Treatment, not sterilization, is the way to help addicted moms

January 30, 2000

By: Lynn M. Paltrow, J.D. and Robert Newman, M.D., (first published in the Houston Chronicle, Sunday January 30, 2000 at 4C).

Just as government data give us welcome news that crack use is on the decline, C.R.A.C.K., a private program that offers addicts $200 to use long-acting birth control or to get sterilized is attracting national support. While it is true that the financial incentive is modest; the numbers accepting the offer still relatively few (fewer than 400) and that at least some of the women express genuine appreciation for the program, there is cause for grave concern about this initiative because it promotes prejudice and perpetuates myths.

Myth #1: Drug problems are irreversible. Simply put, you must believe this to justify an irreversible solution surgical sterilization (the majority are sterilized at taxpayers expense) that prevents a woman from having kids, ever. The fact is, addiction is a treatable disease. A wide range of inpatient and outpatient therapies have been shown to reduce or eliminate illicit drug use.

Comprehensive programs that dont separate mothers from their children are highly successful in treating drug-using women and keeping their families together. They are also cost-effective, especially when one compares their price tag to the staggering financial and social costs of separating mother and child.

Myth #2: Even if treatment is effective, too many drug-using women just wont bother to get it either because they dont want to or because their lives are too disorganized. If you believe this myth, C.R.A.C.K.s simple one-stop sterilization sounds appealing. But consider this: To get the $200, an addicted woman must show up for an interview, fill out a questionnaire, get a physical exam, wait 30 days, undergo a surgical procedure, and submit a signed letter confirming shes been sterilized. If a mere $200 and a little moral support can convince a woman to jump through all of those hoops and give up the fundamental right to have kids, one must wonder what a little support could accomplish if it were instead used to encourage a woman to seek drug treatment?

Actually, a large percentage of drug users desperately want help. And when drug-using women become pregnant, they are often particularly motivated to try to stop their drug use. The real problem isnt that these women are uncaring, irresponsible monsters. Its the waiting lists for treatment true testament to addicts desire to get help and the unconscionable gap between availability of and demand for these services. Add to this womens fear that their children will be taken away or that they will go to jail and the fact that very few treatment programs accept pregnant or parenting women or are responsive to their needs and responsibilities. Many of the few that are available are facing cutbacks in already-inadequate government funding.

Myth #3: Drug-using women are getting pregnant at alarming rates. C.R.A.C.K. points to women who claim they had unusually large numbers of children. But these selective examples are not typical. Drug-using women have the same number of children, on average, as other women. And for many of the same reasons: because they want to have kids with the man they love, they anticipate the joy of raising children, their birth control failed, they dont believe in abortion. Sound familiar? It should. What you might not now is that illicit drug use frequently causes menstrual irregularity that actually interferes with conception, making it harder for addicts to get pregnant.

Myth #4: All drug-exposed children are permanently damaged or likely to die. This is perhaps the most pernicious and dangerous of the myths. Some newborns do suffer adverse short- or long-term consequences -- as do infants whose mothers lacked access to quality prenatal care and adequate nutrition, smoked or drank while pregnant, or used fertility-enhancing medications that cause multiple births associated with prematurity and other life-threatening hazards.

Fortunately, contrary to sensational news reports, research has found that crack-exposed children are not doomed to die prematurely or to suffer permanent mental and/or physical impairment. Healthy, successful children born to women who had crack problems do, however, face devastating stigmatization. No child should ever be made to feel that maybe they should never have been born, to quote the healthy 10-year-old son of a South Carolina woman who was jailed for being pregnant and addicted to cocaine.

Targeting one narrowly defined segment of the population for sterilization is distressingly reminiscent of several sad chapters in recent history. It was not so long ago that this country sanctioned sterilizing allegedly retarded women many of whom turned out to suffer only from poverty in the name of preventing another generation of imbeciles. Nor can we forget that the Nazi Eugenic Sterilization Law of 1933 required sterilization of, among others, all "who suffered from . . . severe drug or alcohol addiction. What C.R.A.C.K. has in common with these programs is that they are based on unsubstantiated myth, prejudice, and fear. Where they differ at least to date is that the C.R.A.C.K. program has not been embraced by those who set our national policies.

Yes, we agree that all potential parents including drug-using women should be encouraged to make responsible decisions about whether to have kids. The solution to the complex medical and social problems facing pregnant and parenting addicts is not a coercive program of sterilization whether it uses the threat of arrest and hard time in jail or the offer of a bribe with $200 hard cash. Rather than giving up on drug-using mothers and their families, C.R.A.C.K. founders should work to ensure that help for overcoming drug dependence and the full range of reproductive health services is within these womens reach. Happily, those who genuinely care about drug-using women, their families, and our community at large have many constructive avenues we can pursue. Coerced sterilization is not one of them.

A version of this article was published in the Houston Chronicle, Sunday January 30, 2000 at 4C.

Lynn M. Paltrow, J.D., is Executive Director of National Advocates for Pregnant Women (NAPW), dedicated to protecting the rights of pregnant and parenting women and their children. NAPW seeks to ensure that all women have access to a full range of reproductive health services and are not punished for being pregnant while addicted. NAPW believes that families should not be needlessly separated and that pregnancy and addiction should be dealt with as public health issues, not criminal justice matters. info@advocatesforpregnantwomen.org, 212-255-9252

Robert Newman, M.D., is the President and Chief Executive Officer Continuum Health Partner, Inc., the parent corporation that controls Beth Israel Medical Center, Saint Lukes-Roosevelt Hospital Center, the Long Island College Hospital, and the New York Eye and Ear Infirmary. Dr. Newman is also a professor in the Albert Einstein College of Medicines departments of psychiatry and epidemiology and social medicine.