WEBVTT

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Prof: We're coming to
the end of the course,

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and the last couple of
lectures, the last few are

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social issues and then we'll
have a very short time for

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environment, unfortunately.

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Today we're going to talk about
abortion.

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It's kind of a unique topic in
the sense that in the United

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States it's--
if you have a global

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perspective, in most of the
world abortion is not a big

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controversial issue.

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In the United States it's just
gone sky high as kind of the

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central issue in the American
debate on values.

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It has tremendous political
significance.

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Large numbers of people vote
for a candidate for,

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say president,
based solely on whether they

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are pro-choice or pro-life.

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One of the things you've got to
figure out, or try to,

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is why has this become so
important an issue.

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I think one of the reasons is
that it encapsulates

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diametrically opposed views of
our roles in everyday life.

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People perceive it as an
everyday kind of issue.

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What are the roles that I'm
talking about?

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Sex roles, work roles,
husband and wife roles,

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motherhood and fatherhood
roles;

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all of those--how you perceive
yourself in those roles will

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very much determine how you feel
about the abortion debate.

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For instance,
both sides in the debate agree

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that the issue is about murder.

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A pro-lifer sees images of a
three month old fetus,

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which even though only about
the size of your finger they

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see--
they're having visuals of blown

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up photographs and I'm sure
you've all seen those things and

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it already looks quite baby
like,

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and thinks of it of being
dismembered and murdered.

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A pro-choicer also sees it
about murder,

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but she, in her mind,
sees a young woman,

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maybe herself,
in a back alley abortion,

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being butchered and possibly
murdered.

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Almost everyone of the older
generation of pro-choice women

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has either themselves had an
abortion,

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or has had a friend who has had
an abortion,

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and they perceived it as
lifesaving,

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or if it was a back alley,
unsuccessful one,

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as a life depriving situation.

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Both sides agree that the issue
is about babies and motherhood.

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A pro-life mother thinks that
babies are so precious that

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whenever they come they will be
loved and wanted.

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There is no such thing as an
unloved or unwanted baby.

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A pro-choice mother thinks that
babies are so precious that they

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should only be had when the
woman really wants the baby and

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is in the situation in life
where they have resources to

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take care of the baby.

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Both sides agree that the issue
is about sex.

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A pro-life woman thinks that
sex is so special that it should

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be guarded by strong religious
and social controls so that it

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always has an almost sacred
character.

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A pro-choice woman thinks sex
is so special that it should be

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freed from worry about pregnancy
and disease so that it can be

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enjoyed as a unique sharing of
intimacy.

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Both sides agree that the issue
is about the status of women.

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Pro-life women think that women
are so important that their

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special life role of motherhood
must be protected.

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Pro-choice women think that
women are so important that they

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should have every bit as much
control over their life roles as

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men have.

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Just viewed in that way,
one of the interesting things

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about this abortion debate is
that the two sides on--

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if you really get down to what
the fundamental values of the

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two sides are,
they're not different.

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They apply them differently.

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They're thinking of different
instances, of different real

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situations in which to apply
these rather same kinds of

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fundamental human values.

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All right, well obviously this
is not a philosophy course and

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not in the slightest set up to
debate the pros and cons of

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abortion,
and that's also a kind of

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sterile debate.

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Anybody--has anybody changed
their mind about abortion since

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they were knee high to a
grasshopper, in the class?

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I don't want to know which
direction you went.

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One has changed her mind,
two have changed their mind.

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That's a high ratio.

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Does anybody know anybody who's
changed their minds,

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except for yourself of course,
one or two more people;

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three another one.

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I mean there's so much about
abortion out there and yet

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people's attitude toward it is
set very early in life,

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by again, these very
fundamental images of what we're

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talking about when we're talking
about abortion.

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No matter how it's argued,
people basically don't change

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their opinions.

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I'm not going to debate pros
and cons at all.

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I'm going to give you as many
facts about abortion as I can

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explain to you:
the demography,

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and the biology,
and the statistics,

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and all of that kind of stuff.

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There are a number of important
things that you should know

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about abortion.

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The first is that induced
abortion is common;

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it's a very frequent situation
in the world.

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There's one abortion for every
3.2 live births,

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so that's 1 in 3.

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Each year about 3% of women in
childbearing ages have an

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abortion,
and if you consider a 30 year

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reproductive lifespan with each
woman having a 3% chance each

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year that's 90%.

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That means that,
in the world,

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the average woman has a 0.9
chance, very close to one.

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Basically, for every woman in
the world, there's one abortion

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in her reproductive lifetime.

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Of course this is an average,
some women have many more,

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and some women have none.

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There are three,
actually three or four standard

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ways of measuring and expressing
the frequency of abortion.

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One is simply the number of
abortions in the world,

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or in the country,
or whatever you want.

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The latest estimate,
all of these latest estimates

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come from 2003.

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About every five years people
try to tally up abortion

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statistics from around the world
and that's a very difficult job

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because wherever its illegal,
you have very great difficulty

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getting statistics.

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In many places--especially
where there's religious

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opposition to abortion they--the
statistics include it as

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'menstrual regulation.'

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That means a woman has missed
her menses and,

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of course, everyone knows
that's a good thing,

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so you have to restore the
menses and you do exactly what's

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an abortion.

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Everybody in the country will
understand what's going on,

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but the statistic is menstrual
regulation.

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Depending on what's happening
in the country,

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you usually have to add one
part of the government

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statistics about menstrual
regulation to another part which

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says abortion.

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Anyway, there are lots of
problems in collecting these

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numbers but they're probably
fairly decent because they're

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very sophisticated--
demographically very

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sophisticated people are the
ones that try to make these best

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estimates.

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The number of abortions in the
world is now considered to be 42

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million per year and the number
has stayed in that range,

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the 40 to 50 million range,
for at least the last two

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decades,
when there's fairly good

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collection of the statistics.

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So that's the number.

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The abortion rate is defined as
the abortions per 1,000 women in

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reproductive ages which is
usually taken as 15 to 44,

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or 15 to 49.

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For the world it's 29 per 1,000.

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So, every year,
per 1,000 women,

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29 have an abortion.

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That's the 3% that I mentioned
earlier;

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if it was 30 it would be
exactly 3%.

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Both the highest rate and the
lowest rates are found in

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Europe.

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Western Europe has 12 abortions
per 1,000 women per year;

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Eastern Europe has four times
as many, 44 per 1,000 women per

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year.

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It's interesting that of the
whole world,

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within Europe,
which we sometimes consider a

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cultural entity,
it isn't with respect to

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abortion, the highest and lowest
numbers are found in Europe.

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Another way of expressing it is
the abortion ratio which is the

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abortions per 100 live births,
and that's what I told you

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before.

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One abortion for every 3.2 live
births.

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In the world,
that comes out to 31 per 100

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and this ranges from 12 in
middle Africa,

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it's a low rate,
to 105 in Eastern Europe,

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again Eastern Europe has the
highest in the world.

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Note that 105;
we're talking about abortions

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per live births.

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When you have 105 abortions per
100 live births,

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there are more abortions than
live births.

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So, at 100 per 100,
half of pregnancies are

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terminated with an abortion.

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Interestingly,
the abortion rate is the same,

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is very closely the same,
independent of whether you're

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in a developing country or a
developed country.

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The rate in developed countries
is 26 per 1,000 and in

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developing countries it's 29 per
1,000;

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not a huge difference.

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China, which everyone worries
about the forced abortions

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there, has about 20% of the
world's population and has about

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20% of the world's abortions.

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Another--the last number that
I'll tell you about that people

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calculate,
is what's called the total

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abortion rate,
which is calculated exactly in

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the same way as the total
fertility rate.

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You take the age specific
abortion rate and add it up,

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and it's the number of
abortions that the average woman

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would have in her lifetime if
she continues with the rates

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that are present at the time you
collect the statistics.

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Again, I mention this,
in the world it's 0.9 very

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close to 1, the average woman
will have 1 abortion in her

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lifetime.

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It ranges from a low of 0.2,
one abortion per every five

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women in several countries,
to a high of 1.7 in Cuba,

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almost two abortions per woman
in Cuba.

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Well I'll talk later about a
very interesting situation in

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Cuba.

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Over time, as I said,
the number of abortions is

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really, on the big scale,
a couple of decades,

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staying pretty constant.

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But, from the last compilation
in 1995, the estimate was 46

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million abortions and now it's
down to 42 million abortions.

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There has been a very small
drop in the number of abortions.

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Where do you think all of that
drop has occurred?

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Eastern Europe;
again they had an extremely

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high abortion rate,
it was the mechanism of

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contraception there,
and they're gradually becoming

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accustomed to contraception so
their abortion rate is going

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down,
three-quarters of the change in

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the whole world is all due to
Eastern Europe.

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The United States looks pretty
much like the rest of the world.

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There's 1 abortion for every
3.2 live births here which is

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exactly the number that is the
average for the world.

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In the United States there are
1.3 million abortions in again

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2003, the last time those
statistics were collected.

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The rate is 21.3 abortions per
1,000 women.

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If you look per woman,
the U.S.

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looks a little better than per
births,

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that the total abortion rate
for the United States is 0.64

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per woman,
that's mean two-thirds of--the

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average is two-thirds of women
will have an abortion during

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their lifetime,
whereas, the world is closer to

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one.

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So, we have a somewhat lower
rate, and again,

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the difference is the use of
contraception and I'll talk

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about that later.

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The United States,
although somewhat better than

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the world average in this,
is not nearly as good as 0.2;

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remember I said ours is 0.64.

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Belgium, Germany and
Switzerland all are down at 0.2,

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so less than a third of the
number of abortions per woman

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that we have.

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A cohort of 1,000 women going
through their reproductive life

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will have 639 abortions,
and that's assuming,

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we currently have been having a
reducing rate of abortion,

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here it presumes that that rate
will stay down.

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Expanding out to the world
again, abortion can be a major

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method of fertility control,
especially when a country first

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goes through its fertility
transition.

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One of the fastest fertility
transitions in the world was in

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Japan, of all places.

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Where they halved the
birthrate--the birthrate in

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Japan was cut in half between
1947 and 1957,

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in ten years it went down to
half, from 34 per 1,000 women to

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17,
and it's remained at that level

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more or less until 1979 and now
it's getting even lower.

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Here is--this is the
interesting case of Japan.

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This is the years
1949--remember MacArthur,

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the U.S. Administration of
Japan was still sort of tailing

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down at that time and we're
looking at a ten year span.

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This is the number of
pregnancies, which is births

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plus abortions,
and you'll notice that during

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this time,
during this ten year time,

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the number of pregnancies
really does not change an awful

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lot;
notice 2,700 to

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2,900,2,600,2,800,2,800,2,600.

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So the number of pregnancies
does not change.

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But look what happens to
abortion.

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It gets legalized here and very
rapidly it goes from 100 to ten

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times as much.

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Correspondingly,
the births go down,

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so abortion goes from an
insignificant fraction of births

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to a very--
so much, much closer to the

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number of births.

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In this case,
it was legalization of abortion

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that sort of,
boom.

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caused the Japanese birthrate
to fall.

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There was no coercion involved
it was purely a legalization

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step.

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In many places,
abortion is the method of birth

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control.

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So, in the Soviet Union,
the official statistics,

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before it fell apart,
were that there five to eight

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abortions lifetime per woman.

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In the Ukraine it was ten to 12
abortions per woman.

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The immigrants that come to
America say that's nonsense.

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That it was 20 to 30 that
everybody they know had 20 to 30

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abortions lifetime.

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Japan also, because,
although they legalized

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abortion very early,
they didn't legalize the pill

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until just a few years ago.

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They legalized it when Viagra
came out and the men demanded to

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get Viagra.

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-- They have a very good
national health plan,

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it's all free and very careful
and very good,

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and men wanted free Viagra.

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Then it became politically
impossible to keep the women

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from having the pill,
but pay for men's Viagra.

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So Japan legalized it very
recently, the pill,

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and their abortion rate has
always been extremely high.

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In some special circumstances
the abortion rates have gone sky

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high.

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In 1966, in Romania,
there were 408 abortions for

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every 100 live births,
four abortions for every one

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live birth.

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The history of that is very,
very interesting.

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In the whole Soviet Bloc it was
a complex of issues.

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Contraception was legal,
it was kind of available but

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the manufacturing was terrible.

17:28.130 --> 17:32.150
They had condoms in the various
Soviet bloc countries but they

17:32.150 --> 17:35.840
were so poorly made that the
people called them galoshes,

17:35.842 --> 17:37.492
they just didn't fit.

17:37.490 --> 17:43.060
Plus, the doctors were working
for the government and not paid

17:43.061 --> 17:45.631
very well,
but they could privately,

17:45.631 --> 17:47.621
outside the government
statistics,

17:47.618 --> 17:50.528
they could privately do
abortions and make money on it.

17:50.529 --> 17:53.039
So, the doctors were all
pushing abortion and for a

17:53.041 --> 17:54.401
variety of other reasons.

17:54.400 --> 17:58.230
We'll talk more about countries
in which abortion is by far the

17:58.229 --> 18:00.329
dominant means of birth control.

18:00.329 --> 18:06.099


18:06.098 --> 18:10.188
Legal and medically performed
abortion, by a trained doctor,

18:10.192 --> 18:13.942
is one of the safest methods of
birth control known.

18:13.940 --> 18:17.120
Here is the statistics on this,
this on this,

18:17.122 --> 18:21.682
this is from the--do you know
the Physician's Desk Reference?

18:21.680 --> 18:25.860
For many years all of the birth
control pills had to have this

18:25.859 --> 18:26.819
graph in it.

18:26.819 --> 18:28.269
What do you see here?

18:28.269 --> 18:33.239
This is the annual deaths--four
women per 100,000 non-sterile

18:33.240 --> 18:37.880
women who are either using or
not using birth control.

18:37.880 --> 18:41.630
What you notice,
the really high category,

18:41.630 --> 18:47.120
was the only super duper high,
is women over 40 who smoke;

18:47.118 --> 18:51.078
bad idea, and use the
pill--smoke and use the pill.

18:51.078 --> 18:53.988
That's the pill--the pill is
their method of contraception

18:53.990 --> 18:54.860
and they smoke.

18:54.858 --> 18:58.288
If you're over 40 and you
smoke, don't use the pill,

18:58.287 --> 19:00.637
that's not a healthy thing to
do.

19:00.640 --> 19:04.820
For every other category of
woman, the white bars are larger

19:04.816 --> 19:08.846
than any of the other bars,
and the white bar is not using

19:08.849 --> 19:10.619
contraception at all.

19:10.618 --> 19:13.028
What this tells you is,
if they're not using

19:13.028 --> 19:15.398
contraception,
they're going to get pregnant

19:15.401 --> 19:18.001
and that the mortality dangers,
this is deaths,

19:18.001 --> 19:22.401
so this is mortality,
that the mortality dangers from

19:22.396 --> 19:28.266
pregnancy are a good bit higher
than any of the methods of birth

19:28.265 --> 19:29.285
control.

19:29.288 --> 19:31.518
Student:  What year was
that from?

19:31.519 --> 19:32.069
Prof: What?

19:32.068 --> 19:32.948
Student:  What year was
this from?

19:32.950 --> 19:37.740
Prof: This is,
I think, about 1990 and

19:37.742 --> 19:42.212
hasn't--well what has changed is
that--

19:42.210 --> 19:47.520
let me finish and I'll tell you
what's changed since then.

19:47.519 --> 19:51.099
The safest is these little
black bars,

19:51.098 --> 19:53.778
which you can hardly see,
which is traditional

19:53.775 --> 19:57.575
contraception which is condoms
is what they're talking about,

19:57.579 --> 19:59.289
backed up by abortion.

19:59.288 --> 20:03.818
That is the safest of all
methods, and then the other

20:03.823 --> 20:07.053
methods like diaphragm and
condom,

20:07.048 --> 20:13.028
IUD, pills for non-smokers,
abortion only,

20:13.028 --> 20:16.768
are all sort of low but
intermediate.

20:16.769 --> 20:19.539
The story is,
with the exception of older

20:19.539 --> 20:22.659
women who smoke,
the worst thing you can do is

20:22.656 --> 20:24.246
not use any method.

20:24.250 --> 20:25.880
That's dangerous.

20:25.880 --> 20:30.630
The best thing you can do is
use a condom backed up by

20:30.625 --> 20:31.605
abortion.

20:31.608 --> 20:36.048
That's surprising because
there's so much popular myth out

20:36.048 --> 20:39.008
there that misconstrues these
facts.

20:39.009 --> 20:42.969
Now what has changed is that
this data was taken in the

20:42.970 --> 20:47.370
earlier days of birth control
pills which were high dose,

20:47.368 --> 20:48.318
and you've probably heard about
this.

20:48.318 --> 20:50.638
They used to have very high
dose because it was new,

20:50.644 --> 20:53.204
they didn't know about it,
and they wanted to be sure.

20:53.200 --> 20:55.170
The main thing was to prevent
pregnancy.

20:55.170 --> 20:58.260
Then they realized they could
get away with lower and lower

20:58.255 --> 21:01.335
doses and the pills nowadays
have much lower doses so there

21:01.339 --> 21:02.989
are much less side effects.

21:02.990 --> 21:08.200
All of these columns would
probably be way,

21:08.198 --> 21:15.388
way down from what they were,
and that's what's changed.

21:15.390 --> 21:19.000
When you go the developing
world, this is United States

21:18.998 --> 21:22.338
data, when you go to the
developing world of course

21:22.338 --> 21:25.278
pregnancy itself is much more
dangerous.

21:25.278 --> 21:28.738
Childbirth is much more
dangerous so what you see is

21:28.737 --> 21:33.277
these white bars go an awful lot
higher depending on the country.

21:33.279 --> 21:36.759
If you're in the middle of
Africa they're very high,

21:36.758 --> 21:40.368
if you're in other places
they're pretty much like the

21:40.373 --> 21:42.013
United States level.

21:42.009 --> 21:46.149


21:46.150 --> 21:49.070
Student:  These are
deaths associated with deaths

21:49.065 --> 21:52.345
while giving birth or these are
deaths from side effects of the

21:52.352 --> 21:53.362
contraceptives?

21:53.358 --> 21:58.578
Prof: Both,
both, both, all of the above.

21:58.578 --> 22:03.258
Okay not only--so this just
shows you immediate mortality

22:03.260 --> 22:06.020
and it's clear what's going on.

22:06.019 --> 22:10.669
Abortion apparently has no long
term clinical effects

22:10.666 --> 22:11.826
whatsoever.

22:11.828 --> 22:14.468
There's no physical affects,
again we're talking about

22:14.467 --> 22:17.527
proper medically done abortions,
sterile abortions,

22:17.528 --> 22:20.458
properly done,
and there are no long term

22:20.460 --> 22:23.330
clinical effects,
neither physical nor

22:23.327 --> 22:24.187
psychiatric.

22:24.190 --> 22:27.710
It doesn't make women sterile,
doesn't increase the chance of

22:27.709 --> 22:30.759
sterility, it doesn't cause you
to go crazy later;

22:30.759 --> 22:33.769
none of that stuff is
statistically true.

22:33.769 --> 22:37.159
Of course there are women who
either having an abortion or not

22:37.164 --> 22:39.954
having an abortion,
go through all these bad events

22:39.949 --> 22:42.119
but statistically they're the
same.

22:42.118 --> 22:45.268
The number of women who've had
an abortion and eventually go

22:45.272 --> 22:48.112
sterile would be the same as
those who have not had an

22:48.105 --> 22:50.185
abortion and eventually go
sterile.

22:50.190 --> 22:53.600
Now that's medical sequelae.

22:53.598 --> 22:59.258
What the emotional content of
having an abortion is,

22:59.255 --> 23:03.465
that varies tremendously by
country.

23:03.470 --> 23:05.630
We'll talk about some countries
where it's absolutely like a

23:05.625 --> 23:07.425
non-event,
having an abortion,

23:07.433 --> 23:11.653
and other places,
and other individuals where if

23:11.646 --> 23:14.336
their own ethics,
their own morality,

23:14.344 --> 23:16.784
their own desire for a child,
their religion,

23:16.777 --> 23:19.327
if it really is opposed to
abortion,

23:19.328 --> 23:23.968
then there can be a lot of
emotional difficulty with it.

23:23.970 --> 23:28.110
But that's not a thing to do
with the abortion itself,

23:28.108 --> 23:30.668
it's to do with the,
shall we say,

23:30.673 --> 23:35.493
the moral context in which that
woman perceives the abortion to

23:35.492 --> 23:36.972
have been done.

23:36.970 --> 23:40.690
Along with this the--So,
you have these generally quite

23:40.693 --> 23:45.043
high rates of abortion around
the world and the question is,

23:45.038 --> 23:47.158
what are the determinants of
that rate?

23:47.160 --> 23:48.240
What makes the rate higher?

23:48.240 --> 23:49.420
What makes the rate lower?

23:49.420 --> 23:52.900
Many people believe that
religious proscription,

23:52.901 --> 23:56.311
that the religion of the
country is what is the

23:56.308 --> 23:59.048
determining factor,
but it's not.

23:59.048 --> 24:02.128
For instance,
in Europe among Catholic

24:02.134 --> 24:05.754
countries,
Belgium has one of the lowest

24:05.751 --> 24:08.811
rates in the world 6.8 per
1,000,

24:08.808 --> 24:13.278
and Hungary another Catholic
country has one of the highest

24:13.275 --> 24:16.735
34.7 per 1,000 so you span the
whole range.

24:16.740 --> 24:20.550
Among Muslim countries,
Bangladesh has one of the

24:20.546 --> 24:24.986
lowest rates 3.8 while Turkey
has six or seven times that

24:24.986 --> 24:25.696
rate.

24:25.700 --> 24:30.630
Again, the Bangladesh rate is a
little confused because of--they

24:30.632 --> 24:33.922
use a lot of menstrual
regulation there.

24:33.920 --> 24:37.050
The U.S.,a largely,
though not-exclusively,

24:37.048 --> 24:40.398
Protestant country,
has about the same rate as

24:40.400 --> 24:41.220
Turkey.

24:41.220 --> 24:44.960
Turkey is essentially all
Muslim, of course.

24:44.960 --> 24:47.840
People believe that the
Catholic Church,

24:47.842 --> 24:51.392
of course, teaches that
abortion is a mortal sin,

24:51.391 --> 24:52.501
its murder.

24:52.500 --> 24:53.660
But, in the U.S.

24:53.655 --> 24:57.115
the abortion rate for
Protestants which is 17 per

24:57.124 --> 25:00.814
1,000 is lower than for
Catholics, 24 per 1,000.

25:00.808 --> 25:04.418
As far as one can tell,
Catholics, because of the

25:04.421 --> 25:08.941
church, slightly underuse birth
control, so, as compensation,

25:08.935 --> 25:11.565
they slightly overuse abortion.

25:11.568 --> 25:15.048
The error bars in all these
basically mean that there's a

25:15.048 --> 25:18.468
barely detectable difference
between say Protestants and

25:18.465 --> 25:21.925
Catholics within America,
within any one country.

25:21.930 --> 25:25.680


25:25.680 --> 25:27.610
There are two issues of why the
Catholic rate is higher.

25:27.609 --> 25:28.579
Yeah.

25:28.578 --> 25:30.678
Student:  Are these
lines per person or per 1000?

25:30.680 --> 25:31.780
Prof: This is per 1,000.

25:31.779 --> 25:34.959
Those are numbers per 1,000;
per 1,000 women of reproductive

25:34.961 --> 25:36.641
age not per 1,000 babies.

25:36.640 --> 25:40.100
The Catholic thing is
most--most of the difference in

25:40.104 --> 25:44.104
that statistic is that there's a
large Hispanic population in

25:44.103 --> 25:47.373
America which happens to
Catholic and has a higher

25:47.367 --> 25:50.297
abortion rate than native born
women,

25:50.298 --> 25:53.168
so that is the most of the
reason why the Catholic rate is

25:53.166 --> 25:53.616
higher.

25:53.619 --> 25:57.269


25:57.269 --> 26:01.409
It's also--you can't tie it
down to legal proscription,

26:01.413 --> 26:04.563
whether abortion is legal or
not legal.

26:04.558 --> 26:08.298
You can't tie that down as a
determining factor in abortion

26:08.298 --> 26:08.878
either.

26:08.880 --> 26:12.670
About half of the abortions in
the world are illegal.

26:12.670 --> 26:16.880
The old statistics used the
word illegal,

26:16.880 --> 26:20.440
but now there is such a variety
of legal rules and such a

26:20.444 --> 26:24.524
variety of situations in each
country where it's legal or not.

26:24.519 --> 26:27.149
Now different states in
different countries,

26:27.150 --> 26:30.650
like in Mexico,
Mexico City has one law,

26:30.650 --> 26:34.820
each state can have a very
different law,

26:34.818 --> 26:39.078
so it gets to be difficult to
describe legality and that's all

26:39.084 --> 26:42.654
tied in with the safety which
we'll come back to.

26:42.650 --> 26:45.670
You see sometimes statistics
about safe abortion,

26:45.671 --> 26:48.251
sometimes statistics about
legal abortion,

26:48.252 --> 26:51.592
and--usually they fit right on
top of each other.

26:51.588 --> 26:55.158
About half of abortions in the
world are illegal,

26:55.160 --> 26:59.220
the other half are legal,
and so for instance in Europe

26:59.218 --> 27:03.348
abortion is generally legal
everywhere under a very wide

27:03.351 --> 27:08.481
range of conditions,
and its abortion rate is 28 per

27:08.483 --> 27:09.223
1,000.

27:09.220 --> 27:14.690
In Africa where it's illegal
almost everywhere it's 29,

27:14.693 --> 27:17.333
so again, no difference.

27:17.328 --> 27:20.168
The lowest rates in the world
are in western--

27:20.170 --> 27:23.570
in northern Europe where
abortion is accessible with few

27:23.567 --> 27:27.557
restrictions so the total--
basically the total legality of

27:27.558 --> 27:31.318
abortion is in a place where the
rates are very low.

27:31.318 --> 27:35.258
Up to 2007 abortion was banned
in Mexico, so it was totally

27:35.258 --> 27:37.158
illegal everywhere Mexico.

27:37.160 --> 27:41.030
Nevertheless,
the number of abortions rose by

27:41.026 --> 27:46.206
50% between 1990 and 2006 with a
constant legal situation of

27:46.211 --> 27:47.531
illegality.

27:47.529 --> 27:53.519
In 2006, Mexico's abortion's
rate was 40% higher than the

27:53.517 --> 27:53.937
U.S.

27:53.944 --> 27:55.874
rate next door.

27:55.868 --> 28:00.538
Here you have three countries
that are all in a line Canada,

28:00.538 --> 28:02.358
the U.S., and Mexico.

28:02.358 --> 28:05.748
Canada has much lower,
and the United States is in the

28:05.753 --> 28:08.383
middle and Mexico--those two are
legal;

28:08.380 --> 28:11.810
in Mexico it's illegal and it
has the highest rate of all.

28:11.808 --> 28:16.528
Of course I should warn you,
and you probably realize it,

28:16.528 --> 28:22.948
that saying that abortion
doesn't--you can't--

28:22.950 --> 28:25.270
the legality is not the
determining factor,

28:25.269 --> 28:28.399
these intercontinental
comparisons,

28:28.400 --> 28:31.690
or country comparison are not
terribly informative because so

28:31.691 --> 28:33.261
many--
between say Mexico and the

28:33.256 --> 28:35.246
United States,
or between Africa and Europe,

28:35.251 --> 28:37.801
there are so many variables,
so many socioeconomic

28:37.801 --> 28:39.851
variables, education,
medical care,

28:39.854 --> 28:41.944
standard of living,
all of this varies

28:41.944 --> 28:42.854
tremendously.

28:42.848 --> 28:46.508
The difference in abortion
rates is not to be found in the

28:46.507 --> 28:49.717
legal or illegal nature,
but in some of those other

28:49.715 --> 28:50.995
characteristics.

28:51.000 --> 28:55.960


28:55.960 --> 28:58.690
In most countries abortion is
legal,

28:58.690 --> 29:02.510
and as of a few years ago,
61% of the world's people lived

29:02.509 --> 29:05.459
in countries where abortion is
permitted,

29:05.460 --> 29:11.760
basically without restriction
or for a wide range of reasons.

29:11.759 --> 29:16.739
Only 25% live in places where
abortion is largely illegal.

29:16.740 --> 29:20.240
These are largely Latin
America, some of the Muslim

29:20.244 --> 29:23.544
countries, and Sub-Saharan
African countries.

29:23.538 --> 29:28.268
Abortion is becoming legal in
more places.

29:28.269 --> 29:34.919
From 1985 to 1998,19 nations
significantly liberalized their

29:34.924 --> 29:41.134
abortion laws and only Poland
de-legalized abortion,

29:41.130 --> 29:44.780
which had to do with its
independence basically from the

29:44.778 --> 29:46.568
Soviet Union at the time.

29:46.569 --> 29:48.589
That was 1985 to 1998.

29:48.588 --> 29:51.438
From 1998 to 2007,
again the latest data,

29:51.440 --> 29:54.680
16 nations liberalized their
abortion laws and two

29:54.679 --> 29:58.179
territories and one state in
Australia liberalized its

29:58.182 --> 30:02.212
abortion laws,
and in Mexico I mentioned.

30:02.210 --> 30:07.540
Mexico City has now made
abortion in the first 12 weeks

30:07.537 --> 30:11.257
legal and that was in 19--
2007 I believe,

30:11.261 --> 30:14.601
and than a few states in Mexico
has followed that,

30:14.599 --> 30:17.819
so Mexico is now a split place.

30:17.818 --> 30:24.738
In this 1998 to 2007 time frame
El Salvador and Nicaragua,

30:24.740 --> 30:28.080
which already had a very
restrictive abortion laws went

30:28.080 --> 30:30.140
to absolute,
under no circumstances,

30:30.144 --> 30:33.314
abortion is totally--
no rape, no death--health of

30:33.311 --> 30:38.711
the mother,
no exceptions in Nicaragua and

30:38.710 --> 30:40.630
El Salvador.

30:40.630 --> 30:43.820
In contrast to the safety of
legal abortion,

30:43.816 --> 30:47.886
where abortions--when it's
legal it's almost always in a

30:47.891 --> 30:50.041
proper medical situation.

30:50.038 --> 30:54.208
When it's illegal,
it's an extremely dangerous

30:54.208 --> 30:55.318
procedure.

30:55.318 --> 31:00.408
There's something like 67,000
abortion related deaths a year

31:00.406 --> 31:04.716
and that leaves 220,000,
a quarter million children

31:04.718 --> 31:06.958
without their mothers.

31:06.960 --> 31:09.130
As you may know,
when it's illegal,

31:09.130 --> 31:15.530
the main procedure is inserting
something up the uterus and

31:15.528 --> 31:21.818
scraping around to try to
dislodge the endometrium and the

31:21.816 --> 31:22.916
fetus.

31:22.920 --> 31:25.750
Well, if you're scraping around
in there with a pointed stick or

31:25.747 --> 31:28.377
a hangar or something,
you're liable to puncture the

31:28.375 --> 31:31.125
uterine wall and make a hole
between the inside of the

31:31.127 --> 31:32.927
uterus,
which is open through the

31:32.932 --> 31:36.152
vaginal canal to the outside,
and the peritoneal cavity,

31:36.154 --> 31:40.134
the inside of your body and so
infection gets through that and

31:40.133 --> 31:43.423
so the main route isn't--
the main reason why

31:43.423 --> 31:48.273
abortion--illegal abortion is so
dangerous is that non-sterility

31:48.272 --> 31:51.202
of whatever it is that's
inserted,

31:51.200 --> 31:56.170
plus it's pointed usually,
and they break right through

31:56.170 --> 31:57.920
the uterine wall.

31:57.920 --> 32:00.880
In addition,
you may know that the fallopian

32:00.875 --> 32:05.065
tube is open into the peritoneal
cavity because the ovary,

32:05.068 --> 32:08.558
which releases the egg is--it
sits right on top of the

32:08.556 --> 32:12.306
fallopian tube and the egg is
released into the peritoneal

32:12.306 --> 32:14.836
space,
the body fluid here and it's

32:14.837 --> 32:18.837
supposed to drop down into the
fallopian tube and cilia push it

32:18.843 --> 32:19.363
down.

32:19.358 --> 32:23.518
That's an opening so if you get
something unsterile into the

32:23.519 --> 32:27.749
womb and then the bacteria can
swim upstream and get into the

32:27.749 --> 32:32.049
body and then you're into sepsis
and you very likely die.

32:32.049 --> 32:36.049


32:36.048 --> 32:43.108
It's a very dangerous procedure
when done not properly.

32:43.109 --> 32:47.119


32:47.118 --> 32:51.608
There are very good statistics
showing that the main

32:51.612 --> 32:56.722
determinant of the maternal
death rate from abortion is its

32:56.721 --> 32:58.221
legal status.

32:58.220 --> 33:01.710


33:01.710 --> 33:04.440
Here again, although I don't
think I showed this slide,

33:04.440 --> 33:07.940
so here is places where
abortion is legal,

33:07.940 --> 33:10.700
here's the abortion rate,
this goes back to saying that

33:10.695 --> 33:13.805
the legal situation doesn't
determine the rate of abortion.

33:13.808 --> 33:20.028
Here are various abortion legal
places and the rate is about 6

33:20.030 --> 33:23.590
to 26,
and here it's illegal and you

33:23.585 --> 33:28.975
have the range of 23 to 52,
so ballpark double or triple

33:28.978 --> 33:30.858
this rate,
so it's illegal.

33:30.859 --> 33:32.759
These are all South America.

33:32.759 --> 33:36.199
This is all Europe,
Japan, Australia,

33:36.198 --> 33:40.208
United States,
very developed countries.

33:40.210 --> 33:43.290
Countries that are partially
developed shall we say.

33:43.288 --> 33:49.208
The illegality correlates with
the abortion rate but it's

33:49.212 --> 33:54.772
almost certainly not the cause,
certainly being illegal is not

33:54.766 --> 33:57.046
causing these high abortion
rates.

33:57.048 --> 34:01.518
Now when you go over and look
at the maternal deaths you see

34:01.521 --> 34:04.521
that there are ten,
the developed regions have an

34:04.519 --> 34:07.409
average of ten,
whereas in Latin America you

34:07.412 --> 34:11.672
have up in the 100 and 200,
and even up to 300 range.

34:11.670 --> 34:14.590
You go to Africa it's 650.

34:14.590 --> 34:18.780
There the illegality really
does make a difference in the

34:18.778 --> 34:23.138
maternal death rate,
that's the dominant effect of

34:23.143 --> 34:27.033
making something illegal is--
doesn't change the abortion

34:27.027 --> 34:28.727
rate and we have a number of
examples,

34:28.730 --> 34:33.670
but it changes the maternal
death rate very,

34:33.666 --> 34:35.386
very clearly.

34:35.389 --> 34:39.049
The most extreme example of
this and the clearest example of

34:39.045 --> 34:40.465
this is from Romania.

34:40.469 --> 34:48.169
Romania had during--after World
War II when it was a Soviet

34:48.173 --> 34:51.123
puppet state,
as I told you,

34:51.123 --> 34:53.773
the abortion rate was
extraordinarily high,

34:53.768 --> 34:56.648
like four abortions for every
one live birth.

34:56.650 --> 35:01.620
Because--well they had a
dictator then,

35:01.619 --> 35:04.179
Nicolai Ceausescu,
who you've undoubtedly have

35:04.177 --> 35:06.087
heard of,
and he decided that for the

35:06.085 --> 35:08.715
glory of greater Romania there
should be more Romanians,

35:08.719 --> 35:13.659
he wanted a big strong state,
so he went on a pronatalist

35:13.659 --> 35:14.629
campaign.

35:14.630 --> 35:17.330
Abortion was immediately
criminalized,

35:17.327 --> 35:21.487
contraceptives became very hard
to get hard, they wouldn't

35:21.485 --> 35:24.835
import them, they didn't
manufacture them.

35:24.840 --> 35:29.800
So what he did was that all
women between 18 and 45 were

35:29.795 --> 35:33.985
rounded up at their workplace,
remember this is a socialist

35:33.985 --> 35:35.675
state so almost all the women
worked,

35:35.679 --> 35:37.559
they were rounded up at their
workplace,

35:37.559 --> 35:40.339
and subjected to a
gynecological examination.

35:40.340 --> 35:44.060
If they were not
pregnant they had to explain to

35:44.057 --> 35:46.737
the government why they were not
pregnant.

35:46.739 --> 35:51.669
It was about as intrusive a
pronatalist campaign as you can

35:51.670 --> 35:52.520
imagine.

35:52.518 --> 35:58.148
It's somewhat the mirror image
of China's anti-birth campaign,

35:58.148 --> 36:01.468
and Romania had the plus
campaign.

36:01.469 --> 36:05.279
Anyway, what happened
immediately--so previously 80%

36:05.284 --> 36:09.404
of pregnancies had been
ending--had been terminated with

36:09.396 --> 36:10.366
abortion.

36:10.369 --> 36:12.599
Abortion disappears,
and was legal,

36:12.599 --> 36:15.949
abortion had been legal,
and boom the birthrate does

36:15.945 --> 36:18.775
indeed go up;
nothing like by a factor of

36:18.775 --> 36:22.265
five but something like a factor
two as I remember but I

36:22.269 --> 36:24.049
want--should--check that.

36:24.050 --> 36:27.210
Then, very rapidly,
women set up networks of

36:27.210 --> 36:31.620
illegal abortion providers and
the birth rate goes up and the

36:31.621 --> 36:36.101
birth rate comes back down and
it ends up somewhat higher than

36:36.103 --> 36:42.523
it had been beforehand,
but not enormously higher.

36:42.518 --> 36:45.918
The maternal death rate is what
changed.

36:45.920 --> 36:50.520
It rose to 200 per 100,000 live
births, from a number in a

36:50.518 --> 36:54.548
developed country that was
something in the tens or

36:54.550 --> 36:55.600
twenties.

36:55.599 --> 37:00.499
It ranged up to ten times that
amount.

37:00.500 --> 37:03.690
The infant mortality rate,
because these mothers didn't

37:03.690 --> 37:06.920
want these children,
presumably, the infant

37:06.922 --> 37:11.182
mortality rate rose to 83 deaths
per 1,000 from--

37:11.179 --> 37:15.879
Japan's rate is 4.8,
the U.S.

37:15.878 --> 37:20.408
is 8.9, so it rose to 83.

37:20.409 --> 37:23.699
So again, something like a ten
times increase in infant

37:23.699 --> 37:24.429
mortality.

37:24.429 --> 37:28.049
The main effect of
de-legalizing abortion was a

37:28.047 --> 37:32.917
temporary rise in the number of
births but a long term increase

37:32.923 --> 37:36.703
in maternal mortality and infant
mortality,

37:36.699 --> 37:38.699
a massive increase.

37:38.699 --> 37:43.719
By the time abortion--of course
when they got free of the

37:43.722 --> 37:46.852
dictator--
it was legalized again and

37:46.846 --> 37:49.616
then, by that time,
things had come back a little

37:49.615 --> 37:50.035
to normal.

37:50.039 --> 37:51.629
But still, the maternal death
rate,

37:51.630 --> 37:53.140
as soon as they legalized
abortion,

37:53.139 --> 37:56.029
the maternal death rate dropped
by a factor three,

37:56.030 --> 37:58.980
so that's Romania's nice
example.

37:58.980 --> 38:01.160
In South Africa,
more recently,

38:01.164 --> 38:04.664
this was in the late 1960s,
the Romania story.

38:04.659 --> 38:09.049
In South Africa the abortion
law was liberalized and the

38:09.045 --> 38:14.305
incidence of maternal infection
due to abortion dropped in half.

38:14.309 --> 38:20.139
In all cases the major effect
of making abortion illegal is an

38:20.141 --> 38:22.821
increase in complications.

38:22.820 --> 38:27.160
You don't change the abortion
rate, but medical complications,

38:27.161 --> 38:30.581
death of the mother,
and death of the infants.

38:30.579 --> 38:33.629


38:33.630 --> 38:36.520
The fundamental--we've been
going through things that are

38:36.521 --> 38:38.591
not the cause of the high
abortion rates,

38:38.588 --> 38:41.118
it's not the religion,
it's not the legality.

38:41.119 --> 38:45.409
The fundamental causes of--kind
of obvious--is unintended

38:45.409 --> 38:46.329
pregnancy.

38:46.329 --> 38:49.619
You may remember that
these--there are very high rates

38:49.623 --> 38:51.243
of unintended pregnancy.

38:51.239 --> 38:55.119
--Here is a comparison of two
regions,

38:55.119 --> 38:58.599
almost all legal in the
developed countries and in

38:58.599 --> 39:02.569
almost all of Africa it's
illegal and the death rate's an

39:02.574 --> 39:06.744
enormous,
enormous difference there.

39:06.739 --> 39:10.349
You may remember these
statistics, just to refresh your

39:10.349 --> 39:12.689
memory, about unwanted
fertility.

39:12.690 --> 39:17.660
This is 71% of living women
want to stop having children.

39:17.659 --> 39:21.289
Yet, as I showed you before,
they have more--

39:21.289 --> 39:23.649
they continue to have children
because they're not using

39:23.650 --> 39:25.930
contraception,
they don't have enough

39:25.931 --> 39:26.991
contraception.

39:26.989 --> 39:28.229
That's Bolivia.

39:28.230 --> 39:31.270
This is from the previous
lecture around the world,

39:31.268 --> 39:34.148
remember this is the line where
people--

39:34.150 --> 39:37.230
this is how many children
people are having,

39:37.230 --> 39:40.080
this is how many they want,
this is the line where they're

39:40.079 --> 39:40.479
equal.

39:40.480 --> 39:42.560
All countries,
all developing countries are

39:42.559 --> 39:44.439
having more children than they
want.

39:44.440 --> 39:48.410
There's a large amount of unmet
need in the world.

39:48.409 --> 39:52.059
The estimate for the world is
108 million women.

39:52.059 --> 39:56.189


39:56.190 --> 40:00.240
Since there's an unmet need,
these women who don't want to

40:00.239 --> 40:04.289
have more children yet do,
that results in some 51 million

40:04.291 --> 40:06.211
unintended pregnancies.

40:06.210 --> 40:10.850
Of those using contraception,
another 25 million happen as a

40:10.846 --> 40:13.906
result of incorrect,
inconsistent use of

40:13.911 --> 40:16.741
contraception or method failure.

40:16.739 --> 40:22.529
You have something like 80
million unwanted pregnancies.

40:22.530 --> 40:27.760
In the world there are 210
million pregnancies annually,

40:27.757 --> 40:31.367
and about 40% of them are
unplanned.

40:31.369 --> 40:34.149
About a quarter of--We know,
from a lot of places,

40:34.154 --> 40:37.454
that when there's an unplanned
pregnancy about a quarter of

40:37.449 --> 40:38.869
them end in abortion.

40:38.869 --> 40:46.009
The main sequence is:
unwanted pregnancy and then

40:46.014 --> 40:49.144
high abortion rate.

40:49.139 --> 40:54.859
Most unintended pregnancies in
the world--most unintended

40:54.862 --> 40:59.362
pregnancies are in the developed
counties.

40:59.360 --> 41:00.740
So there's a difference here
between developed and

41:00.742 --> 41:01.422
undeveloped countries.

41:01.420 --> 41:05.940
Contraception is very available
and highly used in the developed

41:05.943 --> 41:08.643
world,
so in the developed world most

41:08.637 --> 41:11.777
unintended pregnancies are
people who are using

41:11.780 --> 41:15.180
contraception,
and using it fairly accurately,

41:15.184 --> 41:20.044
but there's a method failure,
the contraception just fails.

41:20.039 --> 41:25.459
You have to remember that a
woman is fertile for say 30

41:25.460 --> 41:27.470
years of her life.

41:27.469 --> 41:31.089
She has 12 monthly cycles in a
year, a little bit more

41:31.088 --> 41:35.048
actually, a cycle is 28 days in
principle, but that's close

41:35.047 --> 41:35.797
enough.

41:35.800 --> 41:40.750
In order to not have an
unintended pregnancy her

41:40.751 --> 41:45.601
contraception must be perfect
for 30 years,

41:45.599 --> 41:48.189
12 cycles a year,
that's an awful lot to expect

41:48.190 --> 41:52.470
of a contraceptive,
and contraceptives are just not

41:52.469 --> 41:53.549
that good.

41:53.550 --> 41:57.660
So, in developed countries
also, the main reason for

41:57.659 --> 42:01.449
unintended pregnancy,
it's very heavily--married

42:01.447 --> 42:04.507
women who are using
contraception.

42:04.510 --> 42:06.800
They usually have several
children already,

42:06.802 --> 42:08.442
and the contraception fails.

42:08.440 --> 42:12.260
That's the main reason in
developed countries.

42:12.260 --> 42:17.220
In developing countries where
contraception use is less

42:17.222 --> 42:22.462
prevalent, the main reason is
non-use of contraception.

42:22.460 --> 42:25.790


42:25.789 --> 42:27.879
There is a very strong
relationship between

42:27.884 --> 42:29.334
contraception and abortion.

42:29.329 --> 42:32.869
-- So, we have a country,
most countries,

42:32.871 --> 42:36.521
with this unmet need;
women, before you start

42:36.518 --> 42:39.738
collecting statistics,
want fewer children than

42:39.739 --> 42:42.679
they're having but it's not a
big deal.

42:42.679 --> 42:45.569
Then something changes,
could be a mechanism that we've

42:45.572 --> 42:47.932
discussed the reasons of
cultural change,

42:47.929 --> 42:49.589
and economic change,
or whatever,

42:49.586 --> 42:52.536
and people really start wanting
to have fewer children.

42:52.539 --> 42:56.459
This happened around 1964 in
Korea and you read--and I gave

42:56.463 --> 43:00.663
you one of the stories about how
an example of how this happens

43:00.659 --> 43:01.539
in Korea.

43:01.539 --> 43:05.039
What happens is as women--as
the whole culture changes from

43:05.036 --> 43:08.826
wanting sort of the maximum rate
of fertility to wanting a lower

43:08.833 --> 43:12.273
rate of fertility,
the contraception--the abortion

43:12.271 --> 43:16.371
rate takes off first because in
all these countries abortion is

43:16.373 --> 43:18.783
the traditional method,
the women know it,

43:18.775 --> 43:20.175
and are moderately comfortable
with it,

43:20.179 --> 43:23.489
so you see first the abortion
rate starts going up.

43:23.489 --> 43:26.719
Then, with a short lag,
the contraception rate goes up,

43:26.724 --> 43:29.724
because all the countries
establish national family

43:29.721 --> 43:31.041
planning programs.

43:31.039 --> 43:37.689
What happens is people use more
abortion,

43:37.690 --> 43:40.740
use more contraception,
so they're reducing their

43:40.735 --> 43:43.435
fertility,
but the rate of drop of desired

43:43.443 --> 43:46.973
fertility can be so fast that
even the sum of contraception

43:46.969 --> 43:49.339
and abortion can't keep up with
it,

43:49.340 --> 43:51.140
so both rates keep rising.

43:51.139 --> 43:54.259
Eventually you peak.

43:54.260 --> 43:57.230
Abortion peaks and starts
falling down,

43:57.230 --> 43:59.810
contraception continues upward.

43:59.809 --> 44:04.189
This is the time when the
demand to have less fertility is

44:04.192 --> 44:07.732
more than either method alone
can cope with.

44:07.730 --> 44:12.160
Eventually women--and abortion
is easier because the post--

44:12.159 --> 44:17.539
it's an after the fact method,
but eventually women learn to

44:17.543 --> 44:21.763
use contraception--
learn to use it and learn to

44:21.760 --> 44:26.690
use it properly and so then the
abortion rate declines as the

44:26.690 --> 44:31.540
contraception rate continues on
up to very high levels,

44:31.539 --> 44:34.299
and most of the difference here
is women who want to get

44:34.295 --> 44:35.495
pregnant or something.

44:35.500 --> 44:36.960
You have this trade off.

44:36.960 --> 44:40.590
You have, in an early stage,
both of them rise together and

44:40.590 --> 44:43.660
at a later stage they do very
divergent things.

44:43.659 --> 44:49.059
You'll see when you get a
polemicized discussion of this,

44:49.059 --> 44:52.099
what you'd hear is right to
life people say,

44:52.099 --> 44:54.749
'contraception is no good,
abortion rises with

44:54.753 --> 44:58.003
contraception' and they use
statistics from this half on

44:57.998 --> 44:58.528
down.

44:58.530 --> 45:01.160
People who are pro-choice say
'no, no, no or are

45:01.157 --> 45:04.067
pro-contraception no,
no, no it goes this way and the

45:04.065 --> 45:05.795
use this half of the graph.

45:05.800 --> 45:08.200
But you get both of these
things.

45:08.199 --> 45:10.179
Korea is one example.

45:10.179 --> 45:14.719
Here is another example of the
relationship between

45:14.722 --> 45:18.632
contraception and abortion in
Bangladesh.

45:18.630 --> 45:22.400
Here is--remember Matlab--you
read about Matlab where they

45:22.400 --> 45:26.110
chose some villages and got a
very strong family planning

45:26.106 --> 45:30.006
program and then other villages
which they left as a control

45:30.009 --> 45:30.869
region.

45:30.869 --> 45:32.999
They had family planning
because they had the government

45:32.996 --> 45:35.236
program, but the government
program wasn't any near as good

45:35.240 --> 45:36.480
as the intervention program.

45:36.480 --> 45:40.280
Here's the control region and a
lot to see here.

45:40.280 --> 45:45.920
First of all this is desired
fertility and that starts at

45:45.920 --> 45:51.460
this level and drops down to
somewhat more than half;

45:51.460 --> 45:55.430
desired fertility in the Matlab
region starts at about the same

45:55.434 --> 45:58.004
level and falls about the same
amount.

45:58.000 --> 46:00.500
The difference between the two
regions is not desired

46:00.501 --> 46:01.081
fertility.

46:01.079 --> 46:05.989
The actual fertility rate drops
here, starts higher and drops a

46:05.989 --> 46:09.629
little faster here,
so that it ends up not very

46:09.630 --> 46:10.740
different.

46:10.739 --> 46:14.219
Again, the difference is not
the actual amount of fertility,

46:14.224 --> 46:17.304
which the number of births
isn't enormously different

46:17.295 --> 46:18.945
between the two regions.

46:18.949 --> 46:23.909
In Matlab--in the experimental
region,

46:23.909 --> 46:26.109
the region where they had the
good program,

46:26.110 --> 46:29.770
the contraceptive prevalence
goes very high or goes rapidly

46:29.766 --> 46:32.096
very high from something like
30%,

46:32.099 --> 46:33.769
more than doubles to 70%.

46:33.768 --> 46:39.848
Whereas, in the other--in the
non-control region you have--

46:39.849 --> 46:44.039
it starts much lower--this
rises very rapidly,

46:44.039 --> 46:46.069
this doesn't change at all for
a number of years,

46:46.070 --> 46:48.240
then the government--actually
the government improves its

46:48.242 --> 46:50.772
program,
it jumps up a little bit.

46:50.768 --> 46:53.868
So it's the contraceptive,
this is a really big

46:53.867 --> 46:57.307
difference,
the contraceptive prevalence is

46:57.311 --> 47:02.641
much lower in the control region
than in the experimental region.

47:02.639 --> 47:05.649
The result is:
here's the abortion ratio in

47:05.650 --> 47:09.380
the region where the
contraceptive prevalence is very

47:09.378 --> 47:13.608
high and here the abortion ratio
goes crazy where they don't

47:13.608 --> 47:16.958
have--
they're not using contraception

47:16.963 --> 47:18.013
efficiently.

47:18.010 --> 47:20.670
Again here you can see in those
two regions the same country,

47:20.670 --> 47:22.710
the same time,
neighboring villages,

47:22.710 --> 47:28.980
neighboring districts that
the--there's this tradeoff.

47:28.980 --> 47:31.900
They either use contraception
or they use abortion.

47:31.900 --> 47:35.170
Both places,
they're wanting fewer children

47:35.170 --> 47:38.280
as time goes on,
but in one case they use

47:38.284 --> 47:42.804
contraception and in the other
case they use abortion.

47:42.800 --> 47:46.340
Here's another example of this,
rather different in Shanghai.

47:46.340 --> 47:50.410
This is a more complicated,
somewhat interesting case.

47:50.409 --> 47:54.269
This is the one-child policy
comes in.

47:54.268 --> 47:57.778
They're only allowed one child,
so they have that child and

47:57.784 --> 48:01.364
then they try to do something to
avoid the second child,

48:01.360 --> 48:06.690
and what they use is
contraceptive methods and they

48:06.688 --> 48:10.318
don't work,
they start with very--let me

48:10.322 --> 48:12.162
get this straight here.

48:12.159 --> 48:15.279


48:15.280 --> 48:19.120
They start with a low use of
IUD which is a really secure

48:19.123 --> 48:23.313
method of contraception and the
abortion rate is very high and

48:23.309 --> 48:27.359
they rather rapidly learn that
IUD is the only really secure

48:27.358 --> 48:31.408
way of not getting pregnant and
then the abortion rate falls

48:31.409 --> 48:34.009
down,
so it's another rather

48:34.005 --> 48:38.385
different situation in which
again the abortion rate and the

48:38.391 --> 48:43.151
effective contraceptive rate are
mirror images of each other.

48:43.150 --> 48:47.960
When you have a high rate of
effective contraception you have

48:47.956 --> 48:49.956
a low rate of abortion.

48:49.960 --> 48:59.240


48:59.239 --> 49:02.189
Latin America shows this same
pattern.

49:02.190 --> 49:06.710
In Latin America abortions have
been practiced for centuries.

49:06.710 --> 49:10.080
It was certainly practiced by
the Incas and the Aztecs.

49:10.079 --> 49:14.129
In 1551 the Bishop of Venezuela
reported to the King of Spain

49:14.130 --> 49:18.520
that the natives did not want
their children to become slaves,

49:18.519 --> 49:21.379
so they aborted them, 1551.

49:21.380 --> 49:25.830
Chile has very good medical
statistics.

49:25.829 --> 49:30.029
At the beginning of Chile's
fertility transition in the

49:30.025 --> 49:34.375
1960s 23% of Chilean women
voluntarily admitted to having

49:34.375 --> 49:36.235
an induced abortion.

49:36.239 --> 49:39.349
Again, remember Chile is very
heavily a Catholic country and

49:39.351 --> 49:42.521
this is not really delving into
medical records or making any

49:42.516 --> 49:43.356
corrections.

49:43.360 --> 49:45.020
This is just asking the women,
Have you had an abortion?'

49:45.018 --> 49:47.758
and a quarter of them say,
yes I've had an abortion.

49:47.760 --> 49:52.470
Not only did they have an
abortion but most of them had

49:52.474 --> 49:55.534
more than one abortion,
up to three,

49:55.530 --> 50:00.070
8.4% of the women had more than
seven abortions.

50:00.070 --> 50:04.470
This is early on.

50:04.469 --> 50:08.259
Ten years later in the 1970s
now it's--

50:08.260 --> 50:12.120
where women are really into
their fertility decline,

50:12.119 --> 50:15.439
they don't want the children,
the average woman has almost

50:15.442 --> 50:21.082
three abortions,
lifetime, so that goes up.

50:21.079 --> 50:24.219
Again, those are the openly
admitted numbers and the real

50:24.222 --> 50:26.302
numbers must have been much
higher.

50:26.300 --> 50:30.270
Again, as in elsewhere,
in Chile almost all the women

50:30.268 --> 50:33.198
were married,
almost all middle class women,

50:33.197 --> 50:36.097
and they already had had four
to six pregnancies,

50:36.099 --> 50:39.949
they already had children,
and experience with pregnancy.

50:39.949 --> 50:43.619
In terms of socioeconomic
levels, middle class women had

50:43.623 --> 50:46.433
more abortions than working
class women.

50:46.429 --> 50:51.919
Married women had a greater
abortion rate than those living

50:51.922 --> 50:56.462
in temporary unions,
and in all--through all this

50:56.460 --> 51:01.260
time abortion was completely
illegal in Chile and it still

51:01.264 --> 51:01.774
is.

51:01.768 --> 51:08.138
Going next door to Peru,
in Lima in the 1970s,

51:08.139 --> 51:10.269
again the time when the
fertility was going down,

51:10.268 --> 51:13.208
when people were wanting fewer
children in Peru,

51:13.210 --> 51:16.550
the yearly increase in the
abortion rate was 24%,

51:16.550 --> 51:20.320
every year there was a 24%
increase in abortion.

51:20.320 --> 51:24.280
In any given year a quarter to
a third of the reproductive age

51:24.280 --> 51:27.510
women would have abortions,
that's one out four,

51:27.509 --> 51:31.219
one out of three women every
year would have an abortion.

51:31.219 --> 51:34.269


51:34.268 --> 51:39.878
Again, it's in this--the really
high abortion rates are when

51:39.882 --> 51:42.972
women are--
or families are starting to

51:42.967 --> 51:47.067
want fewer children and haven't
yet really figured out how to

51:47.072 --> 51:48.512
use contraception.

51:48.510 --> 51:52.780
In contemporary Latin America
abortion,

51:52.780 --> 51:55.480
although it's illegal almost
everywhere and it's almost

51:55.480 --> 51:59.700
universally a Catholic place,
abortion is very widespread.

51:59.699 --> 52:04.739
Latin America as a whole has 1
abortion for every 2 live

52:04.735 --> 52:07.665
births;
remember worldwide and in the

52:07.673 --> 52:07.973
U.S.

52:07.965 --> 52:11.245
it's 1 per 3.2,
Latin American has 1 for every

52:11.246 --> 52:12.556
2 live births.

52:12.559 --> 52:15.979
Eventually there's a
generational change and the

52:15.978 --> 52:19.688
younger women start using
contraception and then the

52:19.688 --> 52:22.088
abortion rate starts to fall.

52:22.090 --> 52:32.440


52:32.440 --> 52:38.210
The Philippines,
another example--in the

52:38.213 --> 52:45.763
Philippines have a very
interesting situation of the

52:45.764 --> 52:47.694
politics.

52:47.690 --> 52:51.170
There's a strong
inter-relationship between the

52:51.172 --> 52:54.502
politics of the country,
the Catholic Church,

52:54.503 --> 52:57.763
and the citizen's use of
contraception.

52:57.760 --> 53:03.390
When Fidel Ramos was President,
one of the early very populist

53:03.385 --> 53:06.535
president's,
he supported family planning

53:06.539 --> 53:10.079
and a quarter of the Filipino
women were using the modern

53:10.077 --> 53:10.707
method.

53:10.710 --> 53:15.340
Since then the desired
fertility has gone down in the

53:15.340 --> 53:20.770
Philippines and now more than
half of Filipino women want some

53:20.773 --> 53:23.093
form of birth control.

53:23.090 --> 53:26.870
But the presidency has changed
and a woman,

53:26.869 --> 53:30.969
Gloria Arroyo Macapagal,
came in and since Ferdinand

53:30.965 --> 53:36.105
Marcos was a strong dictator and
they had strong presidencies but

53:36.106 --> 53:39.696
then,
when he was kicked out for

53:39.697 --> 53:44.307
massive corruption and
dictatorial means,

53:44.309 --> 53:46.779
they now have democratic
elections and the governments

53:46.777 --> 53:47.847
have been quite weak.

53:47.849 --> 53:50.759
They don't have much popular
support and so the government

53:50.757 --> 53:53.767
needs to get legitimacy from
somewhere and in this case they

53:53.766 --> 53:56.466
get legitimacy from the Catholic
Church because,

53:56.469 --> 53:58.609
again, the Philippines is a
very Catholic country.

53:58.610 --> 54:02.950
A fairly open deal was made
between Macapagal and the

54:02.952 --> 54:08.052
archbishop of the Philippines
that the church will support you

54:08.047 --> 54:13.227
if you make abortion illegal and
get rid of the family planning

54:13.226 --> 54:14.476
programs.

54:14.480 --> 54:19.470
Now the government--and that
was taken and she got elected --

54:19.469 --> 54:23.479
and now the government only
supports the traditional family

54:23.476 --> 54:30.586
planning method,
which is withdrawal basically.

54:30.590 --> 54:31.670
This had an effect.

54:31.670 --> 54:35.900
So from 1993 to 1998 in the
five, six year period,

54:35.900 --> 54:40.740
the use of traditional methods
went up by 50% while the use of

54:40.737 --> 54:44.297
modern methods didn't--
actually didn't change much.

54:44.300 --> 54:49.060
When the government pushes
something it often goes up and

54:49.059 --> 54:53.649
all those traditional methods
just plain don't work.

54:53.650 --> 54:57.920
The result was that the number
of abortions in the Philippines

54:57.920 --> 55:02.190
in these years increased by 19%
from 400,000 which was already

55:02.190 --> 55:05.350
high--
from 400,000 it went up to

55:05.347 --> 55:08.937
basically a half a million
abortions.

55:08.940 --> 55:11.290
They're all illegal of course.

55:11.289 --> 55:14.779


55:14.780 --> 55:19.210
As I said in the beginning,
in America abortion is a great

55:19.206 --> 55:21.066
source of controversy.

55:21.070 --> 55:24.760
This is not always the case in
a lot of places,

55:24.764 --> 55:29.184
so there's a lot of literature
now on what they call the

55:29.181 --> 55:31.111
culture of abortion.

55:31.110 --> 55:35.550
Those countries for whom
abortion has a non-controversial

55:35.552 --> 55:39.442
place as a mechanism for
fertility control just as

55:39.438 --> 55:44.198
contraception has a more or less
non-controversial place as a

55:44.199 --> 55:48.799
form of fertility control in say
Europe and America.

55:48.800 --> 55:54.190
I got invited a few years back
to talk to the women's health

55:54.190 --> 55:58.300
class about abortion and--
it was one of the things we

55:58.304 --> 56:00.934
talked about,
and afterwards I was talking

56:00.934 --> 56:04.274
with some students and a
professor with the next class

56:04.273 --> 56:08.313
walks in and he turned out to be
from Russia and he asked us what

56:08.307 --> 56:10.007
are you talking about?

56:10.010 --> 56:12.640
The students had started asking
me questions about--something

56:12.643 --> 56:13.393
about abortion.

56:13.389 --> 56:15.789
He was really puzzled;
he said 'abortion,

56:15.789 --> 56:17.249
why is anybody interested in
that?'

56:17.250 --> 56:20.990
Because in Russia it's just an
ordinary, absolutely ordinary

56:20.985 --> 56:23.415
kind of thing;
in places like Romania,

56:23.420 --> 56:26.820
and I'm sure this is to some
degree true in probably the

56:26.820 --> 56:28.490
whole of eastern Europe.

56:28.489 --> 56:32.189
Remember, I mentioned to you
the old theory that the health

56:32.188 --> 56:34.548
of the body depends on the
humors,

56:34.550 --> 56:37.590
that you've got four humors of
bile,

56:37.590 --> 56:40.100
and choler, and all this other
stuff and it's the balance

56:40.097 --> 56:40.947
that's important.

56:40.949 --> 56:44.149
You have to reestablish--What
the menstrual period does,

56:44.150 --> 56:46.590
everyone knows the worst fluid
is menstrual fluid,

56:46.590 --> 56:50.500
and so you've got to get rid of
that and if you don't--

56:50.500 --> 56:52.840
if you're not periodically
getting rid of menstrual fluid,

56:52.840 --> 56:57.990
the bad spirits humors,
fluids, build up in you and you

56:57.985 --> 56:59.505
get unhealthy.

56:59.510 --> 57:01.770
In places like Romania,
many people,

57:01.771 --> 57:05.461
older less educated people,
believe that it's good to have

57:05.456 --> 57:07.456
an abortion every so often.

57:07.460 --> 57:10.230
Having nothing to do with
pregnancy even,

57:10.231 --> 57:14.251
it's just good to do that to
get rid of this evil humor.

57:14.250 --> 57:19.010
That has persisted as well as a
lot of other really

57:19.007 --> 57:21.677
unbelievable--
almost unbelievable to us,

57:21.677 --> 57:24.147
medical myths and is part of
the reason for that very,

57:24.150 --> 57:28.100
very high abortion rate in
Romania.

57:28.099 --> 57:31.529
In the Ukraine,
when the Soviet Union fell

57:31.527 --> 57:33.847
apart,
the family planning programs

57:33.851 --> 57:38.371
that they had also fell apart,
and so the whole area was left

57:38.373 --> 57:41.553
without effective family
planning.

57:41.550 --> 57:44.400
The International Planned
Parenthood Federation,

57:44.396 --> 57:47.726
their nearest office was in
Bangkok and so they couldn't

57:47.728 --> 57:48.878
help very much.

57:48.880 --> 57:51.600
What they did is,
they said, we'll take just the

57:51.601 --> 57:55.021
city of Moscow because it's most
cost effective to work in a

57:55.019 --> 57:56.379
city,
a lot of people,

57:56.384 --> 57:58.054
we don't have geographic
access,

57:58.050 --> 58:00.970
but, we'll try to provide some
contraception in Moscow.

58:00.969 --> 58:03.949
That left all the other Soviet
Bloc countries with nothing.

58:03.949 --> 58:07.089
The Planned Parenthood
Federation of Connecticut here,

58:07.090 --> 58:08.820
I was associated with them at
the time,

58:08.820 --> 58:12.450
got in contact with the
Ukraine--the whole Ukraine was

58:12.445 --> 58:14.905
left like bereft of
contraception.

58:14.909 --> 58:20.699
Got in touch with the main--the
head and the university in Kiev,

58:20.699 --> 58:24.239
the head of the OB/GYN
Department, a very nice woman,

58:24.239 --> 58:29.479
and started to help her
provide--buy contraceptives here

58:29.478 --> 58:31.668
and ship them abroad.

58:31.670 --> 58:33.780
Actually we buy them
internationally,

58:33.784 --> 58:37.254
very cheap, a cycle of pills is
$.80 on the world market.

58:37.250 --> 58:42.660
A condom is like a penny and a
half, diaphragm is $1.25.

58:42.659 --> 58:45.189
So, if you buy them in the
United States they're expensive.

58:45.190 --> 58:47.910
If you buy them in India or
wherever they're made,

58:47.905 --> 58:50.945
the things are a lot of
cheaper, so we could really help

58:50.954 --> 58:51.624
Ukraine.

58:51.619 --> 58:54.849
What they wanted first
was--because you can't use any

58:54.849 --> 58:58.449
of these things if there's
pelvic infections so they wanted

58:58.452 --> 59:01.932
Monistat and other treatments
for vaginal infections as a

59:01.931 --> 59:04.911
first line and than they could
start dealing with

59:04.913 --> 59:06.283
contraception.

59:06.280 --> 59:09.810
Anyway, this program went on
but it wasn't very successful

59:09.811 --> 59:12.781
and the reason was,
the women were using abortion

59:12.784 --> 59:14.834
and were quite happy with it.

59:14.829 --> 59:16.999
They didn't see anything wrong
with it;

59:17.000 --> 59:18.860
they were used to it,
and no problems,

59:18.860 --> 59:20.170
so why should we change?

59:20.170 --> 59:24.240
One of the things that they
did, and we helped them,

59:24.239 --> 59:27.689
was we got some of these
right-to-life films,

59:27.690 --> 59:31.250
which show, in the goriest way,
what the fetus looks like and

59:31.250 --> 59:34.810
what an abortion is like and you
know are really are way,

59:34.809 --> 59:37.179
way off the deep end and
shipped them to them so they

59:37.175 --> 59:38.855
could show their patients and
say,

59:38.860 --> 59:43.720
'see an abortion is not just
this sort of nothing kind of

59:43.719 --> 59:44.499
event.'

59:44.500 --> 59:49.160
The most interesting case might
be Cuba which has one of the

59:49.159 --> 59:52.239
highest abortion rates in the
world,

59:52.239 --> 59:57.299
78 per 1,000 women per year,
compared to Canada which has

59:57.297 --> 59:58.967
15.5,
for instance,

59:58.974 --> 1:00:02.574
again that's the two sides of
the United States.

1:00:02.570 --> 1:00:08.090
Almost 60% of what they call
known pregnancies are terminated

1:00:08.090 --> 1:00:09.380
by abortion.

1:00:09.380 --> 1:00:10.920
So they have a long history.

1:00:10.920 --> 1:00:14.680
Before 1938 they were very much
tied culturally to Spain,

1:00:14.684 --> 1:00:16.974
and Spain was very
conservative.

1:00:16.969 --> 1:00:21.269
That was the Franco era;
a very, very right wing

1:00:21.266 --> 1:00:24.386
fascist, Catholic dictatorship
and so--

1:00:24.389 --> 1:00:26.929
in the Spanish law all forms of
abortion,

1:00:26.929 --> 1:00:31.609
induced abortion were illegal,
and Cuba just used that same

1:00:31.606 --> 1:00:32.086
law.

1:00:32.090 --> 1:00:36.710
It was up until 1938,
and in 1938 they liberalized a

1:00:36.710 --> 1:00:40.880
little bit for rape,
likelihood of death of the

1:00:40.880 --> 1:00:45.230
mother, or severe fetal
malformation issues.

1:00:45.230 --> 1:00:48.970
Despite these restrictions it
was the mechanism of birth

1:00:48.971 --> 1:00:52.711
control in Cuba and it was used
widely by all the social

1:00:52.713 --> 1:00:53.533
classes.

1:00:53.530 --> 1:00:55.610
Well, I'll tell you an
exception to that,

1:00:55.614 --> 1:00:58.644
and by poor people and it was
used in the cities and in the

1:00:58.635 --> 1:00:59.465
countryside.

1:00:59.469 --> 1:01:01.849
So abortion was it.

1:01:01.849 --> 1:01:07.139
Contraception starts coming in
but it's a foreign product and

1:01:07.141 --> 1:01:09.671
it's expensive,
and you need some medical

1:01:09.666 --> 1:01:12.946
knowledge to use it,
so only the upper class uses

1:01:12.952 --> 1:01:15.452
contraception,
at this time,

1:01:15.449 --> 1:01:17.799
used contraception in Cuba.

1:01:17.800 --> 1:01:20.570
At that time a very,
very--few people owned all the

1:01:20.568 --> 1:01:23.838
sugar plantations and everyone
else was basically a slave on

1:01:23.835 --> 1:01:26.885
the sugar plantations,
so the social gulf between the

1:01:26.894 --> 1:01:29.824
rich people using contraception
and the poor people using

1:01:29.818 --> 1:01:32.948
abortion was enormous and they
didn't talk to each other.

1:01:32.949 --> 1:01:36.929
So there was no social
diffusion of the ideas of

1:01:36.927 --> 1:01:40.477
contraception,
so the people just continued

1:01:40.481 --> 1:01:42.091
using abortion.

1:01:42.090 --> 1:01:47.080
1959 Fidel Castro has his
revolution and he takes over,

1:01:47.079 --> 1:01:51.569
and in the beginning he's
anti-abortion,

1:01:51.570 --> 1:01:54.440
he still is,
and a lot of events happened

1:01:54.436 --> 1:01:57.586
and I'm simplifying a
complicated history.

1:01:57.590 --> 1:02:00.620
By 1962 the United States
places an embargo on Cuba,

1:02:00.623 --> 1:02:04.073
including medical supplies,
and guess what the Cubans can't

1:02:04.074 --> 1:02:04.554
get?

1:02:04.550 --> 1:02:07.690
Contraception,
because the United States was

1:02:07.693 --> 1:02:10.913
their source of supply,
so abortion gets more

1:02:10.911 --> 1:02:12.011
entrenched.

1:02:12.010 --> 1:02:16.030
The embargo might have done the
biggest thing to raise Cuban

1:02:16.025 --> 1:02:19.875
rates;
no one has good statistics on

1:02:19.876 --> 1:02:20.556
that.

1:02:20.559 --> 1:02:25.619
While abortion is legal in
Cuba, the government really

1:02:25.615 --> 1:02:27.615
wants to reduce it.

1:02:27.619 --> 1:02:31.409
In 1998 the Pope visited Cuba
as you probably may remember

1:02:31.405 --> 1:02:35.185
from all the headlines and he
talked against abortion,

1:02:35.190 --> 1:02:37.930
then, shortly after that,
Castro gave a seven hour

1:02:37.925 --> 1:02:39.445
lecture,
worse than me,

1:02:39.449 --> 1:02:43.349
a seven hour lecture condemning
abortion as a method of birth

1:02:43.353 --> 1:02:44.073
control.

1:02:44.070 --> 1:02:47.590
He said it was his duty as a
public figure and a

1:02:47.585 --> 1:02:51.545
revolutionary leader to oppose
widespread abortion.

1:02:51.550 --> 1:02:54.770
It didn't have any effect on
the people,

1:02:54.768 --> 1:02:58.068
and it's very interesting,
there is now a wonderful

1:02:58.070 --> 1:03:01.830
article which I actually should
have assigned to you about

1:03:01.831 --> 1:03:03.681
what's going on in Cuba.

1:03:03.679 --> 1:03:06.899
You have too much reading
already.

1:03:06.900 --> 1:03:11.020
The medical--the government and
the medical establishment want

1:03:11.016 --> 1:03:13.846
to get people--wean people off
abortion.

1:03:13.849 --> 1:03:16.539
In these interviews one of the
things they ask the respondents,

1:03:16.539 --> 1:03:19.929
who are women of all ages and
men of all ages,

1:03:19.929 --> 1:03:23.729
'well what have you heard from
doctors and healthcare

1:03:23.728 --> 1:03:24.968
professionals.'

1:03:24.969 --> 1:03:28.679
'Well that's it's dangerous,
that you can die from it.

1:03:28.679 --> 1:03:31.069
Just imagine'--that's what
she's heard from the

1:03:31.068 --> 1:03:34.288
professionals--'but just imagine
if you had to give birth every

1:03:34.289 --> 1:03:35.639
time you got pregnant.

1:03:35.639 --> 1:03:38.649
I got pregnant and had an
abortion when I was 15 even

1:03:38.654 --> 1:03:40.224
though I was on the pill.

1:03:40.219 --> 1:03:43.569
I also got pregnant earlier
when I was using an IUD.'

1:03:43.570 --> 1:03:45.840
This was a woman,
who at the time of the

1:03:45.835 --> 1:03:48.795
interview was age 30,
and she had--this is after her

1:03:48.797 --> 1:03:49.957
fourth abortion.

1:03:49.960 --> 1:03:53.540
The people's perception is very
different than what they're

1:03:53.541 --> 1:03:57.001
hearing from the medical
establishment and the government

1:03:56.998 --> 1:03:58.108
establishment.

1:03:58.110 --> 1:04:03.250
It's an absolutely unremarkable
subject for discussion.

1:04:03.250 --> 1:04:07.190
One male who is now age 49
said, 'I was about ten

1:04:07.186 --> 1:04:12.186
years'--they ask what have
you--do you hear about abortion?

1:04:12.190 --> 1:04:13.100
Is it discussed?

1:04:13.099 --> 1:04:17.559
He says, 'sure,
I was about ten years old,

1:04:17.559 --> 1:04:20.129
I heard about abortion from
people on the street,

1:04:20.130 --> 1:04:24.050
also in my house my mom talked
about it with her friends in

1:04:24.054 --> 1:04:25.074
front of me.'

1:04:25.070 --> 1:04:28.070
Another respondent:
'Around the streets abortion is

1:04:28.074 --> 1:04:30.184
a common thing people talk
about.

1:04:30.179 --> 1:04:31.389
It's an everyday thing.'

1:04:31.389 --> 1:04:35.019
A male aged 23.

1:04:35.018 --> 1:04:38.788
"Do you know anyone in
your family, among your friends

1:04:38.789 --> 1:04:40.739
who's had an abortion?"

1:04:40.739 --> 1:04:42.369
'Yes, an aunt of mine.'

1:04:42.369 --> 1:04:43.339
"What did she tell
you?"

1:04:43.340 --> 1:04:45.930
'That you don't feel anything,
that they give you the

1:04:45.929 --> 1:04:48.219
anesthetic and stuff,
everything goes fine.'

1:04:48.219 --> 1:04:52.149
That was a woman of 18 who's
just had her first abortion.

1:04:52.150 --> 1:04:54.370
Another respondent,
'yes friends of mine,

1:04:54.373 --> 1:04:57.543
they told me that they had it
done and that you don't feel

1:04:57.541 --> 1:04:58.321
anything.'

1:04:58.320 --> 1:05:02.190
Now that was a 15 year old girl
with her first abortion.

1:05:02.190 --> 1:05:04.440
Another respondent,
'my cousin had an abortion,

1:05:04.440 --> 1:05:07.030
she told me that nothing out of
the ordinary happened,

1:05:07.032 --> 1:05:08.552
that everything went well.'

1:05:08.550 --> 1:05:11.800
This is a female aged 21 on her
second abortion.

1:05:11.800 --> 1:05:13.540
Another respondent,
'when I was in school,

1:05:13.541 --> 1:05:15.031
a friend of mine had an
abortion;

1:05:15.030 --> 1:05:18.420
she was fairly young around 13
years old because we were in the

1:05:18.416 --> 1:05:19.286
eighth grade.'

1:05:19.289 --> 1:05:21.589
"What did she tell you,
how did it go?"

1:05:21.590 --> 1:05:25.180
'She told me it went well and
said the anesthetic was fine,

1:05:25.177 --> 1:05:27.587
girls talk about that kind of
stuff.'

1:05:27.590 --> 1:05:33.200
This was a 31 year old woman on
her fourth abortion.

1:05:33.199 --> 1:05:36.229
Another respondent--to the
question, have you heard much

1:05:36.228 --> 1:05:37.438
talk about abortion?

1:05:37.440 --> 1:05:39.030
'Oh yes, among girls at school.

1:05:39.030 --> 1:05:41.190
They don't use anything,'
meaning they don't use any

1:05:41.186 --> 1:05:43.086
contraceptives,
'so when they get pregnant the

1:05:43.090 --> 1:05:44.190
go to get an abortion.

1:05:44.190 --> 1:05:46.140
They talk about it like it's
nothing;

1:05:46.139 --> 1:05:47.929
it's like drinking a glass of
water.

1:05:47.929 --> 1:05:50.959
Some people have problems when
they get an abortion but most

1:05:50.958 --> 1:05:51.728
people don't.

1:05:51.730 --> 1:05:54.530
Almost always the procedure
goes fine.'

1:05:54.530 --> 1:05:59.570
That's a 17 year old girl after
her first abortion.

1:05:59.570 --> 1:06:03.500
It's a very interesting case
because while they're

1:06:03.496 --> 1:06:05.626
experienced,
they're hearing one thing from

1:06:05.625 --> 1:06:07.395
the government,
the same thing from the medical

1:06:07.403 --> 1:06:09.793
community but they know lots and
lots of people who have had

1:06:09.793 --> 1:06:11.143
abortions,
a common subject,

1:06:11.137 --> 1:06:13.747
and they're not hearing about
any difficulties from it,

1:06:13.750 --> 1:06:15.560
or very rarely are they.

1:06:15.559 --> 1:06:18.769
The government's pushing
contraception and they use

1:06:18.766 --> 1:06:21.386
contraception,
92% of the Cuban women have

1:06:21.394 --> 1:06:22.874
used contraception.

1:06:22.869 --> 1:06:26.839
That's some time--even among
adolescent girls who are

1:06:26.835 --> 1:06:31.405
obviously having a very rich sex
life because they're getting

1:06:31.411 --> 1:06:36.531
pregnant all the time,
84% have used some form of

1:06:36.525 --> 1:06:38.285
contraception.

1:06:38.289 --> 1:06:41.409
It doesn't mean anything to
them, because they're just as

1:06:41.413 --> 1:06:42.643
happy with abortion.

1:06:42.639 --> 1:06:45.479
So, they're not worried about
getting pregnant so they

1:06:45.478 --> 1:06:48.408
sometimes use contraception,
they sometimes don't,

1:06:48.411 --> 1:06:51.621
and the reports of when they
use it are almost totally

1:06:51.621 --> 1:06:52.411
haphazard.

1:06:52.409 --> 1:06:54.599
They'll use it for a while,
they'll stop using it,

1:06:54.601 --> 1:06:56.661
they'll start again and they
change methods.

1:06:56.659 --> 1:07:00.929
It doesn't even have any--of
course women go through periods

1:07:00.925 --> 1:07:03.485
and men too,
when they're in a relationship

1:07:03.494 --> 1:07:05.874
having sex or just having a lot
of casual sex,

1:07:05.869 --> 1:07:08.609
and the woman will tell you
this and the use of

1:07:08.608 --> 1:07:12.118
contraception did not correlate
at all with periods when the

1:07:12.121 --> 1:07:13.671
women were having sex.

1:07:13.670 --> 1:07:17.290
It's just a total disconnect
and undoubtedly the reason is

1:07:17.293 --> 1:07:20.923
that they're perfectly happy
with abortion and it's a fine

1:07:20.916 --> 1:07:24.666
backup so they don't have to be
terribly careful about using

1:07:24.668 --> 1:07:25.938
contraception.

1:07:25.940 --> 1:07:32.010
In fact, much as they're
hearing that abortion is no big

1:07:32.007 --> 1:07:34.917
deal,
they're hearing that the other

1:07:34.918 --> 1:07:38.908
forms of other contraception are
really not very pleasant.

1:07:38.909 --> 1:07:41.729
Here are more answers to survey
questions.

1:07:41.730 --> 1:07:45.660
'I don't like the pill because
of extra hormones in the woman's

1:07:45.655 --> 1:07:47.805
body,' a male aged 19 says that.

1:07:47.809 --> 1:07:50.979
This is a woman:
'No, I don't use any IUD

1:07:50.983 --> 1:07:53.763
because my body can't support
it.

1:07:53.760 --> 1:07:55.210
It falls out of place.'

1:07:55.210 --> 1:07:57.590
"You have used an IUD in
the past?"

1:07:57.590 --> 1:08:00.770
'Yes, I had an IUD two
different times and both times

1:08:00.766 --> 1:08:01.986
it fell out place.

1:08:01.989 --> 1:08:03.869
I have problems with IUDs.'

1:08:03.869 --> 1:08:08.409
That's a 37 year old woman on
her second abortion.

1:08:08.409 --> 1:08:11.719
IUD causes pain to women.

1:08:11.719 --> 1:08:14.419
'After my first pregnancy I had
an IUD inserted,

1:08:14.423 --> 1:08:17.823
but I had to have it removed
because it was causing pain.

1:08:17.819 --> 1:08:21.339
I started having problems with
my period and a lot of

1:08:21.337 --> 1:08:24.147
inflammation,
and when I had sex it was

1:08:24.154 --> 1:08:27.834
painful, so I had the IUD
removed,' female aged 35 her

1:08:27.831 --> 1:08:29.081
first abortion.

1:08:29.078 --> 1:08:32.288
'I had an IUD before,
I had it for two years,

1:08:32.292 --> 1:08:36.092
but I had it removed because I
had abnormal menstrual

1:08:36.091 --> 1:08:39.891
bleeding,' a 42 year old woman,
fourth abortion.

1:08:39.890 --> 1:08:42.460
Another woman,
'sometimes I'll use protection

1:08:42.463 --> 1:08:43.813
but the condom broke.

1:08:43.810 --> 1:08:47.130
You explain these things to the
doctors and they say that--this

1:08:47.131 --> 1:08:49.921
doesn't happen but I'm telling
you it's not a lie.

1:08:49.920 --> 1:08:53.950
Sometimes condoms are bad and
they break,' a 19 year old girl

1:08:53.948 --> 1:08:55.558
on her third abortion.

1:08:55.560 --> 1:09:00.660


1:09:00.658 --> 1:09:04.588
At the time of the survey 88%
were practicing contraception at

1:09:04.586 --> 1:09:07.746
the time of the survey,
and again, among adolescents

1:09:07.752 --> 1:09:10.422
68% were using condoms at the
time of the survey.

1:09:10.420 --> 1:09:13.740
Yet, the contraception,
they didn't like it,

1:09:13.743 --> 1:09:17.533
it wasn't effective,
and they were apparently just

1:09:17.532 --> 1:09:19.622
as happy with abortion.

1:09:19.619 --> 1:09:27.909


1:09:27.908 --> 1:09:31.378
It's a very interesting thing
and this is repeated in

1:09:31.382 --> 1:09:34.592
basically all of the east
European countries,

1:09:34.590 --> 1:09:37.460
where again,
they have long experience with

1:09:37.456 --> 1:09:41.136
abortion and they don't
particularly see any benefit to

1:09:41.140 --> 1:09:42.370
contraception.

1:09:42.368 --> 1:09:46.038
Now the standard thing that
you'll hear in America from

1:09:46.036 --> 1:09:49.906
everybody, independent of
their--they can be right to life

1:09:49.907 --> 1:09:51.127
or pro-choice.

1:09:51.130 --> 1:09:55.380
Their thing is that--the idea
is, and I've been sort of saying

1:09:55.382 --> 1:09:58.342
that here,
the idea is to replace abortion

1:09:58.340 --> 1:10:01.820
with contraception,
that contraception is a better

1:10:01.815 --> 1:10:04.525
method of birth control than
abortion.

1:10:04.529 --> 1:10:07.899
It's controversial--but now
it's controversial.

1:10:07.899 --> 1:10:10.499
Actually, what started me
really looking into this was a

1:10:10.497 --> 1:10:12.667
number of years ago I was giving
a lecture,

1:10:12.670 --> 1:10:16.420
and I was saying very overtly,
that well it's progress when

1:10:16.421 --> 1:10:18.621
contraception replaces abortion.

1:10:18.618 --> 1:10:26.238
Now it's not so obvious because
I showed you this one,

1:10:26.235 --> 1:10:34.135
that the safest method is
condoms backed by abortion.

1:10:34.140 --> 1:10:37.970
It's very--it was very
hard--one student asked me this

1:10:37.971 --> 1:10:40.871
question about why is--
why do you think that

1:10:40.869 --> 1:10:43.779
contraception is better than
abortion and it's a very,

1:10:43.779 --> 1:10:48.529
very hard question to answer
and I won't even try to do this

1:10:48.525 --> 1:10:49.165
today.

1:10:49.170 --> 1:10:52.350
It's a very difficult kind of
issue.

1:10:52.350 --> 1:10:56.070
The final thing that I should
tell you is that one of the

1:10:56.065 --> 1:10:59.645
things we worry about is the
population growth rate.

1:10:59.649 --> 1:11:03.639
Abortion makes a huge
difference in the global rate of

1:11:03.643 --> 1:11:05.153
population growth.

1:11:05.149 --> 1:11:08.819
As I told you,
there's ballpark 75 million

1:11:08.822 --> 1:11:11.332
increase in the world now.

1:11:11.328 --> 1:11:16.378
If the abortion rate is about
somewhere between 40 and 50

1:11:16.381 --> 1:11:21.881
million, that means the rate of
world population increase goes

1:11:21.884 --> 1:11:24.324
up by 75% or something.

1:11:24.319 --> 1:11:27.859
Because abortion is such a
large fraction of the birthrate,

1:11:27.859 --> 1:11:31.069
if abortion disappears and is
not replaced by contraception,

1:11:31.069 --> 1:11:34.409
the population growth rate goes
crazy.

1:11:34.408 --> 1:11:37.058
In the world,
as it is now,

1:11:37.060 --> 1:11:43.380
there's probably not any chance
of stabilizing world population

1:11:43.378 --> 1:11:45.518
without abortion.

1:11:45.520 --> 1:11:48.930
Just on time,
we will continue with the

1:11:48.930 --> 1:11:54.320
biology of abortion and some of
the history and philosophical

1:11:54.318 --> 1:11:57.818
considerations in the next
lecture.

1:11:57.819 --> 1:12:04.999