Every country struggles with issues concerning sexual relationships and their consequences. Yet, because of the complexities of U.S. politics and its culture of sexuality and reproduction, the situation here is dramatically different. No other country has enshrined "abstinence until marriage" as official national policy to placate moralistic conservatives. As a result, the reality of people's lives is ignored and the benefits of contraception misrepresented.
The occasion for the latest attack on family planning and reproductive rights was the release of a new report on condom effectiveness by the National Institutes of Health. The report acknowledges what has long been known: Condoms will never be 100% effective in preventing the spread of every sexually transmitted disease. It did not say that condoms are ineffective; rather, the report recognizes both their benefits and limitations. Yet, the abstinence-until-marriage crowd seized upon the results as proof of their views.
Another example of America's moralistic approach to sexuality and reproduction was evident in the backlash to Surgeon General David Satcher's report in June on the nation's sexual health and the need for sex education. One pro-abstinence group called the report "an affront to the values of people of faith."
Most parents work hard to communicate their values to their children. But as the Satcher report pointed out, while they are their children's primary sex educators, many parents acknowledge that there is a role for schools to play in educating youth about sex. His report concluded that comprehensive sex education in schools--education that includes strong messages about abstinence and the use of contraception to avoid unplanned pregnancy and disease--does not increase sexual activity among youth.
There is no question that a primary role for educators should be to help younger teens abstain from sexual activity. Yet virtually all people will become sexually active at some point in their lives, and most do so when teenagers. Research shows that at age 19, four of five teens have had sexual intercourse. With the typical age of marriage being about 25 for women and 27 for men, the reality is that people are becoming sexually active, on average, nine years before they marry.
Those who believe in an abstinence-until-marriage approach have no patience with this reality and the needs it implies. They keep saying that abstinence "is the only 100% effective method of preventing pregnancy and disease." True enough. But just like any other contraceptive method, abstinence "works" only when it is used--every single time. The fact is, few people are so disciplined. Nevertheless, the federal government, especially the Bush administration, is placing more and more emphasis on abstinence-only education, committing nearly $100 million annually to these programs, despite the lack of evidence that they are effective in postponing sexual activity or preventing unintended pregnancy and disease.
Some of the consequences of such misguided politics are clear. American adolescents--and adults--have higher rates of unintended pregnancy, sexually transmitted diseases and abortion than their counterparts in any other industrialized country, except those in the former Soviet bloc. In France, where condom vending machines share sidewalks with pay phones, 15-to 17-year-olds have one-tenth the birthrate and one-third the abortion rate of their American peers.
It may surprise some to know that there has been a federally assisted family-planning program in place in the United States for 30 years. Despite its demonstrated record of success in helping women avoid more than 1 million unplanned pregnancies each year, the program remains plagued by political controversy and chronic underfunding. As a result, family-planning clinics in communities across the country are struggling to meet new challenges, including added costs associated with new contraceptive methods and diagnostic technologies, rapid and sometimes radical changes in health-care delivery and financing, and a growing uninsured population.
Family planning has been so vilified in some parts of the United States that family-planning workers feel they are on the front lines of a battle. During a recent visit I made to the Midwest, some mid-level state employees working with federally funded family-planning programs were afraid to meet with me in their offices. One said her supervisors made her "feel like a leper." Such negative attitudes filter down to affect front-line service providers. Many family-planning workers cannot countenance turning women away without services, so they end up paying for their patients' contraceptives out of their own pockets.
Many international family-planning services supported by the U.S. government are similarly at risk because of the Bush administration's gag-rule policy. The policy requires that, in exchange for U.S. family-planning assistance, health professionals abroad withhold information from pregnant women about the option of legal abortion, abstain from engaging in any public debate on the availability of abortion and refuse to provide legal abortion services, all activities that would be supported with non-U.S. funds.
While many developing countries struggle to improve their family-planning programs in environments of extreme hardship, in the United States, one of the richest and presumably most enlightened countries in the world, we are spending far too much time, energy and money just to protect the progress already made. In other countries, family planning is viewed as a matter of public health rather than politics. There is absolutely no reason why American women, particularly our youth, should not have the same high levels of reproductive health as other women worldwide.