[Pages S8806-S8817]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

NOMINATION OF DR. HENRY W. FOSTER

Mr. KENNEDY. Mr. President, I strongly support the nomination of Dr.
Henry Foster to be Surgeon General of the United States. Earlier today,
the Senate narrowly rejected an attempt to cut off the unconscionable
filibuster being waged against him. I want to take this opportunity to
review the case in more detail for Dr. Foster.
Dr. Foster is a distinguished physician who has dedicated his career
to improving the quality of health care for women and children.
Throughout his 38-year career in medicine, he has had a substantial
influence on the quality of health care through his own practice, his
teaching, and his community leadership.
His outstanding record as a physician, community leader, medical
educator, and public servant make him superbly qualified for this
important position.
I am pleased that we have made it this far in the nomination process,
and that we are on the road to bringing this nomination up for a final
vote. But opponents to this nomination are intent on a filbuster, and
we must invoke cloture in order to get the nomination to a vote. Those
who believe that this nomination deserves a vote must vote for cloture
to make that happen.
Cloture is only the first step on the road to fairness. The second
step--the step that counts--is the up or down vote on the nomination by
the entire Senate.
Throughout this nomination process, several Republicans have stated
that, in fairness, the nomination should go before the entire Senate
for a final vote. Some Members have suggested that by allowing a
cloture vote, the majority leader will be giving the nomination the
fair consideration it deserves. They have suggested that a vote on
cloture is the same as a vote on the nomination. Obviously, that is
wrong and misleading.
Senators who feel strongly about the issue of fairness should vote
for cloture, even if they intend to vote against the nomination itself.
It is wrong to filibuster this nomination, and Senators who believe in
fairness will not let a minority of the Senate deny Dr. Foster his vote
by the entire Senate.
We do a disservice to Dr. Foster, the Senate and the Nation as a
whole by prolonging this process. The Nation has now been without a
Surgeon General for 6 months, and there is no justification for further
delay.
Dr. Foster has demonstrated his impressive qualifications, his
character, and his vision for the future of health care in this
country. During the committee hearings, he successfully put to rest the
charges attacking his character and his ability. He earned the
admiration and respect of the committee and the American public.
Dr. Foster has developed innovative and effective approaches to some
of the most difficult medical and social challenges facing communities
across the Nation today. He began his unselfish crusade early in his
career, and at every stage, he has been an inspiring example of
personal sacrifice and service to others.
During the Labor Committee hearings, Dr. Foster ran the gauntlet of
the committee and emerged with flying colors. With real and very moving
eloquence, he described his background, his career, and his vision for
the future of health care in America.
In doing so, he demonstrated his impressive qualifications for
Surgeon General, and successfully dismantled all of the objections
raised against him. Dr. Foster had the opportunity to make his case,
and he did so very well.
He developed a model prenatal care program to improve health care for
expectant mothers and their babies. He [[Page S 8807]] tried his best
to confront the problems of infant mortality, mental retardation and
birth defects by bringing comprehensive prenatal and postnatal health
care to tens of thousands of poor women.
During his 38-year career, he has been nationally recognized for his
leadership and research on sickle cell anemia, infant mortality,
adolescent health care, women's health care, and teenage pregnancy.
He has made a significant difference in the lives and futures of
those he has served throughout his career, and there is no question
that he will do the same for the Nation.
In a sense, Dr. Foster has been a pioneer all his life. In the course
of his career, he has met and mastered many difficult challenges in
medicine, and has had a positive impact in every community and every
environment he has served.
Dr. Foster was born in 1933 in Pine bluff, AR. He earned his
undergraduate degree from Morehouse College, and was accepted to
medical school at the age of 20--the only African-American in his
class.
After earning his medical degree in 1958, Dr. Foster served his
internship at Detroit Receiving Hospital in Michigan.
From 1959 to 1961, he also served as a captain and medical officer in
the U.S. Air Force, and was stationed in the State of Washington. He
came to Boston to begin his residency training in 1961, and also served
in the active Air Force Reserve during that year. In 1962 he went to
Hubbard Hospital in Nashville, TN, for 3 years to complete his
training.
He decided to begin his practice of medicine in the rural South.
During that time, few doctors set up practice in the disadvantaged
rural areas. Young, able, and well-trained in modern medicine, Dr.
Foster went to Tuskegee to work among the poor, the uneducated, and the
isolated residents living in racially divided rural Alabama.
He practiced there until 1973, when he returned to Nashville as
chairman of the Department of Obstetrics and Gynecology at Meharry
Medical College.
During his years in Tuskegee, the main local hospital served only
whites, except for a few black emergency patients who would be put in
rooms normally used as closets. So black patients often went to the
J.A. Andrew Hospital, where Dr. Foster was on duty and took care of
them.
During that time, Tuskegee suffered from a severe shortage of
doctors, and Dr. Foster filled an urgent need. Most of his patients
were poor, black women who had never seen a doctor in their lives
before being treated by Dr. Foster. Most of them lived without
electricity, a telephone, and in some cases, running water.
Many were forced to deliver their babies at home with lay midwives.
Access to prenatal care was nonexistent. Dr. Foster provided this
critical service, often in life or death situations and under the most
difficult circumstances.
Conditions such as these would be a challenge for even a seasoned
physician well into his practice.
But Dr. Foster took on this challenge at the very beginning of his
career. He took sole responsibility for patients from five counties in
rural Alabama, with a caseload well into the hundreds. He dedicated
himself to providing adequate health care to these women and their
children--sometimes delivering as many as three babies a day. The
community remembers him as the town baby doctor--a doctor who has, in
his 38-year career, delivered literally thousands of babies into the
world.
As his practice and experience grew, Dr. Foster saw first hand how
the lack of adequate health care contributed to an inordinately high
level of infant mortality in the region. To deal with this problem, Dr.
Foster applied for a grant from the Department of Health to expand the
maternity and infant care program at Tuskegee Institute, and he
directed this program from 1970 to 1973. Through this initiative, Dr.
Foster made a significant impact on the effort to reduce infant
mortality and give children a healthy start in life.
He brought together teams of doctors, nurses, social workers, and
nutrition specialists to provide comprehensive services to women and
children in rural communities. These teams worked to reach women early
in their pregnancies, and to identify those with high potential for
complications, so that they could receive proper health care throughout
their pregnancy and following birth.
In his comprehensive approach to maternal and child care, Dr. Foster
was well ahead of his time--so much so that it became a national model
for what is now known as regional prenatal care. This kind of care
involved extensive community outreach, specialized services for high
risk women, and comprehensive care for mothers and infants both before
and following birth. Very quickly, Dr. Foster became one of the
Nation's leading experts on maternal and child health.
His initiatives helped Alabama women learn to take better care of
themselves and their unborn children. He began working with the Robert
Wood Johnson Foundation to extend his health care model to other parts
of the country. In 1972, primarily because of his revolutionary work in
this area, Dr. Foster received the high honor of being elected to the
prestigious Institute of Medicine.
Dr. Foster has served on the Institute of Medicine since 1972. The
Institute was chartered in 1970 by the National Academy of Science to
promote the advancement of the health sciences and the improvement of
health care. It enlists distinguished members of the medical and other
professions in pursuit of these goals.
The Institute of Medicine is a highly selective professional body,
with only 500 regular members, each of whom must be nominated by a
current member and elected by the full membership. The institute is
governed by a council of 21 members elected by the entire membership.
In 1992, the full membership recognized Dr. Foster's distinguished
service for the institute--where he has served on numerous committees
and boards--by electing him to the council. He was elected to a second
term on the council in November 1994.
In 1978, Dr. Foster was also appointed by HEW Secretary Joe Califano
to the Ethics Advisory Board, which was created to examine the moral
and ethical questions raised by advances in medical science. Dr. Foster
was appointed as one of the board's 15 members from a large group of
nominations submitted by professional associations, scientific
societies, public interest groups, and Members of Congress.
Members of the board included such leaders as James Gather, a former
adviser to President Johnson and subsequent president of Stanford
University board of trustees; Dr. David Hamburg, a former president of
the Institute of Medicine and now president of the Carnegie Corporation
of New York; Dr. Daniel Tosteson, dean of the Harvard Medical School
for the past 20 years; and Dr. Sissela Bok, Harvard ethicist and
philosopher.
Dr. Foster is also one of 10 members who serve on the Ethics
Committee of the Nashville Academy of Medicine. The academy has over
1,400 members overall. The Ethics Committee acts as a tribunal for the
discipline of academy members when complaints are received by other
physicians concerning a member's ethical conduct.
According to the academy's executive director, Dr. Foster was chosen
by the board of directors because of his ``outstanding reputation in
the medical community.'' Dr. Foster has served on the committee for 10
years.
In the 1970's Dr. Foster also began a crusade to provide quality
health care to adolescents, whom he recognized as having inadequate
access to care or to information about their health needs. He was
chosen by the Robert Wood Johnson Foundation to direct a multi-million-
dollar grant program to increase health services for teenagers and
young men and women.
Dr. Foster concentrated on young persons between the ages of 15 and
24, who lived in areas characterized by high rates of teenage
pregnancy, violence, drug and alcohol abuse, and mental illness. Under
his guidance, 20 teaching hospitals developed comprehensive health
programs to expand services for youths in their own communities and to
train doctors and nurses in the specialized care of high risk youth.
As a result of Dr. Foster's initiative, between 1982 and 1986, these
programs [[Page S 8808]] provided health services to 306,000 young
people.
In addition, the program significantly increased the number of
professionals trained in providing health care to adolescents. Formal
training in adolescent care was given to 115 adolescent medicine
fellows, 974 medical residents, and 753 graduate trainees in nursing,
medicine, psychology, and social work.
Many of the Nation's first school-based clinics were a direct result
of this initiative. During this time, Dr. Foster began to develop his
strategy for combating the problem that presents perhaps one of the
gravest dangers to health, opportunity, and the future for adolescents
in America--teenage pregnancy.
Teenage pregnancy has become a crisis of significant proportions in
this country. More than a million teenagers become pregnant each year.
For every 1,000 women between the ages of 15 and 19, 13 become
pregnant--the highest rate of teen pregnancy in the industrial world.
In 1987, as chairman of the Obstetrics/Gynecology Department at
Meharry Medical College, Dr. Foster began a landmark effort to reduce
the rate of teenage pregnancy. He went into the community, working with
parents and community leaders in Nashville to find solutions to the
problem. He listened to teenagers themselves, and asked them what they
needed to help them do better in school, stay out of trouble, and avoid
pregnancy.
The result was the I Have A Future program, which Dr. Foster
established at Meharry Medical College in Nashville. He recognized that
school-based clinics were not easily accessible when schools were
closed, so he developed a program to reach teenagers where they live,
during times when they need it most--after school, on the weekends, and
during the summer--when they have free time, need something to do, and
are at greatest risk of getting into trouble.
The I Have A Future program targets teenagers in two public housing
developments in inner-city Nashville. It works to reduce teenage
pregnancy, while also addressing other serious problems facing inner-
city youth--drugs, violence, alcohol abuse, homicide, unemployment, and
lack of educational opportunity. The program raises participants' self-
esteem, promotes abstinence, and offers positive options to help
teenagers make sensible decisions.
One of the most important points is that the I Have A Future program
encourages teenagers to make responsible and sensible decisions. It
gives them a purpose for abstaining from sex and avoiding high risk
sexual behavior.
It raises their self-esteem and confidence. It gives them incentives
to delay early sexual involvement and childbearing, and to focus
instead on education, job skills, and personal responsibility. In
short, the program teaches teens to think hard in advance about their
choices and their future.
It offers on-going activities, such as after-school tutoring,
computer training, sports, art and dance activities, and other
recreation. Because the program is based where teenagers live, it draws
parents and communities together to provide comprehensive and
complementary services to participants, creating a stable and positive
environment.
Dr. Foster has convinced these youths that they have an opportunity
and a right to positive, productive, and fulfilling futures. As one I
Have a Future teenager said:

Dr. Foster has put excitement into learning. Learning could
be fun if you do it in a fun way. Dr. Foster is doing a good
deed by teaching kids to wait before they have sex. Dr.
Foster would rather the young kids not have sex at all,
because they still have a lot of things to look forward to in
life. The ``I Have A Future'' program teaches you that you
don't have to do what everyone else is doing.

Another teenager wrote:

I am a three-year participant in the ``I Have A Future''
entrepreneurship program. Dr. Foster's program has greatly
helped me. I have developed a positive attitude, good morals,
confidence, and the willingness to become a strong,
successful, black female through this extraordinary program.
Dr. Henry Foster is a caring, honorable man who considers the
welfare of others. He takes time out to understand and help
those who may not be as fortunate. He is an inspiration to
me.

One need only look at the results to see the program's effectiveness
in helping students reach their goals for positive futures. The program
has had a significant impact on the number of inner-city teenagers who
go to college. In 1993, nine I Have A Future participants graduated
from high school, and of this number, seven attended college and remain
enrolled. In 1994, 24 participants graduated from high school, and 16
went on to college. Another four entered the Armed Forces. The numbers
in 1995 promise to be even higher.
With the help of the program, these students have learned to overcome
the considerable barriers to achievement in their inner-city
environments. They have learned that they can achieve goals that they
once though were impossible to attain.
This program has been so successful, and has had such a powerful
impact on the community it serves, that it has been nationally
recognized as an outstanding model to combat the problems facing
American teenagers. It has won the support of prestigious national and
local organizations.
It receives funding from the Carnegie Corporation of New York, the
William T. Grant Foundation, Bill and Camille Cosby, the State of
Tennessee Department of Health, the United Way of Middle Tennessee, and
the Middle Tennessee Chapter of the March of Dimes.
The Tennessee Children Services Commission honored the program and
named it one of six model teenage pregnancy programs in the State. The
American Medical Association's National Congress for Adolescent Health
also gave the program an award in recognition of its success in
preventing teenage pregnancy.
The I Have A Future program was honored by President George Bush in
1991, who designated it as one of the Nation's Thousand Points of
Light. As President Bush wrote on March 15, 1991:

Dear Friends: I was delighted to learn of your outstanding
work in behalf of your community. Your generosity and
willingness to serve others merit the highest praise, and I
am pleased to recognize you as the 404th ``Daily Point of
Light.''
Since taking office as President, I have urged all
Americans to make community service central to their lives
and work. Judging by your active engagement in helping
others, it is clear that you understand this obligation.
We must not allow ourselves to be measured by the sum of
our possessions or the size of our bank accounts. The true
measure of any individual is found in the way he or she
treats others--and the person who regards other with love,
respect, and charity holds a priceless treasure in his heart.
With that in mind, I have often noted that, from now on in
America, any definition of a successful life must include
serving others. Your efforts provide a shining example of
this standard.
Barbara joins me in congratulating you and in sending you
our warm best wishes for the future. May God bless you
always.
Sincerely,
George Bush.

In addition to his role as a physician and community leader, Dr.
Foster has had an illustrious career in academic medicine. In 1973, Dr.
Foster became chairman of the Department of Obstetrics and Gynecology
at Meharry Medical College in Nashville, TN. As chairman and teacher,
he trained doctors to work intensively with the communities they
served--to treat the whole patient, not just a narrow specialty--to
understand the issues and attitudes of patients, and to identify the
barriers that exist to the provision of quality health services.
As a medical educator, Dr. Foster made a lasting impact on the young
physicians he trained. One of his students, now a practicing
obstetrician-gynecologist in California, wrote to the committee to
support his nomination:

I offer a unique perspective to Dr. Foster. He had a
tremendous influence on my desire to be an OB/GYN. He taught
me while at Meharry, and at our rotation at Tuskegee
Institute. His bedside manner was gentle, his surgical
technique impeccable, his empathy for these young women
having their babies exemplary. I would say it was he who had
the most profound influence on me to go into obstetrics.

This physician goes on to write:

I offer, also, a unique perspective as I was one of about
eight Caucasian students in a class of about 90 Blacks. I was
the minority. And yet, I couldn't have felt more comfortable,
mainly because of the efforts of men like Dr. Foster.
As for the abortion issue, I would only state that he was
training me right about the time Roe vs. Wade was in front of
the Supreme Court. I am sure he often saw, as I did, the
results of women taking medical care into their own hands
when abortion was illegal. They would often be left
permanently infertile, and some would even die. [[Page S
8809]]
This man is not only a good man, he is a great man. He
represents to me what every student, at whatever level they
would be at, should have--a professor who puts his arm around
your shoulder, who cares about you both personally and
professionally, who takes you under his wing; and as a
student, you are proud to be under his wing.
I have not seen Dr. Foster since I graduated from Meharry
Medical College in June of 1974, but I have often thought of
him as I have practiced medicine these past 17 years. To not
allow him to serve his country would be a greater loss for
our country than it would be for him.
Senators, don't blow it, there are too few men like him.

For the past 21 years, Dr. Foster has trained hundreds of America's
finest practitioners. He served as chairman of the Department of
Obstetrics and Gynecology from 1973 to 1990, and went on to become dean
of the School of Medicine and vice president for health services at
Meharry from 1990 to 1993. Dr. Foster served as acting president of
Meharry Medical College from October 1993 until he left for sabbatical
in June 1994. Since that time, he has been a health policy fellow at
the Association of Academic Health Centers.
Dr. David Satcher, director of the Federal Government's Centers for
Disease Control and Prevention, also served as president of Meharry
Medical College. He has testified to Dr. Foster's intellect, fairness,
integrity, and talent as a medical professional.
Among many other of his colleagues, Dr. Louis Sullivan, president of
Morehouse School of Medicine and the Secretary of Health and Human
Services under President Bush, testifies to Dr. Foster's ability,
intellect, fairness and talents as a medical professional. He writes:

I have known Henry Foster for more than 40 years since our
undergraduate years at Morehouse College in Atlanta. In each
phase of our long association, I have found Dr. Foster to be
an extremely capable scholar, vigorously dedicated to his
patients, an inspiring teacher, an innovative administrator,
and a trusted friend of young people . . . Dr. Henry Foster
would be an able, credible and trusted advocate. His warmth
and sincerity make him an ideal spokesperson for good health
and behavior change.

There is no question that Dr. Foster has devoted his life and career
to improving the health of mothers and infants, reducing teenage
pregnancy, and training skilled doctors in the responsible and
competent practice of medicine. Through his work as a physician, as a
medical educator, and as a community leader, he has made significant
contributions that have improved the lives of those he has served.
Within the field of medicine, Dr. Foster has been recognized by his
peers as a leader in his profession, a physician of unusual stature
whose judgment is trusted in dealing with the most difficult questions
of medical ethics and medical practice.
Any efforts to attack this nomination based on Dr. Foster's
credibility are dead wrong.
Dr. Foster has had an honorable and distinguished career in medicine.
He has been recognized by his professional colleagues and peers, his
community and his patients as having the highest ability, integrity and
compassion worthy of the post of Surgeon General.
Dr. Foster's vision for the health care of America is impressive,
innovative, practical, and progressive.
With this nomination, the nation has an unprecedented opportunity to
deal more effectively with some of the most difficult challenges facing
us in health care today, and to do so under the leadership of an
outstanding physician and outstanding human being, who has devoted his
life to providing health care and opportunity to those who need help
the most.
Opponents of this nomination continue to raise irresponsible
objections based on certain specific questions about Dr. Foster's
record. They have selectively chosen issues on which to base their
objections, but they refuse to tell the whole story of Dr. Foster's
commitment, credibility, and extraordinary qualifications that make him
an excellent choice for Surgeon General.
I would like to take this opportunity to address these objections
again and shed light on the facts that opponents do not want
illuminated to give the complete story on Dr. Foster's record.

The Tuskegee Syphilis study

Some opponents to this nomination allege that Dr. Foster, a black
physician in the rural South in the late 1960's, knew about and
acquiesced in one of the worst abuses ever committed by the U.S.
Government against black Americans since the Civil War. The allegation
is preposterous on its face. Dr. Foster convincingly refuted it.
The committee has documents which clearly show that Dr. Foster was
delivering a baby in a complicated procedure at the time of the meeting
he supposedly attended in 1969 between the Public Health Service and
the Macon County Medical Society.
None of the doctors at the meeting, except for one, Dr. McRae, place
Dr. Foster at the meeting. And even Dr. McRae himself has admitted that
the Federal officials at the meeting did not disclose that the patients
in the study were not being treated for their illness.
The record gives every indication that the PHS officials glossed over
the details of the study, and did not give the local doctors the true
facts. So even if Dr. Foster had been there, which he was not, he would
not have learned enough about the study to raise suspicion.
A physician named Dr. Ira Myers testified in 1974 that he had spoken
with Dr. Foster about the study. But the date of their conversation is
unclear, and there is no evidence that it occurred before, rather than
after, the public scandal first broke in 1972.
In fact, Dr. Myers has rejected efforts to twist his testimony, and
he has publicly supported Dr. Foster's recollection of their meeting.
There is ample evidence that Dr. Foster had no knowledge of the study
until it was publicly disclosed in 1972, and that, upon learning of the
study, he was outraged and called for the immediate treatment of the
surviving patients.
Although it took 8 months for the U.S. Department of Health,
Education and Welfare to provide that treatment, it is unfair to blame
Dr. Foster for HEW's delay.

the ``I have a future'' program

Some opponents of this nomination have chosen to attack Dr. Foster's
I Have a Future Program, which he started in order to combat teenage
pregnancy in the urban housing projects in Nashville in 1987.
Dr. Foster's opponents are reduced to the unseemly position of
looking for bad news with a microscope. But Dr. Foster's program has
worked. It has given teenagers hope. It helps them to make responsible
and sensible decisions. It encourages abstinence.
In establishing the I Have a Future Program, Dr. Foster went to the
families and community leaders first, and asked them what programs they
thought teenagers needed. With the help of these parents and community
leaders, he developed the program.
It gives teenagers a purpose for abstaining from sex and avoiding
high risk sexual behavior. It helps them to focus instead on education,
job skills, and personal responsibility.
In order to promote positive futures for its participants, the I Have
a Future Program provides a wide variety of training, programs, and
services. There is training in pre-employment skills; alcohol and drug
use prevention; conflict resolution and violence prevention; and family
life education.
Other activities include an entrepreneurship program, field trips and
cultural outings, after-school tutoring, sports, art, and computer
training.
The program has been criticized because it provides contraceptives to
teenagers who choose to have sex. Distribution of contraceptives
constitutes a small part of the overall program. Opponents must
recognize, however, that this is the only responsible course to take in
an environment where 74 percent of all teenagers have sex before the
age of 15, and where 91 percent of their parents asked that a teen
pregnancy program make it easier for sexually active teenagers to get
birth control to prevent pregnancy and the spread of AIDs and other
sexually transmitted diseases.
Those who say the program has been unsuccessful should talk to the
teenagers in the program. There is no doubt that they
think it works, especially when compared to their other options in the
only world they know, which is full of violence, drug abuse, schools
that to not teach, joblessness and hopelessness.

The participants are proud of their accomplishments. They have
graduated from high school. They have gone on to college. They think
they have a future--and in the real world they know, [[Page S
8810]] thinking makes it so. Dr. Foster has lit a candle in their
world--while his critics prefer to curse the remaining darkness.
President George Bush thought the program was such a success that he
designated it as one of his well-known ``Points of Light,'' a
significant national honor.

abortion

Republican opponents of a woman's right to choose are filibustering
this nomination because Dr. Foster, a distinguished obstetrician and
gynecologist, participated in a small number of abortions during his
long and brilliant career.
From the beginning, the only real issue in this controversy has been
abortion. All the other issues raised against Dr. Foster have
disappeared into thin air. They have no substance now, and they have
never had any substance. Dr. Foster has dispelled all of those
objections, and he has dispelled them beyond a reasonable doubt.
The die-hard opponents of a woman's right to choose are doing all
they can to block this nomination, because Dr. Foster participated in
this small number of abortions. But Dr. Foster is a baby doctor, not an
abortion doctor. He has delivered thousands of healthy babies, often in
the most difficult circumstances of poverty and neglect.
Dr. Foster has also been charged with misleading the public by giving
conflicting information about the number of abortions he performed.
Dr. Foster has acknowledged that he mistakenly spoke from memory in a
desire to provide immediate information. It is clear, and there is no
doubt in my mind, that Dr. Foster never intended to deceive the public.
He has since reviewed all available medical records, and has
determined the number of procedures for which he is listed as physician
of record.
It is time to end this numbers game. The most important point is that
abortion is a legal medical procedure and a constitutionally protected
right. Dr. Foster is an obstetrician and gynecologist, and it should be
no surprise to anyone that he has participated in this procedure. To
have done so is not a disqualification for the Office of Surgeon
General of the United States. There is no justification for our
Republican colleagues to try to make it one.
In my view, it is Dr. Foster's opponents who have a credibility
problem, not Dr. Foster. They pretend to challenge his credibility on
abortion, when in reality, as all of us know, they are trying to make
abortion the issue indirectly, in a way that will not embarrass them.
One need only review Dr. Foster's record for the past 38 years to see
that his integrity, honesty, and credibility are beyond reproach.
Dr. Foster is a highly qualified physician who has devoted his life
to improving health care for his patients and his community. His
integrity and ability shine through all the muck that has been raked
against him. He will serve the Nation well as Surgeon General, and he
deserves the chance to do so.
He is a talented and passionate physician, a fine human being, and a
remarkable role model of service to others. He has earned the right to
have his nomination considered by the entire Senate, and I urge my
colleagues to vote for cloture and give him the opportunity he
deserves.
I ask unanimous consent that the text of President Bush's letter to
the I Have a Future Program may be printed in the Record.
I also ask unanimous consent that a series of fact sheets on the
nomination may be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

The White House,

Washington, March 15, 1991.
Volunteers and staff of the ``I Have A Future'' Program,
Meharry Medical College, Nashville, TN.
Dear Friends: I was delighted to learn of your outstanding
work in behalf of your community. Your generosity and
willingness to serve others merit the highest praise, and I
am pleased to recognize you as the 404th ``Daily Point of
Light.''
Since taking office as President, I have urged all
Americans to make community service central to their lives
and work. Judging by your active engagement in helping
others, it is clear that you understand this obligation.
We must not allow ourselves to be measured by the sum of
our possessions or the size of our bank accounts. The true
measure of any individual is found in the say he or she
treats others--and the person who regards others with love,
respect, and charity holds a priceless treasure in his heart.
With that in mind, I have often noted that, from now on in
America, any definition of a successful life must include
serving others. Your efforts provide a shining example of
this standard.
Barbara joins me in congratulating you in sending you our
warm best wishes for the future. May God bless you always.
Sincerely,
George Bush.
____

Dr. Foster and the Tuskegee Study--Summary

In 1932, the Public Health Service (PHS) began a study of
600 black men in Macon County, Alabama, some 400 of whom had
syphilis. The disease was not infectious in the 400 men, but
held real health dangers for them. PHS assured the State that
it would treat the men, but did not, even when penicillin
became available. The men were not informed of the study by
PHS, but thought that they were being treated. From roughly
1935 to 1945, PHS actively interfered with treatment of the
men.
By the time Dr. Foster came to Tuskegee in 1965, the Study
was far different than in 1935-1945. Barriers to treatment
had crumbled, and by 1965 all but one of the men had received
treatment from some local doctor or other source outside the
Study. PHS obscured the Study, with misleading information as
to treatment and consent in medical journals and locally.
Even those providing services to PHS, such as X-rays, knew
nothing.
PHS re-examined the study in February 1969, and arranged to
meet with the local Medical Society on May 19, 1969. The PHS
officials were acutely aware of the racial aspect of the
Study, and the strong evidence is that they did not tell the
black Tuskegee physicians that they were withholding
treatment from black men without the men's knowledge or
consent, or ask the black doctors to endorse such practices.
Indeed, the evidence is that PHS told them that all of the
men had received effective treatment, and gave a report of
procedures for their ``continued'' care. Indeed, PHS finally
did begin to provide medical information about the men to
their local physicians in 1970.
One person, Dr. Luther McRae, has stated that Dr. Foster
attended the May 19, 1969 meeting. No other person supports
this recollection, and no document places Dr. Foster at the
meeting. Official state medical records provide strong
evidence that at the time of the May 19, 1969 meeting, Dr.
Foster was delivering a baby. These records are far more
reliable than the memory of Dr. McRae, whose license to
practice medicine was revoked in 1985 for the improper
distribution of controlled substances. Nor is there any
evidence at all that any Society member at the meeting ever
discussed it afterwards with Dr. Foster or any other person.
Even Dr. McRae indicates that the PHS presentation was so
unremarkable that he never mentioned it to anyone. When the
full story of black men misled and untreated came to light in
1972, the shock of Dr. Foster and the other Macon County
doctors was entirely genuine.
The other source of information about the Study was medical
articles in specialty journals unlikely to be read by Dr.
Foster. The articles are at times misleading, and in
themselves did not alert even those national newspapers
provided with copies in 1969 to the nature of the Study. To
condemn Dr. Foster on the strength of these articles would be
to condemn every member of the medical profession who
practiced prior to 1972.
____

Fact Statement

In 1932, the federal government's Public Health Service
commenced its ``Study of Untreated Syphilis in the Male Negro
in Macon County, Alabama.'' The subjects were not aware of
the purpose of the study or even that they had syphilis. The
study's purpose was to observe the effects of untreated
syphilis, not to treat it.
In February 1969, at least partially in response to
concerns about the racial, social, and moral implications of
the study, the CDC convened an Ad Hoc blue-ribbon panel to
consider whether to continue the study. At that meeting, the
panel discussed whether to commence treatment of the
untreated subjects, and devoted considerable discussion to
the fact that treatment at that point was unlikely to do much
good and might be dangerous.
They agreed to continue the study, but also to try to bring
local physicians on board. Communications prior to the
meeting as well as the minutes reflect that the CDC was
concerned that it had a potentially explosive story on its
hands, and several passages suggest that CDC doctors thought
obtaining the concurrence of the Macon County doctors would
provide protection from criticisms of the study. One comment
referred to bringing the doctors on board as ``good public
relations.''
On May 19, 1969, a meeting was held in Tuskegee, Alabama
between the CDC and some members of the Macon County Medical
Society. The CDC was represented by Dr. William J. Brown and
Dr. Alphonso Holguin. Exactly what occurred at the May
meeting is unclear, but what does seem clear is that the
briefing was relatively short--the Macon County doctors who
recall it estimate that it [[Page S 8811]] lasted between ten
and twenty minutes--and that crucial details of the study
were not disclosed.
Indeed, the Macon County doctors who recall the meeting,
never understood the single most important fact about the
study--namely that the study was designed to observe
untreated syphilis and that participants were not supposed to
be treated. Moreover, none of the doctors recalls that the
members of the Medical Society were asked, or agreed, to
withhold treatment from the subjects.
Dr. Settler, the Secretary-Treasurer of the Medical Society
in 1969, states that he remembers no discussion of treatment
and no consent by the Medical Society to continuation of a
study of untreated syphilis. In 1972, the Montgomery
Advertiser reported that Dr. Settler had informed the
Advertiser that Medical Society ``members agreed to continue
the program, but consented under the assumption that the
patients were receiving treatment for the disease. `We were
never really informed of a project in which people were not
being treated,' he said.''
The Advertiser also reported in 1972 that Dr. Brown, the
former chief of the venereal disease branch of the Center for
Disease Control, ``conceded that there might have been a
misunderstanding over certain details of the program
discussed with Macon County physicians in 1969, but there was
no intention on his or Dr. Holguin's part to mislead the
society.''
Whatever the intentions of the CDC doctors, it seems clear
that Dr. Brown's concession was accurate: there was a
significant misunderstanding between federal officials and
Macon County Medical Society members regarding the nature of
the Tuskegee Syphilis Study. Any ``consent'' by the Medical
Society to continuation of the study was based on incomplete
and inadequate information.
Who attended the May 19 meeting is also unclear. Ten
doctors have been identified by at least one person as being
present at a meeting of the Macon County Medical Society at
which a briefing on the Tuskegee Syphilis Study was
presented, but half do not remember being present at such a
meeting. Most who remember the meeting could not place the
meeting in 1969.
Of those who recall being present at the meeting, each has
memories of the meeting that differ significantly from the
memories of the others. Only one--Dr. McRae, President of the
Medical Society in 1969--says that he recalls that Dr. Foster
was present. Another recalls that Dr. Foster was not present.
Moreover, Dr. McRae recalls the presence of other doctors who
do not recall the meeting.
Dr. McRae's recollections on a number of points ranging
from how the May meeting was set up, to the nature of the
Study, to Dr. Foster's role following the public disclosure
of the Study in 1972 are all inconsistent with the facts as
established by the documentary evidence. The confusion and
mixing of memories after 26 years is not surprising.
The CDC doctors have also indicated that they believe the
local Macon County physicians must have known about the
Tuskegee Study in 1969, even without the briefing from the
CDC. But on March 13, 1969, Dr. Ira Myers, the Alabama State
Health Officer, wrote to CDC's Dr. Brown that Dr. Myers had
discussed the proposed meeting with Dr. Ruth Berrey, the
County Health Officer, ``and she knows of no opposition to
the project at this time. She feels that it is not generally
known or publicized. She doubts if the Medical Society is
aware of its existence but hopes they will be sympathetic
with the desires of the Public Health Service'' (emphasis
added). This contemporaneous evidence from a doctor who knew
the local Macon County physicians clearly refutes the
assumption of the federal officials that all the Medical
Society doctors knew about, much less understood the details
of, the Tuskegee Syphilis Study.
This is what Fred Grey, the lawyer who sued the federal
government on behalf of the Study participants, says about
the local Tuskegee doctors:
``I don't believe they were aware of the details of the
study. I think they probably were as much victims as were the
participants themselves.'' (CBS Evening News, 2/24/95)
``Our research showed that the only ones who really made
decisions were persons connected with the federal government
and the (state) health department. Our research showed that
none of the local doctors were responsible for the study.''
(The Washington Post, 2/25/95)
Broadus Butler, former President of Dillard University and
head of the Ad-Hoc Commission appointed by HEW to review the
Tuskegee Study, is equally clear that the local doctors had
nothing to do with the Study:
``What was clear from our review is that this was a federal
government study from start to finish, with no input or
participation from local Tuskegee doctors. Any effort to
assign blame to the local doctors--most of whom weren't even
aware of the study until the very end and then were not aware
of critical details--is terribly misplaced.
``There were really only two issues concerning this study:
first, whether it should ever have taken place; second,
whether it should have been stopped in the late 1940s when
penicillin became widely available. These decisions were made
solely by the federal government. By 1968, one of the study
researchers advised the team and the federal government that
treatment was no longer a viable option.'' (2/24/95)
____

Dr. Foster and His Record on Abortion

Dr. Henry Foster is one of the nation's leading physicians
and medical educators. During his 38-year career as an
obstetrician/gynecologist, he has delivered thousands of
babies and instructed hundreds of young physicians. From
1990-93, Dr. Foster served as the Dean, School of Medicine,
Meharry Medical College in Nashville, after having served as
the Chairman of the Department of Obstetrics and Gynecology
and Chief of the Obstetrics Unit of the Hubbard Hospital for
seventeen years. Before coming to Meharry, Dr. Foster served
as the Chief of Obstetrics and Gynecology at the John A.
Andrew Memorial Hospital at Tuskegee Institute, Alabama,
where he also established and was the Director of the
Maternity and Infant Care Project. In these programs and
through the creation of the ``I Have a Future'' Program in
lower-income areas of Nashville, Dr. Foster has worked to
prevent unwanted pregnancies.
Much debate over the nomination of Dr. Foster to be Surgeon
General of the United States has centered on the issue of
abortion. Critics charge that Dr. Foster has promoted
abortion, provided misleading accounts of his abortion
practices, and has encouraged the development of drugs for
abortion. This paper examines Dr. Foster's views on abortion,
his practices, and his participation in a nationwide clinical
trial funded by the Upjohn Company.

i. statements and writings

Critics contend that Dr. Foster has encouraged the use of
abortion as a contraceptive and has promoted abortion in his
speeches, writings and activities such as Planned Parenthood.
Dr. Foster has consistently advocated greater access to
maternal and child health care, particularly for low-income
communities. He also has encouraged both abstinence, as in
the ``I Have a Future'' program, and family planning where
appropriate.
However, he has explicitly disavowed the use of abortion as
a contraceptive. In a 1975 presentation entitled ``Family
Planning and the Black Community,'' Dr. Foster voiced his
belief that women should use birth control measures to
prevent unwanted pregnancies, rather than rely on abortions.
Dr. Foster also has consistently supported adequate
counseling for patients who are considering pregnancy
termination. He has vocalized the need for informed consent
for a patient to make this personal decision. As the account
of one former patient demonstrates, Dr. Foster has in fact
counseled women not to terminate their pregnancy.
Dr. Foster's association with Planned Parenthood
demonstrates his belief that Roe versus Wade struck an
appropriate balance between the state's interest in health
and the patient's interest in making a decision about her
pregnancy. Dr. Foster has repeatedly voiced his concern that
women be afforded their constitutional right to choose
whether or not to terminate their pregnancies. He has stated
that ``abortions should be safe, legal and rare.'' In a
speech to Planned Parenthood in 1984, Dr. Foster argued
against overly burdensome state-imposed barriers to access to
abortion, because they would have encouraged resort to
unsafe, clandestine abortions.
Thus, an examination of Dr. Foster's statements, writings,
and activities shows that he has supported access to
abortion, but has not promoted the procedure as a substitute
for abstinence, education or family planning.

ii. participation in abortions

Dr. Foster has admitted that he made a mistake by guessing
the number of abortions he performed without first consulting
the medical records. To rectify that problem, he asked
Meharry Medical College to search its records to determine
the number of abortion procedures that he performed or
participated in.
As the attached letter form the General Counsel of the
Meharry Medical College states, Meharry Medical College/
Hubbard Hospital searched its records and found that Dr.
Foster had performed or participated in 39 abortions during
his tenure from 1973-1990. It should be noted that this
period includes the entire post-Roe versus Wade era.
Additionally, Meharry Medical College records indicate that
for approximately three-quarters of these 39 patients,
another physician or resident participated in or performed
the abortion procedure.
The John Andrew Memorial Hospital in Tuskegee Institute has
been closed for several years and records covering Dr.
Foster's tenure were not available for a search.

iii. medical research and the upjohn study

During the 1980's, the Upjohn Company sponsored an FDA-
approved, multi-center clinical trial throughout the country
to determine the safety and efficacy of a drug--methyl ester
prostaglandin--for use in inducing abortions. Upjohn's study
tested whether administering this drug in a suppository form
could provide a safe and less expensive way of performing a
legal, medically accepted procedure.
While Chairman of the Department of Obstetrics and
Gynecology at Meharry Medical College and Hubbard Hospital,
Dr. Foster served as the principal investigator for the
Meharry site, one of numerous sites for the Upjohn study
throughout the country. The clinical trial at the Meharry
site was part of a research project conducted in an academic [[Page S
8812]] setting. All medical procedures were performed in the
university hospital. All patients were volunteers who were
legally approved for pregnancy termination in the State of
Tennessee.
The clinical trial at the Meharry site was subjected to
outside oversight and review. FDA regulations require that an
institutional review board review and approve all clinical
trials such as the Upjohn study. FDA regulations at the time
required that the institutional review board consist of lay
persons of various expertise and backgrounds. The Meharry
site had such institutional review panels overseeing the
Upjohn study.
Dr. Foster served as the principal investigator or grant
administrator for the Meharry site. Residents administered
the suppositories. As grant administrator, Dr. Foster did
have certain responsibilities. FDA regulations specify that
the duties of the investigator include ensuring the
consistency of the investigation with the FDA-approved plan
and applicable regulations, ensuring proper procedures are
followed as well as protecting the rights, safety and welfare
of those taking part in the clinical trial.
Dr. Foster published in 1985 an article summarizing the
results of the administration of the Upjohn product to a
group of 60 women who were eight or fewer weeks' pregnant. As
discussed in the article, the study criteria for success
included safety, efficacy and patient acceptability. Fifty-
five of the women had successful results measured by these
criteria; four women required hospitalization and follow up
procedures. One woman withdrew from the study.
Dr. Foster's work as the principal investigator for the
Meharry site was consistent with his responsibilities as
Department Head to allow opportunities for research into
methods for improving legal, medically accepted procedures.
Such research projects also are consistent with the standards
for accreditation of medical schools. Guidelines published by
the Accreditation Council for Graduate Medical Education
state:
``The quality of the educational experience within a
department of obstetrics and gynecology is enhanced by an
active research environment. It is highly desirable that
every program encourage each resident to be involved in a
research project.''

Additionally, these guidelines provide that teaching staff
should take part in scholarly activity, including research
projects that result in publications.
As a postscript, it is worth noting that Upjohn eventually
determined not to seek FDA approval for the drug that was the
subject of the study.
____

Dr. Foster and Credibility

Dr. Henry Foster's career in medicine has been a model of
integrity and commitment to ethical conduct.
It is, by now, well known that Dr. Foster has devoted his
38 years of practice to improving the health care of mothers
and babies, reducing teenage pregnancy and caring for those
who too often go without care.
What may be less well known is that Dr. Foster has been
recognized by his peers, time and again, as a leader in his
profession, a man of unusual stature, a physician whose
judgment is trusted in grappling with the ethics of medicine
and medical practice. If the truest test of professional
character is the esteem with which one is held by his
colleagues, Dr. Foster stands in the top rank.
The Institute of Medicine. Dr. Foster has served on the
prestigious Institute of Medicine since 1972. The Institute
was chartered in 1970 by the National Academy of Sciences to
promote the advancement of the health sciences and the
improvement of health care. The Institute was designed to
enlist distinguished members of the medical and other
professions in pursuit of these goals.
The Institute is a highly selective professional body, with
only 500 regular members, each of whom must be nominated by a
current member and elected by the full membership. The
Institute is governed by a Council of just 21 members,
elected by the entire membership.
In 1992, the full membership recognized Dr. Foster's
distinguished service for the Institute--where he has served
on numerous committees and boards--by electing him to the
governing Council. The membership elected him to a second
term of the Council in November 1994.
The Ethics Advisory Board. In 1978, then HEW Secretary Joe
Califano created the Ethics Advisory Board to examine the
moral and ethical questions raised by the historic
breakthroughs being made in the world of medical science. He
appointed Dr. Foster as one of the Board's 15 members from a
large group of nominations submitted by professional
associations, scientific societies, public interest groups
and Members of Congress.
The Board was an extraordinary collection of doctors,
lawyers, clinicians, researchers and even a leading
theologian, Rev. Richard McCormick of Georgetown University.
Members included James Gaither, a former advisor to President
Johnson and subsequent President of the Stanford University
Board of Trustees; Dr. David Hamburg, a former President of
the Institute of Medicine and now President of the Carnegie
Corporation of New York; Dr. Daniel Tosteson, Dean of the
Harvard Medical School for the past 20 years; and Dr. Sissela
Bok, Harvard ethicist and philosopher.
The Ethics Advisory Board was active from 1978 to 1980. In
1980, Congress established its own commission on medical
ethics (the President's Commission for the Study of Ethical
Problems in Medicine and Biomedical and Behavioral Research)
and the EAB's appropriations were shifted to this new body.
Nashville Academy of Medicine--Ethics Committee. Dr. Foster
is one of 10 members of the 1400-member Nashville Academy of
Medicine who serve on the Academy's Ethics Committee.
The function of the Ethics Committee is to act as a
tribunal for the discipline of Academy members when
complaints are received by other physicians concerning a
member's professional conduct.
According to the Academy's Executive Director, Dr. Foster
was chosen by the Board of Directors to serve on the Ethics
Committee because of his ``outstanding reputation in the
medical community.'' Dr. Foster has served on the Committee
for 10 years.
In short, those opponents of Dr. Foster's nomination who
pretend to base their opposition on his lack of credibility
or integrity are flying in the face of a career's worth of
honorable and distinguished conduct, recognized as such by
Dr. Foster's professional colleagues and peers.
____

Meharry Medical College,

Nashville, TN.
To Whom It May Concern:
Pursuant to a request by Dr. Henry Foster, Jr., we have
undertaken a search of the medical records of Meharry Medical
College pertaining to operations performed by Dr. Foster
during the years 1973-90. Our records indicate that Dr.
Foster participated in or performed 39 abortions, not
including termination of tubal pregnancies or follow-up
procedures made necessary by incomplete and/or spontaneous
abortions. Our records also indicate that in approximately
three quarters of these procedures, at least one other
physician or a resident performed or participated in the
surgery, in addition to Dr. Foster.
Sincerely yours,
Richard E. Jackson, J.D.,
General Counsel.
____

Dr. Foster and Sterilization

In the 1960's and early 1970's, Dr. Foster performed a
small number of therapeutic sterilizations on severely
mentally retarded women. Some people have sought to distort
this information by failing to place Dr. Foster's practice in
the context of the time and prevailing medical practice.
In August 1974, Dr. Foster delivered a paper before a
meeting of the National Medical Association that included a
discussion of the hysterectomies he had performed between May
1963 and May 1973. The paper, which was published in 1976,
includes a bar chart showing that, among other seasons for
performing hysterectomies to remove normal uteruses, he had
performed four such procedures on severely mentally retarded
women. Dr. Foster noted that hysterectomies could be
performed on women with severe mental retardation ``either
for sterilization or to eliminate the menses which is of
significant hygienic benefit. . .'' See Henry W. Foster, Jr.,
Removal of the Normal Uterus, 69 Southern Medical Journal 13,
15 (1976).
Dr. James Todd, Vice President of the American Medical
Association has confirmed that performing hysterectomies on
severely retarded women for pregnancy prevention or to
eliminate the menses for hygienic purposes ``was thought to
be the state of medicine back then.'' So has Dr. Joseph
Gambone, Acting Director of Reproductive Endocrinology at
UCLA, who indicates that the practice was common at the time.
Dr. Luigi Mastroianni, a professor of obstetrics and
gynecology who heads the division of human reproduction at
the University of Pennsylvania, has said such procedures
``were the most humane method we had to allow people with
severe mental deficiency to have any comfort at all.''
In that same 1976 article, Dr. Foster stressed that
``obstetricians and gynecologists must guard vigilantly
against the injudicious and indiscriminate removal of the
normal uterus.'' Dr. Arthur Caplan, Director of the Center
for Bioethics at the University of Pennsylvania, has said
that Dr. Foster's 1974 paper on this subject ``represents an
enlightened and cutting-edge opinion about the need for
caution and care with respect to that form of surgical
sterilization.''
By the late 1970's, medical practice and legal standards
had shifted, as had Dr. Foster's views. In 1980, Dr. Foster
wrote: ``It is understood if the patient is judged to be
incapable of comprehending and thus not able to provide an
informed consent, she must not be sterilized.'' See Henry W.
Foster, Jr., Ambulatory Gynecologic Surgery, in Ambulatory
Obstetrics & Gynecology 399, 416 (George Ryan ed. 1980).
At all times, Dr. Foster's practice has been consistent
with prevailing medical norms. In many ways, as Dr. Caplan's
comments reveal, Dr. Foster has been ahead of his time on
these issues.
____

Dr. Foster and Planned Parenthood

Planned Parenthood is a health care organization which
manages nearly 1,000 health centers in 49 states and the
District of Columbia. Planned Parenthood serves four million
women and men each year, making it the nation's largest
provider of comprehensive reproductive health care, including
breast examinations, PAP tests, testing and treatment for
sexually transmitted diseases, [[Page S 8813]] infertility
services, birth control methods and counseling, and
comprehensive sexuality education. Dr. Foster has served on
local and national Planned Parenthood boards since 1974.
Planned Parenthood and Dr. Foster share the mission of
resolving our nation's most troubling health crisis by
providing effective solutions which focus on prevention and
responsibility. Throughout his career, Dr. Foster has been a
driving force in the prevention of teen pregnancy and a
leader in the field of public health. The highly effective,
``I Have a Future'' program, which Dr. Foster developed,
stresses sexual responsibility, self-control, education, and
job skills and provides positive alternatives to having
children. Similarly, Planned Parenthood's medical and
educational services help prevent nearly half a million
unintended pregnancies each year.
Although Dr. Foster does not advocate abortions as a
substitute for family planning, he supports Planned
Parenthood's efforts to provide abortion services when a
woman chooses to have the legal, constitutionally-protected
procedure. Dr. Foster has repeatedly voiced his concern that
all women have access to reproductive health care, including
abortion. He also has supported Planned Parenthood's efforts
to secure the passage of the Freedom of Access to Clinic
Entrances Act, legislation designed to protect patients and
staff at women's health care centers.
While Dr. Foster was a member of the organization's Board
of Directors, the Nashville affiliate filed a lawsuit
challenging a Tennessee law requiring parental notice before
a teenage girl could obtain an abortion. Dr. Foster has
sought to involve parents in their children's decisions to
obtain contraceptive or abortion services and strongly
believes that parents should be involved in these decisions.
He has worked to limit the number of abortions performed on
teenagers by promoting abstinence and alternatives to having
children through programs such as the ``I Have a Future''
program. Dr. Foster realizes, however, that some young women
cannot notify their parents, because they come from homes
where physical violence or emotional abuse is prevalent or
because their pregnancy is the result of incest. Dr. Foster
opposed the Tennessee law because it required parental notice
for a minor seeking abortion with no exception for minors
from abusive homes and no bypass mechanism as required by the
United States Supreme Court.
To prevent unwanted pregnancies and to provide alternatives
to sexual activity, Dr. Foster looks primarily to parents and
families. He encourages parents to educate their children
about sexuality and reproductive health and to promote the
need to postpone premature sexual activity. Dr. Foster also
realizes that schools may play an important role in the
process and advocates developing age-appropriate educational
programs which promote abstinence and which prepare teenagers
for responsible sexual involvement as adults.
____

Dr. Foster and ``I Have A Future'': Using Abstinence to Prevent Teen
Pregnancy

An examination of ``I Have A Future's'' teaching modules--
as well as the many supplemental materials [brochures,
videos, games, posters] they utilize--evidences the strong
abstinence message that is integral to the program. IHAF
promotes abstinence to prevent teen pregnancy in several
ways:
First, by stressing the value of abstinence and explaining
why it is so important.
Second, by involving the family and community in promoting
this value.
Most important, the program does not just say the word
``abstinence'' a few times and leave it at that. IHAF devotes
considerable time and effort to giving teens the tools they
need to be responsible, to make good decisions and then stand
up for what they believe in, and, most importantly, to resist
social pressures to engage in sexual activity.

i. ihaf's curriculum

A. Family life education module [staff manual] final copyrighted
version; September 1994

Abstinence message:
``Responsible sexual behavior is defined as abstinence or
acting upon the decision to participate in sexual intimacy
while maintaining a healthy body and exercising assertive
family planning.'' [p. 2]
``It is important for people to practice responsible sexual
behavior . . . 1) Refrain from having sexual intercourse . .
. However, it is best for children to postpone initiating
sexual intercourse and other risky sexual behaviors beyond
the early adolescent years.'' [p. 2]
Kujichagulia [Self-Determination] ``. . . one needs to have
Kujichagulia (Self-Determination) in order to cope with the
negative peer pressure toward early sexual intercourse, and
careless sexual activity.'' [p. 58]
``Adolescents often have the impression that `everyone is
doing it'. Surveys show that more than half of all
adolescents do indeed say `No' to sex.'' [p. 70]
``Discussion: `Encourage the participants to do their best
to postpone having sex at an early age. Before making up
their mind to have sex now or wait, they should ask
themselves the following questions:
1. ``Can I take full responsibility for my actions?''
``Am I willing to risk STDs, pregnancy, future
infertility?''
``Can I handle being a single parent or placing my child
for adoption?''
``Am I ready and able to support a child on my own?''
``Can I handle the guilt and conflict I may feel?''
``Will my decision hurt others? My parents? My friends?''
[p. 60]
``Decisions about sex may be the most important decisions
one will ever make. So, think before you act!'' [p. 60-1]
One exercise is called the ``STD Handshake.'' It asks the
teens to pick an index card from a bag. Some say ``STDs'' and
others say ``Abstinence.'' The point of this exercise is that
Abstinence is the only way to completely avoid the risk of
Sexually Transmitted Diseases. [p. 65]
``Young men and women can say `no' and postpone sexual
intercourse. But, if they do intend to have sex, they must be
informed of the possible consequences of sexual behavior. [If
participants are not ready for the responsibility of
parenthood, they must consider the various ways of acting
sexually responsible.]'' [p. 58]
``There are two ways of exercising responsible sexual
behavior. One can abstain from sexual intercourse or one can
use contraceptives/condoms effectively.'' [p. 75]
``In order to promote the value of sexual responsibility,
it is critical that the community seeks to uplift this value
in a unified manner. [p. 32]
``Each participant is encouraged to discuss values around
sexuality with their parents and/or other adults whose values
are important to the participant.'' [p. 32]
``Educate participants regarding responsible sexual
decision-making.'' [p. 11]
``The teenage years are a good time to assist others with
child care responsibilities but not to take on the full
responsibility of being a parent.'' [p. 46]
``It is important to remember that the purpose of being a
teenager is to finish the process of becoming an adult and
not to create children before achieving adulthood.'' [p. 53]
To show teenagers what having a baby can do to their lives,
one of the exercises is a ``Job Interview for Parent.'' It
discusses issues like financial resources, time required,
emotional needs, etc. to try to convince teenagers to
postpone early sex and pregnancy until a more appropriate
time. [p. 50]
Teaching teens to say no:
``There is no reason for adolescents to feel different or
strange if they say `No'. Because of peer pressure,
adolescents need to master the assertive communication skills
of knowing how to say `No'. They may often worry about
hurting friends' feelings if they say `No'. Hurt feelings go
away but an unintended pregnancy and a baby don't go away.''
[p. 70]
``Goals: `Using assertiveness skills to avoid unwanted
sexual behavior [and to insist that contraception be
utilized.]'' [p. 70]
Motto: ``If you don't stand for something, you can fall for
anything.'' [p. 32]
``To provide participants with options for confronting
pressure to do something that they are uncertain they want to
do.'' [p. 35]
``Definition of Assertive: `to exhibit confidence and
adherence to decision despite others' opinion.' '' [p. 38]
``Example of an assertive technique is to `Use broken
record technique (Keep repeating a simple negative response,
don't provide excuses).' '' [p. 38]
``Emphasize that when a person feels good about him/
herself, that person can express themselves openly, honestly,
and assertively.'' [p. 39]
``Remind participants that their purpose is to develop
positive assertive skills for responding to pressure as an
adolescent and an adult.'' [p. 39]

B. Family life education module [Staff manual] \1\ November 1991

\1\ Footnotes at end of article.
---------------------------------------------------------------------------
Abstinence Message:
``Responsible sexual behavior is defined as abstinence or
acting upon the decision to participate in sexual intimacy
while maintaining a healthy body and exercising assertive
family planning.'' [p. 3]
Kujichagulia [Self-Determination] ``. . . one needs to have
Kujichagulia (Self-Determination) in order to cope with the
negative peer pressure toward early sexual intercourse, and
careless sexual activity.'' [p. 58]
``Adolescents often have the impression that `everyone is
doing it'. Surveys show that more than half of all
adolescents do indeed say `No' to sex.'' [p. 70]
``Discussion: Encourage the participants that they should
do their best to postpone having sex at an early age. Before
making up their mind to have sex now or to wait, they should
ask themselves these questions:
1. ``Can I take full responsibility for my actions?''
2. ``Am I willing to risk STD, pregnancy, future
infertility?''
3. ``Can I handle being a single parent or placing my child
for adoption?''
4. ``Am I ready and able to support a child on my own?''
5. ``Can I handle the guilt and conflict I may feel?''
6. ``Will my decision hurt others? My parents? My
friends?'' [pp. 60-61]
``Decisions about sex may be the most important decisions
one will ever make. So, think before you act!'' [p. 61]
One exercise is called the ``STD Handshake.'' It asks the
teens to pick an index card from a bag. Some say ``STDs'' and
others say ``Abstinence.'' The point of this exercise is that
Abstinence is the only way to [[Page S 8814]] completely
avoid the risk of Sexually Transmitted Diseases. [p. 65]
``Young men and women can say `no' and postpone sexual
intercourse. But, if they do intend to have sex, they must be
informed of the possible consequences of sexual behavior. [If
participants are not ready for the responsibility of
parenthood, they must consider the various ways of acting
sexually responsible.]'' [p. 58]
``There are two ways of exercising responsible sexual
behavior. One can abstain from sexual intercourse or one can
use contraceptives/condoms effectively.'' [p. 75]
``Educate participants regarding responsible sexual
decision-making.'' [p. 11]
``The teenage years are a good time to assist others with
child care responsibilities but not to take on the full
responsibility of being a parent.'' [p. 16]
``It is important to remember that the purpose of being a
teenager is to finish the process of becoming an adult and
not to create children before achieving adulthood.'' [p. 53]
To show teenagers what having a baby can do to their lives,
one of the exercises is a ``Job Interview for Parent.'' It
discusses issues like financial resources, time required,
emotional needs, etc. to try to convince teenagers to
postpone early sex and pregnancy until a more appropriate
time. [p. 50]
Teaching Teens To Say No:
``There is no reason for adolescents to feel different or
strange if they say `No'. Because of peer pressure,
adolescents need to master the assertive communication skills
of knowing how to say `No'. They may often worry about
hurting friends' feelings if they say `No'. Hurt feelings go
away but an unintended pregnancy and a baby don't go away.''
[p. 70]
``Goals: Using assertiveness skills to avoid unwanted
sexual behavior [and to insist that contraception be
utilized.].'' [p. 70]
Motto:``If you don't stand for something, you can fall for
anything.'' [p.32]
``To provide participants with options for confronting
pressure to do something that they are uncertain they want to
do.'' [p. 35]
``Definition of Assertive: `to exhibit confidence and
adherence to decision despite other's opinion.' '' [p. 38]
``Example of an assertive technique is to `Use broken
record technique (Keep repeating a simple negative response,
don't provide excuses).' '' [p. 38]
``Emphasize that when a person feels good about him/
herself, that person can express themselves openly, honestly,
and assertively.'' [p. 39]
``Remind participants that their purpose is to develop
positive assertive skills for responding to pressure as an
adolescent and an adult.'' [p. 39]

C. Family life education module [staff manual] \1\ September 1989

Abstinence Message:
Suggests handing out pamphlet: ``Many Teens Are Saying No''
\2\
``The Family Life Education Module is designed to help . .
. generate attitudes and values positive toward contraception
and abstinence.'' [1st page after course outline, no page #8]
``Deep love between close friends can exist without the
presence of open or conscious sexual desire . . . Sex is not
what makes a relationship work. Sharing thoughts, beliefs,
feelings, and most of all, mutual respect, is what makes a
relationship strong.'' [Session IX]
``Sexual feelings may be expressed in a variety of ways,
only one of which is sexual intercourse.'' [Session IX]
``Decisions about sex may be the most important decisions
you'll ever make. So, think before you act!'' [Decision-
Making Handout]
Should you have sex now or should you wait? Ask yourself
these questions before making up your mind?
1. ``Can I take full responsibility for my actions?''
2. ``Am I willing to risk STD, pregnancy, future
infertility?''
3. ``Can I handle being a single parent or placing my child
for adoption?''
4. ``Am I ready and able to support a child on my own?''
5. ``Can I handle the guilt and conflict I may feel?''
6. ``Will my decision hurt others? My parents? My
friends?''
Teaching Teens To Say No:
``Let the youth know that it's okay to say `no'. There is
nothing wrong with saying it. Even more important, there is
no reason for them to feel different or strange if they do
say `no'.'' [Assertive Communication]
``Because of pressure from their friends (peer pressure)
the youngsters need guidance in knowing how to say `no'.
Young people often worry about hurting friends' feelings if
they say `no'. Hurt feelings go away but an unintended
pregnancy and a baby don't'' [Assertive Communication]

D. Prosocial skills modules [staff manual] October 1994

``Emphasize that when we choose tough values such as
abstinence, our choice may not be the most popular choice. We
are likely to receive little positive reinforcement for these
choices. Therefore, we must develop the capacity to praise
ourselves for courage in living the values we believe are
best for us.'' [p. 28]
``To provide a framework for adolescents to understand that
to say `no' is not abnormal but normal.'' [p. 19]
``Emphasize the need to make you own decisions and to take
responsibility for the outcome.'' [p. 19]
``To assist participants in developing skills to resist
group pressure.'' [p. 28]
``To increase participants' positive refusal skills.'' [p.
28]
``To teach participants how to look beyond the immediate
benefits and consider the long-term consequences.'' [p. 28]
``To assist participants in developing coping strategies
when their peer group does not positively reinforce him/her
for standing up for his/her beliefs.'' [p. 31]
``To teach participants how to cope with group pressure.''
[p. 33]
Quote from Malcolm X: ``It is always better to form the
habit of learning how to see things for yourself, listen to
things for yourself, and think for yourself; then you are in
a better position to judge for yourself.'' [p. 36]

E. Prosocial skills module [staff manual] November 1991

``Emphasize that when we choose tough values such as
abstinence, our choice may not be the most popular choice. We
are likely to receive little positive reinforcement for these
choices. Therefore, we must develop the capacity to praise
ourselves for courage in living the values we believe are
best for us.'' [p. 28]
``To emphasize that even when you make a decision, you are
not always totally locked into that decision if you have
reservations.'' [p. 19]
``To provide a framework for adolescents to understand that
to say `no' is not abnormal but normal.'' [p. 19]
``Emphasize the need to make your own decisions and to take
responsibility for the outcome.'' [p. 19]
``To assist participants in developing skills to resist
group pressure.'' [p. 28]
``To increase participants' positive refusal skills.'' [p.
28]
``To teach participants how to look beyond the immediate
benefits and consider the long-term consequences.'' [p. 28]
``To assist participants in developing coping strategies
when their peer group does not positively reinforce him/her
for standing up for his/her beliefs.'' [p. 31]
``To assist participants in confronting those feelings
which may prompt them into responding impulsively and giving
in to the group.'' [p. 31]
``Emphasize that no one has to fall prey to persuasion. By
getting the facts, one can make their own decisions and
define for themselves what they will do and who they will
be.'' [p. 33]
Quote from Malcolm X: `It is always better to form the
habit of learning how to see things for yourself, listen to
things for yourself, and think for yourself; then you are in
a better position to judge for yourself.' [p. 36]

F. ``I have a future'' program evaluation: Renewal grant proposal to
W.T. Grant Foundation April 1991

One Goal [Hypothesis] of The Program: ``Active participants
will delay the initiation of sexual intercourse longer than
youth who do not participate and comparison site youth.''

ii. brochures

As Dr. Foster mentioned during his hearings, since its
inception ``I Have A Future'' has distributed brochures to
the teenagers--and even to their parents--that have a strong
abstinence message. A variety of brochures have been used
over the years, as can be seen below. IHAF staff is always
looking for new brochures and teaching materials to catch the
teens attention and get the message out in different ways.\4\

A. ``Many teens are saying ` no' '' [U.S. Department of Health and
Human Services, 1986] \5\

``Don't be fooled into thinking most teenagers are having
sex. They aren't!! There's a lot to know before you say `yes'
to having sex.''
``Face it! Sex for young people is pretty risky!''
``Sexual feelings can be pretty strong! So think before you
act. Think about your future. Think about the consequences.
In other words, think about yourself! Ask yourself, `Am I
ready to have sex now?' To answer this question you need to
decide which is more important to you--giving in to your
sexual feelings or being true to your inner feelings that may
be telling you to `wait.' ''
``There's a lot to know before making your decision about
whether or not to say ``yes'' to sex:
Is having sex in agreement with your own moral values?
Would my parents approve of my having sex now?
If I have a child, am I responsible enough to provide for
its emotional and financial support?
If the relationship breaks up, will I be glad I had sex
with this person?
Am I sure no one is pushing me to have sex? [--]
If any of your answers are NO, then you'd better WAIT.''
``Decisions about sex may be the most important decisions
you'll ever make. So, think before you act.''
``What should I know if I decide not to have sex?
Congratulations . . . contrary to rumor, so have lots of
other teens. It's not hard to say ``NO'' and still remain
friends if you are careful not to hurt the other person. For
example you might say:
`I like you a lot but I'm just not ready to have sex.'
`I don't believe in having sex before marriage. I want to
wait.' [[Page S 8815]]
`I enjoy being with you but I don't think I'm old enough to
have sex.'
`I don't feel like I have to give you a reason for not
having sex. It's just my decision.'
``Also, there are different ways to show affection for
another person without having sexual intercourse.''
``Try to avoid situations where sexual feelings become
strong. ``Stopping'' is much harder then.''
``Talk about your feelings and what seems right for you. If
you and you partner can't agree, then maybe you need to find
someone else whose beliefs are closer to your own.''
``Will having sex really make you more popular, more
mature, more desirable? Probably not. In fact, having sex may
even cause your partner to lose interest. The one sure thing
about having sex is that you may be in for problems you don't
know how to handle.''
``Sex is not what makes a relationship work.''
Watch out for lines like, ``If you care about me, you'll
have sex with me.''
You don't have to have sex with someone to prove you like
them.
Sex should never be used to pay someone back for something
. . . all you have to say is, ``Thank you.''
Sharing thoughts, beliefs, feelings and most of all mutual
respect is what makes a relationship strong.
Saying ``No'' can be the best way to say, ``I love you.''
B. ``AIDS and sex: What you should know'' [Tennessee responds to AIDS,
December 1992]

``What do I do?: First, understand it's okay to say `No' to
sex. Get to know the person better. Date. Don't be afraid to
talk about your choices with your friends. Have respect for
your body. This way, you can avoid HIV and problems like
unplanned pregnancy and other sexually transmitted diseases
like gonorrhea and syphilis.''

C. ``AIDS: What you should know'' [Tennessee responds to AIDS, July
1989]

``How can I protect myself . . . The only way to be
absolutely safe is to avoid all drug needles and not have sex
until you are in a marriage or permanent relationship with a
faithful, uninfected partner.
Until this is possible . . . Say `No' to sex.''
``Remember: Alcohol and drugs make it harder to say no to
dangerous behavior.''

D. ``AIDS and teens: What you should know'' [Tennessee responds to
AIDS, June 1991]

``How do I protect myself? Don't have sex. Express your
affection in other ways such as holding hands or hugging.''
``The safest way to protect yourself from becoming infected
with HIV is by avoiding sex and drugs. Because this is your
life and your body, you have a right to say NO. Remember, you
can't tell by looking at someone if they are infected with
the virus.''
``Remember the best protection against getting HIV is to
avoid sex and drugs. Both drugs and alcohol will affect your
judgment and you will be less likely to take steps to protect
yourself.''

E. ``AIDS and the black community: What you should know'' [Tennessee
responds to AIDS, June 1991]

``How do I avoid HIV?
Say `No' to sex.
Alcohol and drugs make it harder to say no to dangerous
behavior.''
F. ``A parents' guide to the facts: to help mothers and fathers talk to
their teenagers about sexual responsibility'' [American College of
Obstetrics and Gynecology (ACOG), 1986]

The facts: No. 1: Young people can postpone sex--
``Fact: Today's youngsters often have the impression that
`everyone is doing it.' Surveys show that more than half of
all teenagers do indeed say `no.' The `everyone is doing it'
comment is typical big talk by young people who want to make
themselves look important in the eyes of their friends.''
``Let your children know that it's okay to say `no.'
There's nothing wrong with saying it. Even more important,
there's no reason for your children to feel different or
strange if they do say `no'.''
``Because of pressure from their friends your children need
guidance in knowing how to say `no.' Explain to your children
that the best way to say `no' is to decide before they get
into a situation that might force that decision.''
``Young people often worry about hurting friends' feelings
if they say `no.' Hurt feelings go away but an unintended
pregnancy and a baby don't.''
``Wrapping up the facts: When parents can establish
themselves as the best source of information on sex, the
chances of misinformation are reduced. . . . When they (your
children) have the Facts, you can help guide them in making
the decisions that are best for them. They can say `no' and
postpone having sex. . . .''

G. ``A message for teens from teens'' [March of Dimes Birth Defects
Foundation, November 1986]

``We all know how difficult peer pressure can be--people
our own age telling us to do something that we don't really
feel good about doing. We don't want to feel different. We
don't want to feel left out. But there is such a thing as
positive peer pressure. Our true friends wouldn't want us to
do anything that would hurt us or get us into trouble.''
No one should try to rush you into anything. That's not the
way to express your love for someone.''
``Guys take it less seriously because they're not the ones
who get pregnant.''
H. ``Sexually transmitted diseases'' [March of Dimes Birth Defects
Foundation, October 1986]

``Obviously, there is no risk of infection if there is no
sexual contact.''

III. SUPPLEMENTAL TEACHING MATERIALS

A: Game: Crossroads--teen relationships and teen sexuality

1. Objective:
``The objective of CROSSROADS is to encourage sexual
abstinence, goal-setting, parent-teen communications, strong
moral values, self-control, responsibility, self-respect, and
respect for others.''
``Sexual abstinence is important because it provides an
opportunity to practice self-control, self-respect, respect
for others and other important moral and religious values. It
decreases the occurrence of teen pregnancy and sexually
transmitted diseases and increases your opportunity to
complete educational and vocational goals.''
``Teens should be very careful about the selection of their
peers. They should choose friends and dates who value sexual
abstinence and other positive moral standards.
2. Sample game cards \6\
a. ``If parents find out that their son or daughter is
sexually active, they should discuss birth control because it
is too late to discuss abstinence. True or False.
Answer: False . . . It is never to late too discuss
abstinence.''
b. ``It is important for both males and females to keep
their virginity because (a) it decreases the chances of
getting sexually transmitted diseases (b) takes away the
possibility of unwanted children (c) both a and b.
Answer: (c)''.
c. ``What is the best method a teen may use to keep from
getting a sexually transmitted disease? (a) condoms (b)
abstinence (c) frequent visits to the doctor.
Answer: (b)''.
d. ``Why do you think a male or female teen would choose to
abstain from sex until marriage? Explain your answer.''
e. ``Which two methods can be used to control your sexual
feelings? (a) maintain the value of abstinence (b) take a
cold shower (c) don't deny your feelings, talk to your
parents (d) ignore your feelings, they will go away
Answers: (a) and (c)''
f. ``What are the advantages for males and females who
abstain from sex until marriage? (a) no advantages (b) they
can set goals and achieve them through self-control (c) no
children born before marriage'' Which statement was
incorrect?
Answer: (a)''
g. ``What is sexual abstinence? Please explain your answer
. . .
Answer: Sexual abstinence means to refrain from sexual
activities, including the more advanced stages of petting and
sexual intercourse.''
h. ``Can you truly love someone and abstain from premarital
sex with that person? Yes or No?
Answer: Yes. Love is a strong affectionate bond that
consists of respect, trust and commitment.''

B. Video: ``Who do you listen to? choosing sexual abstinence''

Note: There is no date on the invoice [which was enclosed
in the video sent to the Committee.] A fax--apparently sent
to the program from the video company--is dated 8-21-92.
``It gives them the facts and feelings teens must confront
in order to take responsibility for their own sexual
activity, and presents a healthy option for them to
consider--sexual abstinence before marriage.''
Objectives: ``To help students: [. . .]
Explain the physical, emotional, and psychological risks of
premarital sexual activity.
Make more responsible decisions about their sexual
behavior.''
Discussion topics and activities: [. . .]
4. Psychological Risks: Consider the psychological risks
involved in having sex before marriage, such as feelings of
guilt, doubt, fear, disappointment and even the pain of being
used. Why do these feelings often follow pre-marital sex?
Could they possibly interfere with your ability to
concentrate on other things, like building friendships,
studying or working?
5. Physical Risks: Consider some of the physical risks
involved in having sex . . .
6. Practicing Sexual Abstinence: Discuss the advantages and
disadvantages of practicing sexual abstinence before
marriage. List some concrete reasons for saying ``no'' to
pre-marital sex that you have learned from the video . . .
Why would it be a good idea to refrain from sexual activity,
despite what your body can be saying to you? List four
activities that can constructively channel your time and
energy.
7. Saying No: What are the most common ways others might
try to convince you that you should have sex? Practice
avoiding the pressure to have pre-marital sex by coming up
with reasons to say ``no''.
Suggestions for group leaders:
Share some adult pressures that you face, such as belonging
to a certain club, going out for a drink when you'd rather
not, etc. Tell a story illustrating an effective way that you
have handled peer pressure, and ask your group to tell you
about situations they have seen or been involved in having to
do with peer pressure.
Encourage adolescents to talk to their parents, school
counselors, health teachers or physicans . . . Offer a
supportive environment for them to share the information they
[[Page S 8816]] find. Encouraging them to discuss these
issues with their parents can help bridge any embarrassment
they may feel regarding these intimate matters.''

C. Video: ``It only takes once''

The main theme of this video is abstinence, following a
young woman--who has decided with her boyfriend not to be
sexually active--through a variety of social settings. She
speaks to a group of teens saying that it's possible to be a
virgin and still be cool. [referenced in Family Life Module,
p. 59]
D. AIDS poster: ``With AIDS around, gonorrhea, syphilis and herpes are
fair warning''

Poster shows a STOP sign and at the bottom it says: ``You
want to be risk-free from AIDS? Don't have sex. And as long
as you aren't shooting drugs, you'll be fine. No worries
about who's slept around, who's had blood tests, and whether
your condoms are latex or not.''

iv. medical student handbook

As ``I Have A Future'' falls under the Department of
Obstetrics and Gynecology at Meharry Medical College, medical
residents and students often rotate through the programs's
clinics. The IHAF staff prepared a handbook\8\ to train
residents before they begin their rotation. The handbook
gives specific guidelines for providing counseling--stressing
abstinence as the first and best option.
Discussion of questions on ``personal information form''.
``The following questions are sensitive and emotional and
could take much more time than is available at the clinic. It
is important to schedule a special session with the client to
talk in more depth if necessary.'' [...]
``2. Have You Talked to Either of Your Parents About Coming
Here?
``Determine teen's comfort level in talking with parents''
[...]
``Provide teen with `Can I Tell My Parents?' brochure and
encourage her to tell her parents in the future. Emphasize
that parents can be a source of support for them. If they
can't talk to them now, maybe they will be able to some time
later. (Don't give up!) [...]
``4. Have you ever had sexual intercourse?
If yes, discuss how she made the decision to have sex and
ask how often she has intercourse. If the teen felt pressure
to have intercourse, let her know that she can stop if it
doesn't seem right for her. You can say `no' after saying
`yes'.
You shouldn't have sex: 1) just for another person or 2) to
be like your friends. What you really want is most important.
This is your decision. . . .
If no, discuss teen's feelings about her decision.
Legitimize decision not to have sex . . .''
``15. The goal of this [sic] questions is to increase the
client's realistic understanding of how a pregnancy would
affect her life . . .
Have you thought about when you will be ready to have a
baby? Deal with a pregnancy? When do you think you will be
ready? Imagine for a moment that you were pregnant? How would
you feel?
Discuss wide range of emotions involved in hearing news
like this. What kind of reaction would she have? Who could
she turn to for information and support? What options would
she have?
Have she and boyfriend discussed possibility of pregnancy
with sexual relationship?
How would pregnancy/parenthood affect their goals?
Possible role-play situation [unplanned pregnancy]
``Initial visit interview/counseling session.
Contraception and STD's (using protocol guidelines):
The manual lists a number of options for avoiding Sexually
Transmitted Diseases--the first of which is ``abstinence.''
``Provide the following brochures for the teen to take with
her:
AIDS Brochure.
What Every Teen Needs To Know.
Your Pelvic Exam--the 1st or 21st.
Can I tell my Parents?
The Facts [STDs].
NO and Other Methods of Birth Control''.
v. listen to teenagers who are in the program

``But if you let the youngsters tell it, there is less
sexual activity among those in the program. Part of it is
knowing they are not the only one deciding on abstinence.
Part of it is having adults they can talk to openly. Part of
it is realizing the repercussions of early sexual activity.''
[The Tennessean. 2/5/95]
Rhiannon Wilson:
``In `I Have A Future' I have learned why it's best to
abstain from sexual activities through a class called Family
Life. With me being a young lady, this class and all the
other very positive things we do has helped me realize that I
truly do have a future and a bright one at that.'' [Personal
Statement]
``Dr. Foster always tells us that abstinence is what should
follow.'' [Testimony to Senate Committee]
Jason Gordon:
``The program stresses abstinence to the fullest extent, it
is the major goal of the program.'' [Testimony to Senate
Committee]
``The program taught him one thing most of all, [Jason
Gordon, 18] said. `I know I'm not ready to have a child.''
[New York Times, 2/11/95]
``I Have A Future tell inner-city youth that their futures
can be more positive and more successful if they delay sex
and pregnancy until they are adults and can handle the
responsibilities of a family.'' [Statement at White House, 5/
1/95]
``I know that I would not be where I am if I had gotten
shot, gotten someone pregnant, or dropped out of school. That
is what IHAF tells us--if we stay out of trouble, abstain
from sex, and avoid drugs and alcohol, our futures can be
anything we want. Having a child can limit us forever. Taking
responsibility for our lives puts us in charge and lets us
define our lives ourselves.'' [Statement at White House 5/1/
95]
``It's a lot more than just delaying pregnancy and not
having sex. It's a lot about responsibility, about having
dreams, about having goals.'' [AP, 5/1/95]
Deanna Garrett:
``The `I Have A Future' program tries to teach the teens
that abstinence is the only way that we can put a stop to
teen pregnancy, the spread of sexually transmitted diseases,
and the transmission of the HIV virus.'' [Testimony to Senate
Committee]
Gary Hicks:
``Dr. Foster is doing a good deal by teaching kids to wait
before they have sex. He would rather the young kids not have
sex at all, because they still have a lot of things to look
forward to in life. The `I Have A Future' program teaches you
that you don't have to do what everyone else is doing.''
[Testimony to Senate Committee]
Terrell Carter:
Terrell Carter said the program has given him a new
perspective on interaction between the sexes. ``I thought
that having sex was part of everyday life. It showed me
abstinence is cool . . .'' [The Commercial Appeal, 2/14/95]
Terrell Carter, 18, credits the program for teaching him
that fathering a child is ``nothing to be proud of.'' He now
has ``more respect for girls. They're not just sex objects.''
[USA Today, 2/9/95]
Charmaine Harris, 18, says that the program taught her
skills she could use to resist pressure to have sex: ``Let's
say you have a date, dancing, and things start getting hot.
Are you going to be passive or stand up for what you believe
in?'' [The Tennessean, 2/5/95]
``As a member of the `I Have A Future' program, I have
learned how to choose and make decisions that will have a
positive effect on my life and benefit me as well as others
around me. I learned that it is alright to be different
because the only person I need to please is me.'' [Testimony
to Senate Committee]
Tonya Rutledge:
Tonya Rutledge, 17, thinks that her life would be different
if she hadn't been in the program. ``I think I would probably
be like my other friends which have children or they're about
to have a child. . . . .'' [USA Today, 2/9/95]
Amelia Turner:
``When I first moved to Nashville. . . I was confronted
daily with negative influences such as pressure to have sex
and use drugs and alcohol. Fortunately, people like Dr.
Foster realized those kinds of pressures, and they did
something about it. Joining `I Have A Future' gave me a safe
alternative to doing those negative things. It taught me how
to resist the peer pressures in order to be the best person I
can be by not letting others pull me down.'' [Statement at
D.C. Arrival Event, 5/1/95]
`` `It kept me busy, I had friends trying to take me in the
wrong direction,'' said Amelia Turner, 18, who joined the
program when her family moved to Nashville five years ago.
`[The program leaders] constantly stressed the importance of
higher education . . . having a child is down the road.''
[The Commercial Appeal, 2/14/95]
``This would be a nice program to have in other cities,''
said Amelia Turner, who wants to major in both medicine and
biomedical engineering. ``In the little town I came from,
there is nothing to do, so you may go over to your
boyfriend's house. This takes you away from that. You don't
have time to do crazy things.'' [The Boston Globe, 2/10/95]
Eighteen year old Amelia Turner says that in her life she
is under ``a lot of pressure'' to have sex. I have A Future
counselors ``let us know that if you want to have sex, here's
what you can use. But, the best sex is no sex.'' [USA Today,
2/9/95]
Floyd Stewart:
Floyd Stewart has been in the ``I have A Future'' program
for 4 years and says that unfortunately most people ``don't
know about how [Dr. Foster] preaches abstinence.'' [Testimony
to Senate Committee]
Johnetta Nelson:
Johnetta Nelson, a student, believes that the program
taught her many things. ``I chose to further my education,
and I knew that if I was to become impregnated that it would
probably hold me back. And I know that I want a lot of things
out of life, so I figured that it's not the time. [CNN, 2/13/
95]
``I owe a great deal of credit to ``I Have A Future'' for
keeping me active and busy. The program helped me keep my
focus on my future and kept me from straying away. It taught
me that your education comes first and having children comes
later.'' [Statement at D.C. Arrival Event, 5/1/95]
Melissa Hunter:
``Melissa Hunter . . . said [Dr. Foster's] brainchild gives
her and her friends a choice they seldom had before. A few
make it out of the projects and their teen-age years without
a baby and the limitations that babies bring, purely on
strength of character alone, she said. But it is hard. `Here
they keep you too busy to get into trouble.' '' [The New York
Times, 2/11/95] [[Page S 8817]]
Latara Gooch:
The ``I Have A Future'' program has ``taught me how to
think of myself, and not let everyone think for me. It also
has kept me from making a big mistake in my life. The mistake
is having sex at an early age.'' [Personal Statement]
Tyreca Bowers:
``I have been in the `I Have A Future' program for
approximately 2 years. This program has helped me to prepare
for the real world. It teaches me to be responsible.''
[Personal Statement]
footnotes

\1\ Many of these quotes also appear in the final [September
1994] version of the Family Life Module.
\2\ This pamphlet--produced by HHS in 1986--has been given to
the Committee and is excerpted on pps. 10-11.
\3\ Many of these quotes also appear in the final [October
1994] version of the Prosocial Skills Module.
\4\ The new brochures Dr. Greene ordered in March 1995 were
the first she had seen which a) showed African American role
models; and b) had a message targeted specifically to teenage
males. The publisher of the pamphlets said in a letter to
Senator Dodd that ``I have long known Dr. Foster to be a
strong advocate for abstinence . . . When these pamphlets
were first published. . . I immediately requested my staff to
send copies to his program because I knew they would be
interested in seeing them. . . His program immediately
purchased and began using them . . . reflection of their
interest in keeping their program up to date. . .'' [May 5,
1995 letter from Journeyworks Publishing]
\5\ This pamphlet is referenced in the September 1989 draft
of the Family Life Education Module [Staff Manual] which was
given to the Committee.
\6\ These are only a small selection of the cards focusing on
abstinence. Many more were given to the committee. The game
also had cards addressing AIDS and STDs.
\7\ The Committee has the only copy of this video so I was
not able to quote directly.
\8\ Final Report To Health Of The Public; Submitted by ``I
Have A Future'', Department of Obstetrics & Gynecology,
Meharry Medical College; October 1992.

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