16 Days of Activism – Statement on [Gender-Based Violence against] Pregnant Women and Women with Children

During the 16 days of activism, which started on November 25th on the International Day for the Elimination of Violence Against Women and will end on December 10th on the International Day of Human Rights, the WFAD Gender Working Group is publishing statements every day highlighting issues faced by different specific populations while continuing to highlight the topic of this year: UNiTE! Activism to End Violence against Women and Girls

Gender-based violence and substance use are strongly interlinked. The negative health impact the experienced violence has on the survivor can lead to substance misuse. Additionally, substance use perpetrator often accelerates violence. Therefore, each statement, calling for preventing and eradicating gender-based violence, also calls for substance use prevention as well as sensitised and comorbid treatment.

Women in many countries experience great vulnerability due to gender inequalities that find expression in the cultural, social, and economic spheres. The percentage of working women is very low in many countries of the world and, when they do work, there is still a significant gender gap in wages, which not only does not fully recognise the equal value of their ability to work, but often hinders their complete economic autonomy. Moreover, this economic and cultural subjugation often encourages psychological and physical violence by the intimate partners, because women are not seen as individuals holding specific rights and carrying autonomous identities, but as objects to be owned and over which to exercise decision-making authority.

Although much progress has been made, much remains to be done. Even in the so-called developed countries, gender inequalities still manifest themselves, sometimes in more subtle ways, as in the more difficult access to executive careers compared to male peers, or in more violent ways: think of the number of women killed in 2021, over 81,000, 56% of whom at the hands of partners or family members, but this number is a conservative estimate. “More than five women and girls were killed every hour by a family member in 2021, according to new UN figures on femicide.”¹

Of course, this situation can only worsen in the event of pregnancy or children: work becomes a difficult option without adequate aid, which does not exist in many countries, while the lack of economic autonomy becomes an aspect on which the woman becomes blackmail-able because at that point her priority becomes safeguarding her children. This situation increases her exposure to psychological and physical violence, humiliations, and abusive acts.

And if this is the condition of women in the world, what can we think happens to women with substance use problems who get pregnant or have children? It is unanimously recognised that most of the services for substance use disorders are still too often male-oriented: drug policies and guidelines for services are on their way of being fully developed and implemented when it comes to gender approach and specific elements to be introduced in addressing women’s specific needs.

In order to substantially improve drug policies and programs in this area, introducing a gender-sensitive approach in drug policies, it is necessary to assess the underlying causes of substance use among women. We must remember that a high percentage of women who develop severe forms of substance use disorders have experienced Adverse Childhood Experiences; women who use drugs are five times more likely to suffer GBV at the hands of an intimate partner and at the same time the use of substances might be a coping mechanism for those women who suffer GBV; women progress into severe dependency more rapidly than men, and develop more intense and critical issues related to mental and physical health, social and economic poverty, discrimination, and stigma. If we can say that women with SUD experience a double stigma and discrimination, of being a woman and of being a drug user, being pregnant or having a baby amplify the stigma: the woman is not considered reliable and fit for parenting, and the prejudice is embedded in the services offered as well as in the practitioners that are supposed to offer real, concrete help.

Children and pregnancies occur in women who use drugs often as an unwanted event, almost always with drug-using and abusive partners who are neither in a position nor willing to take care of the child. On the contrary, this condition may trigger episodes of gender-based violence. Loneliness in bearing the burden of pregnancy and motherhood is often the rule. Relationships with families of origin are often disrupted and no support from friends or relatives is available. Facing the double challenge of her substance use disorder and of becoming a mother might be overwhelming: while on one side the pregnancy could be an important reason to seek for help to address her difficulties and find support, on the other hand, the sense of inadequacy and internalised stigma can be so powerful to destroy any goodwill.

This situation highlights the shortage, inadequacy and lack of understanding both of drug policies and available programs.

Addressing the medical issues connected to pregnancy is not enough: OAT might tackle the risk of damages to mother and child caused by withdrawal syndrome, but this is a first very small step in the direction of offering a comprehensive support, accompanying woman in this difficult pathway to motherhood, while contemporarily facing the challenges of the complex process of recovery from substance use disorder.

On the contrary, in many countries the standard intervention pushes for the mother to improve her quality of life in a very short period of time, while the child is removed from her custody and placed in foster care. But without adequate support and with the added burden of self-stigma reinforced by the stigmatising attitude of services, she is unlikely to succeed, thus reinforcing the idea that drug-using and recovering women are unfit for motherhood. Millions of children in this difficult situation are placed in foster care every year, grow up moving from one foster family to another and are very rarely reunited with their mothers. They are at very high risk of engaging in risky behaviour, of developing a substance use disorder themselves, and of coming into contact with the criminal justice system at a very early age².

It is necessary for drug policies to promote and provide services sensitised to the conditions of these women to cope with their many problems and substantially improve their quality of life, while at the same time offering their children the opportunity to grow up within their own family. A strong parental bond exists despite the challenges and breaking this bond can only be detrimental to positive development for both mother and child. This requires time, connections, peer support, hope, empowerment, trained and non-stigmatising professionals, available, affordable and accessible services, and equipped with all the necessary tools to cope with the different adverse experiences and challenges that women with SUD and mothers face in their lives: from childhood trauma to sexual abuse, from marginalisation to poverty, from gender-based violence to mental health problems, from separation from their children to being considered irredeemably hopeless.

There are some good practices, thanks to the commitment of NGOs that are closely connected to women in difficulties and have a clear vision of the holistic approach that needs to be implemented to wrap women and mother in a welcoming, non-judgmental, embracing intervention. Good recommendations have been made by international bodies such as the WHO, several UN agencies, the EMCDDA, the Pompidou Group and others³, but when it comes to actually implementing gender-sensitive drug policies, there is much to research, study and advocate for. Women, joining their forces and resources, have to make their voices heard also for those who have no voice, no power, no strength to advocate for their rights.

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