Visual aids including puppetry supplement the written word in promoting literacy and social welfare in the villages of India.
LITERACYHOUSEcarries the torch of learning to about 150 villages around Lucknow each week, through its teachers, newspaper, mobile libraries and puppet shows. Successfully fighting against indifference, suspicion and resistance to change, it has taught the rudiments of knowledge so far to some two million illiterates. And to make the new knowledge meaningful to them, Literacy House correlates it to matters of everyday concern to the villagersfood production, rural industries, credit and the money-lender, health and sanitation, care of children, size of the family, social evils such as the dowry system. Literacy classes are held in various centres-in the evening for men who work in the fields and during the day for women -over a normal period of ten months.
FAMILY WELfARE
PLANNING
These classes are taught by teachers specially trained in techniques of adult education, who use textbooks, coloured charts and other teaching material prepared by Literacy House experts. To maintain the neo-literates' interest in learning after the course is over, mobile libraries take to their doorsteps a wide range of books suited to their needs. The books may be carried by station wagons to a market place where people from several nearby villages gather; or librarians riding bicycles, fitted with large-size trunks, may deliver them at villagers' homes. More than 90,000 books were loaned in this way last year, and of these less than 1,500 were lost. Much of this reading material for the new literates combines instruction with fiction since it is stories, rather than sermons o.r. homilies, which appeal to the unsophisticated. Apart from books, audio-visual aids are extensively used to illustrate a classroom lesson or to portray interestingly a social or economic theme. Puppet shows, an ancient Indian art, seldom fail to hold the attention of a rural audience. Literacy House makes imaginative use of puppetry in its educational programmes and is currently employing it to emphasize the need for family planning. Puppet shows have also been used to demonstrate, among other themes, the advantages of cleanliness and precautions against disease, the burden of unproductive debts incurred on marriages and other ceremonial occasions, and, on the request of the Life Insurance Corporation of India, the benefits of life Il1surance. The silkscreen printing unit set up at Literacy House has produced thousands of coloured charts, posters, flashcards and book covers. In addition to ensuring a continuous supply of teaching aids and publicity material, the unit has organized courses of training in the silkscreen process of printing. (continued) Course in silkscreen printing is part of Literacy House training programme. Cololll'ed poster at left was produced by printing unit; photos show steps in preparation of poster.
CABINET
THENIXON
BACK
John N. Mitchell
ROW
Attorney
FRONT ROW
General
John A. Volpe Transportation
Maurice H. Stans Commerce
Winton M. Blount Postmaster
Clifford M. Hardin
General
Melvin R. Laird
David M. Kennedy
Defence
Treasury
George P. Schultz
Agriculture
Labour
William P. Rogers State
Robert H. Finch Health, Education & Welfare
Walter J. Hickel Interior
George Romney Housing
MELVIN LAIRD, Secretary of Defence As A TOP-RANKINGRepublican leader and member of the Appropriations Committee on National Defence in the U.S. House of Representatives, Melvin Laird, 46-year-old Secretary of Defence, has had considerable experience with the intricacies of the U.S. defence budget. He has also taken active interest in a wide range of national issues including education and social welfare. In his new job he will supervise the activities of nearly five million military and civilian personnel in the U.S. armed forces and control a current annual budget of 81,000 million dollars. Mr. Laird began his political career in 1946 when he was elected to the Wisconsin State Senate, and six years later became a U.S. Representative. In his book A House Divided: AmericaJs Foreign Policy and Strategy} he stressed the need for unity in America's foreign policy and military strategy. He is reported anxious to strengthen the Rep'ublican Party's efforts for peace. WINTON M. BLOUNT, Postmaster General BREAKINGPRECEDENT,the President appointed Winton M. Blount as Postmaster General, not as a reward for his services to the Party, but because he is an efficient, successful businessman and is expected to introduce modern business techniques into the U.S. postal system. Mr. Blount, 47, served as a pilot in the U.S. Air Force during World War II, and for the last twenty years has built a construction business, handling contracts for space exploration ground facilities and nuclear reactors, in addition to more mundane projects. Mr. Blount firmly believes that businessmen have a responsibility in helping with the solution of domestic problems. He is the only Southerner in the Cabinet, and the high esteem in which he is held by Republican leaders in the South is expected to be an asset to the Administration. He is respected for the quiet work he did behind the scenes to lessen racial tensions in Southern cities of Selma and Birmingham. A Commission last year recommended that the U.S. postal department be converted into a Government Corporation. If the scheme is adopted by the Nixon Administration, Mr. Blount may be the nation's last Postmaster General.
JOHN MITCHELL, Attorney General ONE OF THE important issues during tbe last election campaign was the rising crime rate. Mr. Nixon pledged that his Administration would take firm steps to restore law and order. The man whom he has chosen to assist him in fulfilling this pledge is 55-year-old John Mitchell. a close associate and former law partner. The new Attorney General was largely responsible for the imaginative bond issues of New York State which financed State colleges and several other programmes of nation-building activity. In the 1968 Presidential elections, he served as the national campaign manager of the Nixon-Agnew ticket. During the Second World War, Mitchell was in command of a United States PT boat flotilla in tbe Pacific, and one of the officers who served under him was John F. Kennedy.
tiveness, in many places where the dia- Greek physicians, in what is perhaps the phragm has not yet been introduced or is first written mention of safe days, stated prohibited by law. that people who wanted to prevent pregAnother barrier between sperm and nancy should avoid intercourse on the days womb, the device now known as the con- just before, during and just after menstruadom, also has a long history. The first of tion. This theory was not seriously chal'them may have been worn by women lenged until the mid-nineteenth century, rather than by men; they were loose and persists in some places even today. It pouches, made of the membranes of has probably been responsible for much of animals, used to line the vagina and catch the world's population growth, for the the sperm. This type of device, made from facts are quite the opposite. the bladder of a goat, is mentioned in The modern rhythm method represents Roman literature. The same idea is still the culmination of the old search for safe used today by some of the primitive people days. There is, indeed, a period lasting of South America, who cut the end off a many days each month when a woman large seed pod and place it in the vagina. Condoms for use by men are much newer, probably because of the difficulty of finding a suitable material for their manufacture. In a 1564 treatise, the Italian anatomist Gabriello Fallopio recommended the use of a linen sheath. Some of the early ones were made of animal gut or leather. In 1671, the French aristocrat Mme. de Sevigne wrote a letter to her daughter describing the condom as "an armour against enjoyment and a spider web against danger." In fact, not until the vulcanization of rubber was introduced in 1844 were condoms used to any wide extent. Today most are made of synthetic rubber and they are used by the millions all over the world. They are one of the most effective methods of birth control and also a positive protection against venereal disease, a fact that had led to their legalization in a number of countries where devices designed exclusively for contraception are prohibited. In addition to searching for mechanical and chemical methods of birth control, mankind has for centuries placed faith in JUST AS SCIENCE has revolutionized everythe idea of "safe days"-some part of the thing else from the growing of food to the menstrual cycle in which conception is means of travel, so it has revolutionized the impossible. Unfortunately for our ances- old fumbling search for birth control. tors, the safe days represent a case where Although there are still some mysteries, the laws of nature appear to violate the science has unlocked many of the riddles of laws of common sense. It seemed only the female menstrual cycle, conception and logical to believe that conception would the events of pregnancy. The process is now occur during the woman's menstrual period knownto be one of nature's most intricate, when something unusual seemed to be cunning and awe-inspiring triumphs~a going on inside the female body. The "safe miracle of interconnected bodily activities, period," therefore, existed somewhere in delicately regulated and precisely timed. the days between the end of one menstrual We know the remarkable details of how the period and the start of the next. One of the female egg ripens and how it travels to the
cannot get pregnant. If these days can be determined accurately, and if intercourse is confined to these days, she can avoid pregnancy without using any mechanical devices or drugs. The rhythm method is one of today's most important methods of birth control, especially since it is the only method now authorized by the Roman Catholic Church. Like all other modern methods, however, it is only a refinement of a very ancient idea. The search for some means of limiting the size of families is older than Christianity, older than any other modern religion, older by far than the discoveries of science.
-The methods
place where it can be fertilized; we know how the sperm overcomes almost insuperable obstacles to reach the egg; how fertilization takes place and how the egg grows from a single cell to a living baby. We know many of the subtle ways in which this complicated step-by-step process can go wrong, and thus why some people are unable to have children; indeed we know how to make some of the minute readjustments that may help these people have children. In acquiring all this knowledge, medical science has also found that there are many ways in which the, process can deliberately continued
Bi~llhI con ro be interrupted. Birth control, once a matter of guess and superstition, has been placed upon a solid scientific basis. Thanks to these developments, any couple that wants to limit the size of its family has a number of proven tools at its disposal-and the world has available, if it cares to use them, all the necessary tools for controlling the population explosion. As of today, there are nine different' methods of birth control, all of which have been carefully studied and evaluated. All the methods have advantages and disadvantages, they differ in how much of a guarantee they can offer against an unwanted pregnancy; some may be suitable for one couple but' not for another. The facts are ,well known. Any man and wife who want to limit the size of their family can study the facts and choose the method that is best for them in' the light of their personal needs, their aesthetic attitudes towards sexual relations and their religious convictions.
The rhythm method The great advantage of the rhythm method for those with religious doubts is that it is the one form of birth control approved by the Catholic Church. There are no religious objections of any kind to its use. It is legal everywhere, and it requires no equipment except a calendar or a piece of paper on which the days of the month can be marked. (In primitive societies, which lack paper and pencil, track of the days can even be kept with pebbles or beads.) Any couple can practise it with clear conscience, if only they ar~ willing to keep count, and many couples do practise it. The rhythm method is based upon the scientific fact that, ordinarily, only once a month does a woman produce a ripe egg that can be fertilized by the male sperm and then develop into a baby. There is a period of no more than twenty-four hours during which the ripe egg remains alive and can be fertilized; if fertilization does not take place in this twenty-four-hour period, the egg breaks apart and disappears. Charts for the rhythm system also take account of the fact that sperm can stay alive inside the woman's body for forty-eight hours after
intercourse and still fertilize an egg. Conception can occur only if intercourse takes place during the period in which the egg stays alive-or has taken place recently enough so that there are still live sperm swimming about in the woman's body. Thus there is no more than one period a month, lasting in all for seventytwo hours, or three days, in which intercourse can possibly result in pregnancy. When does this period occur? The answer to this is based on the work of two scientists, Dr. Kyusaku Ogino of Japan and
Dr. Hermann Knaus of Austria (in some countries, the rhythm method is still known as the Ogino-Knaus method). Their studies, made in the 1930s, showed that ordinarily a woman produces a ripe egg about fourteen days before the start of menstruation. Unfortunately, the word "about" is very important in that last sentence. Even in a woman whose menstrual periods are always completely regular, invariably occurring twenty-eight days apart, the ripe egg may be released anywhere from the
sixteenth through the twelfth day before menstruation begins. * There is no way of predicting, in any given month, whether this will occur on the sixteenth day, the twelfth day, or one of the days in between. A very few women experience some pain or minor bleeding at the time the egg is released, but most have no sign at all. To • In theory, "safe" and "unsafe" days are calculated in terms of days before the next menstruation. In practice, as will be seen, once a woman begins using the rhythm method, she can count her safe and unsafe days as days since the last menstruation.
be on the safe side, the woman with completely regular periods must not have intercourse from the eighteenth day before menstruation-for sperm deposited on that day will still be alive two days later, which may be when the egg is released. Nor should she resume having sexual relations until after the eleventh day before menstruation-for the egg may not have been released until late on the preceding day and may therefore still be in a position to be fertilized. Thus, for women with an invariably regular cycle, there is a period
of eight days out of each month during which they must not have intercourse (from the eighteenth day before menstruation through the eleventh day). Most women; of course, do not have completely regular menstrual cycles; sometimes menstruation recurs less often than twenty-eight days and sometimes it is delayed for several days longer. It is not especially unusual for menstruation to occur at intervals as short as twenty-one days, or as long as thirty-eight days. For women whose cycles are irregular, there is a great deal more uncertainty as to when the ripe egg will be released. Some women have such irregular menstrual cycles that they cannot use the rhythm chart at all; perhaps fifteen wbmen out of every 100 are in this category. The system cannot be -used by any woman immediately after childbirth, for the first few menstrual cycles are usually extremely irregular, and the appearance of the egg cannot be predicted with any accuracy at all. Even for those women who can use the system, who have waited a suitable length of time after childbirth and who have kept careful records of their periods, the rhythm method often requires abstinence from intercourse over an extended number of days each month; to many couples, this is its chief disadvantage. For some couples, there is also the psychological problem of "programmed sex," of deciding in advance the days on which intercourse can or cannot be practised. Another disadvantage is the fact that the rhythm method is by no means 100 per cent effective against pregnancy. The estimate is that out of every 100 women who have used the rhythm system for a full year, twenty-four will become pregnant anyway. This figure of twenty-four per 100 women-years of use, like all statistics on the efficiency of birth control methods, doubtless includes many pregnancies that resulted becau~e couples were careless; in the case of the rhythm method, they forgot to avoid some of the unsafe days; in the case of other methods, they neglected to take the proper precautions on some occasions. Thus a couple that practises any of the methods faithfully, never once continued
Bir,lh I can ro forgetting or taking a chance, can expect a higher degree of efficiency than the statistics show. Nonetheless, the figure for the . rhythm method is quite high~higher than for any other except the douche-and indicates that the method has some builtin inaccuracies. Why should this be? One reason is that the menstrual cycle may change at any time as a woman grows older. It may be extremely regular for years, then suddenly shift: the start of a new period may begin much earlier than ever before, or not until much later. Another reason probably lies in recent findings that indicate that the sperm of the male may occasionally live much longer in the female genital tract than was formerly assumed. In rare instances, it now appears, sperm may remain active and therefore capable of fertilizing the egg for as long as five days.
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, nce considered foolproof, recent scientific studies of the diaphragm, however, have shown it to be somewhat suspect.
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A number of gadgets are sold as aids to practising the rhythm method; they include special calendars, slide rules and other types of calculators for keeping track of the days-even a clock on which a window turns red at the start of the unsafe period. Most of these gadgets are quite expensive and none of them is any more accurate than a simple chart. The whole secret of practising the rhythm method is to keep accurate track of menstrual periods for a year, then never-without exception -to have intercourse on the unsafe days. The one available device that does have value to the rhythm system-for women who are willing to go to the not inconsiderable trouble of using it-is a special fever thermometer. For reasons concerning glandular activity and bodily chemistry, the
release of the ripe egg noticeably changes a woman's temperature, though only by rather small amounts. At about the time the egg is released, the body temperature may drop slightly. A day or two later it rises to above normal by about 0.6° F. It stays at this higher level until just before the start of the next menstruation, when it again drops to the normal level. The temperature rise, if noted carefully with a thermometer, serves two purposes. Once the rise has occurred, and the higher temperature level has been recorded for three days, the woman can be sure that the egg has broken apart and that the unsafe period is now over. Moreover, a physician can use temperature records, if they are kept over a period of several months, to work out a more accurate schedule of safe and unsafe days than is otherwise possible. Some women combine the use of the chart with temperature readings, estimating their first unsafe day by the chart, their last by temperature readings. This combined method is safer than use of the chart alone. The safest rhythm method is to limit intercourse to the days following the temperature rise, when the egg has disintegrated. However, this method requires abstinence during the greatest part of each month. There is no question that use of the thermometer, with or without the chart, greatly increases the effectiveness of the rhythm system. Unfortunately the keeping of temperature records is a burdensome process. The temperature must be taken every morning upon awakening and before getting out of bed- for any kind of activity, illness or distress may throw off.the reading. It is best taken rectally rather than by mouth, and with a special thermometercalled a "basal body temperature thermometer"-which, unlike the ordinary fever thermometer, covers only 96° to 100° F. and is especially sensitive to the small changes that are involved. (The same kind of thermometer and the same system of readings can be used -to increase the chances of pregnancy.)
The diaphragm The diaphragm, manufactured and sold widely in the United States, is a shallow
rubber or synthetic rubber cup designed to cover the neck of the womb and prevent sperm from entering. It ranges in diameter from about two to four inches to allow for variations in the size of the female internal organs, and is built around a flexible metal ring that helps to hold it in place. To determine the proper size, a woman must be "fitted'~ for a diaphragm by a physician or other trained person, who also demonstrates the technique of inserting the diaphragm into the vagina so that it properly covers the entrance to the womb. A contraceptive jelly or cream that kills sperm on contact is always used along wit~ the diaphragm. A small amount of the jelly is rubbed around the edge of the diaphragm, and about a teaspoonful is placed inside the cup. The diaphragm is then put in place over the neck of the womb, with the fingers or with a tool designed for this purpose. For still greater protection, an additional amount of the contraceptive jelly is then squeezed up against the diaphragm through a narrow plastic tube. The diaphragm must be inserted before every act of sexual intercourse and must remain in place for at least six hours after intercourse. It can then be removed and a douche can be used, if desired, to remove the jelly that remains in the vagina. But the douche is not necessary-and must not be used under any circumstances for at least six hours. Many women routinely insert the diaphragm each night. Properly inserted, it can stay in position safely for twenty-four hours without causing the wearer any discomfort. Invented by a German physician in 1882, the diaphragm was once considered a foolproof method of birth control and was widely prescribed in clinics all over the world, especially in the United States. In 1960, a study showed that three million women in theU nited States and 50,000 women in Great Britain used the diaphragm. In recent years, however, its efficiency has become somewhat suspect. New studies have shown that even the most carefully fitted diaphragm may sometimes be pushed out of position and cease to protect the womb. Out of every 100 women who rely on the diaphragm for a full year, it has been found, about twelve are likely .to become pregnant. Whether these preg-
nancies result from a failure of the diaphragm itself, or from the carelessness of individuals in its use, the results are unfortunately the same. A variation called the cervical cap has been used in some parts of the world, especially Great Britain and Germany. Made of plastic or metal, the cervical cap is smaller than the diaphragm and is designed to fit snugly over the neck of the womb; it, too, must be fitted by a physician. Once in place, it can be left undisturbed from the end of one menstruation tojust oefore the start of the next. It stays in position better than the diaphragm and affords a much greater measure of protection. But it is difficult to insert properly, and soine women find the task awkward or impossible. Another variation, employed for hundreds of years, is the use of a small sponge dampened with soap suds, a weak solution of vinegar or a contraceptive jelly and then inserted as far into the vagina as it will go. Usually a string is attached to the sponge to make it easier to remove. Like the diaphragm, the sponge is intended to cover the entrance to the womb and prevent sperm from entering. Although it is cheap, readily available and partially effective in preventing conception, the sponge is far less effective than the diaphragm or cervical cap.
phragm. The condom's efficiency can be made even greater by using it in conjunction with a contraceptive jelly inserted into the vagina before intercourse. The jelly serves as an added protection in the unlikely event that the condom should break. It also protects against sperm which may leak out around the edges of the condom after intercourse, or which may accidentally be deposited on the outside of the condom while it is being put into place before intercourse.
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'\ ondoms are one of the most reliable, effective and widely used methods of birth control In the whole world.
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It must be noted in this connection that, in preparation for the act of intercourse, a set of glands releases a thick lubricating fluid into the male genital tract; this fluid, which often flows quite freely before ejaculation, may itself carry a small number of sperm and serve' to cause pregnancy. It is this substance which The condom occasionally may be introduced into the The condom, usually a syrithetic rubber vagina on the outside of the condom. sheath worn rather tightly over the male Until the discovery of synthetic rubber, sex organ, is widely known and used condoms were rather thick and awkward; around the world. In many countries, the moreover, they sometimes had small manufacture, sale and use of condoms. defects through which semen could leak, are legal only as a protection for the man or which caused breakage. Condoms against venereal disease. But condoms are made today, however, are far more relialso a reliable method of birth control and able. Although the best ones are expensive, are so used by many people who ostensibly the cost can be reduced by using them buy them for protection against disease. more than once. If they are washed after A recent study indicates that 8:25 million each use, then dried with a towel, powcouples in the United States use condoms; dered with talc and reroIled, they can be 3.75 million in Japan, 1.5 million in Eng- used five or six times, though it is generland, 300,000 in France. , ally a ~ood idea to test them after each Since the condom prevents the male use by filling them with water to make sperm from ever reaching the woman's sure no small holes have developed. body, it is one of the most effective of all meSome condoms are packed with a thods of birth control-statistical studies 'lubricant that counteracts the natural dry, show it to be almost as reliable as the dia- ness of synthetic rubber and makes the I
act of intercourse easier. The same effect can be obtained by lubricating the outside of the condom with a contraceptive jelly, which also affords additional protection. Vaseline and other naturally greasy or oiiy substances are less suitable because they cause synthetic rubber to deteriorate; they should never be applied if the condom is to be saved and used again. Since condoms can be bought almost anywhere-if only on the pretext of using them as protection against disease-they are one of the handiest as well as most effective methods of birth control. The only disadvantage, aside from moral or religious objections to their use, is the fact that some couples find that they interfere with full enjoyment of the sexual act. This is particularly true of older men whose responses are slower anyway. Many couples in the past have used condoms in the earlier years of marriage, then switched to ,other methods like the diaphragm or the cervical cap later.
Withdrawal ('coitus interruptus') One way of preventing the sperm from getting inside the woman, even without the use of a condom, is for the male to withdraw just before his orgasm occurs. This very ancient technique of withdrawal -mentioned in the Bible-was especially popular in Europe for many decades and is believed to be the reason that the birth rate in many European countries was quite low long before the rhythm method and such devices as the diaphragm and condom were developed. A survey made a few years ago showed that forty-four per cent of couples interviewed in Great Britain had practised withdrawal at times and that for somewhere around a fifth to a third of these couples it was still the only method ever used. In the United States it has been much less popular-used at times by only eighteen per cent of couples and, as the only method, by fewer than five couples in 100. , Many couples have used withdrawal for years and have found it perfectly acceptable-though hardly 100 per cent effective. Although it introduces a certain amount of tension into the sex act-iri that the man must be alert to the first signs of continued
Bir,'h can rol orgasm and prepared to terminate intercourse abruptly-for most couples it does not appear to have any ill effects on either the man or the woman. To many men who have practised the technique over long periods, the act of withdrawal becomes almost second nature; they do it automatically. Some couples, however, find that by its very interruption of intercourse, withdrawal greatly disturbs the nature of the sexual relationship. As for effectiveness, withdrawal is less useful than generally supposed. One reason is that fluid from the glands lining the male's genital tract, as mentioned above in connection with the use of condoms, may contain sperm and deposit them in the woman even before orgasm. Another is that the slightest mistake in timing permits a certain amount of semen to be deposited before withdrawal. Even a drop is sufficient to cause pregnancy-especially since the first drops of semen expelled by the man contain unusually high concentrations of sperm. Among every 100 couples who practise withdrawal for a full year, one survey has shown, eighteen women are likely to get pregnant. Thus withdrawal is one of the less effective of birth control methods used today. To couples who are determined to limit the size of their families, its chief or only value is as an emergency measure that can be taken when no other is available.
Chemical barriers In many parts of the world, various chemical preparations are sold as contraceptives, acting to kill or immobilize sperm on contact. Some are available as jellies and creams, similar to those designed for use with a diaphragm, but are intended to be used alone. Usually these are somewhat stronger than the preparations that go with a diaphragm. Besides their chemical action, they also form a coating that keeps surviving sperm from reaching the egg. These preparations are sold in a tube with a plastic applicator that deposits them high in the vaginal tract at the neck of the womb. Other contraceptive chemicals come in tablet form; they dissolve on contact with the moisture in the vagina and spread a protective coating. Others are in
the form of suppositories that melt when exposed to the heat of the body. All these preparations must be used before intercourse; the suppositories, indeed, must be inserted fifteen minutes in advance to give them time to melt. All of them provide a certain amount of protection-the creams and jellies more than tablets or suppositories-although none, used alone, is as effective as use of a diaphragm and jelly.
Ji 11the chemical contraceptives provide some protection, but none of them is as effective as a diaphragm.
~_-_-_-_-_-_-_-_rf The newest type of chemical barrier is packaged under aerosol pressure in a bottle or can with a valve at the top and is sold along with a plastic applicator. When the applicator is pressed down on the valve, the pressure inside the package forces the chemical substance up into the applicator in the form of a thick foam, which is then inserted high into the vagina. The consistency of the foam is such that it quickly and evenly covers the walls of the vagina and the neck of the womb with a protective film that is extremely difficult for sperm to penetrate. Of all the chemical barriers, this new aerosol foam is considered by far the most effective.
The douche Many women in many parts of the world cling to the belief that pregnancy can be prevented by washing away the semen after intercourse with a douche. Various devices are made and sold for this purpose; some of them have a large rubber bulb that can be filled with water and emptied into the vagina; others rely on the force of gravity to introduce water into the body from a sort of hot water
bottle held above the head. Some women believe that hot water makes the most effective douche; others believe in cold water or in various kinds of chemical solutions. It is true that a douche, used as soon after intercourse as possible, has some value in preventing pregnancy. The water does wash away some of the semen and therefore reduces the chance that sperm will find their way to the egg. The effectiveness of the douche, however, is very lowlower than for any other method commonly in use. The reason is that the act of intercourse often discharges semen directly into the opening of the womb and that even sperm not deposited this way often reach the womb within a matter of minutes. Once in the womb, the sperm cannot be washed away; thus the douche, no matter how quickly it is used, is often too late to serve any purpose. Of 100 women who rely on the douche alone for a year, it is estimated that thirty-one are likely to get pregnant. The type of solution used for a douche makes little difference. Water alone is about as good as anything else-and water at body temperature, which is the most comfortable, is as effective as hot or cold water. None of the special chemicals sold for this purpose is any better than two tablespoonfuls of vinegar, lemon juice, or soap chips dissolved in a quart of water. About the best that can be said for the douche is that it is better than nothing at all. But it is not much better than nothing at all-and its continued wide.spread use is strictly due to misinformation. When a diaphragm is used, as was mentioned earlier, or when a chemical barrier like aerosol foam is injected before intercourse, the douche does no good at all and. in fact increases the chances of pregnancy if used before six hours have passed.
Intrauterine devices One of the newest methods of birth control-a method that is perhaps destined to play the greatest role of all in controlling the population explosion-comes in various forms that in different parts of the world are called "the ring," "the loop," "the bow" or "the spiral." These are all
vanetles of a simple kind of equipment technicaIIy known as intrauterine devices (or "IUDs")-that is, devices inserted into the uterus, or womb, to help prevent conception. The devices come in many sizes and shapes and are made of many different kinds of materials. Individual devices usually take their names from their shapes; the ring, for example, is a circle of stainless steel, and the loop is a piece of plastic with loops resembling one letter S on top of another. These devices, although varying slightly in size, measure about an inch in diameter. Introducing such an object into the womb seems at first glance a difficult proposition, but this is not true. Thanks to the springlike qualities of modern plastics, any of the plastic devices can be compressed and, pushed through a small tube about the size of a soda straw inserted in the opening of the womb. Once inside, they spring back into their original shape. The process is simple and ordinarily painless; only with the metal ring, more difficult to insert, must an anaesthetic be used. Both the intrauterine device and the insertion tube must, of course, be sterilized, but the placement can be made without danger by any physician or other trained medical technician. One reason intrauterine devices are considered such promising weapons against the population explosion is their low costthey can be manufactured for as little as two cents apiece. Another advantage is the short time it takes to insert them. At some crowded clinics in India, the devices are inserted in little more than the amount of time it takes for a woman to get on and off the examining table. Insertion of an intrauterine device is easier for women who have already had a baby and is easiest of all just after menstruation, when the opening of the womb is somewhat enlarged. It is possible, however, for all women at all times. Once in place, the device can remain for many years, for it appears to have no harmful effects whatever. Or it can be removed at any time that the woman decides she wants to have a baby. In the majority of cases where this has been done, the woman has usually become pregnant within six months to a year, indicating that use of the device
will not interfere at all with future plans for children. Immediately after one of these devices is introduced into the womb, there are usually some mildly unpleasant side effectsa certain amount of bleeding, sometimes accompanied by backache or by pains similar to menstrual cramps. Ordinarily these soon disappear. Some women, however, cannot tolerate the devices; the bleeding and pain continue and the device has to be removed. Sometimes it is expelled automatically through muscle contractions (this is particularly likely to happen at the time¡ of menstruation). It can be reinserted but may again be expelled. Any difficulty in the use of an intrauterine device tends to show up within the first two years; a woman who has been able to retain the device that long should be able to continue with it as she likes. A recent study of more than 24,000 American women indicated that two out of three can use an intrauterine device satisfactorily; the third cannot.
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'\ ntrauterine devices like the loop seem destined to play the greatest role of all in controlling the population explosion.
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Although these devices look like nothing ever seen in the world until recently and, in fact, are usually made of materials which did not exist until a few years ago, they too are only a new version of an ancient idea. The principle has been known for centuries to the inhabitants of North Africa, who have placed pebbles in the wombs of their female camels to prevent pregnancy during long trips across the desert. How and why the pebbles worked was never known, and it is not known to this day how the modern intrauterine devices work for human beings. One current theory is that they set up muscular movements that force the egg
into the womb before it is ready to be implanted there. Or, the devices may somehow prevent the walls of the womb from accepting the egg. Thus, even if fertilization has occurred, the egg cannot develop in the womb. The effectiveness of the devices varies by shape and size but never reaches 100 per cent; the best available statistics show that, of women fitted with a spiral, 1.8 in 100 have become pregnant by the end of a year; with a loop, about 2.4 in 100; with a bow, 5.7 in 100; and, with a ring, 7.5 in 100. Some of the pregnancies occurred because the device had been expelled without the woman's knowledge. But others occurred while the device was still in place in the womb. When this happens, the intrauterine device does not interfere with the normal development of the unborn child or with the delivery; it is usually expelled, harmlessly, at the time of birth. To reduce the number of accidental pregnancies due to undetected loss of the devices, some are made with attached "tails" that are left extending through the opening of the womb and into the vagina. A woman wearing this type of device can 'tell, by feeling with a finger, whether it is still in place. If the device is made of metal, an X-ray will show whether it is in place, and many of the plastic devices, which cannot themselves be seen by X-ray, are made with a core of metallic salts. Attempts are constantly being made to learn what kinds of devices combine the least danger of side effects and accidental loss with the greatest amount of protection when they do stay in place. At present, the loop is widely regarded as the most successful of all the intrauterine devices on the bases of pregnancy rate, frequency of expulsion and number of medically necessary removals. The great advantage of intrauterine devices, for both individuals and nations that have no religious or moral objections to mechanical methods of birth control, is that they are easy and cheap to acquireand that once put in place they require no further attention (although a yearly checkup is advisable). Every other birth control method demands constant motivation and sustained attention; the diaphragm or condom must be used every continued
The pill "THE PILL," a daily dose of medicine, which has achieved an almost perfect record of preventing pregnancy, is actually composed of some of the very chemicals that ordinarily make a woman able to conceive a baby. These chemicals, or female hormones, direct a complicated, interconnected, delicately timed series of events that occur during the menstrual cycle, preparing the woman's body for pregnancy. A description of the menstrual cycle,one of nature's most marvellous processes, is a necessary packground for discussion of the pill ..
The cycle, which begins on the first day of menstruation, is set into motion by the pituitary gland. This is a gland about the size of an acorn, which is imbedded in the bones of the skull just below the brain; stimulated by impulses from the brain, it produces a number of different chemicals called hormones that are fed directly into the bloodstream, are carried through the body, and activate many kinds of physical processes. The hormone that the pituitary secretes on the first day of menstruation has the effect of stimulating the ovaries, the glands that produce the female egg.
Each ovary contains a large number ¡of tiny pouches, or sacs, technic¡ally known as follicles, each of which holds a single unripened egg. All the eggs, as many as 400,000 of them, are present at birth; beginning at puberty about 400 of them are destined to ripen, one each month as long as the menstrual cycle continues. Stimulated by the pituitary's hormone, one of the follicles begins to- swell. The egg inside it starts to ripen. Eventually the enlarged, fluid-filled follicle stands out from the surface of the ovary like a tiny blister. As the follicle grows, it produces a continued
Bir1lh I con ro hormone of its own called estrogen, one of the typically "female" hormones that come from the ovaries. Estrogen has a multiple effect. It acts on a brain centre that controls the pituitary gland, causing that gland to decrease the production of the egg-stimulating hormone; by cutting down the flow of this hormone, it helps prevent development of any other eggs. Estrogen also acts on the wall of the womb; it causes the wall to thicken, and it stimulates the growth of small glands inside the womb's membranes, the first steps in preparing the womb fo receive a fertilized egg. Its third effect is to stimulate the milk-producing glands of the breasts, the first step in assuring a supply of milk if pregnancy occurs. Around the fourteenth day of the normal twenty-eight-day cycle, a whole series of events takes place, almost simultaneously. The buildup of estrogen in the bloodstream, coming from the growing egg follicle, reaches its peak. The increased amounts of estrogen cause changes in the mucus around the cervix, or mouth of the womb ; the thick substance that ordinarily blocks the opening of the womb thins out. Thus a passageway is prepared for the sperm that are expected to seek out the egg. At the same time, the estrogen stimulates the pituitary gland to secrete still another hormone-a chemical that triggers release of the ripe egg. The follicle breaks; the egg bursts loose and starts to travel down a duct, called the fallopian tube, which takes it to the womb. Once the egg follicle has broken, its function changes; it is actually,transformed into a small gland that continues to produce estrogen and begins to manufacture the other typically female hormone, which is called progesterone. The progesterone goes to work to complete preparation of the wall of the womb; it causes the glands in the wall to stop growing and instead to start secreting the various fluids that are essential for receiving the egg. The wall continues to grow thicker and becomes gorged with a plentiful supply of blood and the other fluids required during the early stages of pregnancy. Like estrogen, progesterone also seems to prevent the release of any more eggs. Thus on and just after the fourteenth day of the cycle everything is ready for
conception. The ripe egg is travelling down The search for something like the pill the fallopian tube; the mouth of the womb has been going on ever since the women is' open to the passage of sperm; the wall of ancient Africa swallowed the froth from of the womb is rapidly growing to peak a camel's mouth and the women of Greece condition to be implanted with a fertilized and Rome drank teas made from roots and egg. tree bark. But all the old methods were If pregnancy occurs, the menstrual cycle merely shots in the dark, prescribed withis interrupted and both estrogen and pro- out any real knowledge of chemistry or of gesterone continue to be produced-prethe processes that go on inside the female venting the release of any more ripe eggs body. The pill had to await the discovery until after the baby is born. (The pill con- of the hormones that regulate human tains both of these hormones, as will be fertility. It is the product of the genius of described.) If fertilization does not take the physiologists who have investigated the place on or after the fourteenth day, the mysteries of the human body and the¡ cycle moves on to completion. About the subtle workings of the glands concerned twenty-fourth day, the follicle that has with reproduction. It is also a triumph of released the egg exhausts its functions and the biological chemists, who have managed reaches the end of its life. As it starts to to synthesize new substances formed nodisintegrate, the flow of progesterone and where in nature, which duplicate the action estrogen stops. The thickened wall of the of the complicated chemicals produced by womb, no longer stimulated by these human glands. hormones, starts to break down. After For millions of women around the twenty-eight days, the lining of the wall is world, the pill has now become a routine sloughed off in the form of the menstrual part of life; they take it, each morning or flow. The pituitary gland, which is no evening, as automatically as they put on longer inhibited by the ovary's hormones, their clothes or brush their teeth. The pill is once more secretes increasing amounts of sold legally, if only for treatment of menthe chemical that stimulates the growth of strual disorders, in almost, every major an egg follicle. With this the menstrual nation. In most countries it requires a physician's prescription. cycle starts all over again. In early 1967 the pill was being taken by about five million women in the United States, where it was discovered and first produced, and by 3.5 million women in hough now used by other countries, where its use and its fame millions of women are newer. Millions of new users are being added each year. Most physicians who everywhere, the prescribe the pill are careful to watch for pill had to await the any adverse reactions to it. But for most women who use it, the pill is already taken discovery of the hormones for granted, as if it were an old established that regulate fertility. remedy like aspirin. Actually it is one of the newest scientific discoveries .to affect "~iiiiiiiiiiiii:iiiiiiiiiiiii:iiiiiiiiiiiii:iiiiiiiiiiiii:iiiiiiiiiiiiiii~/{ the lives of ordinary people-much newer than television. It was not discovered until A woman who takes the pill is adding a 1955 and not licensed for use until 1960. small daily dose of estrogen and proges- Its own popularity explosion, from only a terone in synthetic form to her body's own few hundred experimental users in 1956 to production of hormones. The result is a 8.5 million today, is an indication of its balance of hormones that normally would effectiveness and its convenience, as well as occur only after pregnancy had begun. The of the modern demand for methods of effect of this added estrogen and proges- limiting the size of the family. The pill has a dramatic history. It would terone is to prevent conception, just as it would during the course of a normal preg- not exist today were it not for the work of an eccentric, lone-wolf chemist who, nancy.
against all advice from people who claimed to know better, walked offhis job as professor at an American college and went looking for a will-o'-the-wisp in the uncharted Mexican hill country. It would not exist except for a wild and useless Mexican vine called the cabeza de negro-"head of black." The final discovery resulted from a chance meeting between two American scientists-one of whom had been foolish enough to, start a search for a new method of birth control with a grant of $2,100, hardly enough to buy the first animals needed for his experiments, and the other of whom, ironically, was trying to help women who wanted to get pregnant but were unsuccessful. The story begins with the eccentric chemist, Russell Marke.r, and his stubborn search for new sources of the substance called progesterone-a hormone that, as has been explained, plays such an important role in the female fertility cycle. When Professor Marker began his work, about thirty years ago, progesterone was one of the rarest and most expensive drugs in the world, selling for $200 a gram, $200,000 a kilogram. It was in great demand for the treatment of women whom physicians call "habitual aborters"-women who, because their own bodies do not manufacture enough progesterone, invariably lose their babies through miscarriage in the early months of pregnancy. It had been found that injections of progesterone obtained from animals could relieve this condition; even a woman who had always suffered miscarriages in the past could, when treated with progesterone, give normal birth. But the cost of treatment was prohibitive-for it took tons of the brains and spinal cords of animals, or of the grease from sheep's wool, plus much expensive processing, to produce just a tiny amount of progesterone. Marker decided to look elsewhere, in the vegetable rather than the animal world. In the roots of plants of the lily family, he knew, there was a substance somewhat like the important chemical in animal brains and sheep grease. The resemblance was basic but there were also sharp differences -such imposing differences that no other chemist had ever attempted to turn the plant substance into progesterone. Walking
in where angels feared to tread, Professor Marker achieved the impossible. By complex and brilliant methods, isolating and breaking apart a single specific plant molecule, he extracted progesterone from p.lant life.
)i ut for an eccentric chemist's relentless search for the substance called progesterone~ the pill would not exist today.
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But plants of the lily family are scarcegrowing mainly in extremely hot climates. Where was he to find enough raw materials for his process? All during his university's summer vacation of 1940, and again the next year, Marker tramped alone through the wilds of the southwest United States and Mexico, searching for likely plants. He persuaded botanists in the United States and Mexico to make collections for him. Eventually his university laboratories were bulging with more than 400 different kinds of obscure plants and their roots, weighing more than 100,000 pounds. Through this imposing storehouse, Marker and his assistants began a systematic search, carefully analyzing each plant for the substance he was seeking. The job was monotonous and frustrating. About half the plants were totally useless; they did not contain even a trace of the substance. Others contained only the smallest of amounts. But at last the search succeeded. In the lumpy, black roots of the cabeza de negro-a vine with heartshaped leaves and small, colourful flowers-Marker found the magic substance in quantity. If there were enough cabeza de negro in the Mexican hill country where his specimen vines came from, the world's shortage of progesterone would be ended. Despite the high value of progesterone, despite the proof that he could manufacture it, Marker tried in vain to get financial
backing for his project. To more sensible men, the whole idea still seemed preposterous. The cabeza de negro grew in the wildest mountains of southern Mexico, in unexplored land inhabited only by American Indians and marked only by American Indian trails. How could anybody find the plants? If by chance they could be found, who would dig up the roots? If the roots could be dug, how would they be transported out of the mountains? Without building a plant costing hundreds of thousands of dollars, how would they be processed? The problems were endless. To all Marker's pleas for backing, the answer was no. He did what only a man who was both self-sufficient and erratic could do. Right in the middle of a university term, he walked off his job and travelled alone to Mexico City. There as his laboratory, he rented a small cottage on a back street, with a run-down shed in the yard where pottery had once been made. With this as his humble base, he set off alone into the mountains, a small bald man, smoking a cigar; unable to speak very much Spanish or any of the American Indian languages; equipped with nothing more than a machete, a spade, a pack mule and some burlap sacks. With the roots he managed to bring out of the mountains on the pack mule, Marker went to work in the pottery shed. Except for the American Indians, who continued sending him roots, he had no help; he was himself the chief chemist, plant manager, foreman, working staff and janitor. His ,hours were from the time he woke up until the time he was exhausted and fell asleep. But by the end of the summer, his job was done. He walked into the office of a small drug firm in Mexico City with two jars wrapped in newspaper. The jars were filled to the top with a white powder-more progesterone than had ever before been seen in one batch anywhere on the face of the earth. At the prevailing price, the two jars were worth $160,000. Marker was rich -and the progesterone shortage was over. Thanks to Marker, the manufacture of progesterone and other hormones is now a major industry in Mexico, seIling about $60 million a year worth of products to other nations. Where Marker is, is a myscontinued
Birth
control tery. For severaJ years he was a partner in the once-small drug firm to which. he took the two jars. Then, even though the firm was on its way to becoming an industrial giant, he walked out one day just ashe had walked out of his teaching job. For a time he had his own firm but again he walked away-this time leaving no trail. His old associates have not seen him in years. When they write to him at the hotel where he lived during his prosperous years in Mexico City the letters are returned unclaimed, with a notation that he left no forwarding address. The unpredictable genius who gave the world the makings of the pill has disappeared.
he pill wa~ the brainchild of Dr. Gregory Pincus who produced a drug that successfully checked birth in rabbits and rats.
Professor Marker and the cabeza de negro made the pill possible. The idea for \
the pill was the brainchild of Dr. Gregory Pincus-another American scientist-who got the inspiration within twelve hours after he first became interested in the birth control movement. Dr. Pincus, a biologist, helped run a research institute that had been exploring the relation of hormones to cancer, mental illness and sexual disorders. He had never really thought of studying birth control until one winter day in 1950 when he was invited to spend the evening with an old friend, a physician prominent in the birth control movement, in New York City. Also present was Margaret Sanger, who had virtually founded the birth control movement in the United States. Dr. Pincus' hosts were upset. They had won many victories for birth control; they had reached the point where they could legally give women advice on birth control almost anywhere in the United States and in many
other parts of the world. Yet they felt that their crusade was a failure. The diaphragm, the method most frequently advised by theirclinics,was simply not good enough. Its record of effectiveness-about twelve pregnancies per 100 woman-years of usewas too low. For women who desperately wanted to avoid another pregnancy, for reasons of health or of poverty, it did not provide sufficient safety. They needed something better and they needed someone like Dr. Pincus to discover it. By the end of the long evening, Dr. Pincus had agreed to take their $2,100, all they could afford for expenses, and begin the search. And by the end of the next afternoon, as it happened, he already had a blueprint for the search. Alone in his automobile, on the 180-mile drive from New York City to his home in Massachusetts, he analyzed the problem with quick and incisive clarity. Mechanical barriers like the diaphragm were not good enough. What was needed was a physiological method that would go right to the core of the reproductive process. If there were no ripe egg to fertilize, for example, fertilization could not possibly take place-and right there Dr. Pincus had his idea. During pregnancy, no ripe eggs are released by the female ovaries. The reason is that the body produces large amounts of progesterone during this period; the progesterone prevents the release of any more eggs. As a result of Professor Marker's work, progesterone was available for experimentation; it had been widely used in treating habitual aborters and was known to be safe for human beings. Progesterone-unless Dr. Pincus was badly mistaken as his thoughts unfolded on that long automobile ridewas the key to the problem. One difficulty was that progesterone had always been administered by injection, with each injection requiring a visit to a physician's office. Dr. Pincus, with his associate Dr. Min-Chueh Chang, set out to see whether it was effective when taken by mouth. The two scientists fed it, in varying quantities, to female rabbits and rats in their laboratories. Although allowed to mate normally, most of the rabbits and rats did not get pregnant. Dr. Pincus' search had already resulted in a substantial success. Very quickly he and Dr. Chang
had created a "pill" that would work for animals. But how to find out whether¡ it would also work for human beings? It is one thing to test an untried medical theory on animals, another to test it on people. Even if a group of women should volunteer to take progesterone, in full knowledge of the facts, there was still serious question whether Dr. Pincus had any right to tamper with the female reproductive cycle on the basis of what little he then knew. Scientists and physicians feel justified in trying unproven theories of medication and surgery on patients who are clearly doomed to death unless a new kind of treatment proves successful--,.but in this case the "medicine" was not intended as a cure. Sometimes new methods are tried on longterm prisoners who, knowing they must spend the rest of their lives behind bars anyway, volunteer for medical experiments -but in this case prison experimentation was impossible. The next necessary step in research on the pill seemed an almost insuperable obstacle. It was at this point, fortunately, that Dr. Pincus had his chance meeting with Dr. John Rock, a professor of gynaecology at Harvard University. Dr. Rock, it turned out, had also been experimenting with progesterone, in quite a different way. Dr. Rock was director of a so-called "fertility clinic" for women who were unable to have children. Among the patients who came for help, he had found, were many whose inability to become pregnant had no obvious cause. Tests showed that their reproductive cycles were normal; they produced a ripe egg each month. There was nothing about the physical or chemical condition of the vagina or womb to prevent sperm from reaching the egg. Yet, for some obscure and mysterious reason, they never became pregnant. The only clue Dr. Rock had been able to find was that many of them seemed in one respect-the size of the womb or of the fallopian tubes-to be rather small and underdeveloped. During pregnancy, Dr. Rock knew, the tubes and the womb always become enlarged; this is due to the extra amounts of progesterone and other female hormones produced at that time. Perhaps, he decided, large doses of progesterone and estrogen I
Bir1lh I can ro unpleasant side effects sometimes produced by progestin. Despite the addition of estrogen, some women still experience side effects such as nausea, headache, swelling of the breasts and breakthrough bleeding. These symptoms usually disappear after the first or second month, however, or may be corrected by changing the daily dosage or switching to a different brand of pill with a slightly different formula. The chief effect of the progestin in the 20-day pill is to prevent the release of a ripe egg, which in itself is enough to make conception impossible. The pill seems to have two other effects, however, that add to its effectiveness. Apparently it counteracts the influence of natural hormones that, at the time the egg is normally released, thin the mucus deposits at the mouth of the womb and make it easier for sperm to reach the egg. It also seems to disrupt the normal sequence of hormones that make the lining of the womb receptive to a fertilized egg. Thus, even if an egg should be released, fertilization is unlikely; and, even if fertilization should take place, implantation and growth of the egg would hardly be possible. Also being made and widely used today is another type of pill, the "sequential pill." This is in fact two different pills, one taken on Days 5 through 20 of the menstrual cycle, the other on Days 21 through 25twenty-one pills in all. (For some brands of sequential pills, the days are slightly different.) These pills are usually packaged in a way that makes it very simple for a woman to take them in the right order in the course of each month. The pills taken over the first fifteen days contain estrogen, the pills taken for the last five days contain both estrogen and progestin. Like the 20-day or "combined" pill, the sequential pill also acts to prevent the release of a ripe egg. But the sequential pill has several advantages: it seems a closer imitation of nature since it reflects the ordinary changes in a woman's hormone balance over each monthly cycle; women tend to put on less weight while taking the sequential pill and their periods are usually fuller and more like a normal menstrual period. However, the sequential pill also has one disadvantage: it does not seem to be quite as effective in preventing pregnancy as the original 20-day pill, although the difference is very
slight. (Of 100 women using the sequential pill for a year, only about one is expected to become pregnant.) The pill, of whatever type, certainly tinkers with the body's chemical processes; it upsets, though only by small amounts, the natural hormone cycle. For this reason, many physicians wonder about its longterm effects; they are concerned about what would happen, for example, to a woman who took the pill over a period of two or three decades from time of early marriage until menopause. But the United States Food and Drug Administration, the only government agency that has thus far made a thorough study of the pill's effects, places no time limit on taking the pill. In fact, some of the first women to use the pill have continued taking it for more than ten years without any evidence of long-term ill effects.
Ji or any woman who takes the pill 20 days a month, it is one of the most reliable methods of birth control now known.
Several mistaken notions about the pill's effects have made some women afraid to take it and kept some doctors from prescribing it. For one, there have been occasional reports that the pill might cause cancer. At present there is no convincing evidence for such a conclusion. Indeed, there is some evidence that use of the pill reduces the danger of breast cancer and, in certain cases, cancer of the womb. Another misconception about the pill is that it might limit the woman's ability to bear children after she stops taking it. In fact, it has been found that women who have taken the pill for as long as five years, then have stopped because they wanted a child, have become pregnant in about average numbers-more quickly, if anything, than women who had used other
methods of birth control. Equally unfounded is the belief of some women that the pill, taken over many years, might postpone menopause and result in a pregnancy in their later years. In fact, women taking the pill reach menopause at the same time of life as they wouid using any other birth control method, or using none at all. Women who take the pill do run some risk of side effects. A small number have developed blood clots or other adverse reactions. These risks are far less than those of an ordinary pregnancy, but any woman taking the pill should report any unusual complaints' to her physician. About the only patients for whom the pill is considered unsuitable are those with diseases of the liver, with cancer of the breasts or reproductive organs, or with abnormal blood clotting or varicose veins. There are other diseases that may sometimes be aggravated by use of the pill; among them are asthma, eczema, migraine headaches and epilepsy. The pill should be taken only after a thorough physical check up and this should be followed by physical examinations every year as long as the pill is used. New studies of the side effects of the pill, particularly when used over long periods, are of course being made all the time. When used under a physician's supervision, the pill is by all odds the best of today's methods for the individual couple seeking to avoid pregnancy. For any woman who will remember to take it for twenty days each month-'-or for twentyone days in the case of the sequential pillit is the most effective of all methods now known, except sterilization. Beyond the swallowing of the pill each day, it requires no other equipment or bother; t!lerefore it does not interfere with the spontaneity of sexual relations. As a large-scale means of controlling the population explosion, the pill has some serious disadvantages. One of them is its expense. In 1967, a month's supply of pills usually cost between $1.75 and $2.50. To a middle-class family in an industrial nation, this sum is hardly prohibitive-but it does price the pill out of reach of millions of families in the underdeveloped parts of END the world.
Before and after. Good planning and close co-operation between the local and Federal governments transformed an ugly-looking section of Hartford, Connecticut, above, into a tastefullydesigned, multi-block plaza, below. Mammoth platform with architectural flair rises above the traffic. Pedestrians stroll safely among the commercial buildings surrounded by gardens.
TODAY,SEVEN out of ten Americans live in cities and their future will be determined in the city. But, critics ask, does the city have a future? "Sick cities," "troubled cities," "urban decay," "battlefield, U.S.A." These are some of the epithets that are being used with increasing frequency to describe conditions in cities. The urban blight has many faces: slums, snarled traffic, air pollution, overcrowding. Urban crisis manifests itselfin poverty and sickness, despair and decay, crime and violence, racism and rebellion. Another important ingredient is joblessness. Some 200 years ago Benjamin Franklin wrote in his autobiography: "When men are employed, they are best contented; for on the days they work they are good-natured and cheerful. ... But on idle days, they are mutinous and quarrelsome." The truth of this statement surfaced in the summer _of.1965 when the Watts area of Los Angeles erupted with violence and rioting that resulted in thirty-four deaths and destroyed property worth forty million dollars. The next year, riots struck Cleveland, Ohio, and Newark, New Jersey. "The greatest internal crisis since the Civil War," Henry Ford II told a Washington meeting of the newly-formed Urban Coalition, an assembly of the nation's leaders in business, labour, municipal administration, civil rights and the clergy. Last June, Senator Jacob K. Javits of New York told a conference convened by the American Management Association: "I do not believe that it is necessary any longer to ask whether business should or could undertake urban action programmes. That bridge has been crossed." The question, he said, is no longer whether but how. One city that has forcefully waged this war on urban blight and is now a recognized leader is Connecticut's port city of New Haven (population: 142,000) on the east coast. Until some fifteen years ago, its reputation rested solely on its being the home of Yale University. Critics often described it as "a big slum around a big school." That was in 1953. By 1967, however, New Haven had become America's largest urban success story-"a model city." Dr. Robert C. Weaver, first Secretary of Housing and Urban Development, once said that New Haven came closest to "our dream of a slumless city." The man responsible for the transformation is Richard C. Lee who became the Mayor of New Haven in 1953 and is cur-
At the Weavers' Service Centre in Banaras, a skilled craftsman. left, works at the modern tapestry shown below.
Le/t, goathair blanket (rom Barmer was among interesting textiles that Goodman collected during his travels. (contil/ued)
"When I hold a beautiful Jamawar or Patola in my hands, I find it quite overwhelming," says Goodman, "It is like looking at the Pyramids and knowing they are the product of human hands."
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tures, demonstrations and slide shows before weavers and weaving centres, design institutions and university art departments. He has a degree in weaving from the Cranbrook Academy of Art near Detroit, Michigan; one in design from California State College; one in ceramics from Los Angeles City College. He has also had training in sculpture, drawing and painting. At present, he teaches fabric construction and decoration at the University of Georgia's Art Department, in addition to carrying on his own research in textile techniques. "I first began working with fabrics in 1963," Goodman recalls, "starting with the basic techniques-tapestry, rug-making and simple fabric weaves. After a few years of loom fabric construction I began exploration of hand, off-the-Ioom processes like knitting, knotting and crocheting. With my background in several of the arts and crafts, J wanted to be able to 'paint' and 'sculpt' with yarns. I found that crocheting allowed me to do this, that I could use it as a means ofpersonal aesthetic expression. "In fabric decoration I studied many techniques, among them stencil-priming, silk-screening, batik and tie-and-dye, and I found the greatest creative freedom in working directly with dyes, pigments and resists. Interesting results can be achieved by combining different techniques, as I once discovered after a happy accident in my studio." Relating the incident, Goodman says, "One day after a session of working with dyes, I found that my hands and arms were brilliantly coloured. The quickest way to clean them is to immerse them in a weak bleaching solution. As I did this, I noticed that the colours on my hands were changing. Colours are made up of primary colours-red, yellow and blue. Purple is a combination of red and blue. If the proper discharging agents are used, you can take out specific colours-either red or blue-which make up the colour purple. By combining this discharge technique with fabric tying, I found a new type of surface decoration." Designer Goodman produces work that is not necessarily worn
as a garment or used to cover a chair. Many of his pieces stand on their own as decorative objects-works of art. In the U.S. he has participated in several exhibitions of his creative efforts. But just before his departure from Delhi last November, Goodman held a different kind of exhibition: a display of old Indian fabrics -Jamawar shawls, Kutch embroidery, mirror work, tie-and-dye, and block prints-which he collected during his Indian travels. He acquired many of these pieces while roaming streets and alleyways in the big cities, tracking down old families in villages, following up tips from art dealers. Wherever he went he moved around with rtmarkable e~e. He had no trouble with accommodation ("I lived in places which cost Rs. 2 or Rs. 3 a day, or with Indian families"); with language (Goodman's Third Law is: "If there's anyone within a radius of fifty miles who speaks English, he will appear"); or with clothes ("Most of the time I wore kurta-pyjama"). With Indian clothes, in fact, Goodman apparently enjoys complete affinity; he can wear several kinds of lungis and dhotis, can tie two types of Sikh turbans and three types of Rajasthani turbans. In general Goodman reports that he preferred travelling in the rural areas "where the people have such a natural sense of values." After visiting a remote tribal area, he commented, "They are an exquisite people .... They have nothing, less than nothing, but they will share more than half of that with you." Goodman tells of his visit to Madhubani, the village in north Bihar where for hundreds of years women have done paintings on the walls of their huts. (A few years ago these paintings were most successfully adapted as textile prints and today Madhubani scarves are a fast-selling export item.) Here Goodman spent two days looking at thousands of paintings, and asking the artists to explain the various figures and symbols. Regretfully he notes that civilization is creeping up even on Madhubani, because some of the contemporary pictures fall way short of the traditional. He still feels, however, that "their design sense is delightfully childlike, highly imaginative and tremendously spontaneous." There is a spontaneous quality about Indian life in general, Goodman observes. "At railway stations or bus depots," he says, "I would invariably meet someone who would ask me to dinner, or to be his house guest, or offer to assist me in some other way." A folk dancer himself, he has been drawn into impromptu performances with the Republic Day dancers in Delhi, with Bhangra dancers at a Diwali mela, and in a Punjabi wedding procession in Patna. "Things like this have happened to me all over India," says Goodman. While such factors playa part in Goodman's desire to return to India, the real drawing force is a textile tradition extolled in history and legend and unsurpassed in variety. And because Ronald Goodman is aware of all the facets in this tradition, he says: "When I hold a beautiful Jamawar or Patola in my hands, I find it quite overwhelming .... It is like looking at the Pyramids and knowing that they are the product of human hands." Right, fabric designed by Goodman is example of fold-and-dye technique, in which material is bent along precise lines, then dipped in a dye-bath. Left, Goodman demonstrates how to join broken threads without knotting.