It is understandable that condom availability programs in public schools have become lightning rods for controversy. These programs touch on issues of private morality versus public policy, not to mention important questions pertaining to the rights of parents, the health of young people, and the role of the state. However, the bigger issue remains the very problems that condom availability programs are designed to address: namely, STIs and teen pregnancy. Condom availability programs are a potentially very useful tool with which to combat these problems, and the arguments against such programs prove to be remarkably unfounded, either logically or morally.
Condom availability programs were originally implemented in public schools in response to a widespread and worrying (from a public health point of view) trend: a lack of condom use among adolescents (Institute of Medicine [IM] 141). According to the Institute of Medicine, high schools constitute ninety-two percent of the “431 schools in 50 school districts in 21 states” that have undertaken such programs (141). In Los Angeles, New York City, and some other major cities, these programs have been implemented as part of city-wide initiatives aimed at HIV prevention (141). Predictably enough, such efforts in New York City met with parental lawsuits, raising what is easily the most fundamentally important question about these programs: do they violate parental rights? (Schwab and Gelfman 238). The parents won on appeal, but this decision was appealed to an appellate court, which ruled that the programs constituted a health service (238).
Importantly, however, the court also prescribed a crucial remedy to the problem of whether or not these programs violate parental rights: the court stipulated that the schools had to offer an “opt out” proviso (Schwab and Gelfman 238). The idea is simple: if a parent does not want their minor child to receive free condoms at school, they need but notify the school to opt out (238). If the school receives no such notification, the student will be allowed to participate (238). In all fairness, this does place the onus on the parent to make an affirmative statement: the student is assumed to be allowed to participate in the program, unless/until the parent takes some action to bar participation (238, 242). However, again, the parent does have the option to opt out, and the service being provided serves a very real public health need. As such, participation is voluntary—it is not mandatory.
Thus, although publically-funded schools are playing an activist role in distributing condoms, what they are not doing is requiring participation: no student has to take the condoms, and no parent has to allow their student to be able to take condoms. Moreover, as Schwab and Gelfman point out, as things stand now, in most states it is the case that if a female minor becomes pregnant, she has the choice on whether or not to terminate the pregnancy (242). Kansas is an exception, though even Kansas provides for a female minor to be able to give consent “’to the furnishing of hospital, medical and surgical care related to her pregnancy’” in the absence of a parent or legal guardian (qtd. in Schwab and Gelfman 243).
An important point here is, again, that STIs/STDs and teen pregnancy are very real and very serious issues. This is a point that bears ample reiterating, particularly in the face of the reasons given by the opposition to condom availability programs. According to Eisner, no less an authority than the American Academy of Pediatrics recommends making condoms available to high school students, precisely because of high rates of STDs, as well as teen pregnancy. And as Schmiedl explains, condom availability programs have successfully increased condom use among adolescents, and appear to be correlated with reductions in STDs and teen pregnancy both (18). And abundant evidence indicates that condom availability programs do not increase the incidence of sex among adolescents (18-19).
This is an important point, one that should put opponents to condom availability programs very much on the defensive—or better yet, encourage them to rethink their position: ample evidence indicates that making condoms available to adolescents does not increase their sexual activity. For example, Sellers, McGraw, and McKinley studied the effects of an HIV prevention program in Boston, Massachusetts, which was initiated in 1990 to target a high-risk population of Latino youth (1953). What they found was that in fact, distributing condoms to teenagers does not make them more likely to have sex—it just makes them more likely to have safer sex. What they found was that males in the intervention group were actually slightly less likely to engage in sexual activity, although they were more likely to have multiple partners, though this difference was very slight as well (1955). Females showed no differences between the intervention and control groups (1956).
Student responses to such programs have often been overwhelmingly positive, though they also contain some grounds for improvement. For example, Brown, Pennylegion, and Hillard conducted a study of condom availability in Seattle, Washington public schools, and found that it did improve rates of condom usage among adolescents (339). However, lack of availability was only rarely mentioned by students who gave reasons why they did not use condoms (339). Student feedback was generally positive, i.e. that the program sent the message that protection should be taken seriously (339). However, students in these schools also made the case that the condoms should be made available in private, not public, locations, and that the schools should do more to make all students aware of the availability of condoms (340).
In a study of California schools, Schuster, Bell, Berry, and Kanouse found mostly positive student responses to the condom availability programs, although there were indicators that at least a minority of the students did have some issues that needed to be addressed. Case in point is the finding that thirteen percent of respondents agreed with the statement “’having condoms available at school makes it harder for someone who doesn’t want to have sex to say no’” (693). Although seventy-one percent disagreed with this statement, nonetheless it is still suggestive of the need for sexual education programs to equip students with more than just information about how to prevent pregnancy and STDs: students must also be taught to respect themselves and others, and—crucially—how to feel the freedom to say no to sexual activity, and to respect the statements of others in this vein (693).
This takes away a major prop from the argument against condom availability programs—a major prop of the argument as constructed, that is. Condom availability programs, when effectively constructed and managed, can and do help students, and at least generally speaking they do not encourage increased sexual activity. But even if they did encourage increased sexual activity, the question then becomes, would this be an argument for in any way reducing or eliminating condom availability programs? Moreover, what about the deeper question raised by opponents of such measures, namely that teens having sex before marriage is immoral according to their own personal sensibilities?
One rebuttal to this is rather obvious, so obvious that it even made it into the decision of the Supreme Judicial Court of Massachusetts to allow condom availability programs in Boston schools: “’Parents have no right to tailor public school programs to meet their individual religious or moral preferences’” (qtd. in Weiss and Cohen 20). This is why condom availaibility programs that do not coerce parents or students to accept the condoms have an intrinsic edge over the opposition to those programs, at least politically speaking: they give students a choice, and parents a choice about that choice (20-21). As Philipson and Posner pointed out, this is, in essence, the Achilles heel of moral conservatism: the fact that “people have a smaller stake in correcting the behavior of other people than in reducing the cost of their own preferred behavior” (206). They made this point specifically in the context of the HIV/AIDS epidemic, but it has a much broader application to many societal and political issues: the advantage of condom availability programs is precisely this element of choice. If the moral conservatives get their way, no student has the choice to take advantage of free condoms in their school. If the moral conservatives do not get their way, then every student whose parents do not specifically bar them from participating has such a choice.
Another point, very much in this same vein: there is absolutely no reason not to encourage students to practice abstinence. Sexual activity is not only STD risks and pregnancy scares: it is also something of profound emotional and psychological significance. Sexual education programs should encourage students to not allow themselves to be pressured into sexual activity, and to not pressure others into such activity. They should teach the skills of refusal: how to say no, how to anticipate situations in which saying no might become a problem for any reason (parties with alcohol, for example), and how to look out for others. This is a valid thing to do for the following reasons: first and foremost, it serves a legitimate secular interest of education. It is indeed a fact that for many, many people, sexual activity has emotional and psychological ramifications, and encouraging students to not engage in sexual activity before they are ready to do so is therefore a valid educational goal in such a context.
Secondly, it is important from the standpoint of any kind of broadly-agreed upon moral stance. Here, an important contrast: teaching students that it is good to respect self and others is good ‘citizenship’ behavior, behavior that accords with the aforementioned educational aim. Moreover, sexual harassment and rape are illegal for good reason, so teaching students to avoid unwanted sexual attention or activity is itself a good. Importantly, this stance fully accommodates the conservative position on abstinence: teens from morally conservative homes simply have an additional reason not to engage in sexual activity, and hopefully they will learn a few skills for refusing any unwanted advances.
Viewed thusly, can the moral and religious convictions of some really be allowed to overrule a valid health concern to others, not to mention the moral convictions of others? After all, it is not as if this is a debate between moral people and immoral people, people without morals: at issue is the question, Should public schools be allowed to take this specific step of distributing condoms to students, in order to help reduce the rates of STDs and teen pregnancy? Whether teens having sex is ‘moral’ or ‘immoral’ in the eyes of some is not really the issue, nor is whether or not they will have more sex. That is to say, these are the issues raised by the opposition, but they are, in many ways, fundamentally beside the point.
The real point is, How can we best educate young people about sexual activity, in order to equip them to avoid the very real dangers posed by irresponsibility? The evidence is very clear that there are health benefits to condom availability programs, though they do need to be constructed in ways that optimize their efficacy. The fact that such programs maximize choice and are not mandatory is an important point against detractors. Such programs also need to be combined with comprehensive sex education, including teaching students skills for refusing unwanted sexual advances, and to respect self and others.
Brown, Nancy L., Michelle T. Pennylegion, and Pamela Hillard. “A Process Evaluation of Condom Availability in the Seattle, Washington Public Schools.” Journal of School Health, 67.8 (1997): 336-340. EBSCOhost. Web. 06 Oct. 2013.
Eisner, Robin. “Docs: Give Teens Condoms in High School.” ABCNews.com. ABC News, 04 Jun. 2013. Web. 06 Oct. 2013.
Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, D.C.: National Academy Press, 2010. Print.
Philipson, Tomas J., and Richard A. Posner. Private Choices and Public Health: The AIDS Epidemic in an Economic Perspective. Cambridge, MA: Harvard University Press, 1993. Print.
Schmiedl, Renee. “School-Based Condom Availability Programs.” The Journal of School Nursing, 20.1 (2004): 16-21. EBSCOhost. Web. 06 Oct. 2013.
Schwab, Nadine, and Mary H.B. Gelfman, eds. Legal Issues in School Health Services: A Resource for School Administrators, School Attorneys, School Nurses. 2nd ed. Lincoln, NE: iUniverse.
Schuster, M.A., R.M. Bell, S.H. Berry, and D.E. Kanouse. “Students’ acquisition and use of school condoms in a high school condom availability program.” Pediatrics, 100.4 (1997): 689-694. EBSCOhost. Web. 06 Oct. 2013.
Sellers, D.E., S.A. McGraw, and J.B. McKinlay. “Does the promotion and distribution of condoms increase teen sexual activity? Evidence from an HIV prevention program for Latino youth.” The American Journal of Public Health, 84.12 (1994): 1952-1959. EBSCOhost. Web. 06 Oct. 2013.
Weiss, Catherine, and Sherrill Cohen. “Condom Availability Programs in the Public Schools: Approved in the Courts.” Human Rights, 26.2 (1999): 19-22. EBSCOhost. Web. 06 Oct. 2013.