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Worse than cure

Monday, August 30, 2010

Project Prevention, an American sterilisation programme that pays problematic drug users either to be sterilised or to accept long-term contraception, is coming to the United Kingdom. Niamh Eastwood argues that, far from alleviating suffering and protecting women and children, the controversial programme is a fundamental attack on the rights of the most vulnerable.


Project Prevention was established in 1998 by Barbara Harris, an American with four adopted children she calls her “crack babies”. Harris describes her work as “humanitarian”, but it is unclear what is all that humanitarian about targeting some of the most defenceless, desperate and disenfranchised people in society.

Project Prevention was not Harris’s first attempt to control the reproductive rights of women. In the past, she has lobbied the California State legislature to criminalise women who use illicit drugs while pregnant.

Thankfully, a draft Bill to this effect never became law. If it had, women with drug problems who became pregnant would have become a hidden population afraid to access prenatal services or drug treatment centres. Harris continuously talks about “the rights of the children”, but such an approach would have clearly put both mother and child at risk.

harris project prevention aug 2010Harris says she wanted legislation to make long-term contraception mandatory for women who had children that were substance-exposed in the womb. Since the State would not take action, she decided to do so herself and set up Project Prevention.

Initially called Children Requiring a Caring Kommunity, or CRACK, the programme pays problematic drug users either $200 to agree to long-term contraception or $300 to be sterilised. Harris’s aim is to stop drug users having children, and it is clear that, as a group, she has deemed them unfit parents.

By encouraging sterilisation, Project Prevention is taking away reproductive rights for women at a point when they are not able to make a clear decision about such an important issue. Harris’s retort is that, if they are not able to make an informed decision about their health, they are not able to look after a child. However, it is not that simple. As a society, we must protect the fundamental human rights of every person, including their sexual and reproductive rights.

Project Prevention also targets specific groups within society. Firstly, women make up the vast majority of ‘clients’ – since its inception, 3,432 people have been paid, and 3,381 of these have been women. More than a third have been sterilised.

Secondly, and most obviously, the programme targets poor women – very few of us would agree to limit or potentially end our ability to have children for a few hundred bucks.

Thirdly, Project Prevention appears to target African Americans and other ethnic minority groups. Harris denies this, saying she herself is married to a black man and has adopted four black children, but this does not detract from the fact that more than half those paid by Project Prevention are either African American, Hispanic or from another ethnic background. This is despite the fact that non-whites make up 25 percent of the US population and that drug use amongst all groups is comparable.

Lynn Paltrow, Executive Director of the National Advocates for Pregnant Women, has advocated against Project Prevention in the US. She has thoroughly researched the organisation and writes specifically about how Harris targets those who access the project. Paltrow says Project Prevention in California has placed large billboards in Black and Latino communities in Los Angeles. Flyers are handed out containing statements such as, “Don’t let a baby ruin you drug habit”.

This counters Harris’s contention  that Project Prevention does not seek out ‘clients’. In reality, it is clear that the programme actively and aggressively tries to attract women to its service. This was borne out in the UK in June when Harris and others actively lobbied women outside a surgery in Glasgow. That the project targets poor people is also demonstrated by the fact it advertises at bus stops, welfare agencies, soup kitchens, areas of high prostitution, methadone clinics and probation offices.

Harris’s view on women who use drugs is deeply offensive. She makes statements such as: “I’m not saying these women are dogs, but they’re not acting any more responsible than a dog in heat” and “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.” Her colleagues have described the children of drug ‘addicts’ as “pre-doomed” – failing to consider the stigma and damage caused by such labelling.

In April 2010, Harris announced Project Prevention was coming to the UK. Release was shocked and appalled. We vehemently oppose the idea that vulnerable and desperate people – people with serious health problems – could be coerced into making longterm decisions about their reproductive choices. It is reprehensible that someone’s fertility is thought to be for sale because they are deemed an unfit parent.

Release has been at the forefront of challenging Project Prevention and is working with other organisations and medical authorities to stop Project Prevention in the UK. We have been active in the media and have brought the issue to the attention of the British Medical Association (BMA).

When Harris has been interviewed by the British media, her responses have been bluntly simple. When asked about the fact that the money would be used for drugs or would only benefit drug dealers, she answers that she does not care. When questioned about the funding she receives in the US (which comes from sources considered to be right wing), she says she does not care where the money comes from. When challenged about the ethical nature of the programme, she answers in a number of different ways ranging from, “What about the rights of the children?” to attacking the right of anyone to oppose her views unless they have adopted a child addicted to crack.

When I was interviewed with her on Al Jazeera, she responded to my point about the fundamental right to have control over your own sexual and reproductive choices by saying, “Well, she goes on about the rights of the mother, but what about the rights of the child?”. She also claims the women who had accessed Project Prevention in the US had already been pregnant several times before. All of the examples she provided were women who had “22, 23 or even 24” pregnancies prior to being sterilised, but statistics from the US show that women who have drug problems only become pregnant at a rate slightly higher than the national average. Harris uses simple, anecdotal and provocative stories to justify what she is doing because this is the only way she can get support.

The problem with Project Prevention and Barbara Harris’s viewpoint is that it fails to consider a number of important factors.

Firstly, she asks, “What about the rights of the child?” but her approach results in no children. They are essentially hypothetical children, and for those who are born into families where there is drug addiction, their value and potential are undermined.

Secondly, she completely fails to understand that by ‘incentivising’ vulnerable people into making choices about their reproductive rights, we are effectively coercing them into making a decision that may not be in their best interests.

Thirdly, for many women using drugs, their children or becoming pregnant are the catalyst for change.

Fourthly, it fails to consider the public health messaging around safe sex and that there are better alternatives – more money for drug treatment and familyfocused interventions, better housing and education, recognition that this is a complex social and economic issue.

Finally and probably most importantly, it smacks of eugenics. If we allow drug users to be subjected to such interventions, who is next – people with mental health problems, those who are obese, maybe those who simply cannot afford children? Many involved in this debate, both for and against, have said calling Project Prevention a form of eugenics may be over stating, but Harris’s recent interview in The Guardian may lead to some reconsider.

Her next project, she says, will be in Haiti. “We’re going to offer Depo [contraceptive] injections every three months to women in exchange for food cards. The women in Haiti are having children they can’t even feed, so why are they getting pregnant? Just think about how much suffering that’s going to prevent.”

...Then she begins talking about women in Africa who have AIDS. “My thinking is, why are they having these babies? I’m sorry – tell me that you don’t agree! If you know you have AIDS, why are you getting pregnant and having babies that you know are going to have AIDS? Babies are suffering. It’s preventable.”

In September 2010, the BMA Ethics Committee is meeting to consider the activities of Project Prevention, as GPs would be required to be part of the process. Harris has already announced they will not be offering sterilisation in the UK because of its medical system here but that it is her intention to offer long-term contraception.

Release will be submitting its view to the BMA Ethics Committee that this is still unethical – no decision around healthcare should involve coercion through bribery. We are not allowed to sell our organs or even receive payments for donor sperm. It is also without doubt that, as a society, we should not allow vulnerable and disenfranchised people to be paid to make decisions about their reproductive choices.

  • Niamh Eastwood is Head of Legal Services and Deputy Director of Release, UK’s national centre of expertise on drugs and drugs law.