The U.S. is in a bad way when it comes to policymaking around human sexuality and reproduction—and has been for decades. To be sure, recent developments are concerning enough. The Supreme Court seems poised to overturn Roe v. Wade, which would return abortion back to the states, half of which have restrictions already in place. There’s the potential for a federal ban on abortion, which Mitch McConnell has said is “possible” (although other GOP elected officials have emphasized that it’s a states’ rights issue). 

And this is in the context of an ongoing moral panic over trans youth. Texas Governor Greg Abbott earlier this year ordered state officials to investigate for child abuse the parents of children receiving gender-affirming healthcare (the governor’s authority to order such investigations has been challenged by a recent court ruling). A recent Alabama bill makes it a felony to practice gender-affirming medical care for minors. These are just snapshots of a broader conservative movement to keep trans people from receiving medical care and to stigmatize them. The nationwide anti-trans bathroom bill craze starting around 2015-2016 grew out of right-wing Christian activism that aimed to portray trans people as sexual predators. Right-wing activists wanted to mobilize Christian voters’ sense of “fear and disgust” of trans people. 

Add to this multiple failed conservative attempts to overturn the Affordable Care Act—which required health insurance plans to cover contraception at no additional cost—and we’re seeing an all-out assault on measures that would actually increase people’s freedom to control their own bodies and their fertility.

Meanwhile, Democrats continue to use abortion to fundraise. Democrats recently voted on legislation to codify Roe v. Wade, but this was guaranteed to fail in the Senate (and it did fail) without elimination of the filibuster. It’s hard to see this move as anything other than performative, as President Biden himself has said he’s unwilling to get rid of the filibuster even to protect abortion rights (he also made it seem like he intended to codify Roe.) 

It’s not exactly hard to be better than a reactionary right wing determined to roll back the gains made on racial, gender, and reproductive justice since the 1960s. But Democratic capitulation to conservatives’ cultural standards over the years is illustrative of what the supposedly more progressive party is willing to stand for. It also shows just how conservative our policymaking is around human sexuality and reproduction—and thus how far we have to go to achieve a leftist vision of liberating people from the stifling (and deadly) mandates of white patriarchy, heterosexual normativity, gender binaries, and family-centered sexual mores. 

Sex in America: ‘We can do it. But we can’t talk about it.’

A look at how sex education has unfolded under Democratic administrations is informative. Sex education has long been a favorite target of conservatives, who fear the erosion of family values and of anything promoting sexual activity outside the confines of marriage and heterosexuality. Nearly 6 in 10 teenagers have had sex by the 12th grade, according to recent estimates. Premarital sex is “nearly universal among Americans.” So there is a great need for adolescent sex education in the population. Yet sex education varies widely by state in terms of content and whether it’s mandated, with recent surveys indicating that only about half of teenagers receive formal sex education that meets federal government standards. The federal government has long funded (since 1981, under the Reagan administration) abstinence-only (until marriage) education, which has not only been found ineffective¹ at reducing unintended teenage pregnancies or sexually transmitted infections (STIs), but is also harmful. Such education tends to be “stigmatizing and shame-based” and has been found to promote misinformation and outright lies. As Jessica Valenti explained in 2018: 

Nearly a decade ago, I wrote a book about abstinence-only education. The lies told by federally funded “educators” to students across the country ranged from inaccurate to astounding. I spoke to young people who were taught they could be arrested for having premarital sex, and others who were warned birth control pills would make them infertile. Students in Montana were told condoms could give them cancer. A widely used textbook taught that AIDS is transmitted by skin-to-skin contact. Another said that a girl who has had sex is no longer “fresh.” Young people were given false and dangerous information about their health. These classes didn’t stop at inaccurate health information—they also promoted outdated gender roles, such as telling students that boys are wired for science while girls are “feelings” oriented and claiming that girls don’t like sex as much as boys so they need to be the ones to “put the brakes on” to stop intimacy.

Bill Clinton’s 1996 Welfare Reform Act created the federal Title V abstinence-only-until-marriage funding stream. As explained by the Sex Information and Education Council of the United States (SIECUS), a nonprofit that promotes sex education:

The creation of the Title V abstinence-only-until-marriage program marked a significant shift in resources and ideology from pregnancy prevention to promoting abstinence from sexual activity outside of marriage, at any age. The intent of Congress in drafting the provision was made clear in comments by congressional staff members who were instrumental in crafting the “abstinence education” language. They wrote that, while some might consider the standard required by the law to be outdated, it “was intended to align Congress with the social tradition … that sex should be confined to married couples.”

In 1994, Clinton forced his Surgeon General, Dr. Joycelyn Elders, to resign over (pretty reasonable) remarks she had made about drug legalization, masturbation, and contraceptives.²As a New York Times article at the time made clear, the move was intended to appease conservatives after Democratic losses in the midterm elections:

The White House today surrendered to Republican pressure by forcing the resignation of Surgeon General Joycelyn Elders, whose outspoken views about drugs and sexuality had made her the target of a conservative campaign to oust her from office. … Some moderate Democrats had also urged Mr. Clinton to dismiss the Surgeon General, adding their voices to conservative members of Congress who were mounting an active public campaign to force her from office. The decision to seize on her last transgression as the rationale for ousting her was the latest in a series of shifts to more conservative positions by Mr. Clinton and his advisers following the Republican landslide in the Nov. 8 election.

Elders had said, about masturbation: “I think that is something that is a part of human sexuality and it’s a part of something that perhaps should be taught. But we’ve not even taught our children the very basics.” (She’s right.) In a 2016 interview with Newsweek, Elders clarified that she hadn’t been promoting teaching young children how to masturbate but to be taught about it, that it is “natural and common.” She also added: “We in America can’t talk about sex,” she says. “We can do it. But we can’t talk about it.”

Silence and Shame Around Sex

I grew up in a conservative Catholic family. Nobody talked about sex except to send the message that you shouldn’t do it (outside of marriage). In public high school, I received what I would now call Condom Education. A fairly detached sports coach told us about STIs and condom use (which, in retrospect, is impressive considering that that was more than abstinence-only). But it would be untrue to say that the talk was actually about sex or human sexuality. There was no sex and no humanity there. Nothing about why a young person would want to have sex—such as curiosity, bonding with another person, or just because of a rush of teen hormones. 

Novelist Sandra Cisneros (who, like me, grew up in a conservative Mexican American family), wrote about how she grew up uninformed about sex. In her 2015 book A House of My Own: Stories from My Life, she wrote about the messaging she got regarding sex and the patriarchal expectations of sexual behavior imposed by her Catholic schooling:

What a culture of denial. Don’t get pregnant! But no one tells you how not to. If you can’t control your fertility, you can’t control your destiny. No wonder Church, State, and Family want to keep you in the dark. This is why I was angry for so many years every time I saw la Virgen de Guadalupe [apparition referring to Mary, the Virgin mother of Jesus], my culture’s role model for brown women like me. La Lupe was damn dangerous, an ideal so lofty and unrealistic it was laughable. Did boys have to aspire to be Jesus? I never saw any evidence of it. They were fornicating like rabbits while the Church ignored them and pointed us women toward our destiny—marriage and motherhood. The other alternative was putahood [to be a whore].

Cisneros wrote that this culture of denial caused her to be “as ignorant about my own body as any female ancestor who hid behind a sheet with a hole in the center when husband or doctor called.” As she posed, “How could I acknowledge my sexuality, let alone enjoy sex, with so much guilt? In the guise of modesty my culture locked me in a double chastity belt of ignorance and vergüenza, shame.”

When I read Cisneros, I realized that I, too, had been impacted similarly. Church, State, and Family had not prepared me to navigate the world as a sexually active adult. I could relate to Cisneros’s feelings of ignorance and shame.

Ultimately, Cisneros had to look beyond the confines of her upbringing to discover her own “sexual power, my sexual energy.” She had this to say about her experience with sex as an adult:

Discovering sex … was powerful in a way I couldn’t explain. Like writing, you had to go beyond the guilt and shame to get to anything good. Like writing, it could take you to deep and mysterious subterranean levels. With each new depth I found out things about myself I didn’t know I knew. And, like writing, for a slip of a moment it could be spiritual, the cosmos pivoting on a pin, could empty and fill you all at once like a Ganges, a Piazzolla tango, a tulip bending in the wind. I was no one, I was nothing, and I was everything in the universe little and large—twig, cloud, sky. How had this incredible energy been denied me!

This isn’t to overly romanticize sex (intimate partner-based violence is a major problem worldwide). Just to point out that the richness of the experience, the complexity of it, is absent from mainstream discourse about sex education. Similarly, political discourse about policies related to sex or reproduction often focuses on restricting what people can do rather than enhancing freedom and promoting positive experiences in people’s lives. Says no one: why don’t we make policies that would give people the utmost freedom to manage their fertility and keep themselves healthy, which would, coincidentally, probably lead to more enjoyable sex because people wouldn’t have to worry so much about, say, unintended pregnancies? 

Sex shouldn’t be thought of, or taught, as shameful, dirty, evil, or otherwise negative. It should be regarded (and taught and talked about) as other human experiences: complex, different for each person, something we’re all going to do sooner or later, something that is supposed to be enjoyable, and it has health (and emotional, and even economic) consequences. This is the approach we try to take in general pediatrics, my former line of work. Usually, pediatricians talk to teenagers about sex by themselves; unfortunately, this is a reflection of the way teenage sexual activity is made shameful or unacceptable in our culture, and teens often keep their sexual activity secret from their parents. It would be ideal to talk to teens and parents together; but the judgment around sex is so high that sometimes this can be destructive for the sexually active teen, who fears their parent’s response. Our culture clearly has a long way to go in de-stigmatizing sexual activity, particularly among young people.

Sex Ed and Abortion as Bargaining Chips

By the early 2000s, research started to show that abstinence-only sex education was not effective. Numerous medical and other groups now oppose abstinence-only sex education. In contrast to abstinence-only education, comprehensive sex education, according to the Guttmacher Institute,

teach[es] students about a wide range of subjects, including human development, relationships, communication and decision-making skills, sexual behavior (e.g. abstinence, sexuality throughout life), sexual health, and cultural representations of sexuality and gender. These types of curricula frame sexuality as a normal part of life—and are medically accurate, LGBTQ inclusive, and culturally and age appropriate. Evidence indicates that CSE [comprehensive sex education] programs can reduce homophobia, expand students’ understandings of gender and gender norms, decrease intimate partner violence and improve communication skills, among other benefits.

Barack Obama initially ended abstinence-only education funding in favor of comprehensive sex education. But ultimately, sex education and abortion restrictions became bargaining chips during his tenure. For instance, abstinence-only sex education funding got reinstated in 2010 during Affordable Care Act (ACA) negotiations with conservatives—even though conservatives did not support the ACA. As one article at the time asked, “Which Democrat Restored Sexual-Abstinence Program”? Funding levels have since increased over time. In 2019, abstinence-only education received $110 million in federal funding. (This may seem like a small amount of money, but why spend any money on harmful programs?)

And then abortion. There was one Republican who voted for Obama’s health care reform: Representative Joseph Cao from Louisiana. Why did Cao agree to vote for Obama’s legislation? Because Nancy Pelosi agreed to put in an amendment to restrict public funding³ for abortions: 

As the Times wrote, the move resulted from conservative efforts within the Democratic Party, not just from without:

A restriction on abortion coverage, added late Saturday to the health care bill passed by the House, has energized abortion opponents with their biggest victory in years, emboldening them for a pitched battle in the Senate. The provision would block the use of federal subsidies for insurance that covers elective abortions. Advocates on both sides are calling Saturday’s vote the biggest turning point in the battle over the procedure since the ban on so-called partial birth abortions six years ago. Both sides credited a forceful lobbying effort by Roman Catholic bishops with the success of the provision, inserted in the bill under pressure from conservative Democrats. 

Current Democratic leadership continues to flip-flop on abortion. President Biden, who ran for office on appeals to the legacy of his Democratic predecessor, dropped the Hyde Amendment (which, since 1976, has prohibited federal funding of abortions except in certain cases) from his 2021 budget—only to see it reinstated during negotiations “to appease conservative lawmakers.” As Briahna Joy Gray has pointed out, Obama had said he would codify Roe but didn’t, and House Speaker Nancy Pelosi has “seemingly worked overtime to make the Democratic Party a safe space for the anti-Roe minority.” 

Of note, House Rep. Barbara Lee (CA-13) has tried for years to end abstinence-only education funding. Senator Cory Booker (D-NJ) has introduced sex education bills over the years. (He even proposed to create an Office of Reproductive Freedom in his 2020 presidential campaign.) His 2021 bill included comprehensive sex education and an end to “harmful” abstinence-only education programs. The bill did not make it out of committee. 

In 2018, the UN put out a report recommending comprehensive sexuality education, including guidance on how to educate children as young as 5 years of age. In Sweden, education around sexuality and gender has been compulsory since 1956. According to the European Union, sexuality education in Sweden starts at age 6. As a sexuality education instructor in Sweden explained to The Guardian:

“To have fun with sex, to be a person who really wants to be alive and can say yes, and can say no, you have to know quite a lot about this, about how your body works,” says Holmström. Her own sex education was, she says, basically biology and her aim is to equip her students for the complexities of the world they live in today.

While EU member states vary in their approach to sexuality education, the approach outlined by the EU is holistic and includes psychological, social, and emotional aspects of sexuality and sexual relationships. American children ought to be receiving such comprehensive sexuality education as well.

Ultimately, there is a tendency to appease conservative sentiment around policy that pertains to sex and reproduction. Conservative ideology revolves around maintaining heterosexual marriage-based sex and binary genders, and promoting fear, shame, and disgust for behaviors outside of those boundaries. When we add to that the violence of the anti-abortion movement and increased pregnancy-related deaths from abortion bans, we can see what a nightmare our society turns into because of conservative policies and manufactured moral panics.

The advances in surgery, medicine, and pharmacology that allow us to control our fertility, our bodies, and our gender expression belong to everyone. Dr. Mark Vonnegut wrote in a recent book that healthcare, derived from scientific research and human knowledge, belongs to all of us. We need these services available for all—even for those who think they might never need them. We need (Improved) Medicare for All, which would cover contraception, abortion, sterilization, gender-affirming care, and all medically necessary care for everyone at no cost at the point of care. Those who do not want this care can opt out. We need to create a society in which we have “not merely the absence of disease, dysfunction or infirmity but a state of physical, emotional, mental and social well-being in all aspects of sexuality and reproduction.” 

We cannot allow the feigned moral smugness—and the blatant move toward social control—of conservative politicians of either party to deny people the benefits of science and medicine. We on the left need to maintain our values, not capitulate to conservative notions of gender and sexual behavior that reinforce patriarchy. Legislation ought to reflect and honor the diversity and complexity of the way in which humans experience sexuality, gender, and the desire (or not) to procreate. We cannot have a healthy society, and a free people, when we cannot control our own bodies and thus our own destiny.

1. Even on a most basic logical level, abstinence-only makes no sense. It is true that not engaging in an activity ensures that the risk of experiencing harm from such activities will be zero. But this approach would be like telling people not to drive a car so their risk of a car accident will be eliminated; or to stop eating raw spinach to fully avoid any risk of food-borne illness. You also wouldn’t keep people from learning about seat belts and speed limits and washing their produce. You would inform them of ways to mitigate harms so they can live their lives. ↩

2. Take a look at this interview with the Times where Elders discusses her support for medical abortion and condom use; the idea that legalizing drugs needed to be looked into; and her opinion that the U.S. let the AIDS epidemic get out of hand. ↩

3. Banning federal funding of abortion creates a stigma around abortion. The implication is that abortion is not a public good, not a necessity; that it ought to be paid for privately; or even that it’s a kind of indulgence. This reminds me of being reimbursed for work conferences in my former job. I could get reimbursed for flights, hotels, and food and drink—just not alcohol. Alcohol is seen as something that’s not necessary: a pleasure, an indulgence. There’s a kind of psychology of denial there. Similar with abortion. By continuing to allow federal bans like this, lawmakers continue to promote the idea that abortion is something that is nonessential or indulgent. What we need is policymaking that makes abortion universal and free, a policy that reflects the essential nature of the procedure. ↩