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STATEMENTS OF HON. JOSEPH D. TYDINGS, FORMER U.S. SENATOR FROM THE STATE OF MARYLAND; FREDERICK S. JAFFE, VICE PRESIDENT, PLANNED PARENTHOOD FEDERATION OF AMERICA; RUSSELL H. RICHARDSON, PRESIDENT, FAMILY PLANNING FORUM; SHELDON J. SEGAL, PH. D., VICE PRESIDENT AND DIRECTOR, BIOMEDICAL DIVISION, POPULATION COUNCIL; DR. THOMAS L. HALL, ACTING DIRECTOR, CAROLINA POPULATION CENTER; DR. WILLIAM LITTLE, CHAIRMAN AND PROFESSOR, DEPARTMENT OF OBSTETRICS-GYNECOLOGY, UNIVERSITY OF MIAMI, SCHOOL OF MEDICINE; AND DR. LOUISE B. TYRER, FACOG, PROJECT DIRECTOR, DIVISION OF FAMILY PLANNING, AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS Mr. TYDINGS. Mr. Chairman, in the procedure which you wish to follow

Mr. ROGERS. Any way you would like to proceed.

Mr. TYDINGS. Allow me to suggest I will begin and each probably has a statement they will submit for the record and make comments based on that statement.

Mr. ROGERS. Without objection, all of the statements will be made a part of the record in full.

STATEMENT OF HON. JOSEPH D. TYDINGS

Mr. TYDINGS. My name is Joseph Tydings. I am, as you indicated, national cochairman of the Population Crisis Committee. However, I have not cleared this statement with them this morning; this is my

own statement.

I am speaking as the author, at least the Senate sponsor, of the Family Planning and Services Act. As you know, it is H.R. 11845 which is before this committee this morning.

I would ask that my statement be incorporated into the record in its entirety and would like to make basically three points, Mr. Chairman. First of all, I would hope that you extend the legislation for 3 years rather than 2. I say that because of the difficulties in extending this type of authorization and the need for proper planning to be based on a 3-year rather than a 2-year period.

The second point I would like to make is I would hope you would use the authorizations from HEW's own 5-year funding program for fiscal years 1975 and 1976, this is for services now. That would mean for fiscal year 1975 you would have $181 million instead of $120 million and in fiscal year 1976 you would have $225 million instead of $120 million.

Third, I would hope you would restore the funding authority for research. Here, again, I would think that the authorizations should be based on the exact figures of HEW's own 5-year funding plan, that would be for fiscal year 1975, $100 million, and fiscal year 1976, $125 million.

Now, if you will forgive me, Mr. Nelsen and Mr. Rogers, I will endeavor to educate you a little on the history of this entire fight with HEW and the bureaucracy over the years to try and get family plan

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I have read some of the testimony which has been before you in your current hearings, testimony of the distinguished Assistant Secretary for Health, Dr. Edwards, who states:

The provisions relating to family planning activities also would not assist us in carrying out our family planning responsibilities.

The whole tenor of this testimony is an exact duplication of the same type of testimony the Congress has received over the years from HEW beginning with John Gardner back in 1966, Wilbur Cohen, Bob Finch, right on down to date.

All the Federal Governmental progress that has been made in family planning in the United States has been because of your committee and because of the U.S. Senate. It has been the congressional initiative. When the Congress finally passed the Family Planning Services Act of 1970-and, as you know, Dr. Carter was instrumental in working this out it was only after we finally battered down the bureaucracy in HEW.

The testimony transcribed before congressional committees is replete with quotations from Secretary Gardner and Secretary Cohen, and Secretary Finch about how they already had the funds and, if Congress wouldn't do anything, if we wouldn't authorize anything, if we wouldn't direct anything, the necessary family planning work would get done anyway. It just never happened.

In the hearings which were chaired in the Senate in 1969 and 1970 by Senator Eagleton and Senator Javits, we prepared an effective cross-examination we knew exactly what Mr. Finch was going to say because he said exactly what Mr. Cohen and Mr. Gardner had said several years earlier. Senator Javits and Senator Eagleton and I finally nailed him down about the same old broken record, that is when we adopted the Family Planning Act which provides categorical grants.

Now we have before you a statement from HEW that we really don't need categorical grants so much, that we are going to tie the Nation's family needs to medicaid and tie it on to welfare. I don't have to tell you, Mr. Chairman, or you, Mr. Nelsen, the problems we have with welfare in the country or the problems with medicaid.

The title IV regulations they proposed earlier last year, if they had been adopted, if the Congress had not stopped them, would have vitiated what little progress had been made. You just can't hook family planning program onto medicaid or welfare and expect this program to go forward.

Now, if I might, let me focus on one other HEW misconception, that is, that we have no real national problem with unwanted pregnancies. True, the population growth rate has been declining but, unfortunately, we still have a tragic number of unwanted pregnancies, many of which are dangerous medically.

I might suggest that when the gentleman from Chapel Hill testifies, you might ask him a little bit along this line because I was educated a number of years ago by some of the men at Chapel Hill as to the dangers a mother runs with a pregnancy if she is under the age of 12 or 13 or over the age of 40: The likelihood of her child being Mongoloid, the likelihood of mental retardation, all of the problems that relate to medically high-risk pregnancies.

There are many of our citizens in this country who do not believe in abortions, who do not want abortions but last year we had 700,000 legally reported abortions. Now if there is any possible clearer testimony that we need better contraception or we need our national family planning program to work, I don't know what better documentation than these abortions. I think no one wants abortions. But at least 700,000 women were sufficiently desperate when they didn't have access to contraceptives or the contraceptives failed, to take that step.

One final point I would like to make, and I would like to offer for the record at this time a research report completed in 1973 by the Center for Family Planning Program Development entitled "ShortTerm Costs and Benefits of the Federal Family Planning Program" (see p. 837). It so happens the director of that project, Mr. Jaffe, is here.

This research was undertaken at the request of General Draper, myself and others over a year ago to show to Secretary Weinberger and others in HEW the tremendous cost savings and cost benefits to the Federal Government of our Federal family planning program. When it was organized, engineered, prepared, we told Mr. Jaffe who directs the Center for Family Planning Program Development that this study ought to be the most conservative possible type of report and that we only wanted the medical dollar savings to the Federal Government and the States in the year after the family planning expenditures were made, not the long-term savings on welfare, or housing or education or anything like that, just the medical savings with respect to the cost to the Government of medical care during pregnancy and medical care and public assistance during the first year of the child's life.

The figures here are tremendously impressive. They show that the savings to the State and to the Federal Government in the first year for every dollar spent, every dollar appropriated here in medical costs, public assistance, and welfare just during pregnancy during that first year amounted to $2.50 for every dollar spent.

Those are tremendously impressive facts, particularly in the times that we live in today.

I would like, Mr. Chairman, to give this to the reporter.

Mr. ROGERS. Without objection, it will be made a part of the record. Mr. TYDINGS. Let me say, this year, 1974, is "World Population Year." The United Nations, pressed by the United States with our leadership and support, is holding a world conference in Bucharest, Romania. The idea is to focus the attention of the entire world on too rapid population growth and come up with programs or projects that can be adopted voluntarily around the world.

At this particular time when in a sense we are leading the world effort to focus on this problem, I think it would be most unfortunate if we took steps backward from the tremendous steps forward we have taken in the last 3 or 4 years.

Let me close by saying, Mr. Chairman, that all the initiatives have been from the legislative branch and, if you listen to the executive branch (and I have the greatest respect for these gentlemen, I worked with them and admire them), the bureaucracy in both administrations, Democrat and Republican, have not focused on the problem and have not been responsible for the gains we have made.

This has been a legislative program, and it needs legislative leadership again.

Thank you.

[Testimony resumes on p. 859.]

[Mr. Tydings' prepared statement and attachments referred to follow :]

STATEMENT OF HON. JOSEPH D. TYDINGS, A FORMER U.S. SENATOR FROM THE STATE OF MARYLAND

Mr. Chairman: I am delighted to be here today in support of H.R. 11845, a bill to extend for two years the Family Planning Services and Population Research Act of 1970 (Title X of the Public Health Service Act) along with other expiring health authorities. I recall with great pleasure the cordial reception given to me and other witnesses some three and one-half years ago by this subcommittee when we testified before you regarding the need for a strong national program to extend family planning services to all Americans who want but cannot afford them and for a major new commitment to population research. The members of this subcommittee have always acted expeditiously and forcefully by supporting the type of family planning services and population research programs which can best meet the nation's needs. It is perhaps ironic that we are here again to discuss how best to finance the family planning program, when Title X has proven to be one of the most successful items of health legislation ever enacted by the Congress. Until OMB decided to freeze the project grants funding under Section 1001 of the Act, the program met its goals consistently on schedule, according to its own five-year plan.

The history of the family planning legislation very clearly demonstrates that without categorical grants for services and a continuing direct accountability to the Congress, the Department of Health, Education and Welfare would have done little to extend access to family planning to low-income individuals who need and want them. As you are well aware, Mr. Chairman, the Department has consistently opposed categorical grant programs as unnecessary for the provision of family planning services. In May, 1966 the then Secretary of Health, Education and Welfare, John Gardner, announced his opposition to S. 2993, a proposal for a five-year categorical grant program for family planning services which I had introduced.

Mr. Gardner favored a broader authorization, S. 3008, which subsequently became the Comprehensive Health Act of 1966. Wilbur Cohen, then Undersecretary of HEW. notified me that the Department contemplated spending $20 million in FY 1968 and $25 million in FY 1969 for family planning, under Section 314(e) of that Act. However, with this broad authorization, HEW only spent some $200.000 in FY 1968 and $300.000 in FY 1969-one percent of the Department's announced projections for family planning.

In 1967, former Senator Ernest Gruening held hearings to examine the progress made by the Department in providing access to family planning services to lowincome individuals. It quickly became apparent, according to a review of the programs undertaken at the initiative of Secretary Gardner, that the Department was making little headway still. Consequently, the Congress earmarked specific funds for family planning in both the Maternal and Child Health program authorized under the Social Security Act and under the Economic Opportunity Act. Yet, the Department continued to drag its feet. The Congress received promises rather than programs.

We were barraged, as we are now, with misleading data about the levels of funding and numbers of patients covered by federally subsidized family planning programs. Under Congressional scrutiny, in 1969, the then Secretary of HEW, Robert Finch, admitted that the data, particularly the data concerning the Medicaid program which he characterized as "Mickey Mouse" figures, was misleading. It was only in that year, and in response to the introduction of the Family Planning Services and Population Research Act, that the Department took the first concrete step to expand family planning services by creating the National Center for Family Planning Services, an administrative structure finally capable of developing a broad scale program.

In 1969, at the same hearings on S. 2108, the Family Planning Services and Population Research Act, many of the old familiar arguments were presented by DHEW, asking once again for "one more year" and leading Senator Eagleton

services were in fact needed. However, he opposed the section of the legislation which called for special grants and contracts for research in human reproduction and contraceptive development as "unnecessary," although only $9.8 million were being spent in this research area by NIH in 1969. He also lobbied hard against the establishment of a National Center for Population and Family Planning which would have been responsible for both services and population research. The continuing merits of such a proposal have already been discussed by members of Congress appearing before this Committee.

In compromise, the Department withdrew its opposition to the legislation in exchange for a modified organizational framework. Instead of a National Center for Population and Family Planning, the bill provided for an Office of Population Affairs, within the Office of the Assistant Secretary of Health, to be headed by the Deputy Assistant Secretary for Population Affairs. Dr. Louis Hellman was selected for that post. Secretary Finch indicated at the time that the Department would be willing to reconsider its position if the arrangement proved unsatisfactory.

Since the passage of the Family Planning Services and Population Research Act, the course and progress of the program has intermittently run afoul of administrative and fiscal obstacles. First, DHEW refused to seek a supplemental appropriation necessary for the speedy implementation of the legislation. Then, in October 1971, the Five-Year Plan for Family Planning Services and Population Research, which is required under Title X, was submitted to the Congress nearly three months late, and only after considerable Congressional prodding. The annual update for FY 1972 was received by the Congress five months late. The plan due this year on January 1 still has not been forwarded to Congress and is being held up by OMB.

In 1973 the Administration's contradictory initiatives were nothing short of bewildering. DHEW first asked for a considerable increase in project grant funds, an increase large enough to require an increase in the Title X authorization level. After Congress had approved the increased authorization and approved the DHEW budget request, OMB apparently changed its mind and the funds were impounded. A similar request for increased funding of research was approved by Congress and then impounded. The Administration proposed to do away with the Congressionally-mandated national program goal of reaching over 6.6 million low-income women with subsidized family planning services by shifting the responsibility of providing services for those not covered by present programs on to the states to be financed by third-party reimbursement through the Title IV-A and Medicaid mechanisms. These are programs over which Dr. Hellman has no substantial authority. Then it proposed new and stringent regulations for the IV-A program which could only insure that there would be very modest increases in the number of family planning patients served by this program. It was only prompt Congressional action which suspended the implementation of these social service regulations. Most recently, the Department has abolished the National Center for Family Planning Services-the only agency clearly responsible to the Congress for the provision of such services. The research program which grew very rapidly as a result of the 1970 legislation is at a standstill and totally lacks visibility in the National Institutes of Health.

Mr. Chairman, although much progress has been made, it sometimes appears as if the progress has occurred in spite of rather than at the initiative of the Department. In terms of both services and research programs, the broken record mentioned by Senator Eagleton is still very much with us. Listen to what Secretary Gardner said to Senator Joseph Clark back in 1966. "We strongly endorse the basic objective of the bill-i.e., to make comprehensive voluntary family planinng programs available to those who would not otherwise have access thereto but we already have and are increasingly using such authority in that respect and we believe [what] is needed at this time [is] authority which will be made even broader by the enactment of S. 3008. We therefore cannot recommend enactment of S. 2993 at this time."

Dr. Edward's testimony of last Thursday is substantially the same: "The provisions relating to family planning activities, also would not assist us in carrying out our family planning responsibilities. The authorizations for research training and information activities are duplicative and unnecessary and we oppose them as sufficient authority already exists under other parts of the Public Health Service Act."