As Trevi chief executive Hannah Shead told the 2023 DDN conference, women may make up more than 50 per cent of the UK population, but their treatment needs still often aren’t being thought about in a ‘specialised, specific way’ (DDN, September 2023, page 7). While things have started to improve – she told DDN last year that she’d seen more willingness to understand women’s needs as different (May 2024, page 10) – there’s clearly still some considerable distance to go.
It’s a situation that’s obviously not limited to the UK. Gender might well be mentioned as a priority for a great many drug strategies and policies, but the reality was that there ‘were not enough programmes that are genuinely gender-based and tailored to gender needs’, EUDA executive director Alexis Goosdeel told the recent Health and social responses for women who use drugs — perspectives from Latin America, the Caribbean and Europe webinar.
Drug use and its consequences were often treated as if they were ‘gender neutral’, said principal scientist at EUDA, Linda Montanari – despite there being a range of differences in risk factors, behaviour and more. These included mental health issues, pregnancy, childcare and even imprisonment. ‘A big issue among women who use drugs is gender-based violence,’ she said – whether current, or issues like previous sexual abuse with its associated trauma. Although there were efforts to overcome barriers to accessing treatment, many countries still had no gender-specific interventions at all, while in others they were often exclusively focused on pregnancy and maternity. ‘Of course a very important aspect, but there are many other issues that need to be tackled,’ she stated.
COMPREHENSIVE APPROACH
These barriers to accessing treatment obviously included stigma – something that was ‘multiplied’ for women – along with women’s comparative lack of economic resources, and the very real fear of having their children taken away. But it was vital to look at the intersections between all of them, she stressed. ‘Women have specific needs because they use drugs but also because they’re parenting or pregnant, because they’re involved in sex work, they’re from an ethnic minority or they’re in prison. It’s really necessary to have a comprehensive and holistic approach.’
When it came to lack of economic resources, Latin America and the Caribbean was the most unequal region in the world, said Corina Giacomello, a professor at Mexico’s Universidad Autónoma de Chiapas – with more than 170m people not having enough income to meet their basic needs. Poverty affected more women than men of working age, with the region facing ‘persistent’ gender inequality. There were also inequalities of access to health services between and within countries, as well as between urban and rural areas, and for indigenous populations.
While the number of women using substances In Latin America was lower overall than for men, the gap closed among younger generations and in the case of controlled medicines was reversed, she pointed out. Despite ‘increasing evidence on the vulnerable situations of women who use substances’ drug policies still tended to maintain a male-centred approach. Not only was there low availability of exclusive services for women, but services for women who’d experienced gender-based violence generally often didn’t accept women who used drugs – ‘reproducing the forms of violence and symbolic and institutional discrimination that puts the lives of women and their children at risk’.
STARK DISPARITIES
And nowhere is this gender disparity more stark than in criminal justice. Drug offences were one of the leading causes of incarceration for women in the region, particularly women from poor households. Children of parents deprived of liberty for drugs offences were also an ‘invisible population’ in both the drugs and children’s rights agendas, she added.
In Uruguay, in a prison population of almost 16,000 people, 14,700 were men and 3,300 women, said Mariana Silva of Uruguay’s National Drug Secretariat. However, when it came to drugs offences, 58 per cent of those jailed were women. In Europe, meanwhile, women accounted for 5 per cent of the prison population, said Montanari. ‘They don’t commit other crimes as much as men, and they tend not to commit violent crimes. But the link with drugs is very important. The proportion of women in Europe for drug law offences is maybe not as high as in Latin America, but when we look at those who have problems with drugs and are in prison for acquisitive crimes the percentage becomes huge.’
But it’s not just the proportion of women jailed for drugs offences, it’s how they’re treated while they’re imprisoned – and anyone thinking these kind of disparities don’t apply to the UK would be wrong. According to an HM Inspectorate of Prisons report published in February, the lack of care to meet women’s basic needs is causing such distress that ‘they resort to harming themselves’.
Uruguay is now attempting to address some of these issues in its own criminal justice system, and last year launched its ‘national plan on problematic drug use for persons deprived of liberty’ – one of the strategic objectives of which was to ‘incorporate a gender and diversity perspective’ and recognise that ‘women and other vulnerable groups may have different needs that must be specifically addressed.’
SOCIAL PENALTIES
More widely, barriers to accessing drug treatment for women in Uruguay included ‘unsafe places’ and a lack of spaces for children, said Silva. This was despite much higher consumption among women of tranquilisers and other medically prescribed drugs. Women tended to seek help for others and not themselves, she added, the result of ‘greater social penalties for the same behaviour’. Complex problems needed complex responses, she said, including raising public awareness of the rights of drug users, and training medical staff to avoid moralising and prejudiced approaches. Drug policies needed to have a ‘comprehensive and balanced approach’ with a ‘cross-cutting human rights and gender perspective’, she stressed. Incorporating gender into its drug policies would allow Uruguay to make inequalities ‘visible’, she said, and build targeted responses that ensured gaps were narrowed as well as avoid stigmatisation and discrimination.
Europe had much to learn from Latin America and the Caribbean, said Goosdeel – unfortunately including around the increase in drug-related violence, something they’d ‘faced for many more years than us’. This also meant a growing risk that ‘all drug policy in Europe could shift towards only repression and the war on drugs and war on people using drugs’, he said, something that would ‘again be at the expense of vulnerable groups.’ In many cases the response of the state could increase vulnerability instead of reducing it, he warned.
It was important to guard against these shifts, he said, and this year would see an evaluation of the current European strategy on drugs. EUDA was looking for ‘concrete proposals’, he said. ‘If we do as the European Parliament suggests and just present statistics when we can with detail on sex and gender then I’m afraid it’s partly useless. We can’t consider that the job is done just by splitting the data. It’s not enough.’
What was needed was information that could allow ‘punchy recommendations’ to be made to member states, he said. Drugs were changing, which was bringing new problems, while ‘the stigma on women – especially women who are pregnant or who have children – is so huge that they do not feel they’ll be helped. Some are afraid that social services will take their children, so what are the concrete things that we can do together? After 30 years of discussion, we know what the priorities are. So how can we concretely provide help?’