RISK FACTORS AND MEASURES TO REDUCE RISK for disciplinary offences. Other instruments of restraint may only be used when authorised by law and for specific objectives (e.g. precaution against escape, if other methods fail to prevent harm from prisoner or others). Furthermore, they should be imposed only when no lesser form of control would be effective to address the risks posed, and the method ought to be the least intrusive available and they should be removed as soon as possible. Training needs to be provided in the use of instruments of restraint, but also on control techniques which would obviate their need or reduce their intrusiveness.73 Additionally, the Bangkok Rules prohibit the use of instruments of restraint on women during labour, during birth and immediately after birth.74 Nevertheless, in some countries body restraints, such as shackles, are used on pregnant women during transfers to hospitals, gynaecological examinations and birth,75 despite pronouncements by medical specialists against the use of shackling during labour and childbirth.76 The CPT has stated that ‘[…] from time to time, the CPT encounters examples of pregnant women being shackled or otherwise restrained to beds or other items of furniture during gynaecological examinations and/or delivery. Such an approach is completely unacceptable, and could certainly be qualified as inhuman and degrading treatment. Other means of meeting security needs can and should be found.’77 Monitoring groups should ensure that their fact finding activities include an examination of the use of restraints on women, in particular on women who are in labour, who are giving birth and who have just given birth, with reference to the Bangkok Rules and the revised Standard Minimum Rules, which explicitly prohibit the use of instruments of restraint on these categories of women.78 h. Inadequate provision for gender specific hygiene, sexual and reproductive healthcare Poor conditions and services, exacerbated by overcrowding in many prisons, have a serious impact on the mental and physical wellbeing of all prisoners, including women. As this paper focuses only on those needs that are unique to women or which women experience much more acutely than men, two particular issues deserve being singled out. These are women’s gender specific hygiene and healthcare requirements. Women need to have regular access to water, especially in the case of women who are menstruating, who are going through menopause, who are pregnant or who have children with them in prison. Women also need to have ready access to sanitary towels/pads, free-of-charge, and without being embarrassed to have to ask for them.79 The CPT considers that the failure to provide basic necessities, such as sanitary pads, can amount to degrading treatment.80 Particularly in resource poor countries the special hygiene requirements of women and any children with them in prison can be severely compromised. They may also be discriminated against, as in the examples from Benin, referred to in an SPT country visit report: “ The delegation observed a woman in police custody with her 8 month old naked baby… The cell smelt overpoweringly of urine and faeces. The woman explained that there was no bucket for sanitation in the cell, as the police indicated that they would allow the woman out to use the toilet; however, she had called in vain at night and the baby had defecated in the corner of the cell. The woman had no means of cleaning the cell. Flies buzzed in the cell and the baby had several mosquito bites. In the morning the staff had come and taken her to the toilet near the cell. The delegation also observed a second cell (5m x 4.4m with a height of 2.7m) in which five men were detained. This cell had access to running water as well as a separate area with a toilet and a shower. 81 “ ” In [the] prison … there were four buildings in which detainees slept, but approximately 60 women, including babies and young children and all the female adolescent detainees, slept outside for lack of space … The conditions outside were extremely harsh and unhygienic, particularly for those women with young babies or for pregnant women. 82 ” 73. Revised Standard Minimum Rules, Rule 43 (2), Rules 47-49 and Rule 76 (c). 74. Bangkok Rules, Rule 24; see also revised Standard Minimum Rules, Rule 48 (2). 75. For example, in the USA since 2000, while 14 states have banned shackling women prisoners while they are in labour, efforts to halt the practice elsewhere are opposed by jail administrators. (see: http://www.thecrimereport.org/archive/2011-08-chained-and-pregnant and http://ipsnews.net/ news.asp?idnews=106119) <accessed 24 November 2015>.; see also ‘Va. House subcommittee rejects bill to restrict use of restraints on pregnant prison inmates’, By Associated Press, Published: February 9, http://apvonline.org/page/10/ <accessed 24 November 2015>. 76. For example, the American College of Obstetricians and Gynecologists and the American Public Health Association have condemned the practice of shackling, recognising that it compromises women’s health and causes severe pain and trauma. The Center for Reproductive Rights points out that unrestrained movement is critical during labour, delivery, and the post-delivery recovery period. (See Shackling of pregnant women and girls in correctional systems, NCCD Center for Girls and Young Women, (http://www.nccdglobal.org/sites/default/files/publication_pdf/shackling.pdf <accessed 24 November 2015>.). Amnesty International has reported the concerns expressed by an obstetrician and gynecologist at Northwestern University’s Prentice Women’s Hospital; in ‘Not part of my sentence: Violations of the Human Rights of Women in Custody,’ AI Index: AMR 51/01/99, Amnesty International, March 1999.) 77. The European Committee for the Prevention of Torture and Inhuman or Degrading Punishment, CPT Standards, CPT/Inf/E (2002) 1 – Rev. 2006, Extract from the 10th General Report, CPT/Inf (2000) 13, para. 27. 78. Bangkok Rules, Rule 24, revised Standard Minimum Rules, Rule 48 (2). 79. Bangkok Rules, Rule 5. 80. CPT Standards, 2006 Edition, Extract from the 10th General Report, CPT/Inf (2000) 13, para. 31. 81. Report on the visit of the Subcommittee on Prevention of Torture and Other Cruel, Inhuman or degrading Treatment or Punishment to Benin, CAT/OP/ BEN/1, 15 March 2011, para. 114. 82. Ibid. para. 185. 14 | Penal Reform International | Women in Detention: a guide to gender-sensitive monitoring