Harm Reduction Lessons for Reproductive Justice

Jaspreet Chowdhary

Harm reduction is a public health philosophy that emphasizes individual safety, regardless of lifestyle choices, over prohibition. How can this approach make sex work safer?

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.  

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.

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.

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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.

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 have previously blogged about abstinence-only programs, 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. 

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

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.

This post first appeared on Repossess Reproductive Justice.

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