Should addicts be sterilized?

Project Prevention has long paid poor, addicted women not to procreate. Now the far right is helping it go global

Published May 2, 2012 12:00PM (EDT)

 A volunteer outside a Project Prevention van       (<a href="">Project Prevention</a>)
A volunteer outside a Project Prevention van (Project Prevention)

“Don’t let a pregnancy ruin your drug habit,” the slogan on the fliers reads. Another says, “She has her daddy’s eyes…and her mommy’s heroin addiction.” Then: “Get birth control, get ca$h.” These are posters that show up nationwide in homeless shelters and methadone clinics, in AA and NA meeting rooms and near needle exchange programs, distributed by volunteers for Project Prevention. Formerly called Children Requiring a Caring Kommunity (CRACK), the controversial nonprofit pays drug addicts $300 to either undergo sterilization or use a form of long-term, “no responsibility needed” birth control.

“What makes a woman’s right to procreate more important than the right of a child to have a normal life?” Project Prevention founder Barbara Harris told Time magazine in 2010. The question is entirely rhetorical: her self-professed mission in life is to zero out the number of births to parents who abuse illegal drugs, particularly crack cocaine. “Even if these babies are fortunate enough not to have mental or physical disabilities, they're placed in the foster-care system and moved from home to home,” she says.

Critics of many stripes have piled on. They argue that Harris' campaign deprives women who are addicted, poor and vulnerable of reproductive choice even as it feeds their drug habit.

Some opponents say that, since the financial incentive is tantamount to giving addicts money to buy drugs, Project Prevention should be illegal.

Others say that if addicted women are viewed as not responsible enough to have a baby, then they should also be viewed as not responsible enough to give informed consent to having a serious medical procedure in exchange for drug money.

Still others say that Harris is stuck in the past by targeting the wrong drugs: these days, more babies are born dependent on Oxy and other legal opiate painkillers than cocaine or heroin, according to a report published just this week in JAMA.

And many opponents say that the payment is a bribe, and some have even called Project Prevention a revival of the eugenics movement.

Harris takes none of these criticisms seriously. The California foster mother, age 59, started the program in 1997, following her failed effort to get the Prenatal Neglect Act through the California state legislature. The bill would have made it a crime for a pregnant woman to use illegal drugs. (Such laws exist in many states: last week's Sunday New York Times Magazine profiled an Alabama woman named Amanda Kimbrough who is serving 10 years in prison for doing crystal meth while pregnant and giving birth after only 25 weeks to a very underweight baby who died.) Shifting tactics, the homegrown activist then began her campaign for a less punitive, if more final, solution to the “problem” of drug-addicted mothers bringing children into the world: pay them not to procreate.

“We don’t allow dogs to breed. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children,” Barbara Harris says.

Though based in North Carolina, Project Prevention mainly targets the nation’s major cities, especially poor and minority communities —“drug areas,” in Harris’s words. In addition to posting fliers, volunteers do ride-alongs with police; a mobile billboard (see the photo on The Fix homepage) tours the country.

Harris originally offered addicts $300 for sterilization and only $200 for contraception, but the ensuing bad press—mainly charges that the program was incentivizing addicted women to choose an irreversible decision about reproduction—put an end to that practice. In fact, the vast majority of the birth-control procedures come on the government’s dime, via Medicaid. After the procedures, the women send the medical paperwork and a “paper trail” that proves that they are addicts—“usually arrest records”—to Project Prevention to receive their check. That is the extent of the group’s involvement in the women’s lives.

Project Prevention has paid a total of 4,077 people (including 65 men), 987 of whom have been African-Americans, to get a tubal ligation (tube-tying) or an IUD, implanon (a hormonal contraceptive that is implanted in a woman’s arm), Depo-Provera (an injection that lasts three months) or (for men) a vasectomy, Harris says.

Those numbers aren’t overwhelming, given that the project is in its second decade. Yet with its goal to “save our welfare system and the world from the exorbitant cost to the taxpayer for each drug-addicted birth,” Project Prevention has sparked a firestorm of opposition.

The outrage stems as much from what Harris says as from what Project Prevention does. For one thing, in the considerable press she has sparked, Harris typically characterizes her target population less as drug-addicted women than as breeding machines, spitting out a baby a year.

“I became more angry at the system that allows [these drug-addicted women] to drop babies off yearly at the hospital with no consequences,” she told The Fix. “If there’s a scale, and it’s between her never having any more babies and her having five more babies who may be damaged, then what’s more important? For me it’s the children. And if she can’t have any more children, then that’s just the consequence of her actions, like getting AIDS or something.”

Harris says that she relies on the discretion of the doctors not to give birth-control procedures to women who haven’t already had a child, and says—despite the fact that she does not collect this data—that most of the women have had “at least three children, as many as a lot.”

She told the Telegraph, a British paper, "The last 20 women who underwent sterilization had been pregnant a total of 121 times and had 78 children in foster care.” A 2004 review of the data that Project Prevention collects on its clients (an incomplete and unscientific data set) reveals that their average birth rate was 3.5—above the national average, but not exactly "a lot."

Another of her favorite comparisons, not surprisingly, is to dogs. “We don’t allow dogs to breed," she said. "We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children.” Given the chance to distance herself from this comment on a segment on 60 Minutes II, she doubled down, saying, “It’s the truth—they don’t just have one and two babies, they have litters.”

Her statements only invite charges that her entire campaign is racist, targeting as it does crack-cocaine users. In defense, Harris, who is white, likes to cite the fact that her husband is black and, even more counterintuitively, that they adopted and raised four black children from a crack-addicted Los Angeles mother.

Harris' politically incorrect bravado may win Project Prevention both media and money, but such statements are unsupported by empirical evidence. No studies have been conducted that reliably measure the fertility rate of drug-using women vs. the general population—there are too many variables: What kinds of drugs? What patterns of use? A study funded by the National Institute on Drug Abuse found that of 120 low-income, drug-using women, “most” “had one or two children and were expecting or had recently given birth to a newborn.

Yet if Project Prevention’s rhetoric and tactics are problematic, its goal of decreasing the number of unintended and unwanted pregnancies among drug addicts is one that many people, including public health officials, support.

Dr. Peter Beilenson, who was then the Baltimore City Health Commissioner, told the Baltimore City Paper in 2003 that his opinion of the organization was “bifurcated.” “While it is rather coercive to pay people to do things, I don't have much problem with encouraging people to use reversible birth control at a time when they might not be in full possession of their faculties,” he said.

In 2009, Los Angeles Times columnist Sandy Banks wrote glowingly about Harris’ campaign as not only a cost savings for the foster-care system but a benefit for the mothers themselves. “So we can talk about women's rights or about the privilege of procreation. However we cast the conversation, there is one truth we can't avoid: We are helping mothers heal when we keep unwanted children from being born.”

Paying poor women who are addicted to drugs to undergo sterilization obviously leads to a thicket of troubling moral issues, even if it falls short of outright eugenics. In addition to the racism accusations, there is criticism that Project Prevention betrays an abuse of women’s right to informed consent. If a person who is addicted to crack cocaine and has few material resources is in no position to assume responsibility for a baby, are they truly capable of making long-term or permanent decisions about their reproductive health?

Both the American Civil Liberties Union and Planned Parenthood say no, and many bioethicists agree. “Rewarding someone for having a surgical procedure, they note, violates a basic principle of medical ethics: Health care decisions should be made by patients, without any form of pressure,” Barry Yeoman wrote in Mother Jones magazine in 2001.

One frequent Harris opponent is National Advocates for Pregnant Women (NAPW). When asked why NAPW has dogged a relatively obscure grassroots group, Executive Director Lynn Paltrow told The Fix, “The greatest harm of Project Prevention is that they are a propaganda machine used against pregnant women to take away their civil and human rights.”

Paltrow charges that Project Prevention perpetuates the racist bugaboo of the “crack baby,” which has served Harris well in winning funds from some high-profile Republican Party extremists. In fact, the generation of “crack babies” that was predicted in the wake of the crack cocaine epidemic in the 1980s never materialized, nor did a “biological underclass” and its ensuing crime wave. That’s not to say that the fear had no realistic basis: In 1991, some 22,000 “boarder babies” were left at hospitals by parents unwilling or unable to care for them, according to a federal study.

“Of all the risks to future children, among the smallest numerically is use of any illegal drug. Compared to poverty, lack of access to prenatal care, obesity, cigarette smoking, we’re talking relatively few women,” Lynn Paltrow says.

While the use of crack cocaine during pregnancy has been found to increase the risk of miscarriage and of low birth weight, the babies rapidly make up for the deficit. According to a scientific review of the research, “Cocaine exposure in utero has not been demonstrated to affect physical growth. It does not appear to independently affect development scores in the first six years. Findings are mixed regarding early motor development, but any effect appears to be transient and may, in fact, reflect tobacco exposure.” Harris’s own adopted daughter is evidence of this; as a proud mother, Harris told The Fix that “she’s on the chancellor’s list at college, she’s brilliant.” Yet by the logic of Harris’s own activism, her daughter never should have been born.

The use of alcohol (11.6 percent) and tobacco (16.4 percent) during pregnancy is far more widespread than the use of any illicit drug (5.2 percent), according to the Department of Health and Human Services. Yet while smoking and drinking while pregnant are viewed as health problems, taking illegal drugs—especially crack cocaine—is widely considered a moral failing, and in some states a crime. Women who do so often lose custody of their children; in the 1990s, at the peak of the “crack baby” craze, a large number were prosecuted and jailed.

For Paltrow, Harris’s emphasis on the effects of drug use on the fetus deflects attention from the myriad more pressing problems facing children born in poverty. “Of all the risks to future children, among the smallest numerically is use of any illegal drug. Compared to poverty, lack of access to prenatal care, obesity, cigarette smoking, we’re talking relatively few women,” she says. Most public health officials agree that poor parenting, family violence, substandard schools, exposure to lead and other poverty-related stressors have more serious and lasting effects on the development of children, but these issues do not spark the same level of public outrage as “crack moms.”

To the charge that her program disproportionately singles out black women, Harris told The Fix, “If you’re a drug addict, we’re looking for you, and I don’t care what color you are, because we don’t even know what color your baby will be, because often these babies come out all different colors, you know what I mean? They’re mixed.”

Be that as it may, Harris also faces criticism that she does not help women access drug treatment services. In fact, the treatment and care of the woman is incidental to Harris’ aim; her compassion, like that of an anti-abortion advocate, seems reserved exclusively for the unborn, leaving flesh-and-blood mothers and children out in the cold. “A lot of people aren’t looking for treatment, and until they are, they’re not going to do it,” Harris says dismissively.

Funds for drug treatment have been slashed over the past two decades, in any case. The main source, the federal Substance Abuse and Mental Health Services Administration, has cut funding for treatment programs for women by almost 40 percent since 1994; programs for pregnant and postpartum women and their children is now less than 10 percent.

Project Prevention ignores other risks facing drug-addicted women, according to Julia Scott, president of the National Black Women's Health Project: “to focus solely on pregnancy prevention without acknowledgment of the seriousness of HIV/AIDS is callous and life-threatening.”

Other opponents of Project Prevention are more worried about the human rights of the women. Stuart Sorenson, a mental health and addiction worker in London who led a successful campaign in 2010 to shut down Project Prevention soon after it launched in Britain, says, “It’s not up to me to decide who has value. Any organization that thinks it’s OK to decide who has the right to live is arrogant in the extreme.” He also pointed out that the European Convention on Human Rights designed to prevent another Nazi Holocaust makes the activities of Project Prevention illegal in Europe, because it amounts a discriminatory practice against a population of vulnerable adults: “It’s essentially a form of eugenics dressed up in a thin veneer of compassion,” he told The Fix.

In fact, a well-known, century-old slogan of the eugenics movement might be mistaken for a Project Prevention flier, allowing for differences in style. “I must drink alcohol to sustain life. Shall I transfer the craving to others?” Before the Nazis spectacularly ruined the reputation of eugenics, the movement had garnered widespread approval in the U.S., resulting in state laws permitting the forced sterilization of prostitutes, mental patients, criminals, addicts and other stigmatized people.

Opponents also say that the program ignores the potential of these women not only to recover from their addiction but to be good parents—even during their addiction. Typically, Harris doesn’t even bother to pay lip-service to this bleeding-heart sentiment. “What if five years down the line they get clean and they want to have children but they can’t because they were sterilized? Well, to me it’s a gamble. What if they didn’t get off drugs in five years, and in those five years they had five more babies,” she says.

Yet Advocates for Pregnant Women has released a new video claiming that pregnancy can be a motivation for addicted women to seek treatment and recover the full ability to be good mothers. And Sorenson points out that in Britain, there are welfare-state programs that can help addicted parents keep their children. The fact that Project Prevention’s guide for the volunteers who distribute their fliers instructs them to target “AA and NA Meeting Places” suggests that the organization is equally interested in sterilizing recovering and former addicts.

Project Prevention appears to be very well funded, especially given the scope of its work. Harris says that she has never had to fundraise; donations arrive from around the world without being asked. One of her largest longtime donors is the Allegheny Foundation of arch-conservative billionaire Richard Mellon Scaife, dubbed by the Washington Post “the funding father of the right.” Other notable far-right deep pockets include Dr. Laura Schlessinger, the former talk-show host whose homophobia cost her her advertisers, and Jim Woodhill, a Houston venture capitalist and self-proclaimed member of the "Republican Rebel Alliance.”

Woodhill hired Chris Brand, a British psychologist who was fired from his tenured teaching position at Edinburgh University, to export Project Prevention overseas. Among the claims of a self-proclaimed “race realist” are that blacks are intellectually inferior to whites, that “wanton and criminal females” should be sterilized and that sex with children 12 and over should be legal.

Lynn Paltrow says, “Why would someone like Richard Scaife fund them? To promote disinformation for those who believe that all social problems are about bad individuals and have nothing to do with the social and economic circumstances of their lives.”

The organization has had mixed success in establishing a global footprint; the public outcry in Britain forced the group to decamp for the presumably more welcoming environs of Haiti, which is the world’s poorest nation. In 2010, the organization opened a beachhead in Africa with a new campaign in Kenya targeting women with HIV—on the theory that a child with HIV, like a child exposed to drug addiction, is better off not being born. HIV advocates have attacked the program, pointing out that mother-to-child HIV transmission during childbirth is preventable if the mother can access even temporary antiretroviral treatment, not to mention that the disease is no longer a death sentence—again, if treatment is available.

But rather than help pay for such treatment, Project Prevention offers the women $7 to undergo sterilization or long-term contraception, plus another “$40 American to use as they please.” That’s not even the $300 that drug-addicted women in the U.S. receive, but in Kenya, where average-per-capita GDP is $315, $47 can go a long way.

By Jed Bickman

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