Donne e addiction: La prospettiva di genere nella medicina delle dipendenze AULSS 9 Treviso 7 ottobre 2016 Alessandra Liquori O Neil Programme Officer liquori@unicri.it www.unicri.it
SUSTAINABLE DEVELOPMENT GOALS 2030
Gender Mainstreaming Definition Gender mainstreaming is the process of assessing the implications for women and men of any planned action, including legislation, policies or programmes, in all areas and at all levels. It is a strategy for making women s as well as men s concerns and experiences an integral dimension of the design, implementation, monitoring and evaluation of policies and programmes in all political, economic and societal spheres so that women and men benefit equally and inequality is not perpetrated. The ultimate goal is to achieve gender equality (UN Economic and Social Council, 1997)
Mainstreaming Gender in the Global Agenda The gender equality and women s empowerment mandate is universally agreed on by Member States and is cross cutting through all the SD Goals
UNICRI s Mandate contribute to the formulation and implementation of improved policies of: crime prevention control intervention through: Research Training Field activities Knowledge dissemination
UNICRI and the SDGs Goal 16: Promote peaceful and inclusive societies for sustainable development Provide access to justice for all and Build effective, accountable and inclusive institutions at all levels
Health Definition Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO). Health is a fundamental right indispensable for the exercise of other human rights. Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity (WHO).
Social Determinants of Health Social determinants of health include the range of personal, social, economic and environmental factors which determine the health status of individuals or communities and they are multiple and interactive.
Women and Justice Gender equality does not concern only the differences between women and men. Ethnicity and poverty are social determinants that intersect with gender and together contribute to shape the different experiences of oppression and privilege by both men and women, as well as their health, well-being and social functioning. Evidence is growing on the potentials to include social justice and human rights perspectives to address gender inequalities and the barriers that perpetuate such inequalities for vulnerable groups In an expanded and more nuanced concept, Gender is to be seen more and more as a social and relational process, shaped by economic, political and cultural relationships, within a complex and specific local context. The SDGs reflect this expanded interpretation of gender that includes a range of inequalities and considers men as well as women. Gender equity is grounded in human rights principles and centred on the concept of universality and social justice.
Women and Justice While the world has achieved progress towards gender equality and women s empowerment under the Millennium Development Goals women and girls continue to suffer discrimination and violence in every part of the world. Gender equality is not only a fundamental human right, but a necessary foundation for a peaceful, prosperous and sustainable world. Providing women and girls with equal access to education, health care, decent work, and representation in political and economic decisionmaking processes will fuel sustainable economies and benefit societies and humanity at large.
Women and Justice
UNICRI and the Gender Equality Agenda Mainstreaming gender in the access to care for substance use and dependence. Countering trafficking in persons. Combating violence against women Addressing Gender equality, development and women s rights in times of economic crisis in the EU and Mediterranean Basin
Women and Substance Use A Gender GAP we do not want to close: differences in rates of substance abuse in the general population and treatment-seeking samples always show higher rates of men, although the gap is narrowing in recent decades BUT: Women start earlier and are more susceptible to develop an addiction; Women are also more vulnerable to drug-related pathologies, such as liver and cardiovascular diseases, and are more exposed to sexual and physical abuse and violence and to sexually transmitted diseases. Lifetime rates of mood and anxiety disorders are significantly higher among women than men, with and without substance-use disorders
Women and Substance Use Among treatment-seeking women with substance abuse, rates of physical or sexual abuse are high, ranging from 55% to 99%, with many of these women manifesting a diagnosis of PTSD. Research made in the last twenty years on trauma, and the effect of adverse childhood experience on health later in life, have drawn attention to the connection between trauma and addiction disorders. Early-childhood trauma is strongly associated with developing mental health problems, including alcohol dependence, later in life. People with early-life trauma may use alcohol to help cope with trauma-related symptoms.
Evidences and Challenges for gender mainstreaming in drug prevention and recovery Most strategies for drug prevention and recovery in the world are tailored to men, with the result that they have little or no impact on women. In many countries, especially in developing countries, women who use drugs are facing cultural, social and religious barriers and stigma that prevent them from accessing the existing health and social services, even more so as regard the services dedicated to treatment and recovery from substance use disorders.
Evidences and Challenges for gender mainstreaming in drug prevention and recovery Through Project DAWN, UNICRI has been working to clarify the different gender roots and routes of substance use, in order to call for a re-direction of policies and practices that can address the gendered gaps in health service provisions with respect to their: Accessibility (physical, organizational) Affordability (financial, social, economical) Acceptability (effectiveness, stigma based on sex, gender, religion, ethnicity)
Project DAWN Resolution at the Commission on Narcotic Drugs, 2012 UNICRI Good Practice Manual, 2013 At its 55th Session, the United Nations Commission on Narcotic Drugs (CND) the legislative arm of the world s drug decision arena approved a resolution in favor of female-oriented approaches to drug policy: Promoting strategies and measures addressing specific needs of women in the contest of comprehensive and integrated drug demand reduction programs and strategies
Evidences and Challenges for gender mainstreaming in drug prevention and recovery Project DAWN carried out two surveys in Italy between 2012 and 2015: 1. The evaluation of drug dependence services by a sample of female clients, 2012; 2. The degree of inclusion of gender responsive strategies within drug dependence services, 2015
Female Clients Survey, 2012 Main objectives: To evaluate the opinions of women referring to drug dependence treatment units and recovery centres on first access and barriers; To collect their opinion on the importance of involving their families and their partners in the treatment and recovery process; To collect their opinions on the factors that facilitate treatment access and retention; To measure their opinions on the importance of those factors that do not delay access and promote the therapeutic relatioship; Investigate the overall satisfaction with the services
Survey Results: first access
Survey Results: during treatment
Survey Results: delay in requesting help
Survey Results: service drop out
Overall service satisfaction
Conclusions Overall, women are satisfied with the services The most important issue they higlight is respect for privacy and to be assisted during pregnancy by a gynecologist, preferably a woman and preferably within the drug dependence service; the gynecologist is a very important figure that all women underline Fear of losing children prevents women from seeking treatment or it may delay it
Survey: Inclusion of gender responsive strategies within drug dependence services, 2015 Aims To investigate opinions, attitudes and practices on gender mainstreaming in addiction treatment rehabilitation and prevention services Methods Target: private and public services involved in prevention, treatment, and social reintegration of addicts semi-structured questionnaire (by e-mail) 19 questions (closed and open) Sample - Type of institution (N. 313) (%) Sample - Type of services (N. 310) % 15 Public 3% 2% 5% Local Addiction Services Therapeutic communities 18,2 Private 30% Services for alcoholics 66,8 With contract 60% Other Harm reduction services
Survey Results Opinions about gender responsive approaches 63,2% of respondents think that it would be very useful to adopt a gender responsive approach in addiction treatment service, but One out of tree (36,5%) seems to be sceptical or critical about it > positive attitude among public services and harm reduction services Awareness among social and health workers: 24,5% declare no or low awareness of the importance of gender mainstreaming Utility of gender approach in addiction services (%) 1= not at all important; 5= extremely important 22,9 40,3 0,3 3,9 5,5 27,1 1 2 3 4 5 Missing For these reasons, the topic should be part of professional training (> public services): only 7,1% declares that this is not useful
Higher efficacy Strengths To better understand and take into consideration specific needs To facilitate access to services To reduce stigma To increase the compliance More advantages for pregnant women and mothers: higher protection of parenthood and minors Higher collaboration with other services Effective in detecting, preventing and addressing violence and drug related disease transmission Weaknesses Lack of human resources, economic support, structural challenges Lack of gender specific competences It would be necessary to include a social approach next to the medical consideration of addiction Weakness of institutional networks Lack of a more general gender culture (at the society level) Critical approach In a individualized treatment the gender responsive approach is not needed
Conclusions A complex picture coherent with the scientific literature A need of increasing gender responsive approaches in addiction services but we need to account for the 1/3 of the professionals who think that this is not useful or it is even dangerous This attitude is coherent with a general tendency to the individualization of addiction, that could imply a reduced attention to social and structural factors. Gender responsive approaches are mainly applied to pregnant women and mothers at risk or using substances, and generally not included in a broad gender approach, this is at risk of reinforcing gender stereotypes that identify woman with her mother s role, underestimating the needs of other women. The study supports the need to strengthen the professional knowledge on gender mainstreaming through specific training and including other aspects, such as the social determinants of health.
Of all the forms of inequality, injustice in health care is the most shocking and inhumane Rev. Martin Luther King Thank you for your attention