Prescription for Sex Ignored
It can't be easy being the Surgeon General. Well, at least not when you choose to talk about sex. After months of what appears to contentious infighting within and with the Bush Administration Dr. David Satcher has finally released – or been allowed to release – his long-awaited report on sexual attitudes and education. The report was to be distributed in April but never materialized. Satcher's office dodged questions and spokespersons for the Bush administration were equally mum. But, as James Wagoner, president of Advocates for Youth, a group that promotes extensive sex education in schools, noted: "It doesn't take a lot of political math to figure out what happened here." After a flurry of news reports – all of them indicating that Satcher's study was being suppressed by the White House – the report has finally been made public, and it is easy to see why conservatives were eager to have it languish.
Begun in 1998 the Surgeon General's report had a radical reputation from its inception. As planned by Satcher, the report would, by giving an accurate overview of the tolls of sexually transmitted diseases on young people as well as the extant of unwanted pregnancy, make a strong argument for comprehensive sex education in all grades in public schools as well as promote greater access to condoms and contraceptives. Last April, after returning from an AIDS conference in Durban South Africa, Satcher gave a speech in which he expressed his hope that in five years "all schools would have comprehensive sex education, and all people would be empowered, regardless of orientation, to be sexually responsible." Supporters of the forthcoming report were hopeful that it would be a potent intervention in usually right-leaning, ongoing battles over sexuality and public policy.
Finally released on June 28th, the report, indeed, is a much needed rejoinder to the increasingly rightward slant of government attitudes and policies about sexuality. Defining sexual health as including "the ability to understand and weigh the risks, responsibilities, outcomes and impacts of sexual actions and to practice abstinence when appropriate" the report is a strong counter to the federally funded abstinence-only programs that now make up most high school curriculum. But the report went even further in stating that sexual health "also includes freedom from sexual abuse and discrimination and the ability of individuals to integrate their sexuality into their lives, derive pleasure from it and reproduce if they choose." It also emphasizes the need to respect diversity in sexual orientation and states that there is no proof that sexual orientation can be changed. In fact, it contends, there is proof that physical and emotional abuse of gay teenagers can result in depression and suicide. In what may be its boldest move, it defines abstinence as celibacy "outside of a mutually monogamous relationship," not necessarily marriage.
While health and education professional have praised Satcher's report, conservatives have, universally, condemned it. Peter Brandt of Focus on the Family, a Protestant church-based lobby group, called it ideology disguised as science from the beginning to end" and claimed it called into question Satcher's "ability to remain chief medical officer of the United States." The Bush White House has not disowned the report it has made clear that it had nothing to do with commissioning or releasing it (Satcher works under the Department of Health and Human Services) and has stated that the President's "overall approach on these matters focuses on abstinence and abstinence education." If the Surgeon General's report is an embarrassment, they are choosing to ignore, not attack, it.
The release of the Surgeon General report is something to celebrate. But the larger question remains: will it have any effect on this administration's policies? It is hard to see that it will. The federal government, with matching state funds, has budgeted nearly $500 million for abstinence programs over the next five years. Even though Satcher's report stated that there was absolutely no evidence that these programs prevent the spread of AIDS, unwanted pregnancies, or even delayed sexual activity of unmarried teenagers they are, at the moment, a securely fixed item of Republican social policy. As for the other issues raised by the report? For more than two decades Republicans have consistently battled liberal sex education programs, AIDS and safe-sex education, access to contraceptives or safe-sex materials for teens in schools, and recently have even attacked educational programs that address the verbal and physical abuse of gay teens in high schools. This is a culture war that is here to stay.
Given this history it is astonishing that Dr. Satcher's report was even released. But none of this should be a surprise. Satcher himself had a difficult time attaining the post of Surgeon General when he was nominated in fall of 1997. Senate opposition led by John Ashcroft attacked Satcher for his "soft" stand on abortion, his limited support of needle exchange, and his endorsement of a study on AIDS in the third world. His nomination itself was in the shadow of another recent battle – Dr. Henry Foster, Clinton's original choice for the post had, months earlier, failed to win confirmation when it became known that he had performed abortions during his medical career. Before that, the post of Surgeon General had been unoccupied for almost three years after Dr. Joycelyn Elders was forced to resign because of her support of sex education and her implicit endorsement of masturbation as "safe sex." Some political commentators at the time of Satcher's nomination suggested that his moderately easy confirmation (the vote to end the debate was 75-23) was helped by the fact that many Senators were leery about denying the Surgeon General post yet again to an African-American.
The sad and chilling reality is that Satcher's report will probably have very little effect. Although he remains Surgeon General until 2002, Satcher's power is extremely limited. Under Clinton he also held the post of Assistant Secretary of Health and Human Services, with a staff of 200, but was replaced by a Bush appointment, and as Surgeon General he has only a staff of four. But staffing is not the problem. Although national surveys show that three out of four parents support sex education in school, including access to contraceptives and condoms, conservative pressure is far too great for that to be implemented in any comprehensive way. While educational curricula that support sexual orientation diversity or address homophobic abuse are being designed on a school by school basis, there is no sustained support for this on a state or federal level. As is so often the case about sex in America both public discourse and public policy are lagging far far behind people's needs and desires.