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Fact Sheet on Positive Prevention/CRACK (Children Requiring A Caring Kommunity) Prepared by Theryn Kigvamasud’Vashti, Communities Against Rape and Abuse P o s i t i v e Prevention, a population control organization in Seattle, offers a $200.00 cash incentive to people who are addicted to drugs and alcohol to undergo a form of long-term or permanent birth control. Their mission is to "save our welfare system" and the world from the exorbitant cost to the taxpayer for each "drug addicted birth" by offering "effective preventive measures" to reduce the "tragedy" of numerous drug-affected pregnancies. Positive Prevention/CRACK claims to "look not only at the occurrences during pregnancy, but also the environment that follows in terms of structure and love." Yet, Positive Prevention/CRACK’s decentralization of the woman from her addiction and her addiction from her body and her body from the contexts of poverty, racism, paternalism and heterosexualism2 actually negates Positive Prevention/ CRACK’s claim of compassionate follow up. Positive Prevention/CRACK is clear that its mission is not to help pregnant, chemically addicted women receive support services but to disengage women from their reproductive freedom with the offer of $200.00 during a profoundly vulnerable time in a women’s life.
CARA believe that pregnant mothers who abuse substances during pregnancy need comprehensive drug treatment and consistent low cost or free prenatal care. Positive Prevention’s approach is dangerous because the use of payment as an incentive to receive birth control undermines the very notion of reproductive choice, drug treatment, and is reminiscent of the Eugenics movement, which had the greatest momentum in the United States (1907-1941).3 Positive Prevention’s strategy is also coercive because it targets people during a significantly vulnerable period due to their chemical addiction, lack of resources, and economic desperation. Positive Prevention is the Seattle chapter for Children Requiring a Caring Kommunity (CRACK) founded by Barbara Harris in 1994 at her home in Anaheim, California. CRACK is now based in Fresno.4 There has been resistance to CRACK chapters in other cities like Chicago (July, 1999), Houston (January, 2000), Pittsburgh, Cleveland, Denver, Detroit, New Orleans and Florida (April 2001). Some of Harris’ initial billboards read "Don’t let a Pregnancy Ruin Your DrugHabit."5 However in Seattle, Positive Prevention advertisements have not been that bold.
Positive Prevention’s "$200.00 Cash" flyers have tabbed phone numbers at the bottom of the sheet so people may tear off the 1-800 phone number. In the Belltown neighborhood resistance activists have removed the "$200.00 Cash" flyers off of garbage dumpsters, alleys walls, inside the doors of homeless shelters for women and Street Outreach Services on (1st and Pike), and off of Metro bus shelter windows, walls and bunches of hand sized flyerscrammed together in the crevasses between the windows and the bus shelter walls.
1) Positive Prevention/CRACK ignores rape, sexual trade and sexual coercion for drugs,money, food or shelter, the overall complex nature of sex and sexual activity among womensubstance abusers. Positive Prevention/CRACK fails to acknowledge the correlationbetween childhood sexual and physical violence and drug addiction.
• "Divorced or separated, urban, poor women, ages 16-24 experience the highest • "Women in house holds of $15, 000.00 or less are 3 times more likely to be raped or sexually assaulted and Black women are more likely to be poor."7 "Rape victims have higher rates of drug and alcohol consumption and a greater likelihood of having drug and alcohol-related problems than non-victims."8 • "Rape victims with rape related posttraumatic stress disorder (RR PTSD) are 13.4 times more likely to have two or more major alcohol problems and 26 times more likely to have two or more major serious drug abuse problems."9 Positive Prevention acknowledges that their offer of $200.00 is more appealing to poorwomen than to middle class women but they do not draw any other connections betweenchemically addicted women living in poverty and the fact that these women are most likelyto be homeless and at greater risk for rape.
Physical abuse, sexual abuse, and partner violence tend to be intercorrelated. These formsof abuse have been associated with lower self-esteem, lower perceived health status, andlower life satisfaction. In addition to these circumstances, chemically addicted individualsare also at greater risk for symptoms of depression, self-destructive behavior, anddifficulties in interpersonal relationships.10 2) Positive Prevention/CRACK lacks a complex analysis of substance abuse thereforeignoring poverty as context for the intersection between the lack of economic and medicalresources, disabilities, homelessness, drug addiction and racial disproportionality.
Chemically addicted people who are most likely to accept birth control for the $200.00 cashare people who, because of poverty, also experience disproportionate rates of sexual andphysical violence, HIV, mental illness, homelessness, instability, imprisonment and deathrow sentences, posttraumatic stress disorder, and repetitive micro and macroaggressionand insults11 as a result of oppression. For example, African Americans encounter a varietyof assaults to their health and well being. Rates of HIV among women continue to increaseeven as overall national rates have begun to decrease. In Los Angeles County, AfricanAmerican women account for 45% of AIDS cases, despite being 10% of the femalepopulation (Los Angeles County Department of Health Services, 1999).12 Yet PositivePrevention/CRACK support birth control methods that do not protect people from HIVcoupled with the fact that Positive Prevention and CRACK specifically target communities ofcolor that are often Black and Latino and those most likely to be homeless as a result oftheir addictions. Positive Prevention/CRACK billboard ads, Metro Bus ads (subsidized twofor one in Seattle), and "$200.00 cash" flyers do not offer, encourage, or advocate for drugtreatment for drug problems. The Committee on Women, Population, and the Environment(CWPE) makes the point that "CRACK’s quick fix approach effectively gives up ontreatment as a solution to addiction." 13 On CRACK’s website, in their "objectives" section CRACK states that though they"cannot make anyone stop using drugs! That is the focus of drug rehabilitationfacilities that exist nationwide and that they do not have the resources to solve allproblems for addicts including housing, nutrition, education and rehabilitation."Well, you don’t say. Yet here in Seattle, a local needle exchange and the drugtreatment drop in center in downtown are being forced out of their location bythe newly elected Mayor Greg Nichols because the storefronts are prime real estatefor development. Considering the direction of the U.S. "war on drugs" is continuingto be played out what is happening to SOS in Seattle is an indication of a regrettabletrend in ending user harm reduction strategies are increasing city by city. 14 3) Positive Prevention/CRACK targets the bodies of women of color and poor women ignoring thehistory of sterilization, Norplant, and Depo-Provera used against Black, Indigenousand poor women Positive Prevention boasts that it does not matter what race thewoman is as long as the women are interested in the offer. Admittedly, however, whenasked about the location of CRACK ads being placed in predominantly black neigh-borhoods, Lyle Keller, a licensed social worker and founder of CRACK Chicago,responded that it was a matter of cost (implying that if CRACK Chicago had morefunding then they would have been able to spread their advertising over severalneighborhoods that were not just Black and Latino communities) and CRACK Chicagowanted to start "where people who need the offer can see it." 15 According to "TheDo’s and Don’ts of Pamphleteering" the offer of $200.00 appeals more to the poorthan it does to the rich." Therefore suggesting that it is more practical to post fliersin areas where poor people live and congregate.
Positive Prevention/CRACK’s disproportional targeting of Black women’s bodiesmust be seen in a historical context of hundreds of years of oppression by men withprivilege in the dominant class and culture of the United States. Rape, racism, s e x i s m a n d c a p i t a l i s m h a v e b e e n c o n s i s t e n t e l e m e n t s i n a l o n g h i s t o r y o fdocumented assaults against the reproductive sovereignty of Black women. TheAmerican Slave Trade to current day coercive birth control methods "the sheerscope of restrictions on Black women’s maternity both tangible (punitive public policies) and intangible (a lack of positive images of Black motherhood) has shapedthe meaning of reproductive freedom in this country."16 Additionally, "women withs u b s t a n c e a b u s e p r o b l e m s n e e d d r u g t r e a t m e n t , d e c e n t j o b s , e d u c a t i o n a lopportunities, and mental health and childcare services. It is the lack of respectfulcomprehensive healthcare along with the denial of human dignity, which exacerbatesconditions of poverty, racism, social status and gender discrimination. Theseconditions can lead to women seeking out substances to medicate pain. Oppressionneeds to be eliminated, not the reproductive capacity of women."17 4) Positive Prevention/CRACK asserts an able-bodied supremacist notion of "value" by allegingthat the babies born drug exposed are doomed to fail and the lives of their parentsare expendable.18 "Our objective is to offer effective preventive measures to reduce the tragedy of numerous drug affected pregnancies."--CRACK website Consider Positive Prevention /CRACK’s decision to refer to babies born to the drugusers as "damaged babies." This is not a casual choice of language. CRACK hasintentionally chosen this negative reference to establish that infants born to drugusers are worth less than those born to non-drug users. This idea of diminishedworth is based on the assumption that these babies will experience short and longterm health effects based on their parents drug use. But it is inaccurate to say thatall babies born to drug users will be in poor health. Some will be affected but evenso, health is a poor and subjective criterion for determining the value of a humanlife. Too often the standard for judging quality life is an able-bodied standard.
Positive Prevention /CRACK’s has determined that it is better not to be born than tobe born a "damaged baby" is the ultimate example of able-bodied supremacy.
"Damaged" babies do not have less inherent value than babies that are not "damaged." All babies have potential and we do not know what the potential lookslike from here. The assumption that drug-exposed babies will inevitably fail is amyth. Drug exposure at birth is not a guarantee of failure. It is the environment thatthe child is likely to be returned to that has the greatest impact on that child’s abilityto thrive. The environmental needs of drug-exposed babies must be supported. Theanswer does not lie in not creating babies but how do created babies get support.
Another motivation for discouraging the birth of "damaged babies" is the judgmentthat such babies are likely to be burdens on society. There are components to theargument that a person can be a burden to society: capitalism, utilitarianism, andthe importance of self-sufficiency. The value of people with disabilities is too often measured in capitalist terms-- infact, when officials are determining if a person meets the federal definition of disability, one of the ten criteria considered is whether the person is economicallyself sufficient.
Just as one’s ability to make an economic contribution is a criterion used by federalofficials to determine if a person has a disability, capitalistic considerations play animportant role in CRACK’s evaluation of whether these "damaged babies" will beburdens to society.
Remember, this is an organization that places a two hundred dollar monetary valueon reproduction, so there is clear evidence that the organization is invested incapitalism. CRACK, again acting on an assumption, figures that babies born to drugusers will automatically cost taxpayers more than they will ever contribute to the tax base.
Altering the bodies of the drug addicted doesn’t recognize the sovereignty they haveover their own bodies. It is able-bodied supremacy to think that we have a right tocontrol the "out of control disabled body." In our culture a chemical addicted body isa body out of control. Therefore, chemically addicted people are disabled by theirout of control body and minds. Positive Prevention/CRACK’s mission concludes thatit is their responsibility to control the bodies of "drug addicts." 5) Positive Prevention/CRACK uses coercion, intimidation and guilt as a means of gainingcooperation from people at their most vulnerable. Women who struggle with chemical addic-tion do not intentionally have babies because they just love giving birth to children they can-not support.
The culture of drug use and drug sales is such that sex is the most available means of acquiring money for drugs or the drug itself, particularly for women. Getting pregnant issometimes a consequence of intercourse, and women who use sex to support their drug habitare at hirer risk for pregnancy. When chemically addicted women become pregnant it is oftenthe pregnancy itself that actually motivates women to seek drug treatment.19 However, waitinglists to enter drug treatment programs are often so long that women become discouraged andstop trying. And, because there are very few long-term drug treatment centers that offerprenatal care for pregnant drug users, the cards stacked against these women to findresources grows even higher.
So chemically addicted women who become pregnant, looking for help get discouraged whenthere is little to no help available, and placed in a profoundly vulnerable position. When thesewomen see Positive Prevention/CRACK’s offer of $200.00 as a "cash incentive to encouragethem to choose birth control,"20 the message is: "since you (the woman) cannot control yourdrug habit, we will pay you money to stop getting pregnant." (Note: $200.00 is not a lot ofmoney, and is even less supporting a drug addiction). This in turn gets internalized as, "youcan not control yourself and creating more people like you cannot be allowed, and thereforewe do not care about what you do to yourself. Since we do not believe you have any value,neither do the children you create." Women who then internalizes the attitude "I do not deserve to be saved and so why should Ibe able to have children?" do so by being intimidated and publicly shamed by a society thatreject them. This society says they have no value and do not deserve the right to havechildren. This message creates enormous guilt for the substance abuser and is coercion.
The experience of guilt layered by the nihilism of desperation, convinces a number of womento accept the offer of $200.00.
6) Positive Prevention/CRACK practices sneaky and anonymous flyering tecniques at locationswhere Black, Indigenous and poor women are likely to gather. In their "Do’s and Don’ts ofPamphleteering," Project Prevention advises that their offer of $200.00 in order to be seen,be distributed in "areas where substance abusers are likely to spot them."21 They have con-sulted Seattle Police reports to determine the downtown areas that are mostcommon sites for drug related arrests, suggest that their volunteers "keep a low profile." Theytell volunteers to intentionally be discrete to "avoid conversations with angry types who mighttry to challenge you about the controversial aspects of this program" 22 by "developingtechniques that make your activities undetectable to people nearby." It is appalling that Positive Prevention/CRACK does not engage the community that they arealways t argeting with their message. Positive Prevention/CRACK volunteers are not havingone on one conversation with chemically addicted women, sex workers, women withdisabilities, and homeless women. CRACK does not collaborate with drug treatment andmental health care providers. However, Barbara Harris and her CRACK chapter in Seattle, post their "200.00 cash offer" on the doorways and in front of agencies, most of which arenon-profit agencies. Children Requiring a Caring Kommunity would suggest that the practicea real ethic of care is at the center of their organizing efforts. Yet, instead of engaging theorganizations in the community that are already providing services to this population, insteadof asking the community how they could best contribute to the health of women who arechemically addicted, instead of actually speaking to any woman who is a known addict in thearea, Positive Prevention/CRACK claims that their efforts intentionally teaches theirvolunteers to actually "case the joint" and "to bid [their] time.come back and leave the flierlater when no one is looking." This demonstrates a complete lack of care and overwhelmingcowardice. There is absolutely no compassion for the would-be mothers of these "damaged"children they claim they are trying to save and what is a care community withoutcompassion? 1CRACK website. First viewed February 2001. 2Hoagland, Sarah. Lesbian Ethics: Toward New Value. Palo Alto: Institute of Lesbian Studies. 1988. Hoagland defines "heterosexualism" as an entire way of life promoted and enforced by every formal and informal institution of the father’s society, from religion to pornography to unpaid housework to medicine. p. 7.
Heterosexualism is a particular economic, political, and emotional relationship between men and women: men must dominate women and women must subor - dinate themselves to men in any of a number of ways." p. 29 3Roberts, Dorothy. Killing the Black Body: Race, Reproduction and the Meaning of Liberty. Vintage. 1997 Roberts second chapter "The Dark Side of Birth Control" lays out the history of the Eugenics movement and its relationship to Margaret Sanger and the inception of the birth control movement.
4O’Neill, Anne-Marie and Kelly Carter (September 27, 1999). Desperate Measure. People Weekly, 145-149.
5Smith, Andrea (Winter 2000-2001). Better Dead Than Pregnant. Color Lines, 22-23.
6National Black Woman’s Health Project: Violence and Black Women: Homicide, Rape, and Domestic Violence website. <http://www.nationalblackwomenshealth -> . First viewed on April 2001.
8Kilpatrick, Dean. National Victim Assistance Academy, Chapter 9: Sexual Assault, 1999. <>. First 11Bell, Carl C. and Jacqueline Mattis. "The Importance of Cultural Competence in Ministering to African American Victims of Domestic Violence." Violence Against Women Wyatt et al. (May 2000) : 515-532.
12Axelrod, Julie, Jennifer Vargas Carmona, Dorothy Chin, Tamara Burns Loeb, Gail E. Wyatt. "Examining Patterns of Vulnerability to Domestic Violence Among African American Women." Violence Against Women Wyatt et al. (May 2000) : 495-512.
13Green, Linda, Karyn Pomerantz, Kathleen Stoll, April J. Taylor. "Opposition to the CRACK Campaign." American Public Health Association Late-Breaker 14Street Outreach Services is intentionally located at 2nd and Pike in downtown Seattle just a one black away from the historic Pike Market, which is a central tourists draw all year round. SOS chose to "conduct outreach activities in this neighborhood precisely because it was the single largest outdoor drug market in Seattle." Comments by Kris Nyrop, Executive Director for SOS. Interview from Seattle Times. January 24 - 30, 2002 15Project Prevention "The Do’s and Don’ts of Pamphleteering." Received from Ella Sonnenberg, Executive Director of Positive Prevention in Seattle. March 2001.
16Brennan, Moira. Interview "Dorothy Roberts: What we talk about when we talk about reproductive rights." Ms. Magazine. April/May 2001 17Hartmann, Betsy. "Cracking Open CRACK." October 22, 1999. First viewed on the web April 2000. <> 18Brouner, Joelle. All analysis of abled-body supremacy from Joelle Brouner, Project Action, CARA. "From One "Damaged Baby" To Another: Why People With Disabilities Should Oppose CRACK And The Effort To Positively Prevent You And Me." April 2001.
19Hartmann, Betsy. "Cracking Open CRACK." First viewed on the Internet April 2000.
20Project Prevention "$200.00 CASH" flyer removed from the side of a garbage dumpster in the Belltown neighborhood of downtown Seattle, Washington. April 21"The Do’s and Don’ts of Pamphleteering." 2001.
22"The Do’s and Don’ts of Pamphleteering." 2001


Assessment of progression of COPD: report of a workshopheld in Leuven, 11–12 March 2004M Decramer, R Gosselink, M Rutten-Van Mo¨lken, J Buffels, O Van Schayck, P-A Gevenois,R Pellegrino, E Derom, W De Backer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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