The Bangkok Rules 31 In addition, Member States of the UN have reached consensus on treatment strategy development that specifically includes references to gender.51 A gender sensitive approach to women’s health care should therefore also take into account the need to provide specialized treatment programmes for women substance abusers. Harm reduction programmes may be considered in programmes responding to the needs of women with drug dependency. Rule 16 Research in some countries indicate that women may be at higher risk of harming themselves or attempting suicide in comparison to men in prison, due to the higher level of mental illness and substance addiction52 among women prisoners and the harmful impact of isolation from the community on the mental well-being of women. These rules therefore provide for appropriate measures to safeguard against such acts. All too often initiatives to prevent suicide consist only of technical solutions, such as the removal of items that may be used for suicide, the introduction of additional restrictions to reduce possibilities of suicide, which do not address the cause of mental distress, which lead to acts of suicide or self-harm. Such precautions may in many cases exacerbate the situation. It must be emphasized that a fundamental element of strategies to reduce incidents of self-harm and suicide in prisons, is to create a prison environment, which promotes mental health. In parallel to the identification, and supervision of “at-risk” prisoners and the individual treatment provided to them, there is a need for prison managers and staff to take a proactive and positive approach to improve prison morale, in order to reduce incidents of self-harm and suicide. Rule 17 Women prisoners, typically from economically and socially disadvantaged backgrounds, and often uneducated and illiterate, will generally have received minimal education or awareness-raising about prevention from STDs and reproductive health conditions. It is therefore important to raise the level of knowledge and awareness among women in prison, in order to prevent the development of such diseases. Volunteers, health services from outside and NGOs may be constructively involved in providing such awareness raising and education. Consideration should also be given to giving access to condoms and dental dams to women prisoners, to prevent the spread of sexually transmitted diseases. Rule 18 Since all persons in prison, including women, enjoy the right enshrined in the International Covenant on Economic, Social and Cultural Rights, Article 12, to the highest attainable standard of mental and physical wellbeing, the preventive health services provided in prisons should be equivalent, at least, to those in the community, which means that women should receive all the preventive services, such as Papanicolaou test and screening for cancer, that are available in the community for their age group. Contraception should be available in prison on an equal basis as in the community, taking into account that contraceptive pills are not only used to prevent pregnancy, but also to treat other gender specific conditions, such as painful menstruation. The European Committee for the Prevention of Torture and Inhuman or Degrading Punishment has noted, “[t]he ___________ Ibid., referring to the Twentieth Special Session of the General Assembly, Devoted to Countering the World Drug Problem Together, 8-10 June 1998, paragraph 8 of the Declaration on the Guiding Principles of Drug Demand Reduction. 52 E.g. according to a study conducted by the Bureau of Justice Statistic in 2002 and 2004, mental health problems in prison were found to be much higher among women than men; in the UK, according to research published in 2006, 80 per cent of women prisoners were found to suffer from diagnosable mental health problems, 66 per cent were drug dependent or used alcohol to dangerous excess, 37 per cent had attempted suicide at some time in their lives (See UNODC Handbook on for prison managers and policy makers on women and imprisonment, 2008, p. 9). 51