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50 UNIVERSITY OF BOTSWANA LAW JOURNAL DECEMBER 2010 Conference launched “the global campaign to reduce maternal mortality” and had two key action messages: (1) “any pregnant woman can develop lifethreatening complications with little or no advance warning, so all women need access to quality maternal health services that can detect and manage lifethreatening complications” and (2) the presence of a health-worker with midwifery skills at every childbirth should be ensured. 44 In 1997, the focus of the Safe Motherhood Initiative shifted away from encouraging mass-training programs for traditional birth attendants to prioritizing health-sector interventions, which were designed to increase women’s access to a professional medical during pregnancy and childbirth, especially for lifethreatening complications. 45 The Safe Motherhood Initiative, launched by international agencies and governments, immediately found support in many other international coalitions and confederations, such as the International Confederation of Midwives (“ICM”). 46 The ICM, for example, used the Safe Motherhood Initiative to campaign for health care for pregnant woman to combat maternal mortality. 47 The “ICM’s clear message in the campaign for Safe Motherhood, which has been widely agreed [with] by other agencies, is that care during childbirth from an attendant with midwifery skills is the single most effective way to reduce maternal death.” 48 The Safe Motherhood Initiative developed along with the international community policies that continued to be established in international instruments after 1994. In 2004, WHO published a joint statement with ICM called “Making Pregnancy Safer,” which again emphasized the critical role of a skilled health care attendant at a birth in reducing maternal mortality, and comprised WHO’s own then-current drive toward Safe Motherhood. 49 ICM itself today works with other “professional federations,” such as the International Federation for Gynecologists and Obstetricians (“FIGO”), the International Council of Nurses (“ICN”) and partners with the Partnership for Safe Motherhood and New Born Health in advancing the goals of the Safe Motherhood Initiative. 50 United Nations agencies have also used the Safe Motherhood Initiative as impetus to develop priorities and programs to combat maternal mortality. As new international instruments have shaped international community policy, the resulting projects designed to reduce maternal mortality have also been reshaped. Since the ICPD Programme of Action established in international community policy the recognition that women have the right to go through pregnancy and 44 Safe motherhood initiative, supra note 50. 45 Id. 46 International Confederation of Midwives, The Safe Motherhood Initiative, http:// www.internationalmidwives.org/TheSafeMotherhoodInitiative/tabid/616/Default.aspx (last visited 4 March, 2010). 47 Id. 48 Id. 49 Id. 50 Id.
THE RIGHT TO MATERNAL HEALTH CARE 51 childbirth safely, including the right of access to appropriate health care services during pregnancy and childbirth, United Nations agencies have been able to approach reducing maternal mortality as a “human rights imperative.” 51 Drawing from the layers of international community policy that have been established by new international instruments since 1994 (see above table), United Nations organizations, such as UNFPA, have implemented strategies to reduce maternal mortality. UNFPA uses a three-pronged strategy to work toward the Millennium Development Goal of reducing maternal death globally: “(1) All women have access to contraception to avoid unintended pregnancies; (2) All pregnant women have access to skilled care at the time of birth; and (3) All those with complications have timely access to quality emergency obstetric care.” 52 Using this three-pronged strategy and drawing from international community policy as enunciated in the Millennium Development Goals, UNFPA has established the Maternal Health Thematic Fund to “increase the capacity of national health systems to provide a broad range of quality maternal health services, reduce health inequities, and empower women to exercise their right to maternal health.” 53 UNFPA has also joined with UNICEF, the World Bank and WHO – the four agencies collectively are known as “The Health 4” or “H4” – to enhance support to the sixty countries with the highest maternal mortality rates. 54 UN agencies are not alone in using a human rights approach to combat maternal mortality. The International Initiative on Maternal Mortality and Human Rights (“IIMMHR”), which is a partnership of “international, regional, and national civil society organizations” also seeks to make recognizing the connection between maternal mortality and human rights a political priority. 55 In promoting government accountability for the implementation of policies to reduce maternal mortality, IIMMHR lists five “core global commitments that address maternal mortality,” including the Millennium Development Goals, the Beijing Platform for Action, the World Summit Outcome and the ICPD Programme of Action among the five. 56 IIMMHR uses international instruments to establish that international community policy dictates that the reduction of maternal mortality is a human rights imperative. In so doing, IIMMHR is able to place attainable obligations on governments to eliminate preventable maternal mortality. Perhaps the most important obligation, at least the most effective in reducing maternal mortality, is to provide maternal 51 United Nations Population Fund, Safe Motherhood, http://www.unfpa.org/public/mothers/consensus.html (last visited 4 March, 2010). 52 Id. 53 Id. 54 Id. 55 IIMMHR, About Us, http://righttomaternalhealth.org/about-us/about (last visited 4 March, 2010). 56 International Initiative on Maternal Mortality and Human Rights Brochure, available at http:// righttomaternalhealth.org/about-us/about (last visited 4 March, 2010).
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