Brief. AGI. Nov. 1996.
Telephone: 212 248-1111
do SO because they believe
Despite being a program that
Kull, S., "Americans and Foreign Aid: A
Fax: 212 248-1951
that "all men and women in
is popular with Americans
Study of American Public Attitudes,
the world who want birth con-
and one that provides ser-
Summary of Findings," Center for the
e-mail: [email protected]
trol should be able to get it."
vices that people in the
Study of Policy Attitudes and Center for
International and Security Studies at
1120 Connecticut Avenue, N.W.
developing world need and
Maryland, College Park. MD, 1995.
Suite 460
The Future at a Crossroads
want, this worldwide effort is
McDevitt, T.. World Population Profile:
Washington, DC 20036
in doubt. U.S. participation
1996, U.S. Agency for International
Telephone: 202 296-4012
Even though the world's pop-
in the international program
Development (USAID) and U.S. Bureau
Fax: 202 223-5756
ulation growth rate appears to
has been under siege over
of the Census, Washington, D.C., 1996.
e-mail: [email protected]
be slowing down, the world's
the last two years. largely in
Population Reference Bureau, Family
population promises to con-
the name of opposition to
Planning Saves Lives, second ed.,
http://www.agi-usa.org
The Alan Guttmacher Institute
8
Concerns About Population Assistance
Teen Pregnancy Facts and Stats
http://www.teenpregnancy.org/factstats.htm
Campaign Home
FACTS AND STATS
How bad is the problem?
The United States has the highest rates of teen pregnancy and births in the western
industrialized world. Teen pregnancy costs the United States at least $7 billion annually. 1
More than 4 out of 10 young women become pregnant at least once before they reach the
age of 20-nearly one million a year. 2 Eight in ten of these pregnancies are unintended³ and
80 percent are to unmarried teens⁴.
The teen birth rate has declined slowly but steadily from 1991 to 1996 with an overall decline
of 12 percent for those aged 15 to 19. These recent declines reverse the 24-percent rise in
the teenage birth rate from 1986 to 1991. The largest decline since 1991 by race was for
black women. The birth rate for black teens aged 15 to 19 fell 21 percent between 1991 to
1996. Hispanic teen birth rates declined 5 percent between 1995 and 1996. The rates of both
Hispanics and blacks, however, remain higher than for other groups. Hispanic teens now
have the highest teenage birth rates. In addition, despite the recent declines in teen birth rates
in general, the overall teen birth birth rate for 1996 is still higher than it was in the early to
mid 1980s when the rate was at its lowest point. Also, most teenagers giving birth before
1980 were married whereas most teens giving birth today are unmarried. For more detail,
including state by state rates, visit the web page of the National Center for Health Statistics. 5
The younger a sexually experienced teenaged girl is, the more likely she is to have had
unwanted or non-voluntary sex. Close to four in ten girls who had first intercourse at 13 or
14 report it was either non-voluntary or unwanted. 6
Who suffers the consequences?
Teen mothers are less likely to complete high school, (only one-third receive a high school
diploma)⁷ and more likely to end up on welfare (nearly 80 percent of unmarried teen mothers
end up on welfare). 8
The children of teenage mothers have lower birth weights⁹, are more likely to perform
poorly in school¹⁰, and are at greater risk of abuse and neglect. 11
The sons of teen mothers are 13 percent more likely to end up in prison while teen daughters
are 22 percent more likely to become teen mothers themselves. 12
What helps prevent teen pregnancy?
The primary reason that teenage girls who have never had intercourse give for abstaining
from sex is that having sex would be against their religious or moral values. Other reasons
cited include desire to avoid pregnancy, fear of contracting a sexually transmitted disease
(STD), and not having met the appropriate partner. 13 Three of four girls and over half of
boys report that girls who have sex do so because their boyfriends want them to. 14
Teenagers who have strong emotional attachments to their parents are much less likely to
l of 3
11/20/98 5:26 PM
Teen Pregnancy Facts and Stats
http://www.teenpregnancy.org/factstats.htm
become sexually active at an early age. 15
Most people say teens should remain abstinent but should have access to contraception.
Ninety-five percent of adults in the United States-and 85 percent of teenagers-think it
important that school-aged children and teenagers be given a strong message from society
that they should abstain from sex until they are out of high school. Almost 60 percent of
adults also think that sexually active teenagers should have access to contraception. 16
Contraceptive use among sexually active teens has increased but remains inconsistent.
Two-thirds of teens use some method of contraception (usually a condom) the first time they
have sex. 17 A sexually active teen who does not use contraception has a 90 percent chance
of pregnancy within one year. 18
Parents rate high among many teens as trustworthy and preferred information sources on
birth control. One in two teens say they "trust" their parents most for reliable and complete
information about birth control, only 12 percent say a friend. 19
Teens who have been raised by both parents (biological or adoptive) from birth, have lower
probabilities of having sex than teens who grew up in any other family situation. At age 16,
22 percent of girls from intact families and 44 percent of other girls have had sex at least
once. 20 Similarly, teens from intact, two-parent families are less likely to give birth in their
teens than girls from other family backgrounds. 21
When should I talk to my child about sex?
Before they make you a grandparent. One of every 3 girls has had sex by age 16, 1 out of 2
by age 18. Three of 4 boys have had sex by age 18. 22
Surprise: Your teen wants to hear from you. Seven of ten teens interviewed said that they
were ready to listen to things parents thought they were not ready to hear. 23 When asked
about the reasons why teenage girls have babies, 78 percent of white and 70 percent of
African-American teenagers reported that lack of communication between a girl and her
parents is often a reason teenage girls have babies. 24
Do teens wish they had waited to have sex?
Yes. A majority of both girls and boys who are sexually active wish they had waited. Eight in
ten girls and six in ten boys say they wish they had waited until they were older to have
25
sex.
ENDNOTES
1. National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Problem of Teen
Pregnancy in the United States. Washington, DC: Author.
2. Analysis of Henshaw, S.K., U.S. Teenage Pregnancy Statistics, New York: Alan Guttmacher Institute, May, 1996; and
Forest, J.D., Proportion of U.S. Women Ever Pregnant Before Age 20, New York: Alan Guttmacher Institute, 1986,
unpublished.
3. Henshaw, S.K. (1998). Unintended Pregnancy in the United States. Family Planning Perspectives, 30(1):24-29, 46.
Based on data from the 1982, 1988, and 1995 cycles of the National Survey of Family Growth, supplemented by data
from other sources.
4. National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Problem of Teen
Pregnancy in the United States. Washington, DC: Author.
5. Ventura, S.J., Curtin, S.C., & Mathews, T.J. (1998). Teenage births in the United States; National and State trends,
1990-1996. National Vital Statistics System. Hyattsville, Maryland: National Center for Health Statistics.
6. Moore, K.A., & Driscoll, A. (1997). Partners, Predators, Peers, Protectors: Males and Teen Pregnancy. In Not Just for
Girls: The Roles of Boys and Men in Teen Pregnancy (pp. 5-10). Washington, DC. The National Campaign to Prevent
Teen Pregnancy.
2 of 3
11/20/98 5:26 PM
MAR. 25. 1998
1:01PM
NO.524
P.3
DRAFT -- DO NOT CIRCULATE
Family Matters
The National Campaign to Prevent Teen Pregnancy has reviewed recent research about
parental influences on their child's sexual behavior. From this review, we think that some clear
lessons emerge for parents and for other adults who are involved with children and teenagers.
Most fundamentally, there is much that parents and adults can do to reduce the risk
of kids becoming pregnant before they've grown up. In particular, they can help them delay
becoming sexually active. Four factors can help to make the influence of parents and adults on
teen sexual behavior especially powerful:
a. Whether the young person himself sees his relationship with his parent(s) as strong
and close generally. That is, does the young person herself perceive her relationship with
her parent(s) as being a "well connected" one, with a rich array of interactions and
communication?
b. Whether the parent(s) provide appropriate levels of monitoring and supervision.
c. Whether parents themselves are clear about their own values pertaining to sexual
behavior and make a concerted effort over time to communicate their values to their
children.
d. The extent to which those parental values are apparent to the young person; that is,
does the parents' behavior match their stated values, and does the parent talk about his or
her values openly?
Sexual risk-taking among young people seems especially low when all four factors are
present. Having only one present is not as powerful. For example, a parent may feel she is doing
a good job of communicating her values to her son - she brings relevant subjects up often and
emphasizes a few key ideas that she feel especially strongly about. But because her son doesn't
regard her as a credible source of information or values, and because he doesn't respect or trust
her very much, the communication about sexual values has little beneficial impact on her son.
So, what to do??
1. Most fundamentally, build a strong relationship with your children from an early age, one
that emphasizes mutual trust and respect, and encourages independence and good decision-
making. Express love and affection clearly and often, not just for specific accomplishments.
Listen carefully to what they say and pay careful attention to what they do. Strive for a
relationship that is warm, firm, and rich in communication.
MAR. 25. 1998
1:01PM
NO.524
P.4
DRAFT -- DO NOT CIRCULATE
2. Spend time with your child engaged in activities that suit his age and interests, not just
yours. A rich history of frequent, small, meaningful and close exchanges builds a "bank account"
of affection and trust that forms the basis for future communication with her about specific topics,
including sexual behavior. Be supportive and be interested in what interests him. Attend her
sports events; learn about his hobbies; tell your children about your own childhood and the
problems you faced at their age. Help them to build self-esteem by mastering skills (self-esteem is
earned, not given).
3. Think about and clarify your own sexual values, and discuss them with your children
and teens. Tell them candidly and confidently what you think and why you take these positions.
Be sure to have a two-way conversation, not a one-way lecture. Learn and study about teen sex,
pregnancy and other risks. What do you think constitutes a mutually respectful relationship
between men and women? between girls and boys? Under what circumstances is sexual intimacy
acceptable? understandable? Who is responsible for setting limits in a relationship and how is that
done, realistically? What do you really think about school-aged teenagers being sexually active --
perhaps even becoming parents? Were you sexually active as a teenager? What do you know and
think about contraception? Do you know about the serious consequences of teen pregnancy, or is
it not such a big deal, particularly compared to other problems like violence? If you're unclear
about these issues, your child will sense it. And, by the way, make sure your behavior matches
your words!!
4. Talk with your children early and often about sex, and be specific. Kids have lots of
questions about sex and they say that the source they'd most like to get answers from is often
their parent(s). Initiate the conversation. Tell them about love, sex, and what the difference is.
Conversations about sex should begin early in a child's life and continue through adolescence.
Resist the idea that there is ever just one conversation - you know: "the talk" -- the truth is that
parents and kids should be talking about sex and love all along. Many inexpensive books and
videos are available to help with any detailed information you might need, but don't let your lack
of detailed technical information make your shy. Kids need as much help in understanding the
context of sex as they do in understanding how all the body parts work. Here are the kinds of
questions kids say they want to discuss:
How will I know when I'm ready to have sex? Should I wait till marriage?
How do I tell my boyfriend no to sex without hurting his feelings? How do I manage
pressure from a girl to have sex?
Will having sex make me popular?
Everyone else is doing it -- is it really "okay to delay?" How do I do that?
Can you get pregnant the first time?
Isn't contraception dangerous?
The point is: Be an "askable parent" and answer the questions -- if you don't know the
answer, find it and then share the information. And be a parent with a point of view. Don't be
afraid to say, for example:
MAR. 25. 1998
1:02PM
NO.524
P.5
DRAFT -- DO NOT CIRCULATE
I don't think kids in high school should be having sex; they're too young to manage it,
especially given today's risks..
Finding yourself in a sexually charged situation is not unusual; you need to think about
how you'll handle it in advance. Have a plan.
It's OK to think about sex. Most people do! But it's not okay to get pregnant/ get
somebody pregnant.
(For boys) Having a baby doesn't make you a man. Being able to wait/acting
responsibly does.
(For girls) You don't have to have sex to keep a boyfriend. If sex is the price of loyalty,
find someone else.
5. Supervise and monitor your children and adolescents. Establish rules, curfews, and
standards of expected behavior, preferably through an open process of family discussion and
respectful communication. If they get out of school at 3 pm and you don't get home from work
until 7 pm, who is responsible for making certain that your child is not only safe, but also is
engaged in useful activities? Where are they when they go out with friends? Are there adults
around? Remember: supervising and monitoring your kids' whereabouts doesn't make you a nag;
it makes you a parent.
6. Know your children's friends and their families. Friends have a strong influence on
friends, so help your children and teenagers become friends with kids whose families share your
values. Some parents of teens even arrange to meet with other parents to establish common rules
and expectations. It is easier to enforce a curfew that all your child's friends share rather than one
that makes him different.
7. Discourage early, frequent and steady dating. Group activities among young people are
fine and often fun, but beware allowing young younger teens to begin one-on-one dating much
before 16 or 17. Let your child know about this strong preference throughout childhood -- don't
wait until presented with real situations; otherwise they'll think you just don't like a particular
person or invitation.
8. Take a strong stand against your daughter dating a boy more than 2 years older than
she is. And don't allow your son to develop an intense relationship with a girl more than 2
years younger than he is. Older guys can seem glamorous to a young girl - sometimes they
even have money and a car to boot! But the risk of matters getting out of hand increases with
significant age differences. The power differences between older boys/men and younger girls can
lead girls into situations they are not able to handle, including unwanted sex and sex with no
protection..
"MAR. 25. 1998
1:02PM
NU.
P.O
DRAFT -- DO NOT CIRCULATE
9. Help your teenagers to have options for the future that are more attractive than early
pregnancy and parenthood. The chances that your son or daughter will delay first sex,
pregnancy and parenthood are increased if the future is bright. This means helping them to set
meaningful goals for the future, talking to them about what it takes to make future plans come
true and helping them reach their goals, teaching them to use free time in a constructive way, and
explaining how becoming pregnant -- or causing pregnancy -- can derail the best of plans.
Community service, for example, can not only teach job skills, but can also put teens in touch with
a wide variety of committed and caring adults.
10. Value education highly. Encourage your child to take school seriously and give generous
amounts of your own personal time to your children's schools. School failure is often the first
sign of trouble and can end in teenage parenthood. Be very attentive to your child's progress in
school and intervene early if things aren't going well. Meet with teachers and principals, guidance
counselors and coaches as needed. Know about homework assignments and support your child in
getting them done. Volunteer at the school. Schools want more parental involvement, not less.
11. Know what your kids are watching, reading and listening to. The media are chock full
of material that makes early sex - and even early pregnancy and parenthood -- seem acceptable
and inconsequential. Sex rarely has meaning, pregnancy seldom happens, and no one who is
having sex ever seems to be married or even especially committed to anyone. Is this consistent
with your expectations and values? If not, it is important to talk about what the media portrays
and what you think about it all. If certain programs or movies offend you, say so, and explain
why. If certain magazines value women and girls only for what they look like, tell your children
and teens why you dislike such material.
Shirley
Teenage Pregnancy:
The Case For Prevention
An Analysis of Recent Trends &
Federal Expenditures Associated
With Teenage Pregnancy
ADVOCATES
FOR YOUTH
EXECUTIVE SUMMARY
Recent declines in teen sexual activity and increases in contraceptive use by sexually active teens
have resulted in reduced rates of teenage pregnancy and births. Nevertheless, the United States
continues to exhibit the highest rates of adolescent births in the industrialized world.
The social and economic consequences of too-early childbearing for teens and their children can
be grave and long-lasting. The public costs associated with teenage pregnancy also are great.
Advocates for Youth estimates that, in fiscal year 1995 alone, the federal government spent over
$39.3 billion to help families that began with a teenage birth.
Increased public commitment to prevention is clearly warranted. In FY 1995, the federal
government allocated less than one-fifth of $1 billion ($131 million) for teen pregnancy
prevention, or three hundred times less than the amount of expenditures to support families
begun by a teenage birth.
It is unquestionably important that the U.S. government continue to help young families, but it is
also necessary that the nation reduce the number of adolescents who will require this support in
the future by increasing investment in pregnancy prevention. For example, in 1996 the Alan
Guttmacher Institute estimated that publicly subsidized contraceptive services annually avert
385,800 teen pregnancies, consequently preventing 154,700 teen births and 183,300 abortions.¹
For every dollar invested in publicly subsidized contraceptive services, U.S. taxpayers save $3.00
in Medicaid costs for pregnancy and neonatal related health care alone.' Just as important,
385,800 fewer teens suffer the emotional, social, and economic consequences of an unwanted
pregnancy.
Tragically, current levels of pregnancy prevention funding are insufficient to sustain recent
declines in teenage pregnancy rates. Census Bureau projections indicate that, by the year 2005,
13 percent more young people ages 10-19 will live in the United States than did in 1995. Higher
levels of prevention investment will be necessary simply to sustain current teenage pregnancy
rates.
Investments in pregnancy prevention must be made wisely. Returns on prevention investments
are maximized when dollars are allocated to the most effective and promising approaches.
Research indicates that comprehensive sexuality education-including information on abstinence
as well as contraception-can delay the onset of sexual activity and increase contraceptive use by
sexually active teens. Contraceptive availability programs-such as family planning clinics and
condom availability-also reduce risky adolescent sexual behavior. Youth development
programs, which motivate teens to avoid pregnancy by helping them develop their skills and
abilities, are particularly effective for young people at high risk for too-early childbearing.
Unfortunately, in 1996, Congress allocated $50 million to fund abstinence-until-marriage
(abstinence-only) education. This represents over 38 percent of the total prevention investment
($131 million) made in the previous year, and there is no evidence that abstinence-only education
effectively reduces adolescent pregnancy. If the abstinence-until-marriage education funds were
invested instead in adolescent contraceptive services, the savings would be at least three-fold in
averted Medicaid expenses for pregnancy and neonatal-related care.
Congressional funding of ineffective pregnancy prevention strategies reflects American
discomfort with adolescent sexuality and with sexually active youth. By age 19, over 70 percent
of teens have had sexual intercourse. Twelve million American teens are sexually active. Yet,
Congress continues to allocate precious prevention dollars to programs that withhold information
about contraception.
U.S. adolescent sexual behavior differs little from that of their peers in other industrialized
countries. Public policy in these countries, however, reflects a commitment to helping sexually
active teens avoid sexually transmitted diseases and unplanned pregnancy. In Sweden and the
Netherlands, for example, investments to increase access to sexuality education and
contraceptive services have helped sustain a teen birth rate that is one-ninth that of the United
States. In 1990, the teen birth rate in the United States was six times higher than in France,
almost twice the birth rate in the United Kingdom, and more than double that of Canada.²
These findings indicate that the U.S. should:
Reduce the costs of teenage pregnancy through investment in prevention rather than in
limiting federal support for families began by a teen birth.
Invest wisely. Prevention funding should be allocated to scientifically evaluated
strategies which reduce teenage pregnancy and too-early childbearing, such as
comprehensive sexuality education, contraceptive services, and youth development
programs.
ii
INTRODUCTION
Despite recent declines in teen pregnancy, the United States continues to have the highest
adolescent birth rate of all industrialized countries. Continuing this decline is a primary interest
of policy makers and community members alike. Early pregnancy affects not only adolescents
but also families, communities, and the nation as a whole. Factors linked to teenage pregnancy
are complex and range from poverty, school failure, and behavioral problems to family distress
and restricted access to health services. Preventing these pregnancies, however, is no easy task.
In 1986, Advocates for Youth began calculating federal expenditures to support families that
began with teen births. Advocates calculated this figure on a regular basis in order to highlight
the public and social consequences of too-early childbearing. In 1993, some members of
Congress argued that the large costs associated with teen childbearing were best addressed by
cutting appropriations for social services and other welfare benefits. This misguided policy
ignores the inevitable and enormous health, education, and juvenile justice costs incurred when
we fail to assist young families and other individuals in need.
To provide context for the expenditures to support young families, Advocates for Youth now
also calculates the federal dollars allocated to the prevention of teen pregnancy. To meet the
challenge of teen pregnancy prevention, the U.S. government operates and funds numerous
programs that help adolescents prevent too-early childbearing. The federal government expends
far more money, however, to provide services for families begun with a teenage birth. Clearly,
society has an obligation to provide funds both for prevention and for support of families begun
by teens. So long as prevention dollars remain inadequate, the United States will continue to
have very young families in need of support.
This year for the first time, Advocates additionally calculated the amount of money invested by
the federal government in preventing adolescent pregnancy. Advocates chose to examine the
investments and expenditures on the national level because the federal government is the largest
funder of prevention programs, sets national priorities by its funding decisions, and supports the
greatest number of prevention programs consistently found across the nation.
In fiscal year 1995, the federal government spent over $39.3 billion to help families that
began with a teenage birth (including families currently headed by adults) and invested less
than one-fifth of $1 billion ($131 million) in helping adolescents prevent a first birth." These
are conservative figures, since limited data were available to quantify how many adolescents are
being reached by prevention as well as intervention programs.
The figures provide a reflection of the nation's weak commitment to preventing teenage
pregnancy compared to its stronger obligations to support families begun by a teenage birth. The
One billion is 1,000 millions.
1
calculations indicate that, despite the potential for saving public dollars by reducing teenage
pregnancy and childbirth, the United States is not investing enough in preventing teen
pregnancies and protecting young people's futures.
While this study reflects a snapshot of the situation in fiscal year 1995, Advocates believes the
policy implications apply to the future as well. The welfare reform initiatives of 1996 are likely
to result in a decline in funding for services for low-income families. At the same time, public
dollars are likely to increase for welfare-to-work programs, such as job training and day care.
This shift in emphasis may eventually lower expenditures of the nature described in this analysis.
Without an increase in federal dollars allocated to effective prevention programs, the nation is
unlikely to fully realize the economic savings predicted by the sponsors of welfare reform.
Concurrently, some projections show that, from 1995 to 2005, there will be a 13 percent increase
in the number of young people ages 10-19 who live in the United States.4 As the population of
teenagers expands, so will the number of those at-risk of teenage pregnancy. Without a
significant investment in pregnancy prevention, the number of those requiring support after a
teen birth will continue to rise.
STATISTICS AND TRENDS IN TEEN PREGNANCY AND CHILDBEARING
Adolescent pregnancy and early childbearing are not new phenomena; young American women
have traditionally become pregnant and given birth during the teen years. In fact, the adolescent
birth rate was the highest ever in the late 1950's and early 1960's.
The contemporary view of teen pregnancy as a
social and moral problem is closely related to
Myths About Teen Pregnancy
changes in family structure and the economy.
Myth: Today, teens are giving birth at
Young people of the 1950's and 1960's tended to
unprecedented levels.
marry young (often following a premarital
conception) and to have relatively large families;
Fact:
The teen birth rate is significantly
and one wage earner, even-without a high school
lower in the 1990s than in the 1950s and 1960s.
diploma, could find work to support a two-parent
In 1996, the teen birth rate was 54.7 births per
1,000 females ages 15 to 19 compared to 81 per
household with children.³ Today, both teens and
1,000 in 1950 and 89 per 1,000 in 1960.8.9
adults are more likely to have children outside of
marriage. In 1960, 15 percent of all teen births
occurred outside of marriage; in 1995, 76 percent of
teen births occurred to single women. Despite an
increasing number of single-parent households, it has become difficult for one wage earner to
support children adequately.
2
The following facts highlight recent trends in teenage pregnancy and early childbearing.
Most teenage pregnancies and births are unintended and occur to older adolescents.
Nearly two-thirds of all adolescent pregnancies occur to women ages 18 to 19.6
Nearly 82 percent of teenagers report that their pregnancies are unintended; overall, about
25 percent of all unintended pregnancies occur among teenage women. Women over 40
are almost as likely as adolescents to say that their pregnancies were unintended.'
Among teenage women, approximately
nine percent of 14-year-olds, 18 percent
Myths About Teen Pregnancy
of 15- to 17- year-olds, and 22 percent
of 18- to 19-year-olds experience a
Myth: Teenagers are responsible for the vast
majority of unintended pregnancies.
pregnancy each year.6
Fact:
Of all unintended pregnancies, 75 percent are
The birth rate for 15- to 19-year-old
experienced by adult women. Further-more, in 1987,
adolescents declined 12 percent from
about 50 percent of pregnancies among women aged
1991 to 1996, reversing the trend from
20-34 were unintended, while more than 75 percent of
pregnancies to women over 40 were unintended.'
1986 to 1991, when the birth rate
increased 24 percent. The teen birth
rate declined from 62.1 in 1991 to 54.7
births per 1,000 females ages 15 to 19 in 1996.8
Birth rates dropped in all adolescent subgroups between 1991 and 1996. There was a
decrease of 14 percent in those ages 10 to 14; 12 percent for those ages 15 to 17; and
eight percent for those ages 18 to 19.8
In 1950, the birth rate was 81 births for every 1,000 girls ages 15 to 19; in 1960, the birth
rate was 89 births for every 1,000 teenaged girls this age.9 In comparison, the 1996 teen
birth rate was 54.7 births per 1,000 females ages 15 to 19.8
The abortion rate among teens has declined over the past two decades.
Adolescents obtain about 20 percent of
all abortions performed in the United
Myths About Teen Pregnancy
States each year.10
Myth: Adolescents account for most out-of-wedlock
births.
Since 1980, both the numbers of
abortions and the abortion rate among
Fact:
Thirty-three percent of all out-of-wedlock
teens ages 15 to 19 have decreased.
births are experienced by adolescents, down
from 50 percent in 1970.5
The adolescent abortion rate in 1980
for this age group was 42.8 compared
3
to 25 per 1,000 teens in 1993. 11,12
Between 1980 and 1990, the abortion rate decreased by 24 percent among sexually
experienced women ages 15 to 19. This may be related to the declining pregnancy rate; it
is also possible that restrictive laws, limited availability of abortion providers, and
decreased public funding have limited the ability of teens to choose abortion. 13
Contraceptive use among teens, particularly condom use, increased considerably during
the last decade, and sexual activity rates have declined.
In 1993, although slightly more than half of all high school students reported ever having
had sexual intercourse in the years 1993-1995, rates among high school seniors declined
during the same years from 68.3 percent in 1993 to 66.4 percent in 1995. Rates among
ninth graders also fell from 37.7 percent in 1993 to 36.9 percent in 1995. 14.15
Seventy-six percent of young women
ages 15 to 19, who first had
Myth: African-American teens are responsible
for dramatic increases in out-of-wedlock
intercourse between 1990 and 1995,
births.
reported that they used contraception,
up from 45 percent in 1982. 16.17
Fact: The non-marital birth rate for African-
American teens has risen only four percent
Contraceptive use among young men
since 1970 while the rate for white teens has
has also increased. In 1993, 59.2
tripled from 10.9 to 35.5 per 1000 women.⁵
percent of high school males reported
condom use at most recent
intercourse compared to 60.5 percent in 1995.' This is particularly significant since
condoms also provide protection from HIV and other STDs.
The Centers for Disease Control and Prevention attributes recent declines in adolescent
pregnancy and birth rates to a leveling off of sexual activity and increased condom use
among sexually active youth.8
CALCULATING THE FEDERAL EXPENDITURES AND INVESTMENTS
FOR TEENAGE PREGNANCY: THE COST STUDY METHODOLOGY
Since 1986, Advocates for Youth has calculated the amount of money the federal government
spends in a single year on behalf of all families in which the first birth occurred when the mother
was a teenager-even when the mother is no longer a teenager. The Cost Study is intended to
draw public attention to the need to invest federal dollars in preventing adolescent pregnancy.
4
pregnancy and childbearing. For example, costs are not included for job training, housing
subsidies, subsidized school meals, special education, foster care, and day care programs,
because there is greater variability of individuals who utilize these programs, as compared to
national programs, such as AFDC, which are consistently more available across the country.
Expenditures to Support Families Begun
Investments to Prevent Pregnancies and
with a Teen Birth
First Births Among Teenagers
Medicaid health care services
$19.3 billion
Medicaid family planning services
$77.4 million
Maternal and Child Health
$3 million
Maternal and Child Health
$862,500
Bureau, Title V
Bureau, Title V
Aid to Families with Dependent
$7.6 billion
Public Health Service Act,
$48 million
Children
Title X
Food Stamps
$10.5 billion
Community Health Centers
$200,000
Special Supplemental Food
$1.9 billion
Healthy Schools, Healthy
$600,000
Program of Women, Infants, and
Communities
Children
Centers for Disease Control and
$835,500
Social Services Block Grant (Title
$13.3 million
Prevention
XX of the Social Security Act)
Adolescent Family Life Act
$4.5 million
Adolescent Family Life Act
$2.2 million
TOTAL: $39.3 Billion
TOTAL: $131 Million
Federal Expenditures: Providing Services and Support to Families Which Began
with a Teen Birth
Using the formula described above, Advocates calculated the federal expenditures on families
begun by teens via seven federally funded assistance programs." These expenditures were then
totaled to ascertain federal dollars spent directly to support these families.
The amount spent in FY95 to provide social services for families which began with a teen birth
was 39.3 billion dollars ($39,268,749,354).
6
Redressing teen pregnancy means accepting the reality that 12 million American teens are
sexually active and that a large number of these teens lack access to family planning counseling
and services. Society has an obligation to help these young people make informed, responsible
decisions about the prevention of unintended pregnancies and too-early childbearing.
The United States compares poorly with other industrialized nations in terms of addressing
adolescent sexuality and pregnancy prevention-the nation has the highest teen birth rate of all
developed countries. In countries such as Sweden and the Netherlands, where the national
governments have made significant commitments to family planning and comprehensive
sexuality education, teen pregnancy rates are significantly lower. For example, in the
Netherlands-where teenage sexual activity is about the same as in the United States, but where
teens receive more education about sexuality and have better access to family planning
services-pregnancy rates are only one-seventh those of the United States. Data from 1990
indicates that the teen birth rate in the United States is six times higher than in France, almost
twice the birth rate in the United Kingdom, and more than double that of Canada.²
In general, most of these countries provide comprehensive sexuality education, affordable and
accessible family planning services, and broad "safe sex" messages. Philosophically. these
countries accept that adolescents, especially older teens, may well be sexually active. Therefore,
programs and policies focus on teaching young people protective behaviors and skills, as well as
providing accurate information about sexuality. While United States youth tend to be as sexually
active as their peers in industrial Europe, they are often both uninformed and uncomfortable
about sexuality and reproduction, as well as how to access reproductive and sexual health care.
CONCLUSION
As noted, rates of adolescent pregnancy, childbearing, and abortion have been declining for
several years. To continue these welcome trends, however, the country must make political and
economic commitments to prevention programs that work. In general, the nation can and must
take steps to protect our young people:
Reduce the costs of teenage pregnancy through investment in prevention rather than in
limiting federal support for families which began by a teen birth.
Invest wisely. Prevention funding should be allocated to scientifically evaluated
strategies which reduce teenage pregnancy and too-early childbearing, such as
comprehensive sexuality education, contraceptive services, and youth development
programs.
16
R
Planned Parenthood
Federation of America, Inc.
January 15, 1999
Noa Meyer
Office of the First Lady
Old Executive Office Building
Washington, DC 20500
Dear Noa;
Enclosed is the information that we discussed via our phone conversation today.
As I mentioned on the call, Barbara Snow from our New York office will also be
faxing additional materials to your attention.
Please let me know if we can be of further assistance. I can be reached at 202-
785-3351.
Sincerely,
Rines
Ronnie Todaro
Director
State and Affiliate Program Development
1120 Connecticut Avenue, N.W., Suite 461, Washington, DC 20036 (202) 785-3351 FAX (202) 293-4349
Responsible
Choices
Action Agenda
Planned Parenthood®
Planned Parenthood®
Planned Parenthood®
Federation of America
Action Fund
810 Seventh Avenue, New York, New York 10019-5882
Phone: 212-261-4302 www.plannedparenthood.org
May 1998 Produced by Public Media Center
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
found out I was pregnant My son is going without a lot of things he'd have if he had two
parents. You need a family. You need to be stable. I'm alone except for my baby. --
Jayme, 19
I got pregnant at the age of 14 and had no clue what to do people these days seem to
talk of only two or three solutions to teen pregnancy, although most people forget another
-- adoption. It was the best yet hardest decision of my life. I look at all I am doing now
and think where I would be with a baby. I was not and will not be ready to take care of a
baby for a few years Plus the most important to me is that my baby has two parents who
love each other. - Jennifer, 15
*The sources for these stories are available on the NCPTP website
Stories
The following stories were taken from Sex etc., a website run by teenagers for teenagers.
Abortion
Erin's Choice
By Arlene Brens
It was the most difficult decision Erin ever made. When she first found out she was
pregnant at the age of 18, she and her friend screamed with excitement at the idea of having a
baby. It seemed so sweet. Then reality hit.
"How am I going to tell my Mom? How will I support the baby? Will my boyfriend
support me if I keep it?"
The questions scared her.
"If I was going to keep the baby, I wanted my boyfriend to be there for me through every
step of the pregnancy and after the baby was born, especially since I was just finishing high
school. I didn't want to do this alone," she says now, three years later. At first, Richard, then 19,
wanted to keep the baby. He said he would support Erin's choice. They talked and decided they
would become parents. They were going to get an apartment and begin their life together.
Then Richard changed his mind. He started seeing other girls. He told Erin, "The baby
isn't mine." Next, Erin found out that Richard had been sentenced to prison. So she decided to
have an abortion. "I just couldn't tell my mom," says Erin. "She's Catholic and doesn't believe in
abortion. I was afraid she wouldn't accept me any more as her daughter and
that she'd say 'I told you so.'"
Even though Richard said he would go with her to get the abortion, he kept putting it off
until finally she couldn't wait any longer. Two of her close friends went with her to the clinic.
They held her hand. And they helped pay for the abortion. (Richard never gave Erin the money he
had promised, either.)
Erin says the abortion hurt physically a little--"like huge cramps." Emotionally, she felt
"knocked out."
Afterwards, her friends just held her as she cried for her baby. Erin still feels she made the
best choice for the situation she was in at the time. She still hasn't told her mom. But she has
learned to be careful. She has had sex with only one guy since the abortion. And she always uses
birth control.
"In a way, I regret my decision because when I think of how old my baby would be now
or what she would be like, I feel terrible and start to cry. I wonder if she would have had my eyes
or my nose," says Erin. "But when I think of how young I was and how Richard and I aren't
together anymore, I know I made the right decision for myself and for the baby, because I wasn't
ready."
Teen Parenthood
Shannon's Choice
By Samantha Nay
Shannon King is 15. She is a sophomore at a regular high school, in a regular town, and
she planned on living a regular life. But last July, Shannon found out she was pregnant.
"I cried. I was scared. I didn't know what to do," she remembers. At 15, Shannon was faced with
probably the most important decision she would ever have to make. Would she keep her child?
Would she miss out on being a teenager in order to raise her baby? Would she take on the
enormous responsibility of being a mom when the only responsibility she knew was getting her
homework in on time and making her curfew?
For most people, this decision would have taken a lot of thought, but for Shannon, all it
took was the plus sign on the home pregnancy test--and a gut feeling. "I couldn't picture giving
the baby up for adoption," explains Shannon, who had her baby in February. "I feel abortion is
wrong. And my family is here to help me. I have someone to turn to." Her ex-boyfriend and the
baby's father, Kevin, was only 13 when Shannon found out she was pregnant.
Shannon didn't discuss her decision with Kevin. He was already dating other girls when
she found out she was pregnant, she says. She doesn't want Kevin to be part of their daughter's
life, but she is counting on Kevin's mother to help. His mom has promised to take care of the
baby and give Shannon money. She's also counting on her own parents to help, even they're not
happy about her decision. Shannon knows she will have to grow up faster. She knows she will to
be home-schooled and will have to find someone to take care of her baby when she goes back to
school. She has canceled her plans to go to college. And she has had to ask others to support her
and her child. Basically, her life has totally changed. But all this doesn't matter to Shannon. Her
baby is part of her. And she says she wants to be there to finish what she started.
-
THE WHITE HOUSE
WASHINGTON
Seb.20th
-Planned Parenthood. org
Martha Sanger
-Population Action Internation
- NARAL
Rosalyn Patchesky Petschesky
Susan Cohen- AGI
296-4012
-
28th
THE WHITE HOUSE
WASHINGTON
Microcredit award
20th
@wf WIPUTUS as wellas
Travel - mho of POTUS
family centered
Budget announcement
21800
(did last yr.)
Family event (w/or w/o Posus)
(NEC)
possible charter
I possible Indevent
22nd
mtq wl family Planning
Advocates — need TPs
= Pediatric AIDS remarks
23rd
Social Security Speech
(Len)
(Nicole)
29th
OVS Conf of Mayors on
25th
Millum comm - Ellen
1 Childrenis hospitals -Jen
2Ath
3rd
Foster Care- -
(Mare)
aging out Budget
WH - announcing mentoring mentoning event quant
annorncement
(Neera)
Page 13
LEVEL 1 - 29 OF 64 STORIES
Copyright 1992 Newspaper Publishing PLC
The Independent (London)
October 4, 1992, Sunday
SECTION: THE SUNDAY REVIEW PAGE; Page 37
LENGTH: 571 words
HEADLINE: BOOK REVIEW / A mother of invention
BYLINE: By JAN DALLEY
BODY:
WE expect a lot from our heroines. Nobody questions if the buildings Edison
hoped to electrify were used for worthy causes; no one is surprised if male
social reformers turn out to have the politics of Brooks's and the morals of the
gutter. But in the women's movement we tend to assume that good deeds are done
by good people, and for good reasons. In the case of Marie Stopes, pioneer of
birth-control and prophet of 20th-century attitudes towards female sexuality,
there is shock and horror when it is revealed - as it is, eloquently, in June
Rose's able biography - that Stopes was arrogant, snobbish, cruel, racist, an
emotional tyrant and a monster egotist. Worse: her crusade for birth-control
became confused with an interest in eugenics and racial purity.
So what? Or rather, why should we be surprised? Stopes needed the will of a
pile-driver (and all its subtlety) to defy the weight of convention and do her
work. Born Marie Carmichael Stopes (she married twice, but never changed her
name), she was a second-generation New Woman. Her mother Charlotte, a woman of
daunting rectitude and scholarship, was distant with her two daughters,
preferring to follow her academic interests; only Marie's mild and loving
father, Henry, a passionate amateur palaeontologist, gave her warmth and support
- and implanted her early interest in science.
Something - competition with her high-achieving mother? - made Marie
fanatically ambitious. She set herself to storm the bastions of the male
scientific establishment, gaining an honours degree in one year, a doctorate
soon after. As an eminent botanist she travelled to Japan (where she spent 18
months) and Canada (where she married one Reginald Ruggles Gates), and lectured
extensively. She applied to accompany Captain Scott on his second Antarctic
expedition, and was outraged to be ruled out solely on grounds of sex.
She was, in fact, a paragon of pioneering achievement even before she began
the work that made her famous. But love and sex were a great problem for Marie.
Her prolific writings - plays, novels, stories and, as her biographer succinctly
puts it, ''unfortunately'' also poems - reveal a gushy romantic dreamer within
the uncompromising scientist. She was vaguely bisexual, entering into passionate
if non-physical relationships with women, and her miserable first marriage was
ended on the grounds of non-consummation. But her interest in her own,
considerable, sexuality (the unfortunate Ruggles Gates described her as
'super-sexed to a degree which was almost pathological'', but then he would,
wouldn't he?) was a subject where the scientist and the romantic in her could
TM
TM
TM
LEXIS·NEXIS'
LEXIS:NEXIS®
LEXIS·NEXIS'
A member of the Reed Elsevier pic group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 14
The Independent (London), October 4, 1992
meet. Camping alone on a windswept beach after her divorce, she kept a
'Tabulation of Symptoms of Sexual Excitement in Solitude'', complete with
charts and notes.
It was in 1918 that her ground-breaking Married Love was published - printed
by a small press with a handsome private subsidy from the dashing RAF officer
Humphrey Roe, who became her second husband. Fame and fortune, and plenty of
trouble, came soon after. Marie founded the free birth control clinics that
still carry her name and, at 44, she finally became a mother. Until the end of a
long life (she died in 1958), she never let up on her goals. June Hall gives a
picture of a woman of extraordinary and enduring achievement: it would be
ridiculous to want her to be nice as well.
LANGUAGE: ENGLISH
TM
TM
TM
LEXIS:NEXIS
LEXIS:NEXIS'
LEXIS:NEXIS®
A member of the Reed Elsevier ple group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 15
LEVEL 1 - 31 OF 64 STORIES
Copyright 1992 Sentinel Communications Co.
Orlando Sentinel Tribune
September 27, 1992 Sunday, 3 STAR
SECTION: ARTS & ENTERTAINMENT; Pg. F11
LENGTH: 693 words
HEADLINE: A PIONEER IN FIGHTING FOR RIGHT TO BIRTH CONTROL
BYLINE: Reviewed By Susan M. Barbieri, of The Sentinel Staff
BODY:
When it comes to reproductive freedom, the similarities between the climate
of 1992 and the early 1900s are startling. Ellen Chesler's biography of birth
control pioneer Margaret Sanger serves as an ironic look at history's cyclical
battle over women's bodies.
"Every woman in the world today who takes her sexual and reproductive
autonomy for granted should venerate Margaret Sanger," Chesler writes in the
introduction to Woman of Valor: Margaret Sanger and the Birth Control Movement
in America.
Overpopulation was a hot topic in the intellectual circles of Sanger's
day.
Sanger advocated voluntary family planning as the solution; but then, as now,
the birth control issue was explosive because some linked it with abortion.
Sanger patiently explained the difference between prevention and abortion and
her belief that availability of birth control would cut the number of
abortions.
So for 50 years she fought government, the Catholic church and other
formidable opponents. Her story spans the radical movements of pre-World War I
to the family-planning initiatives of the Great Society era. She published a
newsletter called "The Woman Rebel, railed against the "Comstock laws"
that banned contraceptive distribution and was thrown in jail. She married
twice, bore two sons and had a number of lovers - including writer H.G. Wells
and sexologist Havelock Ellis.
"Margaret Sanger was an immensely attractive woman, small but lithe and
trim. Her green eyes were flecked with amber, her hair a shiny auburn hue, her
smile always warm and charming," " Chesler writes. Men adored her. However, she
could also be extremely stubborn and difficult.
Sanger was utterly devoted to her cause. She envisioned a united front of
women who would claim the legalization of contraception, along with greater
public candor about sexuality, as a fundamental right.
Women always had sought to control fertility. In the 1800s and early 1900s,
contraceptive tracts and devices were distributed widely, but the options were
primitive and unreliable. It was estimated that one out of every five to six
pregnancies in America was terminated in the 1850s. More than 1 million
pregnancies had been aborted by 1930, representing 40 percent of all
conceptions.
As one of 11 children whose mother died young and whose father barely could
TM
TM
TM
LEXIS:NEXIS
LEXIS·NEXIS'
LEXIS:NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier ple group
A member of the Reed Elsevier plc group
Page 16
Orlando Sentinel Tribune, September 27, 1992
support the family, Sanger's sympathy for poor women fueled her political
indignation. Lecturing before Socialist women in New York in 1910 and 1911,
Sanger condemned public prudery for prohibiting open discussion of sexuality
and reproduction, leaving women "innocent victims of their own ignorance."
Sanger promoted gender equality and healthier, happier families. She
pleaded eloquently for a "new morality" expressing women's responsibility to
refuse to bring unwanted children into the world.
The mail was her link to the masses. Thousands of the letters she received
were lost, but surviving examples bear witness to the tragic circumstances of
women who were unable to find reliable contraceptive advice. Still, Sanger
couldn't interest President Roosevelt in legalizing birth control - even
though she had studies showing that millions were dying needlessly from the
complications of self-induced or illegal abortions.
It was not until 1970 that Congress rewrote the Comstock laws and formally
removed the label of obscenity from contraception. Two years later, the
Supreme Court, in Eisenstadt V. Baird, extended the right of contraceptive
practice to the unmarried.
Late in life, Sanger was honored in Sweden for her work. In her speech, she
said she always had believed it was her duty to place motherhood on a higher
level than "enslavement and accident." By 1963, she was bedridden but still
irrepressible, as evidenced by this snippet from Parade magazine:
"I realized what was coming - the population explosion we hear so much
about today, women having more and more babies until there's neither food nor
Sanater
room for them on earth. And I tried to do something about it."
GRAPHIC: PHOTO: (Margaret Sanger) ; Sanger advocated voluntary family planning.
LANGUAGE: ENGLISH
COLUMN: Books
Woman of Valor: Margaret Sanger and the Birth Control Movement in
America
By Ellen Chesler
Simon & Schuster, $27.50, hardcover, 468 pages
LOAD-DATE: May 14, 1993
TM
TM
TM
LEXIS·NEXIS'
LEXIS-NEXIS'
LEXIS-NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier pic group
A member of the Reed Elsevier plc group
Page 17
LEVEL 1 - 33 OF 64 STORIES
Copyright 1992 Information Access Company, a Thomson Corporation
Company
ASAP
Copyright 1992 Reed Publishing USA
Publishers Weekly
August 17, 1992
SECTION: Vol. 239 i No. 37 i Pg. 480; ISSN: 0000-0019
LENGTH: 175 words
HEADLINE: Marie Stopes and the Sexual Revolution. reviews
BODY:
June Rose. Faber & Faber, $ 22.95 (256p) ISBN 0-571-16260-6
Marie Stopes (1880-1958), a successful British botanist, was also a
pioneer of birth control and sexual freedom. Rose (Modigliani), who obtained
access to her subject's private papers, has written an objective and readable
study of the life of the woman who, with the assistance of her second husband,
Humphrey B. Roe, opened Great Britain's first birth control clinic in London in
1921. The sexual frustration Stopes had experienced during her first marriage
inspired her to write and publish, after great difficulty, Married Love (1918),
an explicit guide to sexual intercourse and, in the same year, Wise Parenthood,
which clearly described available methods of contraception. Although her
autocratic nature enabled Stopes to surmount opposition to her emancipated ideas
and the controversies they provoked, as Rose observes, it sometimes estranged
her from her family and friends. This is an important contribution to women's
studies. Illustrations not seen by PW (Oct.)
IAC-NUMBER: IAC 12532394
IAC-CLASS: Magazine; Trade & Industry
LANGUAGE: ENGLISH
LOAD-DATE: August 28, 1995
TM
TM
TM
LEXIS-NEXIS
LEXIS:NEXIS'
LEXIS·NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier pic group
A member of the Reed Elsevier ple group
Page 18
LEVEL 1 - 43 OF 64 STORIES
Copyright 1991 The Times Mirror Company
Los Angeles Times
June 8, 1991, Saturday, Home Edition
SECTION: Part A; Page 26; Column 1; Metro Desk
LENGTH: 153 words
HEADLINE: DR. MIN-CHUEH CHANG; HELPED TO DEVELOP BIRTH CONTROL PILL
BYLINE: By Associated Press
DATELINE: WORCESTER, Mass.
BODY:
Dr. Min-Chueh Chang, a developer of the birth control pill and a pioneer in
research that made in vitro fertilization possible, has died. He was 82.
Chang, who died Wednesday of unreported causes, did much of his work at the
Worcester Foundation for Experimental Biology, where he rose to the rank of
scientist emeritus.
Last year, he was elected to the National Academy of Sciences, the most
prestigious honor that can be given to an American scientist short of the Nobel
Prize.
In 1951, Chang began studying synthetic progestins' effects on reproduction.
The research, done with Dr. Gregory Pincus, a founder of the foundation, led to
the development of an oral contraceptive in 1959.
Chang also is credited with carrying out basic research in the 1950s into
techniques that made it possible to fertilize a human egg with sperm outside the
body, resulting in the births of so-called "test-tube babies."
LANGUAGE: ENGLISH
7M
TM
TM
LEXIS-NEXIS
LEXIS:NEXIS'
LEXIS:NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 19
LEVEL 1 - 46 OF 64 STORIES
Copyright 1991 The New York Times Company
The New York Times
April 7, 1991, Sunday, Late Edition - Final
SECTION: Section 1; Part 1; Page 32; Column 1; National Desk
LENGTH: 244 words
HEADLINE: Somers H. Sturgis, 86, Birth Control Pioneer
BODY:
Somers Hayes Sturgis, a pioneer in birth control research who was a founder
of the first abortion clinic in Massachusetts, died Wednesday at his home in
Cambridge, Mass. He was 86 years old.
He died of lung cancer, said his daughter, Joan Sturgis Mann.
Dr. Sturgis was an advocate of abortion rights for many years. In 1973, six
weeks after the Supreme Court ruling legalizing abortion, he opened the
Crittendon Hastings clinic in Boston.
In the 1930's and 40's, Dr. Sturgis collaborated on a series of reports from
the Harvard School of Medicine that demonstrated that estrogen inhibits
ovulation. Information from his research with Dr. Fuller Albright formed the
basis of the contraceptive pill.
Dr. Sturgis was born in Groton, Mass., and attended the Groton School. At
Harvard University, where he graduated in 1927, he majored in fine arts. He then
entered the medical school, and graduated in 1931. He received his post-graduate
training at Massachusetts General Hospital.
He was chief of the department of gynecology at the Peter Bent Brigham
Hospital, now Brigham and Women's Hospital, in Boston, from 1951 to 1969, and a
professor of gynecology at Harvard from 1951 to 1971.
He is survived by his wife, Frances Ann; three daughters, Ms. Mann, of
Brooklyn; Ann F. Watt, of Cambridge; and Margaret Ratheau, of Marlboro, Vt.;
seven grandchildren; a sister, Susan B. Goodale, of Ipswich, Mass., and a
brother, Warren, of Southbury, Conn.
LANGUAGE: ENGLISH
LOAD-DATE: April 7, 1991
TM
TM
TM
LEXIS-NEXIS
LEXIS-NEXIS
LEXIS:NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 20
LEVEL 1 - 47 OF 64 STORIES
Copyright 1991 The New York Times Company
The New York Times
January 23, 1991, Wednesday, Late Edition - Final
NAME: Alexander C. Sanger
SECTION: Section B; Page 2; Column 2; Metropolitan Desk
LENGTH: 632 words
HEADLINE: Another Sanger Leads Planned Parenthood
BYLINE: By NADINE BROZAN
BODY:
The grandson of Margaret Sanger, the fiery birth-control pioneer, has become
president and chief executive of Planned Parenthood of New York City.
The new leader of the largest Planned Parenthood affiliate, Alexander C.
Sanger, is a former Wall Street lawyer and executive who has also served on the
board of the nonprofit organization.
"With all her success, my grandmother left some unfinished business, and I
intend to finish it," Mr. Sanger said in an interview at the agency's
headquarters at 380 Second Avenue.
Elected unanimously last month by the board of trustees, he succeeds Diana M.
Gurieva, who resigned after 20 months in the post for personal reasons.
Fighting Federal Rules
The New York organization has an annual budget of $18 million, a staff of
250 and 85,000 visits a year to its clinics. Mr. Sanger, 43 years old, takes the
reins at a critical juncture in its history. It is a lead plaintiff in a lawsuit
to be decided this year by the United States Supreme Court that challenges 1988
Federal regulations barring recipients of Federal family-planning funds from
discussing abortion with their clients.
"If the decision goes the wrong way," Mr. Sanger said, "we will close down
rather than stop counseling about abortion. But I will vigorously go to the
state, the city and private funders and get every penny I can to keep our
clinics going. We've already started some preliminary planning for that."
In particular jeopardy is the Hub, a multiservice center for adolescents that
Planned Parenthood operates in the South Bronx in conjunction with the
Bronx-Lebanon Hospital Center. "It receives almost half a million dollars in
Federal funds a year, and is a beacon of hope for kids in the South Bronx, " he
said.
Despite the legacy of his grandmother, the founder of Planned Parenthood, and
of his father, Dr. Grant Sanger, a surgeon who was a board member of the
TM
TM
TM
LEXIS·NEXIS'
LEXIS:NEXIS'
LEXIS·NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 21
The New York Times, January 23, 1991
Margaret Sanger Research Bureau, Mr. Sanger took a circuitous route to his new
post.
He graduated from Princeton University, where he wrote his senior thesis on
his grandmother, and Columbia Law School, and also holds two master's degrees.
He was a partner at White & Case, the Wall Street law firm, before becoming
chief executive of Sanger Plastics and later Old Line Plastics. He is married to
Jeannette Watson, the owner of Books & Company on Madison Avenue, and has two
sons and a stepson.
'Name Is Invaluable'
While Mr. Sanger has no public reputation in the field of birth control and
abortion services beyond the inner circles of the organization, he has served
for seven years on the board of Planned Parenthood of New York City, the largest
of 170 affiliates nationwide.
He acknowledged that his name would be an asset. "Like it or not, my last
name is invaluable and recognizable and important to many people,' he said. "But
I intend to be out on the front lines of our issues. That is why I'm here, why I
want to do this job."
A week after taking office on New Year's Day, he delivered eight speeches at
a conference sponsored by the organzation on "America's Birth Control Crisis."
He plans to testify in favor of Chancellor Joseph A. Fernandez's plan to make
condoms available to New York City high school students, and later this month
will go to Albany for the annual meeting of Family Planning Advocates and "to
lobby the Legislature and the Governor."
Mr. Sanger said he would formulate his agenda based on an evaluation of his
organization's strengths and shortcomings. "Right now we have three clinics in
the city and I want to have 10 more," he said. "There are so many areas that are
underserved. We currently have a small storefront office in central Harlem, and
it is my first priority to see if we can transform that into a clinic."
GRAPHIC: Photo: Alexander C. Sanger, the new president and chief executive of
Planned Parenthood of New York City. (Don Hogan Charles/The New York Times)
LANGUAGE: ENGLISH
LOAD-DATE: January 23, 1991
TM
TM
TM
LEXIS:NEXIS'
LEXIS:NEXIS'
LEXIS:NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 22
LEVEL 1 - 50 OF 64 STORIES
Copyright 1990 Chicago Tribune Company
Chicago Tribune
July 28, 1990, Saturday, NORTH SPORTS FINAL EDITION
SECTION: NEWS; Pg. 11; ZONE: C
LENGTH: 113 words
HEADLINE: Dr. J.L. Brodie, a pioneer on birth control
BYLINE: Associated Press
DATELINE: PORTLAND, Ore.
BODY:
Dr. Jessie Laird Brodie, an internationally known physician who pioneered
birth-control legislation and education in Oregon in the 1930s, died Wednesday.
She was 92.
In 1930, Dr. Brodie opened a private practice in her Northeast Portland home.
Specializing in pediatrics, gynecology and marriage counseling, she continued to
operate her own office until 1960.
During the early years of her practice, Dr. Brodie took a leadership role in
the area of family planning, a subject that continues to cause considerable
social discomfort decades later.
In 1934 she led a successful campaign to pass legislation to regulate the
quality and sale of contraceptives.
LANGUAGE: ENGLISH
TM
TM
TM
LEXIS:NEXIS®
LEXIS:NEXIS'
LEXIS·NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 23
LEVEL 1 - 51 OF 64 STORIES
Copyright 1989 Orange County Register
THE ORANGE COUNTY REGISTER
September 21, 1989 Thursday EVENING EDITION
SECTION: HEALTH-TECH; Pg. E01
LENGTH: 1041 words
HEADLINE: Father of 'the pill' calls for new research
BYLINE: Mike Woods, The Toledo Blade
BODY:
Dr. Carl Djerassi, father of "the pill, " says the American
pharmaceutical industry has virtually abandoned research on new methods
of birth control.
The situation, he says, all but guarantees that no fundamentally
new method of contraception such as a male pill, an anti-fertility
vaccine or a once-a-month menses inducer will be available in the
United States for 10 to 20 years.
And, as a result, he predicts there will be no significant
reduction in the number of abortions -- currently about 1.5 million
performed each year.
"Many people ignore the fact that the incidence of abortion
reflects the state of contraception. In the Soviet Union, the country
with the highest per capita abortion rate in the world, the quality of
birth control is exceedingly poor and the pill is essentially
unavailable. Japan, the country with the third or fourth highest
abortion rate, is the only industrialized country in which the pill is
not approved for contraceptive use."
Djerassi, professor of chemistry at Stanford University, says fear
of product-liability suits has driven American drug companies away from
birth control research and development.
In 1951, Djerassi and a group of co-workers at Syntex Laboratories
Inc. developed a synthetic version of progesterone that became the
active ingredient in birth control pills. Progesterone is a female sex
hormone that prevents women from ovulating during pregnancy.
But because legal and product liability costs for oral
contraceptives are higher than for any other category of drugs,
Djerassi says, there will be no fundamentally new birth control methods
until Congress modifies the exposure to liability of manufacturers for
new contraceptives and vaccines.
A no-fault insurance program that limits manufacturers' liability
would be the most important incentive for getting US drug companies
TM
TM
TM
LEXIS·NEXIS'
LEXIS·NEXIS'
LEXIS·NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier ple group
Page 24
THE ORANGE COUNTY REGISTER September 21, 1989 Thursday
back into development, he said. Such a program would compensate victims
for medical costs, loss of earnings and pain and suffering and would be
financed through a surcharge on the price of the contraceptive.
In a report in Science, the journal of the American Association for
the Advancement of Science, Djerassi describes a broad retrenchment of
the pharmaceutical industry.
In 1970, 13 major pharmaceutical companies, including nine US
firms, had research and development programs on contraceptives. Today
there are four, only one of which is a US company.
No new active ingredients have appeared in pills sold in the United
States since 1960. In contrast, three new ingredients were introduced
in the 1980s in Europe, where women now have access to the world's most
advanced birth control pill.
Djerassi says top priority in research on new contraceptive methods
should go to development of a new spermicide with anti-viral
properties. "The acquired immune deficiency syndrome epidemic alone
justifies putting this item at the top of the list."
Second priority would go to a once-a-month pill that women would
take to induce menstrual flow only during those months when they had
unprotected sexual intercourse. The woman would take the pill at the
expected time of their menstrual period, without waiting to see if she
had missed a period time or taking a pregnancy test. Such a pill, he
says, "could become the single most effective method for reducing the
40 to 50 million abortions performed annually throughout the world.'
Third priority would be development of a reliable test for
predicting ovulation that could be used by couples practicing the
"rhythm method,' or natural family planning. Since sperm have a fertile
life span of three days, the test would need to predict ovulation at
least three days in advance.
Djerassi assigns fourth priority to a reliable and easily
reversible method of male sterilization that would make vasectomy a
more acceptable fertility control method for young men with no
children. Vasectomy, used by millions of men, often can be reversed
now. But reversal requires expensive microsurgery.
Fifth priority would be development of a pill taken by the male.
Sixth would be the most revolutionary of all: development of an
anti-fertility vaccine that would gradually wear off over a set period.
The vaccine, he says, could have a major impact in decreasing America's
teen-age pregnancy and abortion rates, which are the highest in the
industrialized world.
Djerassi points out that even if research and development on new
contraceptive methods resumed today, no fundamentally new method could
be available for 12 to 20 years. Authorities believe it would take that
TM
TM
TM
LEXIS·NEXIS'
LEXIS:NEXIS
LEXIS·NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 25
THE ORANGE COUNTY REGISTER September 21, 1989 Thursday
long to complete stringent government testing requirements to establish
the new product's safety and effectiveness.
CHART: Identifying priorities for improving birth control
According to Dr. Carl Djerassi, pioneer of the birth control pill,
no fundamentally new method of birth control will be available in the
United States for at least 10 years. He says top priorities in research
for new contraceptive methods should include:
Spermicide with anti-viral properties.
Once-a-month pill to induce menstrual period.
Development of reliable test for predicting ovulation that
could be used by couples practicing the rhythm method.
Reliable and easily reversible method of male sterilization.
Male birth control pill.
Development of an anti-fertility vaccine that would gradually
wear off over a set period of time.
GRAPHIC: BLACK & WHITE PHOTO; CHART; Dr. Carl Djerassi, pioneer of 'the pill,
says no-fault insurance is the key to getting US drug companies back into
development of contraceptives.; CHART; Identifying priorities for improving
birth control - see end of text
LANGUAGE: ENGLISH
LOAD-DATE: April 10, 1997
TM
TM
TM
LEXIS·NEXIS'
LEXIS·NEXIS®
LEXIS:NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 26
LEVEL 1 - 55 OF 64 STORIES
Copyright 1988 The Times Mirror Company
Los Angeles Times
August 16, 1988, Tuesday, Home Edition
SECTION: Part 1; Page 1; Column 1; Foreign Desk
LENGTH: 1979 words
HEADLINE: KENYAN A BIRTH CONTROL PIONEER;
10-MINUTE OPERATION AIDS FAMILY PLANNING IN AFRICA
BYLINE: By MICHAEL A. HILTZIK, Times Staff Writer
DATELINE: NYERI, Kenya
BODY:
The first time Dr. Joseph Kanyi performed the operation, his nurses fled.
"I thought they were going for tea," he recalled in his whitewashed office
one day recently, 13 years later. "But they never returned."
It was not tea, but the unfamiliarity of Kanyi's procedure that drove the
nurses away: It was the first time that they had seen abdominal surgery
performed using only local anesthesia.
"They disapproved of doing the operation while the patient was awake," Kanyi
said. His staff gone, Kanyi glumly canceled the three other operations he had
scheduled for that day. Racked by frustration and embarrassment, he spent a
sleepless night.
That was the inauspicious beginning of Kanyi's pioneering work in birth
control, or "family planning," in the preferred terminology of Africa. The woman
on the table was Kanyi's first patient for a procedure known as a
minilaparotomy, a simple and convenient method of performing tubal ligations, or
surgical sterilizations.
After years of searching for a simple way to provide his rural patients with
the permanent contraception they desired, Kanyi had learned the technique abroad
and brought it to his tiny clinic here in the shadow of majestic Mt. Kenya. With
a three-inch incision and an hour's surgery, since reduced to 10 minutes, he
could surgically sterilize a woman and have her out of his clinic and on her way
home that day.
Within a year of that first operation, with a new staff of nurses, Kanyi was
performing hundreds of the voluntary procedures annually. Since that
discouraging day in 1975, he has done 3,500. In Kenya, the leader in Africa in
the procedure, the 300 doctors and nurses he has trained perform 9,000 every
year.
It is on women's shoulders that the burden of Africa's population explosion
falls disproportionately. Often bearing as many as eight or 10 children, they
TM
TM
TM
LEXIS:NEXIS
LEXIS:NEXIS
LEXIS:NEXIS®
R
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier ple group
Page 27
Los Angeles Times, August 16, 1988
are frequently left to support the children on their own. By a wide margin, it
is women who have the greatest incentive for birth control and who suffer its
myriad inconveniences.
Thus, to thousands of women, and perhaps to the continent as well, the
minilaparotomy has been a godsend, for in few other places on Earth is birth
control more urgent than in Africa.
In population growth, as in SO many other fields, the continent seems forever
out of step with the rest of the world. In the 19th Century, for example, it was
the only continent, Antarctica aside, to suffer a declining population.
Then the European colonists arrived with their own ideals of medical care and
disease eradication. Africa's infant mortality rate dropped, and life expectancy
increased.
Since 1950, education and medicine have cut Kenya's infant mortality rate
from 163 deaths per 1,000 births to about 70 today. Life expectancy at birth in
the same period has risen to 53 years from 39.
High Fertility Rate
Conventional wisdom dictates that, high mortality rates being the leading
inspiration for high fertility, African birthrates should be falling. Yet in
Kenya, to take one example, the fertility rate the average number of children
born per woman has scarcely budged: It was 8.2 in 1950, and it is 8.12 today.
One reason may be that the drop in the infant mortality rate is not so
clearly visible to rural villagers.
"Even though the rate is down, as many children die as in the past because
there are SO many more children," said Dr. Eric Krystall, head of the Family
Planning Private Sector program, a privately financed group operating in Kenya.
"In Kenya, there are still 70,000 child funerals a year, so we still have a job
convincing people."
Although Kenya has the world's highest natural growth rate, its problem is
mirrored by many other nations in sub-Saharan Africa. With mathematical
inevitability, the continent's human population has begun to outstrip the land's
ability to support it.
In 1950, the region supported about one-fifth as many people as all of the
developed world; by 1985, it had closed the gap to about a third. United Nations
statistics indicate that in the year 2025, even assuming Africa's growth rate
falls to 0.72% annually from today's 1.84%, the continent will have 1.1 billion
people, equal to all the people in the developed world.
Bride Price
The population impact already cuts across all economic categories in Africa.
In Rwanda, the tiny central African nation with the continent's heaviest
density, population growth has so reduced the size of most families' cattle
herds that the traditional price of a bride, a cow, has become hard to meet. On
the alternative cash market, brides fetch as much as $1,350. This spring, the
government responded to this inflation by fixing the price of a bride at three
TM
TM
TM
LEXIS·NEXIS'
LEXIS:NEXIS®
LEXIS·NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 28
Los Angeles Times, August 16, 1988
hoes.
Africa's fragile ecology suffers as well. In Niger, where the growth rate
will double that destitute West African country's population to 13.6 million
in 23 years, the U.S. Agency for International Development blames the population
explosion for contributing to extensive deforestation and desertification, as
people strip the country's forests for wood to burn.
Even if Africa were to sharply cut back its fertility and growth rates today,
the continent's future is etched in stone for decades to come. Half its
population is below the age of 15; in many countries, this youthfulness might
presage an explosion of industry and economic vitality. In the straitened lands
of Africa, it portends a geometric increase in population and an overwhelming
strain on inadequately developed resources.
More and more, African governments have come to recognize population growth
as their paramount economic curse. Even some Muslim countries, with traditional
censures against birth control, have instituted official programs.
Few Use Birth Control
But all falter in the face of logistical, educational and cultural obstacles.
In Kenya, where family planning is a national policy aggressively supported by
every government minister, a 1980 international study showed that only 29% of
women had ever used any form of birth control, including 18% who used such
traditional methods as rhythm and abstention.
In other countries, the rate is much lower 6% to 10% use modern methods in
Niger, 4% to 6% in the destitute West African nation of Burkina Faso and 3% in
sub-Saharan Africa's most populous nation, Nigeria.
Few subjects are as charged with contention and emotion as family planning in
Africa. National programs have collapsed after confronting unexpected tribal
sensitivities. In semi-literate societies, the mine field of misunderstanding
can be catastrophic.
For example, the male equivalent of the minilaparotomy, the vasectomy, is
rare to the vanishing point throughout Africa. Men and women alike equate it
with castration and fear it causes impotence.
Rumors, Misconceptions
"Rumors and misconceptions are bad even in the United States," says one
family planning expert active in Kenya. "In Africa, they spread like wildfire.
If a contraceptive user in some village becomes ill, a rumor spreads identifying
the method with the illness, even if it's unrelated."
Kanyi himself recalls hours of sessions with his patients disabusing them of
common fallacies. Some women believed that if they conceived while using an IUD,
"it would go through the baby's heart, or the baby would come out holding it."
Others feared that contraceptives would make them frigid, or cause birth
deformities.
Even as birth control officials struggle to gain acceptance for their
TM
TM
TM
LEXIS·NEXIS'
LEXIS-NEXIS'
LEXIS:NEXIS®
R
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier ple group
Page 29
Los Angeles Times, August 16, 1988
methods, the efficacy of traditional methods has been declining. African women,
for example, have traditionally breast fed their children for their first two
years or even longer. Breast-feeding diminishes a woman's fertility, and in many
African tribes it is also taboo to have sex with a breast-feeding woman, so that
helped to space children naturally.
Social Taboos
In many traditional societies it was also taboo for a woman to have any more
children once her oldest daughter became pregnant another social limit on
fertility.
But as Africa becomes more urbanized, population experts say, traditional
restrictions disappear.
"In cities there are fewer taboos,' " said one population official in Nairobi.
"Breast feeding is no longer a child's sole nourishment, for example. Women are
productive well into their 40s."
With modern contraceptive methods, one problem is the continual difficulty of
getting devices to the users.
"There are problems both on the supply and the demand side," remarked one
foreign aid official in Africa involved in population matters. In the past, some
countries have been afflicted with erratic supplies of such contraceptives as
Depo-Provera, an injectable contraceptive popular in Africa but not yet approved
for use by women in the United States.
Users of most contraceptives also are inconvenienced by the need to travel to
remote clinics to renew their supplies every three months in the case of
Depo-Provera. For this and other reasons, many older African women have long
sought a permanent birth-control technique to substitute for the need to use
temporary methods for what might be as much as 20 years between the birth of
their last wanted child and the end of their period of fertility.
"They would ask why I couldn't give them a method to get them out of the
queue," Kanyi recalled. "It became rather a challenge to me."
Not Uncommon Method
Of course, a method did exist: tubal ligation, or the cutting of a woman's
Fallopian tubes to block the movement of the ovum into the uterus. Not uncommon
in the developed world, this method of surgical sterilization created huge
problems for doctors and patients in Africa.
The conventional procedure required the patient to check into a hospital for
more than a week, go under the knife for hours and subject herself to general
anesthesia. Any of those factors alone would be enough to discourage most of
Kanyi's potential patients.
In the cash economy that prevails in most of Africa, that much time out of
pocket was insupportably costly. Such a long sojourn away from home, as well as
the long scar, also made it impossible for a woman to keep her operation
confidential more than an inconvenience in societies where she might feel the
TM
TM
TM
LEXIS·NEXIS®
LEXIS-NEXIS'
LEXIS-NEXIS'
A member of the Reed Elsevier pic group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 30
Los Angeles Times, August 16, 1988
sting of disapproval or even ostracism for taking such a permanent step. General
anesthesia also frightened potential patients.
So tubal ligations tended to be performed in sub-Saharan Africa only on
"women who were most desperate,' said one leading expert in surgical
contraception in East Africa. "They were those with a ruptured uterus, or 13,
14 kids, or several Caesarean sections."
New Set of Concerns
The advent of the minilaparotomy has changed that, although the availability
of such an easy and permanent method of birth control has brought its own array
of problems. The Family Planning Assn. of Kenya and other family planning
agencies here have financed an extensive program of counseling to screen
patients, rejecting those for whom permanent contraception might be a grave
mistake. In Kenya's polygamous tribes, out-of-favor wives might be pressured by
their husbands to undergo sterilization.
Counselors in Kenya generally recommend the procedure only to women who have
had six children or more.
"If a woman comes in at the age of 24 and with one child, it's very
questionable," said one family-planning worker. "What if the child dies, or the
woman is divorced and remarries? There would be very heavy pressure on her in
that case to produce children in the subsequent marriage."
But counselors find that among appropriate patients, acceptance of the
procedure runs very high.
"When we tell clients it just takes 10 to 15 minutes," said Jennifer Mukolwe,
executive director of the Family Planning Assn., "they say, 'My goodness, it's
just like going to the market and no one even has to know. 1 "
LANGUAGE: ENGLISH
TM
TM
TM
LEXIS:NEXIS'
LEXIS-NEXIS'
LEXIS:NEXIS
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 1
MAIL-IT REQUESTED: JANUARY 13, 1999
100Y5T
CLIENT: OSTP
LIBRARY: NEWS
FILE: MAJPAP, MAGS
YOUR SEARCH REQUEST AT THE TIME THIS MAIL-IT WAS REQUESTED:
HLEAD (BIRTH CONTROL) AND BIRTH CONTROL W/3 HISTORY
NUMBER OF STORIES FOUND WITH YOUR REQUEST THROUGH:
LEVEL 1
63
LEVEL 1 PRINTED
THE SELECTED STORY NUMBERS:
22,23,37,38,45,59,61
DISPLAY FORMAT: FULL
SEND TO: CRAGG, JACQUI
OFFICE OF ADMINISTATION LRSD
725 17TH ST NW RM G-07
WASHINGTON DISTRICT OF COLUMBIA 20503
02660
TM
TM
TM
LEXIS:NEXIS'
LEXIS:NEXIS'
LEXIS·NEXIS'
R
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
R
A member of the Reed Elsevier plc group
Page 2
LEVEL 1 - 22 OF 63 STORIES
Copyright 1995 The Chronicle Publishing Co.
The San Francisco Chronicle
MAY 10, 1995, WEDNESDAY, FINAL EDITION
SECTION: NEWS; Pg. A2
LENGTH: 640 words
HEADLINE: Gynecologists Salute Birthday of the Pill C
BYLINE: Sabin Russell, Chronicle Staff Writer
BODY:
The birth control pill turned 35 yesterday, and 4,000 gynecologists just
happened to be in San Francisco to celebrate.
In town for the annual meeting of the American College of Obstetricians and
Gynecologists, the doctors are spending most of the week discussing the latest
findings on matters such as menopause, childbirth and alternatives to
hysterectomy.
But they couldn't pass up a chance to mark one of the great moments in the
history of birth control.
The pill started in controversy, and controversy seems to have strengthened
it, rather than weakened it, said Dr. Celso-Ramon Garcia, a Philadelphia
gynecologist who led clinical testing of the popular oral contraceptive in
Puerto Rico during the late 1950s.
At a press conference called to mark the anniversary, Garcia said that early
researchers could not find an American hospital willing to conduct trials of the
pill, and major drug companies that later reaped billions selling it were
unwilling to bankroll its development.
Today, an estimated 10 million women hold prescriptions for the pill in the
United States alone. Besides sterilization, it is the most popular form of birth
control in America.
There ought to be tremendous fireworks to celebrate this anniversary,'
proclaimed Ruth Westheimer, the sex educator better known as Dr. Ruth, whose
frank talk on television and radio about human sexuality has made her a media
celebrity.
Mainstream Americans first learned of the birth control pill May 9, 1960,
when the Associated Press reported that the Food and Drug Administration had
quietly agreed to add contraception to the list of approved uses for a drug
already being prescribed for a variety of menstrual disorders.
Word that the drug, called Enovid, was an extraordinarily effective
contraceptive had already spread among gynecologists and their patients.
According to its manufacturer, G. D. Searle & Co., as many as half a million
TM
TM
TM
LEXIS·NEXIS'
LEXIS·NEXIS'
LEXIS·NEXIS®
A member of the Reed Elsevier ple group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 3
The San Francisco Chronicle, MAY 10, 1995
American women may have been taking the pill for birth control by 1959.
A combination of synthetic versions of the hormones estrogen and progestogen,
the pill has proved more than an effective birth control method: Its
introduction brought about a revolution that challenged American sexual mores
and paved the way for large numbers of women to enter the workplace.
The pill not only liberated women from unwanted pregnancy, said Dr. Ruth, but
enabled millions to get more enjoyment out of sex. ''A woman cannot have sexual
satisfaction if she's worried, she said.
Yet the sexual revolution heralded by the pill has left a troubling legacy.
Thirty-five years after its introduction, according to the New York-based Alan
Guttmacher Institute, the United States has the highest rate of teenage
pregnancy in the industrialized world.
, Over one-half the pregnancies in this country are still unplanned, said
Dr. Anita Nelson, medical director of the Women's Health Care Clinic at
Harbor-UCLA Medical Center.
Part of the problem is that many women still do not trust the pill.
According to Nelson, 25 percent of the women surveyed in 1993 believed the
failure rate for oral contraceptives is greater than 20 percent. In reality,
only 6 percent of all pill users become pregnant each year, and the failure rate
for those who adhere strictly to instructions is less than one in 1,000.
At 35, the pill itself has undergone major reformulations. Today, estrogen
levels are only 20 percent, and progestogen levels about 10 percent, of those in
the original pill.
The lower dosages have decreased side effects, although pill users still face
a slightly higher risk of stroke and heart attack and some experience problems
such as irregular bleeding. One manufacturer estimates that half the women who
try the pill eventually switch to other contraceptives.
GRAPHIC: PHOTO, Lena Young inspected packages of birth control pills at the
Ortho-McNeil Pharmaceutical plant in Raritan, N.J. , BY FEATURE PHOTO SERVICE
LANGUAGE: ENGLISH
LOAD-DATE: May 10, 1995
TM
TM
TM
LEXIS-NEXIS
LEXIS·NEXIS'
LEXIS·NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 4
LEVEL 1 - 23 OF 63 STORIES
Copyright 1995 Gannett Company, Inc.
USA TODAY
May 4, 1995, Thursday, FINAL EDITION
SECTION: LIFE; Pg. 1D
LENGTH: 1299 words
HEADLINE: THE PILL TURNS 35 / A new era for women was born, too
BYLINE: Marilyn Elias
Relief Womans allability of
BODY:
Karen Robillard, 54, remembers exactly when she heard about the pill. She
was in her early 20s, a department store buyer, engaged and desperate for
reliable birth control.
Driving to work one day in Providence, R.I., she heard "this startling news"
on the radio.
"My first reaction was 'Yesssss!' I remember talking to my girlfriends about
it, and we all felt it was too good to be true."
Other birth control methods "were a pain, and they didn't work very well
Then if you got pregnant, what could you do? In those days you had to hide
your head in shame. Someone I knew got an abortion in a third-floor apartment in
East Providence, but that was frightening to think about."
Robillard's doctor hesitated to prescribe oral contraceptives for a single
woman. "He said, 'There's time for this,' but I said, 'The time is now! "
She wasn't alone in that emphatic response. The Food and Drug Administration
approved the pill's final product labeling as a contraceptive 35 years ago
today. By now, 4 out of 5 sexually active women have used the pill. It's still
the most popular reversible method of birth control, chosen by about 10 million
women in this country.
Even as oral contraceptives now appear old hat, new uses and controversies
over the pill are emerging. But whatever lies around the bend probably looks no
more dramatic than the changes already spurred by pill use.
As the first female-controlled method not linked to the sex act, the pill
ushered in an era of wider sexual activity, without worry over unwanted babies.
"It was an enabler, a big catalyst allowing women to make major changes in their
lives,' " says Susan Scrimshaw, dean of the school of public health at University
of Illinois, Chicago.
"It made it so much easier to postpone, to space children and then to choose
smaller families. For the first time, you didn't
have to feel beholden to a biological destiny. "
That
TM
TM
TM
LEXIS·NEXIS'
LEXIS·NEXIS'
LEXIS·NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 5
USA TODAY, May 4, 1995
unprecedented freedom eased the way for women to pursue education and careers
without forgoing relationships or family. "If the pill hadn't been discovered,"
says Scrimshaw, "we'd have less perfect methods, and employers wouldn't have
been as willing to let women in en masse."
This wasn't all good news, she adds. Ambitious women who were students in
the '60s sometimes postponed too long, not realizing their biological clocks
wouldn't tick forever. "The pill indirectly contributed to fertility problems
we're seeing now in women in their 30s and 40s," Scrimshaw says.
Oral contraceptives still are favored by younger women: Usage peaks in the
late teens and 20s. By ages 35 to 39, only 11% of women using birth control take
pills, compared with 61% of those 18 to 19 years old.
Young women today, though, face sex-related problems their pill-popping
mothers couldn't have imagined. "Pregnancy is no longer the worst thing that can
happen to them. They can die from sex," says Dr. Judith Reichman, a Los Angeles
gynecologist.
She prescribes pills, "but only with a lecture on how this can't protect them
from AIDS or sexually transmitted disease. They're getting more
condom-conscious but still don't want to give up the better birth control you
get from pills." (About 1 in 6 women whose partners use condoms has an
accidental pregnancy every year vs. 1 in 14 for those on the pill.)
Pill use is dropping among married couples, largely because more than half of
them now choose sterilization after all wanted babies have been born. And condom
use is growing, "but too slowly," among young, unmarried women, says Jacqueline
Darroch Forrest of the Alan Guttmacher Institute, New York City.
Today's pill carries nowhere near the hormone punch of the Enovid capsule
approved in 1960. Versions now on the market have one-fifth to one-third as
much estrogen and one-10th the progestin.
Pill boosters tout its proven benefits: cutting a woman's risk of ovarian and
uterine cancer; lowering the incidence of pelvic inflammatory disease and benign
breast lesions that often prompt surgical biopsies; even improvements in
symptoms of rheumatoid arthritis.
Oral contraceptives, though, aren't for everyone. Even with lower estrogen
doses, pills can promote potentially fatal blood clots; they're not recommended
for smokers over 35, women with hypertension and those at high risk for blood
clots or heart disease. They can intensify migraine headaches, too.
The most heated recent criticism of pills centers on a possible link to
breast cancer. Most studies show no tie for women overall, "but we're beginning
to see a consistent link between taking the pill and breast cancer diagnosis
before 35," says Dr. Herbert Peterson, chief of the women's health and fertility
branch at the Centers for Disease Control and Prevention.
Peterson's own national study of 5,000 women, ages 20 to 54, paints a mixed
picture for pill users:
Before age 35: A 40% increase in breast cancer.
TM
TM
TM
LEXIS:NEXIS
LEXIS·NEXIS'
LEXIS·NEXIS®
A member of the Reed Elsevier ple group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 6
USA TODAY, May 4, 1995
-- 35-44: same as non-users.
-- 45-54: 10% lower risk.
But only 8% of women are under 40 when they're diagnosed with breast cancer,
so the pill's beneficial effect on older women's cancer rates, if it holds up,
may save lives in the long run.
Peterson speculates that pills, like pregnancy - which they mimic by
suppressing ovulation - raise short-term breast cancer rates because they spur
growth of tumors already in the breast. That's why higher rates show up in
younger women: They're the fertile ones taking pills, which make their cancers
grow rapidly and become apparent sooner.
Pregnancy lowers long-term breast cancer risk, and pills may do the same, he
says. About 3 out of 5 women diagnosed with breast cancer are 60 or older. A
federal study is, for the first time, looking at whether pill use affects breast
cancer rates in these older women. Results will be out in the year 2000,
Peterson says.
Even as scientists study how youthful pill use affects women later, there's a
growing trend to prescribe oral contraceptives during peri-menopause, which
lasts an average of four years before menopause. Pills stop the typical
symptoms of abnormal bleeding and sporadic hot flashes, Reichman says. Many
women go directly from them onto hormone replacement.
Not everyone is delighted with the prospect of women taking synthetic sex
hormones from teen age to old age.
"We're concerned about the possibility of an additive harmful effect. Taking
the pill and hormone replacement is going where no woman has gone before,"
cautions Cindy Pearson of the National Women's Health Network, Washington, D.C.
"It's possible there may be health problems, there certainly hasn't been enough
study to prove there won't be."
Still, Forrest predicts a rosy future for the pill. "It's by no means
perfect - we don't have a perfect method. But for years to come, I think it's
going to be mostly the pill and condoms."
Robillard, who rejoiced at the pill's birth 35 years ago, lately has found
herself suggesting it to her teen-age daughter. "She has just fallen in love,
and I'm biting my nails. She assures me that she's not ready for the pill -
thank God!
"But when the time comes, I told her I'd take her to get them.'
The Pill - approved as a birth control device 35 years ago today - has been used
by four out of five sexually active U.S. women.
About a third (34.3%) of all women 15 to 44 used non-surgical contraceptives
in 1990, the latest data available. The breakdown:
Pill
49%
TM
TM
TM
LEXIS·NEXIS'
LEXIS·NEXIS'
LEXIS·NEXIS'
A member of the Reed Elvevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier pic group
Page 7
USA TODAY, May 4, 1995
Condom
31%
Other (Rhythm, abstinence, withdrawal, etc.) 13%
Diaphragm
5% %
IUD
2%
GRAPHIC: GRAPHIC, color, Suzy Parker, USA TODAY (Pie chart)
LANGUAGE: ENGLISH
LOAD-DATE: May 05, 1995
TM
TM
TM
LEXIS:NEXIS®
LEXIS·NEXIS'
LEXIS·NEXIS®
A member of the Reed Elverier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 8
LEVEL 1 - 37 OF 63 STORIES
Copyright 1993 Plain Dealer Publishing Co.
The Plain Dealer
May 21, 1993 Friday, FINAL / ALL
SECTION: TODAY; Pg. 9C
LENGTH: 597 words
HEADLINE: PICKING UP TORCH FROM HIS GRANDMOTHER
BYLINE: By LAURA YEE; PLAIN DEALER HEALTH REPORTER
DATELINE: CLEVELAND HEIGHTS
BODY:
Alexander C. Sanger remembers his famous grandmother as someone who never
took no for an answer.
Like the times when naysayers hurled tomatoes and dirt at her as she began in
1912 to advocate the importance of birth control - a phrase she coined. Still,
Margaret Sanger persevered.
Or the time when she and her sister in 1916 opened the country's first
contraception clinic in Brooklyn, N.Y. Nine days and 900 patients later,
authorities shut down the clinic and threw Margaret Sanger in jail for 30 days.
Eventually, she prevailed in her mission to help protect the reproductive
rights of women. Today, there are 168 affiliates of Planned Parenthood, an
organization founded on her work and unwillingness to take no for an answer.
"We've made great progress," says Alexander Sanger, president and chief
executive officer of Planned Parenthood in New York City. "No other movement has
been this successful."
Sanger provided several anecdotes about his grandmother Wednesday at the
local Planned Parenthood 65th anniversary forum as if to illustrate how the
battle that his grandmother began waging 81 years ago is not all that different
from the one he continues to fight today.
During his grandmother's time, no one was allowed to discuss birth control,
and doctors, who feared losing their licenses, would not address the issue.
Religious groups and courts that believed birth control was anti-family were
also impediments for Margaret Sanger, who died in 1966.
Alexander Sanger said he believes women must continue to say 'no' as
anti-abortionist and other groups attempt to shut down clinics and terrorize
doctors who perform abortions.
Constituents must still lobby the government to reverse laws that impinge on
the right of women to control their own bodies, he said. And he thinks the
country's future doctors must be encouraged to include abortion and the
TM
TM
TM
LEXIS:NEXIS'
LEXIS:NEXIS®
LEXIS-NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 9
The Plain Dealer, May 21, 1993
history of the birth control movement in their training.
"My grandmother knew that the price of liberty is eternal vigilance," Sanger
said, borrowing a few words from Thomas Jefferson. "She knew it would be a
constant fight after what she had been through. "
Part of that vigilance, Sanger said, is to be prepared for the protests that
Operation Rescue plans to stage in Cleveland this summer.
Gather political support, he advised. Get laywers to put injunctions in place
and form coalitions with women's organizations and other groups to get
volunteers. Form human blockades against the anti-abortionists.
"I mean for this to sound like combat, Sanger said after his speech at the
College Club in Cleveland Heights. "Because that's exactly what it is."
But he cautioned pro-choice advocates not to resort to terrorist tactics.
"The time is right for us to take the moral high road," he said. "We must
talk about morality and responsibility because that's what we're all about. "
Sanger, a partner in a law firm and a businessman before taking the Planned
Parenthood position, said he is also aware that there's no time to waste.
With the change in political climate that came with the Clinton
administration, pro-choice groups have to accomplish as much as possible in the
next 3 years.
Sanger said there should be an increase in federal funding for contraceptive
research and that every community should fight to ensure that health care reform
does not hinder a woman's right to abortion.
"We've come a long way but we still have a lot of work to do," he said. "We
started out facing obstacles we can't imagine, but today our beliefs and
services are woven in the fabric of the nation.'
GRAPHIC: PHOTO by PD/JAMES A. ROSS:; ALEXANDER SANGER: "We've come a long way
but we still have a lot of work to do."
LANGUAGE: ENGLISH
LOAD-DATE: May 24, 1993
TM
TM
TM
LEXIS:NEXIS'
LEXIS·NEXIS'
LEXIS:NEXIS'
R
A member of the Reed Elsevier ple group
A member of the Reed Elsevier plc group
A member of the Reed Elvevier plc group
Page 10
LEVEL 1 - 38 OF 63 STORIES
Copyright 1993 Newsday, Inc.
Newsday
March 23, 1993, Tuesday, CITY EDITION
SECTION: PART II; LECTURE ON 1916 BROOKLYN CLINIC; Pg. 55
LENGTH: 626 words
HEADLINE: The Legacy Of Sanger's Birth Control Battle
BYLINE: By Esther Iverem. STAFF WRITER
BODY:
A DECADE OF escalating violence at abortion clinics, culminating in the murder
two weeks ago of a Florida physician, echoes a time earlier in the century
during the struggle to legalize both abortion and birth control.
And then, Brooklyn was at the heart of the controversy.
During a lecture and slide presentation tomorrow night at 6:30 at the
Brooklyn Historical Society, author Ellen Chesler will describe how, in 1916,
feminist activist Margaret Sanger established the country's first birth control
clinic, inside a storefront tenement in the Brownsville section of the borough.
"Unwittingly, Sanger controlled the course of birth control in America,"
Chesler said of the Brooklyn clinic during an interview last week. "Even today,
birth control clinics are independent, nonprofit organizations rather than in
hospitals."
An account of the clinic's weeks of existence before it was closed down and
Sanger and her sister Ethel Byrne were imprisoned is included in Chesler's book,
"Woman of Valor," a biography of Sanger published last year by Simon and
Schuster.
According to Chesler, the Brownsville clinic was born during a time when
condoms were illegal and women were routinely maimed by "birth control" douches
made from Lysol and chlorine bleach. Though abortion was legal in the country
until the early to mid-1800s, by that time a combination of the medical
establishment, religious fundamentalists such as Anthony Comstock and others,
succeeded in passing laws that banned abortion, birth control and pornography,
which were lumped together as degenerate.
Chesler is quick to point out that though the laws did restrict a woman's
right to choose, they also put an end to some level of medical quackery.
Sanger selected Brownsville for her clinic, Chesler said, because it, along
with the Lower East Side, was the place where newly arrived immigrants lived and
because it was a place of desperate poverty and language barriers. In poor
communities such as this, she believed, the ability to limit family size could
TM
TM
TM
LEXIS:NEXIS®
LEXIS:NEXIS'
LEXIS:NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 11
Newsday, March 23, 1993
greatly affect a family's well being.
"MOTHERS! CAN YOU AFFORD TO HAVE A LARGE FAMILY?" said a circular advertising
the clinic in English, Yiddish and Italian. "DO YOU WANT ANY MORE CHILDREN? IF
NOT, WHY DO YOU HAVE THEM?"
"Sanger believed that one of the reasons women were so downtrodden was
because they couldn't control their fertility," Chesler said. "And they were
constantly being infected and dying from illegal abortions and gynecological
devices invented by quacks. II
Under these conditions, "the women of Brownsville patiently stood in line for
service,' Chesler writes in her book, which lists the location of the clinic as
Amboy Street near the corner of Pitkin Avenue. "There were 464 recorded clients
during the several weeks the facility remained open. Surviving photographs show
them handsomely attired in shirtwaists and billowing skirts. Draped in a shawl
to protect against the autumn chill, one young mother hovers over a graceful
wicker baby carriage in a romantic tableau that conceals the full dimension of
the neighborhood's dispiriting poverty."
Sanger opened the clinic to test New York State's anti-birth-control laws on
First Amendment grounds. For a 10- cent fee at the clinic, they provided birth
control information and sex education. They were cautious not to dispense birth
control devices but did have in their inventory the Mizpah Pessary, a device
commonly available in pharmacies at the time and used by women with distended
wombs. But the pessary could also be effective as a birth control device.
Before Sanger, birth control was awkwardly referred to by names such as
"feminine hygiene" or "family limitation," Chesler said. "They didn't know what
to call it."
GRAPHIC: 1) Sophia Smith Collection, Smith College photo- The Brownsville
birth-control clinic, the first in the nation. 2) Photo- (A circular advertising
an abortion clinic)
LANGUAGE: ENGLISH
TM
TM
TM
LEXIS·NEXIS'
LEXIS:NEXIS
LEXIS·NEXIS®
A member of the Reed Elsevier ple group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 12
LEVEL 1 - 45 OF 63 STORIES
Copyright 1989 Information Access Company, a Thomson Corporation
Company
ASAP
Copyright 1989 RD Publications Inc.
American Health
July, 1989
SECTION: Vol. 8 i No. 6 i Pg. 114; ISSN: 0730-7004
LENGTH: 354 words
HEADLINE: Before birth control: unwanted children often abandoned by guilt-free
parents; family report
BYLINE: Gilman, Lois
BODY:
Before birth control
Unwanted children were often abandoned by guilt-free parents
Modern family planning methods may be controversial. But as late as the 18th
century, it was common for European parents to abandon their unwanted children.
That's historian John Boswell's startling conclusion in The Kindness of
Strangers: The Abandonment of Children in Western Europe from Late Antiquity to
the Renaissance (Pantheon, $ 24.95). As Boswell puts it, "Abandonment was
postnatal birth control."
The children weren't abandoned with the expectation they'd die, Boswell
thinks. Parents left them in public places, hoping they'd be picked up by
strangers to be reared as their own. "Parents had specific hopes that their
children would have a better life,' he says.
The Romans believed it was noble to care for foundlings. After 400 A.D.,
growing concern about genealogy led adults to pretend the waits they reared were
biologically theirs.
Boswell maintains that until the 14th century, the mortality rates of the
abandoned were only a bit higher than contemporary death rates for other
infants. But in the 1300's, foster care was supplanted by the foundling home.
Disease ran rampant through the new institutions, and abandonment became
synonymous with death. Those who survived were not much better off. Truly
strangers in their own lands, foundlings had to make their way alone, lacking
even an adoptive parent's last name to bind them to legitimate society.
"We tend to think there has been steady progress in family planning in
Western society," says Boswell, "but in the Renaissance, things actually went
backwards."
What is the 20th century parent to make of what seems like the heartless
measures of the past? "We need to realize that in different times and places
TM
TM
TM
LEXIS:NEXIS
LEXIS·NEXIS'
LEXIS:NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 13
American Health, July, 1989
there are and have been a great many different ways for parents to discharge
what they regard as parental responsibility," says Boswell. As The Kindness of
Strangers emphasizes, certain family problems transcend time and place: Like our
forebears, we're still seeking a civilized way to deal with the burden of too
many children.
IAC-NUMBER: IAC 07942699
IAC-CLASS: Health; Magazine
LANGUAGE: ENGLISH
LOAD-DATE: August 04, 1995
TM
TM
TM
LEXIS:NEXIS®
LEXIS:NEXIS®
LEXIS·NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier pic group
Page 14
LEVEL 1 - 59 OF 63 STORIES
Copyright 1984 Information Access Company, a Thomson Corporation
Company
ASAP
Copyright 1984 Meredith Corporation
Ladies Home Journal
January, 1984
SECTION: Vol. 101 ; Pg. 30; ISSN: 0023-7124
LENGTH: 2220 words
HEADLINE: Women's health: the story of the century.
BYLINE: Weinhouse, Beth
BODY:
Women's Health
THE STORY OF THE CENTURY
The life they saved was yours
Imagine yourself a woman in 1883, about to give birth. Whether it's your
first child or not (and chances are it isn't, since there is no effective
birth control available), you are terrified, because you know that mothers and
babies die in large numbers during delivery or soon afterward. For the last
several months, you've been confined to your house, because it isn't considered
proper for a pregnant woman to be seen in public. Now the contractions have
started, and you've summoned a midwife to your home. If there are any
complications, your midwife will be almost helpless; her function is mainly to
offer. emotional support and to help care for your family while you are
bedridden.
If you are an exceptionally educated, enlightened woman, you might summon a
physician to your home, or even enter a "women's hospital, just starting to
come into vogue. There, doctors dressed instreet clothes and with unwashed
hands, unwashed instruments and barely rinsed sponges attend your delivery,
spreading germs and infection. Puerperal infection (called childbed fever) is
the leading cause of maternal death. The only anesthesia available is a rag
soaked in chloroform or ether. If you have complications, your chances for a
successful delivery are dismal, even in a hospital. Caesarean section is a
dangerous operation, often fatal to the mother. The doctor's alternative is to
remove the child whatever way possible
usually dead. As you recuperate
from your delivery, you are not permitted even to sit up in bed until the sixth
day and then for only two hours. You aren't allowed out of bed until the ninth
day, and you're sent home on the tenth. If the birth was difficult, you may have
to remain in the hospital for a number of weeks.
After you have recovered from this terrible ordeal, you can look forward to
having another child soon
and another, and another. With luck, if you
don't die in childbirth, you may reach the age of fifty--the average life
TM
TM
TM
LEXIS·NEXIS'
LEXIS·NEXIS'
LEXIS:NEXIS'
R
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 15
Ladies Home Journal, January, 1984
expectancy. With more luck, a few of your many children will live to adulthood
(one in ten children dies before the first birthday).
The picture in 1883 was grim indeed, but even then there were a few hints of
the more modern and enlightened health care to come Primitive practices, such
as bloodletting with leeches, or ovariotomies (operations to remove the ovaries,
performed unnecessarily by many doctors to treat a variety of unrelated
complaints, such as overeating and attempted suicide) were falling out of favor.
The practice of washing hands and instruments before surgery was catching on
with a few progressive doctors. And women were starting to realize that they
didn't have to take to their beds each month during their menstrual periods.
But 1883 is perhaps most significant for the births of two people who would
change the future of women's health care: George Papanicolaou, the physician who
developed the Pap test to detect cervical cancer in its earliest stage; and
Margaret Sanger, the nurse who became America's foremost advocate of birth
control.
For many years after 1883, conditions changed little from those of the
childbirth just described (with the exception of moderate improvements in
hygiene within the hospitals). But after the turn of the centry there was an
important leap in women's health care
and nurses brought about much of the
change. Imagine their horror as they repeatedly and helplessly watched other
women die giving birth. And imagine their frustration at being unable to help
the "lucky' women who survived but suffered lacerations and other injuries
during birth that would plague them for the rest of their lives. Nurses knew
something had to be done, and their response was to introduce the concept of
prenatal care, one of this century's most important contributions to women's
health care.
Pregnant women in 1883 were not given any medical attention until they went
into labor. They ate and drank what they pleased, and if they were poor, they
often worked long hours in sweat shops right up until delivery and returned to
work soon afterward. Pregnant women were not checked for high blood pressure or
venereal disease, and they did not receive pelvic exams or blood and urine
tests.
DEATH RATES DROP
Organized prenatal care in America began in Boston in 1901, when a group of
concerned nurses, reacting to the growing body of knowledge on the importance of
health care during pregnancy, began visiting some of the women enrolled in the
home delivery service of the Boston Lying-In Hospital. By 1912, these nurses
were visiting women an average of three times before delivery, teaching them how
to take proper care of themselves during their pregnancies. The idea caught on
in other parts of the county. Now instead of waiting, ignorant and terrified,
pregnant women could actually participate in their own health care. This was
truly a milestone for women. And in areas with these first prenatal programs,
maternal-and infant-mortality rates began to decrease.
By this time, Margaret Sanger had begun her mission. A nurse herself, she
had reacted to the plight of her sex differently. Working among the poor of New
York City, Sanger was appalled to see women who were old and tired before forty
because of their many pregnancies. What she found even more painful was having
to watch women die from dangerous, illegal abortions they had turned to in
TM
TM
TM
LEXIS-NEXIS'
LEXIS·NEXIS'
LEXIS:NEXIS®
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier ple group
Page 16
Ladies Home Journal, January, 1984
desperation. She was determined to be able to help these women when they begged
her for a way to avoid further pregnancies.
Sanger studied contraceptive methods in Europe, and when she came back to
America, she began to spread the word, using the term "birth control, which she
coined. Although Sanger was persecuted and prosecuted, she continued her work
and passed contraceptive information on to as many women as she could. In 1917,
she helped found the National Birth Control League, which eventually became the
Planned Parenthood Federation of America. In the 1920s, the diaphragm became
widely available. Gradually, women were gaining control of their bodies and
being liberated from what Sanger saw as sexual servitude.
THE JOURNAL'S ROLE
What were male physicians doing for women's health care during this time?
They were not passing out birth control devices or information. The
male-dominated medical establishment was firmly opposed to the idea of birth
control; in fact, the American Medical Association didn't even acknowledge the
benefits of contraception until 1937. But doctors had begun to treat cervical
cancer, for the first time, with radium--discovered by the Curies in 1898.
Although the method was crude, it paved the way for today's more successful
treatments.
How did people find out about these advances in medicine? The history of
women's health care in this country is intertwined with the history of
Ladies' Home Journal. In 1913, LHJ published one of the first articles for
the general public on cancer and the importance of early detection and
treatment. The article was endorsed by the chairman of the Cancer Campaign
Committee of the Congress of Surgeons of North America. Doctors had started to
recognize that people could take considerable responsibility for their health.
Ladies' Home Journal continued to publish educational and historically
important articles on health care. In 1936, a four-part series titled "Why
Should Mothers Die?' charged that most childbed deaths could be prevented by
more enlightened medical practices, such as scrupulous cleanliness to prevent
infection. The article described, quite specifically, how the Chicago Maternity
Center, "where mothers are almost one hundred percent safe, had improved its
care by, among other things, beginning prenatal care from the moment a woman
reports her pregnancy and by aborting dangerous or high-risk pregnancies. (By
World War II, the majority of the births took place in a hospital, not at home.)
Again, in the 1940s, the Journal's article "Killer of Women' about cervical
cancer and the importance of the Pap smear helped to transform medicine. The Pap
smear had been developed in the 1920s but had been practically ignored by
physicians, who weren't interested in examining healthy, nonpregnant women. But
after the Journal's article launched a media carpagin, women began to demand the
simple test that could save their lives.
NEW HEALTH CHOICES
Women's health care progressed rapidly. By the 1950s, doctors were more
confident about performing Caesarean sections--thanks to the availability of
sulfa drugs and antibiotics to prevent infection, better anesthesia and new
TM
TM
TM
LEXIS:NEXIS
LEXIS-NEXIS'
LEXIS:NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 17
Ladies Home Journal, January, 1984
surgical techniques. Also in the 1950s, LHJ readers by the hundreds wrote to the
magazine protesting cruelty in the maternity wards, denouncing such hospital
practices as: attempting to postpone delivery until the doctor arrived by
holding the mother's legs together; refusing permission for a husband to stay
with his wife during labor, much less accompany her into the delivery room; deny
women a choice of general or local anesthesia, or none at all; refusing to
answer questions or being unsympathetic about discomfort or pain. Again, women
were demanding the right to competent and humane medical care.
By the 1960s, a myriad of health-care choices ushered in the modern era of
women's medicine: the Pill went on the market; abortion and sterilization laws
were liberalized; and use of local anesthetics for childbirth became common, so
a woman could be aware of what was happening in the delivery room; or she could
choose not to have anesthetic at all as natural childbirth became popular.
Today, all of us benefit from the knowledge gained over the last century. We
now expect to be healthy, and we aggressively seek qualified medical care when
we do not feel well. And, for the first time, the 24, 000-member American College
of Obstetricians and Gynecologists (an organization founded in 1951) has elected
a woman president, Dr. Luella Klein.
"I don't think there's any question that women are healthier than ever
before. Physiologically, our bodies are "younger" now at a given age than they
were one hundred, or even twenty-five, years ago,' says Dr. Klein, who believes
that effective birth control is the biggest single reason for the health we
enjoy today. "Women are having fewer children now, and spacing their children
further apart,' she says, "It's a big change from around the turn of the
century, when women had one baby after another, and men usually buried a couple
of wives.
And Dr. Klein concurs that, besides birth control and improved medical
technology, women themselves have brought about much of the positive change.
Says Dr. Klein, "Women today are aware of proper nutrition, weight control, the
importance of exercise, the value of a regular breast self-exam and a regular
annual exam by a physician, including a Pap smear.'
Today, medical advances occur at an astonishing rate. "The whole field has
changed as much in the last ten years as in all the time before, claims Dr.
Klein. She cites such achievements as in-office sterilization operations for
both men and women and fertility research (such as artificial insemination,
laser surgery and in-vitro or test-tube fertilization) which allows more couples
to have children. And now almost any woman who wants to can have a baby. "Even
high-risk women--older women, diabetics, women high blood pressure,
spinal-injury victims--can be helped to have normal pregnancies,' says Dr.
Klein.
Amniocentesis (removing and testing a small amount of fluid from the womb)
can detect fetal abnormalities in very early stages of pregnancy. A brand-new
test called chorion villus biopsy--in which a tiny piece of the tissue that
attaches the placenta to the uterus is sampled--can detect birth defects as
early as the eighth week of pregnancy. Ultrasound and other new "imaging"
technologies allow doctors to see a baby while it is still in the womb--and even
to treat it or operate on it if necessary. And in the field of cancer "we've had
remarkable success treating cervical and endometrial cancer, and a vaginal and
TM
TM
TM
LEXIS:NEXIS
LEXIS·NEXIS'
LEXIS:NEXIS®
A member of the Reed Elsevier pic group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier ple group
Page 18
Ladies Home Journal, January, 1984
vulva cancers, says Dr. Klein.
NEW DIRECTIONS
And more than ever, women are determining their own health care. We no
longer tolerate being treated like children by our physicians, or being told
that our very real pains--of menstruation or of childbirth--are psychological.
We demand information and often insist on second opinions. According to Dr.
Klein, the increasing number of women physicians is also helping to change
medicine. "Women doctors, I think, put somewhat more emphasis on prevention and
health maintenance,' she says. "And there's a big advantage to being a woman in
this field. For instance, I didn't have to be told dysmenorrhea menstrual cramps
was real--I knew!' And young male doctors, who have gone through their medical
training with women, have a different and better attitude, too.
As positive as all these changes are, and as lucky as we are to be living
today, instead of one hundred years ago, there is still much research to be
done. But, at the current rate of medical progress, it's likely that we will see
many more exciting breakthroughs during our lifetime.
IAC-NUMBER: IAC 03070159
IAC-CLASS: Health; Magazine
LANGUAGE: ENGLISH
LOAD-DATE: June 28, 1995
TM
TM
TM
LEXIS:NEXIS'
LEXIS·NEXIS'
LEXIS:NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
Page 19
LEVEL 1 - 61 OF 63 STORIES
Copyright 1977 The Washington Post
The Washington Post
January 30, 1977, Sunday, Final Edition
SECTION: Book World; Brief Notices; E8
LENGTH: 318 words
HEADLINE: WOMAN'S BODY, WOMAN'S RIGHT;
A Social History of Birth Control in America
BYLINE: By Linda Gordon
BODY:
Birth control methods (some useless or even dangerous, others remarkably
effective) have existed since ancient times, but have not always been put to
use.
One explanation, according to Linda Gordon, a professor of history at the
University of Massachusetts, is that strictures on birth control fluctuated
according to social need. Among some nomadic people, where dependents were a
liability, infanticide was practiced. In agricultural societies on the other
hand, where many people were needed to get the work done, prohibitions on
birth control were strict.
But the main reason women have not made more use of birth control, Gordon
maintains, is their poor attitude toward themselves. In other words: "Birth
control use is more a measure of women's increased self-esteem and sense of
opportunity than a cause of it.' The modern birth control movement beginning in
the late 19th century was thus an arduous struggle from within as much as from
without - against fear, superstition, ignorance and prejudice.
In appraising the gains of the birth control movement over the last hundred
years, Gordon points out that women still must rely on faulty if not dangerous
methods - the Pill and IUDs - anc concludes that the only real achievement of
the movement so far has been the legalization of abortion. Certainly she
understates the advances in the understanding of female physiology which, along
with improved techniques, have given women more control than ever before. But
she argues very persuasively that while control over reproduction is
fundamental, it is only a first step toward sexual equality.
This book is filled with provocative ideas and facts which will dispel many
conventional notions on the subject. It's a shame that few readers will be
tempted to forage through the thicket of dull, turgid writing in which they are
hidden. (Grossman/Viking, $12.50)
Carol L. Eron
GRAPHIC: Illustration, no caption, by Grandville
LANGUAGE: ENGLISH
TM
TM
TM
LEXIS:NEXIS®
LEXIS:NEXIS'
LEXIS:- NEXIS'
A member of the Reed Elsevier plc group
A member of the Reed Elsevier plc group
A member of the Reed Elsevier ple group
Issues in Brief -- Risks and Realities of Early Childbearing Worldwide
http://www.agi-usa.org/pubs/ib10.html
Parenthood Federation; Zimbabwe, Women's Action Group.
Summary Points
Adolescents, broadly defined as 10-19-year-olds, account for one-fifth
of the world's people. In 1995, they numbered nearly 1.1 billion-913
million in developing countries and 160 million in developed
countries.
Worldwide, approximately 15 million births occur among adolescent
women each year. They account for slightly more than 10% of all
births.
The higher a woman's level of education, the more likely she is to
delay marriage and childbearing.
Women aged 15-19 are two to three times more likely than women
aged 40-44 to have at least seven years of education.
In the past 20-30 years, adolescent childbearing has declined in many
countries of Asia, North Africa and the Middle East. However, 30% or
more of young women in Latin America and 50-60% in Sub-Saharan
Africa still have their first child bef ore the age of 20.
Policy Implications
Provide parents of adolescents with information and support that will
help them to guide their children into adulthood.
Continue to increase the accessibility of schooling for all young
people, but especially for girls and young women.
Help young people understand the possible consequences of sexual
relationships and encourage them to take responsibility for their
actions.
Institute sex education in schools without such programs and improve
and expand on existing efforts.
Permit and encourage pregnant adolescents to attend school-during
pregnancy as well as after birth.
Raise awareness of sexual abuse and train providers to identify and
counsel youth subjected to sexual violence.
Initiate educational and mass media programs that explain the value of
postponing childbearing beyond adolescence.
Improve access to affordable contraceptive services that enable young
people who are sexually active, both married and unmarried, to
prevent unwanted pregnancies.
Emphasize the importance of preventing STDs, including AIDS, and
alert adolescents to the consequences of such infections.
Provide pregnant adolescents, married and unmarried, with access to
prenatal care.
Implement the abortion sections of the Programme of Action of the
International Conference on Population and Development and the
Platform for Action of the Fourth World Conference on Women,
which state that where abortion is not against the law, it sh ould be
safe and accessible; that women should have access to quality services
for the management of complications arising from abortion; and that
countries should consider reviewing laws that punish women who
have undergone illegal abortion S 10
© 1997, The Alan Guttmacher Institute, 2/97
13 of 14
1/12/99 12:50 PM
HEADLINE: HILLARY CLINTON PUSHES EQUALITY IN S. AMERICA / CALLS FOR
EXPANDING
WOMEN'S LEGAL, POLITICAL, MEDICAL RIGHTS
BYLINE: By William Douglas. WASHINGTON BUREAU
DATELINE: Buenos Aires
BODY:
Buenos Aires - In a country where the name of the late first lady Eva Peron
still elicits cheers, first lady Hillary Rodham Clinton yesterday drew applause
by calling for an expansion of legal, political and medical rights for women.
Democracy will thrive, Clinton said, "when women are not barred by law, by
ignorance, by tradition or by intimidation" from making their voices heard at
the ballot box and in society.
"In short, empowering even more women to seek and claim their rights as
citizens and as human beings will ensure that democracies - old and new -
survive and thrive in the Twenty-First Century," she told an audience at a
packed opera house.
While the president has used this trip to Venezuela, Brazil and Argentina to
push for more free trade within Latin America, the first lady has participated
in events that highlight the plight of women and children in the region.
In Caracas, Venezuela, she met with women who are trying to work their way
out of poverty through modest, government-sponsored loans. In Brazil, she
traveled to a poor neighborhood school whose students are receiving help through
a corporate sponsorship program. Following her speech yesterday, Clinton met
privately with members of Mothers of the Plaza de Mayo, women whose relatives -
a total of 30,000 - disappeared during the military dictatorship here from 1976
to 1983.
During her address, Clinton described empowerment as "being able to lead
lives free of sexual and domestic violence. And it means access to justice under
law, to education, to health care, to credit and property ownership."
Clinton also spoke of personal empowerment and the need to respect a woman's
right to choose her own path, whether it's as a married, full-time homemaker or
a full-time career woman.
"It should no longer be a one-size-fits-all prescription for the way a
woman's life should be lived," Clinton said.
PAGE 3
Newsday (New York, NY), October 17, 1997
The first lady made her remarks at the Colon Theater in an appearance
sponsored by Argentina's National Federation for Women. The audience of 1,200
was one of the most enthusiastic crowds that she and the president have
encountered on their their seven-day, three nation Latin American tour.
Hillary Clinton expressed awe about speaking on a stage graced by the likes
of legendary singers Enrico Caruso and Maria Callas. The first lady received
enthusiastic applause when she called domestic violence criminal, not cultural,
and cited access to family planning and reproductive health services as critical
"to advancing the progress of women."
Clinton did not state her position on abortion. In a country that is 92
percent Catholic, the only time she used the word abortion was in describing a
decline in the number of such procedures at a family planning program in
Salvador de Bahia, Brazil.
But spokeswoman Marsha Berry said that when Clinton talks about family
planning and reproductive rights, that includes abortion.
Still, some abortion rights advocates here accepted Clinton's comments as
support in their battle to get abortion legalized here.
"I liked what she had to say because she emphasized reproductive rights,"
said Mabel Bianco, president of Argentina's Foundation for the Study and Resarch
of Women. "It will help us as we are fighting in this country for reproductive
rights."
When Clinton finished her speech, fliers streamed from the upper boxes that
read in Spanish, "In Argentina each day, more than 1,000 women commit abortion
in secrecy. Each day, one woman dies from it." The fliers demanded access to
"safe and efficient" anti-contraception methods and "legal abortion in order not
to die."
Before joining her husband on this tour, Hillary Clinton visited Panama. The
first lady has kept an active schedule since Chelsea Clinton, their only child,
left home to attend Stanford University last month.
"I am, as you may know, an empty-nest mother now," said Clinton, who turns 50
next week. "I called my daughter last night to tell her that I had seen just a
small sample of tango because she loves dance in all forms and wrote a paper in
Latin American history on tango and its origin."
GRAPHIC: 1) AP Photo-Hillary Rodham Clinton greets the audience yesterday at the
Colon Theater in Buenos Aires. 2) Agence France-Presse Photo-Buenos Aires Mayor
Fernando De La Rua presents President Bill Clinton with a key to the city in a
ceremony at Plaza San Martin. Meanwhile, Hillary Rodham Clinton was cheered for
touting women's rights in the Argentine capital. (p. A04 NS)
LANGUAGE: English
LOAD-DATE: October 17, 1997
PAGE
4
DATE: JANUARY 8, 1999
CLIENT:
LIBRARY: NEWS
FILE: ALLNWS
YOUR SEARCH REQUEST IS:
HEADLINE (HILLARY CLINTON AND ABORTION)
1ST STORY of Level 1 printed in FULL format.
Copyright 1998 Times Mirror Company
Los Angeles Times
July 2, 1998, Thursday, Home Edition
SECTION: Part A; Page 16; Foreign Desk
LENGTH: 898 words
HEADLINE: THE PRESIDENT IN CHINA;
FIRST LADY AGAIN SOUNDS THEMES FOR WOMEN'S RIGHTS;
DIPLOMACY: IN LOCAL GATHERINGS, HILLARY CLINTON DISCUSSES
EMPOWERMENT AND
CRITICIZES BEIJING'S ABORTION POLICIES.
BYLINE: JONATHAN PETERSON, TIMES STAFF WRITER
DATELINE: SHANGHAI
BODY:
At a restored synagogue here, she admired a Torah to highlight American
support for freedom of religion in China. At a medical center in Beijing, she
applauded Chinese research on spina bifida and other birth defects.
And in this city's modern library Wednesday, she played on the popular
aphorism that "women hold up half the sky," taking aim at China's practices of
forced abortion and sterilization to limit family size.
"Women can't hold up half the sky," declared Hillary Rodham Clinton, "if they
are denied the freedom to plan their own families."
A world away from the embarrassments of the investigation into Monica
Lewinsky's alleged relationship with her husband or even lingering fallout from
the Paula Jones sexual harassment case, the first lady is conducting a China
trip of her own. It is much lower key than that of the president, with whom she
has appeared across China, typically taking the background role expected of a
leader's spouse.
Yet Mrs. Clinton also has managed to fit in a round of her own appearances,
often reflecting her cherished themes of women's rights, children's well-being
and health care.
At these local gatherings, she has heard Chinese women speak candidly about
abusive husbands, exploitative employers, housing woes of divorcees and the need
for education in China's increasingly unregulated economy.
In a village near the Chinese city of Xian, a professor told her that some
families now sell their donkeys so their daughters can afford college tuition.
Mrs. Clinton later lamented at another appearance that many able young women
"may not have a family to sell a donkey" to pay for their schooling.
PAGE 6
Los Angeles Times July 2, 1998, Thursday,
In sub-Saharan Africa, the former Soviet Union, Eastern Europe, northern
Thailand, the Philippines and the Andes Mountains of South America, this first
lady has made a practice of seeking out those sorts of conversations, always in
the hope of gleaning a little bit of insight that might be put to wider use.
"She's always gone out of her way to meet with women and girls," Melanne
Verveer, the first lady's chief of staff, said as Mrs. Clinton, with daughter
Chelsea and Secretary of State Madeleine Albright, observed exhibits in the old
synagogue. "What she's often said," Verveer continued, "is that we face common
challenges."
Sometimes she is the one facing challenges--to make the best of a situation
engineered by well-meaning foreign hosts. In a stifling, overcrowded legal
conference room in Beijing, where microphones were spewing out ear-splitting
feedback, Mrs. Clinton settled into the chair reserved in her honor--the biggest
and cushiest--only to sink and sink until she sat half a head lower than
everyone around her.
Still, she remained composed and kept the conversation moving, earnestly
asking one participant for examples of "major important cases" that the legal
center has handled. At another point, she wanted to know how a client had "found
her way to the center to seek legal assistance."
If Americans are divided in their views of the first lady, the Chinese have
mixed feelings too. While often speaking of her in admiring tones, in random
interviews some also seemed taken aback by her unabashedly modern style.
"She is very able, very aggressive as a lawyer," said a woman in her late 20s
who identified herself as Miss Tang. "She is totally unlike any of the Chinese
leaders' wives."
A career woman in her mid-40s, who, like many in this nation unaccustomed to
freedom of expression, declined to provide any name, observed of Mrs. Clinton:
"She is a lawyer and a politician. She may be a good partner, but I don't know
if she is a good wife and mother. For most of the people, it is very hard to
make a balance."
While the president's movements require a huge motorcade and bring a retinue
of staffers and press that can impart a circus-like atmosphere to events, Mrs.
Clinton can maneuver a bit more easily, accompanied typically by just a few
staffers.
In China, her appearances have included participating in a round-table at
Beijing University, meeting with physicians from the Beijing Medical Center and
the U.S. Centers for Disease Control and Prevention, as well as visiting a girls
school and retraining center in Shanghai.
It was in Beijing in 1995, at the United Nations Fourth World Conference on
Women, that she delivered a well-received speech, replete with implied criticism
of the Beijing regime for its policies of forced abortion.
That appearance made a big impression on Mrs. Clinton and her close aides.
"While we spoke different languages and came from different places, we shared a
universal belief-that women's rights are human rights and that human rights are
women's rights," Mrs. Clinton on Wednesday recalled of the U.N. conference.
PAGE 7
Los Angeles Times July 2, 1998, Thursday,
In her remarks at the Shanghai library, which aides had described in some
ways as a sequel to the 1995 address, Mrs. Clinton said that progress for
society depends broadly on women "having equal access to life's tools of
opportunity" such as medical care, education, employment and legal rights. "Only
when we create a world where every citizen enjoys fundamental freedoms and every
child is valued and given equal opportunities--then, and only then, will we be
able to say with honesty, 'Yes, women hold up half the sky.'''
Times staff writers Maggie Farley and Tyler Marshall contributed to this
report.
GRAPHIC: PHOTO: Hillary Rodham Clinton listens to Rabbi Arthur Schneider during
tour of restored synagogue in Shanghai. PHOTOGRAPHER: Reuters
LANGUAGE: English
The Associated Press
The materials in the AP file were compiled by The Associated Press. These
materials may not be republished without the express written consent of The
Associated Press.
January 22, 1997, Wednesday, AM cycle
SECTION: Washington Dateline
LENGTH: 483 words
HEADLINE: Gore, Hillary Clinton defend abortion rights
BYLINE: By JAMES ROWLEY, Associated Press Writer
DATELINE: WASHINGTON
BODY:
The 24th anniversary of the Supreme Court's landmark decision legalizing
abortion was marked Wednesday by protest, a bomb scare and condemnation of
anti-abortion terrorism by Vice President Al Gore.
"To those who committed the horrible deeds of Tulsa and Atlanta, I say this
the American people will not tolerate your cowardly crusade," Gore said of
recent abortion-clinic bombings in those cities.
As he and first lady Hillary Rodham Clinton spoke to the National Abortion
and Reproductive Rights Action League, tens of thousands of abortion opponents
rallied near the White House, then marched to Capitol Hill to protest the
Supreme Court's 1973 Roe vs. Wade decision.
The marchers included many schoolchildren, seminarians wearing long black
robes bearing religious icons and busloads of members of the Knights of
Columbus, a Catholic men's group.
Randall Terry, leader of the anti-abortion Operation Rescue group, told
marchers their job was to "carry the banner of resistance and replace evil
politicians."
At a rally on the Ellipse, freshman Rep. Kenny Hulshof, R-Mo., voiced concern
that Gore and Mrs. Clinton would "point to random acts of violence in an effort
to taint our worthy cause.
"But just as we must call for an end to violence outside those clinics, let
us continue to pray for an end to the violence inside those clinics," Hulshof
said.
Protest leaders vowed to push legislation to ban a late-term procedure known
as a "partial-birth" abortion. Clinton vetoed a bill passed by Congress last
year to outlaw the procedure, and Republican leaders vow to bring up the measure
again this year.
PAGE 9
The Associated Press, January 22, 1997
The anniversary got off to a shaky start several hours before the speeches
when a worker at the hotel where Gore and Mrs. Clinton appeared found a small
fusing device used in grenade training. The device, with less force than many
firecrackers, went off in the employee's hand two blocks from the hotel.
Police said there was no evidence the incident was related to the abortion
controversy, even though it was found within a block of a Planned Parenthood
clinic.
Gore, referring to earlier clinic bombings, said the administration would
"find the terrorists who committed these heinous acts and we will pursue you to
the fullest extent of the law."
Mrs. Clinton voiced hope for a dialogue with abortion opponents - "people of
good faith who do not share extremism as their rallying cry."
Gore also said there is room for people on both sides of the issue to work
together, but pledged, "We will not allow a woman's right to choose to be taken
away."
NARAL President Kate Michelman told supporters that the right to obtain an
abortion remained under attack, citing restrictions adopted by states.
Combined with the threat of violence, restrictive laws mean "it's not a safe
place in America today for a woman to obtain an abortion she needs," Michelman
said.
LANGUAGE: ENGLISH
September 5, 1995
SECTION: SPOTLIGHT STORY
LENGTH: 1027 words
HEADLINE: HILLARY CLINTON: LASHES OUT OVER ABORTION AND
STERILIZATION
BODY:
On 9/5, in her first public appearance at the U.N.'s Fourth
World Conference on Women in Beijing, Hillary Rodham Clinton
"lashed out" at gov't-coerced sterilization and abortions that
are "practiced widely" in China and other developing countries.
But the first lady did not mention China or any other country
specifically by name in her speech. Her comments "echoed" those
of many critics of China's family-planning programs who claim
that abortion and sterilization are used as gov't-sponsored
birth-control techniques, often against the will of women. H.R.
Clinton, in her speech, "Women and men must also have the right
to make the most intimate of all decisions free of
discrimination, coercion and violence, particularly any coercive
practices that force women into abortions or sterilizations"
(Farley/Tempest, L.A. TIMES, 9/5). NPR's Mary Kay Magistad:
"Hillary Clinton minced no words in expressing her discontent
about the way China has handled some of its duties as host of the
U.N. Women's Conference and of the companion nongovernmental
forum.
Mrs. Clinton said in her speech that women must enjoy
the right to participate fully in the social and political lives
of their countries." H.R. Clinton: "Let me be clear. Freedom
means the right of people to assemble, organize and debate
openly. It means respecting the views of those who may disagree
with the views of their government" (9/5). ABC's Compton: "This
was something of a watershed moment for Mrs. Clinton. She has
tangled on domestic policy before, but never on delicate foreign
policy" ("GMA," 9/5). Clinton also called for increased access
to health-care and family-planning services for the world's
women. Her comments are "likely to please" factions of Congress
which have urged the first lady to use the Beijing conference and
a platform to condemn human-rights abuses. Pro-life Rep. Chris
Smith (R-NJ) held a press conference on 9/4 calling for H.R.
Clinton to make such a "condemnation." Smith is part of the 44-
member U.S. delegation and has accused the Chinese of conducting
thousands of "forced abortions and forced sterilizations." He
had attempted to cut funding for the trip, but when he failed,
Smith joined the delegation so he could speak out publicly in
China (L.A. TIMES, 9/5).
WHAT SHE HAS TO SAY: H.R. Clinton headed to Beijing "amid
criticism" that the Chinese will use her presence to "whitewash"
human rights abuses. But the first lady also used her weekly
column to "take a shot" at critics who have called the conference
a "radical gathering" (Ball, N.Y. DAILY NEWS, 9/4). The first
lady said nothing about the "international outrage" over China's
PAGE 11
Abortion Report, September 5, 1995
behavior as "ungracious host." H.R. Clinton writes, "It saddens
me that a historic event like this is being misconstrued by a
small but vocal group of critics trying to spread the notion that
the U.N. gathering is really the work of radicals and atheists
bent on destroying our families" (Orin, N.Y. POST, 9/4). WH
press sec Mike McCurry on H.R. Clinton: "She is not going there
to extend the diplomatic dialogue with China." But some
political analysts and Clinton critics said that the first lady's
decision to go will have an "enormous impact" on the "troubled"
U.S.-Sino relationship (Nelkirk, CHICAGO TRIBUNE, 9/3). The
first lady will be continuing on to Mongolia after her time in
Beijing. WH spokesperson Neel Latimore said that H.R. Clinton
was "encouraged" by the State Dept. to visit the new democracy
and her focus will be on women, children and families (AP/MIAMI
HERALD, 8/31).
RAMIFICATIONS: H.R. Clinton's decision to attend the
conference sent a "strong signal" to the political world that
H.R. Clinton, after a "relatively low" profile since the '94
elections, has "re-emerged in the domestic public arena with full
force." Princeton Univ.'s Fred Greenstein: "She's always been
in and out. Like phases in the moon, she's moving toward full
moon again." But Univ./WI's Charles Jones said that Clinton's
trip triggers old perceptions that the first lady plays a "too-
dominant, too influential role" in the Clinton admin. Jones
added that if relations improve with China many Americans will
jump to the conclusion that H.R. Clinton played a behind-the-
scenes role. Additionally, conservatives would likely become
"energized" if H.R. Clinton became vocal on issues like abortion
and other women's issues. Dem political consultant David Walker
said that "people who liked Hillary before are going to like her
now. People who hated her before are going to hate her. That is
not changing because of China. This provides fodder for
conservatives but endears her to liberals" (TRIBUNE, 9/3).
LANGUAGE: ENGLISH
LOAD-DATE: September 5, 1995
PAGE 12
11TH STORY of Level 1 printed in FULL format.
Copyright 1993, The Commercial Appeal
The Commercial Appeal (Memphis)
September 24, 1993, Friday, FINAL EDITION
SECTION: NEWS, Pg. A9
LENGTH: 299 words
HEADLINE: HILLARY CLINTON EXPECTS PLANS TO OFFER ABORTION
BYLINE: Reuters
DATELINE: WASHINGTON
BODY:
First lady Hillary Rodham Clinton, an architect of President Clinton's health
care reforms, said Thursday she expected most new health plans would offer
abortion services.
"I believe in legal abortion; I believe in safe abortion; but I want
abortions to be rarer than they are now. And we think through this plan, which
emphasizes family planning, we will get to that point," Mrs. Clinton said in an
interview with CNN.
"Abortion services will be available in most plans as they currently are in
most insurance company plans. But there will be plans that for conscience-
exemption reasons will be exempt," she said.
The abortion issue is certain to be a flashpoint in Congress and among
religious and social interest groups in the coming year.
Mrs. Clinton said the increased access to medical care for women contained in
the health plan would help more women receive family planning counseling and
medical help to prevent unwanted pregnancy.
The conscience exemption would allow health plans and doctors to decline to
perform abortion. As administration aides have described it in recent weeks, the
health proposal guarantees a woman's right to reproductive services, but does
not specifically mention abortion.
Clinton's lack of specificity on this issue has left abortion rights
suppporters and opponents at loggerheads over what the proposal actually means
for women. Both camps said Thursday they would mount major advertising and phone
pressure campaigns aimed at influencing congressional action on Clinton's plan.
Under the health care reform proposals, "We are not increasing the
availability or decreasing the availability of abortion," Mrs. Clinton said.
"We are trying to really strike a balance so that we provide what is
available now," she said.
LOAD-DATE: March 25, 1996
WHITE HOUSE
Office of the Press Secretary
For Immediate Release
June 19, 1995
Remarks by First Lady Hillary Rodham Clinton at
Mother Teresa's Home for Infant Children
Washington, D.C.
MRS. CLINTON: Thank you all. Thank you very much. And I too
am so pleased that this day has come, and it has come with the
support, and caring, and love and contributions of so many
people. I want to begin by thanking His Eminence, Cardinal
Hickey, Monsignor Duffy, Sister Sylvia, Mayor Barry,
Congresswoman Norton, and all who have participated in bringing
this day to fruition. I also want again to greet and thank Mother
Teresa. We take great inspiration from your work and from your
ceaseless pursuit of what you believe in.
Earlier I was speaking with Mother and she looked at me and
said, "This is a gift of love but I've been told I cannot give
the gift of peace because I don't give peace to anyone." And I
told her that one of my favorite sayings from another woman whom
I admired, Eleanor Roosevelt, when she too would be criticized
for pursuing what she believed in, she would often say, "I
consider my job to comfort the afflicted and to afflict the
comfortable." And so today we have one of those rare moments
when the afflicted and the comfortable come together on behalf of
the future.
I'm often asked what it is I would like to see happen above
all else in our country and in our world and there are so many
things to wish for, aren't there? So many things to pray for, so
many things to work for. But certainly at the top of my answer
would be a world in which all boys and girls are loved and cared
for. First, by the families into which they are born, then into
families-- if those families are not able to take care of them,
and assume the responsibilities for raising them-- then by
extended families and by really the family of us all who more and
more we have to recognize are all interconnected. And then,
finally, by the families that those boys and girls grow up in,
whom they in turn invest with love and caring to create societies
that value every single child as a gift to be nurtured.
We know we are a long way from that even in our own country,
and some days I fear we are retreating from that vision instead
of moving toward it. But we have to continue to work to build
those kinds of conditions for every child. That is why most of
us, I believe, are here today because we do recognize our own
blessings and we do believe that each of us has a responsibility,
not only to our own children, but to all children.
When I visited the home run by the Missionaries of Charity in
New Delhi, I was struck forcefully by the love that emanated from
every corner of that building. Near it was a home that wouldn't
pass inspection in any town in America. There were too many
cribs with too many babies too close together. I am sure there
were not enough toilets or enough space for what was being done
there, by some kind of regulatory formula, but all I knew was
that there was enormous love and care and concern being given to
those children. You can sense it when you walk into buildings
where children are cared for, can't you? You can feel the
difference when you walk in the door of a child care center,
school, or a hospital, or a shelter where children are cared for
and you can know in the gut of your soul whether or not you would
leave your own child there.
That is the test for every single facility that we have for
any child in America. I call it the "Chelsea test. Some of you
might call it the Jane or the Jack or the Mary or the Charles
test. But that should be the test. So by that test this house
passes with flying colors. You can already sense it is a place
where not only those who come here get the care and love they
need but it will have ripple effects throughout this neighborhood
and community.
This has been about 16 months of hard work. As the Cardinal
said, I first spoke with Mother Teresa about this after the
National Prayer Breakfast and then we both agreed that each of us
could work together to help promote better conditions for our
children, that each of us could do what we believe our own
purpose sets us to doing, and that we could, by working together,
create this opportunity.
The truth is that this is just a beginning and it will grow
and have meaning in people's lives as lives here are saved and
changed and allowed to go forward. I'm particularly pleased that
this house will serve as a place from which children will be
adopted under the responsibility of Catholic Charities, and I
would personally plead that everyone who knows of this house,
everyone who knows of other places like it, will do all that can
be done to promote adoption of the children here in our own
country. We have more than 400,000 children languishing in
foster care in America.
Many parents are discouraged from adopting because of the high
profile cases that unfortunately demonstrate that on a rare
occasion an adoptive family may not be able to keep the child
whom they have adopted. Those are rare occurences. They should
2
not be permitted to discourage Americans from adopting American
babies and children. So please use this occasion to do all that
you can to promote adoption, not only of the babies who will come
here, but of all babies and children. They all deserve homes
and families in America today.
I want to join in thanking Mayor Barry and the District
government and especially Hampton Cross, who worked miracles. It
is not easy under any circumstances to get the necessary
permission to do this and I join in the Mayor's plea that the
example of this house will serve as an example for the rest of
the District government so that we can all begin to cut through
red tape on behalf of human needs and services for our people.
I also want to commend Catholic Charities for forming a
partnership with the Sisters on behalf of children in this
district and I want to thank the lawyers who worked so hard
donating their time. Many more hours than they ever thought when
they agreed to do this to bring about all of the necessary
changes that were required. I particularly want to thank Marna
Tucker and Debbie Pollock for your countless hours of help on
behalf of this effort. And I also want to say a personal word of
thanks to Melanne Verveer on my staff for helping to coordinate
this effort.
Let me end by saying that this home will be an extraordinary
place for the children and mothers who come here I know that it
will serve as an example of what all of us can do if we're
willing to work on behalf of one another and particularly on
behalf of our children. I want to thank Mother Teresa for this
gift of love and for the work that she and the Sisters are doing
throughout our community here in America and around the world.
It is my hope that all of us will think in our own ways about
what else each of us can do to ease the passage, to help soothe
the troubles of people around us. There is so much need and as
we rethink what government's responsibility is let's remember we
are our government. In a democracy, there is no "us" and "them"
and if we say we want government to do things other than what it
has been doing in providing direct services to people, then we
have to govern ourselves in such a way that we make up the
difference. Otherwise we will live to see a society in which our
dreams for all of our children, instead of becoming closer to a
reality, recedes further and further away and that on this day is
something none of us should want to see happen. Thank you all
for being part of this.
###
3
The Alan Guttmacher Institute 1997 Annual Report
http://www.agi-usa.org/agi_about/report97.html
ALAN F. GUTTMACHER 1898-1974
The Alan Guttmacher Institute, an independent,
nonprofit, tax-exempt organization with offices in
New York and Washington, D.C., was established in
1968 to provide research, policy analysis and
education in the fields of reproductive health,
reproductive rights and population. It was named to
honor a distinguished obstetrician-gynecologist,
author and leader in reproductive rights. While Alan
F. Guttmacher was president of the Planned
Parenthood Federation of America and a leader in the
International Planned Parenthood Federation in the
1960s and early 1970s, he saw the need for the
institution that now bears his name, and he nurtured
its development.
The entry in Who's Who is factual, terse:
Guttmacher, Alan Frank, physician; b. Balt., May 19, 1898; S. Adolf and Laura
(Oppenheimer) G.; A.B., Johns Hopkins, 1919, M.D., 1923; D.Sc. (hon.), Brandeis U.,
Dartmouth Coll., 1970; m. Leonore Gidding, July 22, 1925; children-Ann (Mrs. Robert Loeb),
Sally (Mrs. Eric Holtzman), Susan (Mrs. Ben Green). Intern Johns Hopkins Hosp., 1925-26;
asst. in anatomy Johns Hopkins, 1923-24, U. Rochester, 1924-25; various positions from
resident to asso. prof. obstetrics Johns Hopkins, 1926-52; practice medicine, specializing in
obstetrics and gynecology, Balt., 1929-52, N.Y.C., 1952-; former chief obstetrics and
gynecology Mt. Sinai Hosp.; emeritus prof. obstetrics-gynecology Mt. Sinai Med. Sch.; vis.
prof. Einstein Med. Sch. Pres. Planned Parenthood Fedn., 1962; bd. dirs. Margaret Sanger
Research Bur. Recipient Lasker award, 1947; Bronfman award, 1970. Diplomate Am. Bd.
Obstetrics and Gynecology. Fellow Assn. Obstetrics and Gynecology, N.Y. Acad. Medicine,
N.Y. Obstet. Soc. (past pres.). Author: Life in the Making, 1933; Into This Universe, 1937;
Pregnancy and Birth, 1957; Babies by Choice or Chance, 1959; (with J. Rovinsky, Williams,
Wilkins) Complications of Pregnancy, rev., 1965; Complete Book of Birth Control, 1961;
Planning Your Family, 1964; Birth Control and Love, 1969; Understanding Sex, 1970. Home:
1185 Park Av New York City NY 10028 Office: 810 7th Av New York City NY 10019
I
t describes a man who lived a long and eventful life, but conveys neither a sense of him as a person
nor of his place in history. To those who worked with him, Alan Guttmacher was:
Inspired leader
Patient teacher
Reluctant boss
Irreverent skeptic
Indignant advocate
10 of 16
1/11/99 7:39 PM
The Alan Guttmacher Institute 1997 Annual Report
http://www.agi-usa.org/agi_about/report97.lhtml
Irrepressible boat-rocker
Old Testament prophet
Compassionate friend.
And much more. He never was comfortable with the complexities of organizational life or the ways of
bureaucracies; yet no one was better able to unite the Planned Parenthood organization or summon it to
carry out its historic mission. He looked like an old-fashioned man and had a penchant for old-fashioned
virtues; yet his rapport with teenagers was magnificent and he refused, as he put it, "to acknowledge the
immutability of the present." He abhorred the cant which, in his experience, was often associated with
power; yet more than most he was able to move the powerful. He was given to strong opinions and
direct relationships; but even those with whom he sharply disagreed walked away from the encounter
respecting and loving him. He was enraged by injustice and hypocrisy and impatient with the glacial
pace of progress; yet he knew that each fear of change, however irrational, must be dealt with, and that a
revolution is composed of a thousand steps, most of them small. Never for a moment did we doubt that
we were in the presence of an authentic and special human being.
"At heart I am a teacher;
teaching gives me more
satisfaction than any other
activity. It makes little
difference whether the
students are in the primary
grades, high school, college, or
graduate school."
He spent his life as a physician, specializing in obstetrics and gynecology, and later concentrated on the
voluntary control of fertility. But the unifying principle of this life was a broad concept of social
medicine and of the social use of knowledge. He saw medicine as a humanistic profession at the service
of the people, assisting in meeting their personal needs and at the same time contributing to the solution
of society's problems. While others were obsessed with a supposed conflict between the personal and the
societal, he found the dichotomy itself spurious. We may not know if taking care of the personal needs
of individuals will "solve" the problems of poverty and population, he would say, but who knows what
would? We know it is doable, now, he argued, and if each person received the respect and dignity he
deserves, it could not but have a significant effect on the larger problems.
In the early 1930s, long before it became fashionable, he decided that women had the right to a
11 of 16
1/11/99 7:39 PM
The Alan Guttmacher Institute 1997 Annual Report
http://www.agi-usa.org/agi_about/report97.htm
straightforward account of what they could anticipate in pregnancy, that the useful knowledge hoarded
by organized medicine had to be demystified and made more generally available. He began to write a
series of books, revised periodically over four decades as medical knowledge grew, which were read and
reread by three generations of young women who wanted to manage pregnancy, delivery and aftercare
successfully. In 1961, he broke ground by authoring the first paperback on birth control, the forerunner
of dozens of popular books and pamphlets which were to follow. Today he might be described as a
premature "consumer advocate," a pioneer in "informed consent" and an early voice in support of
women's right to know about and control their bodies. But when Alan Guttmacher began his educational
program for American women, he received few plaudits from his colleagues, some of whom viewed
writing for the laity as professionally disreputable.
"No woman is completely free
unless she is wholly capable
of controlling her fertility;
BAR
and
no baby receives its full
birthright unless it is born
gleefully wanted by its
parents."
He joined the birth control movement in the 1920s when he was an intern, after witnessing a woman die
from a botched abortion. In Baltimore, he was an effective advocate, organizer and worker for family
planning at The Johns Hopkins and Sinai Hospitals and the Planned Parenthood affiliate. Following his
appointment as Director of Obstetrics and Gynecology at New York's Mt. Sinai Hospital in 1952, he
assumed increasing leadership of the national Planned Parenthood organization, first as member, then as
volunteer chairman of Planned Parenthood's National Medical Committee and, in 1962, as full-time
national President. In the 1960s he took major responsibility for the work of the International Planned
Parenthood Federation, serving as chairman of its Medical Committee and travelling to scores of Asian,
African and Latin American nations to lecture to physicians, work with program personnel, talk with
ordinary people and meet with heads of state.
12 of 16
1/11/99 7:39 PM
The Alan Guttmacher Institute 1997 Annual Report
http://www.agi-usa.org/ag1_about/report97.html
His whirlwind schedule would have exhausted younger men.
His actions were informed by a pervasive social
consciousness: his purpose, to end discrimination in medical
"While flying, I work at frenzied
care based on class or race, to set things right. Almost as soon
pitch, either writing or studying.
as he arrived in New York he was appalled to learn that the
There must be something
city's municipal hospitals, which provided the bulk of medical
about a cabin pressurized at
care for the poor, prohibited physicians from prescribing
5,000 feet or the absence of a
contraception. In the mid-1950s, Alan Guttmacher and a
telephone which stimulates my
handful of colleagues laid the groundwork for the public
adrenal glands."
campaign in 1958 to end the unwritten ban. His role was to
persuade, cajole, badger, shame-through any and every legal
means-to rally the city's sometimes reluctant medical leadership to change what he regarded as a
discriminatory practice which disgraced his beloved profession. The campaign he led succeeded beyond
the most optimistic hopes of those of us who participated. It established the policy framework for the
provision of family planning services by public health agencies throughout the country in the 1960s.
He travelled to Washington innumerable times in the last decade to appear before Congressional
committees and meet with Administration officials. Whenever he was asked for help, he gave assistance
generously. And he made a difference. In 1966, he put the issue before the country simply and squarely:
"We really have the opportunity now to extend free choice in family planning to all Americans,
regardless of social status, and to demonstrate to the rest of the world how it can be done. It's time we
got on with the job."
Fortunately, he lived long enough to see the national family planning program-which now includes
thousands of hospitals, health departments and community agencies-make rapid strides toward this
goal. He had the satisfaction of witnessing many of the principles of voluntary fertility control to which
he devoted his life inscribed in the law of the land by the U.S. Supreme Count in the Griswold and Baird
cases on contraception and the Wade and Bolton cases on abortion.
To those of us who worked with Alan Guttmacher, it has been an exalting experience. We shall miss him
deeply. We have been privileged to know and work with a rare human being. We can pay Alan F.
Guttmacher the homage and respect he richly deserves by completing the social changes for which he
fought and by building a society in which every child is wanted, loved, healthy and brought into the
world with the best care that modern medicine can offer.
Frederick S. Jaffe
March 20, 1974
Reprinted from Family Planning Perspectives, 1974, 6(1): 1-2;
Frederick S. Jaffe was the first president of the Alan Guttmacher Institute, from its founding in 1968 until his death in 1978.
Quotes from the writings of Alan F. Guttmacher.
Photos courtesy of Ann Guttmacher Loeb.
FINANCIAL STATEMENT
S
tatement of Financial Position
13 of 16
1/11/99 7:39 PM
http://www.pub.whitehouse.gov/ur1-res/12..di://oma.eop.gov.us/1998/10/19/18.text.l
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
October 15, 1998
Promoting School Safety, Preventing Youth Violence
and Encouraging Learning
-- The Clinton Administration Record --
Making Our Schools and Communities Safer and Drug-Free
Forging School-Based Partnerships Between Schools and Law Enforcement.
Under the new School-Based Partnerships grant program, the Clinton
Administration released $16.4 million in grants to 155 law enforcement
agencies in September. The School-Based Partnerships grants will be
used by policing agencies to work with schools and community-based
organizations to address crime at and around schools. This initiative
emphasizes using principles of community policing and problem-solving
methods to address the causes of school-related crime. The grants will
help forge or strengthen partnerships between local law enforcement and
schools to focus on school crime, drug use and discipline problems.
Helping Teachers and Principals Respond to the Early Warning Signs of
Troubled Youth. President Clinton directed the Secretary of Education
and the Attorney General to develop a guide to help teachers and
principals identify and respond to the early warning signs of troubled
youth that can lead to school violence. In August 1998, the Departments
of Justice and Education released Early Warning, Timely Response: A
Guide to Safe Schools. This guide provides schools and communities with
information on how to identify the early warning signs and take action
steps to prevent and respond to school violence. Every school in the
nation received a copy of the guide.
Issuing the First Annual Report on School Safety. In December 1997,
President Clinton called for an Annual Report on School Safety, which
will be released on October 15, 1998. The report will include: an
analysis of all existing national school crime data and an overview of
state and local crime reporting; examples of schools and strategies that
are successfully reducing school violence, drug use and class
disruption; actions that parents can take locally to combat school
crime; and resources available to schools and communities to help create
safe, disciplined and drug-free schools.
Strengthening and Expanding the Safe and Drug-Free Schools and
Communities Act. In 1994, President Clinton expanded the Drug-Free
Schools Act into the Safe and Drug-Free Schools Act, making violence
prevention a key part of this program. The Safe and Drug-Free Schools
Program provides support for violence and drug prevention programs to
97% of the nation's school districts. Schools use these funds to keep
violence, drugs and alcohol away from students and out of schools. The
President's FY99 budget expands the Safe and Drug-Free Schools program
by $50 million to fund 1,300 Drug and Violence Prevention Coordinators
that will help junior high and middle schools across the country develop
and implement effective strategies to keep our kids safe and away from
drugs.
Enforcing Zero Tolerance for Guns and Other Weapons in Schools. In
October 1994, President Clinton signed into law the Gun-Free Schools
Act. requiring states to have in effect a law requiring local education
1 of 4
11/6/98 2:33 PM
http://www.pub.whitehouse.gov/uri-res/12.di://oma.eop.gov.us/1998/10/19/18.text.l
agencies (LEAs) to expel students who bring guns to school. The
President issued a Presidential Directive later that month to enforce
"zero tolerance" for guns in schools, a policy requiring the expulsion
of students who bring guns to schools. In school year 1996-97, the U.S.
Department of Education estimates that, under zero tolerance policies,
6,093 students were expelled from public schools for bringing a firearm
to school.
Supporting Civic, Community and Faith-Based Organizations. Recognizing
the important role that civic, community and faith-based organizations
can play in reducing crime, the Administration launched a new
Values-Based Violence Prevention Initiative to make $2.2 million in
grants available to 16 community-based collaboratives, including
religiously-affiliated organizations, that target youth violence, gangs,
truancy, and other juvenile problems by promoting common-sense values
and responsibility.
Providing Safe After-School Opportunities for Up to Half a Million
Children a Year. Last year (FY98), the 21st Century Community Learning
Centers program was expanded by $40 million. This funding will enable
315 rural and urban schools in 36 states to provide school-based
after-school programs, including on weekends and during the summer.
This year, the President proposed a major expansion of this program to
provide safe and educational after-school opportunities for up to
500,000 school-age children in rural and urban communities across the
country. In addition, the Education Department released a report in
June 1998, titled Safe and Smart: Making the After-School Hours Work for
Kids. This report shows that after-school programs can lower juvenile
crime and improve academic performance. Safe and Smart was sent to
every school district in the country.
Cracking Down on Truancy. Truancy prevention initiatives have been
shown to keep more children in school and dramatically reduce daytime
crime. The Education Department issued a guidebook to the 15,000 school
districts nationwide which outlines the central characteristics of a
comprehensive truancy prevention policy and highlights model initiatives
in cities and towns across the country. Since then, the Education
Department has provided grants to local school districts to develop
innovative truancy prevention programs of the kind described in the
guidebook.
Encouraging Schools to Adopt School Uniform Policies. School uniforms
have been found to be a promising strategy to reduce violence while
promoting discipline and respect in school. Because of this, the
Clinton Administration has encouraged schools to consider adopting
school uniform policies by sharing with every school district a school
uniforms manual prepared by the Department of Education in consultation
with local communities and the Department of Justice. Since the
President highlighted school uniforms, a growing number of schools have
adopted these policies including: New York City, Dade County, San
Antonio, Houston, Chicago and Boston.
Supporting Curfews at the Local Level. Community curfews are designed
to help keep children out of harm's way and enhance community safety.
Because of their success, President Clinton has encouraged communities
to adopt curfew policies. A 1997 survey by the U.S. Conference of
Mayors has shown that 276 of 347 cities surveyed -- or 80 percent -- had
youth curfew laws, up from 70 percent in 1995.
Developed a Comprehensive Anti-Gang and Youth Violence Strategy.
President Clinton has proposed a comprehensive strategy to (1) target
gangs and violent youths by hiring new prosecutors and probation
officers, and expanding anti-gang task forces and the use of
racketeering statutes (i.e., RICO) for gang-related offenses; (2) crack
down on kids and guns by prohibiting violent juveniles from buying guns
2 of 4
11/6/98 2:33 PM
http://www.pub.whitehouse.gov/iuri-res/f2.diz//oma.cop.gov.us/1998/10/19/18.texT
and increasing penalties for selling handguns to youths; and (3) keep
kids off the streets and out of trouble by expanding after-school
programs and promoting anti-truancy initiatives and youth curfews.
Keeping Guns Out of the Hands of Children. A number of laws and
initiatives are keeping guns out of the hands of children and away from
criminals. For instance, since the Brady Law's enactment, 250,000
felons, fugitives and stalkers have been denied handguns, and the 1994
Crime Bill banned 19 of the deadliest assault weapons and their copies
-- keeping assault weapons off America's streets. The Youth Crime Gun
Interdiction Initiative (YCGII) is cracking down on the illegal gun
markets that supply firearms to juveniles and criminals in 27 target
cities. The YCGII has already traced more than 93,000 guns, providing
law enforcement with crucial investigative leads about illegal gun
trafficking. The Administration's FY99 budget proposal contains an
expansion of YCGII. In addition to these programs, President Clinton
signed a directive to every federal agency, requiring child safety
locking devices with every handgun issued to federal law enforcement
officers. And, in an historic agreement, eight major gun manufacturers
have voluntarily agreed to provide child safety locking devices with all
their handguns, helping to protect our children.
Encouraging Conflict Resolution. The Departments of Education and
Justice have developed and distributed 40,000 conflict resolution guides
to schools and community organizations, providing guidance on how to
develop effective conflict resolution programs; Education and Justice
are training community officials and educators on these conflict
resolution measures.
Targeting Young People with a National Anti-Drug Media Campaign. In
July 1998, President Clinton launched the national expansion of the
Anti-Drug Media Campaign first proposed in last year's drug strategy and
budget. The 5-year, $2 billion campaign is designed to let teens know
-- when they turn on the television, listen to the radio, or surf the
Net -- that drugs are dangerous, wrong and can kill you.
Building and Strengthening 14,000 Community Anti-Drug Coalitions. In
1997, President Clinton signed into law the bipartisan Drug-Free
Communities Support Program. Over the next five years this program will
provide $143.5 million to help community coalitions rid their streets of
drugs the coalitions are made up of young people, parents, media, law
enforcement, religious and other civic organizations and school
officials. Under this program, the President recently announced new
Federal assistance to enhance grassroots efforts in 93 communities in 46
states to prevent youth drug abuse. This assistance will fund the work
of broad-based community coalitions to target young people?s use of
drugs, alcohol and tobacco.
Strengthening Schools, Promoting Discipline and Supporting Learning
Working Toward Smaller Classes with Well-Prepared Teachers. President
Clinton has proposed helping school districts reduce class size in
grades 1 3 to a nationwide average of 18 students by helping them to
hire an additional 100,000 well-prepared teachers. This initiative will
help children learn to read well in the early grades by giving them more
individualized attention, will help teachers get the training and
preparation they need to succeed and help educators maintain discipline
and order which fosters a better learning environment.
Providing Early Education to More Children with Head Start and Early
Head Start. Since 1993, the Clinton Administration has expanded Head
Start by 57 percent, from $2.8 billion in FY93 to $4.4 billion in FY98.
Now, 830,000 children are enrolled in Head Start, 200,000 more today
than in 1992. In addition, the landmark Head Start Act Amendments of
11/6:98 2:33 I'M
http://www.pub.whitehouse.gov/uri-res/l2.di//oma.eop.gov.us/1998/10/19/18.text.
1994 established the Early Head Start program, which expands Head Start
to low-income families with children under three and to pregnant women.
Under the President's budget, by 1999 nearly 50,000 infants, toddlers
and their families will be served by Early Head Start. Studies have
shown that investments made during the early stages of life reduce
tendencies towards violence later in adulthood. Additionally, early
investments also ensure that children are ready to learn when they enter
school.
Replacing Crumbling Schools with Safer Ones. The proposed School
Modernization Initiative will, if enacted, provide communities with
interest-free bonds to help renovate, modernize and build over 5,000
schools nationwide.
Teaching Every Child to Read by the Third Grade. More than 1,000
colleges have committed work-study students to tutor children in
reading, and thousands of AmeriCorps members and senior volunteers are
organizing volunteer reading campaigns. In addition, a proposed early
literacy bill, such as the America Reads Initiative, will provide more
tutors after school, improve the teaching of reading in our schools, and
help parents help their children learn to read.
Striving for Excellence with National Education Standards. Seeking high
national standards for all students, the President has proposed a
first-ever national test in 4th grade reading and 8th grade math. Goals
2000 is helping States to establish voluntary standards of excellence
and to plan and implement steps to raise educational achievement. In
addition. the Title T. program is helping more than 10 million
disadvantaged students reach high academic standards by giving them
extra help with basic and advanced skills.
Expanding Choice and Accountability in Public Schools. The number of
public charter schools has increased from only one charter school in the
nation in 1993 to more than 1,000 charter schools this year, providing
greater choices in public education to families across the nation. The
Administration has also called for an end to social promotion,
aggressive intervention in failing schools, and higher standards for
students, teachers and schools.
4 of 4
11/6/98 2:33 PM