Joycelyn Elders Is Almost Right
Conservatives have been attacking President Clinton's candidate for Surgeon General, Dr. Joycelyn Elders, for her stands favoring sex education and distributing condoms to teenagers. Efforts to use these tools to stop teen pregnancy and the spread of AIDS have recently become tied up in the abortion crisis. While C. Everett Koop, during his tenure as Surgeon General, came to advocate the use of condoms to reduce the AIDS epidemic, Dr. Elders's strong initial stands and colorful language are a far cry from anything that has been heard from a Washington official for some time.
Dr. Elders's position has put the public spotlight on a major problem. The average age of first intercourse for most teenagers is around 16. Lots of children are having sex before they learn to drive.
Early, unprotected intercourse leads to teenage pregnancies. In New Jersey, there were 41 births for every thousand women ages 15 to 19 in 1990. The numbers were from two to four times higher in the cities. Another result of unprotected sex is AIDS. The most rapidly rising source of AIDS transmission is now heterosexual intercourse. A recent report from the Centers for Disease Control and Prevention finds that more women are getting AIDS from sex than through using needles for drugs.
Under the circumstances, providing children with the sex education that will help them understand the risks they face and how to minimize them makes good, common sense. The only serious objection comes from the political right, where people argue that sex education will promote promiscuity and increase the risks that it is supposed to reduce.
The evidence points the other way. Surveys provide little or no evidence that sex education increases teen sexual activity. Unfortunately, there is also little evidence that such classes reduce that activity either. The sex education that most of our children get does not really change their sexual behavior, although it does increase the use of effective contraception somewhat.
This doesn't mean that sex education can't have the benefits that Dr. Elders and others claim. Large-scale experiments in several parts of the country suggest that well-designed sex-education programs can reduce teenagers' sexual activity and increase the use of contraception, thereby reducing the number of teen pregnancies and--where condoms are stressed--slowing the spread of AIDS. Unfortunately, the programs that work are very different from what most students get.
Effective sex-education programs need at least five characteristics. First, students need to spend enough time on the subject to learn something about it. In our study in New Jersey, we found that, on average, students received only 24 hours a year of sex education (the state uses the term "family-life education''), and they did not take the topic every year. Second, sex-education classes need to provide students with nitty-gritty information about how to minimize risks. In New Jersey, lots of teachers report that they talk about safe topics like the biology of healthy development (mentioned by 72 percent) or self-esteem (also mentioned by 72 percent), but relatively few talk about contraception (43 percent) or sexual expression without risk (31 percent).
Third, sex education must start earlier. Study after study finds that students who start formal sex education after they have begun having intercourse aren't influenced much by their classroom experience. While people worry that middle school students are not ready for frank sex education, some of them are getting an education on the streets with disastrous results. Our New Jersey teachers were very slow to address key issues. For instance, 91 percent of the high school teachers talk about contraception as opposed to 55 percent of those in middle schools. Moreover, almost half the elementary school teachers talk about AIDS but only 4 percent talk about contraception. It appears that little children are getting a big scare but not the information to help them protect themselves.
Fourth, sex educators must take a stand. The programs that reduce teen sexual activity, delay the onset of intercourse, and increase the use of contraception make it very clear that the teachers and other adults involved disapprove of early and unprotected sexual activity. Yet on many areas teachers are unwilling to make their positions clear. As one told us: "I'm uncomfortable about the possibility of stepping on toes. I explain what each side thinks, the decisions they have to make, and tell them that they have to make it.''
Fifth, the programs that work use effective approaches that both persuade and help teens come to terms with their own questions and fears about sex. Instead of lecturing, teachers use role-playing, peers teaching peers, and other strategies to help teens recognize everybody is not doing it and develop skills to resist unwanted persuasion. Yet 54 percent of our teachers lecture their classes, while only 12 percent use role-playing and 7 percent use instruction by peers.
Distributing condoms also helps, but it helps more when accompanied by effective sex education. Without appropriate outreach, the clinics that provide contraception in schools are often not used. This is not an issue in New Jersey, where virtually none of our teachers said condoms were distributed in their schools.
Many social programs in this country get implemented in a half-baked way. The promise of the pilot program doesn't show up when it is expanded. This could happen with sex-education and condom-distribution programs if too many compromises are made while passing legislative programs. Joycelyn Elders and those who think like her are right to advocate sex education. But they can win the battle and lose the war if they don't insure that the programs that are implemented start early enough and are frank enough to help teens really avoid the negative consequences of early sexual activity.
Vol. 13, Issue 01, Page 42Published in Print: September 8, 1993, as Joycelyn Elders Is Almost Right