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able contraceptive methods in this country are woefully inadequate. This is reflected in the fact that more than one-half of the nearly 6 million pregnancies that occur each year in the United States are unintended.

Mr. Chairman, we commend you and this subcommittee for your wonderful leadership in this area. The funding you directed for the establishment of contraceptive and infertility research centers will lead to the development of safer, more effective methods of contraception.

Title x has taken some hard hits over the last decade. And the need for services has increased and funding has been cut. In addition the Reagan administration issued the gag rule. These regulations forbid doctors and other medical professionals from giving patients objective information or referrals regarding their legal options when facing an unwanted pregnancy.

Congress has spoken on this matter before and we ask that you do so again. We ask you to codify language to overturn the gag rule. By doing so you will ensure that woman receiving care through a title X facility will get the same range of information as someone receiving care through a private physician.

It is vital that title X funding be increased. Continuing efforts must be made to bring spending for family planning to levels that will ensure the continuation of services now being provided and to reach the millions of women and teenagers in compelling need of our services.

PREPARED STATEMENT We urge you to appropriate $180 million for the title X program for fiscal year 1992, an amount far short of the $239 million we would have reached had funding continued from 1981 adjusted to inflation.

I thank the Chair and the subcommittee for this opportunity to testify.

[The statement follows:)

STATEMENT OF THERESA SCHEETZ

I am Theresa Scheetz, Board Member of the planned Parenthood of Western Pennsylvania. Today, I am presenting testimony on behalf of the planned Parenthood Federation of America and its president, Faye Wattleton. I thank the committee for the opportunity to participate in this hearing.

with more than 30,000 volunteers and staff and over 500,000 supporters, PPFA is the oldest and largest national voluntary family planning agency in the United States. Our 171 communitybased affiliates in 49 states and the District of Columbia provide medical, educational, and counseling services to more than four million individuals each year at 879 clinics, supported by a mix of public and private funds.

The Title x family planning program is a program that works. It provides needed health care services; it prevents unintended pregnancies and the need for abortion; it effectively addresses teen pregnancy. And, it is cost effective. Yet, it is a program besieged by controversy and politics. As a health care provider, I am amazed and saddened that a program that has done such good for so many can be so hamstrung by. lies and distortions.

I believe the facts speak for themselves.

Since 1970, Title X of the Public Health Service Act has been the core of our national family planning effort.

Each year 4500 public and private clinics around the country provide medical and educational services to over four million low income women and teenagers. While the primary focus of Title x is contraceptive services, Title X-supported clinics offer preventive health services, and are often the first place lowincome women and especially teenagers receive formal medical care.

Title X-supported clinics offer health screening assessments and either treatments or referral for anemia, hypertension, cervical and breast cancer, sexually transmitted diseases, kidney dysfunction and diabetes.

A tremendous number of women continue to go unserved. According to a 1987 study by the Alan Guttmacher Institute, there were approximately 31.8 million low-income women at risk of unintended pregnancy in the United States that is, sexually active, fertile and not seeking to become pregnant.

In 1985, there were 16,350 pregnancies among Pennsylvania state women age 17 and younger. In 1987, Pennsylvania had 542,120 teenage and poor women at risk for unintended pregnancy. In 1988, Pennsylvania had 1,643 infant deaths and 11,417 low birth weight babies. Yet, from FY 1980 to FY 1990, Title x family planning and contraceptive service funding for the State of Pennsylvania was cut 11 percent.

The demands on Title X clinics around the country have grown dramatically. More and more patients are testing positive for sexually transmitted diseases, including AIDS. Family planning clinics are logical sites for counseling, testings and treatment of STDs, but they must have additional funds to provide these new services and continue to see an ever-growing population of patients. Former Surgeon General C. Everett Koop, among others, have recommended that family planning clinics help provide HIV testing and counseling services.

Yet, despite this need for family planning services and despite the accomplishments and proven costs savings of the Title

X program, funding for services has declined from $162 million in
1981 to $141 million today. The effects upon family planning
services have been severe. To avoid turning patients away,
clinics around the country have been forced to reduce the scope
of their services. They have found it difficult to maintain,
much less expand, the other types of clinical reproductive
services so needed in low-income communities.

Title X-funded clinics are being hit with huge increases in costs. The cost of pap smears, critical to the detection of cervical cancer, has increased nearly fourfold over the last two years. New drug pricing policies may dramatically increase the cost of contraceptives to family planning clinics. Norplant, the newest contraceptive method, will cost clinics $350 and an additional $200-$300 for its implantation too much for most clinics to subsidize.

Each year, publicly supported family planning services prevent 1.2 million unintended pregnancies, which would result in 509,000 unwanted births and 516,000 abortions. According to a 1989 study, every public dollar spent to provide contraceptive services saves $4.40 in taxpayer funds that otherwise would go toward medical care, welfare and other mandated social services an overall total of $1.8 billion in savings annually. There should be no question that Title x is one of the most effective preventive public health care programs. (with your permission, I would like to submit a copy of the study for the record.)

clearly, continuing efforts must be made to bring Title x to funding levels that will ensure the continuation of services now being provided and to make progress toward expanding services to the millions in need who are presently not being served. To that end, we strongly urge this subcommittee to provide funding at levels that more accurately reflect the need for family planning services.

of the 36 million American women who are seeking to avoid pregnancy, three million are using no contraception, and another three million are using the least effective methods. A 1989 study published by the Alan Guttmacher Institute showed that, even among those women using the most effective methods, contraceptive failure rates were much higher than generally thought. The most common reason cited for using no method is the fear of possible side effects, despite an increasing body of research proving the safety and efficacy of several major methods. It is critical that further studies be pursued to identify and counteract the specific risk factors that do exist. At the same time, intensified research in the development of new and improved methods of contraception could greatly enhance our ability as a society to lower the staggering 55 percent incidence of unintended pregnancy that still exists in this country today.

We need new safe, effective and acceptable methods of contraception, and we need to assure ourselves about the safety and efficacy of current ones. We are extremely pleased that, at the urging of this subcommittee, NICHD is establishing five new contraceptive and infertility research centers before the end of the year.

Yet, we know that the three million dollars allocated for these centers will not go far. We urge Congress to commit itself to steady and reliable funding for these ner: centers and for general contraceptive development.

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The troubled state of family planning in our country is partly the result of steadily decreasing funds. But Title x has also been hit with a series of repressive and unrealistic regulations that defy good medical care.

The most outrageous of these restrictions is the infamous 1988 "gag rule," formulated by the Reagan Administration and supported by the present administration. Under these regulations, doctors and medical professionals who serve women in Title x clinics are forbidden from giving any information about the legality or availability of abortion to their clients, even when they specifically request it. This abuse of the privacy rights of women and interference with the responsibility of medical professionals to their clients is shameful. The regulations are unethical and set up two kinds of health care: quality care if you are affluent, second-rate care if you are poor.

These regulations have been opposed by 36 state governments, 78 national organizations (including every major medical association) and the deans of each of the 25 schools of public health in the United States.

Congress has spoken on this matter before and we ask that you do so again. We ask you to codify language to overturn the gag rule.

By so doing, you will ensure that women receiving care through a Title x facility will receive the same range of information as someone receiving care through a private physician.

In conclusion, Mr. Chairman, Planned Parenthood respectfully makes the following recommendations to the subcommittee:

Appropriate funds for the title x family planning program at a funding level more in keeping with the needs of the population served. If funding had continued from 1981, adjusted for inflation, the level would be $239 million for FY 1992.

Expand contraceptive research authorization for the new centers and assure reliable funding levels for the current efforts.

- Codify congressional intent that women seeking information about managing an unintended pregnancy in a federally supported family planning clinic be given honest, nondirective counseling about all of their legal options and referrals upon request.

Thank you for your consideration.

Senator HARKIN. Thank you very much for being here. As I told your predecessor who was here earlier, title X is a program that we are very supportive of. We will do everything we can to fund it.

Ms. SCHEETZ. I do have the figure for contraceptive research and that would be requesting $10 million.

Senator HARKIN. Thank you. I appreciate it, Theresa.

STATEMENT OF DR. KENNETH E. QUICKEL, JOSLIN DIABETES CEN

TER, BOSTON, MA Senator HARKIN. Next is Dr. Kenneth Quickel, Joslin Diabetes Center.

Dr. Quickel, I welcome you to the subcommittee. We have your statement. Please proceed. Your statement will be made a part of the record in its entirety.

Dr. QUICKEL. Senator Harkin and members of the staff, if you are as hungry as I am, you will appreciate my brevity.

I must admit that sitting in the back of the room for the morning, I am deeply impressed with the degree of commitment that you folks have to a lot of marvelous issues. I do not see where

you are going to find all the money to do all the things that need to be done, but I certainly respect the process.

I am Dr. Ken Quickel and I am president of the Joslin Diabetes Center in Boston. As the Nation's largest diabetes research and patient care center, we believe that we have an obligation to speak out on behalf of the millions of people who are dedicated to making it a better world for those folks with diabetes.

I hope to communicate a bit with you about what we believe it takes to control this ferocious disease. I had intended to bring with me this morning a young woman from Massachusetts named Pam Fernandez, to show you something about the reality of diabetes, but she is giving a seminar about blindness at Boston University this morning. She is young, bright, attractive, articulate, fully employed. But diabetes since childhood has left her blind and with a kidney transplant. And her brother died of the disease just over 1 year ago.

Diabetes is a very important public health problem. But the public severely underestimates its impact unless, of course, they have diabetes themselves.

Fourteen million Americans have diabetes. 500,000 new cases occur every year. 250,000 deaths occur annually from diabetes. It is especially frequent in minority groups and especially among the elderly. It is a particular risk for women and children who have diabetes.

We cannot yet cure diabetes. Even though it is the third leading cause of death, it hides behind the complications that it causes. People fear blindness and they fear amputations and they fear heart attacks. And they fear the other complications of diabetes without realizing these are simply the public face of a very severe underlying disease.

Diabetes is the leading cause of blindness in working aged Americans. It is the leading cause of nontraumatic amputations due to gangrene often caused by nerve or blood vessel damage. It is the leading cause of end-stage renal failure, a major contributor to heart disease and strokes among the elderly.

The United States is the international leader in biomedical research and in diabetes research in particular. But we are in jeopardy of losing our preeminence in failing to provide leadership if funding should subside.

At Joslin and other diabetes research centers around the country, we are making the greatest strides ever in the history of diabetes right now. We are beginning to bring science to the bedside with remarkable new methods of detection and prevention and treatment.

But the diabetes research structure is fragile. If we do not fund the work, the researchers will be forced to turn their attention elsewhere. At that point our momentum will be lost. As an example, researchers now face about a 15-percent chance of having an NIH grant proposal funded. That is 1 in 6.

I realize how often you folks feel and hear the call for more funding for this program and that. And your task is terribly difficult. But diabetes cost our Nation $25 billion a year and the human cost is even higher. A major proportion of that price is, in fact, paid by

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