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70 UNIVERSITY OF BOTSWANA LAW JOURNAL DECEMBER 2010 Maternal Mortality Resolution i State accountability to the extent that the Maternal Mortality Resolution is a reflection of customary international law. State accountability to the extent that the Maternal Mortality Resolution is a reinforcement of already existing legal obligations under the CEDAW and other human rights treaties. Hold other states politically accountable through using: persuasion, technical assistance, dialogue, and emulation. Develop customary international law to recognize the right to maternal health care through: practice, legislation, pronouncements, and working with international organizations. a. CEDAW, supra note 21, at Article. 12(2). b. Id. See also Toebes, supra note 17, at 335. c. ICPD Programme of Action, supra note 27. d. Beijing Platform for Action, supra note 29. e. Millennium Development Goals, supra note 37. f. See Alston, supra note 120, at 57. g. See MDG MONITOR, http://www.mdgmonitor.org/index.cfm (last visited 6 March, 2010). h. World Summit Outcome, supra note 38, at 57(g). i. Maternal Mortality Resolution, supra note 39. Clarification of Policy Alternatives for States: Recommendations for the United States The United States is not immune to the tragic problem of maternal mortality. In spite of being among the world’s most technologically advanced and wealthy nations, the United States currently falls behind more than 40 other countries when it comes to rates of maternal death. 118 “More women die in the U.S. after giving birth than die in countries like Poland, Croatia, Italy and Canada, to name a few.” This year, the Joint Commission, an independent nonprofit organization that accredits and certifies health organizations and programs in the U.S., issued an Alert that warns: “current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.” 119 Citing a Center for Disease Control and Prevention study, the Joint Commission notes that in the U.S. there is a four-fold increased risk of pregnancy-related death for black women, and an increased risk for women who did not receive prenatal care. For marginalized women in the United States, gaining access to maternal health care may be as difficult as in some of the world’s least developed countries. The United States should take on a leadership role in recognizing the right to maternal health care as a human right, not only to assist and protect 118 K. Snow & S. Amos, Maternal Mortality Rates Rising in California, ABC World News (Mar. 4, 2010), available at http://abcnews.go.com/WN/changing-life-preventing-maternal-mortality/story?id=9914009. 119 The Joint Commission, Preventing Maternal Death, 44 Sentinel Event Alert (26 January, 2010), available at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_44.htm.
THE RIGHT TO MATERNAL HEALTH CARE 71 pregnant women in the United States, but also to tackle the atrocious problems of maternal and infant mortality globally. To elaborate on the policy alternatives for states outlined in Table 2 above, this paper offers recommendations for the United States to advocate for the right to maternal health care globally. The United States should ratify the CEDAW and the CEDAW Optional Protocol. Amnesty International notes: The United States is among a small minority of countries that have not yet ratified CEDAW, including Iran and Sudan. The United States has the dubious distinction of being the only country in the Western Hemisphere and the only industrialized democracy that has not ratified this treaty. The Senate Foreign Relations Committee voted in July 2002 to recommend ratification of CEDAW, but the Treaty has never come before the full Senate for a vote. 120 Currently, the CEDAW is only eight countries away from universal ratification (with 186 states parties to the CEDAW as of March 2010). 121 Without ratification, the United States is not accountable under the provisions of the CEDAW, including Article 12(2), which ensures maternal health care. To help develop a stronger international law regime for the right to maternal health care, the United States should ratify the CEDAW and the Optional Protocol, and support enforcement of CEDAW commitments by the CEDAW Committee to hold other nations legally and politically accountable for the right to maternal health care. The United States needs to hold itself legally accountable under the CEDAW, and therefore ideally ratification should occur without reservations. In 2002, the last time the CEDAW came before the Senate Foreign Relations Committee, ratification was recommended subject to reservations, understandings and declarations. 122 The understandings included: “The United States understands that Article 12 permits states parties to determine which health care services are appropriate in connection with family planning, pregnancy, confinement and the post-natal period, as well as when the provision of free services is necessary, and does not mandate the provision of particular services on a cost-free basis” and that “nothing in this Convention shall be construed to reflect or create any right to abortion and in no case 120 Amnesty International, Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), http://www.amnestyusa.org/violence-against-women/ratify-the-treaty-for-the-rights-ofwomen-cedaw/page.do?id=1108216 (last visited 6 March, 2010). 121 N. Gabr, Chair for Committee on the Elimination of Discrimination Against Women, Statement to Commission on the Status of Women Fifty-Fourth Session (1-12 March, 2010), available at http:// www.un.org/womenwatch/daw/beijing15/statements/CEDAW.pdf. 122 Library of Congress, Legislative Actions: The Convention on the Elimination of All Forms of Discrimination Against Women, Treaty No. 96-53 (2002), available at http://www.thomas.gov/home/ treaties/treaties.html.
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