A/HRC/38/36 Mistreatment of women during childbirth has been reported in prisons and immigration detention centres. Punishment by closed confinement and disciplinary segregation should not be applied to pregnant women, women with infants and breastfeeding mothers. 66 C. Women with disabilities 82. Women with disabilities, especially psychosocial disabilities, are disproportionately represented in prisons, both as compared to the general population and vis-à-vis male prisoners.67 The closure of psychiatric institutions and the lack of adequate housing, mental health and social services in communities have contributed to the increase in the population of women with psychosocial disabilities in prison. 68 The medicalization of women’s behaviour and the construction of women in conflict with the law as “mad”, “irrational” and “in need of repair” has contributed to the labelling of women in prison as having mental health conditions where men would not have been, and in turn, to the over-prescription of psychotropic medications for women suffering from normal levels of distress associated with detention. 83. Many prisons fail to provide reasonable accommodation to people with disabilities, which has significant consequences on their enjoyment of the right to health and, in some cases, may violate prohibitions against torture and ill-treatment.69 The misclassification of women with mental disabilities as higher risk also impede their chances of early release, exacerbating existing mental health conditions. 84. The story of how women end up actually or de facto deprived of liberty, and the high levels of violence and suffering they experience once inside detention facilities, is closely linked to failures to respect, protect and fulfil their right to health. Genderresponsive reforms have failed to effectively address these challenges, which disproportionally affect women in vulnerable, disadvantaged and marginalized situations. VI. From confinement to community: ending public-health detention 85. Confinement has long constituted a public-health strategy to stem the spread of infectious diseases and viruses, including leprosy, HIV and tuberculosis. Various legal frameworks, including national mental health laws, legitimize forced confinement on broad and subjective grounds, including medical necessity and dangerousness. Routinely, and in some cases increasingly, confinement is the policy instrument of choice for addressing complex social and public-health issues. Guided by worst-case scenarios, policies and practices regularly have a significant impact on groups in marginalized situations, entrapping them in criminal or public-health detention regimes on the basis of a health condition. This is despite mounting evidence that health outcomes for these groups, and for the communities in which they live, are better with health care and support in community settings. The place of public-health detention in our rapidly changing global world is a topical and important debate. In the light of the upcoming high-level meeting on the fight 66 67 68 69 The Bangkok Rules, rule 22. United States of America, Department of Justice, “Disabilities among prison and jail inmates, 2011– 12” (2015); Janet I. Warren and others, “Personality disorders and violence among female prison inmates”, Journal of the American Academy of Psychiatry and the Law, vol. 30 (2002); Emma Plugge, Nicola Douglas and Ray Fitzpatrick, The Health of Women in Prison: Study Findings (University of Oxford, 2006). Jennifer M. Kilty, “‘It’s like they don’t want you to get better’: Psy control of women in the carceral context”, Feminism & Psychology, vol. 22, No. 2 (April 2012). European Court of Human Rights, Price v. the United Kingdom, application No. 33394/96, judgment of 10 July 2001, and D.G. v. Poland, application No. 45705/07, judgment of 12 February 2013; United States Court of Appeals, Sixth Circuit, Stoudemire v. Michigan Department of Corrections et al., case No. 14-1742, decision of 22 May 2015. 17