A/HRC/31/57 women, deters them from reporting rape and sexual abuse and can amount to torture or illtreatment per se. Health care and sanitation 25. Most prison health policies and services are not designed to respond to women’s specific health needs and fail to account for the prevalence of mental health and substance abuse problems among female prisoners, the high incidence of exposure to different forms of violence, and gender-specific sexual and reproductive health concerns.10 The provision of appropriate health-care services, including comprehensive, interdisciplinary and rehabilitation-oriented mental health-care programmes, as well as the provision of training and capacity-building to prison staff and health-care personnel to identify specific physical and mental-health needs of female detainees, are key to preventing mistreatment. 26. Of particular concern are a lack of specialist care, including access to gynaecologists and obstetric health-care professionals; discriminatory access to services like harmreduction programmes; lack of private spaces for medical examinations and confidentiality; poor treatment by prison health staff; failures in diagnosis, medical neglect and denial of medicines, including for chronic and degenerative illnesses; and reportedly higher rates of transmission of diseases such as HIV among female detainees. The absence of genderspecific health care in detention can amount to ill-treatment or, when imposed intentionally and for a prohibited purpose, to torture. States’ failure to ensure adequate hygiene and sanitation and to provide appropriate facilities and materials can also amount to illtreatment or even torture. It is essential to engage in capacity-building and adequate training for detention centre staff and health-care personnel with a view to identifying and addressing women’s specific health-care and hygiene needs. Pregnant women and women with small children 27. Studies suggest that up to 80 per cent of women in prison are mothers. 11 Many female prisoners are single mothers or primary caregivers, and imprisonment can result in considerable hardship for their children. Contact between detained mothers and their children is often difficult due to the remote location of female prisons. Concern about their children is a primary factor leading to the high incidence of mental health problems and self-harm among female detainees.12 The Bangkok Rules require that parental and childcaring responsibilities be taken into account in the allocation and sentence-planning processes. The best interests of the child, including the need to maintain direct contact with the mother, must be carefully and independently considered by competent professionals and taken into account in all decisions pertaining to detention, including pretrial detention, sentencing and the placement of the child (CRC/C/THA/CO/2). 28. The Special Rapporteur on Prisons and Conditions of Detention in Africa of the African Commission on Human and Peoples’ Rights noted in a 2001 report on prisons in Malawi that prisons were not safe place for pregnant women, babies and young children and that it was not advisable to separate babies and young children from their mothers. Even very short periods in detention settings can undermine a child’s psychological and physical well-being, compromise cognitive development and result in higher rates of 10 11 12 8 International Committee of the Red Cross (ICRC) Resource Centre, “Health in prison: looking after women in a man’s world”, 27 February 2009. Andrea Huber, “Women in criminal justice systems and the added value of the UN Bangkok Rules”, Briefing Paper, Penal Reform International, 2015. Laurel Townhead, Pretrial Detention of Women and Its Impact on Their Children (Geneva, Quaker United Nations Office, 2007).