[MUSIC PLAYING]
SPEAKER 1: The microtomecan section tissue
to thicknesses of about20 to 50 million microns.
The electron microscope canthen make magnifications
of 100,000 times or more.
Such detailed views ofmammalian ovum and sperm
are a very recent possibility.
But there was seriousinterest in the processes
of reproduction long ago.
People have always wanted toinfluence their own fertility.
Earlier methodswere often magical,
but there is an ancient historyto abortion and infanticide.
Greek and Roman physicians knewa great deal about gynecology.
Delivery itselfcontinued for centuries
to be largely theresponsibility of midwives.
High birth rates werebalanced by fetal wastage,
infant mortality, andgenerally high death rates.
Population remainedabout stable.
The great change had itssource in the Renaissance
in the beginningsof modern science
and the agricultural andindustrial techniques,
which it fostered in thebeginnings of modern medicine.
[MUSIC PLAYING]
The great change was that thedeath rate in Europe, which
had remained relativelystable for thousands of years
began to go down.
This decline at first gradualaccelerated more and more
in the ensuing centuries.
But the birth rate,which up to this point
had been in a state ofmore or less equilibrium
with the death rate, did notdecrease at the same pace.
The disparity betweenthese two lines,
the so-calleddemographic gap accounts
for the rapid increasein population, which has
characterized the modern world.
In the oldercountries of Europe,
the birth rate was graduallybrought down close to the death
rate by coitus interruptusillegal abortion and foundling
homes, which were a thinlydisguised form of infanticide.
In the 20th century, amore rational approach
to fertility controlwon strong support,
not only from crusaderslike Margaret Sanger
but also from physicians likeAbraham Jacoby and Robert Latou
Dickinson.
Technical innovations, suchas the vocalization of rubber
began to make contraceptionmore practical.
But meanwhile, the problemhad been posed on a new scale.
Consider the world ofthe mid-20th century.
Consider, forexample, childbirth.
In a modern hospital,it is managed
by a highly trained team.
Medical science andtechnology have drastically
reduced the dangerto mother and child.
[NON-ENGLISH SPEECH]
Personnel and equipment areprepared for the contingencies,
which used to mean death.
[NON-ENGLISH SPEECH]
This baby will almost certainlysurvive his first year.
He will in all probabilitylive to be more than 70.
In much of the world, birthsoccur in circumstances
more like this.
But even fragmentaryinfluences of modern science
cause radical alterations in thebalance between life and death.
This maybe too hasa chance of living,
of surviving tomaturity and to old age
far beyond what he wouldhave had 50 years ago.
[CRIES]
In other words, there has beena sharp drop in the death rate.
But birth rateshave remained high,
especially in the lessdeveloped areas of the world,
where the impact of technologyhas been sudden and uneven.
There is an enormous demographicgap, a runaway growth.
[CAR ENGINE]
This growth has begun tohave appalling consequences.
[CAR ENGINE]
[CHATTER]
Harrison Brown expert onWorld Resources says--
HARRISON BROWN: It is beginningto look as though the struggle
to increase the well-beingof the people of the world
is being defeated by thesheer increase in numbers.
There are large portions of theEarth in which, for example,
recent increasesin food production
have not kept up with theincreases in population,
and there is less food toeat per person each year.
It is quite likely that ifbirth rates do not come down,
death rates willstart back up again.
SPEAKER 1: For many ofthose who do survive,
the outlook is somber.
SALLY SWING SHELLEY: Thereare about 20 to 25 million
more illiterates every year.
SPEAKER 1: SallySwing Shelley, UNESCO.
SALLY SWING SHELLEY: A quarterof a billion school age
children in the worlddo not attend school.
PHILIP M. HAUSER: What makesthis growth so alarming
is that the rate of increase isnot arithmetic but geometric.
SPEAKER 1: Philip M.Hauser, demographer.
PHILIP M. HAUSER: The numberof people in the world
has increased as muchin the past 50 years
as it increased in1,000 years before.
The present world populationof slightly over 3 billion
will at the current rate ofincrease be more than 6 billion
by the year 2000, 12 billionby the year 2040, 24 billion
by 2080 and so on.
[CHATTER]
SPEAKER 1: It is tempting tothink of this only as a problem
for distant peoplesin faraway lands,
but it is a worldwide problem.
In the United Statesalone if it continues
to grow at its presentrate will in 100 years
reach a population of1 billion seriously
threatening the quality oflife for all levels of society.
Dr. John Rock says--
JOHN ROCK: A societywhich practices
death control must at the sametime practice birth control.
SPEAKER 1: In fact, governmentsand private organizations
all over the worldhave begun to work
with the medical professiontoward effective and acceptable
family planning.
Dr. Alan F. Guttmacher,president of Planned Parenthood
World Population says--
ALAN F. GUTTMACHER:Today there's
a highly developed technologyof contraception resulting
in increasingly wide range ofeffective and tested methods
of fertility control.
[MACHINE]
SPEAKER 1: The moretraditional of these methods
used not only mechanicalbarriers but also a variety
of spermicide preparations.
The orals interfere withthe reproductive process
at an earlier stage.
In the human ovulatorycycle, the hypothalamus
produces aneurohumoral substance
which stimulates the pituitaryto secrete FSH, the Follicle
Stimulating Hormone,and LH, which
is responsible for the rupturingof the Graafian follicle
and the release of the ovum.
The ruptured folliclebecomes the corpus luteum,
which releasesprogesterone and estrogen.
They inhibit the release ofthe neurohumoral substance
and consequently of FSHand LH, thus preventing
further ovulationduring the cycle.
When the corpusluteum atrophies,
its inhibitory influence onthe hypothalamus is removed,
and the entireprocess is repeated.
During pregnancy, theplacenta continues the supply
of progesterone andestrogen maintaining
the inhibition of ovulation.
The oral contraceptive supplyprogesterone and estrogen
like substances, thus preventingovulation in much the same way.
The use of a basaltemperature record
to record theoccurrence of ovulation
may be helpful for thepeople who choose the rhythm
or safe period technique.
The IUD orIntrauterine Device has
been found to provide extremelyeffective contraception.
Made of a chemicallyinert substance,
it is insertedthrough the cervix.
Inside the uterus, itresumes its original shape.
Vasectomy is gaining increasingacceptance in countries
as far apart as Indiaand the United States
where 40 to 50,000 areperformed each year.
There's a relativelysimple operation
and does not diminisheither libido or potency.
Tubal ligation canbe accomplished
either vaginally or abdominal.
It has no effect onmenstruation or ovulation.
One of the most commonmeans of limiting the number
of offspring and in a way thatis very old is still abortion.
In countries in whichabortion is illegal,
it is often induced by peopleoutside the medical profession
or self-induced.
Many of these women arriveat the emergency wards
of hospitals claimingthat they have
begun to abort spontaneously.
All too often, theyare actually suffering
from illegal andinept abortions.
This is one of the reasonsthat the governments
of some countries have legalizedabortion, for example, Hungary.
Any woman may applyfor an abortion
and be almost certain thather request will be granted.
The operation is performedon a regular medical basis.
Mortality and morbidityrates are extremely low.
[NON-ENGLISH SPEECH]
Current research issuggesting other approaches
to fertilitycontrol, but whatever
methods are used nowand in the future,
the overall point seems clear.
A.S. PARKS: Progressive increasein maternal care associated
with various degreesof paternal care
is a notable feature inthe evolution of the higher
animals.
SPEAKER 1: A.S. Parks,British physiologist.
A.S. PARKS: Andthe process may be
said to have reached apeak with the appearance
of the human family in whichparental care continues
long after the biologicalneed for it has ended.
The greater the caretaken of each offspring,
the fewer the offspringthat can be dealt with.
SPEAKER 2: Thank you.
SPEAKER 1: The resolution ofthe American Medical Association
states that anintelligent recognition
of the problems that relateto human reproduction,
including the needfor population control
is more than a matter ofresponsible parenthood.
It is a matter ofresponsible medical practice.
SPEAKER 3: Well.
SPEAKER 4: Easter was here.
SPEAKER 1: Yeah,that's a hard day.
The physician who supervisespregnancy and childbirth
has many opportunities to broachthe subject of contraception.
SPEAKER 3: This isyour second pregnancy,
and you will noticethat this is true--
SPEAKER 1: Often he may haveto bring it up quite directly.
SPEAKER 3: Let's see.
How many have you had, ma'am.
SPEAKER 5: Three.
SPEAKER 3: Three,and you're about
ready to have yourfourth one, are you?
SPEAKER 5: That wasn'twhat I planned, but then I
hadn't planned on three either.
SPEAKER 3: I see.
Are you planning to control youradditional family in some way?
SPEAKER 5: Oh, wethought we were.
SPEAKER 3: How are yougoing to go about that?
SPEAKER 5: Well, I wantedto ask you about the--
SPEAKER 3: How man are yougoing to have, about six?
SPEAKER 6: Oh, no.
SPEAKER 3: No.
SPEAKER 6: This is it.
SPEAKER 1: Even thoughshe has not said so,
the patient may be hoping forguidance from her physician.
SPEAKER 6: Well.
SPEAKER 3: You have plansfor future contraception,
or how are yougoing to continue?
SPEAKER 6: I don't know.
That's what I wantto talk to you about.
SPEAKER 3: I see.
It's a little bit early todiscuss it at this point,
but since you mentionedthat you're not
going to have any moreway, what type were you
contraception were youthinking that you--
SPEAKER 6: I have no idea.
I thought I talked to you andfind out what you'd suggest.
SPEAKER 3: Well, now asfar as their percentage
of prevention of pregnancy.
SPEAKER 7: I don'tknow enough about--
SPEAKER 1: Previous successwith a particular method
is important.
SPEAKER 7: Sure.
I've always used itin diaphragm before.
SPEAKER 3: You've always used itsuccessfully then, haven't you?
SPEAKER 7: Yes.
Yes.
SPEAKER 3: Well, I would suggestthat then as I do to other
patients that if you areusing a successful method
of contraception and you'rehappy with it and your husband
is, then you shouldn't--
SPEAKER 1: It has been saidthat the most effective
contraceptive is the onethat the patient will use.
SPEAKER 8: Oh, Iwanted the pills.
SPEAKER 3: I see.
Now do you have anyknowledge of pills?
Have you used them before?
SPEAKER 8: No.
No.
SPEAKER 3: I see.
Well, I'll explain it toyou a bit and how it works
and also how you use it.
Now the pill, as you mayknow, is a hormone pill,
and it works by preventingovulation or preventing
your ovaries fromproducing eggs.
That's the way thatthey accomplished this.
And now you willhave to wait until
your next menstrual periodbefore you can start them.
SPEAKER 1: Carefulexplanation is
particularlyimportant for patients
who choose the rhythm method.
SPEAKER 3: Now there's a muchmore constant relationship
we feel between ovulationand the next menstrual period
than ovulation in thepreceding menstrual period.
Now for instance, if your cyclewould be regularly 28 days,
that would mean that the 14thday is right in the middle.
And so that means that 14days after a menstrual period
and 14 days before amenstrual period, you ovulate.
SPEAKER 1: Inaddition to the office
of the private physician,this kind of guidance
is offered in Planned Parenthoodclinics and more and more
in the clinics ofpublic hospitals.
SPEAKER 9: Literature here.
You can take it home,discuss it with your husband.
If you've made up yourmind when you are at home,
please call the clinic backand change your postpartum
appointment.
SPEAKER 1: Lack of birthcontrol information
has been a primary causeof excessive multipolarity,
especially among the poor.
SPEAKER 9: This is thefemale reproductive organ.
This is the womb or the uterus,where the baby normally grows.
SPEAKER 1: Everyserious study undertaken
indicates that members ofall socioeconomic groups
in the United States, regardlessof race or national background,
would prefer to havefamilies of limited size
and do make use offamily planning services
when they are available.
SPEAKER 10: Well, Idon't want more children.
I think that's more than enough.
SPEAKER 11: Your husband agrees.
SPEAKER 10: Yes, uh-huh.
SPEAKER 11: Well, Ithink you have plenty.
SPEAKER 10: We didone little girl
being that we have all six boys.
SPEAKER 11: Oh my gosh.
SPEAKER 10: But, well, that's--
it's too much anyway.
We'll just have todo without that girl.
SPEAKER 11: How haveyou been feeling
since the baby was born?
SPEAKER 10: Real good.
SPEAKER 11: No problems?
SPEAKER 10: No, no problems.
SPEAKER 11: When youwere upstairs, did
you go to the lectures about--
SPEAKER 10: Yes, I did, uh-huh.
SPEAKER 11: And Mrs.Fredericks talked to you
about the various methodsthat we have available.
SPEAKER 10: Yes, she did.
She talked to us aboutthe different ways
that they could helpus in this program.
SPEAKER 11: Did you find onethat seemed to interest you?
SPEAKER 10: Yes, I foundthat the hoop or loop I think
is what they call itis the one I'd like to.
SPEAKER 1: In theclinics just as
in the office of theprivate physician,
patient choice is crucial.
SPEAKER 11: Have youseen one of the loops.
SPEAKER 10: Yes, we've seen.
I seen one when Iwas in the hospital.
SPEAKER 11: They're justmade out of plastic.
We straighten them out inthis fashion to put it in,
and then it justautomatically snaps back
in its little loop shape.
And the white part of theloop stays inside the uterus
or the womb like this.
With the threads coming outthrough the mouth to the uterus
into the top of the vagina.
And then I just, sort of, liketo have you feel these threads
so that what they're like.
And the loop here toojust to feel this.
When you examineyourself as long
as you can feel just thethreds, everything's all right.
There are someproblems with the loop,
and you have to understandabout this before we get started
or you might get discouraged.
But, for instance,there's liable to be
some cramping like a--
do you have cramps withyour menstrual period?
SPEAKER 10: Not usually,not unless I've been
working a little hard before.
But otherwise, I have prettygood menstrual periods.
SPEAKER 11: There's liable tobe some cramping for some women
tell us two or three hours,some say two or three days.
Some say they haveno problems at all.
For a while after theloops been put in,
just a little vague,sort of, cramping
feeling low in your abdomen.
Your first fewperiods that you have,
your menstruation islikely to be quite heavy,
heavy enough to worry a littlebit, but this is expected.
And that's why I wantto tell you about it
so it doesn't scare you.
SPEAKER 1: Successdepends largely
upon the care with which thephysician explains the chosen
method and thedegree to which he
responds to theneeds and concerns
of each particular patient.
SPEAKER 11: Thisis a safe method.
You're not worriedabout that, are you?
SPEAKER 12: No, Ihave a girlfriend
say you could get cancer.
SPEAKER 11: Well,that's not true.
SPEAKER 12: I know.
The nurse explainedit to us when she--
SPEAKER 11: You can getcancer, but this doesn't
make the chances any greater.
You still have the same chancesthat any other woman has.
SPEAKER 12: Well, Ididn't believe that.
And plus I read a littlelittle bit about it in--
SPEAKER 11: Oneof the advantages
of coming to see usevery year is we always
do the cancer test, of course,and we find it at the earliest
possible moment.
SPEAKER 13: And if I wantto have a baby later,
can it be taken out?
SPEAKER 11: Yes, youjust take this out,
and then you perfectly easyto become pregnant again.
That's true, of course,with the pills too.
Now no matterwhether your period
lasts two days or sevendays or four days,
you always start takingyour pills on day five, OK.
The day that you starttaking your pills
is not determined bywhen your period stops.
It's determined by whenyour period starts,
and it's always five days afterthe first day of bleeding, OK.
So your period couldstop here or here or here
or here or maybe evenhere, but you still
start the pills on day five.
Now the pills are takenone pill a day every night.
The nighttime is thebest time to take them
for 20 days in a row, OK.
EDRIS RICE-WRAY: After workingin public health for 11 years
I suddenly realized that it'suseless to go on saving lives
if we aren't willing to doanything about the birth rate.
SPEAKER 1: EdrisRice-Wray is a physician
working in public health.
The Mexican villageshe is entering
is typical of therural areas in which
much of the world's populationgrowth is taking place.
[CAR]
EDRIS RICE-WRAY: Wehave found that in order
to start a program, it'svery worthwhile to have
a meeting with the mothers.
Talk to them andfind out how they
feel about their largefamilies, and then you
learn IF they want advice asto how to space their children.
SPEAKER 1: In additionto being a physician,
the public health doctor mustbe something of a sociologist
as well as an educator.
EDRIS RICE-WRAY: Inorder to start a program,
it's necessary to beginteaching them the basic facts
of reproduction.
[NON-ENGLISH SPEECH]
After we talk to themothers, then the next step
is to orient the nurse who willbe carrying out the program.
[NON-ENGLISH SPEECH]
SPEAKER 1: George Brown isalso a physician specializing
in population problems.
He works closely withTunisian officials,
who have initiated an activebirth control program.
[MUSIC PLAYING]
The Tunisian maternal andchild care centers offer
along with their other serviceshelp in family planning.
Medical indicationsfor contraception
are particularlyfrequent among the poor.
[MUSIC PLAYING]
George Brown's role is notthat of the typical practicing
doctor private or public.
He is a consultantand an advisor.
The government ofTunisia has decided
that no program of socialand economic improvement
can succeed unlessit is accompanied
by an effective birthcontrol program.
Many physicians contribute tothe field of fertility control
by doing research.
One example isLuigi Mastroianni,
professor at theUniversity of Pennsylvania.
LUIGI MASTROIANNI: Well,it's been known for some time
that the presence of a foreignbody in the uterine cavity
materially affectsreproductive processes.
As a matter of fact,recently several devices
have been developed which havebeen proved safe and effective,
and they are very useful asa method of family planning.
The mechanism of actionbehind the presence
of an intrauterinedevice is one which
is a matter ofcontinuing speculation.
Many people havefelt for some time
that they act atthe uterine level
by some interference withmyometrial or endometrial
behavior, but afew investigators
have suggested that theyact at the tubal level
by causing a rapid transportof ova from the fallopian tube
into the uterus.
Well, in order toget at the problem,
we decided to study the effectof the intrauterine device
on reproductiveprocesses in the monkey.
For our experiments, we chosethe macaque [INAUDIBLE] monkey
largely because thereproductive processes
in that species of monkeyshave resembled that of people.
The intrauterinedevice was introduced
from below withoutmuch difficulty.
Now we used a Marguliesspiral, which was cut to size,
and I think one of the reasonswe were able to introduce this
into the group of monkeyswe were working with
was that these monkeys allhad recently born young.
That is they were Paris monkeys.
The monkeys incidentally wereobtained directly from India.
They were introducedinto the laboratory.
And after the devicewas introduced
into a group of thesemonkeys, their cycles
were carefully followedby daily vaginal smears.
The animals were observedin captivity for a month
or two over one or twocycles, and subsequently they
were treated with human urinarypituitary gonadotropin in order
to induce super ovulation.
It was reasoned thatwithin a matter of hours
after the lastovulating injection,
super ovulationwould have occurred.
Now on the last three daysof gonadotropin treatment,
we did artificialinsemination on our monkeys.
And for this, we usedelectro ejaculated semen.
Semen was takenin the fresh state
and immediatelyafter liquefaction,
the liquefied portionof the specimen
was introduced into the vagina.
And this was followed bythe coagulant, which should
have acted as a vaginal plug.
Within a few hours of theexpected time of ovulation,
the laparotomy was carriedout, and the fallopian tubes
were flushed.
Using Krebs-Ringerphosphate solution,
the effluent was collectedin a plastic receptacle
placed at the fimbrated atthe end of the fallopian tube.
This material was then inspectedfor the presence of ova.
Actually, approximately50% of the ova,
which were expectedto be present,
were found in the flushing.
Now these ova, which wereobtained from animals,
which did not wear the coil--
that is in the non-coilcontrol group were prepared
for electron microscopy,and several of the ova
were, in fact, actuallyfertilized providing us
with some veryinteresting specimens
for electron microscopic study.
Now in the group of animals inwhich the coil had previously
been placed, a similarprocedure was carried out.
And interestinglyenough, we were not
able to recover a single eggfrom these animals, which
were treated inexactly the same way.
There is one exceptionin this series,
and that was an animal inwhich there were four ovulation
points.
And we recovered three ova.
But afterwards on carefulinspection of the vagina,
it was found that the coilhad been extruded probably
some time previouslyinto the vaginal canal
and was entirelyout of the uterus.
So that this animalthen was reasonably
excluded from the series.
But our failure to recovereggs from the animals
in which the coilhave been placed
suggested one oftwo possibilities.
Either the eggswere not picked up
by the fembrated extremityof the fallopian tube,
or if they were pickedup, they might possibly
have been rapidly transporteddown the fallopian tube
and into the uterus prematurely.
Now in order to decide whichof these two possibilities
was, in fact,operating, we carried
on another set of experiments.
This time we placeda ligature right here
at the uterotubal junction.
The animals were then treatedin exactly the same way.
The other side ofcourse was unlike it.
When we flushed for ova, wefound that over were indeed
present in the ligatedside, because they
were contained by the ligature.
And in fact, we had a 50%recovery rate on this side.
On the unligated side, again,no over were recovered.
So this suggested thatthe eggs were picked up
by the animal in whichthe coil had been placed,
and they were rapidlytransported down the fallopian
tube and out into the uterus.
But of course, onthe ligated side,
they were contained in thefallopian tube by the ligature.
This was all verynice, but where
were the eggs among theanimals in which the coil had
been placed, animals whichdid not have the ligature
placed here.
Did they really getinto the uterus.
And if so, how longdid they stay here?
Well, in order toexplore that possibility,
we made some attempts torecover the eggs actually
from the uterus.
The animals were treatedin exactly the same way.
They did wear coils,and an attempt
was made to recover ovafrom the uterine cavity
by retrograde flushing.
Now in the group ofanimals studied thus far,
there were eightovulation points,
and we were able to recover fourova, four ova from the uterus
at a time when theywould be expected to be
present in the Fallopian tube.
This suggested then thatour theory was correct
and that the eggs wereindeed rapidly transported
from the Fallopiantube into the uterus.
Now the matter of whether ornot these eggs are fertilized
is an interesting matter indeed.
Three of the four ova wereprepared for microscopic study.
Unfortunately, the fourthwas lost in transit,
and here we see an unfertilizedmonkey egg recovered
with the cumulus cells, thecorona radiata still around it,
and this egg is unfertilizedas were the other two.
So that we can saythat in the monkey
and the super ovulatedartificially inseminated
monkey, the presence ofan intrauterine device
results in rapid transport ofova from the Fallopian tube
and into the uterus.
And in the limitednumber of eggs studied,
we can say that theova are unfertilized.
SPEAKER 1: Current researchalso leads towards new methods
of contraception.
Suppression ofspermatogenesis, creation
of immune responsesin male or female
are just two promisingareas of investigation.
The biology ofmammalian reproduction
is extremely complex.
The more we learn aboutit, the more points
there are at whichwe can influence it.
[MUSIC PLAYING]
People have always wanted toinfluence their own fertility
essentially to havethe baby who was wanted
and for whom there was anadequate place in the world.
The realization of thishope depends heavily
upon the physician.
[MUSIC PLAYING]