RISK FACTORS AND MEASURES TO REDUCE RISK Monitoring groups should always check whether women’s special hygiene requirements are being provided for and whether the accommodation of pregnant women, breastfeeding mothers and women with dependent children take into account their and their children’s special hygiene needs. Monitoring groups can go further and, using the Bangkok Rules as a reference point, encourage the use of alternatives to imprisonment in the case of such categories of women, in order to protect the women from conditions which, in some countries, amount to inhuman and degrading treatment and taking into account the best interests of the children, as required by the Bangkok Rules and CRC.83 Women’s gender specific health rights, including specifically their reproductive and sexual health rights, are very often violated in prisons. These may include women’s lack of access to preventive healthcare services focusing on gender specific healthcare needs (e.g. cervical and breast cancer screening), as well as services to treat sexually transmitted infections (STI), including voluntary testing, treatment and care for HIV/AIDS to which women are particularly vulnerable,84 and despite the reality that women in prison comprise a high risk group for having acquired STI, due to their typical background, which may include experience of sexual violence, sex work and drug use. Pre- and post-natal care and healthcare services during delivery are also usually extremely inadequate. It is also important to note that medical examinations themselves can be experienced as inhuman and degrading in certain circumstances, for example, when a woman requests to be examined and treated by female healthcare specialists and her wishes are not granted for unjustifiable reasons. Women prisoners’ right to medical privacy and dignity during examinations may also be denied with the presence of security staff (sometimes male) during intimate examinations. For women who have been victims of gender-based violence, such practices can cause immense distress and humiliation. Monitoring bodies should assess whether genderspecific healthcare services, at least equivalent to those available in the community, are being provided to women prisoners, in line with the requirements of the Bangkok Rules.85 They should also check if when a woman requests that she be examined or treated by a woman physician or nurse, a woman physician or nurse is made available, to the extent possible, except for situations requiring urgent medical intervention, and where a male medical practitioner undertakes the examination, a woman staff member is present during the examination.86 Monitoring groups should also determine whether Rule 11 of the Bangkok Rules is being applied. This rule prohibits the presence of non-medical staff during medical examinations, but provide that, if it is necessary for non-medical staff to be present, for justified security reasons or because the woman requests a female chaperone, ‘such staff should be women and examinations shall be carried out in a manner that safeguards privacy, dignity and confidentiality’.87 i. Inadequate provision for family contact A key problem many women prisoners face is that the location of their place of detention is often far away from their homes, due to the small number of women prisoners and the corresponding small number of women’s prisons. This means that their families face challenges in maintaining contact with them. The disruption of links with their communities, families and especially their children can cause immense worry and distress to the women, many of whom are the primary carers of their children. In some countries where prisoners’ access to food is inadequate and where prisoners rely on their families for food, women prisoners can be severely disadvantaged. In addition, where conjugal visits are allowed, women prisoners usually do not enjoy the same rights as those of men. This is one of those areas where women prisoners are discriminated against in most prison systems, with very adverse consequences on the mental wellbeing of women prisoners. This disadvantage may be exacerbated in systems where disciplinary punishments include the reduction or prohibition of family contact. The Bangkok Rules place responsibility on the authorities to make special efforts to accommodate women close to their places of residence or the place where they would like to be eventually released.88 They also require prison authorities to make a special effort to facilitate links between women prisoners and their families, and to ensure that women have treated by a woman physician or nurse, a woman the same right to conjugal visits as men.89 Monitoring groups should assess whether such an effort is being made by the prison authorities in their countries and develop recommendations to ensure that women are accommodated closer to their homes, in line with the Bangkok Rules. They should also check whether, in cases where this cannot be done, prison authorities have introduced any measures which compensate for the disadvantages faced by women and make recommendations, where such measures have not been introduced. For example authorities may assist with transportation; if prisoners have access to telephones, they may increase the telephone calls female prisoners are allowed to make to their families and they may allow the extension of the length of visits, among other measures.90 83. Bangkok Rules, Rule 64. 84. Women have a particular physical vulnerability to HIV. Studies have shown that women are at least twice as likely as men to contract HIV through sex. The pre- existence of sexually transmitted infections (STI) can greatly increase the risk of contracting HIV. (Women and HIV in Prison Settings, HIV/ AIDS Unit, UNODC, p3.) 85. Bangkok Rules, Rule 10 (1). 86. Bangkok Rules, Rule 10 (2). 87. Bangkok Rules, Rule 11. 88. Bangkok Rules, Rule 4. 89. Bangkok Rules, Rules 26 – 28, revised Standard Minimum Rules, Rule 58 (2). 90. See PRI, Guidance Document on the United Nations Rules on the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules), 2013, p71. 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