A/HRC/32/44 Women’s sexual orientation and gender identity 58. In many settings, especially where same-sex consensual sexual behaviour is prohibited, lesbian, bisexual and transgender persons are deterred from seeking health services out of fear of being arrested and prosecuted. Even in countries where same-sex sexual orientation is not criminalized, lesbians are often discriminated against and mistreated by medical providers, which deters them from seeking health services. In some settings, they are subjected to coercive, inhumane and degrading practices such as “corrective” or punitive rape. Transgender persons are often subjected in law and practice to compulsory medical interventions without being given an opportunity for informed decision-making and choice. Their gender identity is pathologized in many countries and they are often subjected to mental and physical examinations and treatments and forced to undergo “conversion therapies”. Transgender persons’ biological needs, such as transitionrelated medical services, screening for cervical cancer, termination of pregnancy and contraception, are often refused by service providers. Women deprived of liberty 59. Women in detention have specific health needs, particularly in terms of mental and reproductive health care, that are often neglected. Preventive services related to cervical and breast cancer are often unavailable and antiretroviral therapy, even for pregnant women living with HIV/AIDS, is completely absent in some facilities. The lack of adequate access to hygiene facilities and products for women prisoners is a typical and crucial concern in all regions of the world, jeopardizing the dignity and health of women prisoners. Practices such as shackling pregnant inmates during labour still occur in some countries. Detained women also face violence, including sexual violence from other prisoners or by staff. 60. Women prisoners show high rates of mental health problems owing to violence and trauma to which they had been exposed and which are exacerbated by imprisonment. Concerns about their children also have a significant impact on the mental health of women prisoners, especially when they are breastfeeding; separation from their children creates anxiety and guilt, resulting in great suffering. Women are more likely to harm themselves or attempt suicide while in detention than men. Extensive reliance on preventive use of psychotropic medication for “safety” reasons in such situations is an example of overmedicalization. D. Instrumentalization of women’s bodies 61. Throughout their life cycle, women’s bodies are instrumentalized and their biological functions and needs are stigmatized and subjected to a politicized patriarchal agenda. States have also often treated women instrumentally as tools with which to implement population programmes and policies. This is sometimes carried out through the use of criminal sanctions and often under the guise of protecting women’s health and safety and with cultural or religious justifications. 62. Much of the discrimination in access to health services and the resulting preventable ill health of women, including maternal mortality and morbidity and infertility, can be attributed to the instrumentalization of women’s bodies for political, cultural, religious and economic purposes. 1. Negation of autonomy 63. The instrumentalization of women’s bodies may result in conditioning women’s access to medical assistance on the consent of a spouse or male guardian, causing withholding or delay of treatment, curtailment of women’s autonomy and denial of respect 12