Early last year, 43-year-old Julie James was using heroin but not birth control--a potentially problematic mix. But then, the East Baltimore mother of four saw an ad in
City Paper placed by the Stanton, Calif.-based group Children Requiring a Caring Kommunity (CRACK). It read "Get Birth Control Get Cash," and offered $200 to drug addicts or those with a history of substance abuse if they would go on long-term birth control or get themselves sterilized. She dialed the 800 number listed.
"I didn't want to have any more children--not while I was using," James says. "It got me thinking about birth control."
James is now on a methadone program for her addiction and has also been receiving quarterly injections of the contraceptive Depo-Provera, which blocks pregnancy for three months after each shot. For her year-long course of Depo-Provera, CRACK will soon complete the promised payment of $200. (The organization pays $25 for the first three Depo shots and $125 for the fourth.) And she plans to renew with the program.
Twenty-three-year-old Tiffany Dale also spied a CRACK ad last year. "I needed to get on birth control anyway and I figured I'd go ahead and contact them since I was a recovering addict," says the East Baltimore mother of four, a former heroin and crack-cocaine abuser. "I really needed the money and I [had] stopped getting my Depo shot. This got me started again."
James and Dale are among the nine Baltimore women who have responded to CRACK's unique--and, in some circles, highly controversial--approach to stemming the birthrate among drug- and alcohol-abusing women. The group doesn't provide birth control (Medicaid or insurance usually covers that expense), nor does it provide drug treatment--the best it can do is refer women to other sources for treatment and counseling. What it does offer is a cash reward to women with past or present substance-abuse problems who choose to go on long-term birth control or become sterilized through a tubal ligation. The goal of the 10-year-old program is to reduce the number of babies born to addicted mothers--children who often suffer from bad prenatal care and/or wind up in foster care.
The group began recruiting in Baltimore a year ago, when it placed a series of ads in City Paper (Mobtown Beat, April 18). At that time, CRACK founder and director Barbara Harris said she anticipated the program would become a "household name" in town and that Baltimore would soon join 15 other U.S. cities that have volunteer-driven local chapters of the program. To date, however, CRACK's local presence remains minimal. "I don't really have a reason why we haven't [focused] more on Baltimore," Harris says over the phone from her California office. "The ads have been quite successful."
Harris says her organization is renewing its campaign in the area and has bought 10 weeks of City Paper ads (which began running in January) and installed a sign advertising CRACK inside Eastpoint Mall. The Eastpoint sign also requests donations--part of what Harris says is an active effort to build up a Baltimore chapter.
While CRACK's profile in Baltimore remains low, it has caught the eye of a number of professionals and activists involved in women's health, family advocacy, and drug treatment. Many of them say that the cash-for-contraception approach--aimed largely at poor, inner-city addicts--is shortsighted, misguided, and possibly racist. Harris herself is white (though her and her husband's adopted children are African-American), and critics see overtones of eugenics in the program's mission.
"We have taken a position in opposition to programs like this one that coerce women into a certain method of birth control or sterilization," says Planned Parenthood of Maryland spokesperson Wendy Royalty. "We believe women should make informed decisions about the type of birth control they use based on the full range of options. And when you're talking about addicted women, it's coercive to offer them money. I don't think it's a leap to say that the money will most likely go for drugs."
Baltimore City Health Commissioner Dr. Peter Beilenson describes his opinion of CRACK as "bifurcated." "While it is still rather coercive to pay people to do things, I don't have much problem with encouraging people to use reversible birth control at a time when they might not be in full possession of their faculties," Beilenson says. "I don't think there should be any coercion involved when you're talking about [birth control] that should be considered permanent, like tubal ligation." Two of Baltimore's nine CRACK clients have chosen to receive a tubal ligation to qualify for payment; nationwide, 260 of CRACK's 627 clients have opted for sterilization. Phone numbers provided by CRACK for its two local tubal-ligation clients had both been disconnected, which the organization says is not uncommon for its participants.
Rajani Bhatia, a coordinator in Baltimore for the Committee on Women, Population, and the Environment, an Amherst, Mass.-based women's-issues watchdog group, helped unite local opponents of CRACK last spring, largely via e-mail. The Public Justice Center, the Johns Hopkins Hospital Comprehensive Women's Center, Baltimore Healthy Start, and other groups endorsed a statement of opposition to CRACK. In other cities where Harris' effort has made inroads, the opposition forces have also launched their own media campaigns, buying ads and billboards to denounce the program. But Baltimore hasn't reached that point.
"All of us who oppose CRACK are linked up, but we really don't know what our future actions might be," Bhatia says. "We don't know if CRACK intends to become very active in Baltimore or not. We're keeping an eye on them."
Harris defends her program as a logical and realistic approach to the problems of multiple births among women addicts. "We know that these women don't want to be having babies every year, and if it takes $200 to stop them from doing that then that's the best $200 we can spend," she says.
For their part, neither Dale nor James rues the decision to contact CRACK. Indeed, Dale says her only regret is that the program was not around earlier, as it may have encouraged her to consistently use birth control as a teenager. "I love my kids and I don't regret them, but I wish I had waited," she says. "I could have done a lot more with my life if I didn't have them so fast. [I've since] told a few friends about [CRACK], and they were shocked--they were like, 'Give me that number!'"
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