Babies of women who use cocaine during pregnancy are 2 to 6 times more likely to be low weight at birth, 40 times more likely to die in their first month, and those who do survive are at increased risk of life long disabilities including mental retardation, cerebral palsy, and visual and hearing impairments.

To reduce the incidence of such pregnancies, a private California-based organization called Children Requiring A Caring Kommunity (C.R.A.C.K.) has taken a controversial approach. C.R.A.C.K. gives money to women addicted to cocaine, alcohol and other drugs who undergo tubal ligations or get semi-permanent birth control.

• Since 1997, C.R.A.C.K. has paid out more than $60,000, or $200 each, to 302 women.

• Clients are required to provide proof of a current or previous drug addiction, and before they receive the payment, a physician, nurse or other health care provider certifies that the service was rendered.

• Participants have a choice of method -- 148 had tubal ligations and the rest opted for birth control implants.

• The offer is open to men who have vasectomies, but so far only two have participated.

While no studies have been done on the program's long-term effects, prior to the procedures the clients had an average of 6 pregnancies and 2 abortions.

The program is voluntary and thus ethical, says C.R.A.C.K. However, critics say the program is unethical because the clients are suffering from an illness (addiction), and thus may not be able to give informed consent. Moreover, the monetary incentive lures addicts who may not be able to rationally weigh the decision.

C.R.A.C.K. has now expanded into 17 communities across the nation.

Source: Vida Foubister, "Crackdown on Drug-Addicted Pregnancies Draws Concern," Professional Issues, American Medical News, November 20, 2000.