A program that pays drug-addicted women $200 to get sterilized or to use long-term birth control opened here this week amid criticism that it coerces poor women impaired by drugs into making what often is an irreversible reproductive decision.
The privately funded program, which began in Anaheim, Calif., 18 months ago and has attracted attention in Minneapolis, Dallas and Fort Pierce, Fla., was branded as exploitive and "basically bribery" by reproductive rights advocates and other critics who vowed to fight it.
"Dangling $200 in front of seriously addicted women seriously calls into question whether participation is voluntary," said Steve Trombley, president of Chicago Planned Parenthood. "Where is the informed consent?"
Trombley said his group and other birth control providers will meet to discuss strategies for countering the new program, which opened here with billboards in poor neighborhoods declaring, "If you are addicted to drugs get birth control--get $200 cash."
Other opponents said that the program may be a well-intentioned effort to reduce the number of babies born with drug addiction but that it is misguided and should instead be directed toward establishing drug treatment programs in prenatal clinics.
"If you know absolutely you want sterilization and you get $200 for it, that's great," said Priscilla Smith, deputy director of litigation for the New York-based Center for Reproductive Law and Policy. "But if you are extremely indigent and on drugs, this smacks of forced sterilization."
Smith said little is being done nationally to help drug-addicted pregnant women get off drugs.
Some states, including Illinois, have sought to prevent drug-addicted women from harming their unborn children by charging them with child abuse or even involuntary manslaughter, but most of the cases have not stood up in court.
The program--called CRACK, for Children Requiring a Caring Kommunity--was founded by Barbara Harris of Anaheim, who after adopting four children from the same cocaine-addicted mother tried to get legislation passed in California making it a crime to give birth to a drug-addicted baby.
Failing in that effort, she devised the unorthodox incentive program intended to persuade women to agree to tubal ligation, which is not always reversible, or to get long-term birth control, such as Norplant capsules inserted under the skin. Other options are to get an intrauterine device or to take Depo Provera, an injectable contraceptive.
To get the $200, women have to submit documents, such as an arrest report, to prove they are addicted. They also must submit a letter from a doctor detailing the form of birth control they are using.
So far, CRACK has paid $200 each to 57 drug-addicted women in California who had been pregnant a total of 423 times and had given birth 262 times, Harris said. Forty-three of the women chose tubal ligation--or having their fallopian tubes tied--which was not paid for by the program but which normally is carried out with government assistance. Male drug addicts are eligible for $200 payments for vasectomies, but none has undergone that procedure yet.
The Chicago CRACK program was organized by Lyle Keller, a social worker who used his own money to advertise the campaign after hearing a radio news report of Harris's California program. Keller, who trains clinical services workers under a consulting contract with the Illinois Department of Children and Family Services, said two Chicago women already have signed letters agreeing to tubal ligations.
He said there was a "huge potential" in Chicago for sterilization and long-term birth control for addicted women, and he predicted similar programs would begin soon in New York, Philadelphia and other cities. Keller also rejected arguments that addicted women cannot make rational decisions about sterilization.
"If the concern is a woman is not coherent enough to make such a decision, what is her ability to effectively parent her child?" he asked. "CRACK Chicago supports a woman's right to choice and self-determination."
Harris, who is white, denied allegations by some critics that CRACK is racist because it targets mostly minority neighborhoods. She noted that her husband, a surgical technician, is black and that nearly half the women she has paid so far are white. "Race shouldn't even be the issue," she said. "It's about child abuse."
She cited the case of Sharon Adams, 38, a former addict in Los Angeles who decided to have her tubes tied after having 14 children. Four of the children died and nine were placed in foster care. Adams, who is now drug-free and raising her youngest child, said: "I figured it was about time to do it, and the $200 motivated it."
CRACK gets most of its funding from private donations, including $5,000 from Laura Schlessinger, the conservative radio talk show host who advocates personal responsibility, Harris said.
Harris said that 12,338 drug-addicted babies were born in Los Angeles alone from 1992 to 1996 and that the number of "substance-exposed infants" in California rose from 915 in 1986 to 69,000 in 1990. She said that less than 20 percent of the babies go home with their mothers and that in most of the other cases, legal petitions eventually are filed against the mother and the child is placed in foster care.