Alessandra Liquori O'Neil

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
a.oneil@unicri.it
www.unicri.it

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

SUSTAINABLE DEVELOPMENT GOALS 2030

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.

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).

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)

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

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.

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.

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)

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.

UNICRI’s Mandate
contribute to the formulation and
implementation of improved policies
of:
crime prevention  control  intervention
through:
Research
Field ActivitiesTraining
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

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

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.

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

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.

 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.

“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

 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)

 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.

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.

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).

 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.

 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

 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.

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
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.

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

MedNET
Mediterranean network for cooperation on
drugs and addictions
Partners

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

International Working Group
Algeria, Austria, Cyprus, Egypt, France, FYROM
Greece, Israel, Jordan, Lebanon, Morocco,
Netherlands, Portugal, Sweden, Spain,
United Kingdom, USA

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.

UNICRI Good Practice Manual:
“DAWN: Promoting a gender
responsive approach to
addiction”, 2013

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.

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

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.

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.

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)

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

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;

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

Survey Sample
274 women
Average age 34, 5 years
Età media 37, 0
Età media 26,5

Survey Sample
Reason for seeking treatment (%)

Survey Results: first access
1 less important, 7 very important

Survey results: direct questions

Survey results: presence of families

Survey results: various items

Survey results: Item 13: partner involvement

Survey results: Item 14: relationship with
personnel

Survey results: relationship with personnel

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;

The degree of inclusion of gender
responsive strategies within drug
dependence services, 2015;

The questionnaire
Addressed to public services for prevention,
treatment and rehabilitation of persons with
substance use/addiction problems.
19 items (mostly closed questions)

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

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

“Of all the forms of inequality, injustice in health care
is the most
shocking and inhumane”
Martin Luther King
Thank you for your attention
a.oneil@unicri.it
www.unicri.it

Alessandra Liquori O'Neil

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (6)

Similaire à Alessandra Liquori O'Neil

Similaire à Alessandra Liquori O'Neil (20)

Dernier

Dernier (20)

Alessandra Liquori O'Neil