Women experience increased barriers to health and social services, and when they use drugs and/or engage in sex work they experience additional stigma and discrimination. Women who are pregnant experience the additional judgements of government authorities and many health care providers about the choices they make including: to carry or not carry a fetus, to parent or give a child up, to access or not access prenatal care. In addition power imbalances in relationships mean that as injection drug users they are often second on the needle, reliant on a male for drugs to be injected. There are a range of factors, and layers of overlapping oppression including sexism, racism, and classism, that lead women to need women-centred harm reduction programs and policies responsive to their lived realities. Their resilience is our teacher.