HUMAN RIGHTS COUNCIL HOLDS PANEL DISCUSSION ON MATERNAL MORTALITY

The Human Rights Council this afternoon heard a panel discussion on the human rights dimensions of maternal mortality. Opening the discussion, Navi Pillay, the United Nations High Commissioner for Human Rights, said that according to the latest United Nations official figures, 529,000 women died every year from pregnancy-related causes, and for every maternal death, an estimated 20 women suffered pregnancy-related injuries and disabilities. In some countries the risk of maternal death was as high as one in seven, whereas in others the rate of maternal mortality was extremely low, showing that maternal mortality could be reduced significantly. About 80 per cent of maternal deaths were caused by a medical cause, but, all too often, underlying these causes were gender-based violence and discrimination, and more fundamentally, lack of women's full enjoyment of their human rights. Experience and studies had shown that appropriate medical interventions and access to quality healthcare services were critical factors in reducing maternal deaths and disability.

Ms. Pillay also noted that loss of life was not an inevitable danger inherent in pregnancy and childbirth; it was often the result of policy decisions that directly or indirectly discriminated against women. States were obliged under international human rights law to respect, protect and fulfil the human rights related to pregnancy and childbirth, and these rights included the State obligation to ensure women access to a wide range of sexual and reproductive health services as part of preventing maternal mortality and morbidity. Similarly, obligations existed requiring the elimination of underlying risk-factors, such as violence against women, female genital mutilation and early marriage.

Dragna Korljan, on behalf of Anand Grover, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, said it was a well known fact that the vast majority of deaths of women during pregnancy or at child birth could be prevented with low-cost, targeted interventions, and with far greater efficacy than the slow pace seen in many countries during the last decades. Many of the women who faced death or disability in the course of pregnancy were poor, lived in rural areas or in suburban neighbourhoods, or were adolescents and young women under the age of 25.

Rocio Barahona Riera, Member of the Committee on Economic, Social, and Cultural Rights, said the Committee was currently drafting a General Comment on the right to sexual and reproductive health. Its purpose was to give a clear definition of the legal content of this right, which included the adoption of public policies aimed at eradicating traditional harmful practices that were in violation of this right as well as access to child and maternal services, contraception information services, obstetric care and sufficient information to enable women to make their own decisions with regards to family planning.

Susana Fried, Senior Gender Advisor, HIV/AIDS, Bureau for Development Policy, United Nations Development Program, said human rights, including women's rights and gender equality, constituted common denominators in relation to maternal mortality and HIV/AIDS. According to the most recent evidence, 18 percent of maternal mortality globally was attributable to HIV/AIDS. Like gender equality, securing women's health, reducing maternal mortality and morbidity and addressing the gender dimensions of HIV/AIDS were human rights issues requiring concerted attention.

Aminta Touré, Chief, Gender, Culture and Human Rights Branch, United Nations Population Fund, said it was unacceptable in the twenty-first century that between 350,000 and 500,000 women continued to die every year while giving birth. The lack of progress in reducing maternal mortality in many countries highlighted the low value placed on the lives of women. A human rights-based approach was critical in applying the principles of accountability, the rule of law, participation, and non-discrimination into policies and programs.

Via a video presentation, Michael Mbizvo, Director of the Department of Reproductive Health, World Health Organization, said preventing maternal mortality required access to health services and access to information. It was also essential to ensure that there was quality care available and it could be accessed at affordable prices. Mr. Mbizvo emphasized the issue of education and said that where women were adequately educated, they were empowered to make decisions that ultimately reduced maternal mortality.

Alicia Yamin of Harvard Law School and Harvard School of Public Health, also addressed the Council in a video presentation, and she noted that that 99 per cent of maternal mortality occurred in developing countries. But it should not be forgotten that women in the developed world, including the United States, faced the same issues, such as access to affordable and quality health care and having their voices heard.

Mahmoud Fathalla, chair of the World Health Organization Advisory Committee on Health Research, noted that a recent study which tracked the progress in the reduction of maternal mortality in the past decades in 181 countries showed that significant progress had been achieved in a number of countries. Maternal educational attainment was one of the powerful drivers of this progress. Mr. Fathalla said that mothers were not dying because of conditions that could not be treated, but because societies had yet to make the decision that their lives were worth saving.

Ariel Frisancho, National Coordinator of the health team of Care International, Peru, said to save women’s lives, health care facilities must respect women’s dignity and human rights, and good quality, timely obstetric care, as well as other heath services, must be administered in a respectful manner. One of the most important challenges was to ensure appropriate participation, and when women enjoyed their right to participate in public policy decision-making, pregnancy would be safer for all.

In the ensuing discussion, speakers said, among other things, that maternal mortality and morbidity was a pressing and delicate issue connected with public health, poverty, gender inequality and discrimination against women. According to the World Health Organization, more than half a million women died of preventable pregnancy and child birth-related complications every year, while 10 million experienced injury, infection, disease or disability. Eighty per cent of women who died could be saved if they had access to basic health services. Many speakers were concerned because the Millennium Development Goal 5, reducing maternal mortality, was the farthest from being achieved and said that the Millennium Development Goals Summit in September this year was an opportunity to present the thematic study on maternal mortality and morbidity. Speakers hoped that the study would further discussions on human rights aspects of maternal mortality and would renew the commitment and action towards achieving the Millennium Development Goal 5.

Speaking in the discussion were the representatives of Colombia on behalf of a cross-regional group of 108 countries, New Zealand, Pakistan on behalf of the Organization of the Islamic Conference, Indonesia, Brazil, the African Union, Turkey, Spain on behalf of the European Union, Cuba, Burkina Faso, Hungary, Paraguay, Sudan on behalf of the Arab Group, Netherlands, Mauritius, Mexico, Japan, Senegal, Australia, Argentina, Belgium, Uruguay, Malaysia, Algeria, Finland on behalf of Nordic States, China, and Egypt. Also speaking were the following non-governmental organizations: Amnesty International and Centre for Reproductive Rights.

The Human Rights Council is scheduled to meet again at 10 a.m. on Tuesday, 15 June 2010 when it will hold a general debate on agenda item 8, follow-up to and implementation of the Vienna Declaration and Program of Action.


Introductory Remarks from the High Commissioner for Human Rights

NAVI PILLAY, United Nations High Commissioner for Human Rights, said she saw the Human Rights Council's discussion of the human rights dimensions of maternal mortality and morbidity as a milestone in its efforts and commitment to work on women's rights. There were multiple human rights dimensions to maternal mortality and morbidity, ranging on how they compromised the right to life, to be equal in dignity, to education and others that were relevant to the enjoyment of other human rights including, for example, the right to privacy and the right to an effective remedy. According to the latest United Nations official figures, 529,000 women died every year from pregnancy-related causes, and for every maternal death, an estimated 20 women suffered pregnancy-related injuries and disabilities. In some countries the risk of maternal death was as high as one in seven, whereas in others the rate of maternal mortality was extremely low, showing that maternal mortality could be reduced significantly. About 80 per cent of maternal deaths were caused by a medical cause, but, all too often, underlying these causes were gender-based violence and discrimination, and more fundamentally, lack of women's full enjoyment of their human rights. Experience and studies had shown that appropriate medical interventions and access to quality healthcare services were critical factors in reducing maternal deaths and disability.

It was necessary to address the underlying socio-economic causes of these deaths, and guarantee to women enjoyment of the full range of their human rights. Maternal deaths were overwhelmingly caused by a number of interrelated factors, especially delays, which ultimately prevented pregnant women from accessing the health care to which they were entitled. These high rates of maternal mortality and morbidity were unacceptable considering that in a majority of cases this could be avoided. Loss of life was not an inevitable danger inherent in pregnancy and childbirth; it was often the result of policy decisions that directly or indirectly discriminated against women. Maternal mortality and morbidity were dramatic in terms of scale. There was no single cause of death and disability for men in the same age range that came even close, but causes of death and disability among men continued to receive more attention. States were obliged under international human rights law to respect, protect and fulfil the human rights related to pregnancy and childbirth, and these rights included the State obligation to ensure to women access to a wide range of sexual and reproductive health services as part of preventing maternal mortality and morbidity. Similarly, obligations existed requiring the elimination of underlying risk-factors, such as violence against women, female genital mutilation and early marriage.

Through the 2000 Millennium Declaration and World Summit Outcome, the international community committed itself to reducing maternal mortality and morbidity by three-quarters, and achieving universal access to reproductive health by 2015. Despite these commitments, current Millennium Development Goal development measures indicated that the effort to reduce maternal mortality was insufficient, and the target set for 2015 was unlikely to be met, and the Goal on improving maternal health was the most off-track of all Goals. The international community should recognize and treat maternal mortality as a human rights issue of utmost importance, affecting all countries. A human rights-based approach to preventable maternal mortality and morbidity could contribute to more effective, equitable, sustainable and participatory programmes and policies. This would lead to a reduction in maternal mortality and morbidity rates. The application of a human rights-based approach helped to understand that maternal mortality and morbidity were not simply issues of public health, but the consequence of the lack of fulfilment of multiple rights.

Member States should systematically address the human rights dimensions of maternal mortality and morbidity in their reporting under the Universal Periodic Review, and the Council could consider requesting States to report on certain human rights aspects of preventing maternal mortality during the review. The Council should invite United Nations agencies, funds and programmes that were undertaking initiatives and activities in relation to maternal mortality and morbidity systematically to contribute information for consideration in the review. The Council's Special Procedures should integrate consideration of the human rights dimensions of maternal mortality and morbidity within their respective mandates. It was time for the Council to make very constructive and effective contributions to the global effort to eliminate maternal mortality and morbidity through its mandate to protect and promote human rights. The implementation and monitoring of the operational framework of human rights was also necessary. Currently there was a vacuum in this respect at the international level, and thus it was even more important that the Council took on the issue. The scale of maternal mortality and morbidity across the world was a stark reminder of the inequality and discrimination women in all parts of the world experienced throughout their lifetimes. These were maintained and perpetuated by formal laws, policies and harmful social norms and practices and this deserved collective attention.

Opening Remarks from Panellists on Maternal Mortality

DRAGANA KORLJAN reading out a statement on behalf of ANAND GROVER, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, said it was a well known fact that the vast majority of deaths of women during pregnancy or at child birth could be prevented with low-cost, targeted interventions, and with far greater efficacy than the slow pace seen in many countries during the last decades. Several United Nations agencies and non-governmental organizations around the world had been systematically drawing the international community’s attention to the magnitude of the problem. However, what the report and today’s panel brought to the fore was a lesser known fact: maternal mortality was not only a health issue, but also a human rights issue requiring the concerted efforts of various Government departments and civil society, as well as the political will to address discrimination against women in several areas. In fact, States had various obligations under international human rights law, including taking legal and policy measures – with the maximum use of their available resources – to address critical issues for the most vulnerable in society. Many of the women who faced death or disability in the course of pregnancy were poor, lived in rural areas or in suburban neighbourhoods, or were adolescents and young women under the age of 25.

When States agreed to the target in Millennium Development Goal 5 to reduce maternal deaths, they made an international commitment, at the same time reaffirming several of their international human rights obligations toward women. And yet, after two decades, this target was the furthest off track. Furthermore, the rights to health and to non-discrimination gave rise to a responsibility of international assistance and cooperation to reduce maternal mortality. Those responsibilities were reflected in Millennium Development Goal 8. The fact that Millennium Development Goal 5 was framed in such a way as to tolerate a continuation of the tragic and preventable deaths of some 125,000 women each year was a human rights failure of the highest proportions. Would the international community set a target that would explicitly allow 125,000 summary executions a year? Or 125,000 cases of torture? Worse yet, the fact that the international community was lagging behind so significantly on this already too modest goal confirmed that the human rights of those women had been utterly disregarded. That could not be allowed to stand and the international community still had the chance to set things rights. At the summit in September, and in the five crucial years that followed, the international community must insist on a right to health-approach to Millennium Development Goal 5 and, indeed, a human rights-based approach to all eight Millennium Development Goals.

ROCIO BAHARONA RIERA, Expert Member of the Committee on Economic, Social and Cultural Rights, said that the issue under discussion today was a highly important problem. There were massive violations of the right to health and of the right to sexual and reproductive health. Several States were not guaranteeing these rights, as enshrined in the International Covenant on Economic, Social and Cultural Rights. This situation also affected several related rights, such as the right to health, the right to life, the right to education, the right to non-discrimination, the right to equality, the right to culture and the right to enjoy and benefit from scientific progress. The recently adopted Optional Protocol to the Committee on Economic, Social and Cultural Rights would introduce the possibility to submit communications concerning violations under the Covenant. The Committee was currently drafting a General Comment on the right to sexual and reproductive health. Its purpose was to give a clear definition of the legal content of this right, in order to be able to help States parties to comply with their obligations regarding this right. This included the adoption of public policies, including those aimed at eradicating traditional harmful practices that were in violation of this right. Other obligations required States to guarantee equality of child and maternal services, contraception information services, obstetric care and access to sufficient information to enable women to make their own decisions with regards to family planning.

Ms. Barahona Riera said Millennium Development Goal 5 had raised much awareness about maternal mortality, but the world was very far from reaching the target, especially in the least developed countries and efforts should be targeted towards achieving this goal. Basic health services should be of good quality and free in certain cases. The Covenant required compliance of States parties with certain core obligations, such as providing resources for programmes on reproductive health, free contraception, family planning services, free and general access to post-partum care and access to safe abortion, among others. If these obligations were not implemented, sexually transmitted diseases and illegal abortion would otherwise continue to affect women and young girls throughout the world.

SUSANA FRIED, Senior Gender Advisor, HIV/AIDS Practice, Bureau for Development Policy, United Nations Development Programme (UNDP), said from the United Nations Development Programme’s perspective, human rights, including women's rights and gender equality, constituted common denominators in relation to maternal mortality and HIV/AIDS. Safeguarding women's rights and promoting gender equality was central to achieving all the Millennium Development Goals. According to the most recent evidence, 18 per cent of maternal mortality globally was attributable to HIV/AIDS. Like gender equality, securing women's health, reducing maternal mortality and morbidity and addressing the gender dimensions of HIV/AIDS were human rights issues requiring concerted attention. The importance of concrete action on gender equality could not be overstated: while gender equality was a human right and a Millennium Development Goal in and of itself, it was also essential to achieving the other Millennium Development Goals. Sustainable rights-based HIV/AIDS, health and development results depended on addressing the root causes or structural drivers, such as laws, policies and practices that failed to recognize the different conditions in which women and men lived and which impacted on their differential ability to claim rights and access HIV/AIDS and health services.

From UNDP's perspective, human rights were the common link with all Millennium Development Goals. HIV/AIDS and maternal mortality and morbidity were inter-elated, and both flourished when human rights were not enjoyed and inequality prevailed. Rights-based maternal mortality and morbidity programmes could have a broader impact on HIV/AIDS and other development goals. Multi-pronged strategies that addressed the need to scale up health and community systems could have an impact across health and non-health Millennium Development Goals, to empower women to secure their sexual and reproductive health, and to address root causes of vulnerability to maternal mortality and morbidity and HIV/AIDS through fostering gender equality and securing human rights. By the same token, rights-based HIV/AIDS programmes contributed to progress on maternal mortality and morbidity and other Millennium Development Goals. Across all the Millennium Development Goals, UNDP advocated tackling multiple goals at once, highlighting innovative interventions and scaling up local, country-led, and country-driven initiatives. Essential to this was investing in women, girls and gender equality; enhancing governance, and addressing the development dimensions of HIV/AIDS and health.

AMINATA TOURE, Chief, Gender, Culture and Human Rights Branch, United Nations Population Fund (UNFPA), said it was unacceptable in the twenty-first century that between 350,000 and 500,000 women continued to die every year while giving birth. The lack of progress in reducing maternal mortality in many countries highlighted the low value placed on the lives of women. Women, and particularly women living in poverty, were often unable to access care because they lacked the financial resources or the decision-making power to obtain a full range of quality reproductive health services. Based on its experience in 140 countries, the United Nations Population Fund believed that a human rights-based approach was the most effective and sustainable way to reduce maternal mortality and morbidity. A human rights-based approach was critical in applying the principles of accountability, the rule of law, participation, and non-discrimination into policies and programs. That meant to ensure that all cases of maternal mortality were recorded and explained; that participatory mechanisms were in place to ensure that women’s organizations participated in health planning at the local and national level; that national human rights institutions integrated reproductive rights into their work; that judges understood that preventable maternal mortality was a human rights issue; and that mechanisms were in place to ensure redress and reparation for victims and survivors of preventable maternal mortality.

The United Nations Population Fund also knew from experience that it was important to guarantee access to family planning, skilled birth attendance, and emergency and newborn obstetric care. These interventions had proven to be effective in many countries that appeared to have decreased their maternal deaths by half in only one decade. Community participation and community-driven interventions were also critical to reduce maternal mortality. There was also a need to focus on disadvantaged and marginalized people; improvements in national health indicators could mask a deteriorating situation for the poor and disadvantaged groups. In addition, user fees were a strong barrier to access of maternal health services because poverty in general and significant out-of-pocket expenditure was a challenge for poor women in need of services. The attention of the Human Rights Council to women’s rights and to maternal health had contributed to give a high profile to this issue in the development arena. It was known that human rights were the strongest argument because they were the highest moral argument that represented the natural aspiration of all peoples, of all women to enjoy the right to life and the right to live a life of dignity.

MICHAEL MBIZVO, Director of the Department of Reproductive Health and Research at the World Health Organization in Geneva, via a video presentation, said that preventing maternal mortality required access to health services and access to information. It was also essential to ensure that there was quality care available and it could be accessed at affordable prices. Mr. Mbizvo emphasized the issue of education and said that where women were adequately educated, they were empowered to make decisions that ultimately reduced maternal mortality.

ALICIA YAMIN, Harvard Law School and Harvard School of Public Health, via a video presentation, said that 99 per cent of maternal mortality occurred in developing countries. But it should not be forgotten that women in the developed world, including the United States, faced the same issues, such as access to affordable and quality health care and having their voices heard. Preventing maternal mortality required addressing what they already knew were underlying causes of maternal mortality and that in the United States one of the greatest concerns was discrimination. A recent study had shown that women of colour were four times more likely to die in birth than white women and this disparity was unacceptable.

MAHMOUD FATHALLA, Professor of Obstetrics and Gynecology, Egypt and chair of the World Health Organization Advisory Committee on Health Research said that empowerment was what women needed most for their health. The powerlessness of women was a serious health hazard, and particularly in maternal health. A recent published study which tracked the progress in the reduction of maternal mortality in the past decades in 181 countries showed that significant progress had been achieved in a number of countries. Maternal educational attainment was one of the powerful drivers of this progress. If the Council declared that women had a human right to go safely through the risky journey of pregnancy and childbirth, it would be sending a great empowering educational message for women.

While women in the north had long forgotten what maternal mortality was, their sisters in the south had come to accept it as a matter of fate, said Mr. Fathalla. But mothers were not dying because of conditions that could not be treated, but because societies had yet to make the decision that their lives were worth saving. Women needed to be empowered with the education that they no longer had to accept maternal death as a matter of fate.

ARIEL FRISANCHO, National Coordinator of the Health Team of Care International, Peru, and Steering Committee member of International Initiative on Maternal Mortality and Human Rights, said there had been important advances in the fight against maternal mortality. Credit should be given to those Governments that evidenced the political will and took effective action to reduce maternal mortality and morbidity. To save women’s lives, health care facilities must respect women’s dignity and human rights, and good quality, timely obstetric care, as well as other heath services, must be administered in a respectful manner. One of the most important challenges was to ensure appropriate participation, and when women enjoyed their right to participate in public policy decision-making, pregnancy would be safer for all. It was necessary to listen to the people; substantial and sustainable change would only be achieved if poor people had greater involvement in shaping health policies and practices. That was one of the contributions a human rights-based approach made to improving maternal mortality and morbidity.

Mr. Frisancho went on to say that the Council had an important role to play in eliminating maternal mortality and morbidity, and specifically in meeting the Millennium Development Goal 5. To more fully integrate maternal mortality and morbidity into its work, the Council could consider requesting States to report on certain human rights aspects of addressing maternal mortality and morbidity during the Universal Periodic Reviews. The Council should also invite relevant United Nations agencies, funds and programmes, as well as civil society and grass-roots organizations, to provide information on maternal mortality and morbidity for consideration in the Universal Periodic Review. Furthermore, individuals and their representatives should be proactively invited to those reviews and other consultations. Mr. Frisancho then explained that Care International used a “four delay” model, where the fourth delay was the political delay by Governments and donors in addressing maternal mortality as an urgent human rights concern. Nevertheless, the Council’s resolution gave hope that Governments and Member States had the political will to overcome that fourth delay. The international community needed to act together and succeed on behalf of all those who were waiting for its decisions.

Interactive Dialogue

In the ensuing discussion, speakers said, among other things, that maternal mortality and morbidity was a pressing and delicate issue connected with public health, poverty, gender inequality and discrimination against women. According to the World Health Organization, more than half a million women died of preventable pregnancy and child birth-related complications every year, while 10 million experienced injury, infection, disease or disability. Eighty per cent of women who died could be saved if they had access to basic health services. Many speakers were concerned because the Millennium Development Goal 5, reducing maternal mortality, was the farthest from being achieved and said that the Millennium Development Goals Summit in September this year was an opportunity to present the thematic study on maternal mortality and morbidity. Speakers hoped that the study would further discussions on human rights aspects of maternal mortality and would renew the commitment and action towards achieving the Millennium Development Goal 5. International solidarity, cooperation and coordination was crucial and speakers hoped that the September Summit would result in renewed political commitment, technical assistance, increased budgets and strengthened capacity of international organizations to improve the health of women. Funding for women’s health was not a cost, but an investment, and poor regard for maternal health was a reflection of a lack of respect for women and their rights. A human rights-based approach could be positive for preventing maternal mortality and morbidity throughout the world and several speakers wanted to hear what the Council itself could do to address this problem. Also, some speakers asked how addressing maternal mortality was linked to international human rights obligations and commitments of governments.

During the second slot of the panel discussion, speakers said that poverty and discrimination were just a few of the factors that caused preventable maternal mortality and morbidity. Speakers also expressed their sincere thanks to the panelists and called on all States to support their mandate and to promote good practices domestically in the fight against maternal mortality and morbidity. A number of Member States reiterated the importance of reviewing and updating health curricula in national education systems, which would continue to play a crucial role in helping to achieve Millennium Development Goal 5. All women had the right to life and the right to quality health care. Developing countries, and in particular rural areas within developing countries, needed greater technical and financial assistance from the world’s most developed nations. Women had the right to choose if and when they became pregnant and certain speakers stated that States also had an obligation to provide women with access to family planning as well as comprehensive sexual education to prevent unwanted pregnancies. States were responsible for protecting the rights of women and needed to ensure that all women had access to adequate health care and health-related education.

Concluding Remarks

ROCIO BAHARONA RIERA, Expert Member, Committee on Economic, Social and Cultural Rights, responding to questions asked by countries as to what could be done in terms of international cooperation, said the solution must come from the September meeting when the Millennium Development Goals would be evaluated. In Ms. Barahona Riera’s view, the solutions encompassed having more resources for international aid; ensuring coordinated work among the High Commissioner’s Office, the human rights committees, and other entities and stakeholders; ensuring a human rights-based approach to health; and making sure that stakeholders commit to guaranteeing sexual and maternal health and providing access to free care, particularly for women in vulnerable and poor situations. Those were essential aspects that must be addressed to reduce maternal mortality and human rights violations.

SUSANA FRIED, Senior Gender Advisor, HIV/AIDS, Bureau for Development Policy, United Nations Development Programme, in concluding remarks, said that a number of delegations raised the importance of the Millennium Development Goal 8, a global partnership for development, and said that the United Nations Development Programme considered international cooperation to be of utmost importance. Ms. Fried reaffirmed the importance of an integrated and rights-based approach as the essence of achieving all Millennium Development Goals. The United Nations Development Programme saw maternal mortality as a human rights issue and hoped to see it discussed during the September Summit. A recent document produced by UNAIDS-Agenda for Action, could be used as a framework for action of this Council in promoting the human rights dimensions of maternal mortality and morbidity.

AMINATA TOURE, Chief, Gender, Culture and Human Rights Branch, United Nations Population Fund, responding to questions raised in the panel discussion, said that developed countries had an obligation to help support developing nations in tackling this important issue. The United Nations Population Fund had undertaken a number of initiatives to help those countries where maternal mortality was most acute. These initiatives sought to address the root causes of maternal mortality and morbidity, including unwanted pregnancies and the need for better education and awareness. On the issue of ensuring that women had more decision-making power, Ms. Touré stated that women needed to be involved in the Government policies that affected them.

MAHMOUD FATHALLA, Professor of Obstetrics and Gynaecology, Egypt, and Chair of the WHO Advisory Committee on Health Research, said with the way the international community was going, Millennium Development Goal 5 would certainly be left far behind. The international community now only had two options: either to do it differently, by raising maternal mortality to a platform of human rights, or keep on doing the same thing. If they opted for the second option, they should at least have the honesty to look mothers in the face and say: “Sorry, we will fail you.”

ARIEL FRISANCHO, National Coordinator of the Health Team of Care International, Peru, in concluding remarks, referred to the question of increasing the participation of women in decision making that affected their health. First, political will was needed to downsize inequities and to implement the right of women to have a say. There were four layers in health: the first layer was good governance and participation of people; the second layer was dialogue and space, to address what did not work and talk about rules of the game, so that people had trust in the services, used them and thus contributed to their sustainability; third was social and economic environments; and finally, the will of donors and the international community who were mainly focused on technical interventions and did not see the importance of governance and participation. Regarding access to health services in remote areas, Peru was an example of a country which used mobile health teams. In order to do so, people had to be trained in cultural aspects, and needed resources and local partnerships, because formal health systems could not cover all the areas.


For use of the information media; not an official record

HRC10/078E