Ruth Birgin coordinates the Women and Harm Reduction International Network according to which drug policy presents the single greatest threat to the health and well-being of women who use drugs.
Can you introduce yourself and explain the work of the Women and Harm Reduction International Network (WHRIN)?
Ruth: Certainly. My name is Ruth Birgin and I work as WHRIN Coordinator. Women who use drugs along with members of the international harm reduction community recognized the need to establish a mechanism to focus on gender responsive harm reduction services, leading to the development of the Women and Harm Reduction International Network (WHRIN), formed in 2009 and led by women who use drugs. The goal of WHRIN is to improve the availability, quality, relevance and accessibility of health, social and legal services for women who use drugs.
Women who use drugs face specific problems as compared to men… Can you explain what they are?
R: Without a doubt the challenges faced by women who use drugs are overwhelmingly linked with and exacerbated by prohibition rather than the substances themselves. When combined with the social and structural impacts of gender inequality it is little wonder that, for example, rates of HIV prevalence are higher among women who use drugs than their male counterparts. (I list more women-specific challenges in other questions)
Could you explain why and in what ways women who use drugs are stigmatized, and what messages would you like to convey in this regard?
R: Women who use drugs face compounded stigma where gender inequality and punitive drug policy converge to mete out unique punishments and risks. Women who use drugs are doubly demonised for challenging gender stereotypes of women as conventional, demure mothers/daughters/sisters etc., simply by using drugs, with criminalization and media sensationalism and misinformation further exacerbating gendered stigma and discrimination.
This places women who use drugs in a unique situation, restricting access to health services while elevating the risk of violence and BBV transmission. Our key messages include that drug use does not equate with bad parenting, it is part of the human condition and that the world is in dire need of humane drug policy where women who use drugs are no longer criminalised, pathologized or infantilised – but instead enjoy the same human rights as other people.
Can you describe the principal barriers women who use drugs face in accessing harm reduction services, and what would be the solutions to overcome those barriers?
R: The first barrier is inadequate availability of harm reduction services; worldwide these essential services are not available to scale despite UN endorsement and overwhelming evidence proving lifesaving necessity and cost effectiveness.
Second, where harm reduction services are available, they are invariably designed with male clients in mind or demonstrate gender blindness by not assessing or catering to the needs of women. The obvious solutions are scaling up of harm reduction services and then ensuring involvement of women who use drugs in design and delivery of services. More detail on ways forward can be found here and here.
What are the specific consequences of drug prohibition for women?
R: This is difficult to answer comprehensively in an interview as there are so many gendered impacts of prohibition, so I will just provide some examples rather than attempting an exhaustive reply.
‘Foetal abuse’ laws are a particularly egregious example – where women are punished for drug use in pregnancy whether or not a causal link with poor foetal outcomes can be established. Similarly sensationalism around so called “neonatal abstinence syndrome” stigmatises women who use illicit drugs, albeit that this is often a temporary and easy to treat condition, where legal substances (tobacco and alcohol) are known to be the chief contributors to pregnancy complications.
There is no mother who does not wish the best for their child. The unfortunate outcome of such punitive approaches is predominately counter to any intentions of support for mother and child as they primarily serve to amplify stigma and function as a barrier to timely medical supports.
Although we know that drug use does not bring about poor parenting, prohibition has fostered incredibly harmful policies and perceptions where drug use alone can mean coerced contraception and sterilisation (see for example, Project Prevention), loss of child custody in many countries – separating children from capable mothers and creating lasting trauma in those families.
Counter to the international standards on incarceration of women (the Bangkok Rules) recommending alternatives to non-violent crime, women are being sentenced and imprisoned for low level drug related offences at inordinate rates due to the over-zealous punitive approach to prohibition taken by too many governments around the world.
Prohibition dramatically increases the risk of gender based violence, including at the hands of law enforcement and often with no or severely limited options for recourse – where reporting and justice are undermined by criminalization of drug use, allowing perpetrators to act with impunity.
Does WHRIN advocate the decriminalization of drug use?
R: Criminalisation is demonstrably both the main cause of harm and the greatest barrier to health for women who use drugs. Decriminalisation is a primary feature in WHRIN’s work with anti-prohibition as an essential and core value.
On the same grounds, WHRIN also support abolition of the prison industrial complex.
Can you explain the concept of intersectional feminism, why does it matter, and how is it related to drug-related issues?
R: Intersectionality can give us a clearer understanding of the different aspects of a person’s identity that can expose them to overlapping forms of discrimination and marginalisation. Awareness of feminist intersectionality is very useful for identifying and addressing inequities experienced by women who use drugs. WHRIN work in this space can help to better identify specific needs and help ensure compassionate and effective policies and health options.
As a network, WHRIN is particularly concerned to tackle the intersections between patriarchy and prohibition – two forms of systemic oppression. To do this optimally we take into account additional axes of exclusion that impact on the experience of women who use drugs. The spectrum of women’s experience varies enormously according to factors such as drug use status, colour, sex, ethnicity, vocation, mental health, gender identity, religion, age, wealth, nationality, criminal record and HIV status. Without accounting for the intersections between such factors, barriers to health and justice services will remain and discrimination and exclusion will continue.
Women who use drugs are the experts on our own lives. WHRIN work with our members and others to promote the understanding that if you are involved in policy or programming that impacts women or drug users, it is critical to speak with and meaningfully involve women who use drugs, in all their diversity without stigma and judgment. Without this, there will be sub-optimal results, with partial or profound exclusion, reduced effect and wasted resources.
What should be the government’s priority to advance the rights of women who use drugs?
R: Some of the asks we have been repeating across our advocacy work include these (most recently listed in our ‘support don’t punish with a focus on women’ press release and campaign report):
- Immediate abolition of capital punishment, extrajudicial killings, compulsory treatment, drug user registration systems and punishment for use of drugs in pregnancy.
- Decriminalisation of drug use and sex work
- Allocation of resources and long term funding to harm reduction services and networks that are led by and meaningfully involve women who use drugs and are based around care, compassion and individual autonomy
- Creation of gender responsive comprehensive harm reduction services and policy environments that are non-judgemental, non-discriminatory, safe, relevant and supportive for all women who use drugs
- An end to the distortion of facts that surround drug use and pregnancy and coercive campaigns of abortion and sterilisation
- Upholding the right to autonomy over the bodies of women who use drugs including choices around safer drug use
- Implementation of mechanisms for prevention of violence and support for women who use drugs who are subject to violence
- An end to using drug use as reason for the invasion or disruption of women’s privacy, family or domestic life
- Inclusion of women who use drugs as a key part of research, planning, design, implementation, monitoring and evaluation of any policy or action that affects them.