A new article in the Journal of the American Medical Association, authored by Andrea Swartzendruber, who has a master’s in public health and Dr. Jonathan M. Zenilman, calls for a national strategy for improving sexual health. The authors write:
… [T]he United States lacks an integrated approach to sexual health. Public health programs such as sexually transmitted disease (STD)/human immunodeficiency virus (HIV) prevention and family planning are categorically funded and organizationally fragmented, and federal reproductive health programs in the past decade emphasized abstinence. As a result, sexual health indicators are poor. Incidence of HIV has not decreased since the 1990s,1 and rates of STDs, unintended pregnancy, teen pregnancy, and abortion are higher than in many developed countries. “Sexual health” does not appear once in the more than 1,000 pages of the new health care legislation. Nevertheless, the public is keenly interested in sexual health, as evidenced by the uptake of recent medical advances. For example, there are an estimated 17 million prescriptions for erectile dysfunction annually, and 26 million doses of human papillomavirus vaccine have been administered since its licensure in 2006.
Building on the 2001 Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior, we propose that a framework promoting health and responsible behavior can serve as a unifying goal and improve health indicators.
This strategy includes a national public awareness campaign, integration of sexual health services into primary care, comprehensive sex ed, and ensuring funding access for sexual health services (condoms, contraception, and STD testing are issued by name).
In the conclusion, the authors argue that “Politicization of sexual health results in division, bad policy, ineffective programs, and poor health outcomes.” Exactly. Instead of paying for effective programs, funding abstinence-only education, something that has been proven ineffective. I’d love to see us adopt a national strategy that seeks to treat sexual health as part of one’s overall health instead of as a hot-button political issue.
But though investing in STD testing and awareness about more responsible sexual behavior, the study didn’t mention abortion or pregnancy care as part of sexual health care. This is the heart of the problem with arguing for better sexual health education and care. Part of sexual health education and care necessarily includes talking about unintended pregnancy and therefore abortion. As we saw with the Stupak/Nelson debate, abortion is increasingly viewed as somehow separate from other kinds of medical care. Here, it’s left out of the discussion on sexual heath.
I’m all for increasing STD testing and improving access to comprehensive sex ed and contraception. If we really tackled all that stuff in a comprehensive way and really integrated it with the rest of health care, it would have a significant impact on unintended pregnancy. But unintended pregnancy will still occur, even if we have the best sexual health education in the world.
I’m glad that these two authors are arguing for better sexual health education in such a prominent publication. And I understand why the left it out. As abortion has become so politicized, lots of serious people exclude it to avoid getting derailed into an unproductive discussion about abortion. But I want to see us get to the point where abortion access is perceived as part of sexual health — and all medical care.