A/HRC/38/36 72. The manner in which women are actually or de facto deprived of liberty arises from structural inequalities and discrimination, harmful gender stereotypes and deep disadvantage, which lead to failure to secure their rights to social and underlying determinants of health, to reproductive autonomy, to an environment free from genderbased violence, and to services and support in the community. Once women are inside, the gendered and challenging environment of detention and confinement compounds their immediate and long-term health risks, reproduces past violence and trauma, and undermines the full and effective realization of the right to health for themselves and their dependent children and families left on the outside. A. Addressing the gendered pathways of incarceration 73. Studies in several countries have found that violence, sexual, physical and emotional abuse and economic dependence are linked to women’s incarceration. Many women in prison are mothers and the primary, if not only, caregivers for their children or other family members. In many countries, prison sentences for women lead to the incarceration of their infants or young children. Children left behind have limited contact with their mothers, often struggling to cope, living in street situations, in institutions, in foster care or with relatives.48 74. In some countries, pregnant women who use drugs, including legally prescribed drugs, face civil or criminal detention for extended periods of time, sometimes for the length of the pregnancy. This can have a discriminatory impact on women with disabilities who take prescription drugs while pregnant. 49 In other countries, women are imprisoned for “moral crimes”, such as adultery or extramarital relationships, or to protect them from gender-based violence (“honour crimes”).50 75. Criminal laws and legal provisions that restrict access to sexual and reproductive health goods, services and information also contribute to women’s imprisonment.51 In some States, dispensing information on preventing interrupting pregnancy or materials deemed to conflict with notions of “morality” or “decency” is criminalized with punishments ranging from fines to imprisonment. Criminal laws have also been used to prosecute women for other conduct, including failure to follow a doctor’s orders during pregnancy, failing to refrain from sexual intercourse and concealing a birth. 52 Where abortion is illegal, women may face imprisonment for seeking an abortion and emergency services for pregnancyrelated complications, including those due to miscarriages. Fear of criminal punishment for “aiding or abetting” abortions can lead health-care providers to report people suffering from pregnancy complications to authorities. 53 76. A substantial proportion of women in prison are incarcerated for non-violent, lowlevel drug offences: between 40 and 80 per cent in some countries in the Americas, Europe and Asia.54 While men are more likely than women to be involved in the drug trade, a 48 49 50 51 52 53 54 United Nations Development Programme, Addressing the Development Dimensions of Drug Policy (2015), p. 26; Moira O’Neil, Nathaniel Kendall-Taylor and Susan Nall Bales, “Communicating about women and criminal justice in the United Kingdom”, FrameWorks Research Brief (June, 2015), p. 3; Carolyne Willow, Children Behind Bars: Why the Abuse of Child Imprisonment Must End (Policy Press, 2015). Amnesty International, Criminalizing Pregnancy: Policing Pregnant Women Who Use Drugs in the USA (2017). A/68/340. A/66/254, A/68/340 and A/HRC/14/20. See A/66/254, paras. 18, 38 and 62. See, for example, CEDAW/C/SLV/CO/8-9, paras. 37–38. See A/68/340, paras. 23–24; Rebecca Schleifer and Luciana Pol, “International guidelines on human rights and drug control: a tool for securing women’s rights in drug control policy”, Health and Human Rights Journal, vol. 19, No. 1 (2017); Thailand Institute of Justice, Women Prisoners and the Implementation of the Bangkok Rules in Thailand (2014). 15