THE list of human rights recognised by the international community continues to grow. Since 1948 when the Universal Declaration of Human Rights was adopted by the UN General Assembly the dimension of the rights issue, especially its nature, has changed enormously.
Rights of all variety have received formal recognition, and therefore states are legally obliged to implement them. From political freedoms that are essentially designed to empower people — such as the right to freedom of speech, association, movement, etc — the concept of human rights has moved on to a vast non-political area encompassing practically every aspect of human development that impacts on the quality of life of an individual. The latest to enter this hallowed precinct is 'preventable maternal mortality and morbidity' which the 47-member UN Human Rights Council has now recognised as a human rights issue.
In a landmark resolution adopted on June 18, governments (including Pakistan) expressed grave concern at the “unacceptably” high rates of global maternal mortality (1,500 women die daily in childbirth or due to pregnancy-related causes) and committed themselves to enhance their efforts at the national and international level to protect the lives of women and girls.
The resolution identified some of the factors that lie at the root of this problem. Poverty, gender inequality, multiple forms of discrimination and lack of adequate access to healthcare are some of them. The resolution recognised that the prevention of maternal mortality requires effective promotion of the human rights of women, in particular, their right to life and equality in dignity, education and access to information.
This is a positive development not just from the point of view of health. It reflects on the assertiveness of women's rights activists worldwide that such a demand can be made. It is now being increasingly recognised that maternal mortality rates are intrinsically linked to the status of women. A society that holds its female members in high esteem also cares for their health, maternal health being a top priority. That is why in UNDP's human development index the countries that figure high on the gender empowerment measure (GEM) also have a very low maternal mortality rate. The two are inversely proportionate.
Take Norway, for instance, that ranks at the top of the list in GEM and had a maternal mortality ratio (MMR) of seven per 100,000 live births in the year 2000 (the cut-off year for the data). The same year Yemen which is last (93rd) on GEM had an MMR of 430 per 100,000. Pakistan which is 82nd on GEM recorded an MMR of 329/100,000. It is said to be 276/100,000 according to the demographic and health survey of 2006-07.
Pakistan is a member of the Human Rights Council which adopted without a vote the resolution recognising maternal mortality as a human rights issue. Hence it was saved the dilemma of taking a position for or against the resolution. Earlier when 83 countries had presented the draft resolution to the Council in March 2009, Pakistan had not joined hands with the sponsors who had reaffirmed their commitment to address maternal mortality as a human rights issue.
When the preventable maternal mortality and human rights resolution is introduced in the UN General Assembly in its next session later this year, the votes of countries, such as Pakistan, will prove to be a test case.
The health professionals concerned with women's reproductive health in Pakistan recognise the link between maternal mortality and the rights of women. The Pakistan Demographic and Health Survey (PDHS) clearly states that a maternal death is not merely a result of treatment failure. It is the final outcome of the interplay between a myriad social, cultural and economic factors. It reflects the failure of a society to look after its mothers.
Will this concern reach those who can make a difference? These are the policymakers and those who shape opinion. The millennium development goals require Pakistan to bring down its MMR to less than 140 by the year 2015. It must also enhance the skilled birth attendance to 90 per cent — at present it is 39 per cent. The two are interrelated. If all the traditional birth attendants were to be trained so that they can identify health hazards in pregnancy and childbirth and refer risky cases to hospitals promptly, many lives would be saved. This would also call for an infrastructure of health institutions at different levels and a communication network to facilitate the transportation of women to a hospital if the need arises.
In this context it must be pointed out that many lives are lost due to unsafe abortions performed by untrained dais whose knowledge and skills are minimal. By denying the existence of this problem, we cannot solve it. According to the PDHS, five per cent of maternal mortality is due to abortions but experts feel sceptical about this data. The figure cited internationally is 13 per cent.
Dr Sadiqua Jafarey, chairperson of the National Committee for Maternal and Neonatal Health, would like the incidence of abortion to be reduced by preventing fertility through the effective use of family planning, She would prefer the focus to be on birth control, education and reproductive health to avert unwanted pregnancies that drive women to have their pregnancies terminated. This is a more feasible approach, she feels, than seeking to legalise abortion.
With all the brouhaha about maternal mortality and human rights, one wonders if it will really reduce the high MMR in Pakistan? Dr Jafarey expresses
strong doubts. She feels that laws alone make little difference. It is the political will that counts; for what use are laws if they are to be flouted?
She has a point. But to generate pressure on the government to honour its commitment it is important to create public opinion as has been done about women's rights. It is time, as the Human Rights Council resolved, that the government started talking about the human rights implications of maternal mortality and morbidity so that there is greater awareness about this issue.
The resolution requests the UN High Commissioner for Human Rights to prepare a thematic study on maternal mortality with the help of other UN agencies. This may help governments determine their priorities and give a direction to their efforts.