Hu­man right ap­proach to ma­ter­nal health


Ifound the tech­ni­cal guid­ance on the ap­pli­ca­tion of a hu­man rights based ap­proach to the im­ple­men­ta­tion of poli­cies and pro­grammes to re­duce pre­ventable ma­ter­nal mor­bid­ity and mor­tal­ity a very use­ful tool if well im­ple­mented es­pe­cially in Sub Sa­ha­ran Africa will re­verse the wor­ri­some trend in ma­ter­nal mor­bid­ity and mor­tal­ity.

It is not only rec­om­mended to pol­icy mak­ers and duty bear­ers but also to ad­vo­cates that en­gage govern­ment on daily bases to en­sure the right ser­vices to women are avail­able and ac­ces­si­ble ir­re­spec­tive of creed, re­li­gion or lo­ca­tion.

The tech­ni­cal guid­ance is a re­port of the Of­fice of the United Na­tions High Com­mis­sioner for Hu­man Rights (OHCHR). My ob­jec­tive in this ar­ti­cle is to pro­vide key high­lights of the 20 page re­port with the hope that it will catal­yse a re­sponse from rel­e­vant stake­hold­ers to seek to read the en­tire re­port as well as to de­velop key mes­sages and en­hance ca­pac­ity via train­ings that will em­power civil so­ci­ety or­gan­i­sa­tions and me­dia to do more ad­vo­cacy as well as em­power duty bear­ers and ser­vice providers to im­ple­ment ma­ter­nal health ser­vices from the an­gle of rights and not priv­i­leges.

The sum­mary is apt as it cap­tures the essence of the re­port as fol­lows “The present re­port con­tains con­cise tech­ni­cal guid­ance, in ac­cor­dance with the re­quest made by the Hu­man Rights Coun­cil in its res­o­lu­tion 18/2. The aim of the re­port is as­sist pol­icy mak­ers in im­prov­ing women’s health and rights by pro­vid­ing guid­ance on im­ple­ment­ing poli­cies and pro­grammes to re­duce ma­ter­nal mor­tal­ity and mor­bid­ity in ac­cor­dance with hu­man rights stan­dards. It high­lights the hu­man rights im­pli­ca­tions for mul­ti­ple ac­tors in the pol­i­cy­mak­ing, im­ple­men­ta­tion and re­view cy­cle, as well as the need for ro­bust en­force­ment mech­a­nisms and in­ter­na­tional as­sis­tance and co­op­er­a­tion.”

In its res­o­lu­tion 18/2, the Hu­man Rights Coun­cil re­quested the Of­fice of the United Na­tions High Com­mis­sioner for Hu­man Rights (OHCHR), in co­op­er­a­tion with con­cerned United Na­tions agencies and other ex­perts, to pre­pare con­cise tech­ni­cal guid­ance on the ap­pli­ca­tion of a hu­man rights-based ap­proach to the im­ple­men­ta­tion of poli­cies and pro­grammes to re­duce pre­ventable ma­ter­nal mor­tal­ity and mor­bid­ity, and to present it to the Coun­cil at its twenty-first ses­sion.

The re­port ob­served that the ma­ter­nal mor­tal­ity and mor­bid­ity con­tinue to ex­act a ter­ri­ble toll on women, and es­pe­cially im­pov­er­ished women, in many coun­tries world­wide. Some 287,000 women died of ma­ter­nal causes in 2010, and be­tween 10 and 15 mil­lion more suf­fer de­bil­i­tat­ing com­pli­ca­tions an­nu­ally, se­verely af­fect­ing their well-be­ing. The World Health Or­ga­ni­za­tion (WHO) es­ti­mates that from 88 to 98 per cent of ma­ter­nal deaths are pre­ventable.

It also re­minded us that the Mil­len­nium De­vel­op­ment Goal 5 aims at 75 per cent re­duc­tion in ma­ter­nal mor­tal­ity ra­tios from 1990 lev­els and uni­ver­sal ac­cess to re­pro­duc­tive health by 2015 and in 2010 at the High-level Ple­nary Meet­ing of the Gen­eral As­sem­bly on the Mil­len­nium De­vel­op­ment Goals in 2010, the Sec­re­tary­Gen­eral launched the Global strat­egy for women and chil­dren to ac­cel­er­ate progress. As a re­sult of the Global Strat­egy, an in­for­ma­tion and ac­count­abil­ity com­mis­sion was es­tab­lished, which is­sued a re­port rec­og­niz­ing the cen­tral­ity of hu­man rights to achiev­ing progress, and made 10 rec­om­men­da­tions, the im­ple­men­ta­tion of which can sup­port the guid­ance con­tained in the present re­port.

The re­port ob­served that hu­man rights are about em­pow­er­ment and en­ti­tle­ment of people with re­spect to cer­tain as­pects of their lives, in­clud­ing their sex­ual and re­pro­duc­tive health. In­ter­na­tional hu­man rights law in­cludes fun­da­men­tal com­mit­ments of States to en­able women to sur­vive preg­nancy and child­birth as part of their en­joy­ment of sex­ual and re­pro­duc­tive health rights and liv­ing a life of dig­nity. Sound pub­lic health prac­tice is cru­cial to en­able States to ful­fil these ba­sic rights, but it must be com­ple­mented by broader mea­sures to ad­dress women’s em­pow­er­ment.

It moved fur­ther to say that the tech­ni­cal guid­ance is grounded in the re­spect for sex­ual and re­pro­duc­tive health and rights, as set out in the Pro­gramme of Ac­tion of the In­ter­na­tional Con­fer­ence on Pop­u­la­tion and De­vel­op­ment and re­it­er­ated and ex­panded upon in sub­se­quent United Na­tions documents and In­ter­na­tional law. States must take all ap­pro­pri­ate mea­sures to elim­i­nate dis­crim­i­na­tion against women, in­clud­ing gen­der-based vi­o­lence, forced and early mar­riage, nu­tri­tional ta­boos, fe­male gen­i­tal mu­ti­la­tion/cut­ting and other harm­ful prac­tices. Ma­ter­nal mor­tal­ity and mor­bid­ity is a prod­uct of dis­crim­i­na­tion against women, and de­nial of their hu­man rights, in­clud­ing sex­ual and re­pro­duc­tive health rights.

It also high­lighted that ac­count­abil­ity is not an af­ter­thought in a rights-based ap­proach, but fun­da­men­tal to each stage of the process, from iden­ti­fy­ing ac­count­abil­ity gaps in a sit­u­a­tional anal­y­sis to en­sur­ing ap­pro­pri­ate mon­i­tor­ing mech­a­nisms and reme­dies in a na­tional plan, to al­lo­cat­ing re­sources for these mech­a­nisms and reme­dies, to en­sur­ing feed­back from the ground through to im­ple­men­ta­tion in prac­tice.

Un­der plan­ning and bud­get­ing, the guide­line has made a strong case for a hu­man rights-based ap­proach which re­quires a multi-sec­toral ap­proach to eco­nomic and so­cial plan­ning and bud­get­ing, in­clud­ing, at a min­i­mum, co­or­di­na­tion among a va­ri­ety of Govern­ment min­istries and de­part­ments, as well as with other key ac­tors, such as the pri­vate sec­tor, de­vel­op­ment part­ners and civil so­ci­ety. The guide­line also places ac­count­abil­ity at the heart of right based ap­proach to ma­ter­nal health as it has stress that ac­count­abil­ity is cen­tral to ev­ery stage of a hu­man rights-based ap­proach. It re­quires not just trans­parency but mean­ing­ful par­tic­i­pa­tion by af­fected pop­u­la­tions and civil so­ci­ety groups. It also em­pha­size the sig­nif­i­cance of mon­i­tor­ing in a hu­man rights frame­work which re­quires the use of in­di­ca­tors to sys­tem­at­i­cally track and eval­u­ate pol­icy and bud­getary ef­forts.

In con­clu­sion the guide­line also em­pha­size the need for re­view and over­sight through ad­min­is­tra­tive, so­cial, po­lit­i­cal and le­gal ac­count­abil­ity.

All com­ments to Dr Aminu Ma­gashi at health­weekly@ya­

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