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Alexandra M. Lord, Condom Nation: The US Government's Sex Education

Campaign from World War I to the Internet

Article  in  Social History of Medicine · November 2010

DOI: 10.1093/shm/hkq061

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Social History of Medicine Advance Access published November 8, 2010
Social History of Medicine page 1 of 2

Focus on Sex and Sexuality

Alexandra M. Lord, Condom Nation: The US Government’s Sex Education

Campaign from World War I to the Internet, Baltimore: Johns Hopkins University
Press, 2010. Pp. xi + 224. $40. ISBN 978 0 8018 9380 3.
News that Bristol Palin, eldest daughter of former American Republican Vice-Presidential

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‘family values’ candidate Sarah Palin, abstinence ambassador for the Candies Foundation
and unwed teenaged mother, will wed Levi Johnston, self-proclaimed redneck, Playgirl
coverboy and father of her young son, led comedian Jay Leno to quip of the nuptials:
‘Rumor is that Bristol has asked Levi to wear his camouflage hunting vest—which
would be the closest he’s ever come to wearing protection of any kind’ (http://content.
usatoday.com/communities/entertainment/post/2010/07/jay-leno-offers-up-some-bristol-
palin-jokes-/1 accessed 20 July 2010). Readers of Alexandra Lord’s Condom Nation will
not consider the Palin–Johnston saga mere comedic fodder. They will likely treat it as
an illustration of the one-step-forward-two-steps-back approach to sex education the
American government has taken over the last century.
Lord, a historian who worked for the federal Public Health Service (PHS), has written a
sweeping account of PHS attempts to use sex education to combat sexually transmitted
diseases and unwanted pregnancy. PHS origins lie in the Marine Hospital Service, treating
sailors, tracking epidemics and researching communicable diseases. Women social refor-
mers influenced the PHS’s early sex education programmes. These were directed at boys
and men and focused on protecting the family. The PHS next took up the goals of the
American Social Hygiene Association (ASHA), which included removing the silence sur-
rounding venereal diseases, studying their causes and effects and bringing sex education
into schools.
Due to venereal infection in army recruits, the PHS launched a ‘People’s War’ at the end
of the First World War using pamphlets, exhibits and films to alert the general public to the
perils of venereal disease. These materials emphasised the importance of wholesome
activities and abstinence as good sex education. During the interwar years, the PHS
under Surgeon General Thomas Parran, came to deal openly with venereal disease,
even recommending condoms against venereal infection. Throughout, the PHS tapped
into long-held notions that women, immigrants and African Americans were responsible
for spreading venereal disease because they were more sexually promiscuous. Notor-
iously, in the 1930s, PHS employees embarked upon the Tuskegee Syphilis Experiment.
Intended to observe the progress of untreated syphilis in poor black men from rural
Alabama, the Experiment lasted until the 1970s. It was riddled with ethical breaches.
The men were not asked for their consent, they were never correctly informed about
their own health and they were never properly treated even when penicillin became avail-
able as the definitive cure for venereal disease.
During the Second World War, the PHS, the ASHA and the armed forces joined
together in encouraging testing and treatment for venereal disease, suppressing prostitu-
tion and promoting sex education. The armed forces pushed the message of abstinence

© The Author 2010. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
All rights reserved.
Page 2 of 2 Focus on Sex and Sexuality

but also provided soldiers with condoms. The PHS had some luck implementing sex edu-
cation in schools. Yet the notion that students might practise what they learned meant
that the PHS focused not on condoms but on preaching abstinence until marriage and
strengthening the family life of youths. After the war’s end, the PHS grew concerned
with the high rates of venereal disease and unwanted pregnancy among teenagers.
Despite evidence of the gap between sexual values espoused and actual sexual behaviour,
the use of penicillin to cure venereal disease and the growing acceptance of contracep-
tives (albeit illegal), the PHS recycled its abstinence message.
Lord’s book is not just about the relationship of condoms to sex education but about
the ways in which PHS-initiated sex education programmes have often been condemned
to failure by a conflation of medicine and morality, an ethnically diverse population,
racism, religious conservatism, spotty private, community and public partnerships,
budget cuts, the lack of universal health coverage, conflicting local, state and federal pri-

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orities and by the fear of government control over citizens’ private lives. The
coming-of-age of baby boomers in the 1960s and 1970s, a putative population explosion
in the developing world, a sexual revolution and the legalisation of contraception and
abortion led the PHS to move toward comprehensive sex education that includes infor-
mation about abstinence, monogamy, contraceptives, homosexuality and the prevention
of sexually transmitted disease and unwanted pregnancy. But with the rise of the Reli-
gious Right in the 1980s, politicians moved against comprehensive sex education and
towards abstinence-only sex education even when faced with a new and deadly epidemic
of sexually transmitted disease, HIV/AIDS. Lord shows that the path to the White House is
strewn with Presidents who catered to the Religious Right to win votes despite the fact
that their personal lives and/or belief systems contravened its stringent family values
codes. Under Ronald Reagan, funding for comprehensive sex education declined while
funding for religious groups promoting abstinence-only education increased. George
H. W. Bush rejected his previous support for contraceptives. Bill Clinton bowed to pressure
and fired Jocelyn Elders, the first African American and the second woman to hold the
post of PHS Surgeon General, for her outspoken support of condoms, comprehensive
sex education and masturbation. George W. Bush increased abstinence-only sex edu-
cation funds further, leading to the development of pedagogical materials of dubious
scientific merit. The end result, Lord notes, is that as of 2005 the United States had the
highest rate of teenage pregnancy in the industrialised world.
Lord’s book can be read as a twentieth-century primer on the PHS’s sex education cam-
paign. It can also be understood as a cautionary tale of social engineering. Ultimately, all
sex education programmes aim to regulate the sexual behaviour of individuals for the per-
ceived benefit of society. Nevertheless, the millions of dollars poured into abstinence-only
sex education programmes neither deterred Bristol Palin and Levi Johnston from having
sexual relations before marriage nor from becoming unwed teenaged parents. In the
end, supporters of abstinence-only sex education may be undone not by those who
demand comprehensive sex education but by the sexual behaviour of their very own
children.
Christabelle Sethna
University of Ottawa
doi:10.1093/shm/hkq061

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