Cecilia M. Vega

Sterilization offer to addicts reopens ethics issue

A flier hanging on a pole in Brooklyn looks, at first glance, as if it might offer a room for rent or a job. There are phone numbers, dollar signs and tabs for people to tear off and take with them. But the offer is intended for a specific group: drug-addicted men and women. "Get birth control, get cash," the flier reads. "If you are addicted to drugs and/or alcohol then this offer is for you." While offers of birth control to drug addicts are common — distribution of condoms in particular, as a means not only for birth control but also to stem the spread of AIDS — this offer is much more radical. It offers men and women $200 to be sterilized or put on long-term birth control. The group making the offer, Children Requiring a Caring Kommunity, or Crack, contends that the program is a humane effort to keep children from being born to women ill-equipped to raise them. Critics counter that it is little more than a bribe to women to make an irreversible decision, and argue that counseling is the best method for both ending drug use and promoting responsible parenthood.

So far, the presence of the group in New York is minimal; it is based in California, and its only chapter here consists of a 27-year-old office worker from Brooklyn, who with the help of her husband and another volunteer has posted fliers across the city and held meetings with hospitals and community groups. But if Crack's reception in other cities is any indication, there is likely to be heated debate about the efficacy and the ethics of its offer.

"The program is fundamentally incompatible with a health care policy that respects a woman's right to choose," said Donna Lieberman, executive director of the New York Civil Liberties Union. "It certainly raises policy concerns for government entities to be providing referrals to this program or endorsing it in any way." The organization was started in Orange County, Calif., in 1997 by Barbara Harris, a housewife and former waitress, after she adopted four children from the same drug-addicted mother. Children born to drug addicts regularly suffer emotional scars and medical disabilities and end up in foster care at taxpayers' expense, she said.

"It's common sense," she said. "Why should a drug or alcohol addict get pregnant? I watched how my children suffered when I brought them home from the hospital, and no child should go through that." Critics, however, say that Crack's stance is aimed not at helping children but at selective breeding. They point to comments like those Mrs. Harris made in 1998, when she was quoted in the British edition of Marie Claire magazine saying: "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." The organization has softened its message, and now refers to itself as Project Prevention as often as it calls itself Crack.

But opponents say Crack's $200 offer misses the real issue, which is helping people get treatment for their addiction. "What she's doing is suggesting there are certain neighborhoods where it is dangerous for some people to be reproducing," said Lynn Paltrow, executive director of National Advocates for Pregnant Women. "It suggests they are not worthy of reproducing. It is very much like the eugenics history in America. The Nazis said if you just sterilized the sick people and Jews you would improve the economy."

When it first started, Crack offered payments on a sliding scale, giving more money to women who chose tubal ligations and men who chose vasectomies than to those who chose long-term birth control like intrauterine devices, Norplant or Depo-Provera. But the criticism was so harsh that the group changed its policy and began offering a flat payment of $200. Women submit such documents as an arrest report or doctor's letter to prove they use drugs. They have the procedure done, usually paid for with government assistance, and then they send Crack written proof.

Brookdale University Hospital and Medical Center in Brooklyn has plans to refer patients recovering in the psychiatric emergency room to Crack, officials there said. The director of chemical dependency services at Lutheran Medical Center in Brooklyn said he was reviewing the program. Dr. Attilio Rizzo Jr., a social worker in Brookdale's psychiatric emergency room, said that the program was "a godsend" and that he had already referred one woman, who did not respond to his offer. "A lot of them are homeless and have H.I.V. and are on drugs and they don't want to have any more babies," Dr. Rizzo said. "I believe it's up to the individual to make that decision."

The program was introduced to the hospital by Asia Tepper, 27, a Brooklyn resident who heard about Crack on a radio program two years ago and volunteered to run its fledgling local chapter. She spends many evenings and weekends carrying a black bag filled with rolls of tape for the fliers and handouts on the organization and scouting out what she calls "prostitution-infected areas." "To me it's about the children. That's it," she said. "It's about preventing a child from being born in what is not the best environment." She said she had received favorable comments at police precinct stations and hospitals and from social workers. "They're being very, very helpful," she said.

But not everyone is lining up to support the program. Dr. Van Dunn, the chief medical officer of the New York City Health and Hospitals Corporation, which oversees hospitals in all five boroughs, said no hospital in his organization would have anything to do with Crack. "It raises a lot of ethical questions about trying to pay women for sterilization," he said. "Reproductive choice should always be an option, and people shouldn't be paid. You provide family planning counseling and let them make their decision." Across the country, reaction also has been mixed.

In the San Francisco area, opponents tore down Crack's signs; in Kansas City, billboard companies took down the group's messages after a public outcry. But since May, Crack volunteers in Albuquerque have met weekly with female inmates in the county jail, said Matthew Elwell, programs director for the Bernalillo County Metropolitan Detention Center. And last spring about 30 Crack billboards stood in Detroit, where Mrs. Harris was invited to speak to a predominately black church congregation of 5,000 people. "I don't see the controversy," said the Rev. Charles H. Ellis III of the Greater Grace Temple in Detroit, where Mrs. Harris spoke. "People in the Betty Ford Clinic have some kind of support. In urban Detroit, a lot of time there is no support system."

Of the 833 women and 21 men nationwide who have been paid by Crack since its inception, 369 have been sterilized and the others have had long-term birth control, Mrs. Harris said. Theresa Prautzsch, 24, an alcoholic who lives in a drug rehabilitation home in Niagara Falls, N.Y., accepted Crack's offer to get Depo-Provera birth control injections last year. "When you're using you don't think about a condom," she said. "The women are under the influence. I've seen the children that have been born on drugs, and I'd rather have them have their tubes tied than have those babies. If anything, it's the smartest thing they can do."