[Congressional Record Volume 141, Number 102 (Wednesday, June 21, 1995)]
[Senate]
[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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