One glance at the mass of black and brown faces locked in prison on nonviolent drug charges and it’s clear that the so-called War on Drugs has deep roots in racism. But what about the drug war’s impact on gender? While not as widely discussed as racism, sexism infiltrates every aspect of drug policy, even within the reform movement itself, impacting how women who use drugs are viewed, treated and punished.

Women are currently the fastest growing segment of the U.S. prison population. According to the ACLU report “Caught in the Net,” over the past three decades, the number of females in prison has increased at twice the rate of their male counterparts—even more so for women of color. From 1977 to 2007, the female prison population grew by 832%, while the male population grew by 416%. Two-thirds of these women are serving time for nonviolent offenses and more than three-quarters are mothers.

The staggering increase in the number of women in prison does not reflect larger numbers of women using drugs, but rather, changes in criminal sentencing. Many of the women in prison are there for co-habitating with a boyfriend or husband who committed drug offenses in the home. Women who refuse to testify against a partner could face conspiracy charges on top of the drug charges, in many cases causing them to serve longer sentences than the partner who actually committed the crime.

Women who don’t serve prison time for a partner’s offense are often left behind as sole caretakers of the next generation. When men come out of prison, dehumanized, angry, and unable to get decent jobs due to criminal records, they re-enter households dominated by women, who now have an extra mouth to feed and a potentially volatile situation on their hands.

“Men come back from prison with trauma and not much marketability because employers won’t hire formerly incarcerated people,” says Xochitl Bervera, co-director of the Racial Justice Action Center in Georgia. The R.J. Action Center runs a program organizing currently and formerly incarcerated women to reduce the number of women in jails and prisons.

A growing prison population is not the only bad news for women and drugs. While drug overdose fatalities for men have tripled in the past decade, the number of women dying of opioid drug overdose has risen fivefold during the same period. African-American women are also the fasting growing demographic of people with HIV, which can be acquired through injecting drugs or having sex with a partner who has injected drugs.

Because of the high standards that society holds to mothers, women also bear the brunt of stigma against drug users. While absentee fathers who use drugs might be given a pass, being a mother on drugs is an unforgivable offense. Women who admit to drug use are at risk of losing their children and suffer greater economic and social consequences than those born by men. Some states have even passed laws criminalizing pregnant women who use drugs. Last year, Tennessee enacted a law that allows pregnant women to be criminally charged with an assaultive offense if their baby is born with withdrawal symptoms indicative of opioid use. The law passed despite strong dissent from the medical community, which pointed out that criminalizing pregnant women deters them from seeking drug treatment and prenatal care, putting both mother and fetus at greater risk for poor birth outcomes.

“Society views drug use as a moral problem and women, especially mothers, are judged the most harshly,” says Senga Carroll, Training Director at UNC Horizons, a program that works with pregnant and parenting women with substance use disorders in Chapel Hill, North Carolina. “A number of women [in our program] have described delivering babies in small hospitals and being made to feel like ‘dirt beneath the dirt’ by medical staff. This is a major concern because women who feel judged will often lie to health care providers about their situation and if we don’t have a clear picture of what is going on, we can’t get the best help for the mother and baby.”

While sexism and double standards impact the health, stigma and sentencing of women who use drugs, even the movement to reform drug policy is not immune from gender bias. Despite intentions to address the causes of the drug war and its deep roots in subjugation of low-income people and minorities, the reform movement does not always address the issues most important to these populations.

“One primary concern is that historically, a lot of funding [for drug policy reform] comes from libertarian movements,” explains Anna Saini, statewide organizer for VOCAL New York, a nonprofit agency that works to empower low-income people affected by HIV/AIDS, the drug war and mass incarceration. “These funders approach reform work from a more privileged, white male perspective, such as ‘the government should not be impeding my civil liberties’ or ‘I should control what comes in and out of my body,’ as opposed to addressing the impacts of the drug war on people of low income and resources.”

According to Jennifer Flynn, the first female executive director of VOCAL New York, it’s difficult to penetrate sexism within the drug policy reform movement precisely because many men see themselves as more progressive than they actually are.

“The harm-reduction movement can be a bit of a boys' club,” says Flynn. “Especially the high-level thinkers seem to consider themselves above racism and sexism. Things won’t change until they realize that they are guilty of it, too, and need to do something about it.”

Many women recall instances of sexism in the workplace, often in the form of being interrupted and talked over by men, or relegated to roles with little decision-making power. Denise Cullen, founder and co-director of the GRASP movement to organize mothers who have lost children to drug overdose, recalls an incident at a conference when she was speaking to a group of mothers.

“We were at a Moms United [to End the War on Drugs] meeting and a man came in and just took over the whole meeting. He went on for 20 minutes about supposedly looking for a cure for addiction. It was like he was saying, ‘I’ve got this, ladies. You can go home now.’”

But Cullen and other experts assert that sexism or lack of adequate conversation about gender bias within drug policy reform is not unique to the movement, but a reflection of how society at large views gender and work.

“In harm reduction, women are often in the role of service-oriented work in communities, while men dominate advocacy and policy work where most of the decisions are made,” says Anna Saini. “It’s the same idea of gender roles at work that we see play out in other social justice movements. It undermines women’s ability to take leadership positions and be part of the decision-making process.”

Lack of women in leadership positions means less attention to issues that affect women who use drugs, such as treatment access for pregnant drug users, the disproportionate HIV and hepatitis C burden for women who can’t access clean syringes, and growing proportion of middle-aged women dying of drug overdose. But evidence from many states shows that women’s leadership often produces the most compelling and consistent results for reform. The recent surge in the number of states with overdose prevention laws, such as the 911 Good Samaritan Overdose law and access to the opioid antagonist, naloxone, to reverse drug overdose, is often driven by mothers grieving the loss of a child. Even the fight for marijuana reform is being taken up, and won, by women.

“When we think of the marijuana issue, especially around stop and frisk, we think of an issue that effects mostly men,” says Anna Saini. “But here in New York we have a strong group of women and mothers fighting for medical marijuana to treat breast cancer or sick children. We can credit them largely with making medical marijuana happen here.”

Looking at the overdose prevention, medical marijuana and other successes, it’s clear to most experts that to ensure that the issues of women are addressed, the movement needs to embrace female leadership.

“To combat sexism we need to invest in the leadership of directly impacted women,” says Xochitl Bervera. “If we push forward without them, we run the risk of implementing reforms that sound good but actually perpetuate the same problems. Directly impacted women are the nexus [of the drug war]. They bear the brunt of all the various pieces, so they can bear the solutions as well. We need affirmative action to make sure to include directly impacted women on every panel, organization, action and legislative convening. Reform needs to come from conscious policies, not just good intentions.”

“Agency employees should have mandatory trainings on how to work with women and communities of color and how to make a deep and profound commitment to those issues,” says asha bandele, director of the Advocacy Grants Program at the Drug Policy Alliance. “Right now there is not a lot of space where women’s concerns are normalized within the general conversation. Too often they are ghettoized, an add-on.”

It won’t be easy change to implement. Sexism is engrained not only in every aspect of the drug war, but in every aspect of how we live our lives. Even the most progressive among us are not immune from its influence. But if there is any place from which to start, it should be from a movement that already questions social norms, already challenges the status quo, a movement like drug policy reform.