The following is condensed from an interview with former U.S. Surgeon General Joycelyn M. Elders. A pediatric endocrinologist, the 64-year-old Elders is on the staff of Children’s Hospital in Little Rock, Arkansas, and on the faculty of the School of Medicine at the University of Arkansas. She was interviewed by Priscilla Pardini.
Q: What’s wrong with abstinence-only sexuality education programs?
Nothing, in the very early grades. If we did a really good job in the first 10 or 12 years of children’s lives teaching them about abstinence, as well as about honesty and integrity and responsibility and how to make good decisions, we would not have to be talking to them at 15 about not getting engaged in sex.
But we haven’t done that. Mothers have been teaching abstinence, schools have been teaching abstinence, preachers have been preaching abstinence for years. Yet more than three million teens get STDs every year, and we still have the highest teen pregnancy, abortion, and birth rates in the industrialized world. But we seem to feel that we don’t need to educate our children about their sexuality. That makes absolutely no sense. We all know the vows of abstinence break far more easily than latex condoms.
Teens need a comprehensive sexuality program that gives them all the information they need to become empowered and responsible for preventing pregnancy and disease. We have to stop trying to legislate morals and instead teach responsibility. Abstinence-only does not do that. You can’t be responsible if you don’t have the information.
Q: But is school the best place for sexuality education? Isn’t this better left to parents?
I have no problem leaving it to parents, if you have parents who can and will do it. But we have many dysfunctional parents — some on drugs, some into alcohol, some who are stressed out, and some who just don’t know how to talk to their children about sex. Then the responsibility belongs to the community. And since the only place we’ve got access to every child is in school, we need to use our schools to teach about sexuality. We don’t depend on parents to teach math and English and science and geography. So why should we depend on parents to teach children all of their social and behavioral skills?
Q: Teachers say they don’t have enough time as it is to adequately cover academic subjects. Doesn’t sexuality education cut into precious time now allotted to basics such as reading and math?
I think teachers are doing a wonderful job — the best they can under difficult circumstances. But what good is knowing math and science if you don’t know how to protect yourself? The fact is, we invest more money in prisons than we do in schools. We’re putting out a dragnet when we ought to be putting out a safety net.
Our children, from the time they enter kindergarten through 12th grade, spend 18,000 hours watching TV, but only 12,000 hours in reading and math classes and only 46 hours in health education classes. I say let’s take away some of the TV time — and devote more hours to the school day, to summer school.
Q: How early should sexuality education start? What kinds of topics should be covered in the early years?
As early as kindergarten children need to be taught to respect their bodies, to eat in healthy ways and to feel good about themselves. They need to know how to make good decisions and how to deal with conflict in non-violent ways. People who feel good about themselves feel in control of their lives and can make decisions that are right for them. Years later, these children, if they choose to be sexually active, will probably also choose to use a latex condom to protect themselves. But if you’re not in control of your sexuality, you can’t control your life. Those are the people who end up saying, “It just happened.”
Q: How can teachers evaluate whether material is age-appropriate for their students? Can you offer some guidelines for elementary, middle and high school?
There are a lot of high-quality, well-tested curricula out there that are age-appropriate. Even very young kids should know that anytime anyone touches you in a way you don’t want to be touched, even if it is your parents, you have to tell somebody. That message needs to start in kindergarten, but also needs to be repeated and reinforced. Older kids should learn about the menstrual cycle, that if they choose to be sexually active they can get diseases or get pregnant. They should know that you can get pregnant the first time you have sex … that you can get pregnant if you have sex standing up.
By high school, you need to be teaching them more about responsibility and equality — that boys and girls have equal responsibility for their sexuality. They should be taught about date rape, about birth control. They should be taught to assume that anytime they have sex they are risking — boys and girls — AIDS, sexually transmitted disease, and becoming a parent. At this point, when you simply tell them they should “just say no,” they look out the window and start singing. It’s too little too late.
Q: What about the charge that teaching teens about sexuality actually increases sexual activity?
There has never, never been any study that has documented that teaching young people about sex increases sexual activity, and most studies say it decreases sexual activity. In fact, according to a new study [“Impact of High School Condom Availability Program on Sexual Attitudes and Behaviors,” Family Planning Perspectives, March-April, 1998] even when condoms were made available in a high school, sexual activity did not increase.
Q: How serious are teen pregnancy, STDs and HIV among teens?
There are more than 3 million STDs a year reported in those under 19 years of age. Genital herpes — which cannot be cured — has increased almost 30% in young people in the last eight or nine years. The pregnancy rate is slightly down, but there are still almost 900,000 teen pregnancies a year. When it comes to HIV, the largest increase in cases is seen in teenagers. This is serious. The stakes are very high.
Q: Yet, sex education has been part of the curriculum in many schools for many years. Why isn’t it working?
We’ve not had comprehensive K-12 sexuality education. We’re still out there giving kids an annual AIDS lecture. We might as well keep that. We don’t teach math by giving one lecture a year. You have to do it all the time and keep reinforcing it. We’re not making a committed effort to change things. What we’re doing is criticizing and blaming. The problem is, we’re willing to sacrifice our children to preserve our Victorian attitudes. We know what to do. We know how to do it. We just don’t have the will to get it done.
In the 1960s, when we found out our children were behind in math and science, we added courses in math and science. So if we want to address the social problems our children are having now, we have to put in the programs to do it.
Q: How should a school administrator respond if a parent or group of parents demands that an abstinence-only curriculum be taught?
A superintendent should agree with the parents and put in an abstinence-only program for kindergarten and elementary students. When it comes to older students, he really needs to tell other parents what’s going on so they can rise up and fight. Ultimately, a superintendent has to do what his board members tell him to do. But it’s the parents who carry the big stick. Parents can get anything they want, and two major studies have shown that most parents want comprehensive sexuality education, with condom availability, in the schools. Yet, because of their silence, they let this other side get their way and destroy their children.
Q: What is the relationship between public health departments, public schools, and the U.S. Surgeon General’s office?
There should be a marriage between schools and public health. We should have health education programs in schools along with school-based clinics that would be easily accessible to students and affordable. Now, many young people don’t know where to go or don’t have the money to pay for health services. We also need to teach people how to be healthy. We have a health-illiterate society, and one place to correct that is in the schools. I think the Surgeon General has a role to play in promoting good health practices and focusing on prevention — to try and make this country as healthy as it can be.