WEBVTT 00:00.982 --> 00:03.437 [MUSIC PLAYING] 00:27.005 --> 00:29.520 SPEAKER 1: The microtome can section tissue 00:29.520 --> 00:32.280 to thicknesses of about 20 to 50 million microns. 00:48.420 --> 00:51.150 The electron microscope can then make magnifications 00:51.150 --> 00:56.960 of 100,000 times or more. 00:56.960 --> 00:59.780 Such detailed views of mammalian ovum and sperm 00:59.780 --> 01:01.490 are a very recent possibility. 01:07.040 --> 01:09.040 But there was serious interest in the processes 01:09.040 --> 01:12.520 of reproduction long ago. 01:12.520 --> 01:15.580 People have always wanted to influence their own fertility. 01:18.340 --> 01:24.030 Earlier methods were often magical, 01:24.030 --> 01:28.100 but there is an ancient history to abortion and infanticide. 01:32.700 --> 01:36.120 Greek and Roman physicians knew a great deal about gynecology. 01:41.210 --> 01:43.250 Delivery itself continued for centuries 01:43.250 --> 01:46.400 to be largely the responsibility of midwives. 01:46.400 --> 01:49.160 High birth rates were balanced by fetal wastage, 01:49.160 --> 01:55.260 infant mortality, and generally high death rates. 01:55.260 --> 01:57.195 Population remained about stable. 02:00.080 --> 02:02.810 The great change had its source in the Renaissance 02:02.810 --> 02:04.640 in the beginnings of modern science 02:04.640 --> 02:07.010 and the agricultural and industrial techniques, 02:07.010 --> 02:11.270 which it fostered in the beginnings of modern medicine. 02:11.270 --> 02:26.170 [MUSIC PLAYING] 02:26.170 --> 02:29.230 The great change was that the death rate in Europe, which 02:29.230 --> 02:32.260 had remained relatively stable for thousands of years 02:32.260 --> 02:34.420 began to go down. 02:34.420 --> 02:39.280 This decline at first gradual accelerated more and more 02:39.280 --> 02:40.810 in the ensuing centuries. 02:45.680 --> 02:47.990 But the birth rate, which up to this point 02:47.990 --> 02:50.180 had been in a state of more or less equilibrium 02:50.180 --> 02:53.150 with the death rate, did not decrease at the same pace. 02:56.000 --> 02:58.580 The disparity between these two lines, 02:58.580 --> 03:01.370 the so-called demographic gap accounts 03:01.370 --> 03:03.560 for the rapid increase in population, which has 03:03.560 --> 03:05.090 characterized the modern world. 03:12.605 --> 03:13.980 In the older countries of Europe, 03:13.980 --> 03:16.770 the birth rate was gradually brought down close to the death 03:16.770 --> 03:21.930 rate by coitus interruptus illegal abortion and foundling 03:21.930 --> 03:25.260 homes, which were a thinly disguised form of infanticide. 03:29.940 --> 03:32.130 In the 20th century, a more rational approach 03:32.130 --> 03:35.550 to fertility control won strong support, 03:35.550 --> 03:38.070 not only from crusaders like Margaret Sanger 03:38.070 --> 03:41.970 but also from physicians like Abraham Jacoby and Robert Latou 03:41.970 --> 03:42.630 Dickinson. 03:45.540 --> 03:48.300 Technical innovations, such as the vocalization of rubber 03:48.300 --> 03:50.580 began to make contraception more practical. 03:55.580 --> 03:59.960 But meanwhile, the problem had been posed on a new scale. 03:59.960 --> 04:03.200 Consider the world of the mid-20th century. 04:03.200 --> 04:07.610 Consider, for example, childbirth. 04:07.610 --> 04:09.290 In a modern hospital, it is managed 04:09.290 --> 04:11.840 by a highly trained team. 04:11.840 --> 04:14.300 Medical science and technology have drastically 04:14.300 --> 04:16.234 reduced the danger to mother and child. 04:18.979 --> 04:24.400 [NON-ENGLISH SPEECH] 04:24.400 --> 04:26.890 Personnel and equipment are prepared for the contingencies, 04:26.890 --> 04:28.090 which used to mean death. 04:41.730 --> 05:19.180 [NON-ENGLISH SPEECH] 05:19.180 --> 05:23.440 This baby will almost certainly survive his first year. 05:23.440 --> 05:26.215 He will in all probability live to be more than 70. 05:30.730 --> 05:33.430 In much of the world, births occur in circumstances 05:33.430 --> 05:36.680 more like this. 05:36.680 --> 05:39.640 But even fragmentary influences of modern science 05:39.640 --> 05:43.030 cause radical alterations in the balance between life and death. 06:26.940 --> 06:29.430 This maybe too has a chance of living, 06:29.430 --> 06:32.160 of surviving to maturity and to old age 06:32.160 --> 06:35.010 far beyond what he would have had 50 years ago. 06:35.010 --> 06:45.290 [CRIES] 06:45.290 --> 06:48.140 In other words, there has been a sharp drop in the death rate. 06:50.680 --> 06:53.960 But birth rates have remained high, 06:53.960 --> 06:56.740 especially in the less developed areas of the world, 06:56.740 --> 07:02.620 where the impact of technology has been sudden and uneven. 07:02.620 --> 07:08.216 There is an enormous demographic gap, a runaway growth. 07:08.216 --> 07:19.130 [CAR ENGINE] 07:19.130 --> 07:22.442 This growth has begun to have appalling consequences. 07:22.442 --> 07:37.048 [CAR ENGINE] 07:37.048 --> 07:45.440 [CHATTER] 07:45.440 --> 07:48.497 Harrison Brown expert on World Resources says-- 07:48.497 --> 07:51.080 HARRISON BROWN: It is beginning to look as though the struggle 07:51.080 --> 07:54.080 to increase the well-being of the people of the world 07:54.080 --> 07:58.520 is being defeated by the sheer increase in numbers. 07:58.520 --> 08:02.520 There are large portions of the Earth in which, for example, 08:02.520 --> 08:04.790 recent increases in food production 08:04.790 --> 08:08.450 have not kept up with the increases in population, 08:08.450 --> 08:13.040 and there is less food to eat per person each year. 08:13.040 --> 08:16.820 It is quite likely that if birth rates do not come down, 08:16.820 --> 08:19.025 death rates will start back up again. 08:22.280 --> 08:24.560 SPEAKER 1: For many of those who do survive, 08:24.560 --> 08:26.330 the outlook is somber. 08:26.330 --> 08:28.700 SALLY SWING SHELLEY: There are about 20 to 25 million 08:28.700 --> 08:30.680 more illiterates every year. 08:30.680 --> 08:32.809 SPEAKER 1: Sally Swing Shelley, UNESCO. 08:32.809 --> 08:35.059 SALLY SWING SHELLEY: A quarter of a billion school age 08:35.059 --> 08:38.074 children in the world do not attend school. 08:42.340 --> 08:44.560 PHILIP M. HAUSER: What makes this growth so alarming 08:44.560 --> 08:49.150 is that the rate of increase is not arithmetic but geometric. 08:49.150 --> 08:51.370 SPEAKER 1: Philip M. Hauser, demographer. 08:51.370 --> 08:53.495 PHILIP M. HAUSER: The number of people in the world 08:53.495 --> 08:55.960 has increased as much in the past 50 years 08:55.960 --> 08:59.740 as it increased in 1,000 years before. 08:59.740 --> 09:03.160 The present world population of slightly over 3 billion 09:03.160 --> 09:07.450 will at the current rate of increase be more than 6 billion 09:07.450 --> 09:13.930 by the year 2000, 12 billion by the year 2040, 24 billion 09:13.930 --> 09:16.450 by 2080 and so on. 09:26.593 --> 09:30.370 [CHATTER] 09:30.370 --> 09:32.870 SPEAKER 1: It is tempting to think of this only as a problem 09:32.870 --> 09:38.730 for distant peoples in faraway lands, 09:38.730 --> 09:41.130 but it is a worldwide problem. 09:41.130 --> 09:43.680 In the United States alone if it continues 09:43.680 --> 09:46.710 to grow at its present rate will in 100 years 09:46.710 --> 09:50.760 reach a population of 1 billion seriously 09:50.760 --> 09:55.080 threatening the quality of life for all levels of society. 09:55.080 --> 09:56.610 Dr. John Rock says-- 09:56.610 --> 09:58.950 JOHN ROCK: A society which practices 09:58.950 --> 10:06.000 death control must at the same time practice birth control. 10:06.000 --> 10:08.460 SPEAKER 1: In fact, governments and private organizations 10:08.460 --> 10:10.260 all over the world have begun to work 10:10.260 --> 10:13.020 with the medical profession toward effective and acceptable 10:13.020 --> 10:13.785 family planning. 10:17.570 --> 10:20.900 Dr. Alan F. Guttmacher, president of Planned Parenthood 10:20.900 --> 10:23.695 World Population says-- 10:23.695 --> 10:25.070 ALAN F. GUTTMACHER: Today there's 10:25.070 --> 10:28.910 a highly developed technology of contraception resulting 10:28.910 --> 10:32.630 in increasingly wide range of effective and tested methods 10:32.630 --> 10:34.130 of fertility control. 10:34.130 --> 10:37.118 [MACHINE] 10:51.200 --> 10:53.200 SPEAKER 1: The more traditional of these methods 10:53.200 --> 10:56.500 used not only mechanical barriers but also a variety 10:56.500 --> 10:58.330 of spermicide preparations. 11:07.260 --> 11:09.660 The orals interfere with the reproductive process 11:09.660 --> 11:10.620 at an earlier stage. 11:16.150 --> 11:18.640 In the human ovulatory cycle, the hypothalamus 11:18.640 --> 11:20.740 produces a neurohumoral substance 11:20.740 --> 11:24.970 which stimulates the pituitary to secrete FSH, the Follicle 11:24.970 --> 11:28.150 Stimulating Hormone, and LH, which 11:28.150 --> 11:30.943 is responsible for the rupturing of the Graafian follicle 11:30.943 --> 11:32.110 and the release of the ovum. 11:34.920 --> 11:37.590 The ruptured follicle becomes the corpus luteum, 11:37.590 --> 11:40.980 which releases progesterone and estrogen. 11:40.980 --> 11:44.250 They inhibit the release of the neurohumoral substance 11:44.250 --> 11:47.790 and consequently of FSH and LH, thus preventing 11:47.790 --> 11:49.380 further ovulation during the cycle. 11:53.890 --> 11:55.540 When the corpus luteum atrophies, 11:55.540 --> 11:59.360 its inhibitory influence on the hypothalamus is removed, 11:59.360 --> 12:00.970 and the entire process is repeated. 12:17.900 --> 12:21.230 During pregnancy, the placenta continues the supply 12:21.230 --> 12:24.050 of progesterone and estrogen maintaining 12:24.050 --> 12:25.760 the inhibition of ovulation. 12:28.900 --> 12:31.930 The oral contraceptive supply progesterone and estrogen 12:31.930 --> 12:35.665 like substances, thus preventing ovulation in much the same way. 12:39.420 --> 12:41.400 The use of a basal temperature record 12:41.400 --> 12:43.680 to record the occurrence of ovulation 12:43.680 --> 12:45.960 may be helpful for the people who choose the rhythm 12:45.960 --> 12:47.430 or safe period technique. 12:50.450 --> 12:53.300 The IUD or Intrauterine Device has 12:53.300 --> 12:56.240 been found to provide extremely effective contraception. 13:18.700 --> 13:20.950 Made of a chemically inert substance, 13:20.950 --> 13:22.690 it is inserted through the cervix. 13:32.020 --> 13:34.885 Inside the uterus, it resumes its original shape. 13:46.150 --> 13:49.030 Vasectomy is gaining increasing acceptance in countries 13:49.030 --> 13:52.030 as far apart as India and the United States 13:52.030 --> 13:54.670 where 40 to 50,000 are performed each year. 13:58.620 --> 14:00.300 There's a relatively simple operation 14:00.300 --> 14:02.520 and does not diminish either libido or potency. 15:30.410 --> 15:32.210 Tubal ligation can be accomplished 15:32.210 --> 15:35.090 either vaginally or abdominal. 15:35.090 --> 15:37.760 It has no effect on menstruation or ovulation. 17:00.040 --> 17:02.470 One of the most common means of limiting the number 17:02.470 --> 17:08.230 of offspring and in a way that is very old is still abortion. 17:08.230 --> 17:11.290 In countries in which abortion is illegal, 17:11.290 --> 17:15.310 it is often induced by people outside the medical profession 17:15.310 --> 17:18.099 or self-induced. 17:18.099 --> 17:20.440 Many of these women arrive at the emergency wards 17:20.440 --> 17:22.089 of hospitals claiming that they have 17:22.089 --> 17:24.069 begun to abort spontaneously. 17:39.020 --> 17:40.910 All too often, they are actually suffering 17:40.910 --> 17:43.100 from illegal and inept abortions. 17:50.932 --> 17:52.890 This is one of the reasons that the governments 17:52.890 --> 17:57.455 of some countries have legalized abortion, for example, Hungary. 18:02.540 --> 18:04.400 Any woman may apply for an abortion 18:04.400 --> 18:06.755 and be almost certain that her request will be granted. 18:33.210 --> 18:37.650 The operation is performed on a regular medical basis. 18:37.650 --> 18:41.775 Mortality and morbidity rates are extremely low. 18:41.775 --> 18:44.940 [NON-ENGLISH SPEECH] 18:44.940 --> 18:47.130 Current research is suggesting other approaches 18:47.130 --> 18:49.380 to fertility control, but whatever 18:49.380 --> 18:52.110 methods are used now and in the future, 18:52.110 --> 18:53.625 the overall point seems clear. 18:56.190 --> 19:00.550 A.S. PARKS: Progressive increase in maternal care associated 19:00.550 --> 19:03.610 with various degrees of paternal care 19:03.610 --> 19:06.880 is a notable feature in the evolution of the higher 19:06.880 --> 19:07.750 animals. 19:07.750 --> 19:09.780 SPEAKER 1: A.S. Parks, British physiologist. 19:09.780 --> 19:11.770 A.S. PARKS: And the process may be 19:11.770 --> 19:14.500 said to have reached a peak with the appearance 19:14.500 --> 19:18.250 of the human family in which parental care continues 19:18.250 --> 19:22.420 long after the biological need for it has ended. 19:22.420 --> 19:25.060 The greater the care taken of each offspring, 19:25.060 --> 19:27.715 the fewer the offspring that can be dealt with. 20:04.595 --> 20:05.470 SPEAKER 2: Thank you. 20:10.390 --> 20:13.030 SPEAKER 1: The resolution of the American Medical Association 20:13.030 --> 20:15.880 states that an intelligent recognition 20:15.880 --> 20:18.950 of the problems that relate to human reproduction, 20:18.950 --> 20:21.520 including the need for population control 20:21.520 --> 20:25.120 is more than a matter of responsible parenthood. 20:25.120 --> 20:29.155 It is a matter of responsible medical practice. 20:29.155 --> 20:30.230 SPEAKER 3: Well. 20:30.230 --> 20:31.640 SPEAKER 4: Easter was here. 20:31.640 --> 20:33.098 SPEAKER 1: Yeah, that's a hard day. 20:33.098 --> 20:35.480 The physician who supervises pregnancy and childbirth 20:35.480 --> 20:39.620 has many opportunities to broach the subject of contraception. 20:39.620 --> 20:41.690 SPEAKER 3: This is your second pregnancy, 20:41.690 --> 20:43.580 and you will notice that this is true-- 20:43.580 --> 20:47.535 SPEAKER 1: Often he may have to bring it up quite directly. 20:47.535 --> 20:48.410 SPEAKER 3: Let's see. 20:48.410 --> 20:49.618 How many have you had, ma'am. 20:49.618 --> 20:50.660 SPEAKER 5: Three. 20:50.660 --> 20:51.350 SPEAKER 3: Three, and you're about 20:51.350 --> 20:53.120 ready to have your fourth one, are you? 20:53.120 --> 20:54.590 SPEAKER 5: That wasn't what I planned, but then I 20:54.590 --> 20:56.223 hadn't planned on three either. 20:56.223 --> 20:57.050 SPEAKER 3: I see. 20:57.050 --> 21:02.350 Are you planning to control your additional family in some way? 21:02.350 --> 21:04.130 SPEAKER 5: Oh, we thought we were. 21:04.130 --> 21:05.340 SPEAKER 3: How are you going to go about that? 21:05.340 --> 21:07.550 SPEAKER 5: Well, I wanted to ask you about the-- 21:07.550 --> 21:09.717 SPEAKER 3: How man are you going to have, about six? 21:09.717 --> 21:10.580 SPEAKER 6: Oh, no. 21:10.580 --> 21:11.163 SPEAKER 3: No. 21:11.163 --> 21:12.958 SPEAKER 6: This is it. 21:12.958 --> 21:14.750 SPEAKER 1: Even though she has not said so, 21:14.750 --> 21:17.490 the patient may be hoping for guidance from her physician. 21:17.490 --> 21:18.950 SPEAKER 6: Well. 21:18.950 --> 21:23.240 SPEAKER 3: You have plans for future contraception, 21:23.240 --> 21:24.800 or how are you going to continue? 21:24.800 --> 21:25.020 SPEAKER 6: I don't know. 21:25.020 --> 21:26.790 That's what I want to talk to you about. 21:26.790 --> 21:27.842 SPEAKER 3: I see. 21:27.842 --> 21:30.510 It's a little bit early to discuss it at this point, 21:30.510 --> 21:33.920 but since you mentioned that you're not 21:33.920 --> 21:37.610 going to have any more way, what type were you 21:37.610 --> 21:39.950 contraception were you thinking that you-- 21:39.950 --> 21:41.240 SPEAKER 6: I have no idea. 21:41.240 --> 21:45.200 I thought I talked to you and find out what you'd suggest. 21:45.200 --> 21:49.730 SPEAKER 3: Well, now as far as their percentage 21:49.730 --> 21:51.087 of prevention of pregnancy. 21:51.087 --> 21:52.670 SPEAKER 7: I don't know enough about-- 21:52.670 --> 21:55.490 SPEAKER 1: Previous success with a particular method 21:55.490 --> 21:56.263 is important. 21:56.263 --> 21:56.930 SPEAKER 7: Sure. 21:56.930 --> 21:58.833 I've always used it in diaphragm before. 21:58.833 --> 22:01.500 SPEAKER 3: You've always used it successfully then, haven't you? 22:01.500 --> 22:02.125 SPEAKER 7: Yes. 22:02.125 --> 22:03.050 Yes. 22:03.050 --> 22:06.230 SPEAKER 3: Well, I would suggest that then as I do to other 22:06.230 --> 22:10.640 patients that if you are using a successful method 22:10.640 --> 22:13.220 of contraception and you're happy with it and your husband 22:13.220 --> 22:14.000 is, then you shouldn't-- 22:14.000 --> 22:16.125 SPEAKER 1: It has been said that the most effective 22:16.125 --> 22:20.140 contraceptive is the one that the patient will use. 22:20.140 --> 22:21.620 SPEAKER 8: Oh, I wanted the pills. 22:21.620 --> 22:22.800 SPEAKER 3: I see. 22:22.800 --> 22:26.870 Now do you have any knowledge of pills? 22:26.870 --> 22:28.010 Have you used them before? 22:28.010 --> 22:28.593 SPEAKER 8: No. 22:28.593 --> 22:30.650 No. 22:30.650 --> 22:31.980 SPEAKER 3: I see. 22:31.980 --> 22:37.280 Well, I'll explain it to you a bit and how it works 22:37.280 --> 22:40.220 and also how you use it. 22:40.220 --> 22:44.570 Now the pill, as you may know, is a hormone pill, 22:44.570 --> 22:49.520 and it works by preventing ovulation or preventing 22:49.520 --> 22:51.910 your ovaries from producing eggs. 22:51.910 --> 22:54.740 That's the way that they accomplished this. 22:54.740 --> 22:58.520 And now you will have to wait until 22:58.520 --> 23:01.315 your next menstrual period before you can start them. 23:01.315 --> 23:02.690 SPEAKER 1: Careful explanation is 23:02.690 --> 23:04.430 particularly important for patients 23:04.430 --> 23:06.530 who choose the rhythm method. 23:06.530 --> 23:09.710 SPEAKER 3: Now there's a much more constant relationship 23:09.710 --> 23:14.330 we feel between ovulation and the next menstrual period 23:14.330 --> 23:17.330 than ovulation in the preceding menstrual period. 23:17.330 --> 23:23.510 Now for instance, if your cycle would be regularly 28 days, 23:23.510 --> 23:27.780 that would mean that the 14th day is right in the middle. 23:27.780 --> 23:30.650 And so that means that 14 days after a menstrual period 23:30.650 --> 23:33.710 and 14 days before a menstrual period, you ovulate. 23:33.710 --> 23:35.210 SPEAKER 1: In addition to the office 23:35.210 --> 23:37.820 of the private physician, this kind of guidance 23:37.820 --> 23:41.450 is offered in Planned Parenthood clinics and more and more 23:41.450 --> 23:42.995 in the clinics of public hospitals. 23:42.995 --> 23:44.120 SPEAKER 9: Literature here. 23:44.120 --> 23:46.820 You can take it home, discuss it with your husband. 23:46.820 --> 23:49.460 If you've made up your mind when you are at home, 23:49.460 --> 23:53.420 please call the clinic back and change your postpartum 23:53.420 --> 23:54.017 appointment. 23:54.017 --> 23:55.850 SPEAKER 1: Lack of birth control information 23:55.850 --> 23:59.030 has been a primary cause of excessive multipolarity, 23:59.030 --> 24:01.490 especially among the poor. 24:01.490 --> 24:04.460 SPEAKER 9: This is the female reproductive organ. 24:04.460 --> 24:07.820 This is the womb or the uterus, where the baby normally grows. 24:07.820 --> 24:09.830 SPEAKER 1: Every serious study undertaken 24:09.830 --> 24:12.890 indicates that members of all socioeconomic groups 24:12.890 --> 24:16.910 in the United States, regardless of race or national background, 24:16.910 --> 24:20.060 would prefer to have families of limited size 24:20.060 --> 24:22.700 and do make use of family planning services 24:22.700 --> 24:24.260 when they are available. 24:24.260 --> 24:26.870 SPEAKER 10: Well, I don't want more children. 24:26.870 --> 24:28.237 I think that's more than enough. 24:28.237 --> 24:29.570 SPEAKER 11: Your husband agrees. 24:29.570 --> 24:30.640 SPEAKER 10: Yes, uh-huh. 24:30.640 --> 24:32.195 SPEAKER 11: Well, I think you have plenty. 24:32.195 --> 24:33.612 SPEAKER 10: We did one little girl 24:33.612 --> 24:35.152 being that we have all six boys. 24:35.152 --> 24:36.110 SPEAKER 11: Oh my gosh. 24:36.110 --> 24:38.510 SPEAKER 10: But, well, that's-- 24:38.510 --> 24:40.430 it's too much anyway. 24:40.430 --> 24:43.768 We'll just have to do without that girl. 24:43.768 --> 24:45.310 SPEAKER 11: How have you been feeling 24:45.310 --> 24:46.420 since the baby was born? 24:46.420 --> 24:47.470 SPEAKER 10: Real good. 24:47.470 --> 24:48.070 SPEAKER 11: No problems? 24:48.070 --> 24:49.210 SPEAKER 10: No, no problems. 24:49.210 --> 24:50.530 SPEAKER 11: When you were upstairs, did 24:50.530 --> 24:51.940 you go to the lectures about-- 24:51.940 --> 24:53.320 SPEAKER 10: Yes, I did, uh-huh. 24:53.320 --> 24:55.660 SPEAKER 11: And Mrs. Fredericks talked to you 24:55.660 --> 24:57.948 about the various methods that we have available. 24:57.948 --> 24:58.990 SPEAKER 10: Yes, she did. 24:58.990 --> 25:02.110 She talked to us about the different ways 25:02.110 --> 25:04.475 that they could help us in this program. 25:04.475 --> 25:06.850 SPEAKER 11: Did you find one that seemed to interest you? 25:06.850 --> 25:11.020 SPEAKER 10: Yes, I found that the hoop or loop I think 25:11.020 --> 25:13.950 is what they call it is the one I'd like to. 25:13.950 --> 25:15.325 SPEAKER 1: In the clinics just as 25:15.325 --> 25:17.200 in the office of the private physician, 25:17.200 --> 25:19.458 patient choice is crucial. 25:19.458 --> 25:21.250 SPEAKER 11: Have you seen one of the loops. 25:21.250 --> 25:22.417 SPEAKER 10: Yes, we've seen. 25:22.417 --> 25:24.445 I seen one when I was in the hospital. 25:24.445 --> 25:26.320 SPEAKER 11: They're just made out of plastic. 25:26.320 --> 25:28.487 We straighten them out in this fashion to put it in, 25:28.487 --> 25:30.250 and then it just automatically snaps back 25:30.250 --> 25:32.440 in its little loop shape. 25:32.440 --> 25:34.930 And the white part of the loop stays inside the uterus 25:34.930 --> 25:37.180 or the womb like this. 25:37.180 --> 25:40.210 With the threads coming out through the mouth to the uterus 25:40.210 --> 25:42.108 into the top of the vagina. 25:42.108 --> 25:44.650 And then I just, sort of, like to have you feel these threads 25:44.650 --> 25:45.733 so that what they're like. 25:49.670 --> 25:54.340 And the loop here too just to feel this. 25:54.340 --> 25:55.870 When you examine yourself as long 25:55.870 --> 25:58.397 as you can feel just the threds, everything's all right. 25:58.397 --> 25:59.980 There are some problems with the loop, 25:59.980 --> 26:02.980 and you have to understand about this before we get started 26:02.980 --> 26:04.370 or you might get discouraged. 26:04.370 --> 26:08.530 But, for instance, there's liable to be 26:08.530 --> 26:10.780 some cramping like a-- 26:10.780 --> 26:12.850 do you have cramps with your menstrual period? 26:12.850 --> 26:15.550 SPEAKER 10: Not usually, not unless I've been 26:15.550 --> 26:17.290 working a little hard before. 26:17.290 --> 26:19.990 But otherwise, I have pretty good menstrual periods. 26:19.990 --> 26:23.140 SPEAKER 11: There's liable to be some cramping for some women 26:23.140 --> 26:26.540 tell us two or three hours, some say two or three days. 26:26.540 --> 26:28.450 Some say they have no problems at all. 26:28.450 --> 26:31.000 For a while after the loops been put in, 26:31.000 --> 26:33.430 just a little vague, sort of, cramping 26:33.430 --> 26:37.890 feeling low in your abdomen. 26:37.890 --> 26:40.580 Your first few periods that you have, 26:40.580 --> 26:46.430 your menstruation is likely to be quite heavy, 26:46.430 --> 26:49.600 heavy enough to worry a little bit, but this is expected. 26:49.600 --> 26:51.350 And that's why I want to tell you about it 26:51.350 --> 26:53.413 so it doesn't scare you. 26:53.413 --> 26:54.830 SPEAKER 1: Success depends largely 26:54.830 --> 26:57.530 upon the care with which the physician explains the chosen 26:57.530 --> 27:00.470 method and the degree to which he 27:00.470 --> 27:02.390 responds to the needs and concerns 27:02.390 --> 27:05.653 of each particular patient. 27:05.653 --> 27:07.070 SPEAKER 11: This is a safe method. 27:07.070 --> 27:09.380 You're not worried about that, are you? 27:09.380 --> 27:10.970 SPEAKER 12: No, I have a girlfriend 27:10.970 --> 27:12.163 say you could get cancer. 27:12.163 --> 27:13.580 SPEAKER 11: Well, that's not true. 27:13.580 --> 27:13.970 SPEAKER 12: I know. 27:13.970 --> 27:15.550 The nurse explained it to us when she-- 27:15.550 --> 27:17.180 SPEAKER 11: You can get cancer, but this doesn't 27:17.180 --> 27:18.710 make the chances any greater. 27:18.710 --> 27:22.130 You still have the same chances that any other woman has. 27:22.130 --> 27:23.896 SPEAKER 12: Well, I didn't believe that. 27:23.896 --> 27:25.520 And plus I read a little little bit about it in-- 27:25.520 --> 27:26.480 SPEAKER 11: One of the advantages 27:26.480 --> 27:28.272 of coming to see us every year is we always 27:28.272 --> 27:30.950 do the cancer test, of course, and we find it at the earliest 27:30.950 --> 27:31.760 possible moment. 27:34.440 --> 27:36.480 SPEAKER 13: And if I want to have a baby later, 27:36.480 --> 27:37.610 can it be taken out? 27:37.610 --> 27:39.277 SPEAKER 11: Yes, you just take this out, 27:39.277 --> 27:43.910 and then you perfectly easy to become pregnant again. 27:43.910 --> 27:47.030 That's true, of course, with the pills too. 27:47.030 --> 27:49.640 Now no matter whether your period 27:49.640 --> 27:55.100 lasts two days or seven days or four days, 27:55.100 --> 27:59.240 you always start taking your pills on day five, OK. 28:02.033 --> 28:03.700 The day that you start taking your pills 28:03.700 --> 28:06.850 is not determined by when your period stops. 28:06.850 --> 28:09.265 It's determined by when your period starts, 28:09.265 --> 28:14.140 and it's always five days after the first day of bleeding, OK. 28:14.140 --> 28:16.810 So your period could stop here or here or here 28:16.810 --> 28:19.480 or here or maybe even here, but you still 28:19.480 --> 28:20.965 start the pills on day five. 28:23.500 --> 28:28.060 Now the pills are taken one pill a day every night. 28:28.060 --> 28:30.460 The nighttime is the best time to take them 28:30.460 --> 28:33.370 for 20 days in a row, OK. 28:36.750 --> 28:39.360 EDRIS RICE-WRAY: After working in public health for 11 years 28:39.360 --> 28:43.410 I suddenly realized that it's useless to go on saving lives 28:43.410 --> 28:46.502 if we aren't willing to do anything about the birth rate. 28:46.502 --> 28:48.210 SPEAKER 1: Edris Rice-Wray is a physician 28:48.210 --> 28:50.850 working in public health. 28:50.850 --> 28:52.500 The Mexican village she is entering 28:52.500 --> 28:54.600 is typical of the rural areas in which 28:54.600 --> 28:58.025 much of the world's population growth is taking place. 28:58.025 --> 29:04.517 [CAR] 29:04.517 --> 29:06.350 EDRIS RICE-WRAY: We have found that in order 29:06.350 --> 29:08.930 to start a program, it's very worthwhile to have 29:08.930 --> 29:12.140 a meeting with the mothers. 29:12.140 --> 29:13.760 Talk to them and find out how they 29:13.760 --> 29:16.160 feel about their large families, and then you 29:16.160 --> 29:18.965 learn IF they want advice as to how to space their children. 29:21.797 --> 29:23.630 SPEAKER 1: In addition to being a physician, 29:23.630 --> 29:27.170 the public health doctor must be something of a sociologist 29:27.170 --> 29:29.760 as well as an educator. 29:29.760 --> 29:31.850 EDRIS RICE-WRAY: In order to start a program, 29:31.850 --> 29:34.670 it's necessary to begin teaching them the basic facts 29:34.670 --> 29:35.510 of reproduction. 29:35.510 --> 29:38.570 [NON-ENGLISH SPEECH] 29:54.560 --> 29:57.050 After we talk to the mothers, then the next step 29:57.050 --> 30:02.720 is to orient the nurse who will be carrying out the program. 30:02.720 --> 30:11.180 [NON-ENGLISH SPEECH] 30:11.180 --> 30:13.670 SPEAKER 1: George Brown is also a physician specializing 30:13.670 --> 30:15.830 in population problems. 30:15.830 --> 30:18.890 He works closely with Tunisian officials, 30:18.890 --> 30:21.680 who have initiated an active birth control program. 30:21.680 --> 30:25.173 [MUSIC PLAYING] 30:45.650 --> 30:48.860 The Tunisian maternal and child care centers offer 30:48.860 --> 30:53.960 along with their other services help in family planning. 30:53.960 --> 30:55.970 Medical indications for contraception 30:55.970 --> 30:58.130 are particularly frequent among the poor. 30:58.130 --> 31:01.609 [MUSIC PLAYING] 31:54.300 --> 31:57.270 George Brown's role is not that of the typical practicing 31:57.270 --> 32:00.120 doctor private or public. 32:00.120 --> 32:03.450 He is a consultant and an advisor. 32:03.450 --> 32:05.250 The government of Tunisia has decided 32:05.250 --> 32:08.130 that no program of social and economic improvement 32:08.130 --> 32:10.200 can succeed unless it is accompanied 32:10.200 --> 32:14.370 by an effective birth control program. 32:14.370 --> 32:17.160 Many physicians contribute to the field of fertility control 32:17.160 --> 32:18.610 by doing research. 32:18.610 --> 32:20.490 One example is Luigi Mastroianni, 32:20.490 --> 32:22.980 professor at the University of Pennsylvania. 32:22.980 --> 32:25.230 LUIGI MASTROIANNI: Well, it's been known for some time 32:25.230 --> 32:29.130 that the presence of a foreign body in the uterine cavity 32:29.130 --> 32:32.520 materially affects reproductive processes. 32:32.520 --> 32:35.760 As a matter of fact, recently several devices 32:35.760 --> 32:39.420 have been developed which have been proved safe and effective, 32:39.420 --> 32:45.000 and they are very useful as a method of family planning. 32:45.000 --> 32:49.080 The mechanism of action behind the presence 32:49.080 --> 32:51.510 of an intrauterine device is one which 32:51.510 --> 32:54.390 is a matter of continuing speculation. 32:54.390 --> 32:56.580 Many people have felt for some time 32:56.580 --> 32:58.680 that they act at the uterine level 32:58.680 --> 33:02.910 by some interference with myometrial or endometrial 33:02.910 --> 33:06.660 behavior, but a few investigators 33:06.660 --> 33:09.360 have suggested that they act at the tubal level 33:09.360 --> 33:12.600 by causing a rapid transport of ova from the fallopian tube 33:12.600 --> 33:14.920 into the uterus. 33:14.920 --> 33:17.130 Well, in order to get at the problem, 33:17.130 --> 33:22.260 we decided to study the effect of the intrauterine device 33:22.260 --> 33:26.640 on reproductive processes in the monkey. 33:26.640 --> 33:30.330 For our experiments, we chose the macaque [INAUDIBLE] monkey 33:30.330 --> 33:32.850 largely because the reproductive processes 33:32.850 --> 33:36.420 in that species of monkeys have resembled that of people. 33:38.970 --> 33:43.170 The intrauterine device was introduced 33:43.170 --> 33:48.060 from below without much difficulty. 33:48.060 --> 33:53.460 Now we used a Margulies spiral, which was cut to size, 33:53.460 --> 33:57.900 and I think one of the reasons we were able to introduce this 33:57.900 --> 34:00.930 into the group of monkeys we were working with 34:00.930 --> 34:03.992 was that these monkeys all had recently born young. 34:03.992 --> 34:05.325 That is they were Paris monkeys. 34:12.040 --> 34:15.040 The monkeys incidentally were obtained directly from India. 34:15.040 --> 34:16.870 They were introduced into the laboratory. 34:16.870 --> 34:19.719 And after the device was introduced 34:19.719 --> 34:22.000 into a group of these monkeys, their cycles 34:22.000 --> 34:24.654 were carefully followed by daily vaginal smears. 34:33.310 --> 34:36.400 The animals were observed in captivity for a month 34:36.400 --> 34:40.840 or two over one or two cycles, and subsequently they 34:40.840 --> 34:46.000 were treated with human urinary pituitary gonadotropin in order 34:46.000 --> 34:48.489 to induce super ovulation. 34:48.489 --> 34:51.340 It was reasoned that within a matter of hours 34:51.340 --> 34:53.409 after the last ovulating injection, 34:53.409 --> 34:55.075 super ovulation would have occurred. 34:58.460 --> 35:02.590 Now on the last three days of gonadotropin treatment, 35:02.590 --> 35:06.100 we did artificial insemination on our monkeys. 35:06.100 --> 35:09.205 And for this, we used electro ejaculated semen. 35:20.550 --> 35:23.070 Semen was taken in the fresh state 35:23.070 --> 35:25.650 and immediately after liquefaction, 35:25.650 --> 35:27.450 the liquefied portion of the specimen 35:27.450 --> 35:29.033 was introduced into the vagina. 35:29.033 --> 35:31.200 And this was followed by the coagulant, which should 35:31.200 --> 35:32.595 have acted as a vaginal plug. 35:39.670 --> 35:42.880 Within a few hours of the expected time of ovulation, 35:42.880 --> 35:47.110 the laparotomy was carried out, and the fallopian tubes 35:47.110 --> 35:47.725 were flushed. 35:54.150 --> 35:56.550 Using Krebs-Ringer phosphate solution, 35:56.550 --> 35:59.340 the effluent was collected in a plastic receptacle 35:59.340 --> 36:02.295 placed at the fimbrated at the end of the fallopian tube. 36:24.950 --> 36:28.265 This material was then inspected for the presence of ova. 36:33.330 --> 36:37.620 Actually, approximately 50% of the ova, 36:37.620 --> 36:39.450 which were expected to be present, 36:39.450 --> 36:41.820 were found in the flushing. 36:41.820 --> 36:44.670 Now these ova, which were obtained from animals, 36:44.670 --> 36:46.560 which did not wear the coil-- 36:46.560 --> 36:50.940 that is in the non-coil control group were prepared 36:50.940 --> 36:54.300 for electron microscopy, and several of the ova 36:54.300 --> 36:57.270 were, in fact, actually fertilized providing us 36:57.270 --> 36:59.250 with some very interesting specimens 36:59.250 --> 37:01.680 for electron microscopic study. 37:01.680 --> 37:04.890 Now in the group of animals in which the coil had previously 37:04.890 --> 37:07.950 been placed, a similar procedure was carried out. 37:07.950 --> 37:11.730 And interestingly enough, we were not 37:11.730 --> 37:15.360 able to recover a single egg from these animals, which 37:15.360 --> 37:17.950 were treated in exactly the same way. 37:17.950 --> 37:19.860 There is one exception in this series, 37:19.860 --> 37:22.320 and that was an animal in which there were four ovulation 37:22.320 --> 37:22.980 points. 37:22.980 --> 37:25.740 And we recovered three ova. 37:25.740 --> 37:29.850 But afterwards on careful inspection of the vagina, 37:29.850 --> 37:33.150 it was found that the coil had been extruded probably 37:33.150 --> 37:36.090 some time previously into the vaginal canal 37:36.090 --> 37:39.220 and was entirely out of the uterus. 37:39.220 --> 37:41.820 So that this animal then was reasonably 37:41.820 --> 37:43.980 excluded from the series. 37:43.980 --> 37:48.810 But our failure to recover eggs from the animals 37:48.810 --> 37:51.120 in which the coil have been placed 37:51.120 --> 37:54.340 suggested one of two possibilities. 37:54.340 --> 37:55.920 Either the eggs were not picked up 37:55.920 --> 37:58.530 by the fembrated extremity of the fallopian tube, 37:58.530 --> 38:03.060 or if they were picked up, they might possibly 38:03.060 --> 38:06.120 have been rapidly transported down the fallopian tube 38:06.120 --> 38:08.980 and into the uterus prematurely. 38:08.980 --> 38:12.990 Now in order to decide which of these two possibilities 38:12.990 --> 38:15.420 was, in fact, operating, we carried 38:15.420 --> 38:17.460 on another set of experiments. 38:17.460 --> 38:20.460 This time we placed a ligature right here 38:20.460 --> 38:22.800 at the uterotubal junction. 38:22.800 --> 38:25.950 The animals were then treated in exactly the same way. 38:25.950 --> 38:29.430 The other side of course was unlike it. 38:29.430 --> 38:34.050 When we flushed for ova, we found that over were indeed 38:34.050 --> 38:36.060 present in the ligated side, because they 38:36.060 --> 38:37.620 were contained by the ligature. 38:37.620 --> 38:41.130 And in fact, we had a 50% recovery rate on this side. 38:41.130 --> 38:45.870 On the unligated side, again, no over were recovered. 38:45.870 --> 38:48.960 So this suggested that the eggs were picked up 38:48.960 --> 38:52.380 by the animal in which the coil had been placed, 38:52.380 --> 38:55.560 and they were rapidly transported down the fallopian 38:55.560 --> 38:57.510 tube and out into the uterus. 38:57.510 --> 38:59.160 But of course, on the ligated side, 38:59.160 --> 39:04.020 they were contained in the fallopian tube by the ligature. 39:04.020 --> 39:06.600 This was all very nice, but where 39:06.600 --> 39:10.320 were the eggs among the animals in which the coil had 39:10.320 --> 39:13.200 been placed, animals which did not have the ligature 39:13.200 --> 39:14.430 placed here. 39:14.430 --> 39:16.180 Did they really get into the uterus. 39:16.180 --> 39:18.300 And if so, how long did they stay here? 39:18.300 --> 39:21.060 Well, in order to explore that possibility, 39:21.060 --> 39:23.850 we made some attempts to recover the eggs actually 39:23.850 --> 39:24.870 from the uterus. 39:24.870 --> 39:27.390 The animals were treated in exactly the same way. 39:27.390 --> 39:31.890 They did wear coils, and an attempt 39:31.890 --> 39:34.830 was made to recover ova from the uterine cavity 39:34.830 --> 39:35.865 by retrograde flushing. 40:15.880 --> 40:18.670 Now in the group of animals studied thus far, 40:18.670 --> 40:21.670 there were eight ovulation points, 40:21.670 --> 40:26.200 and we were able to recover four ova, four ova from the uterus 40:26.200 --> 40:28.210 at a time when they would be expected to be 40:28.210 --> 40:30.490 present in the Fallopian tube. 40:30.490 --> 40:33.430 This suggested then that our theory was correct 40:33.430 --> 40:36.370 and that the eggs were indeed rapidly transported 40:36.370 --> 40:39.710 from the Fallopian tube into the uterus. 40:39.710 --> 40:42.610 Now the matter of whether or not these eggs are fertilized 40:42.610 --> 40:46.150 is an interesting matter indeed. 40:46.150 --> 40:49.900 Three of the four ova were prepared for microscopic study. 40:49.900 --> 40:52.750 Unfortunately, the fourth was lost in transit, 40:52.750 --> 40:56.560 and here we see an unfertilized monkey egg recovered 40:56.560 --> 41:00.520 with the cumulus cells, the corona radiata still around it, 41:00.520 --> 41:04.840 and this egg is unfertilized as were the other two. 41:04.840 --> 41:08.710 So that we can say that in the monkey 41:08.710 --> 41:11.200 and the super ovulated artificially inseminated 41:11.200 --> 41:14.320 monkey, the presence of an intrauterine device 41:14.320 --> 41:18.460 results in rapid transport of ova from the Fallopian tube 41:18.460 --> 41:19.750 and into the uterus. 41:19.750 --> 41:22.480 And in the limited number of eggs studied, 41:22.480 --> 41:26.860 we can say that the ova are unfertilized. 41:26.860 --> 41:29.350 SPEAKER 1: Current research also leads towards new methods 41:29.350 --> 41:32.200 of contraception. 41:32.200 --> 41:35.110 Suppression of spermatogenesis, creation 41:35.110 --> 41:37.720 of immune responses in male or female 41:37.720 --> 41:41.850 are just two promising areas of investigation. 41:41.850 --> 41:43.890 The biology of mammalian reproduction 41:43.890 --> 41:46.530 is extremely complex. 41:46.530 --> 41:48.960 The more we learn about it, the more points 41:48.960 --> 41:51.432 there are at which we can influence it. 41:51.432 --> 41:54.876 [MUSIC PLAYING] 42:10.160 --> 42:13.670 People have always wanted to influence their own fertility 42:13.670 --> 42:16.310 essentially to have the baby who was wanted 42:16.310 --> 42:19.670 and for whom there was an adequate place in the world. 42:19.670 --> 42:21.860 The realization of this hope depends heavily 42:21.860 --> 42:23.330 upon the physician. 42:23.330 --> 42:26.380 [MUSIC PLAYING]