Summary
Highlights
The speaker shares her personal experience of premature birth as a Black woman, highlighting that race, not just socioeconomic factors, plays a significant role in poor maternal health outcomes. Black women are disproportionately affected by maternal mortality and premature births, despite income or education, due to systemic racism and how they are treated, seen, and valued in healthcare. The 2030 Agenda for Sustainable Development emphasizes human rights, including sexual and reproductive health rights, as crucial for addressing poverty, education, violence against women, and gender equality. These rights are fundamental to achieving the 17 Sustainable Development Goals, with each target acting as a metric and a claim for human rights.
A staggering 295,000 women die annually from pregnancy-related causes, with 94% of these deaths occurring in low and lower-middle-income countries. Complications from delivery, unsafe abortions, severe bleeding, infections, and high blood pressure are leading causes. For adolescent girls, pregnancy and childbirth complications are the leading cause of death. Maternal mortality often results from systemic violations of human rights principles, including accountability, equality, non-discrimination, and meaningful participation. Progress has been made, but not fast enough, underscoring the urgent need for human rights-linked efforts to ensure no one is left behind.
Many factors prevent women from receiving or seeking maternal care, including inadequate hospital equipment, lack of skilled personnel, and significant disparities between urban and rural areas. Indigenous women, in particular, often live in remote regions with limited access to emergency services. Gender biases, rooted in power structures and cultural norms, can limit women's autonomy, requiring permission from male relatives for medical decisions. Child marriage also contributes to higher maternal morbidity and mortality rates. Furthermore, mistreatment during childbirth, including physical and verbal abuse, discrimination, neglect, and unconsented procedures, is normalized, especially for poor and lower-caste women.
Almost half of all pregnancies globally are unintended, leading many women to resort to unsafe abortions when access to safe options is restricted. These complications are life-threatening, with unsafe abortions contributing significantly to maternal deaths. In countries like Mexico, abortion remains a leading cause of maternal mortality due to public health sectors being unwilling or unable to provide safe services, pushing women into dangerous alternatives. Conscientious objection by healthcare providers, as seen in Poland, prioritizes doctors' rights over women's rights to essential services, further exacerbating the issue. Maternal death risk is influenced by broader political, economic, social, and cultural factors including context, gender, race, social position, age, disability status, sexual orientation, ethnicity, religion, employment status, geography, and citizenship.
Accurate measurement of maternal mortality is crucial for monitoring progress towards SDG targets, as many deaths go uncounted or misclassified. Cities are investing in statisticians to track maternal deaths, acknowledging that without data, effective solutions cannot be developed. Strategic shifts are reframing maternal mortality from a medical issue to a human rights challenge, placing women and girls at the center. Advocacy for abortion access has been supported by scientific evidence demonstrating its necessity for public health and saving women's lives. Healthcare systems are strengthened when structured around the needs and values of individuals, supported by adequate resources and financing.
Referral systems are critical for ensuring women receive specialized care when needed. Mexico's recognition of traditional midwives, who have community trust and cultural understanding, has been vital in providing culturally appropriate services and referring high-risk cases. Lobbying for increased budget allocation to health is also crucial. Addressing mistreatment during childbirth requires tackling systemic issues like budget allocation, infrastructure, and medical education. Punitive measures can alienate health professionals, making it important to focus on supportive measures like counseling for burnout, employing more staff, and having effective referral systems to reduce violence and improve care.
Equipping healthcare providers with current tools, training, and clear guidelines, especially regarding abortion responsibilities, is essential for rights-based care. Education programs like 'values clarification' for midwives have successfully reduced maternal mortality and morbidity by promoting a woman's right to choose. Litigation is another pathway for change, as seen in Mexico where a Supreme Court ruling affirmed abortion access for health risks as a human right protected by the constitution. International human rights mechanisms, such as CEDAW, play a crucial role in holding countries accountable. The case of Eline da Silva Pimentel versus Brazil recognized maternal mortality as a human rights issue and a violation of women's right to equality, shifting the landscape for women to demand quality care.
Active community engagement is vital for upholding women's human rights during pregnancy and childbirth. Empowering communities through education and leadership in healthcare programs, such as advocating for hospital deliveries and making budget proposals, strengthens health systems. Increased awareness of human rights dimensions in reproductive rights, often through educational processes, has led to significant street protests, with women demanding their entitlements. Organizing women into collectives and informing them about care standards empowers them to negotiate with providers. Providing rights holders with complete information about their entitlements and expected quality of services is key to delivering on the SDGs and ensuring every woman's right to a positive, healthy childbirth experience.