What can the harm reduction movement teach us about reproductive justice?

Drug policy has benefited from the harm reduction movement’s innovative approach to improving personal safety.  The application of a harm reduction model to reproductive justice has the potential to transform the way we view reproductive justice issues and mobilize support for issues that are traditionally marginalized within the movement.  I want to consider what we can learn from the harm reduction movement in advocating for sex workers’ rights and comprehensive sex education.

Harm reduction is a public health philosophy that emphasizes individual safety, regardless of lifestyle choices, over prohibition.  This approach acknowledges that some individuals may continue to engage in risky behaviors and aims to address the needs created by those behaviors.  The harm reduction movement spearheaded efforts to improve safety and provide services to substance abusers, such as safer injection sites for heroin addicts—the theory being that if addicts were going to use, at least providing them with clean needles would benefit the addicts themselves as well as the overall public health.  Because harm reduction focuses on social and environmental aspects of risky behavior, its application to sex work is intuitive.  

Sex workers face violations of basic human rights on a daily basis, including violence at the hands of clients as well as police brutality.  Additionally, many sex workers must cope with homelessness, substance dependency, and extreme poverty and desperation.  Because street-based sex workers are predominantly indigent women of color, selective law enforcement practices disproportionately target poor, minority women.

Sex workers are isolated from health care services because of fear of arrest and prosecution, as well as the increasingly inaccessible cost of such care.  Street-based sex workers in particular face health risks that the average worker does not, such as violence (perpetrated by police and clients), exposure to sexually transmitted infections and HIV/AIDS, and exposure to the elements.  When sex workers do access health care services, it is generally because of an emergency; thus, lack of access to preventative services is a serious health concern for sex workers.

In the context of providing services and outreach to sex workers, then, an application of the harm reduction model must take into account how various and overlapping forms of oppression create unique challenges for sex workers:  namely, substance abuse problems and lack of resources to access health care.  Services should include the provision of safer sex kits to sex workers and training in condom-negotiation skills, as well as free and confidential STD testing and information about HIV/AIDS.  Holistic services should also embrace substance abuse counseling and clean needles for drug use and hormone injections for transgendered sex workers who utilize hormone therapy.  Programs that collaborate across disciplines would address sex workers’ needs the most effectively by tackling substance abuse, safe housing, domestic violence, and health care.

So, why is this an issue of reproductive justice? First, this approach recognizes that sex workers are often in the industry for reasons beyond their control, such as economic hardship or inability to enter or reenter the workforce due to lack of recognized work experience or a criminal record.  In this respect, this acknowledgement of the multiplicities of oppression reflects the values of the reproductive justice movement—harm reduction recognizes that the decision to enter or remain in the sex industry can be (but is not always) a result of economic, racial, and gender injustice.  Accordingly, rather than criminalize, patronize or demonize sex workers, harm reduction seeks to provide safer options for those who choose to continue in the sex industry.  And, because a harm reduction approach ascribes no moral judgment to the activities of others, the traditional hierarchy assumed by service provision is disrupted.  Significantly, this challenges the notion that those in positions of power “know best” while empowering sex workers to make the healthiest choice possible for themselves under their individual circumstances.  This approach also empowers sex workers to use contraceptives and educate themselves on sexual health issues.  Importantly, then, application of the harm reduction model does not demean the work that sex workers do because it both identifies the intersection of race, class, and gender-based oppression that often create the need to continue working in the sex industry and recognizes that some sex workers remain in the industry by choice.

I already blogged about abstinence-only education, but I think it’s important to consider sex ed in light of harm reduction as well.  The philosophies which underlie harm reduction call for the elimination of funding for abstinence-only education in schools and implementation of comprehensive, sex-positive sex ed.  Abstinence-only education does not actually result in teens abstaining from sex, and instead denies them critical information about sexually transmitted diseases, pregnancy prevention, and, yes—sexuality itself. 

Harm reduction acknowledges that people—and, in this case, young people—make choices that may put their health or well-being at risk, and seeks to provide information to most safely make those choices rather than administer judgment or condescension.  Like the earliest manifestations of the harm reduction movement—safer injection sites combined with resources and support for substance abusers who were trying to stop using drugs—comprehensive sex education presents young people with information and options.  And, like its predecessors in the movement, this information is health- and life-saving.  For teens who are having sex or are going to have sex, comprehensive sex education equips them with the tools and information they need to make that decision in a way that protects them from diseases and unwanted pregnancies as well as providing them with a healthy outlook on sexuality.

Reproductive justice posits that all people have a right to information required to attain sexual and reproductive self-determination.  Providing students with comprehensive sex education reflects the principles that motivate the harm reduction movement, and as such gives students the tools they need to make healthy decisions about their bodies, their relationships, and their futures.

-Amanda Allen