Tuesday, December 19, 2006

More On Paying Women Not To Have Children

Women's Bioethics Blog has a post on Project Prevention, which pays drug addicts to use long-term birth control or get sterilized, and asks these questions: "Does[sic] these women feel coerced? Or do they feel a sense of relief? And what of the ethics of public health, that we all pay when our children suffer?" The post is in response to this piece from the New Haven Register. A couple of excerpts:
  • "'The ethical dilemma is that (Project Prevention) has a good goal, but is it taking advantage of someone who doesn't have a lot of economic options. Is the money a coercion, does it force them to close their reproductive options,' said professor Brian Stiltner, chairman of the Philosophy and Religious Studies at Sacred Heart University in Fairfield. ...'There is a general principle in research ethics to not give financial incentives big enough to be the primary reason for people to make a decision.'"
  • "'If we were paying alcoholics with a record of DUIs to never get behind the wheel of a car again, nobody would have a problem with that. It's the same thing,' Harris argued." Is it? Because you probably wouldn't cut off their hands or feet so they couldn't drive...

    From Project Prevention's website:
    "For a tubal ligation or Norplant, the client receives $200. For Depo-Provera or an IUD they receive $50 every 3 months ($200 maximum per year), but can continue for future years. Project Prevention offers a $200 incentive for any of these birth control methods (those not included are subject to Board approval):
    Depo Provera - paid over the period of one year
    Norplant (5 year contraceptive)
    Tubal ligation"

    From Project Prevention's frequently asked questions [emphasis mine throughout]:
    Q: Some say these people are not capable of deciding on long term birth control.
    A: If you can not trust someone with their reproductive choices, how can you trust them with a child?
    Q: Are you targeting blacks?
    A: It is racist, or at least ignorant, for someone to learn about Project Prevention and assume that only black addicts (or minorities) will be calling us. The reality is, not all drug addicts are black. [Thanks for clearing that up...]

    Project Prevention's promotional flyer [PDF], with headline, "Get Birth Control. Get Cash."

    I don't have a problem with helping women make smart choices about family planning. I still do have a problem with incentivizing women to get sterilized. It simply leaves no room for a woman to clean up her life and bear healthy children later. It takes away future options through a short-term money fix.

    Previous Post: Bribing Women to be Sterilized

    Update: What I said to Carter, who thinks women should get sterilized to receive welfare as well:
    One big problem I have with this program is that it's not "normal" birth control, it's long-term or permanent birth control - sterilization is one of the options. That is permanent. So you're essentially saying to these women, "I don't think you can ever clean up your act to the point that you could have children. If you do, too bad for you." As I understand it, the longer-term methods of hormonal birth control tend to have more severe side effects as well. They are not providing rehab, although they are referring to rehab, so rehab is *not* a condition of being paid to get sterilized. Additionally, there's the aspect of incentivizing people to take a drug or have a permanent surgical procedure, which would generally not be considered good medical ethics. If you're having a truly hard time in life, perhaps with drug addiction and associated financial hardships, you might be tempted to have something done to your body that you otherwise wouldn't, so you can have the cold hard cash to eat or get your fix. How voluntary is it to an addict who has cash waved in front of them? Is that truly informed consent? I think these women are being bribed and abandoned more than they're being helped.

    Blogger CanuckedBrit said...

    What I would like to see efficient rehab programs. Many addicts/alcoholics already have a child or two already. They either don't seek help before things spiral out of control (when they still have a home and a situation resembling normal) because they are afraid of children's aid taking their child/ren away and/or not having access to their children during rehab and/or having a place for their children to go besides foster care.
    For those that the situation has already gotten out of control it is rare for a rehab to take pregnant women. It's almost unheard of to have daycare in rehabs.
    I'm a mother, I wouldn't want to be separated from my kids either.
    I've read some studies before saying that the most effective way to get addict mothers to clean up is the incentive that you will help them get financial control over their own lives. Give a man a fish, you feed him for a day. Teach a man to fish and you feed him for a lifetime. Help these women take care of themselves financially, provide day care assistance during rehab and the results are more positive and long term.

    This would be a much more constructive way of improving the lives of the children than deciding that they should never have existed and stop these women from having more. If you leave them sterilized addicts, what happens to the children they already have? What about the next round of addicts? How many women do we sterilize?

    8:17 AM  

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