A/HRC/41/34/Add.1 therapy is followed by voluntary entry into a therapeutic abstinence-based community, although entrants must pledge to participating in group therapy sessions for up to 18 months. Participants also sign a written pledge to reject all psychoactive substances, including medication linked to any mental health conditions. Upon completion of the programme, the detainee may return to his or her prison unit or be transferred to the “clean zone”, in which commitment to a drug-free lifestyle is compulsory. 73. The Special Rapporteur also observed the ongoing establishment of the Atlantis programme in Colony 2 for women, and improvements in the health-care services and facilities at the pretrial detention centre SIZO-5 in Osh. His visit to Colony 47 revealed the contrast between the detention facilities that have benefited from international cooperation and those that have not, which are deteriorating. He also visited the psychiatric hospital in Kyzyl-Jar, which hosts persons with mental and psychosocial disabilities, committed with or without a court sentence. 74. During his visit to detention centres, the Special Rapporteur noted the progress made in the implementation of the recommendations made by the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment after his country visit to Kyrgyzstan in 2011 (see A/HRC/19/61/Add.2). The Special Rapporteur on health paid special attention to recommendations on health-care personnel, awareness and the implementation of the Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Istanbul Protocol), detainees’ access to independent medical examination, and the number of qualified healthcare personnel in temporary and pretrial detention facilities. In the detention centres that the mandate holder visited, detainees had good access to independent medical examination, particularly in cases of tuberculosis. 75. The Special Rapporteur was also encouraged to learn that most doctors had received training on the Istanbul Protocol. He urges health-care personnel in detention centres to continue to report alleged cases of torture or ill-treatment and to work in cooperation with the relevant authorities to improve and streamline existing reporting processes. Health-care personnel have an ethical and legal duty to document alleged cases of torture and other illtreatment, and play a fundamental role in helping the State to fulfil its human rights obligations in this regard. 76. Medical personnel and the relevant authorities agreed that the jurisdiction of healthcare workers at detention facilities should be transferred to the Ministry of Health. The Special Rapporteur not only agrees with this approach but also strongly recommends that the Government find suitable ways and effective incentives to integrate prison health-care services into the national health system under the Ministry of Health. V. Sexual and reproductive health rights 77. Kyrgyzstan continues to face significant challenges in terms of empowering women to enjoy their sexual and reproductive health rights, including access to and use of family planning services. The percentage of married women who use modern contraceptive methods (around 28–30 per cent) has remained unchanged in recent years, and these methods continue to be ineffective, as shown by the large percentage of women who give birth within less than three years (18.6 per cent) and less than one year (9 per cent) after having given birth to their previous child. Furthermore, a large percentage of women (approximately 19 per cent in 2014) 26 do not have their needs met in terms of family planning, and the overall fertility rate is relatively high at 3.1 births per woman. Abortion continues to be one of the primary methods of birth control. 26 14 Kyrgyzstan, National Statistics Committee, “Kyrgyzstan multiple indicator cluster survey 2014: key findings”, December 2014, p. 11. The survey was carried out as part of the global multiple indicator cluster survey programme developed by UNICEF in the 1990s to collect internationally comparable indicators on the situation of children and women.