U.S. organization paying HIV-positive women in Kenya to get IUDs

Anna Clark has a really important piece at The Nation about the work of Project Prevention (formerly known as CRACK), a previously domestic-based organization that has now spread their efforts internationally in the name of protecting children — by paying HIV-positive women 40 bucks to get an IUD.

That amount of money is actually quite a bit in Kenya, where the average household income makes $400 a year. So when you come across a person who is offering that kind of cash to team up with other HIV-positive women, create a business plan together and get free birth control, it sounds like a sweet deal, no? But the implications that this kind of program has around personal agency and the control of women’s bodies — and primarily women of color — is pretty alarming.

This seems to be part of the reason why the organization changed its name some time ago, because of the controversy it started back in the U.S. around women with addiction:

[Barbara] Harris founded a nonprofit called Children Requiring a Caring Kommunity, or CRACK, in California in 1997; the organization made headlines for offering to pay women addicted to drugs $300 if they agreed to be sterilized, or ongoing payments as long as addicted women used long-term contraception. Harris, who herself adopted four children born to an addicted mother, is committed to using financial incentives as a tactic to reduce the number of infants born to addicted and alcoholic parents.

While CRACK has been the subject of critical media coverage and policy reports, and has changed its name to something more unassuming—today it’s known as Project Prevention—the program is still active, and is now moving beyond the US borders. Both its domestic and international efforts are funded almost entirely by donations, including Harris’s personal funds. [...] [I]n the first nine months of 2010, Project Prevention paid 465 new participants in the United States. And last year, a $20,000 individual donation from a London resident brought the program to Britain—though the British Medical Association’s pushback compelled Project Prevention to drop its sterilization efforts and focus on long-term contraception.

Their efforts in Kenya are under the mission of decreasing the extent of mother-to-child transmission of HIV. In the meantime, women with HIV can decrease their chances of transmitting the virus to their infant to 5% and lower by receiving antiretroviral treatment (and prophylaxis if they breastfeed). Project Prevention still insists that getting them on long-term birth control is the “only way” to reduce the number of infected children. But when does the question of choice come into play? How much of a choice really is it when someone is offering you a good sum of money to not have a child?

Just like women with drug and alcohol addiction, HIV-positive individuals endure their own social stigmas and discrimination — in the U.S. and internationally — and  Project Prevention seems to feed this assumption that not only are these women not fit to be mothers, but also that they’re beyond treatment. National Advocates for Pregnant Women (NAPW) researched Project Prevention when they were still CRACK and just targeting U.S. populations with drug addiction:

NAPW’s examination of the program makes clear that, far from providing a useful response to problems associated with drug use and pregnancy, C.R.A.C.K. instead acts as a dangerous vector for medical misinformation and political propaganda that has significant implications for the rights of all Americans. Under the guise of openness, voluntary choice, and personal empowerment, C.R.A.C.K. not only promotes a vicious image of all drug users, it has won significant support for a program and an ideology that is at the core of civil rights violations and eugenic population control efforts.

It’s pretty obvious that there needs to be a larger scale investigation into the practices of this organization. You can call it what you like, but speaking plainly, these are financial incentives for reproductive control over marginalized women’s bodies. And the ethical implications behind that are far too serious to ignore.

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