By Rosemary Okello and Terna Gyuse
The right to the highest attainable standard of health: not the most fashionable of human rights, but the limits on people's enjoyment of their right to health often coincide with continuing inequalities behind claims of economic growth or political reform.
The quality of life of women and children - particularly poor women, rural women, and women from ethnic and indigenous minorities - is a strong measure of real change for the world's most vulnerable people. During the month of June, women's sexual and reproductive health rights received some welcome attention.
"Of the 500,000 maternal deaths that occur annually worldwide, more than 250,000 occur in Africa. Pregnant women in Africa are at grave risk," Soyata Maiga told the 11th Session of the U.N. Human Rights Council. "Additionally, there are many countries at war in Africa, which compounds pregnant women's risk, with hundreds of thousands of women dying every year."
Maiga, U.N. special rapporteur on the rights of women in Africa, continued: "Socio-cultural practices such as early marriage, early pregnancy, violence, female genital mutilation, marginalization in decision-making regarding issues that concern women, low status of women within the African family, and the fact that women are not enabled or permitted to plan their pregnancies - each of these factors leads to maternal mortality, an issue that can be addressed and prevented if we tackle it as a human rights issue."
The ways in which sustained high levels of maternal mortality stem from a denial of rights was also the central focus of a conference held in Brussels at the end of May to review progress since the International Conference on Population and Development in Cairo. The 1994 conference was a watershed in terms of bringing a rights-based approach to population control and women's sexual and reproductive health.
In Brussels, Indu Capoor, executive director of India's Centre for Health Education, Training and Nutrition Awareness, shared the following anecdote, tracing how poverty sentences millions of women to a cascade of denials of their basic rights before maternal mortality brings impoverished lives to a full stop.
"What kind of human rights can you [speak of to] Lakshmi, a 13-year-old girl forced into marriage because her parents were poor? She was married off to a boy living in a nearby village. She got pregnant immediately, because she was expected to prove her fertility."
Poor women are systematically denied their right to education, to adequate and accessible health care, or to make family planning choices and control their sexuality - multiple inequalities that too often narrow their future prospects to zero.
"Being both poor and young, she has no access to money, information or health services such as ante-natal check-ups. As she has been poor all her life, she was also severely anemic. She had a premature delivery at five months," Capoor continued, "and the baby did not survive. She herself suffered from excessive bleeding and due to her anemic state, died soon after."
On average, a woman somewhere on the planet dies in childbirth every minute. Three quarters of these deaths are preventable.
"Maternal mortality is a human rights issue. Underlying the systemic failure to prevent maternal death is, depending on specific circumstances, the denial of the right to health, to equality and non-discrimination, to reproductive self-determination and to the benefit of scientific progress," said Ariel Frisancho of the International Initiative on Maternal Mortality as a Human Right.
The most recent global estimates of deaths in childbirth - 2005 figures released jointly by the World Health Organization, UNICEF, the United Nations Population Fund and the World Bank - show limited progress.
From 1990 to 2005, maternal mortality declined by 26 percent in Latin America; in Asia the decline was 20 percent over the same period. In Africa, the decline was less than one percent, from 830 per 100,000 live births to 820 - an estimated 276,000 African women died from pregnancy-related complications in 2005.
Speaking on the same Human Rights Council panel of experts as Maiga, Frisancho explained that the majority of these deaths are a result of what activists describe as the Five Delays.
"One, the time it takes to recognize that a woman is facing a life or death health problem; two, the decision-making time to seek services; three, the travel time to receive services; four, the delay in receipt of services upon arriving at the health facility; and five, the political delay by governments and donors in effectively addressing the issue of maternal mortality."
Some programs that respond to this need are in place, but they require greater funding and support from governments.
In Frisancho's native Peru, non-governmental organisations found that in addition to the familiar problems of distance, cost and staff shortages, indigenous women in the Ayacucho district did not trust state public health facilities.
Consultations with the community led to the adaptation of pre- and postnatal care and delivery in new - free - birthing centers to make them more culturally sensitive - including Quechua-speaking birth attendants, facilities for women to give birth in an upright position if they wished, and provision for a family member to receive the placenta in accordance with local traditions.
In West and Central Africa, a project run jointly by UNICEF and USAID in Ngaoundere, Cameroon and Kaedi, Mauritania trained several dozen doctors, midwives and assistants, and provided the towns' clinics with new equipment.
Training in better communication, management of labor and infection prevention improved maternal health, and community health workers were deployed to raise awareness on warning signs for complications in pregnancy, so that women and their relatives would not wait too long to seek emergency care.
In the Indian state of Uttar Pradesh, the rights NGO SAHAYOG has mobilized thousands of poor women to take issues of maternal care and other human rights violations to policy-makers. The women have formed the Mahila Swasthya Adhikar Manch (Women's Health Rights Forum in Hindi), which aims to allow marginalized women to gain a voice in policy-making in order to curb high rates of maternal mortality in the state.
The vision of a rights-based approach to reducing maternal mortality has been around for 15 years and more; what is needed are diverse, wide-scale actions to put it into practice.
On Jun. 17, the United Nations Human Rights Council passed a resolution recognizing that preventable maternal mortality is a violation of a woman's rights to life, health, dignity, education and information. It is hoped this will be a tool allowing women to press for greater accountability.
"Sustainable, substantial change will only be achieved if poor people have greater involvement in shaping health policies and practices," said Frisancho.
