Surgeon-general puts her faith in condoms for all

'Given a choice between hearing a daughter say 'I'm pregnant' or 'I used a condom', most mothers would get up in the middle of the night and buy them herself,' said Joycelyn Elders, nominated to be surgeon-general, at her confirmation hearing at the end of last week

Republican senators queried her promotion of the use of condoms in Arkansas schools; she said she wanted 'to make every child born in America a planned, wanted child'.

Dr Elders is probably the last of Bill Clinton's senior appointments likely to attract serious attacks from the right. The White House is strongly supporting her, if only to rebut charges that Mr Clinton is weak in supporting friends in difficulty.

The right to an abortion and the availability of condoms is also politically dangerous for Republican senators because they know their party's anti-abortion stance in the presidential election lost them votes.

As result the Republican attack on Dr Elders, 59, the top health official in Arkansas for the past six years, known for her support for abortion rights and sex education, never quite got off the ground. The main criticism came from senators who asked why Dr Elders had not publicly revealed that condoms distributed in Arkansas schools were defective, leading to unwanted pregnancies.

She said it was difficult enough to get young men to use condoms anyway so she 'didn't want to make anybody afraid of condoms'. In the same circumstances she would do the same again because 'as a public health decision, you try to do the greatest good'.

In Arkansas Dr Elders, a paediatrician by training, supported the establishment in schools of clinics which could distribute condoms. This does not seem to have been successful and Dr Elders admitted 'the only thing which works 100 per cent is abstinence but we know that our children are not being abstinent'. Denying she was pro-abortion, she said she favoured sexual responsibility but this could not be dictated from above.

The job of Surgeon-General does not have much direct political power but it does have some influence in a country as concerned about its health as the United States. It also acts as a symbol of the administration's attitude towards health care and issues like abortion. Dr Elders, the daughter of a black share-cropper with eight children, says she never saw a doctor before her first year in college.

She said that as a child 'I heard my mother scream during difficult child deliveries without any medical help'. On another occasion her four-year-old brother, suffering from a ruptured appendix, had to be carried on the back of a mule to a doctor 10 miles away.

Given the growing divergence in the health of Americans who can afford full health care and those who cannot, the appointment of Dr Elders also underlines the commitment of President Clinton's administration to health care reform.

Her nomination looked briefly in trouble last week when she was accused of drawing two salaries, one for her job in Arkansas and the other as a consultant to the government in Washington. She was also on the board of a Little Rock bank which had been mismanaged. But in neither case had she done anything illegal. She had not paid the social security taxes for her her mother-in-law's nurse, but she said this was her husband's reponsibility.