A/HRC/38/36 significantly higher proportion of women than men are imprisoned for drug-related offences.55 77. In many countries, the proportion of women held in pretrial detention is equal to or larger than that of convicted female prisoners. 56 This heightens vulnerability to sexual abuse and other forms of coercion that can be used to extract confessions 57 and is compounded by race, disability, foreign national status and other situations of social discrimination. 78. Keeping women out of the criminal justice system in the first place by, for example, repealing laws criminalizing access to, and information about, sexual and reproductive health-care services, consensual adult sex, “morality” and minor drug offences is critical to protecting the right to health. B. Conditions of incarceration 79. Once incarcerated, women often face discrimination based on sex and/or disability and are subjected to treatment and conditions that mirror the violence and abuse the majority have experienced prior to their detention. In a number of countries, because of the limited accommodation available for women prisoners, women are subjected to security levels not justified by the risk assessment undertaken on admission. 58 The lack of available medical or mental health services may also result in women being placed in more secure facilities than otherwise indicated. 59 The situation is exacerbated for women with disabilities because of the scarcity of facilities to accommodate them, and even more so for women with psychosocial or intellectual disabilities, whose actual or perceived impairment is often used as the basis for higher levels of security. 60 80. Like their male counterparts, women in prisons recurrently face overcrowding, violence and unsanitary conditions detrimental to their mental and physical health and conducive to the spread of disease. It is frequently the case that little or no attention is paid to women-specific health-care needs, such as those related to menstruation, pregnancy and childbirth, menopause and sexual and reproductive health. 61 The lack of gender-specific health care in prison, including the lack of specialized obstetric and reproductive health services, poor treatment by staff, medical neglect and denial of medicines, lack of privacy for medical exams and confidentiality, and discrimination regarding access to harm reduction services, may amount to ill-treatment or in some cases torture, 62 and amounts to a violation of the right to health. 81. International standards require “special accommodation for all necessary prenatal and postnatal care and treatment” in women’s prisons,63 and that “adequate and timely food” and a healthy environment be provided free of charge for, among others, pregnant women and breastfeeding mothers.64 However, prenatal care is inadequate or non-existent in many prisons, even where widely available in the general population, and nutrition substandard. 65 55 56 57 58 59 60 61 62 63 64 65 16 Joanne Csete and others, “Public health and international drug policy”, The Lancet, vol. 387 (April 2016); A/68/340, para. 26; CEDAW/C/BRA/CO/7 and Corr.1, para. 32; A/54/38/Rev.1, part two, para. 312. UNODC, Handbook on Women and Imprisonment. Open Society Justice Initiative, Presumption of Guilt: The Global Overuse of Pretrial Detention (New York, Open Society Foundations, 2014); UNODC, Handbook on Women and Imprisonment. UNODC, Handbook on Women and Imprisonment. See, for example, Anti-Discrimination Commission Queensland, Women in Prison (2006). Available from https://www.adcq.qld.gov.au/__data/assets/pdf_file/0018/5148/WIP_report.pdf. UNODC, Handbook on Women and Imprisonment. A/68/340. See also Human Rights Watch, Going to the Toilet When You Want: Sanitation as a Human Right (2017). See A/HRC/31/57, para. 26. The Nelson Mandela Rules, rule 28. United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules), rule 48. A/68/340.