Washington Post - June 26, 2000
Group to Pay Addicts to Take Birth Control
By Avram Goldstein
Melanie Folstad agonized over whether to join the campaign, but each time she considered her son's nightmarish origins and his continuing health problems, the hesitation melted away. So this week, the Bethesda financial planner will help a national children's welfare group make a provocative offer to Washington's drug addicts:
Obtain long-term birth control and get $200 in cash.
The idea is a last-ditch incentive to help prevent the birth of drug-addicted babies, according to the group's national campaign.
The California-based group running the program, Children Requiring A Caring Kommunity (CRACK), will push the plan throughout July on placards in 500 Metro buses. The local effort will be headed by Folstad, who adopted a low birth-weight baby delivered by a drug-addicted D.C. woman who was being held in jail.
The program already has been roundly condemned by area health leaders, who call it simplistic, racist and dehumanizing.
"It's unethical," said Larry Siegel, the D.C. health department deputy director in charge of substance abuse services. "We are talking about attempting to introduce a therapeutic intervention into a population of individuals who are unlikely to have been thoroughly informed of all the potential complications."
Public and private health officials in the District say the care of addicted mothers should be left to health professionals.
The campaign will take advantage of drug abusers with mental illnesses, making them even more vulnerable to the influence of easy cash, Siegel said. "Treatment for the underlying condition has to be part of this conversation before we talk about offering people a therapy with major medical consequences," he said.
Further, Siegel said, the campaign will target the African American community disproportionately.
Folstad, a 31-year-old financial planner, who is white, is bracing herself for the cries of genocide and racism that have been raised in other cities where CRACK has campaigned. "I've gotten a mixed reaction," she said. "I've talked to my pastor and with people in my neighborhood active in social causes. I've heard people call it everything from ethnic cleansing to a good way to encourage responsibility and choices."
Barbara Harris, the group's founder and director, says the offer is a sensible way to help drug addicts halt repeat pregnancies. So far, 236 women and one man have collected the reward, she said.
Many children of drug addicts wind up in foster care and battle health, developmental or emotional problems at taxpayer expense. Some are born with HIV, while others suffer the effects of prenatal drug exposure. Harris figures the program is trading a small sum to pay to avoid the greater cost of coping with abandoned children.
The ad campaign will be subsidized partly by taxpayers, because Metro provides space for free to nonprofit groups whose messages have been approved by a Metro advertising review committee. Instead of paying $7,000, the standard ad rate for 500 interior bus placards for one month, CRACK will pay Metro only the $1,000 installation fee, said Metro spokeswoman Cheryl Johnson.
CRACK, based in Orange County, Calif., has financial and political backing from well-known conservative figures such as radio talk show host Dr. Laura Schlessinger and billionaire Richard Mellon Scaife. But the group doesn't fit into a simple pigeonhole.
Harris said there is nearly an even split between black and white clients who have received the $200, she said.
Most of CRACK's board members are black. Harris is married to a black man with whom she raised six biracial children before adopting four African American siblings of the same drug-addicted mother. Folstad and her husband are white, but her adoptive son and two other children she is now adopting are African American. "People always want to yell racism, but I can take the heat," Harris said. "We don't target a race, but a behavior. This is common sense. It's about preventing pregnancy. It's not about abortion or women's rights. If we use birth control, we don't have to deal with either one of those issues. I've heard from so many African American people who say, 'We don't want our babies born that way.' "
The NAACP national headquarters referred inquiries to the District NAACP chapter, but the local group declined to comment on the reward program.
The Washington area chapter of Planned Parenthood had no such hesitation.
"We believe that any program that offers cash as an incentive to take birth control or become sterilized is inherently coercive," said the chief executive, Jatrice Martel Gaiter. Federal rules require her agency to provide only voluntary family planning services, she said.
Harris accuses Planned Parenthood of being hypocritical. "How do they feel these vulnerable women can make a rational decision to have a free abortion when they are under the influence of drugs?" she said. "That's coercive to a drug addict."
The reaction to the campaign in other cities has been mixed. In Kansas City, a billboard company buckled under community pressure within days and took down the ads. In Oakland, protesters charging racism tore down a billboard as soon as it went up. But in Seattle, it was greeted without much reaction.
The reward is paid only for long-term birth-control methods such as a Norplant contraceptive, which is inserted under the skin and can last five years; Depo-Provera shots, which must be repeated every three months; an intrauterine device, which works indefinitely; and irreversible surgical sterilization known as tubal ligation.
So far, about half of those who have participated chose surgery, the campaign says.
Harris said she has rewarded 237 drug addicts, including a man who had a vasectomy. In questionnaires, the women told CRACK that before seeking the reward they had 1,501 pregnancies--more than six each, on average.
The women reported to Harris that 527 of those pregnancies ended in abortion. Of the 966 completed pregnancies, 117 infants were stillborn and 39 died after delivery. Among the 810 children who survived, 537 are in foster care, Harris said.
Experts acknowledge the devastating toll inflicted on children and taxpayers, but they contend CRACK's approach is flawed.
To Bill McColl, executive director of the National Association of Alcoholism and Drug Abuse Counselors, the organization should focus on getting more women into treatment.
"Two hundred dollars would buy more than a week of long-term residential care," he said. "This non-program preys on an addict's need for cash, stigmatizes them as inhuman, raises extraordinary ethical questions and highlights our society's unwillingness to find real solutions for real problems."
McColl concedes some women often obtain drug treatment and then suffer relapses, during which they can become pregnant again. But he contends outcomes would be improved if pregnant women and mothers with young children encountered fewer barriers to treatment.
Tracy L. McGruder, a 35, of Compton, Calif., gave birth to five children and worked as a prostitute to support her crack cocaine habit for 11 years. Just as she began to get her addictions under control, she accepted CRACK's $200 offer in 1998 and got a Norplant.
Cash is one of the only things that can cut through the fog and motivate an addict to get contraceptives--even if the cash winds up being used on more drugs, she said.
"I've been in 13 [substance abuse] programs, and it did nothing," McGruder said. "Them taking my kids wasn't enough. The judge and the social worker telling me I needed a program--none of that was enough until I did it myself. I did it for me."
She disregarded concerns about the health of her fetus. "The drug has you so insane and crazy that you just don't care," McGruder said. "I would get my drug, and when I would take a hit, the baby would draw up in a knot."
McGruder said she worked the streets at one point with seven other prostitutes and all were pregnant at the same time. "I'm the only one who has their child now," she said of the 2-year-old son she cares for.
Harris's campaign has traveled across the nation one city at a time, starting in Anaheim and then in Los Angeles, San Francisco, Phoenix, Seattle, Kansas City, Chicago and other cities.
The July campaign in Washington, she said, will be the largest advertising effort so far.
"That's where everybody is who's supposed to care about the world's problems," she said. "The audience there has all the people who could make a difference. Maybe somebody will actually care enough to call us and let us explain why there is a need for our program."
Provocative Program
Children Requiring A Caring Kommunity says it has paid rewards to more than 200 women nationally. These are statistics according to questionnaires filled out by clients.
CLIENTS STATS
Paid clients 237
Pregnancies 1,501 Abortions 527
Births 966
Stillborn births 117
Babies who died after birth from complications 39
Children remaining in foster care to date 537
BY RACE/ETHNICITY
White: 101
Black: 102
Hispanic: 25
Indian: 3
Biracial: 6
PROCEDURE CHOSEN
Norplant 29
Tubal ligation 117
Depo-Provera 67
IUD 23
Vasectomy 1
SOURCE: Children Requiring A Caring Kommunity
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