1. 1 Shadow Letter on Brazil’s Excess Maternal Mortality Submitted to the Human Rights Committee, the official treaty monitoring body of the International Covenant on Civil and Political Rights by The Center for Reproductive Rights, a nonprofit legal advocacy organization dedicated to promoting and defending women ’ s reproductive rights worldwide. Andre Verani, JD, NYU Law & MPH Candidate, 2009, Emory University contributed to this shadow letter as part of his Fall 2005 International Human Rights Clinic project at New York University School of Law. The author can be contacted at averani@sph.emory.edu

2. 2 What is a “Shadow Letter”? Submitted by a non-governmental organization To the relevant Treaty Monitoring Body (e.g., Human Rights Committee) Addressing rights specified in a particular treaty and the implementation, or lack thereof, by a State Party to that treaty (e.g., International Covenant on Civil and Political Rights) It “shadows” the self-report submitted to the same Treaty Monitoring Body by a State Party (e.g., Brazil).

3. 3 Why Submit a Shadow Letter? To provide a more critical and independent assessment of a nation’s implementation of treaty-based human rights obligations. So the Treaty Monitoring Body (in this case, the Human Rights Committee) is more informed of the nation’s progress in implementation of such human rights.

4. 4 What is the Human Rights Committee? The International Covenant on Civil and Political Rights (Article 28) established the Human Rights Committee, which is composed of 18 human rights experts who are nationals of the States Parties to the treaty and serve in their personal capacities, not as governmental representatives.

5. 5 Authority of Human Rights Committee Article 40(4) provides for limited authority “The Committee shall:  “study the reports submitted by the States Parties”  “transmit its reports, and such general comments as it may consider appropriate, to the States Parties”  “transmit to the Economic and Social Council these comments along with the copies of the reports it has received from States Parties”

6. 6 Human Rights Committee Cannot: Enforce obligations of a State Party to the International Covenant on Civil and Political Rights to:  Submit initial and periodic reports,  Submit reports in a timely fashion, or  Respond effectively to the Human Rights Committee’s comments

7. 7 Human Rights Committee Can: Urge nations to increase compliance with human rights norms codified in the International Covenant on Civil and Political Rights (ICCPR) Provide an independent and informed assessment of States Parties’ compliance with ICCPR human rights duties, which can be of use to governments and civil society members who advocate for stricter human rights compliance

8. 8 Brazil’s “Excess” Maternal Mortality According to Brazil’s reports to the Committee on the Elimination of Discrimination Against Women (monitor for the CEDAW treaty), maternal mortality is one of the nation’s most serious health problems.

9. 9 Brazil’s “Excess” Maternal Mortality 98% of maternal mortality is preventable, according to a report by Brazil’s Federal Parliamentary Commission of Inquiry Maternal Mortality Ratio of 260 per 100,000 live births (and GDP of US$2,788), compared to:  Paraguay: MMR = 170 & GDP = US$1,069  Uruguay: MMR = 27 & GDP = US$3,308

10. 10 Compared to Neighbors

11. 11 International Covenant on Civil and Political Rights Treaty adopted by United Nations General Assembly in 1966, and later signed and ratified by Brazil Brazil is bound to “take the necessary steps... to give effect to the rights recognized in the present Covenant.” (Article 2) These rights include:  Right to Life (Article 6)  Right to Equal Enjoyment of Civil and Political Rights by Men and Women (Article 3)  Right to Equal Protection (Article 26)

12. 12 Legal arguments put forward in shadow letter by The Center for Reproductive Rights “Women’s lack of access to health services, particularly reproductive health services, has been identified by the (Human Rights) Committee as a violation of Article 3, which guarantees the right of equality of men and women.”  ICCPR Article 3 text: “The States Parties to the present Covenant undertake to ensure the equal right of men and women to the enjoyment of all civil and political rights set forth in the present Covenant.”

13. 13 Legal arguments put forward in shadow letter by The Center for Reproductive Rights Human Rights Committee’s General Comment 6: Right to Life (Article 6), 16 th Session, (1982) interprets Article 6 as requiring governments to take “positive measures” aimed at preserving life, and such measures should respond to both genders’ needs in keeping with Articles 3 and 26.  ICCPR Article 6(1) text: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”  ICCPR Article 26 text: “All persons are equal before the law and are entitled without any discrimination to the equal protection of the law…”

14. 14 In summation… “Because reproductive health care is an essential condition for women’s survival, these provisions collectively give rise to a governmental duty to ensure the full range of reproductive health services, including the means of preventing unwanted pregnancy.” “Brazil must provide better standards of care for all Brazilian women, particularly those who live in the poorest regions.” “Brazil must make the reduction and prevention of maternal mortality a priority.”

15. 15 Other topics addressed in this shadow letter: Abortion HIV/AIDS Violence Against Women Race Adolescents Income Inequality

16. 16 Shadow Letter’s suggested questions for Human Rights Committee to ask of Brazil “What steps are being taken to ensure that women have access to reproductive health services, as well as the provision of contraceptive methods and the dissemination of information regarding contraception?” “What measures are being taken to reduce the high maternal mortality rates, particularly among the most affected populations, namely rural populations and those with lower educational and income levels?” “A report by Brazil’s Federal Parliamentary Commission of Inquiry found that 98% of all maternal mortality deaths are preventable. Therefore, why is the current maternal mortality ratio in Brazil higher than in 1990 and the same as in 1995?”

17. 17 Did the Shadow Letter Impact Health? Shadow letter submitted September 2005 prior to the Human Rights Committee’s scheduled review of Brazil’s periodic report at its 85 th session. Human Rights Committee’s report issued in December 2005 subsequent to its review of Brazil’s periodic report concluded that in its next report Brazil, “should provide detailed information regarding the effectiveness of … measures taken to protect and promote human rights,” in reference to ICCPR Articles 3, 26, and others.

18. 18 Impact of Human Rights on Health? Did the shadow letter influence the Human Rights Committee’s official conclusions? Did the Human Rights Committee’s conclusions alter Brazil’s policies with regard to maternal health? And more broadly, how can we measure the impact of human rights treaties on public health?

19. 19 Sources The shadow letter is available at: http://www.reproductiverights.org/pdf/ltr_shadow _brazil1.pdf The International Covenant on Civil and Political Rights is available at: http://www.ohchr.org/english/law/pdf/ccpr.pdf