To the relief of many on the political left, last week's budget negotiations ended in a compromise that spared funding for Planned Parenthood. Republicans targeted the family planning agency — one of the largest recipients of Title X, the federal grant program dedicated to reproductive health services for low-income patients — because it provides abortions, among other preventive health care services. Although no federal funds under the program are used for abortion, during the tense 2011 budget talks, more than $300 million in cuts to Title X were on the line.
On Thursday, House Republicans continued the fight by voting for a stand-alone resolution to defund Planned Parenthood, a measure that the Senate promptly voted down. But as bigger negotiations loom concerning the 2012 budget and the debt ceiling, conservatives in Congress have signaled that their mission isn't over. It's a political climate all too familiar to Dr. Joycelyn Elders.
Elders, who served as the first African-American U.S. surgeon general for 15 months during the Clinton administration, was a polarizing figure during her days in Washington. Although her advocacy of condoms in high schools rankled conservatives, she shocked much of the country when she was asked, at a 1994 United Nations conference on AIDS, about promoting masturbation to prevent young people from engaging in risky sexual activity. "I think that it is part of human sexuality," Elders replied, "and perhaps it should be taught." Amid ensuing outrage, she was forced to resign.
Today Elders, 77, is a retired professor emeritus of pediatric endocrinology at the University of Arkansas who continues to address sexual health on the lecture circuit. Feisty as ever, she spoke to The Root about the current battle over women's health, why she thinks she was right in the '90s, and why she's so tired of lawmakers "playing vaginal politics" that she could "just vomit."
The Root: When you were surgeon general in 1994, Republicans had just taken over the House of Representatives with a socially conservative agenda. Watching the current debate in the House over Title X funding, are you experiencing déjà vu?
Joycelyn Elders: It certainly does remind me of that time, and it's an indication of just how far we have not come. We're still in the same spot almost. But I think today women are more aware of what's at stake, and because of that we've got to stand up and fight back, especially African-American women.
TR: What do you think is at stake exactly?
JE: If you're rich and don't have to worry about it, then nothing. Except for the fact that you will have a lot more poor, uneducated women with children to support. What's at stake is that these women wouldn't have contraceptives, we would have less STD testing, less pelvic exams, fewer cervical-cancer screenings, less breast exams, less testing for diabetes. Planned Parenthood and Title X funding goes to women's health, not abortion. The mean income for most women who go to a Title X clinic is less than $10,830 a year. That's poor.
TR: As Congress moves on to debate over the 2012 budget, it's very likely that Planned Parenthood will be on the chopping block again. Is this a mostly symbolic debate to get the Republican base revved up, with no chance of passing?
JE: Any woman who has a congressperson who votes against women's reproductive rights is headed back to the Dark Ages, when they were owned by their husbands. The fact that we have these votes [in Congress] alone is a threat. We're still fighting. We've always had to fight. It wasn't until 1965 that we had the right to even use contraceptives, and even then you had to be married and get permission from your husband.
You bright young people — and I love you — but you don't know what it was like for us old folk, when you couldn't have birth control pills, when condoms were not as readily available and we didn't have all the other contraceptives that are now on the market. I think if the women of this country — whether black, white, young, old, Democrat or Republican — cause the reproductive rights of any of our citizens to be lost, then we should never forgive ourselves.
TR: Is this an issue that you think Democrats will go to the mat for and defend?
JE: If the Democrats do not go to the mat and defend women's reproductive health, I think that the loss will be greater than the loss of their jobs next election season. As old and tired as I am, even I would go out campaigning. I think they know that, too.
TR: What are your thoughts on the budget compromise that was reached last week, in which Planned Parenthood funding was spared, but Washington, D.C., lost the right to use local money to help women access abortions?
JE: I think that's a horrible compromise. It's another blow against poor women, young women or women who have very little control over their reproductive lives. For Congress to make that kind of recommendation makes no sense. We spend $9 billion a year taking care of children born to children, and then they talk about saving money. If they really wanted to save money, we would talk about comprehensive health education and make reproductive services, including abortion, available for women.
TR: Budget negotiations aside, do you think President Obama is doing enough to address the needs of women for reproductive services and health care?
JE: I think President Obama would like to do an awful lot more than he's done, but he's burdened down with three wars, a marked decline in our economic situation and the job losses. I think he's doing the best he can.
For example, [American political leaders had] been trying for 100 years to pass a health care bill of some sort. What President Obama signed was not complete, but I was very pleased that we at least got a bill that we can improve. And legislators are still out there trying to put riders on that so that the health exchanges in the states can't offer and pay for abortions. I'm so tired of them playing vaginal politics that I could just vomit.
TR: Do you think attitudes about sexuality and contraception have evolved since 1994?
JE: I think our attitude toward sexuality certainly is evolving, and that's because more people are better educated. We were operating under a theory at that time that ignorance is bliss. Now we know that by sitting around and saying our children aren't having sex, what we're doing is sacrificing them to unplanned pregnancies, HIV and [sexually transmitted infections].
A [Centers for Disease Control and Prevention] study in 2008 said that 25 percent of all 14- to 19-year-old girls have an STI, and among black girls it's up to 49 percent. So we need to teach them how to protect themselves. Other countries can do it. Why can't we?
TR: Talking to teens about contraception is one thing. The last straw with you in 1994 was your remark about possibly teaching masturbation. I suspect that wouldn't go over much better today.
JE: I think you're right, but we're at least talking about it much more. Back then, everybody was acting like this was a word they'd never heard. Everybody does it, but nobody admits to it. If everybody in Congress who'd ever masturbated in their life would turn green, then we would have a green Congress. That's true for the whole country, and other countries, too.
TR: But given that you were the surgeon general in the midst of a culture war in Washington, did you ever think about toning down your ideas to avoid potential backlash?
JE: No. That never occurred to me in any way, shape or form. I felt that I was a surgeon general for the people of this country, and especially adolescents. I was doing what I thought had to be done at that time to improve education and access to services for adolescent youngsters, and I think we did some of that.
There was a lot of progress made. Not as much in the area of comprehensive health education as I would have liked, but I think we made progress in other areas. Over the past 20 years, teen pregnancy has dropped by almost 40 percent.
TR: What do you make of your firing then?
JE: I feel, even to this day, that President Clinton didn't have any real problems with anything I said or did. I feel that he was trying to get some other issues through, such as improving our economic situation and the environment. If he was having to spend all of his time defending Joycelyn Elders, well, then, it was better to let me go. He knew that I was not going to change — I'd worked for him for six years [as director of the Arkansas Department of Health]. And I didn't really have any bad feelings in regard to what he did.
TR: Given that you're an older, Southern African-American woman, people might expect your attitudes toward sexuality and sexual health to be more conservative. What life experiences shaped your frank and open approach to discussing these matters?
JE: I grew up in a small, rural farming community, and nobody ever talked to me about sex or sexuality. My parents didn't sit me down at the kitchen table, but they demonstrated to me all the time the importance of honesty, integrity and treating everybody right. That was demonstrated to me every day in everything they did.
I realized as I got older how much I didn't know. But my thoughts about women's health come from the values that I grew up with. Reproductive rights are just an extension of every other kind of justice and right there is.
Cynthia Gordy is The Root's Washington reporter.