Abstract
Punitive drug laws have had a differentiated and violent impact on women. State-driven stigma, criminalization, and abuse act as major barriers between women who use drugs and critical services, driving disproportionate health and safety harms. At the same time, women involved in illegal drug activities suffer the brunt of disproportionate drug laws, which exacerbate poverty and intersecting forms of discrimination, and have increased dramatically the global number of women behind bars. Although UN fora and women's rights organizations have paid little attention to their situation, affected women have mobilized to affirm their rights and vindicate their experiences, including at CSW65. From grassroots campaigns to organizations of formerly incarcerated women or peer-led harm reduction programs, women have stepped in to provide the support that States have failed to deliver. Decriminalization, reforms of draconian drug laws, gender-sensitive harm reduction services, and peer-led initiatives are essential to tackle violence against women.
Introduction
The past decade has seen mounting evidence from both the United Nations (UN) and civil society of the devastating impacts of punitive drug policies on communities worldwide (Harm Reduction Consortium, 2021), and importantly, on the differentiated impacts of drug control on women, in particular the high levels of violence inflicted by the state against women involved in illegal drug cultivation, supply, and use.
Drug policies, focusing on criminalization and incarceration, have resulted in even higher levels of police abuse of women who use drugs compared to their male counterparts, deterring them from accessing already limited lifesaving health services and exacerbating stigma and discrimination (OHCHR, 2018; UNODC, 2018; WGAD, 2021). Forced crop eradication campaigns in cultivation areas have resulted in civil unrest, internal displacement, and poverty, with women generally left behind in alternative livelihoods programs (Cruz Olivera et al., 2020; Pereira & Ramirez, 2020). The over-criminalization of women for illegal drug supply activities has contributed to mass incarceration, with over a third of women in prison worldwide incarcerated for drug offenses, compared to one in five incarcerated men (UNODC, 2020). Arbitrary detention, police violence, lack of due process, denial of legal aid, torture, and ill-treatment are all common occurrences in women's pathways throughout the criminal legal system when it comes to drug offenses (Cots Fernández & Nougier, 2021).
Although the specific ways in which women are affected by drug policies are receiving increasing visibility, they remain under-reported at the UN. The UN General Assembly and the Commission on Narcotic Drugs, the main UN policymaking body on drugs, did not address the impacts of drug policies on women until 2016, and even then, they refused to reconsider the punitive rationale that drives state violence (CND, 2016; UNGA, 2016). In the meantime, the violence, abuses, and stigma faced by women involved in the illegal drug market remain invisible in UN discussions on women's rights. Although the Committee on the Elimination of Discrimination against Women has started building jurisprudence on women and drug policy, mainly thanks to recent shadow reports produced by civil society ahead of the Committee's sessions, other UN entities (especially CSW) have remained mostly silent. This may be because drug issues have traditionally been handled by Vienna-based UN agencies, with little engagement from UN entities in New York and Geneva. Nonetheless, the 2018 UN System Common Position on Drugs calls on UN agencies to speak with one voice on drug issues and share their expertise on drug-related matters (UNCEB, 2018). It is therefore essential that the CSW step into this policy space. This, however, will likely require sustained civil society advocacy and the identification of key champions within CSW to bring the issue onto the agenda.
Furthermore, while the International Network of People Who Use Drugs (INPUD) and the International Community of Women Living with HIV have recognized the “invisibility” of women who use drugs and the elevated risks of violence they face (International Community of Women Living with HIV & International Network of People Who Use Drugs, 2015), women who use drugs remain largely unacknowledged in the movement of people living with HIV and the feminist movement. In fact, many feminist organizations refuse to engage in drug policy, considering that women who use drugs may lack agency, or somehow pose a risk to feminist goals concerning empowerment, blaming women who use drugs themselves rather than trying to unpack the impacts of drug policies on their lives. This is startlingly at odds with the efforts made by the feminist movement to reverse the harmful messaging around victim-blaming in many other contexts. Positively, this problematic positioning is being challenged by the Association of Women's Rights in Development (AWID), Creating Resources for Empowerment in Action (CREA), and various feminist Latin American NGOs, which have strongly engaged in drug policy advocacy. Efforts have also been made by women who use drugs and formerly incarcerated women to be meaningfully included in the feminist discourse and to ensure greater visibility in local and global-level feminist platforms. Most importantly, various initiatives worldwide have sought to address the harms faced by women impacted by drug policy, providing them with tools to reclaim their rights and advocate for reforms.
The aims of this article are twofold. It first highlights the various forms of State violence against women associated with drug policies. Second, it describes several programs and campaigns through which women have mobilized in solidarity to call for policy change and respond to the needs of those impacted by drug control. The article uses research conducted by civil society, academia, and the UN, and lived experiences, as well as information shared at the UN, especially at a side event held at CSW65, which provided a key opportunity for NGOs and affected women to share with the feminist community their research and lived experiences on how to end violence and promote empowerment via drug policy reform.
Setting the Scene: Women, Drug Policy, and State Violence
Fifty years ago, US President Richard Nixon inaugurated the so-called “war on drugs,” declaring drug use “public enemy number one.” Although punitive drug policies had already been in place for decades, they received strengthened political and financial support and were exported worldwide (Fordham, 2021).
Women who use drugs have borne a differentiated and disproportionate impact of these punitive approaches, which are mediated by criminalization, stigma, discrimination, gender-based violence, and trauma (Stoicescu et al., 2019; UNODC, 2018). For instance, women who use drugs are more likely to contract HIV and other blood-borne diseases than their male counterparts. In the 2010–2020 decade, the number of opioid-related deaths increased 46% faster among women than among men (UNODC, 2020). At the same time, states have dramatically failed to provide appropriate harm reduction and drug dependence services for women: While one in three people who use drugs is a woman, women only represent a fifth or less of all people in treatment (UNODC, 2020).
Women who use drugs also face “high levels of violence and harassment” from law enforcement (OHCHR, 2018). In some countries, police demand money or sex in exchange for not arresting women suspected of a drug offense (WGAD, 2021). In 2020, 18 US states considered drug use during pregnancy to be child abuse; in four states, this can lead to detention (University of Miami School of Law, 2020). Such policies drive women who use drugs away from critical services, from harm reduction and sexual and reproductive health services to responses to gender-based violence (UNODC, 2018).
Women involved in the illegal cultivation of crops such as opium poppy or the coca leaf are subject to intersecting forms of discrimination in their triple condition as women, members of extremely poor rural communities, and people with a criminalized livelihood (Cruz Olivera et al., 2020). In countries like Colombia or Mexico, they find themselves in the midst of armed conflicts driven by the militarization of drug control and are subject to violence by both the state and non-state actors (Pereira & Ramirez, 2020). They have even less access to property rights, income, and state services than men in their communities (Cruz Olivera et al., 2020).
Worryingly, women involved in the illegal drug market are disproportionately impacted by incarceration. Global data show that 35% of women in prison are incarcerated for drug offenses compared to 19% of men (UNODC, 2018). This percentage increases drastically in Latin American and Asian countries, where women imprisoned for drug offenses constitute from 50% to 80% of the female prison population (Cots Fernández & Nougier, 2021).
In most cases, women are incarcerated for drug possession for personal use, or for carrying out nonviolent but highly visible supply activities, such as transporting drugs, for little financial reward (IDPC, 2021). Some women become involved because of coercion, or under the influence or violence of male acquaintances, and many do so to provide for themselves, their children, or other dependents (IDPC, 2021). However, the differentiated pathways and circumstances of women's involvement in drug activities are not taken into consideration in criminal laws (PRI, Linklaters & IDPC, 2020). Instead, women face disproportionate prison sentences, a systematic overuse of pretrial detention, lack of access to legal aid, the denial of alternatives to incarceration, and an overall dearth of gender-sensitive responses (Cots Fernández & Nougier, 2021). Women who use drugs and are deprived of their liberty are at heightened risk of health harms, but in the limited number of countries where harm reduction services do exist in prisons, these are generally only available for men (Shirley-Beavan et al., 2020).
Reducing Stigma and Violence Against Women Who Use Drugs
Women who use drugs and allies have increasingly recognized that the relative “invisibility” of women who use drugs has contributed both to violent state interventions and to affording impunity to perpetrators. Intersectionality and the negative impact of punitive drug policy on women of color, sex workers, and trans women who use drugs should be recognized in this context (Newland & Keylly-Hanku, 2021; WHRIN & Talking Drugs, 2019b). Increasingly, women who use drugs are collaborating to tear away the gendered façade created by punitive drug policies that have otherwise served to reinforce and shield the high rates of violence inflicted on women who use drugs. Women who use drugs are boldly stepping into the women's movement and collectively calling on governments to put an end to failed drug policies. In the section below, we provide examples of various powerful initiatives.
The Campaign for the Elimination of Violence Against Women Who Use Drugs (EVAWUD)
Advocacy conducted by the Women and Harm Reduction International Network (WHRIN) has brought the acute risk of violence against women who use drugs into view by amplifying the voices of women who use drugs, and promoting normative guidance to respond to, and ultimately end, such human rights violations.
The EVAWUD campaign piggybacks on the UN's “16 Days of Activism against Gender-Based Violence” activities (UN Women, 2020), but is exclusively focused on, and led by, women who use drugs. EVAWUD was triggered by the higher rates of violence experienced by women who use drugs, coupled with the absence of attention to their situation in this global UN campaign, as well as the need to collaborate more closely with the women's movement. As its premise, EVAWUD recognized that gender-based violence could not be eliminated unless those most affected were directly and meaningfully involved at all levels in relevant policy and programming.
In 2019 and 2020, EVAWUD campaigns were conducted in over 20 countries, including Australia, Burundi, Greece, Indonesia, Kenya, Lithuania, Mauritius, and others, using the slogans, “The war on drugs enables violence against women! End the war, end the violence!” and “Some women need drugs. No women need violence. Stop violence against women who use drugs” (WHRIN, 2019a; WHRIN, 2020a). Campaign activities include awareness raising; correcting negative perceptions and the presentation of demands for rectification through social media blitzes; the launch of lived experience books, videos, and webinars; art and sport activities; press releases; public marches and rallies; podcasts; story-telling; meetings with parliamentarians, police, community lawyers, health officials, and women's ministries; national symposia; letter-writing to women who use drugs in prison; art therapy, empowerment, and self-defense classes, and more. In 2021, a video summarizing EVAWUD was screened during a side event held at CSW65, highlighting the energy, bravery, creativity, and determination of the activists involved (IDPC, WOLA, Dianova International & WHRIN, 2021; WHRIN, 2021).
The impact of the campaign has been felt in ways well beyond those originally anticipated. In addition to media coverage and capturing the attention of governments, some participating women reported a profound sense of vindication and empowerment. One campaigner in Eastern Europe noted, “I refuse to be treated as any less than a human being; my rights and my fight are just as valid as the person’s next to me, no matter what my gender and personal choices are” (WHRIN, 2020a). In some cases, the campaign kick-started ongoing activities by networks of people who use drugs and harm reduction advocates, wishing to improve services for women who use drugs (such as women-only days, or auxiliary service additions and adjustments). In several locations, EVAWUD activities led to the establishment of resource packs and expanded referral networks, ongoing meetings of women who use drugs geared towards building advocacy actions, the establishment of new networks of women who use drugs, and the strengthening of women's roles in existing networks of people who use drugs.
The Support Don't Punish Campaign
The Support Don't Punish Global Day of Action, held annually since 2013 on June 26 (Support. Don’t Punish, 2021), has also been used as a vehicle to elevate the voices and indignation of women who use drugs against escalating State violence. For instance, in 2019, various organizations and groups led by or involving women who use drugs around the world organized actions to highlight the need to end violence against and improve drug policies for women, uniting under the slogan, “Women fighting back against the war on drug users—support and solidarity” (WHRIN, 2019b).
Resisting “Addiction” to Incarceration
Drug policies are a major driver of incarceration of women worldwide, and formerly incarcerated women are mobilizing to address a myriad of problems brought by criminalization on themselves, their families, and communities.
Reimagining Communities, Ending Incarceration in the United States
The National Council for Incarcerated and Formerly Incarcerated Women and Girls, a US-based network, was founded by women in the Danbury federal prison, at a time when criminal justice reform had become an issue of debate in the country. The United States has the highest rate of incarceration in the world; yet, little was being said about women in prison. The founding members noted, “Although we heard on the nightly news about efforts to begin the work to end mass incarceration, we heard little about ourselves, as incarcerated women. We heard nothing about our children that were left behind without us, and still very little about the needs of the communities we all came from” (National Council for Incarcerated and Formerly Incarcerated Women and Girls, 2021). Women behind bars in the United States tend to have histories of violence and abuse; a study reported that 86% of women in jail had experienced sexual violence, 82% had a drug or alcohol dependency, and 32% suffered from a serious mental illness (Swavola et al., 2016). They are survivors of violence, including sexual violence, before landing behind bars, during their arrest, and while in prison.
The National Council was founded in 2015 and has grown to over 5,000 individuals across the country, united in their mission to end the incarceration of women and girls. Led by formerly incarcerated women, the National Council engages in grassroots organizing and connects community organizers at the local, state, and national levels. In 2018, the National Council launched a “listening tour,” holding town hall meetings with formerly incarcerated women across the country, as well as conversations with women in prison through visits and phone calls. Out of that participatory research, the National Council developed a three-tiered approach that includes political education, hyper-local base building under the banner of “Reimagining Communities,” and nationwide campaigning.
The National Council also runs the national campaign, FreeHer. The first rally was held in 2015, demanding the release of Phyllis Hardy, known fondly as “Grandma.” She was sentenced to more than 30 years in prison for “conspiracy” to import and distribute cocaine and money laundering (defying legal norms, there were no other conspirators in the case). Grandma spent 23 years behind bars before being granted compassionate release by the Obama Administration. She is now the Inreach/Outreach coordinator of the National Council—a point of contact with women in prison, helping them with everything from filing legal papers to connecting with those on the outside. Once women are released, Grandma helps provide them with whatever they need to get back on their feet. The 2015 FreeHer rally was the beginning of the National Council's campaigns for clemency for women behind bars. Most recently, when the new US President took office, the National Council launched a campaign calling on the Biden Administration to grant clemency to 100 women during his first 100 days in office. Although those 100 days have passed, the clemency campaign continues.
Women Bringing Down the Bars in Latin America
Latin America is another region where women are severely impacted by repressive drug policies, with 50–75% of women in prison being incarcerated for drug offenses in numerous countries (WOLA, 2020a). In part inspired by the National Council, formerly incarcerated women in Latin America are also building their own network. Following an initial 2019 workshop held in Colombia (WOLA, 2019), “Women Resisting, Bringing Down the Bars” was launched. The network has members from Argentina, Bolivia, Chile, Colombia, El Salvador, and Mexico. At the local level, formerly incarcerated women started their own organizations and became vocal advocates for addressing the prison crisis across the region as COVID-19 spread. Mujeres Libres Colombia, which was one of the sponsors of the 2019 workshop, launched a campaign to secure much-needed sanitary supplies for those in the women's prison in Bogota, including basic items such as facemasks and soap, which the government failed to provide, and then negotiated with authorities to get the supplies into prison.
Defending the Rights of Trans Women in Prison
The situation of trans women in prison deserves special mention. Around the world, trans people face discrimination, social exclusion, and transphobia—and, in some countries, direct criminalization (Human Dignity Trust, 2021)—which can lead them to work in highly criminalized informal economies, such as illegal drug markets, sex work or sex for survival, making them more vulnerable to police abuse and detention (García Castro & Santos, 2020). Once behind bars, LGBTQI + people are more likely to suffer from diverse forms of violence, including discriminatory and humiliating practices, psychological ill-treatment, and physical violence (García Castro & Santos, 2020). They are at greater risk of sexual violence and assaults by prison staff and other persons deprived of liberty. The situation is even more dire for trans women, as they are routinely incarcerated in men's prisons (IACHR, 2015). Trans women also face particular challenges with regard to their identification, body searches, and access to appropriate medical care.
Despite the myriad challenges they face, formerly incarcerated trans women have created organizations to defend their rights, including Corpora en Libertad, a Latin American regional network of formerly incarcerated women. In December 2020, several national and international civil society actors issued the first-ever declaration on promoting the rights of trans women deprived of liberty in Latin America (WOLA, 2020b).
In Mexico, trans activist Kenya Cuevas has been on the cutting edge of such activism. Detained at a “drug house” and falsely accused of selling drugs (the actual dealer bribed the police and was let go), Kenya spent 11 years in a men's prison in Mexico City, before being acquitted. She explains, “I experienced prison like any other trans women in a male facility, where I was physically assaulted and sexually abused, not just by the other prisoners but also by security personnel and guards” (García Castro & Santos, 2020, p.8). Upon her release, Kenya began working with fellow sex workers on caring for and preventing HIV. In 2018, she founded the Casa de las Muñecas Tiresias, the first shelter for trans women in Latin America; many are women coming out of prison. Kenya says, “This fight has not been easy, nor will it ever be. I have seen my partners die over the years, because of hate crimes or because HIV took their lives, but my convictions hold firm, and I yell to the world that being happy will be our revenge!” (García Castro & Santos, 2020, p.8).
Women Empowered Through Compassion, Care, and Support
Fighting back against decades of stigma, violence, criminalization, and rejection, women who use drugs and formerly incarcerated women all over the world are providing compassion, care, and support to their peers and loved ones. In this section, we present some initiatives for and led by affected women.
Harm Reduction as a Lifesaving Approach for Women Who Use Drugs
Harm reduction refers to policies, programs, and practices that aim to minimize negative health, social and legal impacts associated with drug use, drug policies, and drug laws (Harm Reduction International, 2021). Although women-focused harm reduction services remain scarce, programs have been developed to provide a caring, supportive environment for women who use drugs who have faced situations of violence. For instance, Sheway in Vancouver, Canada, has provided low-threshold harm reduction, and health and social services for pregnant women who use drugs and new mothers since 1993. The program supports women to tackle issues such as drug use and dependence, but also—and mostly—violence and trauma, stigma, poverty, unstable housing, unplanned pregnancy, legal issues, and more. The program is based on the assumption that clients know their own reality best and are experts in their own lives, with Sheway supporting them without judgment. Services include provision of food (a useful way to reach out to new clients), nutrition counseling, primary medical care, prenatal care, sexual and reproductive health advice, overdose prevention, parenting support, housing, and social benefits advocacy, among others (Hardial, 2019).
A similar approach has been adopted by Metzineres, a women-led harm reduction program for women and gender nonconforming people who use drugs in Barcelona, Spain. Created in 2017, the program provides care and support to women who have suffered state violence, including from police, the criminal legal system, and health and social services. Metzineres offers flexible responses tailored to each woman's needs, concerns, expectations, and interests. The all-female interdisciplinary team includes a doctor, social worker, social educator, legal specialist, yoga workshop facilitator, and graphic art designer. It offers harm reduction services and supervised drug consumption, cultural outings, work in community spaces, workshops, educational and therapeutic activities, and basic services such as clothing, food, showers, a washing machine, and beds. These activities are often designed and delivered by the clients themselves and aim to accompany women in their journey to overcome prejudice, stigma (including self-stigma), discrimination, and histories of violence through pragmatic responses of their choice (Metzineres, 2021; Roig Forteza, 2019).
Similar programs also exist in Asia and Africa. In Kachin State, Myanmar, Médecins du Monde supports an advisory group made up of women who use drugs from surrounding townships. Women outreach workers were recruited and trained for women-focused services focusing on sexual and reproductive health and gender-based violence, along with the full harm reduction cascade service delivery (WHRIN, 2020b). In the COVID-19 context, where violence against women who use drugs has become even more pronounced, women who use drugs are taking the lead in assisting their peers. In Nairobi, Kenya, the Women Nest initiative established shelters for women who use drugs, managed entirely by a peer team of women who use drugs (WHRIN, 2021c).
These programs rely heavily on the work and creativity of women who use drugs themselves, showing the importance of solidarity and community mobilization, and the critical role played by networks of people who use drugs.
Getting a Seat at the Decision-Making Table
The empowerment of women impacted by drug control efforts requires their meaningful involvement in decision making, which can range from providing guidance to policymakers and service providers, to ensuring that their stories are heard in international fora. This is a particularly challenging endeavor for women facing high levels of stigma, discrimination, criminalization, and violence by the state apparatus itself. This section provides several examples of how civil society and community organizations have come together to start opening this space.
Providing Guidance and Recommendations to Decision Makers
INPUD, a global network of people who use drugs that have been instrumental in advocating for access to harm reduction and treatment services, has developed several tools and guidance to implement gender-responsive services for women who use drugs, often in collaboration with UN agencies (UNODC, UN Women, WHO, INPUD, 2014; UNODC, INPUD, 2016; INPUD, 2020). These tools aim to offer practical guidelines and examples of good practice for governments, service providers, and peers.
Similarly, WHRIN has published a guide on sexual and reproductive health for women who use drugs with women who use drugs and Frontline AIDS (Voets et al., 2020). Importantly, the guide identifies gender-based violence services for women who use drugs as an integral part of any comprehensive sexual and reproductive health rights package.
Meaningful Participation in Policymaking Fora
In recent years, women who use drugs or who are otherwise impacted by drug control policies, including women involved in drug supply or who have been in prison, have increasingly participated in national and international policymaking fora, and thus engaged with officials and decision-makers. Some examples include seminars organized by NGOs such as the International Drug Policy Consortium (IDPC) (see, for instance, WOLA, 2021); side events at UN fora (see, for instance, IDPC et al., 2021; IDPC, WOLA, WHRIN, Dianova International, 2021; PRI, CELS, Dejusticia, IDPC, TIJ, WOLA, 2021); and webinars and other events (see WOLA, 2021). In some cases, this was the first time that decision-makers had met with women impacted by drug policies.
In another example, women who use drugs in Indonesia submitted a shadow report to the UN Committee on the Elimination of Discrimination against Women (WHRIN, 2021c), with the support of an internship program launched by WHRIN. Building upon that positive experience, WHRIN is now offering an internship with UN Women in an effort to increase the engagement of this UN agency in drug matters.
These efforts are essential to bring the issues faced by women into the political agenda and to ensure that debates and reforms truly address the needs of affected communities. However, women who tell their experiences in public spaces might relive the trauma of incarceration, violence, and abuse and, in some cases, they can face additional stigma, pressure, and criminalization from their communities or authorities. Experience shows that convening actors must take due diligence steps to address these risks and to provide women who speak publicly about their history of drug use and incarceration with encouragement, care, and support.
Conclusion
Although the “war on drugs” has caused severe harm to people worldwide, it has had a differentiated and particularly violent impact on women. Whether facing militarized crop eradication, punitive and abusive criminal legal systems, or the overwhelming lack of gender-sensitive harm reduction services, women's experiences have been pervaded by poverty, gender-based violence, and the stigma associated with breaching patriarchal roles, with a particularly high cost borne by women facing intersecting discrimination, such as women of color, sex workers, or trans women. And yet, the abuse and violence suffered by women who engage with the illegal drug market have historically remained invisible, as gender-disaggregated data and indicators remain scarce (Nougier, 2020), and UN fora and mainstream women's rights organizations are reluctant to engage with these issues.
Left on their own, women have mobilized to defend their rights. This article has shown how campaigns such as EVAWUD, Support. Don't Punish, and FreeHer have become platforms where women impacted by repressive drug policies, state violence, and criminalization can challenge stereotypes and highlight the mutually reinforcing connection between the dehumanization of people involved with drugs and gender-based violence. Women who have been charged with drug offenses and have borne the brunt of draconian drug laws are now part of emerging networks of formerly incarcerated women, as well as of feminist platforms, where they have denounced the logic of carceral systems. At the same time, programs such as Sheway, Metzineres, and Women's Nest provide nonjudgmental and gender-sensitive support and harm reduction services, often relying on the creativity and leadership of clients themselves. Finally, the participation of women from affected communities has become central to the drug policy reform movement.
The policy recommendations put forward by these initiatives can be grouped in four main asks, grounded in the principles of inclusion, peer leadership, and nonjudgment. First of all, decriminalize drug use and possession for personal use. Criminalization targets vulnerable women, creates a barrier to critical health and social services, and deters them from seeking redress for gender-based violence. Second, put an end to draconian drug laws that have dramatically increased the number of women incarcerated worldwide. Criminal laws need to be reformed to reflect the reality that incarceration is neither a just nor effective response to women's specific needs, circumstances, and pathways into illegal drug activities. Third, ensure voluntary access to and funding for gender-sensitive harm reduction and support services for both women who use drugs and women who have suffered gender-based and/or state violence, including incarceration. Finally, support initiatives that ensure the meaningful involvement of affected women at all stages of policymaking.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
