Medicine and Political Control
by Bobby Jindal
Easy access to contraception and abortion is society’s feeble response to the exploding crisis of teenage pregnancy. I suppose one can either rejoice that society has finally taken notice of this phenomenon and agreed that it is indeed a cause of concern, or one can continue to bemoan the fact that the academics, politicians, and social scientists just do not get it. After years of preaching a libertine gospel, apostles of the sexual revolution manage to muster up a sense of surprise at the predictable results. Yet, they fail to reflect any sense of remorse or responsibility that would cause them to alter the destructive path they have chosen for society; rather than changing directions, we have only slowed down. It is as if having discovered that children tend to play with matches, parents provide them with fire extinguishers rather than teaching them right from wrong.
Before society rushes to admit the inevitability of teenage sexual hyper-activity, we should ask ourselves why such activity increased so dramatically with the advent of the sexual revolution. The coincidence of the attack on traditional values and the sudden increase in many social ills accompanying sexual irresponsibility suggest a causal relationship. Yet, this relationship has been a taboo subject, as the supporters of the sexual revolution have been, to borrow Cardinal Newman’s phrase describing liberals of his age, “scarcely a party; it is the educated lay world.” Those foolhardy individuals brave enough to mention the media, popular entertainment, radical activists, and other peddlers of libertine sexuality as contributors to the problem, are dismissed as reactionary and unenlightened prudes who insist on fighting yesterday’s battles. How can society even begin to attack the problem when it does not want to admit the cause? Perhaps if yesterday’s battles had been better fought, we would not have today’s problems.
With much of the media, entertainment, and academic industries reducing heterosexual monogamous relationships to merely one preference among many equally valid alternatives, it should be no surprise to anyone that one out of four babies in America, a number that rises to one out of two for teenage mothers, is born out of wedlock. Study after study has documented the relationship between this trend and the similarly shocking trend that one out of five American children lives in poverty, despite billions of tax dollars already spent on teenagers and their babies. Poverty is just one of many trends, all too common to everyday Americans, that are just being discovered by academics and policymakers. Who knew that unrestrained gratification would result in broken families, random violence, and the other social ills plaguing our many cities? Well, the churches, members of prior generations and others embracing unfashionable family values, all knew; actually, they merely did not forget what everyone used to know.
The only positive outcome of the crisis of the family which threatens society’s very foundation is that it serves to focus attention in a way that volumes of moral rhetoric never could. Church leaders, brave policymakers, and many concerned parents are no longer alone in identifying teenage promiscuity as a cause for concern. Whereas the bolder leaders of the sexual revolution may have once hailed extramarital pregnancy as a sign of liberation from outdated restraints, witness the Murphy Brown controversy, the drug abuse, poverty and violence that have all been shown to be driven partly by teenage pregnancy, and resulting single parent households have succeeded in converting them where moral arguments failed. Yet, modern liberalism’s fear of moving beyond formal autonomy to a content-filled morality, prevents it from adequately handling this crisis which is already overwhelming society’s attempts at containment.
America’s current obsession with separation of church and state interpreted to protect the latter from any influence from the former, has resulted in sexual education classes which, a la Jocelyn Elders, seem more concerned with teaching technique than prevention. Unsurprisingly, these classes, which focus on how to rather than whether to, reinforce rather than deter the behavior which justifies their existence. The Eagle Forum, a conservative group headed by Phyllis Schlafly, which promotes abstinence, has sponsored research indicating that promiscuity actually increases as a result of traditional sexual education classes. The offered explanation is that individuals, especially impressionable teenagers, are more likely to experiment with an activity after being warned of its attraction and dangers; similarly, the incidence of individuals riding motorcycles without helmets as well as individuals riding with helmets, increases after mandatory safety classes. Sexual education classes may be effective at convincing more teenagers to practice safer sex, but they also encourage more unprotected sexual activity.
Another contributing factor is that emboldened teenagers, no longer fearing sexual diseases or pregnancy, feel free to experiment sexually. Sexual education classes may heighten already present feelings of invincibility and curiosity in teenagers. Recent research by the Centers for Disease Control and Prevention on about a dozen randomly selected courses, showed that over half are not successful at reducing “sexual risk taking.” Such studies affirm what conservative activists have long believed, namely that sexual education classes are justified more by political beliefs than results. Yet, many policymakers will not even consider such findings, nor the accompanying studies concerning the efficacy of 100 percent abstinence problems, when approving and funding new programs.
While many dispute the credibility of the Eagle Forum’s research, it is obvious to all that the current approach is a dismal failure. Despite the best efforts of the contraception industry, one in seven teens actively carries a sexually transmitted disease, and 40 percent of all American women become pregnant before the age of twenty. About 90 percent of these teenage pregnancies are unintended, and, historically, half have resulted in abortions. What is particularly pernicious is the ideological assumption that prevents the sexual education establishment from admitting the failure that these startling numbers represent, and even considering alternative approaches. Witness Planned Parenthood’s lawsuit in California, along with People for the American Way, against a school district for promoting abstention with out contraception.
Materials from a typical sexual education course identify the goal as “having fun without an unwanted pregnancy or disease.” Claiming that teenagers are inevitably sexually active, current courses advocate “responsible”‘ sex, defined as involving protection. Thus, parents are urged to discuss contraception at home, while teachers at school illustrate how to use and get contraceptives. Put aside for now the fact that no condoms or other forms of contraception are consistently effective at protecting individuals from disease or preventing pregnancy, with some estimates of the average failure rate as high as 10 percent. Put aside, also, the fact that teenagers are already bombarded with messages in the popular media concerning contraception and probably require little assistance in obtaining them.
How is it that many of the same individuals who are so aggressive in controlling public images of cigarette consumption, to protect children from cancer, are unwilling to display similar vigilance towards the public menace of sexual activity with multiple partners? Just as it would be ridiculous for schools to provide filtered cigarettes to reduce the incidence of lung cancer, they should also not distribute condoms as a means to control the epidemic of sexually transmitted diseases and teenage pregnancies. It is increasingly obvious why many sexual education courses currently do not result in reduced sexual activity, and the resulting decline in teenage pregnancies; they do not even identify sexual activity as the problem or abstinence as the goal. Methinks, for once, that the advocates of the sexual revolution are too modest in their ambitions; the same activists who envisioned a revolution three decades ago cannot even imagine, much less hope for, children refraining from sexual activity. Jocelyn Elders went so far as to advocate teaching children what to do in the back seat as well as the front seat of their cars.
Elders’ promotion of masturbation is the logical extension of reducing sexuality to merely a means for self-gratification rather than an expression of love and a choice with foreseeable and preventable consequences. She lost her job not for her beliefs, which are shared by her many fellow combatants in the sexual revolution, but rather for her honesty. Social activists are allowed, indeed expected, to think such thoughts, but are not allowed to speak them; while the rhetoric has turned towards chastity, the beliefs and actions remain solidly hedonistic. The amazing thing is that they manage to be surprised at the rise of teenage sexual activity as well as the consequences, that occur once they have discredited notions of shame and chastity while teaching the “joys,” but not responsibilities, of sex.
Many sexual education courses have moved beyond merely informing students about the advisability of protecting themselves, almost to the point of advocating both sexual activity and artificial contraception. Justifying their approach with the claim that no sexual-abstinence program “could prove all participants had achieved that goal,” a standard they do not adopt as their own, many educators have abandoned abstinence altogether and aim instead for the goals of delaying sexual intercourse, increasing the use of contraception, and reducing the number of sex partners. Though these goals are all noteworthy achievements, convincing junior high students to wait for two years, hailed by many as a break-through accomplishment, is hardly cause for rejoicing. Noticeably missing from public praise are the hundreds of thousands of teenagers who have committed themselves to chastity, i.e., delaying sexual activity until marriage. This movement, started in the Southern Baptist tradition and now expanded across denominational lines, is far more efficacious at protecting children from unwanted pregnancies and sexually transmitted diseases, and yet receives none of the accolades reserved for those educators who have succeeded in convincing thirteen year old children to wait until they are fifteen.
Conservatives often complain that public schools can distribute condoms, but not Bibles, and can provide abortion counseling, but not aspirin, without parental consent. Somehow, condoms and abortion survive the litmus test of multiculturalism, but the Bible does not. Seemingly, it is wrong to offend, unless one is transgressing against conservative Christians. Social activists often protest against any attempt to promote abstinence, or other concepts, such as faith and the religious basis for self-esteem, as inconsistent with the public nature of the education system. Yet, there is apparently no such concern for the contradiction between sexual education courses, the most radical of which may soon include information on homosexuality and masturbation, and the beliefs of many parents.
The current curriculum is hardly value-neutral, and often overrides the autonomy interests of various groups to promote those ideals a particular part of society deems valuable. For example, local school boards have ignored many parents’ wishes to teach both evolution, rather than creationism, and sexual education in public schools. The decision to provide condoms and abortion counseling is not an isolated example of societal values overriding parental preferences. Political fights in Texas over the content of biology textbooks and the decision by New York City officials to oust a superintendent who attempted to introduce five-year olds to the concept of homosexuality, both illustrate the fact that education involves controversial decisions about values. The question is not whether to teach values, but rather which values to teach.
Even children educated at home or at private schools are increasingly subject to standardized tests and must thus learn a body of knowledge whose composition is determined by the state. Parents whose values differ from those enshrined in formal education, are routinely frustrated by mandatory education laws and standardized curriculums supported by their own tax contributions. Society forces children to be educated according to a specific curriculum, which may be at odds with the priorities and values of the family. For activists to pretend otherwise is to unfairly constrain their opponents from advocating on behalf of their own values.
With the current tax structure, and most state laws preventing parochial and denominational schools from receiving funds available for charter schools, many parents simply have no meaningful choice. Only the most twisted logic would conclude that the separation of church and state forbids parents from spending their money to provide their children with an education which includes religious principles, and yet this situation prevails. Included as part of the secular, supposedly value-free, education provided in public schools, is the presumption that teenagers engage in sexual activity and that adults serve them best by providing easy access to contraception. True neutrality would require presenting abstinence as one choice among many, and would be akin to prescribing a band-aid for a societal crisis requiring surgery; social activists do not even go this far, but have rather thrown fuel on the fire which is consuming society.
Social activists are seemingly willing to sacrifice today’s young men and women and tomorrow’s children on the altar of autonomy. Despite the many social ills tied to the breakdown of the family unit, a crisis finally recognized by social commentators of all political perspectives, all that most sexual education has to offer are means to indulge oneself while avoiding the consequences; anything more profound would be denounced as preaching. Conservatives, especially those whose beliefs coincide with their religious convictions, are criticized for seeking to impose their views on others. Liberals are right, if not consistent, to value plurality for its broad appeal to individuals with differing fundamental commitments, lack of condemnation of unpopular lifestyles, and limitation of the state’s power to promote particular values. Neutrality prevents an overly ambitious state from interfering in the private spheres of its members’ lives. However, it is nonsensical to require society to remain silent while it is torn asunder by the aftershocks of the sexual revolution; it is even more ridiculous to mobilize society’s resources on behalf of sexual education courses which only perpetuate the problem. The resolution lies not in a libertarian protection of all autonomy interests, but rather in divorcing the connection between anti-perfectionism and absolute skepticism towards any particular conception of the good; neutrality, not millions of children, should be sacrificed.
Activists often forget that the right to choose is valuable insofar that it advances human well-being, rather than being valuable for its own sake. A state respects its members by treating them according to moral principles, rather than merely providing freedom; this is especially true in the case of children who deserve some degree of protection from their own desires. Being correct is sometimes, though not always, more important than having a choice. Surely, individuals, including teenage children, possess at least some freedom to choose invalid conceptions of the good, but such freedom does not validate mistaken choices and does not require institutional support for those choices.
Allowing an individual’s desires to be superseded for his own benefit recognizes the Platonic divide between man’s reasoning and desiring capacity; the former must control the instant gratification impulses of the latter. Though social activists routinely use reason to constrain one’s selfish interests for the common good, they make no allowance for this possibility of an individual controlling his desires for his own good. Original sin motivates man to desire goods contrary to his inherent purpose; meaningful liberty involves freeing man from such self-destructive desires rather than respecting them.
Activism’s supposed devotion to choice, which wanes when autonomy is deployed in defense of traditiona1 values, is betrayed by actions both historical and contemporary. Planned Parenthood, that paragon of reproductive choice, is historically linked with imposing its views on women of color and internationally linked with groups who have allowed, without protest, forced sterilization and even worse, in Third World countries. One need not cite past uses of birth control for the cause of racist eugenics or examples of forced sterilizations and abortions in China to demonstrate such hypocrisy. Other atrocities occur today in our own society under the guise of choice.
Despite their intense rhetoric concerning choice, many feminist organizations are curiously silent as many health care providers violate the dignity of underprivileged women. I have talked with medical students, physicians, and administrators concerning the practice of requiring women without private physicians, mainly minorities, to visit family planning clinics after giving birch. An appointment is scheduled automatically after birth; such visits have become such common practice that they are often considered the third step in a process that starts with prenatal counseling and the birth itself. This same procedure is not followed for women who can afford a private physician. It may not make economic sense for these women of limited means to have additional children, but they still deserve to make this decision for themselves and to be treated with the same respect apparently reserved for more affluent patients.
Hospitals in one predominantly Catholic state, with 60 to 70 percent of their patients Catholic, are forcing women to be counseled on artificial contraception methods without mention of natural planning. An Ivy League medical school in that same state has affiliations with all of the state’s hospitals except for its Catholic institution, which serves a disproportionate share of the impoverished population, which form the core constituency of most academic programs, partly due to its refusal to advocate abortion and artificial contraception. Even worse, many physicians aggressively recommend Norplant without disclosing its side effects; these same physicians confuse natural planning, one of the most effective forms of contraception, with its much maligned cousin, the rhythm method. These health care providers are abusing their unique positions of authority to convince poor women, often against their religious convictions, to start using dangerous and often ineffective contraception. Even Dr. Henry W. Foster, Jr., Clinton’s onetime choice for Surgeon General and hardly an opponent of artificial contraception, was quoted as claiming that “there has been a history of virtually forcing blacks to forego pregnancy through belittling, cajolery, and verbal abuse by family planners,” identifying some basis to the link between family planning and “black genocide,” and contrasting the higher priority given to providing minorities with family planning rather than health care.
Women are not the only victims of the contraception conspiracy. Medical students, especially Catholics, have been disciplined in the Observed Clinical Skills Evaluation (OCSE), a subjective evaluative process, for their beliefs. The OCSE is intended to measure the third-year medical student’s ability to interpret lab results, interview patients, and perform other basic clinical tasks. Students, competing for coveted residency spots are understandably nervous about these grades, which can greatly affect their choice of specialties. Thus, they are very responsive when their peers are marked down for using neutral, rather than demanding, language with female patients. For example, one Catholic student lost points for asking “Does contraception interest you?” rather than “Which contraception do you want to be on?”
We are, perhaps, more sensitive when such coercive tactics are deployed on behalf of abortion. For example, an instructor teaching an introductory clinical course in a state-funded medical school recently asked first-year students, on a final exam, about their feelings towards abortion. On a separate occasion, a medical school applicant was berated, not for any particular beliefs or actions, but merely for being Catholic, during an interview at one of the country’s most prominent schools. The interviewer was infuriated by a local mandate restricting abortion and vented her frustrations on the candidate. Both of these cases, shocking as they are, are similar, in that they received due attention and corrective action when brought to the attention of the proper authorities. As polarized as the abortion debate is, institutional authority recognizes, even if it often does so reluctantly the right of individuals to hold a variety of positions.
There may be relief in sight for medical students, if not the women they treat. At the aforementioned medical school, Catholic students organized a petition drive which resulted in the administration considering “cultural/religious sensitivity” training for its students, and perhaps even training in the natural planning method conducted by the local diocese. Even though such actions will not protect the patients who are less able and likely to organize, at least students will no longer have to choose between following their conscience and maintaining good grades.
Still, medical students may be winning one battle only to lose another. What the interest groups cannot accomplish through popular opinion, they are forcing through fiat, i.e., pressuring medical and legal groups. Though one could be forgiven for thinking that only the American Bar Association could simultaneously argue for choice and against litmus tests, while denying pro-life judicial nominees its recommendation, medical groups may soon join the farcical act. In 1976, over a quarter of the residency programs in gynecology required students to learn how to perform abortions and another 66 percent offered it as an option; by 1992, only 12 percent of the programs still required the training, and almost 33 percent do not offer it as an option. Abortion-rights groups report that the number of abortion providers decreased 18 percent from 1982 though 1992, as the number of abortionists declined in 45 states; indeed, 84 percent of counties have no provider.
Despite the incessant rhetoric equating abortion with other medical procedures, i.e., those with therapeutic value, rather than admitting it is the mutilation of a human being, health care providers, normally dedicated to the preservation of and restoration of life, are simply not motivated to learn the trade. The activist response, rather than the expected respect for the choice of medical students and education institutions, has been to lobby the group that accredits medical schools to require that obstetrics training programs teach abortion skills. Students who intend to spend their professional lives participating in the miracle of birth, who are expected to expend any resource to save the lives of both mother and child, are thus forced to learn the seemingly contrary task of killing healthy fetuses. Though medical students are offered a “choice” of opting out of mandatory abortion training for “moral or religious objections,” the unprecedented action of forcing physicians choosing to specialize in a particular field to learn another unrelated specialty betrays yet again the extent social activists are willing to override autonomy to secure their agenda. Where are the self-appointed defenders of choice when the rights and interests of minority patients, medical students, and others are violated, to advance the cause of the faltering sexual revolution?
True reproductive freedom involves more than merely the right to choose abortion and contraception, and requires freedom from the manipulation of these two industries. We, as a society, and not merely as private individuals, must reject promiscuity, in favor of chastity and free ourselves from the readily apparent consequences of broken families, teenage pregnancies, widespread disease and poverty, and the more subtle objectification of the human body and sexuality which results in violence and denigration of that most sacred bond between man and woman. No individual, or society, can be considered liberated while entrapped by a mentality which necessitates sexual activity which is removed from the context of a loving, committed, and monogamous relationship, for individual fulfillment. True liberation, both for society and for women, involves a far more radical solution than the proponents of the sexual revolution are willing to consider, especially since it comes from religious and conservative groups. Yet, if they are really dedicated to promoting welfare rather than advancing a particular ideology, social activists should not care in whose company truth places them.
Activists often claim, through their words if not their actions, that abortion should be “safe, legal, and rare.” The same individuals now voice a desire for decreased rates of teenage pregnancy and promiscuity and the resulting out-of-wedlock births. If social activists truly are ready to join mainstream America in opposing the dramatic increases in abortions (up to 4,000 per day now) and teenage sexual activity, they should act on these beliefs by supporting programs, such as teaching abstinence and advocating adoption as an alternative to abortion, that have been shown to accomplish exactly that.
This article was published in the April, 1997 issue of Culture Wars.
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