Alexandra M. Lord. Condom Nation: The U.S. Government's Sex Education Campaign from World War I to the Internet. Baltimore: Johns Hopkins University Press, 2010. xi + 224 pp. $40.00 (cloth), ISBN 978-0-8018-9380-3.
Reviewed by Tamara Myers (Department of History, University of British Columbia)
Published on H-Education (May, 2011)
Commissioned by Jonathan Anuik
In Condom Nation, Alexandra M. Lord explores the Public Health Service’s (PHS) often frustrated and many times cowardly and inadequate attempts to eradicate sexual illiteracy in the United States. Over the course of the twentieth century, government officials mounted various sex education campaigns, usually with an ambition to eliminate venereal diseases (VD). Teaching the public how to avoid contracting VD required straight talk about sexuality and ran contrary to political expediency. This resulted too often in campaigns advocating twin lofty and unrealistic goals: chastity and fidelity. Strong ambivalence toward sexuality outside of wedlock and the role of the federal government in private lives stymied the possibility of sex education effectively combating sexually transmitted infections (STIs) and reducing teen pregnancy, a social problem that exploded in the latter half of the century. As Lord shows, reducing sex education to a public health issue outside a preventive medicine framework and without addressing broader issues of sexuality had serious consequences. If only the United States had truly been a condom nation.
Sex education is a huge subject, as Lord acknowledges, encompassing politics and policy; social and sexual mores; teenage sexuality and attitudes toward it; race, class, and gender relations; sexual orientation; schooling; public health and disease; birth control and abortion; and so on. A rich historiography covering these subjects can be found among historians of sexuality, of education, of public policy, and of adolescence. Lord contributes her share, not by challenging previous works but by adding a survey of federal policy over the course of the twentieth century, most often being an exploration of the federal government’s PHS and the attitudes and actions of the surgeons general on the subject of sex education. This approach is the book’s strength and also its weakness. As a broad survey of federal public policy Condom Nation provides readers with a solid understanding of the goals and limitations of sex education campaigns that were initiated from the top. As readers, we gain a good understanding of the problems of trying to implement policy on such a hot-button issue and how local initiatives reflecting the biases and political realities of communities could thwart the original goals of the programs. We are left wondering about several issues, including how were the campaigns received and internalized by individuals, especially young people.
Structured chronologically from the first PHS campaign in 1918, Condom Nation charts the emergence of the federal bureaucracy to the struggles of the surgeons general to promote sex education in the late 1990s and early 2000s. She carefully describes the slowly changing programs and the content of the pamphlets, posters, and films produced by the PHS. Not surprisingly, politics and perceptions of what would offend the voting public limited the effectiveness of the campaign.
The periodization of Condom Nation is determined by the characteristics of federal policy on sex education. In chapter 2, “The People’s War, 1918-26,” Lord examines public health innovations, the construction of the problems of syphilis and “illegitimate” births, and how the campaign came to narrowly focus on raising awareness about VD. The limitation of this early phase was that it insisted that young men “Keep Fit” and embrace self-control and will power prior to, and during, marriage. Explicit materials about VD were left out at times by local communities that preferred moralizing and euphemistic messages about health and the sanctity of marriage. Lord concedes the importance of this initial campaign lay in the establishment of a method of communication for later public health campaigns. Chapter 3 looks at the expansion of the federal government under the Franklin D. Roosevelt administration and how Surgeon General Parran turned to frank talk about syphilis and gonorrhea in the late 1930s. For the first time the federal public health campaign against venereal disease, while still advocating abstinence, admitted that condoms could help prevent the spread of disease. At the local level, several cities took the lead in tackling high VD rates by opening clinics and funding treatment. Chapter 4 examines the importance of the Second World War context, showing that while general sex education programs were ineffectual in eradicating syphilis and gonorrhea, sulpha drugs and penicillin made a huge dent in the VD rates. Importantly, from the perspective of the federal public health officials, the Armed Forces provided a captive population for both the testing of VD and for sex education. Protecting young men’s bodies and health also became a priority, leading to crucial preventive measures: fifty million condoms were handed out monthly to the troops to help reduce the incidence of VD transmission. Through all of these changes, though, moralism remained strong: the message to the public and the troops contained harsh words on “promiscuity” (and women who allegedly encouraged it). Using fear (of contracting a debilitating illness) continued to be a cornerstone of sex education. In chapter 5, “False Sense of Security, 1946-59,” Lord describes how the PHS laid the foundation for the family planning programs of the 1960s and 1970s but in the short term maintained its focus on VD even while teen pregnancy rates were skyrocketing. The focus of chapter 6 is how the anxieties over population explosion and unwanted pregnancies led policymakers to finally embrace a comprehensive sex education program. Chapters 7 and 8 show how previous patterns of sex education hindered any effectual combating of the AIDS epidemic and also how the political Right challenged comprehensive sex education programs--preferring that the government stay out of people’s private lives and discourage young people from having sex. This in turn laid the foundation for the return to abstinence as a solution to STIs and unwanted pregnancies.
The premise of Lord’s Condom Nation is that despite ninety years of public policy addressing what were and are considered serious social problems--especially teenage pregnancy and STIs--conservative politics, shortsightedness, and U.S. ambivalence about sex hindered the success of sex education programs. Lord provides proof: in the late 1990s, twelve million U.S. citizens were infected annually with STIs; between 1996 and 2005 one billion dollars was spent on abstinence-only programs; and by 2005 the United States led industrial nations in teenage pregnancy. Or, consider that between 1981 and 1998, 700,000 U.S. citizens developed AIDS.
Fundamentally this book is about the power of knowledge and institutionally determined ignorance. Sexual literacy was and is power; sexual illiteracy resulted in compromised health and even death and still does. And that is why U.S. citizens consistently asked for sex education over the twentieth century. Sex education continues to be a minefield where teachers and policymakers too often subordinate science to morality’s whims. Lord’s book demonstrates that no matter how much abstinence as a moral position is preferred as a method of preventing the spread of disease and unwanted pregnancies, it is not realistic. As Lord notes in the epilogue, “Teens in abstinence-only programs had the same rates of [STIs] as those who had attended comprehensive sex education programs” (p. 189). The only difference is that the former were less likely to use condoms or seek medical treatment.
This is a highly readable study about a hot-button issue. Lord’s use of fiction and anecdotes helps to render public policy history usable and meaningful. Condom Nation contextualizes federal policies within the changing sexual mores of the twentieth century and shows how important it is to look at the story behind sex education campaigns. The story is tragic and infuriating, and all U.S. citizens should be familiar with it. Condom Nation indeed and this study could have been subtitled, “How America embraced abstinence and contributed to the devastation of citizens’ health and achieved the highest teen pregnancy rate in the industrialized world.”
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Tamara Myers. Review of Lord, Alexandra M., Condom Nation: The U.S. Government's Sex Education Campaign from World War I to the Internet.
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