Thursday, May 22, 2008

Sex and Schools Aids and The

It took only a single paragraph (four sentences, 91 words) to change the course of an ancient debate. "There is now no doubt," said Surgeon General C. Everett Koop in his grim report on AIDS last month, "that we need sex education in schools and that it must include information on heterosexual and homosexual relationships." With characteristic bluntness, Koop made it clear that he was talking about graphic instruction starting "at the lowest grade possible," which he later identified as Grade 3. Because of the "deadly health hazard," he said later, "we have to be as explicit as necessary to get the message across. You can't talk of the dangers of snake poisoning and not mention snakes."

Some people would clearly prefer not to talk about poison at all. Sex educators face a powerful array of detractors and doubters: Fundamentalist and Roman Catholic leaders, antiabortionists, opponents of the gay lobby, psychologists worrying about the impact of AIDS messages on the young, blacks who consider sex education racist, and even a few capitalists who think that school clinics offering birth-control information should be turned over to private enterprise.

But Koop's speech has thrown the naysayers on the defensive and increased the odds that comprehensive sex education will at last overcome its critics. For years, surveys have shown that about 80% of Americans favor sex education in the public schools. In the wake of Koop's dramatic report, a poll for TIME by Yankelovich, Clancy, Shulman found that instruction is now favored by 86%, perhaps the highest number ever; 89% want such courses for children age 12 to deal with birth-control information, and about three-quarters say homosexuality and abortion should be included in the curriculum (see box). "AIDS will definitely change the nature of sex education as we know it," said Harvey Fineberg, dean of the Harvard School of Public Health. "It will lead to more open, explicit discussions about condoms and other strategies for safe sex." Though some people will be shocked, he said, "we are at a point where sex education is no longer a matter of morals -- it's a matter of life and death."

For opponents of sex ed, that is precisely the problem: the recommendation to students that they use condoms as an anti-AIDS measure helps erode moral opposition to premarital sex and contraception, just as the impartial listing of "options" such as homosexuality and abortion undermines other traditional teachings. Critics of abortion fear that its mention in classes will make it seem like an easy solution to an offhand mistake. "The way sex education is taught in the schools encourages experimentation," says Right-Wing Crusader Phyllis Schlafly. "It's the cause of promiscuity and destroys the natural modesty of girls."

Since President Reagan and Koop have strongly opposed sex education in the past, the Surgeon General's report was particularly galling to conservatives. So was the spectacle of Koop's virtually writing off the family as a reliable source of sexual guidance. Though he insisted that parents stay involved, he said, "Most parents are so embarrassed and reluctant, you can't count on getting the message across at home." Most Americans seem to agree: the TIME poll showed that 69% believe parents are not doing as much as they should to educate their youngsters about sex.

Politically, Koop's statements last month came one step ahead of an AIDS study that might have proved embarrassing to the Administration: a National Academy of Sciences report warned that the AIDS epidemic "could become a catastrophe" without strong White House leadership and a campaign of education and research that would probably cost $2 billion by 1990. Whether Koop's motive was political or not, his report plunged the nation into a thicket of legal and moral questions. Is it unwise to tell third-graders about anal sex and the connection between sex, AIDS and death? Is it the proper function of a public school to push either abstinence or birth control? Is value-free sex education possible, and if not, whose values will be taught?

Sex education has been a program searching for a consensus since it arrived in the schools at the turn of the century, the brainchild of stern progressive-era reformers, mostly doctors and other upper-crust male professionals. The idea, the only idea, was to enforce sexual restraint. Reformers believed that enlightened mass education could help banish venereal disease, prostitution, masturbation and sex outside marriage. The notion of "scientific" sex education arose as a way of deflecting the curious from actual sexual behavior. Instruction, said a 1912 committee, "should aim to keep sex consciousness and sex emotions at the minimum." Then, as now, there were heavy implications that parents, particularly impoverished ones, could not be counted on to teach restraint to the young.

About 80% of public-school children in major U.S. cities now take some kind of sex-education course. As for national figures, no one knows for sure: sex education is strictly a local matter, varying widely from one community to the next, and few accurate statistics are kept. Only Maryland, New Jersey and Washington, D.C., require the subject in all schools.

In a number of schools, sex education turns out to be nothing more than a brief bout with a safely biological "swimming sperm and Fallopian tube" course that has put students to sleep for generations. Or, hardly more energizing, it may be a three-hour course taught by a gym teacher, followed by a display of condoms or foam brought along by a speaker from Planned Parenthood. In Kansas, the curriculums for phys ed, drivers' ed and sex ed are all overseen by the same state board of education official. "No matter what is written in the curriculum, there is not much going on out there," says Mary Lee Tatum, a sex-education consultant. "Under 15% of U.S. children get really good sex education. We are only beginning to institute adequate programs."

Many communities, of course, have outstanding programs, including Arlington, Va., Baltimore, and Irvington, N.J. Teaching can be impressively broad, running from kindergarten through twelfth grade and based on developmental psychology, emphasizing assertiveness training, the mechanics of decision making and assigned essays on topics like sex in the media.

At P.S. 42 on New York City's Lower East Side, Principal Anthony Barry takes the formal sex-ed curriculum "with a grain of salt": teaching the children of fairly conservative parents, most of them Chinese American and Hispanic, means playing things by ear. Says he: "We want parents to know that we're not undermining what they are trying to do."

One technique at the school is to raise animals in the classroom. When they mate, the children understand that they produce babies of the same species -- a smooth introduction to sex education known to every farm child. Nurse Mary Tang teaches anatomy to fifth- and sixth-graders and answers explicit questions, but she does not bring up subjects like abortion and birth control. That is the only formal part of the instruction; most of the rest of the sex- ed time is spent in rap sessions, fielding questions about sex and trying to build personal responsibility.

Good or bad, adequate or not, is some better than none? Does sex education work? So far, studies on the subject have been fragmentary, unconvincing or massively inconclusive. A six-volume 1984 analysis by Mathtech Inc. of nine programs around the country came to the deflating conclusion after a seven- year investigation that sex-ed courses had almost no effect on contraceptive use, views about premarital sex, or such social skills as assertiveness and , self-understanding. The only significant changes in behavior and attitude came in the two programs with strong backing from parents and the local community. And the only increased use of birth control came when the sex-ed program was combined with ready access to a health clinic. The study offered a nugget of hope to conservative parents: graduates of sex-ed programs were less permissive about premarital sex than control groups.

After studying 3,600 students at six high schools in Indiana, Texas and Mississippi, the Center for Population Options found little discernible impact. "Formal sex education appears to have no consistent effect on the subsequent probability that a teenager will begin to have intercourse, neither postponing it nor hastening it," said Douglas Kirby, the head researcher. "Typically, students who take sex-education courses report more tolerant attitudes toward the sexual behavior of others but little change in the values that govern their own personal behavior."

The Surgeon General's intervention brought new doubts about sex education. Some critics who spoke out reacted angrily at the prospect of explicit teaching about homosexuality and anal sex. "Where do we draw the line?" roared Joseph Casper, an outspoken member of the elected Boston school committee. "The gay community would love to come in and say theirs is an alternative life-style that's really O.K. But then what's next? Do we bring in people who want to talk about safe bondage too? Chimps making it with chickens? It's insane." A few people talked as if AIDS were ushering in a new puritan era in which sex-ed courses would be used as a bully pulpit for abstinence. "As awful as it sounds, AIDS is almost a blessing in disguise," said Mary Ann Briggs, a health teacher at Fairview High School in Boulder. "Many kids are very scared by AIDS, and it makes it easier to say, 'Do you really want to get involved with sex?' "

Some proponents of sex education had reservations about Koop's report. Stanford Education Professor Michael Kirst said schools are overburdened enough without becoming the official problem-solving arena for the nation's sex problems. Said Kirst: "Every time schools take on value-laden topics, they end up losing overall public support. It's a no-win ball game." The national president of Planned Parenthood, Faye Wattleton of New York City, offered Koop only cold praise. Reason: she wants upbeat instruction, not just education "within the context of preventing a deadly disease."

$ By far Koop's most explosive proposal is the idea of teaching eight-year- olds about AIDS. Only 23% of those surveyed in the TIME poll agreed with the suggestion. Most professional educators seem opposed. "If you brought up anal sex to third-graders, they would be in a state of shock," said Marilyn Huriwitz, a health teacher at South Boston High School. "How are you going to talk to kids that age about anal sex?" asks Al Wardell, a Chicago high school teacher and a gay activist. "I guess that's my teacher's prudishness." Young children's brains cannot assimilate such information, warns William Chambers, director of pediatric psychiatry at Manhattan's Columbia-Presbyterian Medical Center. "For them, anal sex is going to the bathroom."

A few experts believe the Surgeon General's suggestion makes sense. Observes Harold Harris, a child psychiatrist at Duke Medical Center: "At four or five, they're playing doctor games. Sexuality is what that's all about. We should bring it out of the closet and talk about it in school and home." It would not be necessary to give third-graders the full hair-raising message, only a few basics. Child Psychologist Lee Salk would not favor including the subject as part of sex education, but he thinks that AIDS could be explained as a disease if care is taken to avoid raising undue fear. He would describe anal sex as well as drug use. "One of the ways grown-ups protect themselves is to avoid doing these things," he would continue. But, he points out, "notice I am avoiding alarming language and not saying, 'If you do this, you'll be dead in no time.' "

Pragmatically, Koop might be well advised to abandon campaigning for vivid AIDS instruction in the third grade. The delay of a couple of years would not greatly undermine his overall goal. But the largest problem entwined in sex-ed courses cannot be so easily evaded or resolved. The subject is impossible to teach without plunging into the question of values. Many educators assert that curriculums can be made value free, a dubious idea at best.

The difficulties of remaining value free show up clearly in an 18-minute anti-AIDS videotape prepared for the New York City school system and purchased by groups in 35 states. The narrator is the young movie actress Rae Dawn Chong. She discusses the two riskiest behaviors involved in AIDS, unambiguously advising viewers to avoid intravenous drug use but shying away from a similar warning on anal sex. Instead, she suggests use of condoms for vaginal and anal intercourse and adds offhandedly, "If you decide not to have sex, that's O.K. too."

The videotape is earnestly intent on deflecting criticism of homosexuals for spreading AIDS. In the tape's one emotional scene, the brother of an AIDS victim says, "If I ever hear anyone talking about how gays are to blame for AIDS . . . I swear to God, I'm gonna punch 'em in the head!" New York City is still debating whether to accept the tape. Board of Education President Robert Wagner Jr. has criticized it for not clearly opposing adolescent sex and drug use, but he has not directly objected to its gingerliness about homosexuality and anal sex.

Wagner and Schools Chancellor Nathan Quinones must deal with a minefield of conflicting views. The city's sex-education curriculum is described as "value neutral" but, like many other school systems' courses, is actually based on a generalized secular ethic of caring and respect for others. Parents dissatisfied with the version of the city curriculum served up in their district can pull their children out of particular classes by informing the principal. The program is sometimes popular, as it is at P.S. 42, but the effort to accommodate everyone is unacceptable to many. Last month the board of education mandated sex education for the remaining eleven school districts without it. Last week 250 protesters showed up at city hall to object.

Mary Cummins, head of School Board 24 in Queens, threatens to fight the imposed course plans in court. She complains that chastity is not taught as a value and homosexuality is depicted as an "acceptable alternative life- style." Her board, she said, supports the concept of sex education but not a curriculum that "violates social values and moral principles without consideration of our views and values." Deriding the idea of value-free instruction, Cummins says, "I defy anyone to teach it, including myself, without getting his own moral values across. I know, if I were teaching it, I'd stress morality."

Education Secretary William Bennett supports that kind of concern. His fear, he told a New York City audience last month, is that instead of a clear ethic of right and wrong, sex-ed students are frequently exposed to a hodgepodge of "feel-good philosophy." Bennett accepts sex education "provided that people do not try to make it value free." He would require instruction to include a message on abstinence. "Such courses should take place only if the community wants them and the parents are involved and know what is going to be taught."

One group has confronted value-free teaching by devising and marketing a model curriculum that states traditional conservative values throughout. Teen- Aid Inc., with headquarters in Spokane and 25 affiliates in the U.S. and Canada, urges youngsters to "resist the tide" of a sex-saturated culture. The program tries to sharpen the "refusal skills" of students and sends summaries of lessons home to parents. Students are told to be careful about what clothes they wear on dates, and not to drink or take drugs while on a date.

The feistiest combatants are fighting against not school curriculums but school clinics. These health facilities are attached to or near public schools around the country, and they are spreading rapidly. Most are funded with a mix of public and private money. All offer across-the-board medical care. Some 28% dispense contraceptives, 52% prescribe them, and the rest make referrals to family-planning agencies. So far there are 72, mostly in poor neighborhoods of big cities. A hundred more are in the works.

The Roman Catholic Church, which on the whole has reacted mildly to the growing clamor for more sex education, has been anything but docile about the clinics' birth-control services. Two weeks ago Archbishop Roger Mahony of Los Angeles issued a heated pastoral letter calling for "all those who value the family and have hope for the future of our children" to join him in vigorous protest against a proposal to establish three school-based clinics. In Boston, Bernard Cardinal Law denounced four proposed health clinics that would provide contraceptives in junior and senior high schools. In an 86-page attack, the archdiocese challenged the constitutionality of school clinics and argued that contraceptives increase the amount of teen sex by eroding "cautions and reluctance." Replied Nancy Drooker of Massachusetts' Planned Parenthood: "Most teenagers are sexually active for over a year before they get contraception, so you can hardly say birth control was the cause."

A few black leaders in Boston and New York City have denounced the clinics as racist. In Chicago, 13 black clergymen are suing to block distribution of contraceptives at the DuSable High School clinic. Says the Rev. Hiram Crawford: "If these clinics are so good for black kids, why don't they put them in white areas? It's a form of genocide. Why do they so readily recommend abortion?"

The conservative belief is that such clinics lead students to be more promiscuous, but clearly established facts are difficult to come by. In St. Paul, records show that birth rates fell 40% in schools with clinics, though Health Supervisor Wanda Miller was hesitant to claim full credit for the clinics. Of the adolescent mothers who used the services, 80% stayed in school, and repeat pregnancies were almost nonexistent. Follow-ups are important, says Miller, because teens are "rotten contraceptors."

Other clinics report lower birth rates among those counseled or treated. And a survey of two inner-city schools, released this year by a team headed by Laurie Schwab Zabin of Johns Hopkins' School of Public Health, reported that sexually inactive high school students who used the clinic postponed their first sexual encounter about seven months, to age 16.2 instead of the 15.7 that otherwise was typical. Zabin's study is one of the most frequently cited by activists who support sex education and school clinics. In the first two- plus years of the study, the pregnancy rate fell 30% among teenagers who had access to birth-control supplies at a clinic near their school, while the pregnancy rate rose 57% among a control group.

But conservatives have their own favorite research, described by one of the authors in the Wall Street Journal but not yet generally available: two studies by Utah researchers named Stan Weed and Joseph Olsen. Their major finding is that during a period when the number of teens using family-planning clinics rose from 300,000 to 1.5 million, the teen pregnancy rate actually increased 19%. Births were down, they said, but only because of abortion. "Apparently the programs are more effective at convincing teens to avoid birth than to avoid pregnancy," Weed wrote in the Journal. The point: teens tend to get pregnant not because of lack of information or birth-control devices but because of social and psychological factors, including low self- esteem, impulsiveness and a bleak economic future. In response, the Alan Guttmacher Institute charged that the Journal piece contained "numerous inaccuracies." The number of adolescent pregnancies has decreased for the past three years on record, 1980-83, said the institute, and the pregnancy rate has declined as well.

Another study tends to back the Weed-Olsen view. Deborah Anne Dawson, as a doctoral student at Johns Hopkins, found that two-thirds of girls between 15 ; and 19 have had some instruction about birth control and pregnancy, with only 16% lacking any such education at all. Her conclusion: teaching about birth control and pregnancy has no significant effect on the pregnancy rate among teens, presumably because teenagers are more emotional than rational about sex and its risks. Says Boston's Huriwitz: "Adolescent sex is spontaneous, based on passion and the moment, not thought and reason. They don't worry about AIDS because they think it will never happen to them, no matter what we tell them. And I don't know how we change that."

A few programs incorporating discussions of AIDS were already under way before Koop's report. Last spring, after a student and staff member in two public schools were diagnosed as having AIDS, Boston prepared a 28-minute AIDS videotape filled with medical facts but also polite circumlocutions, including the message that AIDS spreads through blood and semen and "intimate sexual contact." For Boston, that was a shift. "Look, ten years ago, you couldn't even mention intimate sexual contact in this town," says Michael Grady, medical director for the Boston public schools. Grady's defense of the vagueness: "We'd rather do a little education than none at all." This fall Greater Miami began offering comprehensive AIDS information as part of its sex-education program. AIDS is mentioned briefly to seventh-graders as one of many sexually transmitted diseases. Tenth-graders get a more thoroughgoing five hours focused on it. Parents are mostly pleased.

In Omaha, where a beleaguered committee is now cautiously preparing the city's first sex-ed program, there is still controversy about whether to teach the subject at all. In such an atmosphere, school officials tend to talk a lot about the family and the bracing wonders of abstinence. School Superintendent Norbert Schuerman has called for "educational experiences that do not violate the social and moral standards of the total community." He said schools need the help of parents and suggested that any sex-ed program underline the message "It's O.K. to Say No." In a spasm of candor, School Board Member Bill Pfeffer admitted that a lot of sidestepping and shuffling is going on. "Everyone is afraid that the Catholic Church and the other groups are going to get very angry." One board member, John Haller, 77, said he will keep opposing any program because "the kids are getting too inquisitive; we're arousing their curiosity." The difficulty with sex, contended the Rev. Bob Thone of the Omaha Gospel Tabernacle, is that "the more you talk about it, the more it excites the desire to experiment."

New Jersey appears to have managed the task of eroding the conservative beachhead. There are still some angry dissenters who have lawsuits and other protests pending. But the state board of education defused much opposition and won the support of the state's five Roman Catholic dioceses by conducting a three-year public debate before starting sex-education programs in the schools in 1983. Grateful to be asked for their input, the bishops endorsed the state's sex-education plans, but "with reservations," mostly about instruction on abortion and contraception.

One of the state's model programs, designed for the Irvington school system, which is 92% black and Hispanic, runs from kindergarten through twelfth grade, starting with simple instruction on bodily functions and child abuse, then moving on during high school years to instruction in family planning. Fourth-Grade Teacher Linda Lichtenberger conducts her sex-ed classes like rap sessions, and designs homework assignments that encourage students to discuss what they are learning with their parents.

The course does not slip by controversial areas. Lichtenberger shows her nine- and ten-year-olds a chart on contraceptive methods and their efficiency rates. "We really have to arm children with something," she says. "They don't have to be abused or taken advantage of. We want them to protect themselves so they don't become one of the wounded adults that take it out on the next generation." Latasha Gadsden remembers taking the course last year and learning about "VD, how babies are born and how babies form in the uterus." Sometimes "the boys all laughed," she adds. But Latasha thinks "sex education makes people more mature because it's not really funny, it's your own body."

In Rockford, Ill., Teacher Thomas Lundgren's seventh-grade "Family Life and Health" course separates the sexes for two or three days each year because girls do not want to discuss sanitary protection in front of boys, and boys are just as embarrassed to talk about wet dreams in a mixed class. When students talk about the emergence of heterosexuality and homosexuality, Lundgren says, "we tell them we're just giving them an educated guess, and use an analogy with right- and left-handedness, that sexual orientation is something that is established very early in life."

Lundgren talks about condoms ("No glove, no love" is a popular class mnemonic), and abortion is presented as a fact of life. "We explain how suction curettage happens and what happens with a saline injection," says the teacher. "We tell them to keep reading, keep thinking and keep talking about it." Lundgren starts discussions of oral and anal sex by saying, "We're not telling you this to gross you out." Only six or seven youngsters out of 850 are excused from the class each year because of parents' objections. Says the popular Lundgren, one of eight finalists for state teacher of the year in 1985: "Everybody we talk to in the community is positive about what we're doing."

By national standards, St. Paul's sex-ed program is one of the frankest and most thriving. It touches on homosexuality without either endorsing or criticizing it. "We say the gay community defines homosexuality as a trait that is born into them, and we are not putting our own construction on that because we don't have research to substantiate it," says Wanda Miller. Teachers also explain exactly how one gets or avoids AIDS. "We are clear and explicit about semen and blood being the roots of transmission and that condoms offer protection." Despite such directness, St. Paul's program operates without much criticism from parents.

The popular acceptance of these programs seems to rest on their adjustment to their individual communities, something not easily outlined in a lesson plan. Says Harvard Psychology Professor Jerome Kagan: "Human sexuality is a moral issue in every society. But while some societies have a consensus on sex, ours doesn't." The conflicting moral values touch the most seemingly innocuous issues. Everyone, for example, agrees that self-esteem and psychological factors are crucial, particularly to demoralized ghetto youngsters. But even building self-esteem divides proponents and critics of sex education. One side tends to talk of right and wrong, the other of self- enhancement and the importance of feelings. UCLA Health Educator Adrienne Davis says she teaches "that nothing is good that decreases your self-esteem, that you don't feel good about and that hurts another person," the essence of what Secretary Bennett cites when he harrumphs about "feel-good philosophy."

The struggle over sex education echoes the right-left battles over public school textbooks around the nation, notably in Tennessee, where Fundamentalist / parents successfully sued to shield their children from basic school readers they considered offensive. The Roman Catholic Archdiocese of Boston has begun to use language similar to Southern Fundamentalists', charging that school clinics would establish an "official state philosophy of situation ethics and moral relativism" that contradicts the teachings of most major religions. Psychiatrist Thomas Szasz, author of Sex by Prescription, thinks pressures on the public schools are bound to mount. "A covert struggle is going on to see who will control the free schools and mold the minds of other people's children," he says. "You can see a pattern with the Tennessee case -- when one group imposes its values on the schools, everyone else feels mugged." Szasz believes the current debate may foreshadow the breakup of the public school system, something that, as a libertarian, he would not mind in the least.

A sex-ed solution, however, need not await or depend on the crumbling of the public school system. Some towns are evolving their own compromises. In Lindenhurst, N.Y., after a fierce conservative protest against an eleventh- grade sex-ed program, the school decided to offer three different courses. About 60% of the students attend the liberal "Family Life" course; 25% take the conservative option, "Sexuality, Commitment and Family"; and 15%, including those who make no choice at all, end up in a health course without sex ed.

Another promising answer to fundamental differences may lie in an emerging agreement on one basic. A number of cities are turning up evidence that most youngsters are looking for an excuse to abstain. In 1980 the teen services program at Atlanta's Grady Memorial Hospital found that of the thousand or so girls under age 16 it saw each year, the overwhelming majority (87%) wanted to learn how to say no without hurting anyone's feelings. Grady responded with a program for eighth-graders called "Postponing Sexual Involvement." It is now taught in 23 Atlanta-area schools, focusing on decision making, assertiveness and how to articulate values and feelings.

Older teenagers, paid $8 an hour, are the teachers. "The girls who took the program see themselves differently," says Marion Howard, clinical director of the Grady teen services. "They didn't think having sex meant they were grown up. They didn't think it would earn them respect." And only 5% of them started having sex in the eighth grade, in contrast to 16.5% of girls outside the program.

Many educators think the prochastity movement is a pipe dream. "We can't fool ourselves into thinking that abstinence is the solution," says Mary Luke of San Francisco/Alameda Planned Parenthood. "These kids have made their decisions, and we're going to have to deal with the reality of it." But there is no doubt that the threat of AIDS and the need to defuse conservative critics have made the abstinence message politically popular to left and right alike. "Our preferred way to deal with sexual activity is to say no," says Patricia Davis-Scott, clinic director at two Chicago high schools. In the California school system, notes Bill Honig, state superintendent of public instruction, when a boy says, "If you love me, you will," a girl is taught to answer, "If you love me, you won't ask me." Illinois Governor James Thompson told a Republican meeting last month, " 'Just Say No' is a good slogan for drugs, and it is a good slogan for teen sex."

This popular fervor for abstinence, undreamed of just a few years ago, surely is no harbinger of a new puritanism. But it may open up some room for sex education to overtake its critics. In exchange for the abstinence message being treated with respect, many conservative opponents seem likely to follow Surgeon General Koop and accept sex instruction in the schools. As Koop himself seems to argue, there is really no other choice.

Special Thanks to TIME Magazine