Should Addicts Be Sterilized?

Jed Bickman, Salon, May 2, 2012

“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.

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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. {snip}

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.”

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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.

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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.

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