Maternal rites
$200 sterilization offer sets off debate about drug-addicted moms,
their babies and the society that neglects them
ANDREW GUMBEL: Feb. 8, 2004

  Barbara Harris was working as a waitress in a Southern California pancake house when she stumbled on the cause that would become her passion: saving America from the scourge of “crack babies.”  It was 1990, and she and her husband were asked to become foster parents to an 8-month-old girl born to a crack-cocaine-addicted mother. Over the next two years, they took in three more children born to the same woman, including one suffering from a neurological disorder that the Harrises were convinced was the result of damage incurred during pregnancy.
  The idea that poor, drug-addicted women - most of them living in inner-city neighborhoods antithetical to the white suburban landscape of Harris' home in Orange County - were having baby after baby without regard for their own or their children's well-being became her crusade. "These women literally have litters of children!" she later said in a series of provocative interviews. "They're not acting any more responsible than a dog in heat."
  She hooked up with a conservative state assemblyman and tried to introduce a radical law that would have made it a crime for a woman to give birth to a drug-damaged child. When that failed, in part because of concerns about its constitutionality, she set up her own private initiative to encourage drug addicts to opt either for sterilization or for long-term contraception such an IUD or a subcutaneous implant.
  The result was an organization that she initially called Crack, or Children Requiring a Caring Kommunity. Six years on, Crack - or Project Prevention, as it has been renamed in response to its more indignant critics - claims to have made successful interventions in almost 1,100 cases and has set up chapters in 28 states. The deal that it offers drug addicts is straightforward: Get yourself sterilized (a service usually offered free under the Medicaid public health program) and you will be paid $200 cash.
  To say the idea is controversial would be a colossal understatement. In Oakland, Calif., opponents tipped down signs advertising Crack's services. In Kansas City, the signs never went up after a local billboard company caved in to community pressure. Anti-Crack coalitions have sprung up in Baltimore, Washington and Seattle In Los Angeles, one group providing services to the homeless told Harris straight: "Please stay away from our clients."
  To Harris' detractors, she is pandering to the worst stereotypes of decayed inner-city living and has no regard for the scientific literature on crack cocaine and pregnancy rates for addicts. They say she is discriminating against poor women who are not necessarily in the best position to make decisions about their future - or about what to do with the, $200. They point to the disproportionate number of black and Latino women who get sterilized under the program and ask whether there isn't a racist agenda. Worst of all, they say, she is singling out a class of women and saying they am unfit to reproduce - a social engineering project that has prompted unflattering comparisons, in some quarters, with the eugenics movement of the early 20th century, which culminated in the Nazi practice of mass sterilization, "racial hygiene" laws and, eventually, genocide.
  "Their material broadly suggests that there is a particular portion of the population that should not be, or that is not worthy of, reproducing the human race. The risk is that this will be easily interpreted to mean that this group is unworthy of being regarded as fully human," says Lynn Paltrow, a feminist lawyer and executive director of the New York-based National Advocates for Pregnant Women. "Our concern is that this program will result in an increase in prejudice and misinformation about drug use, addiction and about the women and children affected by it."
  To which Barbara Harris says: nonsense. All she is interested in, she says, is preventing children from suffering because of the gross irresponsibility of women too spaced out to control their own fertility. "Lynn Paltrow is an educated idiot," says Harris, from her new home in North Carolina. "To her, it's all about the women's right to have as many babies as they want. But what makes a woman's right to procreate more important than the welfare of the children? There is nothing positive about a woman giving birth to babies that are taken away from her. We're talking six or eight babies. I can't tell you how many of these women I've talked to. They've cried and cried, and don't even know where their children are. Sometimes they know their kids have died, or are brain-damaged. That's a lot of guilt to carry around."
  She explains that, although sterilization is usually freely available at any time, money is the inducement many  women need to follow through. "They're not willing to take the time out of their busy lives. They know it's something they ought to do, but all they are thinking about is how to get drugs. I’ve had letters saying, 'Thank you for helping me to do the first responsible thing about my addiction.'"
  Harris makes a powerful point when she argues that, for all the idealized talk about offering women drug treatment programs or reducing poverty or improving health care and education, none of these is actually happening on anything like the scale required. Project Prevention, she says, exists precisely to take some small positive step amid the dearth of public-policy initiatives.
  But she is also capable of sounding remarkably callous. Her critics say the cash offer is exactly the wrong sort of inducement to offer to an addict, and she isn't entirely inclined to disagree. One of her fliers, now withdrawn from circulation, said: "Don’t let a pregnancy ruin your drug habit." And, although she points out that her group offers referrals to drug treatment, she also tells me she has no interest in monitoring how the money is spent. "Some people say they might spend it on drugs, but as far as I'm concerned they are welcome to," she said. "They can turn tricks, rob, steal, whatever, it's their choice. The babies don't have a choice."
  The notion of "crack babies" has fueled the U.S. war on drugs ever since the epidemic of cheap, highly addictive cocaine derivatives hit the inner cities as a by-product of the Nicaraguan civil war in the '80s. It's certainly an emotive idea - thousands of children suffering horrific neurological disorders because of the addiction of their mothers.
  But it has little or no basis in fact.
  The harm that drugs cause during pregnancy is impossible to measure or single out from other factors (poverty, malnutrition, stress, inadequate prenatal care and so on). Barbara Harris has no way of knowing what exactly caused the screaming fits and, other symptoms that beset her adoptive child, and a growing body of scientists is beginning to wonder whether the link to crack cocaine is even plausible.
  "Crack babies are like Max Headroom and reincarnations, of Elvis - a media creation," the academic specialists John Morgan and Lynn Zimmer wrote in a widely cited 1997 article, The Social Pharmacology of Smokeable Cocaine."Cocaine does not produce physical dependence, and babies exposed to it prenatally do not exhibit symptoms -of drug withdrawal. Other symptoms of drug dependence - such as "craving" and “compulsion" - cannot be detected in babies. In fact, without knowing that cocaine was used by their mothers, clinicians could not distinguish so-called crack-addicted babies from babies born to comparable mothers who had never used cocaine or crack."
  Myth No. 2 is that drug addicts are giving birth at abnormally high rates.
  Although instances of multiple pregnancies can dearly be found, the best research suggests that the average drug user has two to three children, just like anyone else. The best research also points out that the "average" drug user is not, contrary to media-fueled conventional wisdom, a poor, under-educated, black inner-city dweller but more likely a divorced, white high-school graduate struggling to get by with a couple of children in tow.
  Barbara Harris insists she offers her services to anyone and counts stockbrokers and former teachers among her clients. ("When you're on drugs, you don't stay wealthy very long and you don't stay employed.") But it appears, from her flier campaigns and from the statistical breakdowns, of her own numbers, that her organization focuses primarily on the inner city and on ethnic minorities.
  That may be no bad thing, as far as her supporters are concerned. The Crack organization has had positive responses as well as negative, from social workers, prison wardens, probation officers and at least one prominent African American community activist and commentator in Los Angeles. Harris has also become something, of a darling of the conservative right. Funding for her group comes largely from wealthy Republican donors, among them a Texas software entrepreneur called Jim Woodhill. He has acknowledged paying a consultancy retainer to the disgraced British academic Christopher Brand, the author of a scabrous self-published tract called The g Factor, in which he argues that black people are genetically inferior to whites. Brand, who was fired from Edinburgh University (not for his ideas on race but for his opinion that sex between adults and children over the age of 12 was to be encouraged), is held up by some opponents of Project Prevention as proof that the sterilization -for-cash program is part of a sinister resurgence of eugenics.
  But Barbara Harris is no white supremacist. Her husband and adoptive children are all black, and she takes great delight in squashing the racism accusation like a fly on a hot North Carolina afternoon. The pre-eminent chronicler of the U.S. eugenics movement, a Yale history professor called Daniel Kevles, argues that Project Prevention has nothing to do with eugenics because it has no ambition to improve the human gene pool; its aim, misguided or not, is merely to prevent the birth of damaged children.
  "The word "eugenics" is a fighting word, and is used by people to discredit things that they don't like," Kevles says. "It doesn't really get to the heart or the pros and cons of the issue."
  The issue, more precisely, appears to be reproductive discrimination against the poor - what Germaine Greer once described as middle-class resentment at "having to shell out for the maintenance, however paltry and meager, of the children of others." It is perhaps indicative of this that while sterilization is freely available under Medicaid , reproductive services designed to promote fertility are not. There is a long history in the United States of seeking to discourage the poor from having children, during the heyday of the eugenics movement and since particularly in the South, where the class issue has been closely bound up with race.
  In South Carolina, for example, pregnant black drug addicts are routinely arrested and prosecuted for child abuse since the state courts have determined that a fetus has the same legal status as a child. In a notorious case a couple of years ago, an indigent woman whose child was stillborn was sentenced to 20 years in prison for murder, even though the prosecutor could not prove that the stillbirth had been caused by her cocaine addiction. In another notorious case, a hospital in Charleston was taken to court for conducting secret urine tests on its pregnant patients and then calling the police if it found evidence of drug use. Women were dragged out of the hospital in chains, some of them just moments after they had given birth. The U.S. Supreme Court eventually deemed the hospital's behavior to be unconstitutional.
  Is this the path that Barbara Harris's movement is heading down? 'The more you dig, the more frightening this is," Paltrow says. "On some level, I do believe Barbara Harris is a sincere person who does not set out to be discriminatory. But the consequence of her program is to blame the individual and provide further incentive to government to de-fund any kind of public services." As the gap between rich and poor grows ever wider under a Bush administration seemingly intent on privatizing social services altogether, Paltrow’s fears may not be entirely unfounded.