RECENT DEVELOPMENTS

The Human Rights Council's Resolution on Maternal Mortality: Better late than never

Ebenezer Durojaye

Doctoral candidate, Department of Constitutional Law, University of the Free State, South Africa

SUMMARY

The article examines data in relation to maternal mortality and the causes of death during pregnancy and childbirth. It analyses the United Nations Human Rights Council's Resolution on Maternal Mortality and its importance to the prevention of maternal deaths worldwide. The article argues that, although the Resolution of the Human Rights Council should have come sooner, nonetheless it remains a strong statement by a UN body to the international community, particularly poor regions such as Africa, to take adequate measures to address the causes of maternal deaths. The article concludes by commending the Human Rights Council for this Resolution and expresses the hope that greater attention will be given to the issue of maternal mortality by the international community in regions worst affected, such as Africa.

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* LLM (Free State); ebenezer1170@yahoo.com
1 Human Rights Council Preventable Maternal Mortality and Morbidity and Human Rights A/HRC/11/L.16/Rev 1, 16 June 2009.
2 World Health Organization Report of a meeting: Parliamentarians Take Action for Maternal and Newborn Health (2009) 8.
3 As above.
4 A Glasier et al 'Sexual and reproductive health: A matter of life and death' (2006) 368 Lancet 1595-1607.         [ Links ]
5 As above.
6 WHO The tenth revision of the international classification of diseases (1992).
7 See WHO Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA (2004).
8 WHO The World Health Report 2005 - Make every mother and child count (2005).
9 Eg, a report has shown that unsafe abortion constitutes about 30% to 40% of all maternal deaths in Kenya. See Center for Reproductive Rights Failure to deliver: Violations of women's human rights in Kenyan facilities (2007) 24. In Zimbabwe a study has shown that a lack of access to transportation is responsible for 28% of maternal deaths in rural areas. See Center for Reproductive Rights Briefing paper: Surviving pregnancy and childbirth: An international human right (2005), whereas in Ethiopia early marriage has been attributed as a major cause of maternal death in the country. See S Hailu et al 'Health facility-based maternal deaths audit in Tigray, Ethiopia' (2009) 23 Ethiopia lournal of Health Development 115-119.
10 WHO (n 8 above).
11 WHO 'Skilled attendant at birth - 2006 updates. Geneva: World Health Organization, 2006 http://www.who.int/reproductivehealth/global_monitoring/skilled_atten-dant.html (accessed 23 December 2009).
12 WHO, UNICEF, UNFPA and World Bank Maternal mortality in 2005 (2007)18.
13 The Safe Motherhood Initiative that was launched by the WHO, the World Bank, the United Nations Population Fund, the United Nations Children's Fund, the International Planned Parenthood Federation and the Population Council in 1987.
14 M Fathalla et al 'Sexual and reproductive health for all: A call for action' (2006) 368 Lancet 2095-2100.
15 WHO et al (n 12 above).
16 WHO Global burden of disease 2000, Version 1 estimates (2000).
17 WHO et al (n 12 above).
18 As above.
19 As above.
20 As above.
21 V Boama & S Arukumaran 'Childbirth: A rights-based approach' (2009) International Federation of Gynaecology and Obstetrics 125-127.         [ Links ]
22 Adopted by the 2nd ordinary session of the AU General Assembly in 2003 in Maputo CAB/LEG/66.6 (2003), entered into force 25 November 2005.
23 The Right to the Highest Attainable Standard of Health; ESCR Committee General Comment 14, UN Doc E/C/12/2000/4.
24 See the African Commission on Human and Peoples' Rights Resolution on Maternal Mortality in Africa Meeting at its 44th ordinary session held in Abuja, Nigeria, 10-24 November 2008, ACHPR/Res 135 XXXXIIII.
25 Goal 5 specifically relates to reducing maternal deaths by three-quarters by 2015. The MDGs are an outcome of the UN Millennium Declaration and Millennium Development Goals launched in 2000.
26 As above.
27 UN Department of Publication Information Africa and the Millennium Coals 2007 update (2007).
28 See WHO et al (n 12 above).
29 Report of the International Conference on Population and Development 7 UN Doc A/CONF 171/13 (1994).
30 Fourth World Conference on Women Beijing held on 15 September 1995, A/CONF 177/20.
31 See UN Commission on Human Rights adopted Resolution 2001/33 on Access to Medication in the Context of Pandemics such as HIV/AIDS, April 2001.
32 WTO Doha Ministerial Declaration on the TRIPS Agreement and Public Health, WTO Doc WT/MIN(01)/DEC/2 (2001).
33 n 31 above, para 2.
34 RI Cook et al Advancing safe motherhood through human rights (2002). See also A Yamin & D Maine 'Maternal mortality as a human rights issue: Measuring compliance with international treaty obligations' (1999) 21 Human Rights Quarterly 563-607; F Leeuwen & R Amollo 'A human rights-based approach to improving maternal health' (2009) 10 ESR Review 21-24.
35 CEDAW Committee General Recommendation 24 on Women and Health UN GAOR 1999 Doc A/54/38 Rev, para 8(2).
36 n 35 above, para 14.
37 See, eg, Concluding Observations to Democratic Republic of the Congo, para 14, UN Doc CCPR/C/COD/CO/3 (2006); see also Concluding Observations to Mali, para 14, UN Doc CCPR/CO/77/MLI (2003).
38 Center for Reproductive Rights Briefing paper (n 9 above).
39 n 29 above, para 7.3.
40 n 29 above, para 7.20.
41 Special Session: The African Union Conference of Ministers of Health, Universal Access to Comprehensive Sexual and Reproductive Health Services in Africa: Maputo Plan of Action for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights 2007-2010 Sp/MIN/CAMH/5(1) September 2006.
42 n 31 above, para 3.
43 n 31 above, para 4.
44 Fathalla et al (n 14 above).
45 As above.
46 As above.
47 N Master 'Per capita total expenditure on health in international dollars by country' http//www.nationmaster.com/graph/hea_per_cap_tot_exp_on_hea_in_int_dol-capita-total-expenditure (accessed 11 June 2009).
48 As above.
49 African Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, Abuja, Nigeria, 24-27 April 2001, OAU/SPS/ABUJA/3.
50 The 2nd ordinary session of the Conference of the African Ministers of Health CAMH/ MIN/Draft/Decl (II), Gaborone, Botswana, 10-14 October 2005. At this Conference, AU countries committed themselves to the achievement of universal access to treatment and care for all and reiterated the need to allocate 15% of their national budgets to health in line with the Abuja Declaration.
51 Maputo Declaration on Malaria, HIV/AIDS, Tuberculosis and Other Related Diseases Assembly/AU/Decl 6(II) 2003.
52 See, eg, The Guardian 'Africa's military spending rises by 51 per cent' 10 June 2008 http://www.guardiannewsngr.com/news/article06 (accessed 10 October 2009).
53 Art 2(1)(c) provides that '[s]tate parties shall combat all forms of discrimination against women through appropriate legislative, institutional and other measures. In this regard, they shall: integrate a gender perspective in their policy decisions, legislation, development plans, programmes and activities and in all other spheres of life.'
54 See the African Commission Resolution (n 24 above). Para 4 of the Resolution provides: 'Consider the declaration on the state of maternal health in Africa as a continental emergency and to take appropriate regional actions.'
55 See Center for Reproductive Rights Failure to deliver (n 9 above) 87.
56 They include Angola, Benin, Burkina Faso, Burundi, Cape Verde, Central African Republic, Chad, Comoros, Democratic Republic of Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, The Gambia, Guinea, Lesotho, Liberia, Malawi, Mauritania, Mozambique, Niger, Rwanda, Sierra Leone, Togo, Uganda, Tanzania and Zambia.
57 General Comment 14 (n 23 above) para 39.
58 O Nnamuchi 'Kleptocracy and its many faces: The challenges of justicability of the right to Health care in Nigeria' (2008) 52 Journal of African Law 1-42.
59 See conversation with Nuhu Ribadu, anti-corruption crusader, The Sun 24 May 2009.
60 Based on a presentation by A Tinker 'Safe motherhood as an economic and social investment', Safe Motherhood Technical Consultation in Colombo, Sri Lanka, 18-23 October 1997.
61 The decision to create the Global Fund was taken by heads of state at the 2001 G8 Summit in Genoa, Italy, at the urging of UN Secretary-General Kofi Annan.
62 UNAIDS AIDS Epidemic Report (2008) 17.
63 See E Durojaye 'Monitoring the right to health and sexual and reproductive health: Some considerations for African governments' (2009) 42 Comparative and International Law Journal of Southern Africa 227-263.
64 Durojaye (n 63 above) 245.
65 South African Human Rights Commission Fifth Economic and Social Rights Report (2004).
66 As above.
67 See A Bankole et al Barriers to safe motherhood in Nigeria (2009) 17.
68 See the case of Minister of Health v Treatment Action Campaign & Others 2002 10 BCLR 1033 (CC), where the South African government was held to be in breach of its obligation to fulfil the right to health of its citizens by failing to provide medicines to prevent mother-to-child transmission of HIV in accordance with constitutional provisions.
69 Christian Lawyers Association v National Ministers of Health & Others 2004 10 BCLR 1086.
70 See Glasier et al (n 4 above).
71 See Report of the Secretary-General on 'Co-ordinated and integrated United Nations system approach to promote rural development in developing countries, with due consideration to least developed countries, for poverty eradication and sustainable development' made at the substantive session of the Economic and Social Council, New York, 28 June to 23 July 2004, where it is stated that, although UN agencies have continued to play important roles in rural areas across the world, better results can be obtained if the activities of these agencies are well co-ordinated and integrated.
72 Center for Reproductive Rights Broken promises: Human rights, accountability and maternal death in Nigeria (2008); Amnesty International Out of reach: The cost of maternal health in Sierra Leone (2009).
73 Eg, in 2001 the UN General Assembly held a Special Session on HIV/AIDS known as the Declaration of Commitment.