When I hear that New York City has mandated that sexual education be taught in all middle schools and high schools, as a doctor, I can appreciate the motivation behind the mandate. Teen sexual behavior and risk-taking is a serious problem with serious consequences.
But when I see that the content involves a token nod to abstinence and an emphasis on “safer sex” practices, I’m reminded of a saying made popular by Alcoholics Anonymous: “The definition of insanity is doing the same thing over and over again but expecting different results.”
Graphic sex education inside and outside of the schools, which teaches kids about the risks of early sexual behavior and provides detailed information about how to decrease those risks, has been stirring controversy for more than 30 years -- but has little significant effect on outcomes.
If we really cared about protecting our teens, medical professionals, educators, politicians and parents would step back and admit that something is just not working.
I’ll never forget a patient that I cared for during my residency training -- 17 or 18 years old and pregnant for the first time, one of many pregnant teenagers who came to our prenatal clinic.
In the first trimester, we treated her for chlamydia; in the second, for genital warts. In the third trimester, we hospitalized her -- not for pregnancy complications but because she had planned suicide after being notified that the painful blisters on her private parts were incurable genital herpes.
“How could this happen to me?!” she said. “We used a condom almost every time!”
Dealing with pregnant teens and sexually transmitted diseases was part of our daily routine as medical residents. These teens received medical care an average of 15 times throughout their pregnancies.
Most of my fellow residents exerted every effort to educate them about “safer sex” and ensure that they didn’t leave the hospital after delivering their babies without having received a contraceptive shot, pills or condoms. Even so, a staggering number of these girls returned to our prenatal clinic within six months -- pregnant with their second or third child.
Most teenagers that I’ve cared for know about sex, condoms and birth control -- and have ample access to it. They know where to get it, when to use it and what can happen if they don’t. Yet teen pregnancy rates remain unacceptably high; sexually transmitted diseases in some major cities are epidemic.
In medicine, sometimes what is needed is a paradigm shift -- not just small changes but a radical re-evaluation of the problem and the assumptions and presuppositions relating to it.
If we had the courage to look honestly at teen pregnancy, we wouldn’t be satisfied with a mandate that does the equivalent of placing a tiny band-aid on a gushing artery. If we had the courage to admit that we don’t have a solution, we’d be unwilling to spend more money on an old model that has pretty much failed.
If we had the courage, we’d challenge our preconceived ideas about teenage behavior and sexuality and would go back to the drawing board.
Could it be that teens really are capable of self-control, moral decision-making and goal-directed behavior? That teens would adopt healthier behaviors if they got a consistent message from parents, teachers, doctors and the media that risk-avoidance, rather than simply risk-reduction, is possible and would maximize their happiness? Could it be that we -- the adults who discount their potential for acting with integrity and maturity -- are part of the problem?
In every other public-health intervention, an ideal is promoted: no-smoking campaigns, no-soda-drinking campaigns. Why not in the area of teen sexuality?
I don’t believe that this mandate springs from some hidden agenda to increase teen sexual behavior by saturating them with information about sex. It isn’t part of some hidden plot to undermine society or the rights of parents or religious organizations. I just believe that it isn’t going to work -- and that our teens will continue to pay the price for our lack of courage.
Anne Nolte practices family medicine in Manhattan.
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