1. Alisha Bjerregaard Center for Reproductive Rights

2. Defining Maternal Mortality and Morbidity Maternal death is “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” (WHO) Maternal morbidity refers to pregnancy- and childbirth-related illness and injury.

3. Statistical Overview Maternal Mortality Globally, leading cause of death of women of reproductive age. 1,500 women and girls die each day from pregnancy- related causes. Roughly half of the world’s maternal deaths occur in Africa.

4. Statistical Overview: East Africa Maternal Mortality cont… In East Africa, statistics pertaining to MM have stagnated or worsened in past decade. Kenya, Uganda and Tanzania currently all have maternal mortality ratios that hover around at least 500 maternal deaths per 100,000 live births per year. E.g. Kenya: 560/100,000 live births Far from meeting MDG target goals for MM.

5. Statistical Overview cont… Maternal Morbidity For every woman who dies in childbirth, thirty more women will suffer disability and injury. A key example of maternal morbidity is: Obstetric fistula, a chronic pregnancy-related injury which can cause incontinence and nerve damage, is particularly common in Africa. In East Africa, an estimated 6,000 to 15,000 new cases of fistula occur each year. When untreated, it can lead to premature death from infection and kidney failure and leave women isolated and stigmatized.

6. The vast majority of these deaths and injuries are preventable--NOT inevitable. This fact is strikingly evident in the maternal health disparities across regions. In industrialized countries the lifetime risk of dying in childbirth is 1 in 2800 compared to a 1 in 16 risk for a woman in Africa.

7. Leading Causes of Maternal Mortality and Morbidity (Based on our findings in Kenya, but many similarities across the region) Lack of access to quality maternal healthcare due to: physical inaccessibility, particularly in rural areas; lack of trained staff and necessary equipment; formal and informal user fees – in Kenya women are being turned away or detained in healthcare facilities for inability to pay; abusive treatment in facilities by healthcare providers, which deters women from seeking care. Early Marriage— young girls who bear children before their bodies are fully developed often suffer complications.

8. Leading Causes of Maternal Mortality and Morbidity Unsafe abortion—for e.g. in Kenya, unsafe abortion accounts for more than 35% of maternal deaths v. 13% globally. Due to: Lack of access to contraception and family planning information and high rates of sexual violence; restrictive abortion laws; lack of clarity around the law; lack of trained staff and equipment; stigma and discrimination by healthcare providers/community prevents women from accessing safe abortion and PAC services.

9. MM as a Human Rights Issue There is increasing recognition at the regional and international level that maternal mortality and morbidity is a human rights issue Maputo Protocol, Art. 14 (2005) Kenya (signed), Uganda (ratified), Tanzania (ratified) African Commission MM resolution (2008) Human Rights Council MM Resolution (2009)

10. Key Human Rights Implicated with Maternal Mortality High rates of maternal mortality could be linked to violations of a number of women’s rights, including: Right to life Right to health care Right to non-discrimination Right to decide number and spacing of one’s children Right to be free from inhuman and degrading treatment Right to privacy

11. Development of int’l standards TMBs have recognized that these rights are at play with maternal mortality: The CEDAW Committee has stated that high maternal mortality rates are an “important indication for States parties of possible breaches of their duties to ensure women's access to health care.” Human Rights Committee (HRC), has expressed concern over high rates of maternal mortality, and has framed the issue as a violation of women’s right to life. Noting with concern the relation between maternal mortality and illegal and unsafe abortion, the HRC has taken the position that legislation prohibiting abortion violates the right to life.

12. Treaty interpretation on MM The HRC has observed that “the right to life has been too often narrowly interpreted” and that “the protection of this right requires that States adopt positive measures” to prevent losses of life. The majority of maternal deaths are preventable, and therefore governments have a duty to adopt positive measures to prevent the loss of women’s lives. The CEDAW Committee has expressed its concern at the “lack of real understanding of discrimination against women as contained in the Convention, which includes both direct and indirect discrimination.” The Committee remarked that such indirect discrimination “is reflected, in particular…in the high maternal death rate.”

13. Accountability As made clear by the previous conclusions and interpretations from TMBs, with the recognition of maternal mortality as a human rights issue comes the opportunity to ensure accountability. Governments have the obligation to take positive measures to protect, promote and respect human rights.

14. Governmental Obligations There are very concrete things that governments can—and should—do to address maternal mortality. For example: Allocate sufficient funds—ensure transparency in budget allocation to address lack of trained staff, equipment, etc. Address financial barriers—eliminate formal and informal user fees Address abusive care—through trainings and by improving working conditions for healthcare workers; and through a patient’s bill of rights and strong complaints mechanisms Address unsafe abortion—reform abortion laws/ensure access to safe and legal abortion

15. Case Study: Accountability Strategy— Engaging Human Rights Commissions In 2007, the Center and FIDA-Kenya published a fact- finding report on maternal health in Kenya. As a result of the report findings, and the recognition that the Kenyan gov’t is failing to fulfill its obligations re: maternal health, the KNCHR decided to commence a public inquiry on maternal health, whose scope has now expanded to address reproductive rights in general. Expected to commence this year. Highlight this because may be of interest to some Kenyan advocates in the room and may be possible accountability strategy for others in the region.

16. Thank you