America is not a "condom nation." American teenagers, for instance, have about the same rate of sexual activity as their European contemporaries. But they have a higher rate of sexually transmitted diseases, and of unplanned pregnancies, and of abortions. They aren't using condoms the way they ought. But _Condom Nation: The U.S. Government's Sex Education Campaign from World War I to the Internet_ (Johns Hopkins University Press) is the title Alexandra M. Lord has given her book (can it be that she was not only being ironic, but was punning on "condemnation"?). Condoms work, and so do IUDs or the pill or other measures if all you want to do is prevent pregnancies. That's a good thing, but the bad thing is that they keep people who enjoy sex from bearing what other people think they ought to have as consequences from enjoying sex. Americans have a split on the issue: using a condom is a responsible action, but having the sex that makes using a condom a responsible action, well, that's irresponsible and immoral. Lord, a former historian for the Public Health Service, has documented this ambivalent stance throughout her fascinating book, which surprises throughout in showing just how little sex education changed through the twentieth century, even though we profited from an increase in scientific knowledge and from improved contraceptive and prophylactic technologies.
When science began to understand the role germs played in illness, the Marine Health Service (formed by the federal government to help ill seamen) performed such non-nautical efforts as investigating dairies for typhoid. The organization became the Public Health Service in 1912. There wasn't anything controversial about the PHS fighting typhoid, tuberculosis, or malaria: they weren't connected to sex. After World War One, with growing confidence that there was effective treatment for syphilis and gonorrhea, the PHS constructed its health education against disease, not against pregnancy; babies were held to be the welcome effect of sex, which ought to happen in marriage anyway. By 1937, the PHS broke the taboo on mentioning condoms, referring to them in a short sentence in a pamphlet on syphilis and gonorrhea that explained that condoms protect both the man and the woman. The government was not interested in preventing pregnancies, and no contraceptive use of condoms was mentioned. In the years around World War Two, when soldiers were being briefed on the necessity of condoms, kids in school were not. Conservative teaching was just what was expected when C. Everett Koop was appointed by President Reagan in 1981 to be surgeon general. Progressives were worried that the born-again Koop was only there to appease evangelicals and to reverse the legality of abortions. Koop knew little about Washington, and assumed he would be able to advocate sex education any way he thought best. For the first five years of his tenure, however, he was forbidden to talk publically about the newly-understood AIDS epidemic. When unleashed, he spoke like a doctor but not the way the fundamentalists wanted him to. His 36-page report on AIDS was widely disseminated in 1986, and not only did it explain that the disease was a public menace (not just to "any one segment of society"), and that those who merely shook hands, kissed, used public restrooms, or masturbated were safe from it, it also depicted condoms and stressed their usefulness. Koop thought he was building a bridge between religion and science, but he alienated many Christian fundamentalists, who named him the "Condom King." Such fundamentalists were much more comfortable with abstinence-only programs which were pushed especially during the second Bush presidency. (The biggest news during the Clinton years, besides the education many people got about what oral sex was, was when his appointed surgeon general Joycelyn Elders publically announced that masturbation was part of human sexuality and might be a subject of classroom discussion, a harmless and correct stance that got her fired.) The medical and moral forces on the abstinence question continually talk past each other: yes, if you abstain you can never get pregnant or catch a disease from sex; but yes, people are not by nature abstinent and need other tools. Not only was abstinence stressed, there was condom-bashing that was unscientific and untrue. It isn't surprising that teens who took abstinence-before-marriage pledges broke them almost 90% of the time, but they were far less likely (perhaps because they had been told how wicked or unreliable condoms were) to use condoms. It isn't surprising that many states were refusing to accept federal dollars for abstinence nonsense.
Lord's book provides an entertaining and useful historic overview that shows, mostly, that we have not gotten far from where the PHS started. In 1918, parents and teachers were in favor of government-sponsored sex education; today, they still are. The question has always been what to teach, and it has always been colored by our worry about sex, and that young people indulge in it, and even that some of them might masturbate. If the best we can come up with after all this time is abstinence, it is hard to be optimistic that the PHS will be able to get useful scientific advice out to the public as long as conservative religious forces are holding it back.