Maternal Health Task Force

MHTF Blog

The Right to Survive Pregnancy and Childbirth

By: Melissa Upreti, Center for Reproductive Rights

For many women, pregnancy is a joyous occasion, but for millions of women worldwide, it is a dangerous proposition that could result in serious injury or even death.

Nearly 800 women die every day due to complications in pregnancy and childbirth, with the vast majority of these deaths happening in developing countries in the global South.

In many parts of the world, this reality is accepted as a fact of life, but the truth is that it is a violation of women’s human rights since, in most instances, the deaths are preventable. In fact, maternal death is too often directly tied to the severe gender bias women face, including discrimination based on their caste or tribe, where they live, and their socioeconomic status. This underlying discrimination frequently manifests as disrespect and abuse (D&A), which goes unchecked due to a lack of accountability norms, procedures, and mechanisms in health systems to ensure respectful maternity care (RMC). With no accountability for the ill-treatment of pregnant women, these human rights violations will continue.

When the Millennium Development Goals were created over a decade ago, the United Nations and member states prioritized ensuring maternal health care for women worldwide – right alongside eradicating poverty and combating diseases like HIV and AIDS. But the progress towards this critical goal has not been fast enough – and vast inequalities persist when it comes to accessing quality maternal health care with fatal consequence for hundreds of thousands of women.

The good news is that a woman’s right to survive pregnancy and childbirth is increasingly being recognized as a human right, and governments are increasingly being held accountable for their failure to protect a woman’s right to quality maternal health services. A leading global example is the case of Alyne – an Afro-Brazilian woman who died in Brazil after being denied timely medical attention in connection with her pregnancy. The Center for Reproductive Rights and Advocacia Cidadã Pelos Direitos Humanos helped bring Alyne’s case to the United Nations Committee on the Elimination of Discrimination Against Women making it the first maternal death case to be reviewed by an international human rights body. In the end, Alyne’s family finally got justice. The committee found Brazil responsible for violating Alyne’s human rights in 2011 and ordered the state to not only provide individual reparations to her family, but also work to reform their policies to prevent any other women from having to suffer the same fate.

What is profoundly disturbing about most maternal deaths is that there is often no accountability for them or for the abuse and humiliation pregnant women often endure when seeking medical care. It is the absence of formal redress mechanisms and the physical and emotional vulnerability of women during pregnancy and childbirth that often result in women remaining silent when subjected to D&A, making the violations essentially invisible.

In 2010, an Indian High Court considered a young woman’s case after she was repeatedly denied medical assistance during pregnancy because of her age and socio-economic status, and later forced to give birth under a tree not far from a government health clinic. The court concluded that the government failed in its obligation under the Indian Constitution to provide timely and quality maternal health care and awarded the woman financial reparations. Human Rights Law Network filed this case as part of a national legal strategy that the Center helped launch to bring reproductive health cases to the state high courts to seek legal accountability for reproductive rights violations in hopes that the government will improve monitoring and oversight of quality reproductive health care.

Fact-finding and the documentation of the ill-treatment of women in health care settings is another strategy used to establish and address the occurrence of D&A. Fact-finding missions—like those that have documented experiences with pregnancy and childbirth across Africa, Asia and the United States—have helped expose the nature and scope of human right violations associated with D&A. Importantly, they also shed light on the context in which health service providers operate, allowing them to point out the systemic gaps and failures that limit their ability to serve their patients well.

In 2011, the Kenya National Commission on Human Rights published an extensive report in which it highlighted, among other things, the government’s failure to ensure women’s access to RMC – formally calling on the government to take several remedial steps, including building a mechanism through which women can file complaints against health care facilities if they are mistreated.

These are examples of accountability strategies that have been used successfully to expose human rights violations in accessing maternal health care, including D&A, that may be replicated worldwide.

In order to promote RMC and put an end to the D&A of pregnant women seeking care, government health systems must establish accountability procedures and mechanisms and ensure their proper enforcement. Where such procedures and mechanisms already exist, governments must ensure that they are functional and responsive to complaints. Additionally, steps must be taken to empower women to utilize these mechanisms by raising awareness and ensuring adequate protection against retaliation.

The RMC Charter developed under the stewardship of the White Ribbon Alliance offers a framework based on human rights that all countries can use to ensure that every woman receives timely, quality maternal health care. However governments—especially health systems and health services providers—need to commit themselves to these principles and hold themselves responsible for providing quality maternal health care that is gender sensitive and complies with ethical obligations and human rights standards.

All women are entitled to maternal health care when they need it – regardless of where they live, their income, their caste or tribe. But as long as formal safeguards and policies against discriminatory and abusive practices remain absent and consequences for perpetrators of D&A are not enforced, women will continue to be particularly vulnerable and at risk of human rights abuses in healthcare settings.

This post was originally posted by the White Ribbon Alliance.

To promote the WHO’s consensus statement,”Prevention and elimination of disrespect and abuse during childbirth”, follow #EndDisrespect and contact Natalie Ramm at nramm@hsph.harvard.edu for a copy of our social media toolkit.

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