Bronski
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.