Richard Carmona, Joycelyn Elders and David Satcher are, respectively, the 17th, 15th and 16th surgeons general of the United States.
It is difficult to fathom today the political firestorm that erupted more than 20 years ago when one of us called for sex education for the nation’s youth, or the firestorm 14 years ago, when another of us released “The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior.” Since then, the United States has made significant strides. The birth rate among teenagers has declined more than 50 percent since 1991, and the rate of new HIV infections has finally leveled off.
Despite these gains, the United States continues to have one of the highest teen birth rates and some of the highest rates of sexually transmitted disease in the industrialized world. Every hour in this country, 70 teenagers become pregnant, 1,100 youth acquire an STD and one young person contracts HIV. The newspapers are full of accounts of sexual assaults on college campuses, and violence and harassment continue to plague many of our gay and gender-nonconforming youth.
Perhaps most distressing is that our national response continues to misunderstand the challenge. In fact, just last month Congress increased to $75 million a year funding for programs that promote sexual abstinence until marriage. The United States has spent billions of dollars on these “just say no” programs even though a federally funded evaluation shows that they have no impact on delaying sexual initiation or reducing the risk for unintended pregnancy, HIV or other STDs. Never mind that, by law, these programs must withhold lifesaving information about the health benefits of condoms and contraception.
Thirty years of public health research demonstrates that comprehensive sex education is effective. It can provide young people with the information and skills they need to reduce their risk for unplanned pregnancy and STDs. When done well, sex education can also help young people traverse puberty, understand the difference between healthy and unhealthy relationships, develop positive body image, communicate effectively, make informed decisions and navigate the health-care system. In short, quality sex education can go beyond the promotion of abstinence or even the prevention of unplanned pregnancy and disease to provide a lifelong foundation for sexual health.
Fourteen years ago, we called for a thoughtful discussion about sexuality, for the recognition that sexuality encompasses more than sexual behavior and is a fundamental part of human life. We were largely ignored.
We called for providing education about sexual health and responsible sexual behavior that is thorough, wide-ranging and begins early. It did not happen.
We called for the recognition that parents are a child’s first educators and should help guide other sex-education efforts so that they are consistent with a family’s values and beliefs. Because families differ in their level of knowledge, as well as their emotional capability to discuss sexuality issues, we also called for equal access to information for promoting sexual health and responsible sexual behavior and the recognition that sex education is a vital component of a school’s responsibility. Still we wait.
Few would disagree that parents should be the primary sexuality educators of their children. It does seem clear, however, that providing age-appropriate sex education in schools is useful and important to ensure that the youth of this nation have a basic understanding of sexuality and can be prepared to take personal responsibility for their sexual health.
Fourteen years after our call to action, we call once again for a renewed commitment to the sexual education of our youth. We call for age-appropriate, medically accurate, evidence-informed and comprehensive school-based sexual health education for young people. Ignorance is nobody’s ally, and education remains this nation’s most powerful tool.