The criminalization of drug users and associated stigma are factors that create the most harm for people who use drugs (PUD). These harms are significantly compounded for women who use drugs, with implications that permeate health, socio-economic status, family, and entire communities.
Eighty-three million women use illicit drugs globally (1/3 of the total PUD estimate). Due to socially fabricated gender roles, women face judgmental and hostile attitudes and are often reluctant to disclose their drug use. Disclosure can lead to the loss of support from family and other networks and identification by community or police, compulsory treatment/forced labour, harassment and even death – and therefore there is natural hesitancy to access harm reduction services even if available.
Women who use drugs (WUD) are also often criminalized and otherwise stigmatized during pregnancy, despite associated poor maternal and foetal outcomes. The availability of women-sensitive harm reduction services is low and coverage is poor. Most residential treatment programmes and domestic violence shelters around the word do not admit women who use drugs.
WUD are subject to extremely high rates of violence in all forms. Drug treatment clinics are often inundated with male clients, making them uninviting for women. Male perpetrators include partner/spouse, family members and state actors. Due to criminalization, police and ‘treatment centre’ staff are known to subject women to physical, emotional and sexual violence in numerous jurisdictions. Due to criminalization of drug use, women who use drugs are also often less likely to report domestic violence.
Likewise, the sexual and reproductive health rights of women who use drugs are frequently violated. Women are denied accurate information about the effects of drugs on pregnancy, denied birth control choices and variously coerced to use birth control, have abortions, adopt or be sterilized.
Loss of child custody may be one of the most insidious techniques used to punish women who use drugs. Children are often removed from mothers who are good parents, simply because they use drugs.
WHRIN advocates for measures to redress these intolerable violations, as well as service and policy gaps. We propose that while we wait for decriminalization (and de-stigmatization) of drug use, along with significant advances in gender equality, governments and service providers should:
- Meaningfully involve WUD at all levels in developing policy and services impacting on women who use drugs.
- Explore options to reform drug policy so as to better protect the human rights of WUD.
- Enforce the protection of women’s confidentiality, including the review and reform or removal of any existing compulsory drug registration systems;
- Introduce and strengthen systems to enforce accountability among state actors, including safe, supported and effective reporting and prosecution mechanisms.
- Remove any legislation or policy that makes drug use an adequate justification for the removal of children from their parents’ custody, for exclusion from domestic violence shelters and all other available social and health services;
- Develop specific guidelines and targets to address the sexual and reproductive needs of WUD;
- Undertake research to improve understanding of the needs of women who use drugs and support evidence-informed service provision, as well as research into HIV, including co-infection with hepatitis C, women’s sexual and reproductive health, and drug interactions;
- Support the provision of harm reduction services in women’s prisons and other closed settings.