Opposition to Coercion in Family Planning Decision Making

[摘要]

This policy updates current policies of the American Public Health Association that oppose coercing women into sterilization¹ or Norplant use², and that affirm the Association’s support for expanded drug treatment facilities for pregnant women who use harmful drugs³ and its recognition that “racism and its consequences are dangerous to health.”⁴ It also highlights the Association’s concern about the controversial use of cash incentives to influence health decision-making including reproductive decisions.

Whereas over the past several years the organization CRACK, Children Requiring a Caring Kommunity, continues to expand its base of operations across the country.^5-7 CRACK is a non-profit organization that uses a cash incentive program to influence drug-addicted women with a promise of $200 upon verification that they have been sterilized or use long-term birth control methods and devices, such as Norplant, Depo-Provera, or an IUD.^8-10 During the summer of 2000, CRACK opened a chapter in Washington, DC and placed subsidized advertisements in the District of Columbia metrobuses that targeted primarily low-income and predominately African-American communities in the District of Columbia.^10-12 Over the past year, chapters have been started in others cities such as Baltimore with a similar population mix—low-income, African-American.^7,8

Whereas programs such as CRACK violate principles of human rights, civil rights, and reproductive freedoms by:

1. Attacking/addressing the reproductive capacity of women rather than the conditions of oppression under which poor women live.¹³ According to experts, conditions such as poverty, racism, violence and gender discrimination give rise to harmful drug use practices among women. These conditions need to be addressed in order to decrease harmful drug use practices among women.^13-15
2. Targeting communities of color and poor people with controversial and coercive population control strategies. These strategies target and emphasize permanent or long-term birth control for small amounts of cash or gifts such as dresses, t-shirts and food.¹⁶
3. Limiting birth control options. These incentive programs do not compensate women for their use of birth control methods of choice but encourage birth control drugs and devices that may increase health risks⁸ and do not encourage or counsel women about options that protect against HIV and other sexually transmitted conditions.
4. Impeding treatment for illegal drug use. These approaches address the symptoms and not the causative or predisposing factors related to substance use and do not encourage participants to seek or consider drug treatment options.¹⁸ In the District of Columbia, the director of the DC Substance Abuse Services office characterized the recent efforts by one current incentive program, CRACK, as “ill conceived… (and) not supported by the Department of Health.”¹⁰ While drug treatment programs can be successful,^6,17 funding for drug treatment interventions has decreased,^5,19 limiting the options for women of childbearing age to get help.

Because the aforementioned approaches create undue and unfair inducements, APHA will:

1. Oppose the operation of any unproven incentive program particularly those that encourage sterilization and long-term contraception to the exclusion of other available options.
2. Reaffirm its opposition to coercion as it relates to family planning. 
3. Endorse programs and services, such as drug treatment, decent jobs with benefits, educational opportunities, mental health services, and childcare services, that help women terminate harmful drug use.
4. Advocate for increasing the federal budget for drug treatment programs for pregnant women.
5. Advocate for increased access to voluntary family planning programs and services.
6. Oppose publicly subsidized advertisements for coercive incentive programs on public transportation, billboards, and other venues.

References

1. APHA Resolution 7317, Involuntary Sterilization, 1973
2. APHA Resolution 9020, Illicit Drug Use by Pregnant Women, 1990.
3. APHA Resolution 9104, Norplant: Making it Affordable and Voluntary, 1991.
4. APHA Resolution 9612, Threats to Affirmative Action Are Threats to Health, 1996.
5. Chavkin W. Drug addiction and pregnancy: policy crossroads. Am J Public Health 1990; 80(4): 483-487.
6. Chavkin W, Paone D, Friedmann P, Wilets I. Reframing the debate: toward effective treatment for inner city drug-abusing mothers. Bull N Y Acad Med 1993; 70:50-68.
7. Children Requiring a Caring Kommunity website, http://www.cracksterilization.com, viewed on October 9, 2000.
8. CWPE, Committee on Women, Population and the Environment. Fact Sheet on the CRACK Organization, http://www.cwpe.org/, viewed on October 9, 2000.
9. Hadeed AJ, Siegel SR. Maternal cocaine use during pregnancy: effect on the newborn infant. Pediatrics 1989; 84:205-21.
10. Goldstein A. Group to Pay Addicts to Take Birth Control, Washington Post, June 26, 2000, Metro Section, B01.
11. Allen, JW Jr. for the Amalgamated Transit Union (ATU) Local 689. Letter to Mr. Richard White (manager of the Washington Metropolitan Area Transit Authority, WMATA). August 15, 2000.
12. Robinson, D. Cracks in the Armor. City Paper, Washington, D.C., September 2000.
13. Kearney MH, Murphy S, and Rosenbaum M. Learning by losing: sex and fertility on crack cocaine. Qualitative Health Res 1994;4(2):147.
14. National Institute on Drug Abuse (NIDA). National Pregnancy and Health Survey: drug use among women delivering live births, 1992. Rockville, MD: U.S. Department of Health and Human Services. National Institutes of Health publication 96-3819.
15. Neuspiel, DR Racism and Perinatal Addiction. Ethnicity Dis 1996; 6:47-55.
16. Stryer, J (23 July 2000). Under the Influence of Gifts, Coupons, and Cash. New York Times, p. WK 4.
17. Humphries D, et al. Mothers and children, drugs and crack: reactions to maternal drug dependency. Women and Criminal Justice 1992; 1:81-99.
18. Rosenbaum M. “Women: Research and Policy” In: Lowinson JH, et al. Substance abuse, a comprehensive textbook, 3rd edition. Baltimore, MD: Williams and Wilkins, 1997, pages 654-5 and at http://www. lindesmith.org/library/m_rosenbaum2.html, viewed on October 9, 2000.
19. Prendergast ML, Wellisch J, Falkin GP. Assessment of and service for substance-abusing women offenders in community and correctional settings. Prison J 1995:75(2).

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[发布日期] 2001-01-01

[学科分类] 医学（综合）