By Carolina Luna
Editor’s note: [The intention of this article is to introduce the reader to drug abuse, its impact on families and how this impact can be changed in the eyes of different organizations. One organization, Project Prevention, believes the best way to prevent child abuse is to offer birth control to or to sterilize drug users so that children are not born into a potential situation. Other organizations, such as the National Advocates for Pregnant Women and the Committee on Women, Population and the Environment believe Project Prevention is using coercion to achieve this goal. Other organizations and former drug users believe drug abuse is a disease and should be treated and that Project Prevention is imposing on a person’s free will. The job of Nvate is to report the facts from both sides in an unbiased manner and to let you, the reader, decide how you feel about the topic and the issues at hand.]
Over the years many people have applauded Project Prevention as a devoted and socially conscious organization. Formerly known as Children Requiring a Caring Kommunity, or CRACK, Project Prevention is a U.S.-based organization that offers $300 to drug users who agree to undergo surgical sterilization or use long-term birth control methods.
While being commended by some, organizations like The National Advocates for Pregnant Women and the Committee on Women, Population and the Environment, have found Project Prevention to be somewhat disturbing. These organizations say Project Prevention is “exploitative, coercive and racist.” Former drug users believe Project Prevention is seen as dangerous because the organization doesn’t see drug abuse and addiction as a disease.
What is Project Prevention?
According to the organization, their primary goal is “to reach out to addicts offering referrals to drug treatment for those interested and to get them on birth control until they can care for the children they conceive.” In addition, Project Prevention stated that it has lessened the financial burden in the foster care system by reducing the number of children. Project Prevention operates across the United States and abroad—in the United Kingdom, Kenya and will soon be expanding its program to Australia. In the United Kingdom, however, the organization will stop paying women for sterilization procedures due to the strict restrictions placed by the British Medical Association, according to the Project Prevention website.
The National Advocates for Pregnant Women said on their website, “far from providing a useful response to problems associated with drug use and pregnancy, [Project Prevention] instead acts as a dangerous vector for medical misinformation and political propaganda that has significant implications for the rights of all Americans.” Moreover, the organization has been criticized for promoting a vile image of all drug users. Barbara Harris, founder of Project Prevention has denied such allegations. Instead, she affirms that her organization’s main concern is protecting children from abuse and neglect.
Project Prevention’s program raises several questions about people’s rights and how to alleviate social problems in the United States. For instance, some people may ask, as a society, is it our responsibility to regulate and restrict the reproductive rights of certain individuals? Or, is it a matter of free will? More importantly, is Harris’ idea to offer a monetary incentive to drug users the solution to prevent more children in the foster care system and children born with fetal alcohol syndrome, or with other medical conditions?
Protecting Children from Child Abuse through Prevention
At first glance, Project Prevention might appear to have the best intentions to resolve a social problem like child abuse in the United States. In a study conducted by the Department of Health and Human Services—in conjunction with the Administration for Children and Families, Administration on Children, Youth and Families, and Children’s Bureau—it was found that in 2010 nearly 3.3 million reports of child abuse were made involving about 6 million children. This same study also indicated that about 80 percent of child abuse and neglect fatalities were perpetrated by parents. Moreover, more than five children die from child abuse every day.
According to the National Council on Child Abuse and Family Violence, “Children whose parents abuse alcohol and other drugs are three times more likely to be abused and more than four times more likely to be neglected than children from non-abusing families.” Therefore, to prevent further child abuse and neglect, says Project Prevention, the first “responsible” step a drug user can make is to use long-term birth control. Some organizations and private institutions, like the Committee on Women, Population and the Environment (CWPE) and DrugScope, disagree and say that Project Prevention is dehumanizing drug users and portraying them as “child abusers,” especially mothers. In addition, the organization is said to use coercive tactics against drug users. Due to the severity of their addictions—substance dependence or abuse is classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorder—drug users will accept $300 without understanding its implications and agree to get sterilized.
“No matter how you frame it, paying women to become sterilized is coercion,” said Beverly Whipple, executive director of Cedar River Clinics. “How is $300 really going to help that woman? It won’t, of course.” Whipple said that monetary incentives are not the solution to resolve child abuse in the United States. According to the National Institute on Drug Abuse, “many people do not understand why or how other people become addicted to drugs. It can be wrongfully assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behavior.”
Project Prevention says they have the best intentions to prevent child abuse by offering drug treatment referrals to all women that enter their program. On their website it states, “we have gone to great lengths to assist some individuals into treatment, or to locate a treatment program for them.” But with Harris’ recent statements in mind it seems that the organization cares too little about drug users. “It makes no sense for an addict or alcoholic to conceive a child they will marinate in drugs or alcohol until birth [too] often,” said Harris. “They are free to spend the money on drugs if they want [because] it’s their choice. The innocent babies have no choice.” In contrast to these statements are ones made on the Project Prevention website. “Barbara Harris writes on a continual basis to countless Project Prevention clients. She frequently sends cards of encouragement applauding their efforts to get or stay clean.”
Harris’ comments and remarks about drug users over the years—made in several television interviews and public events—have not made her very popular among health care providers. She has compared drug users to animals. “I’m not saying these women are dogs, but they’re not acting any more responsible than a dog in heat,” Harris stated in a Dateline NBC interview from September 1998. “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.” She also stated in a Marie Claire interview from December 1998 that Project Prevention’s main goal is not the welfare of the mothers but to prevent them from having more “doomed babies.” The message, “Don’t let a pregnancy ruin your drug habit,” has also been printed on fliers whose main purpose was to be distributed to drug users.
As of May 2012, Project Prevention reported that 4,025 women and 72 men have participated in their program and, in the process, the organization has spent $1 million. For Harris, saving children from people with substance abuse problems is personal because she is a foster parent. She and her husband adopted four children from a drug-addicted mother.
Reproductive Rights and Free Will: Former Drug Addicts’ Thoughts on the Disease
Project Prevention states that its main objective is public awareness—to inform Americans about the problem drug users are causing to their unborn child during pregnancy and to reduce the economic burden placed on taxpayers by reducing more children in the foster care system. This organization said that they do not “punish” their participants, nor do they enfranchise on their reproductive rights or free will. Instead, they give them a choice to not have more children.
In a letter that appears on Project Prevention’s website, a former client, Denise Lewis, depicts drug users as irresponsible and immoral. And their children as “damaged” and “deformed.” She stated, “An addict woman will cradle her pipe before she cradles her own child.” She further explained, “The stark truth is that most addicts or alcoholics will never get it together, they just continue on, only interrupted by stays in jails, prisons, mental institutions, and ‘rest stops’ in recovery homes. Only to come out, looking good, got the loved ones all hopeful, just to step back off the planet.”
But for many drug users one treatment is not enough. Some will need two or three different treatments before they can stop taking drugs. According to the National Institute on Drug Abuse, “drug addiction is a complex disease, and quitting takes more than good intentions. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so.”
“Our hardest battle is to stay clean,” explained Jack Simien, a 60-year-old former drug user, who used for 30 years. He stopped using drugs about four years ago when he realized that he didn’t want to die like his friend from an overdose. Simien said most people don’t stay addicted to drugs forever, and if they do, they die. Drug users, he said, need treatment and drug addiction is a disease that needs to be treated like any other. Offering sterilization, he said, is not the solution to deal with this disease. “Society should not tell you who should have children,” he said. “That’s an individual’s choice. Free will is something that God gave you.”
To offer sterilization—through the usage of monetary incentives—to former or current users is a “controlling thought,” said Andrea Jackson, a former drug user and now a pastor for Joy Ministries for Christ. Both of her parents were alcoholics and if they had opted for sterilization, she said, she wouldn’t be here helping her community. Jackson believes that Project Prevention’s program is enfranchising on the reproductive rights of people. And she questions the organization’s true motives in promoting sterilization among drug users. Drug abuse is a treatable disease and people should not perceive drug users with disdain, said Jackson.
“What are they trying to do, ‘weed out the bad seeds?’” asked Joseph A. Santangelo Jr., a 51-year-old former drug user. “Or, do they think it’s in genetics and they are lifting a burden off society [by] keeping future drug addicts from being born?” Santangelo said he understands that creating public awareness is important but doesn’t agree with Project Prevention’s program, especially in providing monetary incentives for sterilization to young women and men.
Santangelo started using drugs at a very young age. His father was a heroin user for many years. “I guess that’s where I thought it was OK to act the way I did and do drugs,” he said, “never realizing what problems it caused in his life and the problems it would cause in mine.” Santangelo was a drug user for nearly 25 years and his drugs of choice were cocaine, methamphetamine and heroin, although in small quantities and not very often. Due to his drug addictions, he held several jobs, but lost them all. “There is a time in one’s life when enough is enough and if you’re lucky enough to reach that point before prison and/or death, you’re blessed,” he said. About six years ago he arrived at the Veterans Affairs facilities in Los Angeles, Calif., for help and since then he has been clean and sober.
Is Stopping Women with Substance Abuse Problems Unethical?
In 2006, the Civil Liberties and Public Policy (CLPP) at Hampshire College in Massachusetts published a fact sheet about Project Prevention’s goal to permanently or temporarily sterilize women with a drug abuse problem. According to the CLPP, Harris is luring women to use long-term birth control methods with monetary incentives. As of May 2012, 1,435 women were sterilized by tubal ligation. In the United States, using monetary incentives to change health behaviors is not something new. Incentives have been used by private and state-funded organizations to encourage certain people to participate in vaccination programs, drug abuse treatments and vaccine clinical trials.
Some organizations argue that Project Prevention seeks to eliminate people considered to be “undesirable,” thus promoting eugenics. “Eugenics is based on prejudiced beliefs that people inherently belong to superior or inferior race and class. It is also fueled by a fear that the ‘inferiors’ will breed excessively, thereby ‘threatening’ the proportion of ‘superiors,’” the CLPP said. According to Lutz Kaelber, a professor of sociology at the University of Vermont, in the early 20th century in the United States, about 27 states had created sterilization laws in order to prevent certain people they believed to be “unfit” from procreating. About 60,000 African Americans, Native Americans, the mentally ill, physically disabled and the poor were sterilized. During this same time, American eugenicists successfully lobbied Congress to pass legislation that would restrict European immigration, prevent racial mixing and to sterilize the “unfit.” In addition, in Puerto Rico in the 1970s the U.S. government funded programs to sterilize women—about 34 percent of all women between the ages of 20-49 years old were sterilized according to the Chicago Women’s Liberation Union.
According to the CLPP, the monetary incentive offered by Project Prevention to women with drug abuse problems is not about giving these women a choice but to prey on their vulnerability. “Poor women with substance abuse problems are not likely to be able to make an informed decision with regard to their reproductive capacity, if offered cash as an incentive,” noted the CLPP. Women with substance abuse problems need mental health services, childcare services, drug treatment and more, the Substance Abuse and Mental Health Services Administration stated in a report. According to professor Jeff R. Temple and Dr. Gary D.V. Hankins from the Department of Obstetrics and Gynecology at the University of Texas Medical Branch, “they should have free or affordable access to long-acting contraception, and if they become pregnant [they] should be able to access quality health care and substance abuse treatment.”
“Addicts in American life encounter routine social stigmatization as a deviant, criminal, and risky sub-population,” according to sociology professor Teresa Gowan, sociologist Sarah Whetstone, and scholar Tanja Andic—all from the University of Minnesota. Project Prevention does not recognize addiction as a medical problem and this allows the organization to classify drug users as irresponsible people, according to the Committee on Women, Population and the Environment. In addition, Project Prevention carries on the “crack babies” myth created in the late 1980s, which exaggerated the effects of cocaine on children, as reported by The New York Times. According to the myth, “crack babies” would experience attention and behavior disorders, and learning disabilities. “Today, there is practically scientific consensus that crack cocaine does no more damage to infants than heavy cigarette smoking and does less damage than heavy alcohol use,” according to the CLPP.
New Research: Kaiser Permanente helps Women At-Risk of Substance Abuse
In January, the Journal of Obstetrics & Gynecology published a study by Kaiser Permanente suggesting that a prenatal intervention program may stop substance abuse during pregnancy and save about $2 billion annually if enforced across the nation. In the study, nearly 50,000 women participated in the Kaiser Permanente Early Start Program. The program was developed to help women at risk of substance abuse, decrease illness in mothers and their babies, and in addition, decrease stillbirths. Moreover, as part of the program, pregnant women are screened with urine tests in the same clinic where they receive prenatal care and on the same day they receive prenatal care, a licensed substance abuse expert meets with the expectant mother. The women are also given substance abuse questionnaires. Through the program, health care providers and patients are educated about the effects of alcohol, drugs and cigarette use during pregnancy. The research, however, does not state how many healthy babies were born as a result of the program or how many mothers have quit using drugs through the process.
Former drug users, like Simien, believe Project Prevention is seen as dangerous because they don’t see drug abuse and addiction as a disease. People with substance abuse problems cannot simply abandon their addictions on their own. Many users need a support group and several treatments to stay completely clean, Simien said. “Drug abuse is like cancer,” he said. “You don’t sterilize people with cancer. You treat them.”
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