TREATMENT, NOT STERILIZATION, IS THE WAY TO HELP ADDICTED MOMS

JUST as government data give us welcome news that crack use is on the
decline, C.R.A.C.K. -- Children Require a Caring Kommunity, a private
program that offers addicts $200 to get their tubes tied -- is attracting
national support, including a Houston businessman who recently contributed
$50,000 to the program. True, the financial incentive is modest and the
numbers accepting the offer are few (under 100). But there is cause for
grave concern about this initiative because it promotes prejudice and
perpetuates myths.

* Myth No. 1: Drug problems are irreversible. Simply put, you must believe
this to justify an irreversible solution -- surgical sterilization 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 don't separate mothers from their children are
highly successful in helping women and keeping their families together.
They also are cost-effective, especially when one compares their price tag
to the staggering financial and social costs of separating mother and child.

* Myth No. 2: Even if treatment is effective, too many drug-using women
just won't bother to get it -- either because they don't 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 she's been sterilized. If a
mere $200 and a little moral support can persuade 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 isn't that these women are
uncaring, irresponsible monsters. It's 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 women's
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 No. 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 don't believe in abortion. Sound familiar? It should. What you might
not know is that illicit drug use frequently causes menstrual irregularity
that actually interferes with conception, making it harder for addicts to
get pregnant.

* Myth No. 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 a carrot (like cash) or a stick (the threat of jail).
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
women's 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.

Paltrow is program director of the New York City-based National Advocates
for Pregnant Women, a program of the Women's Law Project. Newman is the
president and chief executive officer of Continuum Health Partner Inc., the
parent corporation that controls Beth Israel Medical Center, St.
Luke's-Roosevelt Hospital Center, the Long Island College Hospital and the
New York Eye and Ear Infirmary.