The European Monitoring Centre for Drugs and Drug Addiction highlights ‘the most important aspects to consider when planning or delivering health and social responses for women who use drugs’.

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has published a collection of mini guides, which examine health and social responses to a range of drug problems in Europe. One of these focuses on women, who “present unique concerns that are sex- and gender-related, although many drug services remain male-oriented”. Below is a summary of the key points – from parity of treatment provision, to the need for trauma-informed services.

Access to treatment

Some research suggests that women may be more likely to access treatment (e.g. because of needs arising from pregnancy or parenting, or a greater willingness to seek care), while other research has found that women are less likely to access treatment (e.g. because of the double stigma of being a woman with a substance use problem). Treatment figures point to the latter. According to the ECMDDA, women make up approximately a quarter of all people with serious drug problems and around one-fifth of all people in drug treatment programmes in Europe.

Specific problems affecting women

Women experience drug use, treatment, and recovery in a different social context than men. For example:

  • Women may face more stigma because drug use contradicts gendered expectations around being ‘responsible mothers and caregivers’.
  • Women may carry heavier socioeconomic burdens because they tend to have lower employment and income levels.
  • Women are more likely to experience ‘lack of childcare’ as a barrier to services.
  • Women are more likely to share injecting equipment (especially with intimate partners), which can increase their risk of blood-borne viruses.
  • Women are more likely to be involved in sex work, which can limit their power to practice safe sex or safe injecting.

Designing ‘gender-responsive’ services

Women tend to face “complex” and “overlapping” issues, and require a “gender-responsive approach” to all aspects of service design and delivery in order to meet their needs. Systems of care can be more gender-responsive by considering practical needs (e.g. childcare), offering women-only services, and working within a trauma-informed framework. Being ‘trauma-informed’ means that services and staff can recognise the signs and symptoms of trauma and the role this can play in women’s lives, avoid further trauma, and restore feelings of safety and self-worth.

Two services from Austria illustrate different ways of being gender-responsive:

  • Dialog is an outpatient support organisation, which has certain opening hours set aside for women, when they can be reassured that no men are present at the centre.
  • Gesundheitsgreisslerei is an outpatient treatment centre, which is run by women for women; it operates on feminist principles, including being oriented towards women’s specific needs and providing a safe space for women.

Identifying key sub-groups

The EMCDDA has identified several sub-groups of women who may require more tailored responses:

  • Women in prison are likely to have unmet health and social care needs. For example, prisons are high-risk environments for the transmission of blood-borne viruses, but many harm reduction services (e.g. needle and syringe programmes) are rare in prisons.
  • Women involved in the sex trade are at risk of experiencing violence and imprisonment, and may face the ‘dual stigma’ of drug use and sex work.
  • Victims of gender-based violence may have started to use drugs as a way to deal with trauma. They may also have experienced violence while taking drugs or being given drugs without their consent.
  • Pregnancy and motherhood can be strong motivators for recovery, but also unique barriers to recovery. In addition to experiencing stigma, shame, and guilt, women may fear having their children taken away.
  • Women who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, pansexual, allies, or other gender or sexuality (LGBTQIA+) may face discrimination, stigma, and an increased risk of violence and mental health problems. They may also be hesitant to seek support for substance use problems due to fears of, or previous experiences of, homophobia or transphobia.
  • Women from migrant or minority ethnic backgrounds may encounter additional barriers to services (e.g. due to language or immigration status); they may have experienced racism and discrimination; and some migrant women may have experienced additional trauma in their home country or when leaving their home country.

by Natalie Davies

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