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By Kay Steiger
January 9, 2009
Caption : The former surgeon general under Clinton weighs in on the potential battles the new surgeon general may face and where women’s health fits into the public health debate.      
Dr. Jocelyn Elders

Former Surgeon General Dr. Jocelyn Elders speaks at a celebration of the 85th anniversary of the 19th Amendment to the U.S. Constitution at the Arkansas state Capitol in Little Rock.

(AP Photo/Danny Johnston)

Appointed by President Bill Clinton, Dr. Jocelyn Elders became the first African American and the second woman to hold the high-profile position of surgeon general. Although she was widely considered a strong advocate for women’s rights and health, she only served in the position for 18 months, and stepped down after a controversy in which she said before the United Nations that masturbation is "part of human sexuality, and perhaps it should be taught." Elders earned her medical degree from the University of Arkansas Medical School, where she serves as professor emeritus in pediatrics today. Elders spoke with Campus Progress about her experience as surgeon general, the role of reproductive and sexual health in the overall health care debate, and the battles the new surgeon general, likely to be CNN’s Sanjay Gupta, may face.

Campus Progress: Why don’t you start by talking about your time as a surgeon general and what was going on in terms of sexual health at the time?

Jocelyn Elders: Let me just start out by saying that I really enjoyed being surgeon general, but there was so much going in regards to sexual health. Not just reproductive health but sexual health. You have to remember we had the AIDS epidemic coming out at that time. Our teenage pregnancy rate had reached a peak. And then there were concerns about our funding of reproductive health for poor women. We were fighting about the abortion issue, so we had just loads of issues related to reproductive health going on.

I was personally very concerned about what was going on with our adolescents in terms of having the highest teenage pregnancy rate in the industrialized world, we had one of the highest abortion rates, and we didn’t seem to want to educate our children. We had been able to show that condoms were certainly protective against HIV disease, protective against pregnancy and many other sexually transmitted diseases, but you know nothing is 100 percent. We were all fighting those battles. That was kind of the environment which I felt I went into. There was obviously the religious right who was out there who felt very strongly, as they still do, just the opposite. So I had to fight through all of that.

CP: It seems like you were in a similar position that Sanjay Gupta—if selected and confirmed—will be in. There’s a large battle about health insurance and health care going on. He might, as you did, try to sell health care reform to the public in addition to addressing some other public health concerns.

JE: I think that’s absolutely true. You have to remember that we were trying to get through the Clinton health plan at the same time. There were just multiple issues that were going on at that time. I think Dr. Gupta has been out there working very hard trying to communicate with the American people. I think he would be an excellent communicator. He was a White House Fellow for a while. Obviously he’s a neurosurgeon so he understands medicine. I’m not sure he understands prevention as well, but he has 6,000 public health people who will be working for him who are the best in the world. So he can get that. I think that at this time he would really be a good choice. I don’t know what his major interest would be, but all surgeons general have to deal with major problem that’s in the country at time. To me the major problem that we have in this country is that we have the very best sick care system in the world, we just don’t have a health care system. We need to work really hard to try to get health and health care for all of our people.

Everybody knew when I came to Washington that I was interested in reducing teenage pregnancy, that I was very into reproductive health. That didn’t mean I didn’t work on anything else because I was very interested in trying to get our health care reform passed. In terms of reproductive health, I think America has learned a lot. I think we’ve come a long way. We’ve reduced teen pregnancy. We’ve reduced the number abortions. Our politicians are beginning to understand that the best way to prevent unplanned pregnancies and prevent abortions is to prevent unplanned pregnancies. So let’s deal with the real issues that are out. They can’t control reproduction if they can’t control their life.

CP: In the past decade there’s been a big push to fund abstinence programming, but now more and more states are refusing those streams of funding. Do you see the pendulum swinging back toward comprehensive sexual health education?

JE: The data are in now. One of the problems in the beginning is that we didn’t have the data. But I think the data now say that abstinence-only education is not enough. We’ve got to provide more. We all talk about abstinence. We want our young people to be abstinent. We’d love for them to be abstinent until marriage. The mean age you’re getting married now is 26 1/2 years old. So, not many people are abstinent until they’re 26 1/2. Some are, but 90-plus percent are not. We know that we need more than abstinence only. I think we need comprehensive health education in our schools from Kindergarten through 12th grade.

Our infant mortality is ridiculous. Our life expectancy is far behind many other industrialized countries. Even for our white women that have the very best. All of those are factors related to the fact that we have not educated our people to be healthy. I very strongly believe in comprehensive health education. Everyone wants to say "sex education," but you know you can’t have sex education unless you have comprehensive health education. We’ve been silent on those issues. I hope we’re going to start talking about it.

CP: What kinds of reproductive health battles do you see coming up in the next few years?

JE: I would hope that we wouldn’t still be battling about reproductive health, but we both know that we will. From even the appointment of Supreme Court judges. We certainly don’t want to get involved with overturning or changing Roe v. Wade. I feel that we need to fully fund Title X, our reproductive health [funding stream], and make sure we have the availability of contraceptives to all people who need them and who want them and who would like to have them. It’s far cheaper than taking care of an unplanned pregnancy or a very low-birth weight baby.

I think we need to get over our ideas about how condoms will break. We know condoms will break, but the vows of abstinence break far more frequently than latex condoms. We need to have our young people understand the importance of using contraceptives if they aren’t planning a pregnancy. So I think that will be a battle. I think comprehensive health education may still be a battle. I feel very strongly that women should have the right to the contraceptive of their choice. I feel the morning after pill should be available over the counter. There’s a need for them. We need to keep trying to develop newer and better contraceptives. Obviously we don’t have a perfect one yet. The ones that are out there don’t suit everybody’s needs.

CP: What about the potential battle over repealing the Hyde amendment. Do you think that will ever happen?

JE: I should hope so. I think that was a terrible, terrible amendment. The only [people] it hurt [were] the young and the poor. I feel like we’ve abused—and I mean abused—our young and disenfranchised poor women in America. It speaks to me a lack of respect for our women. I definitely feel the Hyde Amendment should be repealed. I feel we should fully fund Title X.

CP: Do you have anything else you want to add?

JE: Anything you can do to help us move the women’s rights, women’s health care—when we talk about health care, it’s women who suffer the most—to move that forward and I think reproductive health is part of women’s health, but it’s not the whole part. Whatever we can do to put women in charge of their own reproduction will improve health of our society.

Kay Steiger is an associate editor of Campus Progress.

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