National Advocates for Pregnant Women
Lynn M. Paltrow, Executive Director
In 1994, Barbara Harris founded C.R.A.C.K./Project Prevention after unsuccessful efforts to
convince the California State Legislature to pass a law that would punish women who gave birth to
drug-exposed infants. (1)When the bill to make it a crime to give birth to a "drug baby" died in
committee, (2)Ms. Harris created Children Require A Caring Kommunity (C.R.A.C.K.), a non-profit
organization that offers $200 to any drug-addicted or alcoholic woman who agrees to be sterilized
or to use a long acting contraceptive such as Norplant or Depo-Provera.
Certainly, people have long recognized the value of planning parenthood and encouraging
responsible decision-making about when and whether to become a parent. Private individuals help
support such organizations as Planned Parenthood. Others have formed private groups, such as the
National Network of Abortion Funds to help low-income women pay for wanted abortion services for
which the US federal government will not pay. In some contexts, Ms. Harris' organization has
attempted to position itself as similar to these privately funded organizations that support access
to reproductive health services. There are however significant differences between these programs
and the C.R.A.C.K. program.
One of the key factors that makes the C.R.A.C.K. program different from other programs that help
people who are not ready to become parents is that it targets one group of women: women who use (or
have ever used) drugs. (3) Another factor is that it has launched a significant public
relations campaign(4) that we believe, can all to easily be interpreted to mean that there is a
particular group of women who do not deserve to reproduce. Instead of providing funding for (much
needed) reproductive health services, C.R.A.C.K. uses its funds to pay certain women to be
sterilized or to use particular forms of birth control. Furthermore, C.R.A.C.K. supports an
extensive public relations campaign that focuses not on the numerous barriers to reproductive
health services and to drug treatment that exist in the US, but rather on the harm the women
allegedly do to their children, on the cost to society of their supposed irresponsibility, and on
the value of controlling their reproduction as a solution to complex public health and economic
Our concern is that this program, will more than anything else, result in an increase in
prejudice against and misinformation about drug use, addiction and particularly the women and
children affected by it. (5)For example, by choosing the acronym C.R.A.C.K., the program reinforces
and perpetuates the myths that surround the issue of prenatal exposure to cocaine. (6)Other acronyms,
such as DRUNK, ALCOHOL, or SMOKES, would have drawn attention to the far greater numbers of
newborns exposed to these substances and to the more clearly proven harms they cause. (7)The
group's literature and statements inaccurately equate any exposure to illegal drugs with
inevitable harm and, until recently, portrayed all such exposed children as severely damaged. The
organization's website still uses, as its primary example, a child born with a severe
The organization also perpetuates the myth that drug-using parents have a disproportionate
number of children. Their website states that "[w]omen who are using and/or addicted to drugs are
getting pregnant at alarming rates." (9)And, asserts that: "Women and men who are using or
addicted to drugs are often responsible for an extraordinary number of pregnancies (5-10 or more)"(10)
No citation for this is provided, and, in fact, research on drug-using women indicates that, like
most women, drug-using women have an average of two to three children each. As a report sponsored
by an organizations of Southern US Governors found:
Newspaper reports in the 1980s sensationalized the use of crack cocaine and created a new
picture of the "typical" female addict: young, poor, black, urban, on welfare, the mother of many
children, and addicted to crack. In interviewing nearly 200 women for this study, a very different
picture of the "typical" chemically dependent woman emerges. She is most likely white, divorced or
never married, age 31, a high school graduate, on public assistance, the mother of two or three
children, and addicted to alcohol and one other drug.(11)
The program also asserts that the children are at risk because they are likely to be abandoned
to the costly foster care system. C.R.A.C.K.'s web site states that these children are
"often bounced around in the foster care system, and never given the love and nurturance a young
child needs." (12)This claim is made without any reference to supporting scientific data, and it
ignores a multitude of well-documented studies regarding the actual abilities or inabilities of
drug users to parent. (13)Furthermore, it ignores serious problems with the US child welfare system one
of which includes the frequent removal of children from families based on such factors as poverty
and race. (See, e.g., Nina Bernstein, The Lost Children of Wilder (Pantheon 2001), Dorothy
Roberts, Shattered Bonds: The Color of Child Welfare (Civitas 2002).) Similarly, the
C.R.A.C.K. program fails to acknowledge the children who have not been abandoned, but rather have
been removed from alleged drug-using parents without any evidence of a true inability to
Moreover, the concern over an alleged inability to parent seems disingenuous in light of the
organization's statement that: "The offer is open to any man or woman of childbearing years
who is, or has been, addicted to drugs and/or alcohol." (15) Certainly, a focus on people who are
no longer using drugs but did so at one time, suggests strongly that the program is targeting a
group of people because of a their status and historic stigma, not because of a current or actual
inability to parent. Indeed, the C.R.A.C.K. program must be understood in light of the existing
political context in the US - namely, a context that already stigmatizes drug-users and
deliberately chooses to deprive them of access to cost effective drug treatment. (16)
C.R.A.C.K. does not acknowledge this context. Instead, the program suggests that increasing
access to drug treatment and reproductive health services and responding to the social conditions
of poverty that many women face is simply too costly or time consuming compared to their
"solution." (17)They seem extremely disdainful of the women and their circumstances when they produced
the flyer stating: "Don't let a pregnancy ruin your drug habit."(18)
Although, the program has reached a relatively small number of women, approximately 600,(19)
C.R.A.C.K. has received significant media attention. We are most concerned about the effect their
public messages can have. Their material broadly suggests that there is a particular portion of the
population that should not be, or that is nor worthy of, reproducing the human race. The risk is
that this will be easily interpreted to mean that this group is unworthy of being regarded as fully
Indeed, Ms. Harris often uses animal metaphors regarding drug-using women, insisting on
comparing them to dogs: "I'm not saying these women are dogs, but they're not acting
any more responsible than a dog in heat." (20)She has also stated "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."(21)
The C.R.A.C.K. program also disproportionately reaches low income, often African American
communities. (22)Nevertheless, its leadership vehemently denies that it is racist. (23)Whether intentional
or not, however, the choice of the name, C.R.A.C.K., and this drug's wide public association
with African Americans clearly suggests an emphasis on black women. (24)Moreover, the program's
own data reflect a focus on African American women. Although African Americans make up
approximately 12% of the population, and use drugs at the same rate as people of other races,
(25) fully 40% (157 of a total of 392) of the women paid by the C.R.A.C.K. program as of
last year, were African American. When one takes into account other non-white people who have been
paid by the program, more than half are people of color. A program that did not target African
Americans would be expected to have results that reflected the actual population. In other words,
one would expect that approximately 12% of those being paid by C.R.A.C.K. would be African
Americans if racial targeting was not involved.
Targeting one narrowly defined segment of the population (drug users Ð especially drug users
of color) for sterilization and birth control is distressingly reminiscent of several tragic
chapters of recent history. It was not so long ago that the United States 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. These programs once started out as the ideas of private individuals. Their propaganda
and prejudices, however, eventually became the basis for laws. We can only hope that
C.R.A.C.K.'s public material and statements do not result in widespread popular and
legislative support for similar programs.(26)
Finally, we want to reiterate that we have no objections to educating and promoting a wide range
of reproductive health options and encouraging all people to think about what it means to be a
parent. We also believe that comprehensive sex education programs and full funding for reproductive
health services (and drug treatment) are urgently needed in this country. What we do challenge
however are instances of misinformation and any individual organization's suggestion that
one particular group of individuals in our society is unworthy of reproducing.
Jeff Stryker, Cracking down, Salon (July 10, 1998) (http://www.salonmagazine.com/mwt/feature/1998/07/cov_10feature.html);
http://www.cashforbirthcontrol.org/ ("Ms. Harris had first lobbied legislators to pass a bill that would make people accountable for their inhumane acts against their own newborns.")
- Although the program purports to be available to men and women, it has overwhelmingly been applied to women. As of today, out of the 627 people that have been paid by the C.R.A.C.K. program, only 11 of them were men. http://www.cashforbirthcontrol.org/stats/stats.html. (Visited March 13, 2002).
- See e.g., Stryker supra note 1 (describing how Ms. Harris "took her plea to the media" and her numerous successful efforts in appearing on such programs as Oprah and becoming "a darling of talk radio hosts and newspaper pundits across the nation.")
- See also Lynn Paltrow & Robert Newman, Treatment, not sterilization, is the way to help addicted moms, Houston Chronicle (Viewpoints, 4C Jan 30, 2000).
- Research has found that crack-exposed children are not doomed to suffer permanent mental or physical impairment, and that whatever effects may result from the use of this drug are greatly overshadowed by poverty and its many concomitants - poorer nutrition, inadequate housing, health care and stimulation once the child is born. See Deborah A. Frank, M.D. et al., Growth, Development, and Behavior in Early Childhood Following Prenatal Cocaine Exposure: A Systematic Review, 285 JAMA 1613 (Mar. 28, 2001); Wendy Chavkin, M.D., M.P.H., Cocaine and Pregnancy - Time to Look at the Evidence, 285 JAMA 1626 (Mar. 28, 2001); Hallam Hurt, M.D., et al., Problem-Solving Ability of Inner-City Children With and Without In Utero Cocaine Exposure, 20 DEV. & BEH. PEDIATRICS 418 (Dec. 1999); see also Linda C. Mayes, M.D., et al., The Problem of Prenatal Cocaine Exposure: A Rush to Judgment, 267 JAMA 406 (1992).
- Deanne S. Gomby, Patricia H. Shiono, Estimating the Number of Substance-Exposed Infants, 1 The Future of Children 17 (1991).
- http://www.cashforbirthcontrol.org/ (Visited March 13, 2002). In March of 2001, the website provided examples only of children born with "severe disabilities (deaf, feeding tubes, one in a wheelchair)." Recent changes in their website (in apparent response to criticism) now (grudgingly) acknowledge that " . . .there are some children that have minor problems, or even more rarely no problems at all." However, the site's only illustrative example of a child born to a drug-using woman is a child, born with severe disabilities, who is described as a "victim" and as "drug--addicted." Although this particular story does not identify the drug to which the child was allegedly addicted, the context suggests cocaine. The term "drug-addicted" itself, however, has proven inaccurate when applied to children prenatally exposed to cocaine. It has long been known that no addiction or withdrawal syndrome exists for such children. See, e.g., Barry Zuckerman, Drug-Exposed Infants: Understanding the Medical Risk 26, 31, 1 The Future of Children (1991) ("[A]t this time it is inaccurate to describe a cocaine-exposed newborn as crack-addicted.") As other researchers explain:
The "crack baby" on which drug policy is increasingly based does not exist. Crack babies are like Max Headroom and reincarnations of Elvis - a media creation. Cocaine does not produce physical dependence, and babies exposed to it prenatally do not exhibit symptoms of drug withdrawal. Other symptoms of drug dependence - such as "craving" and "compulsion"-cannot be detected in babies. In fact, without knowing that cocaine was used by their mothers, clinicians could not distinguish so-called crack-addicted babies from babies born to comparable mothers who had never used cocaine or crack.
John P. Morgan & Lynn Zimmer, The Social Pharmacology of Smokeable Cocaine Not All It's Cracked Up to Be, in CRACK IN AMERICA: DEMON DRUGS AND SOCIAL JUSTICE 131, 152 (Craig Reinarman & Harry G. Levine eds., 1997). Earlier versions of the website spoke only of children born "permanently disabled" and stated that "the chances of a normal life are dim." (Visited on stated that "the chances of a normal life are dim." (Visited on 9/22/99.) The website also relies on other data that has been shown repeatedly to be inaccurate. For example, in March of 2001, the website stated that "perhaps as many as 375,000 cocaine--exposed babies are born each year in the U.S." This figure refers to a prevalence study done by Dr. Ira Chasnoff, in which, based on the urine samples of recently delivered women at thirty-six public hospitals in urban areas, he extrapolated that 375,000 American babies annually were prenatally exposed to "some amount of alcohol or illicit drug." LAURA E. GÓMEZ, MISCONCEIVING MOTHERS 23 (1997). In addition to there being significant questions raised about the reliability of the number based on research done only at public and urban hospitals, the number never applied exclusively to cocaine. Id. See also DOROTHY ROBERTS, KILLING THE BLACK BODY 155-56 (1997).
- http://www.cashforbirthcontrol.com (visited 9/22/99).
- See http://www.cashforbirthcontrol.com/objectives/. (Visited March 13, 2002).
- SHELLY GEHSHAN, A STEP TOWARD RECOVERY 1 (Southern Reg. Proj. on Infant Mortality 1993)(emphasis added).
- http://www.cashforbirthcontrol.com/objectives/ (Visited March 13, 2002).
- See, e.g., SUSAN C. BOYD, MOTHERS AND ILLICIT DRUGS: TRANSCENDING THE MYTHS 14-16 (1999) (listing at least fourteen studies demonstrating that women who use illicit drugs can be adequate parents). See also M. Kearney et al., Mothering on Crack Cocaine: A Grounded Theory Analysis, 38 SOC. SCI. & MED. 351, 355 (1994). A book published by the Foster Care Project of the American Bar Association observes, "many people in our society suffer from drug or alcohol dependence yet remain fit to care for a child. An alcohol or drug dependent parent becomes unfit only if the dependency results in mistreatment of the child, or in a failure to provide the ordinary care required for all children." American Bar Association, Foster Care Project, National Legal Resource Center for Child Advocacy and Protection, FOSTER CHILDREN IN THE COURTS 206 (Mark Hardin ed., 1983). See also National Council of Juvenile and Family Court Judges, PERMANENCY PLANNING FOR CHILDREN PROJECT, PROTOCOL FOR MAKING REASONABLE EFFORTS TO PRESERVE FAMILIES IN DRUG RELATED DEPENDENCY CASES 17 (1992) (concluding that "Juvenile and family court proceedings are not necessary, and probably not desirable, in most situations involving substance-exposed infants").
- See generally Lynn M. Paltrow, David S. Cohen & Corinne A. Carey, Year 2000 Overview: Governmental Responses to Pregnant Women Who Use Alcohol and Other Drugs (2000). This report is available at: www.advocatesforpregnantwomen.org.
- http://www.cashforbirthcontrol.com/ (Visited March 14, 2002)(emphasis added.) A Seattle Project Prevention-Cash for Birth Control advisory called the "Do's and Don't of Pamphleteering" includes, under "Best Places," the advice to promote their program at "6) AA and NA Meeting Places." Ella Sonnenberg, Volunteer Coordinator, Seattle Chapter, DO's and DON'Ts of PAMPHLETEERING, Project Prevention -Cash for Birth Control. The fact that they would seek out people in recovery (many of whom no longer use drugs and who would not - by any theory --pose a threat to their children)-further raises questions about the program's agenda.
- See, e.g., MIKE GRAY, DRUG CRAZY: HOW WE GOT INTO THIS MESS AND HOW WE CAN GET OUT (2000); DAN BAUM, SMOKE AND MIRRORS: THE WAR ON DRUGS AND THE POLITICS OF FAILURE (1996); Robert G. Newman, M.D., Addiction and Methadone: One American's View, 2 HEROIN ADDICTION & RELATED CLINICAL PROBLEMS 19, 22 (2000); Ethan A. Nadelmann, Commonsense Drug Policy, 77 FOREIGN AFF. 111, 118, (Jan./Feb. 1998). See generally: www.drugpolicy.org; www.CSDP.org; www.harmreduction.org.
- See, e.g., Fox News Network, Fox the Edge with Paula Zahn (July 7, 2000) (Harris: "Drug treatment is not the solution. Most of our women have been in drug treatment 10 or 12 times and relapsed. That's not the solution.") See also Women's Economic Agenda Project, Lots of people just don't get it, http://www.weap.org/crack_editorial.html (arguing that " C.R.A.C.K. is just the latest in a long line of efforts to marginalize and snuff out the lives of the poor" and that "that C.R.A.C.K. could do lots of good with its money if instead of buying the souls of desperate women for a mere $200, it would instead support the current Just Health Care campaign, which promises universal health care for all people, including treatment on demand.")
- On file with NAPW.
- See http://www.cashforbirthcontrol.com/stats/stats.html (Visited March 13, 2002) (stating that 627 people had been paid to be sterilized or to use long-acting contraception.) In the United States, 24.5 million Americans aged 12 or over (11% of the US population aged 12 and over) used an illicit drug in 2000. See Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Summary of Findings from the 2000 National Household Survey on Drug Abuse (Rockville, MD: SAMHSA, September 2001), p. 124, Table E.4; p. 132, Table F.2; and p. 144, Table F.14, from the web at http://www.samhsa.gov/oas/NHSDA/2kNHSDA/2kNHSDA.htm , (Visited October 15, 2001).
- DATELINE, NBC, NBC News Transcripts, The Crusader; One Woman's Crusade to Help Babies Born to Drug Addicted Mothers (September 9, 1998) at 10, National Broadcasting Co. Inc., NBC News Transcripts (1998). See also Stryker, supra note 1, quoting Harris as saying, "They're having litters. They are literally having litters."
- Crack Uses Unethical Tactics to Stop Women with Substance Abuse Problems from Becoming Pregnant, Political Environments, 8,in POLITICAL ENVIRONMENTS (1999), citing, Mothers Paid to Stop Having Children, Marie Claire, December 1998.
- A Seattle Project Prevention-Cash for Birth Control Sheet entitled DO's and DON'Ts of PAMPHLETEERING states in part: "The $200 appeals more to the poor than it does to the rich. Unfortunate, but a fact of life. Therefore, it is more practical to post fliers in areas where poor people live and congregate."
- See http://www.cashforbirthcontrol.com/website (Director and Founder's Message- March 21, 2001)
- See Drew Humphries, Crack Mothers at 6: Prime Time News, Crack/Cocaine, and Women, VIOLENCE AGAINST WOMEN, Feb. 1998, at 45 ("Socially constructed as Black and urban, the media demonized crack mothers as the threatening symbols for everything that was wrong with America").
- Ernest Drucker, Ph.D., Drug Prohibition and Public Health, 25 Years of Evidence, 114 PUB. HEALTH REP. 14 , 23 (Jan.-Feb. 1999). ("A common stereotype, fostered by the media, is that some 'racial' or ethnic groups use drugs more than others. This is not borne out by the data.").
- The organization nevertheless asks its supporters to contact public officials regarding the value of the program, suggesting that their goals are not limited to privately supported programs. See http://www.cashforbirthcontrol.com/reps/ (Visited March 13, 2002) ("Please take a few minutes to write or call your local politicians with your concerns about this growing problem. If you support our project prevention program please tell them that also. You can find the addresses and phone numbers of your local politicians in the front of your phone book. Thank you so much for caring enough to make your voice heard.").