When we think of new-born babies we think of delicate fingers and toes. Little bundles all warmly cocooned in soft blankets, dozing peacefully. There is a calmness and serenity that comes with new life, a life full of potential and promise. Now picture the scene that takes place in over 3,000 maternity wards in New York every year. A new-born lies in an incubator, its frail body shaking as it wails, trembling and sweating profusely. It is irritable and frantic as its body undergoes the painful process of withdrawal. This is not a normal baby. This is a baby whose mother has a heroin addiction. This new life, full of potential and promise, has been born an addict.
Studies suggest that an estimated 4% of pregnant women use illegal drugs during their pregnancies. The teratogenic effects of these drugs have powerful side effects in the womb that carry on after birth and into the early years of childhood. Risks of premature birth and major birth defects are increased to a minimum 4–5% chance. Later in life studies show that babies born to addicted mothers may be at risk of a developmental path towards anti-social personality and poor intellectual functioning. This is of course before we start to consider the socio-economic impact of drug addiction.
It was first-hand experience of such stories that spurred the founder of Project Prevention, Barbara Harris, to start her crusade. Mrs Harris fostered and adopted four children born to the same mother, a crack-addict. She describes how one of the children she adopted, Taylor, struggled to cope with even the most basic of everyday scenarios. “He couldn’t keep his food down… noise bothered him, light bothered him, he just couldn’t sleep,” she recollects as she describes the anger she felt towards the mother whose actions had caused Taylor’s problems.
Driven by these experiences, Mrs Harris gave birth to Project Prevention. The aim of the project is to hand out 300 to as many drug and alcohol addicted women as possible. To receive payment, the addicts must receive long-term contraception or sterilisation. Documents are then required to show that the procedure has taken place in order to complete the transaction. Since it began in 1997, Project Prevention claims to have paid over 3,500 “clients” around which 1,226 underwent permanent sterilization. Mrs Harris is now bringing her battle across the pond to Britain.
Research conducted in 2008 highlighted that the number of babies being born to mothers with addictions had doubled since 2003. In 2008, over 1,970 women were addicted to drugs at the time of giving birth. Of that number, 1,211 were born suffering the effects of withdrawal from their mother’s habit, passed on to them in the womb. These statistics mean that every day, three babies are born with a drug addiction across Britain. Mervi Jokinen, the Royal College of Midwives Practice & Standards Development Advisor, said, “Of course, we are concerned by these statistics. These women not only have complex health and social needs but their lifestyles can have adverse outcomes on their pregnancy and baby.” But is paid sterilization the answer?
John, a 38 year-old opiate addict from Leicester, is the first person in Britain to receive payment from Project Prevention to encourage him to undergo a vasectomy. Addicted to opiates for 15 years, John told the BBC’s Inside Out television programme that “It was something I’d been thinking about for a long time and something that I’d already made my mind up that I wanted to do but just hadn’t got round to it.”
Unsurprisingly, Project Prevention has faced fierce and unforgiving criticism. The National Advocates for Pregnant Women (NAPW) accuses Mrs Harris of distributing “dangerous propaganda”. They brand the work she does as tantamount to “social engineering”. By offering cash incentives for drug addicts to agree to sterilization, Project Prevention targets and labels one group of society as unfit to have children. Some have even gone as far as to compare the programme to eugenic sterilization in the US in the 1930s and the Nazi programme of eugenics. These criticisms are rejected by Mrs Harris who claims her “heart is with the children. I don’t believe that anybody has the right to force their addiction on another human being.”
But is this really the case? Does Project Prevention isolate drug-addicts? Yes. Does it claim that some drug-addicts are unfit to ever have children? Yes. Does it claim that all drug-addicts are unsuitable to have children and all drug addicts should be sterilized? Well, no. All procedures are conducted with complete respect given to the autonomy and wishes of the individual. The most fundamental principle of medical ethics is the autonomy of the patient, a principle Project Prevention upholds.
Many critics of Project Prevention accuse the organization of exploiting the vulnerable. It is argued that the project will result in many people taking a decision out of desperation and need, a decision that they may later regret. Whilst no drug-addict is explicitly coerced into the treatment, it can be held that offering cash reward is nothing short of a bribe. How far this cash for treatment scheme can undermine autonomy is a question that can only be speculated upon.
Furthermore, many have advocated the argument that by removing the possibility of having a future family removes one of the most valued parts of a person’s life and that taking that away removes a powerful incentive for an addict to get clean. Mrs Harris responds to this argument by claiming that that chance is given to addicted parents every time a child is born. She claims that “they are told if they go into drug treatment they can get their child back. They are given chance after chance after chance. And drugs are more important, but at the very least we can stop them from giving birth to children whose lives may end up the same as theirs.” Whilst some may feel that she takes too hard a line, it is hard to deny the devastating effects drug addiction can have on thousands of babies both in Britain and the U.S.
Perhaps Project Prevention needs some modification? Rather than offering cash incentive in return for sterilisation, why not use that money to encourage more drug-addicts to undergo intensive rehabilitation? Surely the money would be better spent supporting drug-addicts to get clean? After all, sterilisation may help mitigate the effects of drug-addiction on children, but it does nothing to address the wider problems associated with drug-use. A monetary reward in return for compulsory rehabilitation would go much further in tackling the difficulties that come hand in hand with drug addiction, both in the maternity ward and beyond.
Is Project Prevention inherently unethical? Many would hesitate to say so. It does succeed in solving a problem shown to be on the increase. Some would say it exploits the vulnerable, others that it is shameless bribery. Regardless of the conclusions we individually reach, Project Prevention does turn a blind eye to the wider suffering caused by drug-addiction.