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.

Join the Conversation

  • sex-toy-james

    It sounds like Project Prevention is doing something good. Offering a woman 10% of what a household makes in a year doesn’t sound quite irresistible. It’s definitely enough to get people’s attention though. For someone dealing with HIV and possibly supporting a family on $400 a year, would you rather wish on them the option for free effective birth control and $40 or a child with HIV to care for. Also, IUDs can be removed, so all of those women have the ability to choose to have children at a later date.
    Honestly, I wish that everyone everywhere had this option whether or not they have HIV. $2000 with a free IUD in the United States would probably prevent a lot of teen pregnancies, and insure that people plan for their children. The cost of getting it removed later is in no way prohibitive compared to the cost of raising a child.
    I just can’t see incentivized family planning as an assault on people’s rights.

    • unequivocal

      I just can’t see incentivized family planning as an assault on people’s rights.

      I agree. Further, the implication that the offer of financial compensation invalidates choice (for poor people only, of course) has always rubbed me the wrong way. It comes across as classist and condescending. It also sets up a social dynamic wherein we are encouraged to ignore the agency of the impoverished (since they aren’t able to make “real” choices).

      How much of a choice really is it when someone is offering you a good sum of money to not have a child?

      If someone offers you $25,000 to sterilize yourself, do you have a choice, or is the offer of that much money so tempting that suddenly you are not in control of your own actions? What if the sum was $250,000? Or 2.5 million? Or are these questions only relevant if someone has hit a certain level of poverty?

  • http://feministing.com/members/tashabunny/ natasha

    I don’t know. I feel like the intentions behind the program are good. But it just doesn’t sit totally right with me. It might be because I feel they should also be giving help for the health problems the women have themselves instead of solely preventing problems with possible children.

  • http://feministing.com/members/kristakeating/ Krista

    Offering money to women, who are desperate to feed their family or feed their drug habit or are dying from a fatal disease, so that they will in return sterilize themselves is unethical, immoral, exploitative and enabling. Now with that said, as a single mother of three children at times strapped for extra cash, if I was offered not only a full paid for procedure but 300 bucks to tie my tubes, I’m all in! But I do not feel desperate for money, I am not fatally ill and I am not on drugs.

  • http://feministing.com/members/katyg/ KGirl

    I agree with both of the above posts. As someone who has worked with poor populations that often don’t have the resources to access long-term contraception, I do not think that a monetary incentives destroy agency. I also think that many perhaps all people would benefit from the time that long-term contraception affords to prepare for a child if one is desired. Having a child is a big decision, and extreme poverty, drug use, mental illness, and HIV are all factors that complicate the decision. I think it is ok to incentive people who are struggling with any of the above to take additional time to consider their decision to have children. I have worked with many families who had no such luxury, and the consequences are negative for both parents and children.

    • http://feministing.com/members/affekatze/ HolyMoly

      I also worked with poor populations-particularly children- and I have to agree with all your points.

      The analysis of this organization disappointed me. Someone in a university saw a problem – babies being born with HIV – and he wanted to help remedy it. He had no experience in dealing with this type of thing, but he went out and did it anyways. Is it not possible that these women are having children because of an inability to have access to birth control? Is it not possible women have maybe openly complained about there not being birth control? Did anyone stop to maybe…ask the women how they feel about it? So far I hear journalists and the dude

      If b.c. was widely available and easy to get…then there would be some gross ethical implications and it could sound like bribery. As it is, there is none.

      Basically, Vanessa is (accidentally, I hope) stating that African women have no sense of agency and they are not intelligent enough to make a decision of whether or not they want an IUD (that is removable).

      I am also surprised no one here talking about rape which is rampant in Africa and the reason many of these women have HIV in the first place. This IUD could potentially prevent a child being born out of rape IN ADDITION to being at risk for HIV.

      The organization isn’t perfect, but it’s out there – doing something.

      • http://feministing.com/members/affekatze/ HolyMoly

        Also, if this opens a dialog for another group or organization to go in and focus on the medical/health stuff…then all the better. Non-profits can’t be everything to everyone.

  • http://feministing.com/members/nadine/ doubleN

    We must not forget to ask why these women are vulnerable, especially if Project Prevention does not ask. What social factors contributed to their contraction of HIV? Why are they in such dire straights? What is local access like to reproductive health and rights/protections?

    We must also ask after potentially crucial differences between different kinds and degrees of incentives for women in different circumstances.

    The solution proposed by Project Prevention ignores larger issues of social justice (the feminization of poverty, class injustices, neo-colonialisms and globalization, etc.) intersecting with women’s other issues of addiction, health, and/or disability. If Project Prevention does not also work to support the general health and rights of these women, their project may be too close to the eugenics abuses of the (far too recent) past for comfort.

    Women with IUDs need to have access to health care to ensure any complications are looked after. What is the rate of IUD complications? What kind of ongoing access to appropriate and affordable medical care do these particular HIV-positive Kenyan women have? How does Project Prevention propose to support the ongoing health of women who may be affected by the IUDs they encourage?

    Does Project Prevention agitate against the stigmatization of HIV-positive status? Does it financially support home-grown programs by Kenyan women, especially by and for those who are HIV-positive, in terms of health and reproductive choices?

    Because of all these reasons, despite its good intentions, this kind of program is potentially damaging. It has the potential to intensify ableism, classism, racism, and sexism. It has the potential to cause physical harm if it is difficult for women with IUDs to have follow-up care. It could cause a backlash against its own program by the women it is targeting / ostensibly helping. I support the call for an investigation into Project Prevention’s practices.

  • http://feministing.com/members/michaelcrichton/ Michael Crichton

    How much does an IUD cost compared to the 9 months of antiviral drugs needed for an HIV-free birth? Or the 2-5 years needed for safe breastfeeding? Or the 18 years needed to raise that child? If you have limited resources, you have to allocate them to do the most benefit (in this case, reduction of human suffering). Don’t let the perfect be the enemy of the good.

    • http://feministing.com/members/nadine/ doubleN

      Certainly there needs to be prioritization of resources and reduction of human suffering.
      But who decides how best to do this? The HIV-positive Kenyan women, for example? Or the people with the money, who are not HIV-positive Kenyan women?
      Are the HIV-positive Kenyan women being consulted by Project Prevention? If so, how is that process working, and does the women’s feedback affect the project for the better?
      So if the road to hell is paved with good intentions, how do we know which road (among many possibilities) we are paving? Does Project Prevention know? How does the feedback of the women who are most affected get heard, taken seriously, and fed back into this process that is ostensibly about harm reduction? Is Project Prevention concerned about this essential part of harm reduction?