Surgical Strike

Is a group that pays addicts to be sterilized defending children or exploiting the vulnerable?

Barbara Harris was eager to become a foster mother when she received a call from a social worker in 1990, asking her to take in an eight-month-old girl born to a woman addicted to crack cocaine. Harris, a waitress at a pancake house, agreed. Over the next two years, she and her husband provided a foster home in Orange County, California, for three more children born to the same woman, including one boy who suffered violently from his mother's addiction. "He shook," Harris recalls. "His eyes looked like they would pop out of his head. He'd sleep a few minutes and he'd wake up screaming."

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Harris decided something needed to be done to prevent drug-addicted women from getting pregnant. So in 1997 she sat down at her family's computer, created some flyers, and posted them in the impoverished MacArthur Park neighborhood of Los Angeles. That was the birth of CRACK (Children Requiring A Caring Kommunity), a nonprofit organization that offers $200 in cash to addicts who agree to be sterilized or undergo long-term contraception like Norplant, which is surgically imbedded under the skin. Because crack targets the poor, most of the procedures are funded by taxpayers through federal and state programs such as Medicaid and California's Medi-Cal.

Now in its fourth year, CRACK is growing rapidly. The group has chapters in 22 cities across the country, including Seattle, Dallas, and Chicago, and has already handed out more than $100,000 in cash rewards to 500 clients. "The best is yet to come!" boasts the organization's Web site. "Every day we receive phone calls from men and women nationwide that want to make the responsible choice." But many advocates for the poor have attacked the group, saying it deprives desperate women of their reproductive choices while feeding their drug habit. Addicts who agree to be sterilized, they say, often use the cash offered by Harris to buy more drugs. After the group took out billboard ads in Las Vegas, local NAACP president Gene Collins told reporters, "How can you come in and say that you are concerned with the welfare of the mother when here's a person who is not of sound mind, who has been addicted to drugs, and then is told, 'Okay, we're going to give you $200 to become sterile and you can take the money and buy yourself some more crack'?"

Social-service providers have also expressed outrage. "It's a total exploitation of women who have a substance abuse problem," says David LaKine of Faith House, a St. Louis facility for children suffering from prenatal drug exposure. "They will take the $200 because they have a disease, and using drugs and being promiscuous are all symptoms of the disease." Kathryn Icenhower, director of a Los Angeles group that provides services to the homeless, told reporters that she has asked Harris "to please stay away from our clients." Offering addicts cash, she added, is like telling a homeless person, "I'll let you come in here and sleep tonight if we sterilize you."

Harris admits her organization might be fueling the addictions of her clients -- but she is not overly concerned about how women spend the cash. "If they choose to use the money to buy drugs, that's their choice," she says. "Their babies have no choice. If that sounds cold, that's too bad." Before founding CRACK, Harris tried unsuccessfully to convince California legislators to jail mothers of drug-addicted babies unless they agreed to implants or other long-term birth control. She recounts the story of a woman in Pontiac, Michigan, who had given birth to 13 children before CRACK reached her last June. "How many victims does this person need to have before she doesn't have the right to have children?" Harris asks. "The day she had the tubal ligation, I was in my office cheering."

Many right-wing donors are also cheering. According to Harris, the organization has banked $320,000, most of it from wealthy conservatives. Dr. Laura Schlessinger, the controversial talk-show host, has contributed $10,000. Richard Mellon Scaife, the Pittsburgh billionaire credited with funding the New Right, has thrown in $75,000 through his Allegheny Foundation. And Jim Woodhill, a Houston venture capitalist and self-proclaimed member of the "Republican Rebel Alliance," has given $125,000.

Woodhill makes no secret of his desire to bring in new leadership to build a larger, more influential organization. "I'm sure we can get a good executive director whose specialty is fundraising and have her go around and hit up members of the 'vast right-wing conspiracy,'" he says. "We can raise the money." Woodhill has hired Chris Brand, a British psychologist, who is working to expand CRACK overseas. Brand, a self-proclaimed "race realist," claims that blacks are intellectually inferior to whites, and advocates taking a "eugenic" approach to "wanton and criminal females."

Such language gives chills to opponents. "Limiting reproduction as a way of solving social problems has a very horrible history," says Dorothy Roberts, a law professor at Northwestern University and author of Killing the Black Body. "It ends up targeting people who society feels are unworthy of reproduction." The eugenics movement of the early 20th century, she notes, advocated the systematic sterilization of what it called "worthless race types," including the poor and the mentally ill; states adopted laws that resulted in more than 40,000 women being sterilized without their consent.

Indeed, physicians and attorneys worry that the drug-dependent women approached by CRACK are in no condition to consent to sterilization -- especially when enticed with an offer of cash. Rewarding someone for having a surgical procedure, they note, violates a basic principle of medical ethics: Health care decisions should be made by patients, without any form of pressure.

"It's an economic coercion of the poor, giving them a financial incentive to forgo their reproductive choices," says Rocio Cordoba, staff attorney with the American Civil Liberties Union of Southern California. "The ultimate question is whether the woman is undergoing sterilization with full, informed consent -- and that means without coercion."