Promoting a Gender Responsive Approach to Drugs

The achievement of SDG 5 on gender equality will necessitate that drug policies and programmes adopt a strong gender component to ensure that women are not left behind in efforts to control the illicit drug market.

The Civil Society Forum on Drugs (CSF) is a broad platform for a structured dialogue between the Commission and the European civil society which supports policy formulation and implementation through practical advice. Dianova has been a member of the Forum since 2016 and, as such, our representative participated in the reflections that led to this paper

(Excerpts from the document – read complete version)

The Ministerial Segment of the 62nd session of the Commission on Narcotic Drugs (CND) will be held only few days after the largest global event on gender equality, International Women’s Day (IWD) on 8th March. The Civil Society Forum on Drugs (CSFD) takes this opportunity to emphasize the need for global drug policies to pay special attention to women and the promotion and defence of their rights. (…)

Using the UNGASS Outcome Document structure, the CSFD wishes to offer specific recommendations which we hope can be of use in informing the positions of the European Union at the Ministerial Segment and at the 62nd session of the Commission on Narcotic Drugs.

1. Demand reduction and related measures

Women who use drugs encounter significant systemic, structural, social, cultural and personal barriers in accessing risk and harm reduction, drug dependence treatment, rehabilitation and recovery services, as well as other services such as for childcare, sexual and reproductive health and mental health. (…)

The CSFD therefore recommends, for the post-2019 global drug strategy, that member states:

• Promote improved access to a comprehensive range of health interventions tailored to women who use drugs, including access to evidence-based prevention, drug dependence treatment, recovery and rehabilitation services, risk and harm reduction services, and treatment for drug-related health harms (such as HIV, hepatitis, overdoses, etc.) and co-morbidities. Services should also seek to tackle the other health problems that women who use drugs may be facing, including mental health issues, unwanted pregnancies, risks and harms associated with drug use during pregnancy, as well as health and social concerns for the new-born and mother.
• Promote improved access to a range of social services to tackle the socio-economic vulnerabilities often faced by women who use drugs, including housing, transportation, education, childcare support and income support, as evidence shows that these can contribute to better engagement and retention in treatment and improved treatment outcomes.
• Improve training on gender sensitivity for staff working in drug services, to improve their knowledge of how to address the different issues faced by women who use drugs, including gender-based violence and mental health issues, in cooperation with other services specialised in prevention of violence and those focusing on childcare.
• Combat discrimination and the double stigma associated with drug use among women (both for consuming and for being a woman) to facilitate their access to drug services, including risk and harm reduction, treatment, rehabilitation and recovery services, in line with CND Resolution 61/11.14
• Ensure better involvement of affected populations, including women who use drugs, in the design and implementation of drug policies and programmes – as promoted in the UNGASS Outcome Document. (…)

2. Improving access to controlled medicines

Ensuring the availability of internationally controlled substances for medical and scientific purposes is one of the core objectives of the UN drug conventions, and is recognised in the UNGASS Outcome Document. And yet, the availability and accessibility of opioids for pain relief and other symptoms remains direly low. It is estimated that 5 billion people live in countries with low or no access to controlled medication, 80% of the world’s population are denied opioids and only 0.03% of the total morphine production is available in low income countries.

Women are particularly affected by this issue, as pain management is often unavailable for the 110 million births every year worldwide – and for the 300,000 women die each year because of complications related to pregnancy and childbirth. (…)

Bearing these issues in mind, the CSFD recommends that UN member states:

• Commit to ensuring adequate and affordable access to controlled drugs for medical purposes, such as for pain relief, palliative care and the treatment of illness, with a specific focus on women.
• Increase education of healthcare professionals in the correct use of opioids to ensure that patients with pain – including women and children – are managed effectively, safely and in a timely way.
• Support countries in implementing national drug control regulations based on the WHO’s 2011 recommendations to ensure that accessibility and availability of controlled medicines for medical and scientific purposes – especially opioid analgesics – are not unduly restricted.
• Promote a revision of national health strategies for multiple sclerosis, cancer, HIV/AIDS and other conditions, to ensure that these strategies adequately address the need for effective pain management and palliative care.

3. Drugs, and human rights, youth, children, women and communities

Women suffer specific human rights violations, because of drug policies that are not aligned with the UN drug control and human rights conventions, the 2009 Political Declaration, and even less with the more recent 2016 UNGASS Outcome Document. (…)

Bearing these issues in mind, we call on UN member states to:

Develop and implement drug policies in a non-discriminatory way in line with international law, to respond to the needs of women and girls, as well as other vulnerable groups such as ethnic minorities, LGBTQ+ communities, indigenous groups, children and youth.
• Reaffirm sexual and reproductive health and reproductive rights as human rights, integral to achieving transformative sustainable development across social, economic, and societal dimensions – in line with SDG 5 on gender equality.
• Strengthen systematic and coordinated data collection, as well as analysis and use of data disaggregated by sex, age, sexual orientation and gender identity, disability, place of residence, ethnicity, income and other factors to effectively monitor and evaluate on human rights progress in drug policies against human rights standards.
• Promote research on issues related to women, drug use and development, in order to gain a comprehensive overview of these issues and design policies to adequately address them. (…)

4. Supply reduction and related measures

Evidence shows that most women involved in illicit drug supply activities are driven by poverty and economic necessity. And yet, women constitute the fastest growing prison population, as a result of inadequate drug control measures targeting low-level drug offences (which most women are involved in), an approach that is not in line with UNGASS recommendations. (…)

Bearing these issues in mind, urge member states to consider the following recommendations:

• Ensure more proportionate penalties for drug offences, taking into account the specific vulnerabilities faced by women (e.g. being the sole provider of children or other dependents, history of physical or psychological abuse, drug dependence, etc.), and increase the use of gender-sensitive alternatives to incarceration, using prison only as a last resort. Alternative solutions should include education and training opportunities likely to contribute to reducing the number of women involved in drug supply due to their lack of job opportunities, education or other forms of vulnerability.
• Protect women victims of human trafficking who are forced to smuggle drugs.
• Consider the use of restorative justice approaches for drug-related offences and drug-related contexts of community conflict.
• Adopt new indicators of success, focusing on outcomes such as reduced criminal activity, improved access to evidence-based and effective prevention, risk and harm reduction, treatment and recovery services, reductions in drug market-related violence and corruption, improved access to essential medicines, etc.

5. Evolving reality, trends and existing circumstances, emerging and persistent challenges and threats, including new psychoactive substances

According to the UNODC World Drug Report 2018, the use of new psychoactive substances (NPS) is increasing. Especially when these substances are injected, they can pose major risks to the health of people who use drugs. As women who use drugs are particularly vulnerable to these health risks and harms, the CSFD recommends that drug policies:

• Ensure a person-centred approach for service design and delivery to ensure that the needs of the women (for example, homelessness, mental health, use of NPS) are being adequately addressed.

6. Development

In areas where crops destined for the illicit drug market are cultivated, entire families and communities are generally engaged in subsistence farming. However, because of engrained gender inequalities, women are generally those left worst off, with little to no access to a salary, land tenure, education, healthcare services or alternative employment opportunities. (…)

Bearing these issues in mind, we encourage drug policies to:

• Frame alternative development programmes within a broader sustainable development approach focusing the achievement of the SDGs and with a specific focus on women, including a reduction of poverty and social inclusion, improved access to legal markets, a protection of the environment, as well as the development of basic infrastructure, education, social protection, access to housing and employment opportunities.
• End aerial spraying, which has proven ineffective and harmful to people’s health and the environment.
• Ensure that sustainable development programmes do not only focus on rural areas in producing countries, but also on urban areas in producer, trafficker and consumer countries, where tackling the involvement in the drug trade requires a thorough development programme focused on poverty alleviation and strengthening community resilience and solidarity, in particular for women in situation of vulnerability.
• Remind member states of their obligation to achieve the SDGs, and ensure a stronger involvement of the United Nations Development Programme and of UN Women in global drug policy.
• Ensure the meaningful participation of affected communities, including affected women, in the design and implementation of programmes and policies that affect them.
• Establish new and long-term indicators for alternative development programmes based on the Human Development Index.

7. Strengthening international cooperation

Strong cooperation between countries and UN agencies is essential to implement gender sensitive drug policies. In particular we call for the systematic and meaningful participation of all relevant UN agencies in global drug policy debates, in particular UN Women, UNICEF, WHO, UNAIDS, OHCHR, UNDP and others.