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  1. 1. Drogas, Géneros y Redes Segundo encuentro de profesionales en torno a la asistencia, tratamiento y prevencion de las drogodependencias con perspectiva de género Barcelona (Spain) 10 May 2016 Alessandra Liquori O’Neil Programme Officer United Nations Interregional Crime and Justice Research Institute
  2. 2. Outline of this Presentation  The United Nations and the Gender Equality Agenda  Global Definitions/Data  What is UNICRI and how it comes into play  Project DAWN objectives and tools  Evidences, challenges and practices for gender mainstreaming in drug prevention and recovery  Conclusions
  4. 4. Women in the Sustainable Development Goals Achieve gender equality and empower all women and girls. End all forms of discrimination against all women and girls everywhere. Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation. Adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all levels.
  5. 5. Some Definitions •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).
  6. 6. Some Definitions cont.d •“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)
  7. 7. Mainstreaming Gender in the Global Agenda The unequal way in which men and women are perceived and treated in society undermines not only the discriminated gender, but the society as a whole. The importance of mainstreaming gender within professional and policy practice - i.e. assessing implications of policies and practices for men and women and recognizing their respective needs – is considered as an essential and powerful tool at the roots of all development efforts in the post-2015 Millennium Development Agenda. "Gender" refers to the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women. World Health Organization
  8. 8. Milestones on gender mainstreaming  The gender equality and women’s empowerment mandate is universally agreed on by Member States and encompasses all areas of peace, development and human rights. The mandates on gender equality derive from the United Nations Charter, which unequivocally reaffirmed the equal rights of men and women.  The 1995 Fourth World Conference on Women endorsed gender mainstreaming as a critical and strategic approach for achieving gender equality commitments. The resulting Beijing Declaration and Platform for Action mandates all stakeholders in development policies and programmes, including UN organizations, Member States and civil society actors, to take action in this regard. Additional commitments are embodied in the outcome of the twenty-third special session of the General Assembly, the Millennium Declaration, and a variety of resolutions and decisions of the UN General Assembly, the Security Council, the Economic and Social Council, and the Commission on the Status of Women.
  9. 9. Women and Health The WHO Global strategy for women’s, children’s and adolescents’ health, launched in September 2015, aims to accelerate progress on the SDG health related agenda. Investing in women’s health equals to investing in the global welfare of families, communities and nations.
  10. 10. Women and Health  Among women of reproductive age worldwide, AIDS is now the leading cause of death. Biological factors, lack of access to information and health services, economic vulnerability and unequal power in sexual relations expose women, particularly young women, to HIV infection and undercuts abilities to protect themselves and make empowered choices.  Maternal deaths are the second biggest killer of women of reproductive age. Every year, approximately 287 000 women die due to complications in pregnancy and childbirth, 99% of them are in developing countries. Despite the increase in contraceptive use over the past 30 years, More than 225 million women have an unmet need for contraceptive methods.  Countries have committed to universal access to sexual and reproductive health care services, but many gaps have slowed progress so far. Fulfilling the right to health requires health systems to become fully responsive to women and girls, offering higher quality, more comprehensive and readily accessible services. Societies at large must end practices that critically endanger women’s health and well-being— among them, all forms of gender-based violence (WHO, 2013)
  11. 11. Women and Health
  12. 12. Women and Health
  13. 13. Women and Health
  14. 14. What is UNICRI The United Nations interregional Crime and Justice Research Institute was established in 1965 by the Economic and Social Council to assist governmental, intergovernmental and non governmental organizations in formulating and implementing improved policies in the field of crime prevention and criminal justice administration.
  15. 15. UNICRI’s Mandate contribute to the formulation and implementation of improved policies of: crime prevention  control  intervention through: United Nations Interregional Crime and Justice Research Institute Research Field ActivitiesTraining Knowledge dissemination
  16. 16. 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
  17. 17. UNICRI and Gender Equality - 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 Mediterranean Basin
  18. 18. Women and Social Justice
  19. 19. 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.
  20. 20. Social Determinants of Health cont.d  Social determinants of health include:  - Physical environment  - Education  - Social & economic environment  - Employment and working conditions  - Social support networks  - Culture  - Genetics  - Personal behavior & coping skills  - Health services  - Gender
  21. 21. Women and Social Justice  More research and knowledge is required to understand how to include gender perspectives to meet the post-2015 challenges.  Evidence is growing on the potentials to include social justice and human rights perspectives to address gender inequalities and effectively include women in the sustainable development processes.
  22. 22. Women and Social 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 decision-making processes will fuel sustainable economies and benefit societies and humanity at large.
  23. 23. Women and Social Justice “A new Global Investment Framework for Women's and Children's Health demonstrates how investment in women's and children's health will secure high health, social, and economic returns. We costed health systems strengthening and six investment packages for: maternal and newborn health, child health, immunisation, family planning, HIV/AIDS, and malaria. Nutrition is a cross-cutting theme. We then used simulation modelling to estimate the health and socioeconomic returns of these investments. Increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits. These returns include greater gross domestic product (GDP) growth through improved productivity, and prevention of the needless deaths of 147 million children, 32 million stillbirths, and 5 million women by 2035. These gains could be achieved by an additional investment of $30 billion per year, equivalent to a 2% increase above current spending. “ Stenberg et al. Advancing social and economic development by investing in women's and children's health: a new Global Investment Framework The Lancet, 383:9925, (2014), pp 1333–1354
  24. 24. Women and Social Justice  Gender equality does not concern only the differences between women and men.  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.  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. (WHO, 2015)
  25. 25. Women and Social Justice  Mainstreaming gender requires concrete actions to include these elements in all policies and practices, to ensure they address the needs of vulnerable and marginalized groups, both men and women.  Monitoring social inequalities includes collecting data that reflects income, gender, age, race, ethnicity, migratory status, disabilities and where people live.  Barriers to access health and social services must be removed.  We must consider how to make essential health services more resilient to shifts in political and environmental contexts – from normalcy, to fragility, to crisis and back.
  26. 26. Women and Violence Violence  Violence against women is widespread around the world. Recent figures indicate that 35% of women worldwide have experienced either intimate partner violence or non-partner sexual violence in their lifetime. On average, 30% of women who have been in a relationship experienced some form of physical or sexual violence by their partner.  Globally, as many as 38% of murders of women are committed by an intimate partner.  Women who have been physically or sexually abused have higher rates of mental ill-health, unintended pregnancies, abortions and miscarriages than non-abused women. Women exposed to partner violence are twice as likely to be depressed, almost twice as likely to have alcohol use disorders, and 1.5 times more likely to have HIV or another sexually transmitted infection. 42% of them have experienced injuries as a result. Increasingly in many conflicts, sexual violence is also used as a tactic of war.  No country in the world has a national, evidence-based road map to prevent violence against women and their children in a coordinated way.
  27. 27. Women and Substance Use  Addressing women’s substance use is strictly connected with gender based mental health vulnerabilities, where mental illness is both a risk factor for and a consequence of substance use Individual differences in drug-use patterns:  environmental , and  genetic (genes that are passed down from parent to child and which are shared in part by other family members).
  28. 28. Women and Substance Use  Vulnerability = Risk factors + Protective factors  Gender differences in rates of substance abuse in the general population and treatment-seeking samples:  men exhibited significantly higher rates of substance use, abuse, and dependence  Yet, the gap is narrowing in recent decades…  Women suffer largely from co-occurring mental disorders; 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.
  29. 29. Women and Substance Use  And eating disorders…  90% of anorexia and bulimia nervosa cases are found 2 - 3 x higher in women than men.  40% of women suffer from co-existing substance use and eating disorders  55% of women with bulimia also have SUD  Women are more subject to prescription drug misuse and abuse
  30. 30. Women and Substance Use  And Post Traumatic Stress Disorder (PTSD)…  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.
  31. 31. Women, Trauma and Substance Use  Treatment for women’s addictions is bound to be ineffective unless it acknowledges the realities of women’s lives, which include high prevalence of violence and other types of abuse, which increases the likelihood that a woman will abuse alcohol and other drugs. Gender-specific treatments that emphasize prevention, optimize gender specific communication and outreach channels, implement individualized treatment approaches, which promote patient recovery and fight the stigma associated with drug dependence, through evaluating and endorsing evidence based treatment approaches that help “normalize” dependence and its management.  This knowledge is changing the approach to addiction treatment and in recent years screening of women in addiction treatment shows that about 80% have been exposed to violence. This has called for changes in treatment methods and approaches to go from a gender neutral to a gender responsive treatment, based on a psycho-social dimension. There are still many unanswered questions about the cause and treatment of addiction. It is, however, now acknowledged that environmental factors, like adverse childhood experiences, have a great influence on the development of addiction problems (Epigenetic theory of addiction, etc.).
  32. 32. United Nations Interregional Crime and Justice Research Institute 32 Project DAWN Drugs and Alcohol Women Network An International Network to advocate for and support the development and implementation of evidence-based specific gendered interventions for substance use prevention and recovery. The re-orientation of social and health services towards gender- responsive prevention, treatment and rehabilitation strategies to better meet the specific needs of women and vulnerable groups The project’s main objective is to assist policy makers and professionals to mainstream gender within their working agenda, in order to contribute to the advancement of gender equity and equality in this field.
  33. 33. DAWN - Drugs Alcohol Women Network DAWN is carried out within the framework of the United Nations actions to promote gender equality and the empowerment of women, as reflected in the Sustainable Development Agenda, with an emphasis on: Health equity Child health Maternal health Fight HIV/AIDS and drug related diseases
  34. 34. MedNET Mediterranean network for cooperation on drugs and addictions Partners
  35. 35. National Working Group ASS 6 Pordenone Dependence Department ULSS 20 Verona Ser.T ASUR Macerata Ser.T Matera Ser.T Catanzaro Ser.T Catania ASL 7 Ser.D. Iglesias Department of Mental Health-ULS Modena Ser.T. ASL 2 Savonese ASL Torino Dependence Department ASL Varese ASL Frosinone ASL 1 L’Aquila San Patrignano Community Exodus Group MOIGE Italian Parents Movement AGE Italian Parents Association Dependence Department, Foligno
  36. 36. International Working Group Algeria, Austria, Cyprus, Egypt, France, FYROM Greece, Israel, Jordan, Lebanon, Morocco, Netherlands, Portugal, Sweden, Spain, United Kingdom, USA
  37. 37. Instruments and Tools WHO Guidelines for the management of substance use and substance use disorders in pregnancy, 2014 These guidelines contain recommendations on the identification and management of substance use and substance use disorders for health care services which assist women who are pregnant, or have recently had a child, and who use alcohol or drugs or who have a substance use disorder. They have been developed in response to requests from organizations, institutions and individuals for technical guidance on the identification and management of alcohol and other substance use and substance use disorders in pregnant women, with the target of healthy outcomes for both pregnant and their fetus or infant.
  38. 38. Instruments and Tools
  39. 39. Instruments and Tools UNICRI Good Practice Manual: “DAWN: Promoting a gender responsive approach to addiction”, 2013
  40. 40. Instruments and Tools Resolution at the Commission on Narcotic Drugs, 2012 • 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” • The Resolution represents a cornerstone in the pursuit of gender responsive policies and programs in the field of addiction.
  41. 41. Instruments and Tools DAWN Awareness and Information Days 8 March 2013 – International Women’s Day 26 June 2013 – International Day against Drug Abuse and Illicit Trafficking Italy 9 cities more than 2500 students Egypt Greece Israel Italy Morocco Spain Tunisia 22 October 2013 – Project DAWN and the Italian Government celebrate UN Day 2013 in Rome
  42. 42. Instruments and Tools DAWN e-learning platforms DAWN E-learning platform was created with the purpose of offering a 24/7, free-of-charge, easy to use and highly specialized tool for distance learning and training at disposal of health and social professionals and policy makers.
  43. 43. 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 hinder 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.
  44. 44. Evidences and Challenges for gender mainstreaming in drug prevention and recovery The recognition that female substance abuse has different “roots” and “routes” than male substance abuse, calls for a re-direction of policies and practices in order to close gaps in women’s health service provisions with respect to their: Accessibility (physical, organizational) Affordability (financial, social, economical) Acceptability (effectiveness, no stigma based on sex, race, religion, ethnicity)
  45. 45. Main problems of access to addiction prevention, treatment and recovery services for women  Female autonomy  Confidentiality  Voluntary counseling and testing  Cultural, social and religious factors  Training and professional updating  Stigma  Discrimination
  46. 46. Evidences and Challenges for Building Gender Responsive Services DAWN carried out two surveys in Italy between 2013 and 2015:  The evaluation of drug dependence services by a sample of female clients, 2013;  The degree of inclusion of gender responsive strategies within drug dependence services, 2015;
  47. 47. Female Clients Survey, 2013  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
  48. 48. Survey Sample 274 women Average age 34, 5 years Età media 37, 0 Età media 26,5
  49. 49. Survey Sample Reason for seeking treatment (%)
  50. 50. Survey Results: first access 1 less important, 7 very important
  51. 51. Survey results: direct questions 1 less important, 7 very important
  52. 52. Survey results: presence of families 1 less important, 7 very important
  53. 53. Survey results: various items 1 less important, 7 very important
  54. 54. Survey results: Item 13: partner involvement 1 less important, 7 very important
  55. 55. Survey results: Item 14: relationship with personnel 1 less important, 7 very important
  56. 56. Survey results: relationship with personnel 1 less important, 7 very important
  57. 57. 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;
  58. 58. The degree of inclusion of gender responsive strategies within drug dependence services, 2015;
  59. 59. The questionnaire Addressed to public services for prevention, treatment and rehabilitation of persons with substance use/addiction problems. 19 items (mostly closed questions)
  60. 60. Topics under investigation perception of the importance of adopting a gender perspective within addiction services adoption of the gender approach into: prevention, treatment and social/occupational reintegration adoption of the gender approach at the organizational level and in staff training strengths and weaknesses of the gender approach in addiction services
  61. 61. Sample 329 respondents  Public addiction services (60%), alcohol units (5,2%), therapeutic communities (29,4%), harm reduction services (2,3%), other services (3,2%) Women represent the 18,6% of clients
  62. 62. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane” Martin Luther King Thank you for your attention