At the 42nd Session of the Human Rights Council in Geneva in September 2019, Dianova International discussed how gender differences in addictions impact women
By Federica Bertacchini – “Women make up one third of people who use drugs globally and account for one fifth of the global estimated number of the people who inject drugs”. This is how Jennifer Hasselgård-Rowe, from the Geneva Platform on Human Rights, Health and Psychoactive Substances, started her presentation about the “Human Rights violations of women who use drugs”. Despite the striking percentage of female drug users, though, only one fifth of all people enrolled in addiction treatment are actually women.
In a side-event to the Human Rights Council 42nd Session, co-hosted by the Women’s UN Report Network (WUNRN) and moderated by its Managing Director, Ms. Lois A. Herman, a panel of specialists from the United Nations, civil society and academia got together on 18 September 2019 to dig in the topic of Women and Addiction. The side event took place in Geneva’s Palais des Nations, where four women engaged in research, policy-making, project implementation and advocacy, convened to discuss an issue that is still greatly overlooked and underfunded despite its being no longer new: the multifaceted relations between women and addictions.
Ms. Lois A. Herman of WUNRN introduced a written statement from Dr Kamran Niaz – a Senior epidemiologist working for the United Nations Office for Drugs and Crime (UNODC) – that highlighted the main gender differences in drug use patterns and mental disorders, providing the basis for the conversation. Men seem to favour cannabis, cocaine or opiates, while the non-medical use of opioids and tranquilizers is more or less on the same level for both sexes. Very often victims of neglect and physical and sexual abuse from childhood, women who use drugs have a higher rate of post-traumatic stress disorder, compared to men. The same goes for depression and general anxiety.
With the provisions stated by the 1979’s Convention on the Elimination of all forms of Discriminations Against Women (CEDAW) (in particular article 12) proclaiming that all women must enjoy equivalent access to health care services as men, one would expect, as mentioned by Jennifer Hasselgård-Rowe, women and men to have equal access to treatment facilities and medication. However, as stated by Dr Kamran, women still encounter significant systemic, structural, socio-cultural and personal barriers in accessing substance abuse treatment.
If such barriers are affecting – and at the same time are generated by – the basic determinants of health, it clearly looks like we are dealing with a human rights issue. Or worse, with a violation of women’s rights to health.
All of us cited, during our respective presentations, that women generally don’t dare speaking up about substance use or seek help or treatment, because they are afraid of retaliation, stigmatization and, most often, losing their children’s custody. Generally, treatment centres and programmes are not geared towards the specific needs of women and their lives. Numerous gender imbalances and barrier to access health care also affect women in prisons, especially those (35% on the total of incarcerated women, compared to 19% of the total men) who are serving a sentence for drug-related offences. Even concerning rehabilitation and reintegration services, fewer women receive the support they need as compared to men and, once released, they have to face additional stigma and discrimination.
The picture becomes even darker when considering the data presented by Dr Lori Ann Post, the Director of the Institute for Public Health and Medicine (IPHAM) at the Buehler Center for Health Policy and Economics, on the situation of opioid use disorder in the United States. A new study recently found that drug overdose death rates are 3.5 times higher on average, when compared to 17 other high-income countries. She mention that “so many Americans have died from opioid overdoses deaths, that life expectancy has reversed for the first time since the First World War and the Spanish Flu epidemic a hundred years ago”. Because women are more exposed to depression, anxiety and abuse compared to men, they are also more likely to be prescribed and use opioid analgesics and have therefore more risks of dying of opioid-related overdoses.
If drug consumption and inclination to depression is gender-specific, prevention and treatment must be re-thought in a gender perspective, as well.
It is imperative that women be treated for depression and anxiety, as well as protected from violent relationships. Based on Dr Post’s researches, it is likely that violence has two identified paths in addiction. First, women with addictions are more likely to enter violent relationships, and, second, women in violent relationships are more likely to self-sedate as a matter of coping. It is therefore absolutely critical that “practitioners and researchers alike understand that there are independent sex (biological) and gender (social) pathways to addiction and recovery”. As highlighted also by the Sustainable Development Goal n. 5 on achieving gender equality and empowering all women and girls, health data – and in this case health information related to drugs use and mental health – must be reported by sex and gender so that gender-specific treatment and prevention strategies are available to all users in an equal manner.
At the same time, it is essential that health policies are interpreted following a human rights approach, as recommended by the latest report of the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, released in April this year. By pushing States to apply right-based approaches to health policies, the Rapporteur intends to strengthen “the case for action on the determinants of health to promote the well-being of everyone”. This includes not only focusing on eliminating inequalities and ensuring equal opportunities and outcomes also for the most marginalized groups and for society as a whole, but also eliminating what he defines as the “key risk factors” that put certain groups in a vulnerable position. Among such risk factors, he mentions the criminalization of certain behaviors such as drug use and the discrimination against certain populations, such as young people and women.
As highlighted by Hasselgård-Rowe’s presentation as well, putting an end to the criminalization of people using drugs and ensuring their inclusion in all stages of policy-making processes is a critical step towards the end of stigma, especially for women who use. Too many barriers are still keeping women away from accessing adequate prevention, treatment and recovery services. Not enough places are available to them in treatment facilities; activities and therapy-session are not designed to cater for their needs, and often staff members are not only untrained in, but unaware of gender specificities and might, without realizing it, perpetuate stereotypes, abuse and inequality.
In the addiction field, only can the gender gap be closed and real human empowerment attained through rethinking criminalization and prevention policies and through the implementation of addiction treatment programmes and services that consider individuals within the holistic understanding of their social relations and interconnection in society – that is, by applying human-right lenses to look at how health is managed. Needless to say, such shift requires the collaboration and participation of all stakeholders in the sector, including marginalized groups and an equal representation of male and female drug users. A the same time, such a shift would be a great step towards the attainment of an “available, accessible, acceptable and good quality” right to health, as defined by WHO’s constitution in 1946.
Human Rights Council Session 42 – Panel discussion: Women & Addictions
18th September, 2019 – 13:30 – 14:30, Room VIII
UN Palais Des Nations, Geneva, Switzerland
- Kamran Niaz – Epidemiologist, United Nations Office on Drugs and Crime – Statement
- Federica Bertacchini – International Projects Coordinator, Dianova International Ms.
- Jennifer Hasselgård-Rowe – Executive Coordinator, Geneva Platform on Human Rights, Health & Psychoactive Substances
- Lori A. Post – Researcher on Addictions, Northwestern University Medical School
- Moderator: Lois A. Herman – Managing Director WUNRN, Women’s UN Report Network
Factsheet on the latest report of the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health: