Will 2004 be a Pivotal Year for Sexuality in the United States? 

It seems appropriate that we are being asked to predict what might happen around sexual education, health, and rights during this coming year because 2004 marks SIECUS’ 40th anniversary as the premier organization that provides resources and promotes sound policies related to sexuality.

During these past four decades we have seen many changes surrounding sexuality that have focused on education, health, rights, and even social norms. The education community has seen both the emergence of “safer-sex” prevention initiatives and the rise of abstinence-only-until-marriage programs and funding. The public health community has seen the advent of new reproductive health technologies that allow women more flexibility in planning their families, while also witnessing the devastation caused by the worldwide HIV/AIDS pandemic. On the legal front, numerous court rulings have affected sexual rights, from the decision in Roe v. Wade allowing legalized abortion to the recent Supreme Court finding that laws banning acts of sodomy between consenting adults are unconstitutional.

Perhaps the most visible changes, however, have taken place in popular culture. We have gone from prohibiting married couples from sharing a bed on television, to reality TV couples sharing hot tubs in prime time.

Although this varied history gives us many clues as to where we might go in the coming year, there are no crystal balls. 2004 is a national election year and the futures of everything from education to rights depend heavily on which policymakers are in office. Without knowing who will win the elections, accurate predictions are impossible to make, but by looking at the recent past we can gain some insight into what might happen.

How Will We Teach Our Children?

Since 1996 the federal government has spent nearly $900 million on abstinence-only-until-marriage programs that, among other things, teach students that sexual activity outside of marriage is “likely to have harmful psychological and physical effects.” Not only are these claims unfounded, these expensive programs have never been proven effective. In fact, a recent evaluation of Minnesota’s abstinence-only-until-marriage program, Minnesota Education Now and Babies Later (MN ENABL), found that sexual activity among junior high school students that participated in the program doubled between 2001 and 2002. Specifically, the rate of those who said they were sexually active increased from 5.8 percent to 12.4 percent, and the rate of those who said they would probably have sex before finishing high school increased from nine and a half percent to seventeen percent (http://www.saynotyet.com/report.htm).

Still, in Fiscal Year 2004 the federal government is planning to spend more than ever on these unproven programs. This investment in abstinence-only-until-marriage programs is a clear indication that policymakers are allowing ideology to triumph over science—and it seems that this trend will continue. We fear that in the coming year more and more students will be exposed to abstinence-only-until-marriage programs that fail our young people by not providing information about prevention methods other than abstinence, such as condoms and contraception. Moreover, we fear that teachers and health care providers across the country will continue to tell us that students are refusing to use condoms and contraception because they have been told in abstinence-only-until-marriage programs that these prevention methods don’t work.

There is good news, however. Some states have begun to rethink their own investment in abstinence-only-until-marriage programs. Title V, one of the funding streams offered by the federal government, requires states to match every four federal dollars received with three state-raised dollars. Lawmakers in California have never accepted this money because they were unwilling to put state resources behind this unproven message. In the coming year, we hope to see additional states choose to put their scarce resources toward more effective prevention efforts.

In addition, numerous states including Arizona and Washington have introduced legislation that would require all sexuality education to be medically accurate. Although these laws cannot ensure students receive comprehensive sexuality education, they can insure that students do not receive false or biased information in the classroom. On the national level, advocates helped to introduce the Family Life Education Act. This legislation, which was first introduced in 2001, would have authorized $100 million for comprehensive sexuality education. It will be re-introduced this year in both the House of Representatives and the U.S. Senate. Recently, the states of Maine and California passed similar laws supporting comprehensive sexuality education and bills have been introduced in Illinois, Massachusetts, and Rhode Island. In 2002, ten states introduced positive bills related to sexuality education and in 2003 seventeen states did so. We hope to see this upward trend continue and look forward to more legislation of this nature.

Will We Meet the Health Needs of Our Citizens?

One of the most striking observations when we look at reproductive health in this country is the disproportionate rates of STDs, HIV, and unintended pregnancy in underserved communities and communities of color. For example, while the United States Census reports that Blacks represent thirteen percent of the population, forty-two percent of people living with AIDS in 2002 were Black. In addition, while the overall teen pregnancy rate decreased by 25.5 percent between 1990 and 1999, the teen pregnancy rate among Latinas declined only 14.6 percent during that same period.

The reasons for these disparities are clearly rooted in the complex social, economic, and political landscape of our nation and are difficult to fully understand. Still, the Centers for Disease Control and Prevention suggest several important factors including the distribution of poverty and availability and quality of health care.

Unfortunately, while the federal government has consistently increased its investment in abstinence-only-until-marriage programs, the Title X Family Planning program which provides a broad range of reproductive health care services to low-income women has been level-funded for the last four years. This at a time when states are facing significant budget crises and slashing services. Unless there is a dramatic change in the way we provide healthcare in this country, these trends are unlikely to be reversed in the coming year.

At the same time we hope to see expanded access to reproductive healthcare increase. One highly publicized example of this is the bid to make Emergency Contraception (EC) available without a prescription. In December 2003, the Food and Drug Administration’s (FDA) Nonprescription and Reproductive Health Advisory Committees voted twenty-three to four to reclassify Plan B from prescriptive to over-the-counter status.

EC is a high dose of hormones that can prevent pregnancy if taken within seventy-two hours of unprotected sexual intercourse. Since EC is more effective the sooner it is taken, it is vital that women have easy access to this form of pregnancy prevention. Many states, including Alaska, California, New Mexico, and Washington, have already taken steps to allow women to obtain EC without a prescription.

The ultimate decision rests with the Commissioner of the FDA and is expected early this year. However, it would be unprecedented for the Commissioner to reject such overwhelming recommendations. It is our hope that EC will soon become available without a prescription and that this will open the door to future decisions increasing women’s access to the reproductive healthcare they desperately need.

Are Our Rights Here to Stay?

Perhaps the hardest area in which to make predictions is that of legal rights surrounding sexuality and reproductive health. In recent months there have been many events and decisions that have the potential to impact the rights we enjoy.

On November 5th, for example, President Bush signed a bill banning so-called "partial-birth" abortions—a non-medical term coined by abortion rights opponents. The bill, passed by both the House of Representatives and the Senate in October, defines the procedure as one in which the physician performs “an overt act that the person knows will kill the partially delivered living fetus.” Doctors who perform this procedure would be subject to fines and up to two years in prison. The bill does not include an exemption to protect the health of the woman.

A nearly identical Nebraska law was found to be unconstitutional by the Supreme Court in 2000 because it too lacked a health exception for the woman and because the court found the law’s language to be too vague. Abortion rights advocates maintain that the new law is unconstitutional for the same reasons. However, opponents of abortion rights point to findings in the bill that say the procedure is never necessary to protect the health of the woman and argue that the health exception test has been met.

Legal challenges have already been filed and federal judges have granted temporary restraining orders on the ban. Ultimately, a decision on the constitutionality of this law will likely have to be made by the Supreme Court.

Recently, the Supreme Court made a much-publicized decision regarding sexuality when it ruled that the Texas law banning sodomy was unconstitutional. This ruling reaffirms individuals’ rights to privacy when it comes to sexual behavior and has implications for other freedoms based on a constitutional right to privacy such as using contraception and access to abortion.

While we hope to see more positive decisions, the future of the Supreme Court is hard to predict. Votes on issues of privacy have always been very close and are subject to the current make-up of the court. Many people speculate that two or more justices may retire soon. All future decisions depend on which justices retire and who is chosen to replace them. Of course, since Supreme Court nominations are made by the President and approved by the Senate, the future largely depends on the upcoming elections.

Where Will We Go From Here?

Our society often seems like a study in contradictions. Conservative forces are proposing a constitutional amendment to ban gay marriage while at the same time the New York Times has begun to print announcements of gay unions and people across the country are tuning in to Queer Eye for the Straight Guy to watch five gay men improve the appearance, home, and etiquette of your average heterosexual male. Teen pregnancy rates are going down and fewer teens are becoming sexually active in high school while at the same time the media is constantly portraying images of teens in sexual situations and sexualizing younger and younger teens. In school students are learning that they must remain abstinent until marriage while at home they are watching Britney Spears bare almost all on MTV and following the news of her fifty-five-hour Las Vegas union. As conservative lawmakers try to argue that access to EC will increase promiscuity among women a nation of television viewers is glued to the final episodes of Sex and the City, the ground-breaking show that portrayed women’s sexuality as it had never been seen before.

While we can’t know what will happen in the next year in the fields of education, health, and rights, the phrase that keeps coming to our minds is “you cannot put the genie back in the bottle.” Regardless of election outcomes, policy actions, and court decisions, social norms are changing and the nation is beginning to reflect the beliefs on which SIECUS was founded forty years ago: sexuality is a natural and healthy part of life.

* Tamara Kreinin MHSA is the President of SIECUS (Sexuality Information and Education Council of the United States). Martha E. Kempner, MA, is SIECUS’s Director of Public Information.