A Rights-based approach to address maternal mortality and morbidity: Statement by Ms. Navanethem Pillay United Nations High Commissioner for Human Rights

Geneva, 14 June 2010

Mr. President,
Excellencies,
Distinguished Panelists,
Ladies and Gentlemen,

Let me applaud the Council for highlighting maternal mortality and morbidity and for requesting my Office to report to the Council in this regard. I appreciate the opportunity to open this panel which will discuss the report entitled “Preventable Maternal Mortality and Morbidity and Human Rights” that my Office has prepared for this Council’s session pursuant to resolution 11/8. The panel will shed further light on this topic’s important links with human rights.

Human rights dimensions

I see the Human Rights Council’s discussion of the human rights dimensions of maternal mortality and morbidity as a milestone in its efforts and commitment to work on women’s rights. There are multiple human rights dimensions to maternal mortality and morbidity, ranging from how these compromise the right to life, to be equal in dignity, to education, to be free to seek receive and impart information, to enjoy the benefits of scientific progress, to freedom from discrimination, and the highest attainable standard of physical and mental health.  These issues also are relevant to the enjoyment of other human rights including, for example, the right to be free from cruel, inhumane and degrading treatment, the right to privacy and the right to an effective remedy.

Scale and causes

According to the latest UN official figures, 529,000 women die every year from pregnancy-related causes. In simple terms this is one death every minute. Meanwhile for every maternal death, an estimated 20 women suffer pregnancy-related injuries and disabilities - including in many cases, long-term disabilities such as organ prolapse, infertility, obstetric fistula or incontinence.   These affect approximately 10 million women annually.  Pregnancy and childbirth constitute particularly high risks for girls and adolescents whose bodies are not fully developed.

In many countries, complications relating to pregnancy and childbirth are the leading causes of death among girls and women between 15 and 19 years old, with 15 per cent of total maternal deaths worldwide occurring among adolescents. In some countries the risk of maternal death is as high as one in seven, whereas in others the rate of maternal mortality is extremely low.  This shows that maternal mortality can be reduced significantly.  In developed and developing countries alike, when maternal mortality and morbidity data are disaggregated, it becomes obvious that rates vary dramatically among ethnic and socio-economic communities.  This makes clear that addressing the disparities and inequalities in access to quality maternal health care services is a significant challenge.

About 80 per cent of maternal deaths are caused by one of the following medical causes: severe bleeding, infections, unsafe abortion, hypertensive disorders and obstructed labour. However, all too often, underlying these causes are gender-based violence and discrimination and more fundamentally lack of women’s full enjoyment of all their human rights. Experience and studies have shown that appropriate medical interventions and access to quality health care services are critical factors in reducing maternal deaths and disability.  Research and experience also show that medical interventions alone are not sufficient.   It is necessary to address the underlying socio-economic causes of these deaths and guarantee to women enjoyment of the full range of their human rights.

As my Office’s report makes clear, maternal deaths are overwhelmingly caused by a number of interrelated factors, especially delays, which ultimately prevent pregnant women from accessing the health care to which they are entitled.  These delays, often referred to as the “three delays”, are understood to encompass delay in seeking appropriate medical help for an obstetric emergency, delay in reaching an appropriate facility and delay in receiving adequate care when a facility is reached. 

These high rates of maternal mortality and morbidity are unacceptable considering that in a majority of these cases this can be avoided.  Loss of life is not an inevitable danger inherent in pregnancy and childbirth. It is often the result of policy decisions that directly or indirectly discriminate against women.

Maternal mortality and morbidity are dramatic in terms of scale. There is no single cause of death and disability for men in same age-range that comes even close, but causes of death and disability among men continue to receive more attention.  This is illustrated in some national contexts by the level of resources set aside for medical research into diseases prominent among men, compared with resources allocated to address maternal mortality and morbidity.

State obligations and commitments

Mr. President

When examining the elements of the three delays referred to above from a human rights perspective, numerous rights are at play and, consequently, a range of States’ human rights obligations are engaged. States are obliged under international human rights law to respect, protect and fulfill the human rights related to pregnancy and childbirth. These rights include the State obligation to ensure to women access to a wide range of sexual and reproductive health services as a part of preventing maternal mortality and morbidity. Similarly, obligations also exist requiring elimination of underlying risk-factors, such as violence against women, female genital mutilation and early marriage, which contribute to high rates of maternal mortality and morbidity.

States also have obligations to address unsafe abortion which is one of the main causes of maternal death. Notably in my own continent, Africa, with the development of the Maputo Protocol, Governments have committed themselves to a robust roadmap intended to reduce maternal deaths and disabilities directly. Among other things, the Protocol addresses unsafe abortion, strengthening sexual and reproductive health commodity security, with an emphasis on family planning and emergency obstetric care and referral, as well as the provision of sex education.

Though the 2000 Millennium Declaration and World Summit Outcome, the international community has committed itself to reducing maternal mortality and morbidity by three-quarters and achieving universal access to reproductive health by 2015. Despite these commitments, current MDG development measures indicate that the effort to reduce maternal mortality is insufficient and the target set for 2015 is unlikely to be met.    Indeed most disturbingly realization of Goal 5 on improving maternal health is the most off-track of all the MDGs.  In addition, the MDG progress in this area is not always linked to the human rights entitlements of those affected and the human rights obligations of those responsible for change. I hope OHCHR’s study will assist the General Assembly to ensure that a human rights based approach is fully integrated in the MDG process on this and other topics in September 2010.

In response to lack of progress in this area, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and various UN treaty monitoring bodies have consistently urged the international community to recognize and treat maternal mortality as a human rights issue of utmost importance, affecting all countries.
           
A human rights-based approach

Mr. President,

A human rights-based approach to preventable maternal mortality and morbidity can contribute to more effective, equitable, sustainable and participatory programmes and policies.  As a consequence this will lead to a reduction in maternal mortality and morbidity-rates.

The application of a human rights approach helps us understand that maternal mortality and morbidity are not simply issues of public health but the consequence of lack of fulfillment of multiple rights. Recognizing the right to health is a necessary step towards reducing maternal mortality, but is not sufficient to ensure implementation.  Rights embedded in treaties must be translated into services on the ground.

State obligations in the area of maternal mortality and morbidity, including procedural obligations, are underpinned by seven human rights principles: accountability, participation, transparency, empowerment, sustainability, international cooperation, and non-discrimination.  Translating these principles from rhetoric to reality is the core of a human rights-based approach. States and other actors providing international assistance and technical cooperation also need to approach their work on maternal mortality and morbidity from a human rights-based perspective.

A rights-based approach assists States to understand and make visible the connections among poverty, discrimination, equality and health.  This approach allows for the identification of high-risk groups, analysis of the complex gaps in protection, participation and accountability of States.   It also guides the formulation of policies, the setting of budgets and the implementation of programmes.  Accountability should not be narrowly understood as “naming and shaming”, but as an opportunity to identify the gaps and failures of the existing policies and programmes and ways to improve them. A key result of the human rights-based approach is that ultimately women will be able to exercise their right to participate in decision-making processes, including those affecting their sexual and reproductive health, family planning, contraception, pregnancy, childbirth, and in addressing unsafe abortion.

Mr. President  

In its conclusions the report offers some recommendations to the Council, including the suggestion that Member and Observer States systematically address the human rights dimensions of maternal mortality and morbidity in their reporting under the universal periodic review, and that the Council may consider requesting States to report on certain human rights aspects of preventing maternal mortality during the UPR. The report also suggests that the Council invite UN agencies, funds and programmes that are undertaking initiatives and activities in relation to maternal mortality and morbidity systematically to contribute information for consideration in the UPR. The report also encourages the Council’s special procedures to integrate consideration of the human rights dimensions of maternal mortality and morbidity within their respective mandates.  In this regard, it recognizes the contribution special procedures have made in this context.

The report acknowledges that there is, without a doubt, much good practice that States and other actors can helpfully share, and there is much scope for such good practice to be collected in a systematic and thorough manner.  A compilation of good or effective practice could be considered by an expert consultation co-hosted by relevant UN agencies.  This consultation would examine the operational aspects of a rights-based approach to maternal mortality and morbidity in greater detail.

As we approach this year’s assessment of MDG implementation it is the time for the Council to make very constructive and effective contributions to the global effort to eliminate maternal mortality and morbidity through its mandate to promote and protect human rights. The implementation and monitoring of the operational framework of human rights is also necessary.  Currently there is a vacuum in this respect at the international level, and thus it is even more important that the Council takes on this issue.

Let me once again thank the Council for considering this complex issue in-depth. The scale of maternal mortality and morbidity across the world is a stark reminder of the inequality and discrimination women in all parts of the world experience throughout their lifetimes.  These are maintained and perpetuated by formal laws, policies and harmful social norms and practices – and this deserves our collective attention.

Thank you.