Should Addicts Be Sterilized? - Page 2

By Jed Bickman 04/26/12

Project Prevention thinks so—and for years it's been paying poor, addicted women not to procreate. Now, with money from the far right, it's going global.

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A volunteer in front of the mobile billboard. photo

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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%) and tobacco (16.4%) during pregnancy is far more widespread than the use of any illicit drug (5.2%), 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% since 1994; programs for pregnant and postpartum women and their children is now less than 10%.

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 US, resulting in state laws permitting the forced sterilization of prostitutes, mental patients, criminals, addicts and other stigmatized people.

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Jed Bickman is a journalist and copywriter living in the greater New York City area. He is the associate editor at The New Press. You can find him on Linkedin or follow him on Twitter.

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