For the first time in almost 50 years, the International Narcotics Control Board, an independent body of the United Nations drug-control system, has included a thematic chapter on women and drugs in its 2016 annual report. This substantive inclusion of a gender perspective in discussing international drug policies is a step forward. Yet it is miles from protecting the rights, health and well-being of women and girls involved in drug use and commerce.
The report by the INCB, as it is known, highlights some of the adversities that women who use drugs face, such as intense stigmatization, violence, coercion into sex work, lack of gender-responsive drug treatment and punitive criminal justice interventions. Patterns of drug use among women were also noted as being strongly influenced by drug-using partners, a history of abuse and mental health problems.
The report fails, however, to fully address the need for reforms on such fronts as gender-sensitive harm reduction or the shaming of pregnant women drug users or mothers. Women have historically been isolated, marginalized and silenced in policy decisions. President Trump’s re-enactment of the global gag rule, which bars US foreign aid to women’s health services, including reproductive health and HIV prevention, as well as his outspoken condemnation of Planned Parenthood are just two of the most recent examples of the rights and needs of women being ignored.
Higher rates of HIV among women, as compared with men who use drugs, are largely attributed to factors like unsafe injecting practices and sex work. Likewise, in many countries, opioid-related overdose disproportionately affects women at an alarming rate — more than double the rate among men in Britain, for example. Despite these high rates of drug-related harms, there is a troubling lack of research on women and women-centered interventions, particularly in less-developed countries.
The report devotes much of its focus to the worldwide surge in the number of women in prison, a remarkable 50 percent increase since 2002. This dramatic rise is likely attributed to the single intervention in the US-led “war on drugs”: incarceration. In prisons, the basic needs of women are often overlooked, leading to detrimental emotional and physical effects on themselves and on their children and families.
In Latin America, it is common for prisons to have children accompany their mothers while serving their sentences, since many families cannot rely on other caregivers. The report emphasizes that overcrowding and long sentences worsen the problem. Similarly, access to drug-treatment facilities in prisons is severely limited for women in many countries.
The INCB makes several recommendations, including that governments increase the collection of gender-disaggregated data on drug use, prevention and treatment methods. Rather than just having treatment available, providing accessible treatment for women by offering gender-sensitive services was deemed a high priority. Services may include trauma-informed care, women-only treatment centers, prenatal care and access to child care.
In addition, the recommendations emphasize the need for all governments to comply with the UN Rules for the Treatment of Women Prisoners and Non-Custodial Measures for Women Offenders, or the Bangkok rules.
Unfortunately, the report also falters in regard to some critical reforms. A major challenge for women who use drugs is stigma. The implications of intense stigmatization are far reaching and, laudably, were mentioned throughout the report. Solutions, however, were notably absent.
It is possible that the shame and stigmatization of pregnant women and mothers who use drugs that is accepted and even institutionalized in many countries has influenced the report itself. The section on pregnant women offers an incomplete survey of the physiological effects of drug use on the fetus and baby. It fails to offer any contrasting evidence that shows that some of the most important contributors to poor birth outcomes and other mother and fetus adversities stem from harsh stigma, draconian drug laws and limited health services.
The “pregnant women” section also fails to highlight the many risks to the health and well-being of pregnant women who use drugs and ignores studies that could determine the best tools for gender-sensitive services. In many countries, pregnant women who speak to a doctor about their drug use contend with possible arrest, loss of custody of their children and other punitive interventions. These laws and policies deter pregnant women from informing their physician of their drug use.
Equally alarmingly, the report’s recommendations do not mention harm reduction, the most important approach for decreasing drug-related consequences. In light of the overdose crisis that is disproportionately affecting women in many countries, the INCB should recommend evidenced-based harm reduction interventions, such as access to supervised injecting facilities and increased availability of the opioid overdose reversal medication, naloxone.
Furthermore, a meaningful response to the growing number of women in prison must go further than simply suggesting alternatives to incarceration. Any form of criminalization will only undermine access to drug treatment and services for women. As recommended by several leading experts in the global drug-policy field, decriminalization of drug possession for personal use is the most effective approach. The benefits include reductions in criminal-justice costs, racial disparities and exposure to infectious diseases.
While it is significant that the INCB is highlighting women in its annual report, recommendations should include a wide range of evidence-based policies and practices. Likewise, programs and policies designed without the input of women who use drugs will perpetuate their social and political exclusion and continue to inadequately address the myriad challenges affecting their lives.
The International Narcotics Control Board must incorporate feedback from women who are actively using drugs during country visits, rather than solely focusing on prevention and treatment.
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Kasia Malinowska is the founding director of the Global Drug Policy Program at the Open Society Foundations, which promotes drug policies rooted in human rights, social justice and public health. Malinowska previously led the foundation’s International Harm Reduction Development program, which supports the health and human rights of people who use drugs. Before joining the Open Society Foundations, Malinowska worked for the United Nations Development Program in New York and in Warsaw on drug and HIV policy reform in Central and Eastern Europe and the former Soviet Union. Her academic publications include works in The Lancet, the British Medical Journal and the International Journal on Drug Policy. Malinowska co-wrote Poland’s first national AIDS program; and helped form policy at the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Health Organization; and the Millennium Project Task Force on HIV/AIDS, TB, and Malaria. She has a master’s degree in social work from the University of Pennsylvania and a Ph.D. from Columbia University.
Bethany Medley is an advocate for the health and human rights of women who use drugs. She is a graduate student at the Columbia University School of Social Work and an intern for the Global Drug Policy Program at the Open Society Foundations.