Book review: Susan Jacoby reviews 'Condom Nation' by Alexandra Lord
The U.S. Government's Sex Education Campaign From World War I to the Internet
By Alexandra M. Lord
Johns Hopkins Univ. 224 pp. $40
The only false note in this lively historical account of the U.S. Public Health Service's earnest but ineffectual sex education efforts is its title, "Condom Nation," which must have been intended ironically in a country that has one of the highest teen pregnancy rates in the developed world. Although U.S. teenagers are no more sexually active than Europeans, American teens have a much higher rate of sexually transmitted diseases and abortion than western Europeans, and -- could there possibly be a connection? -- a lower rate of contraceptive usage.
Alexandra M. Lord, a former historian for the Public Health Service, makes depressingly clear in "Condom Nation" that birth control is only one of many facts of life downgraded in or excluded altogether from government-funded sex education in schools. President Bill Clinton's first surgeon general, Joycelyn Elders, was known as the "condom queen" for emphasizing birth control until she finally lost her job for having the temerity to say that "masturbation is a part of human sexuality." Ronald Reagan's surgeon general, C. Everett Koop, was lambasted by the Christian Right in the late 1980s -- even though Koop was a devout evangelical -- when he repeatedly told young audiences that a condom was the best defense against contracting the HIV virus during sex.
As Lord observes, public sex education programs -- especially in dealing with contraceptives -- have always been hampered by the perceived conflict between effective medicine and morality as defined by the most conservative religious and cultural forces in American society. It is as though the Public Health Service were asked to fight non-sexual infectious diseases without promoting hand-washing and antiseptics.
If you have ever wondered why the nation's chief public health officer has the peculiar, quasi-military title "surgeon general," the answer lies in the origins of the health service. Today's institution is descended from the Marine Hospital Service, established by Congress in 1798 to look after the health of American seamen. The agency first proved its effectiveness in modern terms in 1906, when a typhoid epidemic swept the Washington area and researchers were able to identify tainted milk as the source.
If the victory over typhoid embodied the best of federal public health efforts in the 20th century, the infamous Tuskegee syphilis experiment, launched in the 1930s, embodied the worst. Generations of black men with syphilis went untreated for "research" purposes. The scandal was not revealed until a Congressional investigation in 1972, and -- although tight new rules for informed consent were the outcome -- the Tuskegee affair has had a lasting effect on the receptivity of African Americans to all government health programs.
Lord is particularly enlightening about the ways in which race, religion and geography have produced an inconsistent approach to sex education. In the early post-World War II era, white Southerners were strong supporters of contraceptive education -- for blacks -- because they saw such programs as "fundamental to encouraging a decrease in the African-American population." Sex education was fine -- as long as it was aimed at the inferior Other and not at "nice" white folks.
The Public Health Service's sex education efforts have always been a potpourri of relatively frank messages aimed at soldiers and more evasive communication, stressing abstinence rather than protection, to civilians. A dominant message was that "loose women" (as opposed to loose men with multiple partners) were primary vectors of venereal disease. In one wartime poster, an image of a sweet-looking brunette is accompanied by the warning: "She May Look Clean -- But . . . ." The poster added, "You Can't Beat The Axis If You Get VD."
In public schools, pressure to tread lightly around the real sexual behavior of Americans has always been stronger than in education campaigns directed at soldiers. Between 1988 and 1999, the proportion of American teachers presiding over abstinence-only classes rose from only 2 percent to 25 percent. Funding for abstinence-only programs increased under President George W. Bush, even though a federally funded 2007 study found that students enrolled in abstinence-only programs were no more likely to abstain from sex until marriage than teens in comprehensive sex education programs that provide information about condoms and other contraceptives.
In abstinence-only programs, millions of tax dollars have been spent on exemplary tales reinforcing old gender stereotypes. In one story, "Choosing The Best," a knight kills a dragon with advice from a smart princess but -- ashamed because he has relied on a woman -- marries a village maiden "after making sure she knew nothing" about dragon-slaying. The apparent moral of the story is that men prefer women who are ignorant about everything. Part of the Christian right's agenda in pushing "abstinence only" is the upholding of traditional stereotypes for male and female behavior in all areas of life. When Obama took office, 25 states had already rejected federal sex education funding to avoid teaching such nonsense.
This fact-filled history casts considerable light on the scientific rationale for the Obama administration's decision to end federal funding for "abstinence-only" programs in next year's federal budget. It also is a sobering tale of the ways in which racial and religious biases, unmoored from scientific evidence, can derail a public mission that ought to be dedicated to improving the health of all citizens. Whether the lesson has been learned, or whether unreason will return in future government-funded attempts to teach a particular version of sexual morality, remains an open question.
Susan Jacoby is the author of "The Age of American Unreason."