Through evidence, change is possible.
Maternal Mortality: A Right to Health Approach Will Ensure Integrated Services and Save Lives
The article Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5, released in The Lancet last week, records a global reduction in maternal mortality rates. A reduction is certainly welcomed. At the same time, whatever the exact reduction – be it indicated by these figures or from the soon to be released U.N. figures – the reduction is not enough. The remaining deaths are largely avoidable, and progress in reducing maternal mortality has been slow.We know that discrimination (including discrimination against HIV+ women), lack of education, poor nutrition and lack of access to reproductive health services, family planning, ante-natal care, skilled birth attendants, effective referral systems and emergency obstetric care lead to maternal death. These are human rights issues.A human rights approach – a right to health approach to maternal mortality – would provide a dynamic model that can be applied in diverse contexts, as outlined by Paul Hunt, UN Special Rapporteur on the Right to the Highest Attainable Standard of Health (2002-2008), in?Supplementary Note on the UN Special Rapporteur's Report on Maternal Mortality in India (doc).?This model is concerned with factors/issues such as:
- The well being of women and newborns being at the centre of all maternal health services and facilities;
- A sufficient number of skilled birth attendants, providers of back-up emergency care, and technical senior managers in maternal health;
- Equality and non-discrimination: maternal health services and facilities that are accessible (in law and fact) to all, including women living in poverty, indigenous and minority women, those with disabilities, and adolescents;
- Transparency, with privacy: public access to all relevant health information (but not at the expense of confidentiality), such as the amount of public funds devoted to maternal health;
- Information: for example, so that women know the importance of skilled care at birth, and have the freedom and means to access that care;
- Accountability (such as through maternal health audits), with the cause of each maternal death being determined and corrective action taken to prevent avoidable deaths in the future;
- Maternal health facilities that are culturally appropriate and provide sexual and reproductive health services and education, family planning, ante-natal care, skilled birth attendance, and referral to/availability of emergency obstetric care;
- Women’s participation in policymaking, implementation and accountability;
- A maternal health strategy (integrated into the comprehensive national health plan) that is based on an up-to-date maternal health situational analysis informed by suitably disaggregated data, and promotes the integration of services, for example HIV/AIDS, ante-natal care, and PMTCT.