quately staffed, tax-supported, municipal hospitals. These hospitals were two or three busfares away from many of the families who had no place else to go for maternity care in 1963 and as a result so many mothers received little or no prenatal care.

In 1963, 40 percent of the city's residents giving birth were medically indigent; in 1970 this had increased to 50 percent. In 1963, the incidence of prematurity among general service patients was 3 times that of the private patients receiving adequate prenatal care and the infant mortality rate of these low- or no-income patients was twice as high as that of private patients.

The New York City MIC program started in 1964 with two maternity clinics in district health centers and has grown each year until there are now maternity clinics in 11 health department centers located in the ghetto areas of the city.

This map of New York City shows here the Bronx, Manhattan, and Brooklyn. The ghetto areas of New York City are the lower portion of the Bronx, the upper part of Manhattan, and the upper sweep of Brooklyn.

The large stars represent the MIC maternity and family planning centers. The 11 smaller stars represent the health department centers where we have family planning but not maternity services.

In other words, we are concentrated in those areas which have the lowest income groups in the city.

In 1970, 13,000 maternity patients received care in these 11 centers that were starred. In 22 health department centers shown there family planning services were provided to 35,000 different women. The graphs attached to my testimony show the growth of the MIC program since 1964. I have been in public health work for 30 years. I have never seen a program accepted as rapidly by the people as this program has been in New York City. Medical care is provided by skilled obstetricians or certified nurse-midwives from the staffs of 10 voluntary and three municipal hospitals affiliated with the MIC project. The women are delivered in these hospitals.

Our whole MIC program is a part of the mainstream of medical care in New York City. The MIC patients receive total maternity care during pregnancy, at delivery, and post partum. In addition to obstetricians and certified nurse-midwives, the clinics are staffed with public health nurses, social workers, nutritionists, dentists and all of the ancillary personnel needed. Humane and dignified patient-doctor, patient-nurse relationships are maintained. Consultation or hospitalization for complications is readily available in the affiliated hospitals. Specialized teenage clinics are now available in two of the boroughs to meet the many difficult problems of the young, unmarried mothers and, if this program is extended, we will have at least five more open by the end of 1972 to serve the particular needs of these youngsters. The MIC program, we believe, has made great strides in reducing

infant mortality in New York City, as evidenced by the following figure. In 1964, when MIC started, the infant mortality rate was 27 per 1,000 live births; in 1970, it was 21.6 and this is a decrease of 24 percent.

However, in the Mott Haven Health District of the Bronx, where you saw two of those large stars where the MIC placed two of its largest services, the infant mortality rate has dropped over 50 percent during these 6 years. In the adjoining Morrisania Health District in the Bronx, also with MIC services, the rate dropped 30 percent. In another adjoining health district in the Bronx-Tremont-without MIC services, there has been an increase in infant mortality during the same 6-year period.

The perinatal-mortality rate, infant deaths in the last months of pregnancy and in the first week of life, a crucial index, is lower for the MIC-delivered women than for all private and nonprivate births in New York City. Considering that the MIC patients live in the ghetto areas of the city and many are known to have had inadequate housing and food for most of their lives, this reduction in infant and perinatal mortality rates must be attributed in no small part to the work of the MIC program.

We talk with every prenatal patient about the importance of preventing unwanted pregancies by using a birth control method after the baby is born. Before they leave the hospital after delivery, our peerlevel family planning counselors help them get started on a birth control regime of their choice.

Studies have shown that 40 percent of the children born to lowincome families in the United States were not wanted by the parents. In New York City alone, this would mean 25,000 unwanted children are born each year to low-income families. Unwanted children often create serious social and economic problems within the family: especially if there are other children. This is why that, at the same time we try to provide good maternity care under MIC, we make every effort to minimize the occurrence of unwanted pregnancies in future years. I am confident these efforts are related to the declining birthrate in New York City.

Furthermore, the cost of raising unwanted children, educating them, and providing health and social services is often a staggering cost to the community. If the MIC and its in-hospital family planning program, described in the reprint attached to my testimony, prevents even 10,000 unwanted pregnancies in a year among the 60,000 women that we counsel each year in the hospitals this would result in a savings of over $10 million in tax funds a year which is three times as much as the annual MIC grants to New York City for MIC.

Mayor John Lindsay, in a recent communication to Secretary Elliot Richardson, stated that:

It appears most unlikely that local funds could be made available to support these lifesaving health programs if the Federal MIC funds are not available after June 30, 1972.

To abandon the MIC program and return the MIC patients to the overcrowded clinics of inadequately staffed and underfinanced municipal hospitals would nullify most of the advancements made in maternity care during the past 7 years. Once again, these patients, many of whom face special health hazards, would be subjected to long hours of waiting in the overcrowded clinics of most of the municipal hospitals. There would be a means test and charges which would result in many of the patients not receiving care. The quality of maternity care now available in the MIC clinics would not be available if we tried to serve this population without the MIC grants.

Gone would be the warm patient-doctor and patient-nurse relationship never before known to most of the patients before MIC. The MIC clinics convenient to the homes of the patients now serve one-fifth of all of the general service patients in the city. Thirty percent of these MIC patients are on welfare and 70 percent come from what have been designated as working poor families.

Without MIC or other Federal funding, the MIC maternity clinics in New York City we are certain will have to close. Last week, I met with Dr. Byron Hawks, the MIC director in Little Rock, Ark., who told me that if MIC funds are not continued there the low-income women in that city would have to return to "granny midwives" for maternity care.

I know your committee is giving consideration to various proposals for financing nationwide health services. I hope that whatever legislation is enacted will assure the financing of specialized high quality maternity and infant care services wherever needed. Since a new nationwide health program cannot be operative for several years, discontinuing MIC would leave an enormous void between 1972 and until a national health program is in full operation.

I can assure you that tens of thousands of women living in ghetto areas of the cities who have or will benefit from MIC services will be grateful and relieved if the Congress approves continuation of these desperately needed health services for mothers and their children. I thank you.

Mr. BURKE. We will interrupt the testimony at this point, and without objection your chart and the data you have provided appended to your statement will appear in the record.

(The charts referred to follow :)

NUMBER OF MEDICAL RE-VISITS

MATERNITY & INFANT CARE FAMILY PLANNING PROJECTS Figure 2. NUMBER OF NEW PRENATAL & NEW FAMILY PLANNING CASES ADMITTED BY MONTH JULY 1964 TO PRESENT

1200

400

2400

1200

NEW YORK CITY'S IN-HOSPITAL FAMILY PLANNING PROGRAM

(By Edwin F. Dailey,* M.D., Aileen R. Sirey and Lucille S. Goodlet)

In May 1970 over 2,800 medically indigent maternity or post-abortal patients in 23 New York City municipal and voluntary hospitals received family planning counseling-and in seven out of 10 cases were initiated on a contraceptive me thod-before hospital discharge. The counseling is provided on the maternity wards by 51 family planning counselors specially trained and employed by the Maternity and Infant Care-Family Planning Project (MIC-FP) of the New York City Department of Health. The counselors are themselves mothers; some had been on welfare; all live in the vicinities of the hospitals they serve.

The In-Hospital Family Planning Program was begun on an experimental basis in July 1969 with maternity patients in three hospitals. The program is expected to reach 4,000 low-income women each month by the end of 1970 and will be extended from the obstetrics and gynecology departments at least to the outpatient departments of the municipal hospitals. Two more municipal, eight voluntary and four state mental hospitals will be added to the program, with counselors assigned to medical, surgical, psychiatric and other services. It is hoped that eventually in-hospital family planning counseling and services can be offered to all of the 140,000 general service patients of child-bearing age who are discharged each year from New York City municipal and voluntary hospitals. The major objectives of the new in-hospital program are:

To offer family planning information and services to large numbers of women of childbearing age at a time when they are most receptive;

To create a community system to provide such patient education and service involving the cooperation of the Department of Health and the OB/GYN departments (and eventually other departments) of New York City's municipal and voluntary hospitals;

To develop an effective method to select and train community women so as to foster a maximum of commitment and initiative, and provide them with sufficient skill and knowledge so that they can work with a minimum of supervision; To operate this program at a per patient cost far less than the cost of traditional outreach programs; and

To augment scarce manpower resources by employing community women and preparing them as family planning counselors, thus channeling much of the program's funding back into the communities that are served.

BACKGROUND

The MIC-FP project basically provides prenatal care for 12,000 new patients each year in 14 neighborhood centers and hospitals, and family planning services for some 16,000 new patients a year in 28 neighborhood centers.

Early in 1968 the Department of Health, Education and Welfare invited the New York City Department of Health to submit a plan and budget for an expanded family planning program. The MIC-FP director met with chiefs of obstetrics and gynecology in 1 hospitals then participating in the MIC-FP program to seek their advice. These physicians emphasized the importance of getting family planning help to patients as soon as possible after delivery, since this was the period when motivation to accept contraception was highest. They pointed out that numbers of patients were becoming pregnant between their hospital discharge and post partum visit, and that at least 60 percent of patients never returned for a post partum examination. They also suggested that it would be useful to introduce birth control to post-abortal, medical, surgical and psychiatric patients of childbearing age. Despite the tremendous need for introduction of such services, these physicians said, family planning was a low priority item for busy hospital residents, nurses and social workers. A new type of health worker was needed, they said, recruited from the patients' own communities, and specially trained to educate their neighbors about family planning.

Initiation of contraceptive counseling and services immediately after parturition and services immediately after parturition had been tried with some success at Cook County Hospital in Chicago and Grady Memorial Hospital in Atlanta. In neither case, however, was the counseling performed by peer group

Edwin Daily is a Director of MIC-FP Projects 507 and 707; Aileen Sirey is Director of Community Education and Training, MIC-FP and Lucille Goodlet is Research Associate, MIC-FP, New York City Department of Health.