Condom Nation: The U.S. Government’s Sex Education Campaign From World War I to the Internet by Alexandra M. Lord (review)

The recent death of C. Everett Koop has brought renewed attention to the legacy of America’s most well-known Surgeon General. Selected by President Reagan for his religious bona fides as much as his medical experience, Koop confounded expectations by becoming an advocate for sex education, especially as it related to the AIDS crisis. Under his leadership, the Public Health Service (PHS) distributed a seven-page pamphlet entitled “Understanding AIDS” to every household in America in 1988—the largest mass-mailing in the nation’s history. As Alexandra Lord notes in Condom Nation, her history of the PHS’s sex education efforts, the distribution of this one pamphlet was a monumental undertaking but ultimately a successful one. An estimated 82 percent of the American public read at least some of the pamphlet, which included basic information about AIDS transmission and safe sex practices. Call centers were set up to answer any questions the public had about AIDS, and for a moment, at least, the PHS managed to facilitate a productive sexual education initiative.

Unfortunately, the “Understanding AIDS” pamphlet is only one bright spot in what is otherwise a rather lackluster list of accomplishments for the PHS’s sex education programs. As an institutional history then, Condom Nation is hampered by its focus on what was, for most of its history, a rather ineffectual institution.

The PHS’s first foray into sex education began in 1918, with the creation of a federally funded venereal disease division. But by this time, there were already several private organizations, most notably the American Social Hygiene Association, which had been working to combat venereal disease for years. As Allan Brandt has documented, medical authorities, state boards of health, and lay social hygiene reformers saturated the public consciousness with concern about the dangers of syphilis and the supposed decline of sexual morality. The efforts of the PHS, then, were a bit Johnny-come-lately and mostly functioned to bankroll the initiatives of private organizations. For example, Lord charts the PHS’s promotion of the Keeping Fit campaign, which was instituted by the YMCA. The PHS extended the reach of this slideshow beyond YMCA camps by offering financial incentives to schools and other groups that chose to use it. However, while this program reached several million schoolboys, Lord is quick to point out that the slides had little to no information about preventing venereal disease beyond vague platitudes about “self-control.”

This narrative arc repeats itself in nearly every chapter of Condom Nation: a renewed focus on eliminating sexual ignorance followed by pamphlets, films, and posters that had an indeterminate effect on the American public. Most often, the federal government was so intent on not offending anyone that their materials wound up feeling dated as soon as they were released. For example, Lord heralds Thomas Parran, who served as Surgeon General in the 1930s, for frankly discussing syphilis in popular magazines and his book, Shadow on the Land. Under his tenure though, the supposed bold new innovations of the PHS consisted primarily of newly revised pamphlets that mentioned condoms as a means of protection which by that time were already widely in use. However, these pamphlets were then not distributed as extensively as others for fear of being too controversial. Similarly, the PHS did not begin to focus on unplanned pregnancy as a part of their sexual education programs until around 1960. But as in past campaigns, the federal government mostly relied on private partnerships with other organizations to carry out the work.

Lord’s wry wit helps make this narrative interesting, but it can only do so much. She details with exasperation that the PHS’s only revisions to their 1960s era pamphlet Strictly for Teenagers were to switch out the images of teens at...