Paying Drug-Addicted Women To Get Sterilized: Choice or Coercion?

Amie Newman

Project Prevention pays low-income, drug-addicted women to get sterilized or use a long-term form of contraception. Is it coercion or simply "reproductive choice?"

Barbara Harris is in the news once again.

The founder of a controversial program that pays drug-addicted women to get sterilized or use a long-term method of birth control, is the subject of a recent New York Post article, with the TV talk-show title, “Why I took $300 to be sterilized.”

Her organization, Project Prevention (formerly called C.R.A.C.K. – Children Requiring A Caring Kommunity) has been extensively covered in the media, analyzed, and discounted by maternal health policy experts and groups including Lynn Paltrow of National Advocates for Pregnant Women (NAPW) and the Committee on Women, Population and the Environment (CWPE). 

However, as the New York Post reports this weekend, Harris continues her quest to ensure that women who are addicted to drugs become permanently unable to procreate, with plans to extend her program to Africa to pay HIV positive women in Kenya $40 to have an IUD implanted.

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Many wonder, lacking appropriate and accessible public health remedies, is this the best we can do?

First some background from my personal experience. In 2003, C.R.A.C.K. began “advertising” via photocopied flyers stapled to telephone poles in the area of Seattle where I worked, at the time. As an employee of a women’s health center, located next to a methadone clinic, C.R.A.C.K. clearly honed in on a location they knew low-income, drug-addicted women congregated.

Their sheets of paper, printed with graying ink, sometimes wet from the ongoing light rain that falls during our Seattle winters, told women they’d be eligible to receive $300 for agreeing to be sterilized or a bit less money for accepting a longer term form of contraception such as Depo-Provera (at the time). A web site for the project (no longer live), noted in the “Do’s and Don’t of Pamphleteering” section, that AA and NA meeting places were appropriate sites for hanging pamphlets. C.R.A.C.K. (aka Project Prevention) obviously also targeted recovering addicts for their “project.” When I first noticed the flyers, I brought the issue to my employer since some of our abortion clients were known to also be clients of the methadone clinic next door. The challenge, of course, was that some of these women were certain to visit us for Depo-Provera, after accepting the cash from C.R.A.C.K. or Project Prevention. What were we to do?

Ultimately, after an in-depth discussion, many meetings with fellow race-based organizations and a  report written about the group, by an employee of a group called CARA (Communities Against Rape and Abuse), we decided that our options, in this scenario, were to simply continue to offer these clients support or referrals for other assistance if they wanted to get help for their addiction or wanted more information about their health care and, as is the case with any woman’s decision to access safe and legal health care including contraception, offer access as well.

The larger issue, of course, is what sort of “help” paying low-income, drug-addicted women to get sterilized truly constitutes. And, Paltrow and others argue, Project Prevention may be more than just ineffectual on a larger scale, it’s harmful as well.

Project Prevention was founded back in 1997, notes Judith Scully in “Cracking Open C.R.A.C.K.: Unethical Sterilization Movement Gains Momentum,” writing for the Population and Development Program at Hampshire College, when it used billboards (“Don’t Let a Pregnancy Ruin Your Drug Habit” and “If You Are Addicted to Drugs – Get Birth Control – Get $200 Cash”) to reel women in. But the group advertised (and still advertises) in low-income neighborhoods, bringing in proportionally many more African-American women than Caucasian women. Though the New York Post article (and the organization’s own web site) attempts to counter critics’ claim that the group is racist, with statistics – since its inception, 1,822 Caucasians and 944 African-Americans have “used Project Prevention’s services” – considering the fact that African Americans make up only 13.5% of the total U.S. population, this hardly seems like a color-blind program.

The article paints Harris as a concerned, compassionate woman who says she adopted four children all from the same, drug-addicted mother, years ago. It’s hard to argue that Harris is not concerned or passionate about her cause – and motherhood, especially when it comes to the children she’s raised. As well, given the realities of a public health system where drug and alcohol abusers find it to difficult to access help when they need it; a national foster care system in need of greater attention; and child abuse costs rising to over $100 billion/year, some argue that Harris is making a positive impact, for very little investment.

However, as Paltrow argues, this program which has garnered immense media attention over the years has also been deemed “a violation of informed consent, exploitative, coercive, racist and a form of eugenic population control.”

In a New York Times article about the group, in 1999, Steve Trombley, the CEO of Chicago Planned Parenthood said, “It’s simply a bribe for sterilization…” It’s hardly a leap to consider, Paltrow notes, “dangling” $200 or $300 in front of a drug-addicted, poor woman to get sterilized, coercive.

While the article quotes a couple of women who desperately express gratitude to Harris and her program for keeping them from having any more children, while addicted to drugs, the women don’t seem certain about much else. In fact, one woman in the story – Kelly – credits the program with ensuring that she doesn’t give birth while drug-addicted ever again. She says, “Babies and drugs don’t mix. My kids are the ones who pay for my partying, and I didn’t want to do that to another one. I love them, they are everything to me – I don’t want to smoke their lives away,” Kelly has been reuinted with her two year old daughter and cannot say for certain whether she’ll end up staying off for drugs. Harris’ program does not address her needs – or her daughters’, in this regard, at all.

Paltrow’s examination and analysis of the program including her questions about the lack of the group’s ability to address drug addiction, unwanted pregnancies, child welfare and public health – should throw the overall impact of Harris’ organization into question. As Paltrow notes, “This examination makes clear that “far from providing a useful response to problems associated with drug use and pregnancy, C.R.A.C.K. instead acts as a dangerous vector for medical misinformation and political propaganda that has significant implications for the rights of all Americans.”

The New York Post article quotes an obstetrician who works with drug-addicted, pregnant women in North Carolina who calls the cash incentives “bribery” and urges people to consider that drug-addicted women need treatment – not money for sterilization. As well, he says, this type of a program focuses on control over empowerment, despite the propaganda pushed by the organization.

When Harris first envisioned “helping” drug-addicted women and their future babies, she attempted to take a legislative route. She reached out to an Assemblyman in California (where she lives), Phil Hawkins, who agreed to sponsor legislation making it a crime to give birth to a drug-addicted baby. Titled the “Prenatal Neglect Act,” the bill proposed creating a crime of “prenatal child neglect.” Ultimately, Harris and her organization “revised” the history to note that, after adopting four of her children from one drug-addicted mother, she attempted to get a bill passed “that would have made it mandatory that after giving birth to a drug addicted baby the birth mother use long-term birth control.”

Harris told Rewire that she was contacted by a male student in Kenya who “begged her” to come to the country to offer HIV positive women long-term birth control. If Project Prevention expands its reach to target HIV positive women, in Kenya, innumerable questions arise, once again. While there is a risk of transmission of HIV between an infected mother and her fetus, the risk is nearly diminished completely when anti-retroviral treament (ART) is used in pregnancy and labor and the woman does not breastfeed. When there are so many millions infected with HIV, globally, including pregnant women, the focus should be on ensuring that those who need treatment, receive treatment;  and that those who are at greatest risk of being infected, before pregnancy occurs, are able to protect themselves. To pay an HIV positive woman, in Kenya, $40 to be implanted with an IUD is short-sighted at best and retains the focus on the woman as a “broken” vessel rather than on a broken system in need of fixing.

This is not about the woman – in any of these scenarios. This is about the lower-income woman’s body as a vessel. Ignoring a woman’s struggle with drug-addiction; targeting low-income women who use “street” drugs (the organization started out with the name C.R.A.C.K.!) for the impact said drugs may have on a newborn, when in fact the consequences of abusing alcohol while pregnant are much greater in terms of the impact on newborn health; and focusing on preventing HIV positive women in Africa from having children instead of on what we can do, globally, to prevent HIV transmission and infection, do little to actually help mend a system which penalizes women and their children. And lest one think Project Prevention is simply a voluntary, reproductive health service program along the lines of Planned Parenthood, for instance – using an “empowerment” and “free will” model – the coercive and dehumanizing tactics, says Paltrow, do not bear those ideas out. Harris has compared the women she serves to animals saying “They’re having litters. They are literally having litters.”  Paltrow writes,

“Unlike privately funded family planning organizations, C.R.A.C.K. does not focus on the numerous barriers to reproductive health that exist in the U.S., but rather on the harm that women allegedly do to their children and the cost to society of their supposed irresponsibility. It emphasizes the value of controlling their reproduction as a solution to complex public health and economic problems. Instead of providing support for much-needed reproductive health services, outreach, or education, it uses its funds to reward or motivate certain women to be sterilized or use particular forms of birth control, at public expense. As Judith M. Scully argues, “[d]espite its benevolent name, C.R.A.C.K.’s primary goal is to promote population control…”

Indeed, statements by C.R.A.C.K.’s founder and Director Barbara Harris not only provide clear examples of negative stereotyping, they also make clear that control, not empowerment, is in fact C.R.A.C.K.’s primary purpose. As one commentary quoting Ms. Harris observed, “[a]ddict, recovering addict, dirty, clean . . .whatever. The distinction hardly matters to C.R.A.C.K. (Children Requiring a Caring Kommunity), the group that gave [the client] the money. ‘As long as they stay on birth control,’ says founder Barbara Harris, ‘[t]hat’s all we care about.’”

Finally, and by no means of least importance, Paltrow reminds us that targeting “narrowly defined segments of the population” for sterilization or long term birth control is frighteningly “reminiscent of several tragic chapters of recent history.”

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