Prevention is not the cure

American charity Project Prevention sounds like the sister organisation of Fight Club’s Project Mayhem – but their incentivised sterilisation of drug addicts draws parallels with darker and more misanthropic dystopian fiction.

Project Prevention “offers cash incentives to women and men addicted to drugs and/or alcohol to use long term or permanent birth control”. 3,500 addicts across the United States have already been treated, and they are now offering users within the UK £200 to be sterilised. Project Prevention’s founder, Barbara Harris, argues that addicts are offered a free choice whilst sterilisation, or long-term contraception, helps solve many drug related problems – such as abusive and broken families, crime, inherited health problems and inter-generational addiction.

Project Prevention’s message is confused and muddled on a number of levels. There is obvious flaw in the affirmation that addicts are offered a “free choice”. A drug users’ already questionable judgement is impaired by their addiction and their frequently desperate need for money – either to pay bills or buy illegal substances. Harris concedes that paying addicts inevitably means some will spend it on drugs – yet she sees it as more desirable than an addict committing crime. But how ethical is it for an anti-drug charity to hand over money knowing that a person will use it to buy drugs? £200 amounts to little more than a two-day heroin binge, but it could mean a lifetime of shame and regret. Offering an addict a quick fix in exchange for ‘voluntary’ sterilisation does not represent a free choice, it represents a cynical bribe.

Removing someone’s ability to procreate and undermining their freedom to choose dehumanises and debases addicts. As Harris says herself:

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.

Dehumanising victims and championing the greater good has been used throughout history to justify eugenics – from Nazi Germany to 1930s America. If you treat someone like an animal, is it any surprise that some people start acting like animals? The whole rhetoric surrounding Project Prevention is fundamentally flawed and, although it may stop some addicts reproducing, it will do more damage by reproducing and deepening existing prejudices and misnomers. Drug users don’t need to be ghettoised and disenfranchised by society, they need support and compassion. Further alienation can only lead to increased social problems.

The overarching problem with Project Prevention is that their message is erratic and their justification is in disarray. They concede that “many drug exposed infants will not have long lasting problems from their prenatal exposure to drugs, but the problems that come with being in foster care are just as damaging if not more so”. It is unclear who their target is – drug users, the children of drug users or the foster care system. After all, why not target resources and support at developing America’s foster care system?

The reason that Project Prevention doesn’t concentrate on revolutionising America’s foster care system is because their perplexing rationale is predicated on economic – rather than social – exposition. Improving foster care would be costly – and that’s clearly not a price worth paying for drug-addled children.

Project Prevention’s contention assumes that babies exposed to illicit drugs within the uterus are more likely to be born prematurely and have a low birth weight:

The cost of hospitalization for a very low birth weight baby in need of intensive care can be as high as $150,000 .... The annual medical cost of caring for cocaine-exposed babies nation wide has been estimated at 33 million for neonates, and as high as 1.4 billion during the babies' first year of life.

Children born with Fetal Alcohol Syndrome need comprehensive long-term, integrated interventions that include social, health, emotional and educational services. These services place additional strain on the economic and social resources of society.

The polemic is in very dangerous territory when sterilisation is being determined by economic factors – because the logical conclusion is that it should be extended to other ‘costly’ groups. After all, why not pay criminals to cut off their hands? Or euthanise pensioners, obese people and smokers when they become a drain on the NHS?

It is important to recognise the cost of drug addiction to the tax payer – such as child care, hospital treatment and prison – but the answer is not to remove someone’s rights. No respectable stake-holder should promote forced sterilisation and it is a dangerous fallacy if Project Prevention’s programme is seen as an objective choice. Most internet critiques of Harris’ programme focus on the “slippery slope” which leads to state-sponsored eugenics and it is important to recognise Project Prevention’s deliberately vague and confusing message mixed with emotive rhetoric. The logical conclusion of much of Harris’ argument is totalitarian social engineering. For instance, what happens if a parent develops a drug dependency when they already have children – should they be forcibly taken from them?

Thankfully, the UK has a much more developed and progressive welfare system than the US. The way we treat the most vulnerable people in society is much more advanced and we have much more comprehensive and accessible drug treatment programmes – many of which focus on long-term contraception. But the problem of drug dependency and its affect on children cannot be solved by treating symptoms or removing choice through financial incentive - it is about addressing the causes of drug abuse and supporting parents. If a drug addict isn’t in a fit state to have children, then they certainly don’t have the capacity to make a decision which will permanently remove their ability to start a family.