WASHINGTON — In what he described as a bid to give scientific grounding to the volatile debate over sex education, the U.S. surgeon general on Thursday urged communities to provide young people with thorough and medically accurate sex education as a way to reduce unwanted pregnancies, rape and sexually transmitted diseases in the United States.
The long-awaited report from Dr. David Satcher, the surgeon general, said there was insufficient research to back claims that courses teaching abstinence until marriage have any success in delaying sexual activity among unmarried teenagers. Such programs, which account for the single largest federal effort in the field of sex education, teach that the only reliable way of avoiding pregnancy and disease is to remain chaste until marriage.
While praising the value of teaching abstinence, Satcher said youngsters also needed instruction in human sexuality. His report found no scientific grounds for fears that talking about sex in the classroom led teenagers to have sex earlier. But studies showed that when students who had taken sex education did become sexually active, they were more likely to use protection, his report said.
Satcher called on individuals and communities to respect diversity in sexual orientation, saying that there was little evidence that sexual orientation, once discovered in adolescence, could be altered later on. But he said there was proof that physical abuse, insults or isolation of young gays can undermine their mental health, sometimes resulting in depression or suicide.
He defined abstinence as celibacy outside of a "mutually monogamous relationship," not necessarily marriage.
"Every child needs to have equity of opportunity for sex education," Satcher said in an interview Thursday. "That's the point we are trying to make."
Originally scheduled for release in the fall, "The Call to Action to Promote Sexual Health and Responsible Sexual Behavior" had been nearly two years in the making. The delay in its publication fueled doubts among scientists and health professionals that it would ever come out, or that it would venture a bold stance in tackling what Satcher acknowledged on Thursday was "the most controversial and sensitive" issue he has faced as surgeon general.
While independent, the surgeon general works out of the Department of Health and Human Services. Satcher, who was appointed by President Bill Clinton, has released other reports shoulder to shoulder with President Bush's secretary of health and human services, Tommy G. Thompson, but he put forth Thursday's report independently.
The White House appeared to tread a delicate line, distancing itself from the work but not attacking it. Ari Fleischer, the White House spokesman, noted that the report was commissioned under Clinton, and he said that Bush's "overall approach on these matters focuses on abstinence, abstinence education."
The White House would not say whether it had vetted the report and referred further questions to the Department of Health and Human Services, which did not return repeated calls.
To the extent that Satcher's report took one side or another in the highly polarized issue of sex education, Satcher appeared to please scientists and health professionals with his call for frank discussion about sexuality.
Dr. Bruce Bagley, chairman of the board of the American Academy of Family Physicians, which represents 91,000 family physicians, praised Satcher's message. "Our ability to change society one person at a time is very limited," Bagley said. "The only way we're going to change approaches to sexual behavior and sexual activity is through school. In school, not only at the doctor's office."
Advocates of abstinence programs were outraged. Peter Brandt, director of issue response at Focus on the Family, a church-based conservative group, called the report "ideology disguised as science from the beginning to the end." He said it "calls severely into question the surgeon general's ability to remain the chief medical officer of the United States." Satcher's term ends in February 2002.
But several recent opinion polls show that while the vast majority of parents want schools to urge teen-agers to remain virgins, they also want schools to teach teen-agers how to protect themselves if they become sexually active.
The majority of parents who were polled said they want teachers to discuss using condoms and contraception with teen-agers, to tell them what to do if they are raped and to tell them where to go for treatment if they suspect they have contracted a disease. Three out of four parents trust schools to discuss sexual orientation with their children.
Drew Altman, president of the Kaiser Family Foundation, a non-profit research group that has done a number of surveys on sex education, said, "There is nothing in that report that isn't endorsed wholeheartedly in every survey we've done of parents.
"Out in America, parents are very practical. They wholly embrace abstinence and comprehensive sex education," Altman said. "They don't see it as either/or. Only in Washington is it either/or."