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January 29th, 2003 Amy Roe | News Stories
 

The Fix

How do you keep an addict from getting pregnant? Pay her.

     
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Sidebar: Death of a "Crack Mother"
Sidebar: Left to their Own Devices

Last month, Heather Keithley, 21, went to Planned Parenthood on Northeast Fremont Street. Inside the clinic she lay down on an exam table, her straight, reddish-brown hair splayed out behind her. She tried not to flinch as a small, T-shaped stick was inserted into her vagina and, finally, her uterus.

She was getting an IUD.

And, because Keithley is a recovering speed freak, she'll also get $200 from a California nonprofit.

Keithley had been doing crank since she was 14. At 16, she moved from Clearlake, Calif., to Portland to live with her dad and was introduced to the drug's purer cousin, crystal meth. They became best friends.

Keithley dropped out of Cleveland High School and spent days studying her pipe. Scoring in her outer Southeast neighborhood was easy. Benders with friends seemed infinite; the drug once kept Keithley up for nearly two weeks, playing cards or dice or just driving around. They tweaked for hours in Walgreen's. There was no hunger, no need of anything--not even sleep.

Besides the body high--like cocaine's rush, without its numbness--Keithley craved the transformation meth gave her: "It changes the whole person that you are. It makes you feel like you're superior and nobody can touch you and you have power."

Like helium in a balloon, the fuel would eventually dissipate, leaving Keithley unbearably low. "Oh, my God, it's horrible," she says of coming off the drug. "You're sick, no energy at all, you get really bitchy. So you want to get back up."

Keithley says she is clean now, and has been for eight months. The $200 she'll get for putting a birth-control device in her uterus will buy a new outfit, not a fix.

Addict, recovering addict, dirty, clean...whatever. The distinction hardly matters to CRACK (Children Requiring a Caring Kommunity), the group that gave her the money. "As long as they stay on birth control," says founder Barbara Harris, "that's all we care about."

Forty-eight Oregon women have taken CRACK up on its offer since 1999, 30 of whom were sterilized. Harris expects that number to grow, but it won't come without a fight.

"We'd be concerned about any program that had any hint of coercion involved," says David Fidanque of the ACLU of Oregon. "It's one thing to make birth control available; it's another to give people cash to use it."

Barbara Harris, who lives in Orange County, Calif., is as blunt as her group's acronym. It's not hard to imagine her as a waitress at the International House of Pancakes--the job she held for 20 years before she and her husband, a surgical technician, became foster parents. They took in the children of a Los Angeles cocaine addict, one after another, until they'd adopted four.

"[CRACK] came out of the frustration of getting a phone call every year," she says.

She tried to get California legislation passed to make it mandatory for women who give birth to drug-exposed babies to use long-term birth control, but the bill failed. That's when Harris came up with the idea of offering cash incentives.

She formed a 501(c)3 nonprofit. Laura Schlessinger donated $10,000 to the program and touted it on her radio talk show, Dr. Laura. The group launched a national mass-mailing campaign to probation departments and drug-treatment centers. She paid her first client in November 1997.

"Once the word got out about what we were doing, we got calls from all over the U.S.," Harris says. "It snowballed."

The organization--which is also known as Project Prevention--has since received more than $2 million in donations, most of it from wealthy conservatives. Pittsburgh billionaire Richard Mellon Scaife contributed $75,000 through his Allegheny Foundation. Jim Woodhill, a Houston venture capitalist and self-proclaimed member of the "Republican Rebel Alliance," contributed $125,000.

Prospective clients call a toll-free number, leaving their name and address after a recorded message. CRACK mails them forms to take to their parole officer, drug-treatment provider or caseworker, who documents the history of substance abuse. The program is open to users of any drug, including alcohol, but the applicant must provide the name and number of a person who can vouch for the abuse as well as documents, such as court papers, to prove it. (According to CRACK, cocaine is the drug most often used by applicants, followed by meth and heroin--but most say they use alcohol as well.)

Applicants take the forms to a clinic, where a health-care provider signs and dates them, verifying that they have received an intrauterine device, Depo-Provera or a tubal ligation. (Birth-control pills are excluded because, as Harris explains, "We don't trust them to take a pill every day.")

Prospective clients mail these forms, along with a questionnaire about their race, sexual history and drug use, back to CRACK, where a worker calls the numbers given to authenticate their claims. Clients usually receive a check in about a week.

Harris is aware junkies sometimes use the money to feed their habit. At least with CRACK, she reasons, they won't get knocked up while they're at it. They won't use abortion as birth control. They won't give birth to sickly babies, babies they can't take care of, babies who often end up shunted from one foster home to another, burdening the system, shaming the mothers from whom they were taken.

Many who work in social-service agencies agree with Harris. At any given time, Oregon's foster-care system houses between 6,000 and 7,000 children. Parental substance abuse, during pregnancy and afterward, is the No. 1 reason they're there, says Jay Wurscher, alcohol and drug services coordinator for the state office of Mental Health and Addiction. Given these statistics, "There's no way [CRACK] can go wrong," Wurscher says. "If you keep somebody on birth control for two to three years--18 to 21--the amount of money you've saved is probably incalculable."

Catherine Earp, Multnomah County nurse health manager for Early Head Start, has seen the effects of addiction. "After you work at Child Protective Services and you have a couple women hand over their babies saying they want their drug instead, it's pretty powerful," Earp says. "I don't care if it's a Band-Aid. If people are not bringing drug-exposed babies into the world, more power to them. That might be radical, but these kids have long-term problems."

Yet even those who generally support CRACK's concept draw the line at rewarding sterilization. "Permanent sterilization is a pretty grim thing to be looking at when a person does recover and achieve sobriety," says Wurscher.

CRACK ought to distinguish between young clients and more hardened drug abusers, says Daniel Pitasky, associate director of New Avenues for Youth. "If they're targeting adults that have long-term addictions, that's one thing, but when you're talking about 15- or 17-year-old youth, somebody could age out of those behaviors."

Then there are those who oppose CRACK altogether. Such critics run the gamut--from public-health officials who express vague discomfort with the idea to advocates for the poor and drug-addicted, who say CRACK's cash-for-birth-control scheme is tantamount to a campaign against minorities and the poor.

Around the nation, reproductive-rights advocates and civil libertarians--the very people who typically champion access to birth control--have been CRACK's most outspoken detractors. The fact that the group's clients are addicts changes things, they argue: The $200 is no longer a choice, it's a bribe. And women like Keithley are not voluntary recipients of a windfall, they're victims, blocked from breeding by a covert campaign that evokes discredited eugenics programs.

Planned Parenthood--which runs the clinic where Keithley received her IUD--was unaware CRACK is operating in the state, not to mention that the organization's own health-care providers had signed CRACK's forms. Nancy Bennett, public-affairs director for Planned Parenthood of the Columbia/Willamette, says the agency does not have a position on the program, but would honor requests for records and services. (The local branch of the agency does not offer tubal ligation.)

Public health officials were less guarded. "This is a slippery slope," warned Margo Salisbury, lead women's health-care nurse practitioner for Multnomah County. "I'm certain we would take a policy of not referring folks to this," she says.

The ACLU's Fidanque is even more strident. Fidanque says CRACK conjures the not-so-distant memory of Oregon's eugenics program. Last month, then-Gov. John Kitzhaber formally apologized for the forced sterilization of more than 2,500 Oregonians, many of them poor or institutionalized, under a law that stood from 1917 to 1983.

Fidanque says he'd be alarmed by any connection between government-funded programs and CRACK. Yet CRACK claims that most of its Oregon clients say they hear about CRACK from Letty Owings Center in Northeast Portland and Willamette Family Treatment Center in Eugene, both of which are publicly funded. Keithley learned about the program from her roommate, who was given a flier by a counselor at the Letty Owings Center. The flier had the group's hotline, 888-30-CRACK, printed on it. "GET BIRTH CONTROL, GET CA," it reads. "If you are addicted to drugs and/or alcohol, THIS OFFER IS FOR YOU."

Ed Blackburn, program director for Central City Concern, which operates Letty Owings, says the center doesn't refer clients. "We don't have any formal relationship. I think the brochures have been there for about three years. We don't refer people to it."

Even so, Fidanque worries that any association with CRACK could be taken as tacit endorsement. "It might be very easy for a client to conclude that taking advantage of that was a condition of participation in a government program," he says.

NARAL Pro-Choice America also opposes CRACK. Caroline Fitchett, interim executive director of Oregon NARAL, says offering cash incentives to drug addicts is coercive and limiting the kinds of birth control rewarded may induce clients to pick a method that may not be best for them.

Fitchett says she's not surprised the program is virtually unknown in Oregon. "It's stealth," she says, explaining that CRACK's low profile is calculated to avoid the controversy it has generated elsewhere.

Of all those who've taken a stand against CRACK, however, the most aggressive opposition has come from the streets. Theryn Kigvamasud'Vashti, director of the Seattle nonprofit CARA (Communities Against Rape and Abuse), says that CRACK implies a certain class of women and men (the poor, drug addicts and minorities) is incapable of being good parents and perpetuates the myth that drug-exposed babies are necessarily wasted lives.

CARA launched a campaign against the program in Seattle last fall, taking down its fliers and even attempting to infiltrate the group.

Kigvamasud'Vashti says the program's racism is blatant. "The program's not called DRUG, it's called CRACK. In America, there's a very specific image when you say crack: poor, urban and black."

Oregon statistics, however, don't support her claims. Of the CRACK clients in this state, 40 are white, five black and one Hispanic. The remaining two listed their race as "other."

Kigvamasud'Vashti says the discrimination goes beyond race. She says it's impossible to imagine anyone but the poor being subjected to such a program. "This is not Robert Downey Jr.'s kids, or Whitney Houston, or Bobby Brown. What happens to the rich when they're drug-addicted, versus the poor?"

To drive home this point, Seattle "Cracktivists" parodied the program, printing stickers offering cash to wealthy white women to get sterilized and posting them in upscale supermarkets.

Barbara Harris is, for lack of a better word, a hardass. Palpably angry about the tragedy of drug-exposed babies, her tough love is unfettered by political correctness. A July 1998 article on the website Salon opened with a quote from Harris saying drug-addicted women were "literally" having "litters" of babies; a similar quote made it into the pages of the U.K. edition of the women's magazine Marie Claire. And although Harris doesn't take credit for coming up with the turn of phrase, she doesn't back down from it, either. "There's more compassion in this country for animals than for children," she says with exasperation.

Harris addresses the program's detractors with similar impatience, calling allegations of racism "ridiculous." After all, though Harris is white, the children she adopted are black, as is her husband.

The complaint that CRACK fails to protect against STDs likewise fails to convince her. Drug addicts aren't having safe sex anyway, she counters. "They don't wear condoms, and they prostitute all day long for all for like, five bucks," she says, her voice curled with disgust.

Then there's sterilization. Everyone fixates on that, Harris says wearily. While there's no minimum age to participate in CRACK, Harris blithely dismisses the suggestion that young women who get sterilized will later regret their decision. They're more likely to regret having drug-addicted babies or abortions, she wagers. Besides, it's difficult to find a doctor who will perform sterilization on a young woman--she says her niece, a mother of two, had a hard time getting one. "I'm actually shocked when people are 23 or 24 and the doctors allow them to do that."

And don't get her started on the oft-repeated suggestion that she should be doing more to help drug-addicted women. "Everybody has a specialty. Our focus is getting these women on birth control. But people will say, 'Why are you doing this, why aren't you doing that?'" she fumes. "We don't solve all the world's problems."

As for her critics, Harris tosses it right back: "They want to tell us what we should be doing--what are they doing?"

Heather Keithley's IUD will keep her from getting pregnant for the next decade. She will be 31 then. In the dim glow of the television set, Keithley twirls a lock of hair on her finger and contemplates this. "I want to have another kid someday, but right now," she says, eyeing the towheaded 3-year-old in front of her, "he's all I can handle."

Keithley was a 17-year-old meth addict when she missed a Depo-Provera shot and got pregnant. She quit using immediately, she says, but it wasn't long after Cameron's birth that she started using again and got charged as an adult with possession of a controlled substance. The state took her son.

Eight months, one relapse and one drug-treatment program later, Keithley got clean and got Cameron back from foster care. They now live with two other single mothers--both recovering addicts with young sons--in an old wood-framed house off East Burnside Street.

The Department of Corrections owns the house and much of its contents, including the dingy sofa on which Keithley sits. She attends classes at PCC-Cascade and subsists on a patchwork of government assistance, including a $10 monthly allowance for things food stamps won't buy, like paper towels and aluminum foil.

She planned to get back on birth control after Cameron was born, but she never got around to it. When she heard she could get cash, though, she made it a priority.

Even though she has yet to receive her $200 check, Keithley is already singing the program's praises. Clients are eligible for a $50 bonus if they refer another eligible participant. "I pretty much refer every one of my female friends," Keithley says. "I think it's awesome."

Left to their Own Devices

Norplant was pulled from the market by its manufacturer in August 2002, so CRACK clients who don't want to be sterilized must now decide between an intruterine device or Depo-Provera.

Some women do not want to use Depo-Provera because of the weight gain that is sometimes a side effect. Weight gain is a particular concern for recovering addicts.

Meth addicts, for example, lose weight rapidly, but in recovery they often gain back all the weight they've lost and more. This sudden weight gain often compounds the anxiety and depression they experience while coming off the drug.

Unlike Depo-Provera, however, IUDs can exacerbate infection caused by STDs, according to the American Association of Family Physicians. The AAFP only recommends IUDs for women in a long-term, mutually monogamous relationship.

Thus, giving an IUD to a woman who does not stay clean is risky. A woman with an IUD who has multiple partners, a non-monogamous partner or an intravenous-drug-using partner--or is herself an IV drug user--may actually increase the severity of an STD, should she contract one, thereby increasing the risk that such an infection would lead to sterility.

At the same time, because the drug stimulates the brain's pleasure center while obscuring the user's decision-making ability, a meth addict who is using is more likely to engage in high-risk sexual behavior and therefore is more susceptible to a STD--the very profile of a person who is not a good candidate for an IUD. --AR

Death of a "Crack Mother"


Anita Nichols, as she appeared on WW's 1989 cover.

Last month, Anita Nichols was struck by a cab as she crossed a poorly lit section of Northeast Killingsworth Street in the dark, rainy night, then was dragged 30 blocks by another vehicle. The medical examiner ruled that she was probably already dead by then. She was 35, the paper said.

I met her in 1988, the year before WW hailed her as the quintessential "Crack Mom" ["Crack Mother," Aug. 24, 1989]. She had only two kids then. When she died, she had 7.

Anita was a client in a family-law office I worked in. She had been busted for drugs and prostitution, and she rotated through every clean-up and dry-out program in town in fruitless campaigns to get her kids back.

Anita was beautiful. Very tall and slender, she moved with great grace. Dark brown, she had a fine, wide mouth and huge, wide eyes. She was very smart. She could spin beautiful lies faster than you could dismiss them--and then snap into rage when the time came to say "No."

She was always asking, begging, hustling. When I volunteered in a church office, it got so I knew her voice, and I would say, "Oh, hi, Anita, and no, we don't have any money today." Her stories changed. She had been beaten up and had to have 16 stitches, and her kids would be hers again if she could pay the deposit on this new place, and could she have the money in cash, please?

When I first met her, she would occasionally be clean and sober, and sweet and kind at the same time. Then she wanted only food, not cash. I remember showing her the tomato plants in the church garden and telling her she could help herself. It was a cool fall afternoon, and she shivered against the breeze. She took some tomatoes that day, but she never came back for more.

In later years, she forgot our earlier kindnesses. A front tooth darkened, then disappeared. The picture they showed on television showed she still had some of her beauty, but not much. She looked reproachful. She had scars on her face, and her lips were closed, smiling only slightly. She had every chance, and she had no chance, just like all of us. --Joyce Boles


CRACK's web site is www.cashforbirthcontrol.com .




Oregon's clients make up roughly 6 percent of the total number of CRACK participants, even though Oregon's population is only 1 percent of the United States'. CRACK does not know why Oregon has a disproportionate share.




CRACK gives cash incentives but does not typically pay directly for birth control. The group will refer women to low or no-cost programs in their area. Most clients qualify for Medicaid or state health programs, which cover birth control.




CRACK has an Oregon contact, a woman who works at a drug-treatment program and passes out the group's fliers. Harris won't divulge her name, for fear she would be harassed or lose her job, as has happened to CRACK supporters elsewhere. "It's sad that it has to be like that," she says.




CRACK also offers $200 to men with a history of substance abuse to get a vasectomy. Twenty- one men have participated.




CRACK's name evokes the loaded image of so-called "crack babies," a phrase coined by the media upon the publication of Dr. Ira Chasnoff's 1985 study.




Chasnoff later expressed regret that his study was used to demonize addicts, saying poverty, not crack cocaine, is the worst thing that could happen to a child.




Roughly 44,000 babies are born in Oregon each year. According to data collected by the state, 1 percent of Oregon mothers used alcohol during pregnancy in 2001, and less than 0.9 percent of mothers used illicit drugs during pregnancy.




Across the nation, 865 people have received cash incentives from CRACK-- some of them more than once-- since the program was founded in 1997. Of those women, 354 were sterilized.
 
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