Controversial Cash-for-Birth-Control Program Comes to Baltimore
Health officials and child-welfare advocates across the country agree that pregnant women shouldn't use drugs, and that drug-abusing mothers rarely provide optimal care for infants and children. Where they often disagree is on how to prevent babies from being born to addicts. Perhaps the most controversial and contested approach comes from a West Coast nonprofit that pays substance abusers to go on long-term birth control or get their fallopian tubes tied, and the organization's recent inroads in Baltimore have brought the wide-reaching sterilization debate to town.
The classified section of the March 21 and 28 editions of City Paper included advertisements bought by Stanton, Calif.-based Children Require a Carrying Kommunity, or CRACK. Under the headline "Get Birth Control--Get Cash!" the ad offers $200 to women with "a history of or current drug or alcohol addiction" if they get "long-term birth control." Mailings and fliers promoting the program, dubbed Project Prevention, also have begun appearing in area drug-treatment facilities and health clinics. And that has local opposition to the program coalescing, even though CRACK isn't due to formally announce its Baltimore operation until the summer.
"It makes far more sense to me to try and encourage people to address their substance-abuse problem rather than to coercively try and address their ability to choose what to do with their own bodies in terms of reproduction," Baltimore City Health Commissioner Dr. Peter Beilenson says. "Increasing the availability of drug treatment will resolve the problem in a much more humane way."
Along with their check, female Project Prevention enrollees will be fitted with an intrauterine device, receive quarterly injections of the contraceptive Depo-Provera (both birth-control methods are typically covered by Medicaid or insurance), or undergo tubal ligation. CRACK, which has outposts in more than a dozen U.S. cities, reports that it has paid 401 addicts to date. That number includes five men who received vasectomies, but women remain the focus of its efforts.
The unconventional approach has received a wealth of media attention, from Oprah to 60 Minutes II, and CRACK's methods have drawn a firestorm of protest from folks who deem a cash-for-contraception scheme focusing on inner-city communities inherently coercive and unethical, even racist. Shortly after the first local ad appeared, an anti-CRACK e-mail petition began making the rounds of Baltimore public-health, reproductive-rights, and drug-treatment facilities.
"I honestly don't think they have the well-being of low-income, drug-using women in mind when they offer their services," says Patricia O'Campo, an associate professor in the department of population and family health sciences at the Johns Hopkins School of Public Health and an early organizer of local opposition to CRACK. "All women should have access to birth control, including low-income women. But saying, 'Here, you can have $200 if you take this kind of birth control or get sterilized'--I think that is potentially coercive."
O'Campo adds that none of CRACK's birth-control offerings prevent the spread of sexually transmitted diseases. (Intravenous-drug-using women are among the fastest-growing sources of AIDS cases in Maryland.) And she and others question whether women grappling with addiction are in the right frame of mind to make birth-control decisions, and whether promising them cash--which might in turn be used to buy drugs--is ethical.
From her California office, CRACK founder and director Barbara Harris says she's heard all these complaints before. "If you can't trust [addicts] with this decision," she counters, "how can you trust them with a child?"
Harris says outrage over the many addicts having multiple, physically and emotionally scarred babies that often wind up in foster care prompted her to start CRACK. She herself has adopted four children born to a mother who abused a myriad of drugs during her pregnancies.
"This is about being responsible, and if it takes $200 to motivate someone to be responsible, then we should be doing everything we can to do that," Harris says. "I don't understand people who are blinded to the fact that the real victim here is the baby. If we can prevent somebody from having 10 pregnancies while they're strung out on drugs, how can anybody find fault in that?"
The answer, CRACK critics maintain, is that the program smacks of racism and eugenics.
"Think about the name, CRACK," says Rajani Bhatia, a coordinator in Baltimore for the Committee on Women, Population, and the Environment, an Amherst, Mass.-based women's-issues watchdog group. "They didn't call the organization DRUNK, because in their minds they know which people they want to make sure couldn't have children. Crack cocaine is used mostly among poor people of color."
Harris calls the correlation between crack cocaine and African-Americans "unfortunate." She says CRACK has paid more white women than black and that, while she is white, her husband and their four adopted children are African-American.
"We don't target any particular race, we target a behavior," she says. "We don't think anybody of any color who's strung out on drugs should be getting pregnant and giving birth to babies."
But some past CRACK statements and outreach tactics have left Harris with some explaining to do. There was an early flier that read don't let a pregnancy ruin your drug habit. In 1998 Harris was quoted in the British edition of Marie Claire magazine saying, "We don't allow dogs to breed. 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." Harris defends the remark, calling it "just a way of saying these women have a lot of babies, not just one or two." She adds that, along with paying women, CRACK refers them to drug-treatment programs.
She says she's received numerous calls from Baltimoreans interested in the program, prompting her to project that, despite the burgeoning opposition, CRACK will soon be "everywhere" and a "household name." "Unless every single person who is opposing us is willing to step up and adopt the next drug-addicted baby and take it home and raise it for 18 years," Harris says, "their opinion means nothing to me."
Local opponents, meanwhile, are making plans for a community forum to discuss CRACK and its methods, and to counter Harris' image as a crusading mother fighting for infants. "While CRACK is trying to solve a problem, their approach is an example of bad public policy in terms of reproductive health and drug treatment," Bhatia says. "We want to look at alternatives."
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