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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