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What a surgeon general’s firing had to do with condoms.

What a surgeon general’s firing had to do with condoms.

Joycelyn Elders and the fight for sex education.

A lot has changed in the last few decades in terms of sex education — arguably not enough, but a lot. In the 1990s, most sex education was abstinence-only — that is, telling young people to only have sex after marriage. This delivers very little actual education, involves ignoring enormous amounts of data about how much extramarital sex has always been had and almost universally involves hypocrisy on the part of the educator.

Someone who was very aware of the flaws of this model was Joycelyn Elders, named as Surgeon General by then-President Bill Clinton in January 1993 — the second woman and the first African-American person to hold the position. 

Elders felt that sex education was being taught in an outdated manner that wasn’t particularly helpful for modern teens, that the young people of America were being short-changed in terms of education due to a confused moral code. “Everybody in the world is opposed to sex outside of marriage, and yet everybody does it. I'm saying, ‘Get real,’” she said. “Our kids already know we're not real. All we have to do is look at the numbers of young people getting pregnant, getting AIDS, getting sexually transmitted diseases. . . . I do think the country is changing. People realize that we all support the moral view, but we know that an awful lot of our children are not being abstinent. [...] Since we can't legislate morals, we have to teach them how to take care of themselves.”

She was dubbed ‘the Condom Queen’ by conservative organizations, an intended insult of a title that she was all too happy to adopt, stating that if it would persuade young people to use condoms more she’d happily wear a crown made of them.

Speaking in 1994 at a UK conference on AIDS, Elders was asked how she felt about the possibility of masturbation being more openly discussed and promoted as a way of keeping young people from engaging in riskier sexual activities. Masturbation is, of course, the safest form of sex there is. Elders replied “I think that it is something that’s part of human sexuality and it’s part of something that perhaps should be taught. But we’ve not even taught our children the very basics. And I feel that we have tried ignorance for a very long time and it’s time we try education.”

Due to a combination of linguistic ambiguity and deliberate courting of controversy by the press, Elders’ comments were widely misinterpreted. She was advocating for masturbation to be something that was discussed, but this was reported in the press into “masturbation being taught in schools”, which in turn was willfully and disingenuously misinterpreted as “teachers showing children how to masturbate”, something that had at no point been suggested. It was to be a subject on the syllabus — if ‘the bubonic plague’ was announced as a subject on the history syllabus, nobody would worry that the kids were going to be exposed to actual plague bacteria, but common sense seems to often go out of the window with these things.

Elders was immediately pilloried in the press, her comments deliberately distorted and malformed, often by the same bodies that had found it difficult to believe she was a doctor for reasons that said a lot more about them than her (on her appointment, several high-up members of the American Medical Association began protesting, campaigning for a law that would require the Surgeon General to be a trained physician — Elders was in fact a physician, pediatric endocrinologist and medical professor). 

She was fired by President Clinton, a spokesman describing her comments as “not what a surgeon general should say”. Her successor in the role eschewed controversy and focused on the importance of physical activity. Over the next decade, the United States became first-ranked among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In 2004, 80% of abstinence-only sex education programs were found to be based in “false, misleading or distorted” information.

Abstinence-based sex education does not work. A 2017 paper in the Journal of Adolescent Health found that comprehensive sex education programs had numerous positive effects on adolescent behaviors in terms of safe and responsible sex, including more condom use, less frequent unprotected sex and lower rates of STIs and pregnancy than abstinence-only programs. 

However, from 2002-2014, the amount of schools requiring students to learn about human sexuality dropped from two-thirds to less than half. While in 1995 over 80% of students were formally taught about birth control, in 2011 that figure was below 60%. 

One of that paper’s coauthors, Dr Laura Lindberg, said that abstinence-only sex education "violates medical ethics and harms young people,” pointing out: "we tell people not to drink and drive, we don't teach them not to drive. [...] We would never withhold information about seat belts.” Elders, similarly, has since described such programs as child abuse.

She tried to tell the country, back in the 1990s: these programs don’t stop anyone having sex, they just stop them doing so responsibly.

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