This article was co-authored with Michelle Movahead, attorney, and Laura Katzive, Deputy Director, both at the Center for Reproductive Rights.
The vast majority of women who die from complications of pregnancy and childbirth – 95% of the more than 500,000 who lose their lives every year – live in the Global South. Most of these deaths are preventable and can therefore be understood to reflect widespread indifference to the rights of the world’s poorest women. But this great global injustice is also evident, on a smaller scale, within high-income countries, such as the United States. In fact, the U.S. has one of the highest maternal mortality ratios among western developed nations. In 2005, there were a total of 623 maternal deaths in the United States. More often than not, such high rates of death during pregnancy and childbirth are inextricably linked to disparities and inequalities in women’s access to health care services.
This spring, the United Nations Human Rights Council adopted a landmark resolution on Preventable Maternal Mortality and Morbidity and Human Rights [Maternal Mortality Resolution], recognizing that maternal deaths and disease occur in all countries of the world and that there is a collective responsibility to eliminate it. The resolution marks the Human Rights Council’s first acknowledgment that these issues reflect governments’ failure to guarantee the rights to life, to equality and non-discrimination, to benefit from scientific progress, to information, and to health, including sexual and reproductive health.
In the resolution, the passage of which was first reported on RH Reality Check on June 18th, over 70 U.N. member countries, including the U.S., expressed grave concern over unacceptably high rates of maternal deaths and disease around the world and committed themselves to enhancing their efforts at the national and international levels to protect the lives of women and girls.
The U.S. government not only co-sponsored the resolution, but also played an active role during the negotiations of the text. This support reflects, without a doubt, a welcome shift towards positive and constructive engagement with the Human Rights Council and is consistent with the U.S.’s recent decision to take a seat on the Council. In addition, the U.S. government’s backing of the resolution, which specifically acknowledges the right to the highest attainable standard of health, including sexual and reproductive health, is a heartening step towards putting women’s human rights front and center. This approach is essential to addressing the high number of maternal deaths that occur within the U.S. every year.
Maternal mortality in the U.S. is characterized by pronounced racial disparities, which have remained unchanged for the past fifty years. African-American women are nearly four times more likely to die in childbirth than white women. Access to prenatal care can reduce the rates of pregnant women who die during pregnancy: women who receive no prenatal care are three to four times more likely to die after a live birth than women who receive any prenatal care.
Women of color are more likely to be denied medical care, including prenatal care, because they disproportionally fall within the group of Americans who lack private health insurance but have an income level too high to be eligible for public health care programs, such as Medicaid. Barriers to Medicaid eligibility, even for those women with qualifying incomes, can also prevent women from getting prenatal services.
In 2007, the United Nations Committee on the Elimination of Racial Discrimination (CERD) addressed the racial disparities and inequalities in access to health care in the U.S. And in its Concluding Observations, the Committee expressed concern and called on the federal government to take measures to improve access to sexual and reproductive health care services in order to address these disparities and reduce the rate of maternal deaths [ii].
The U.S. government should implement the CERD Committee’s recommendations and improve the quality of and access to health care services across the board in the country, but also enhance efforts internationally to eliminate preventable maternal deaths and disease, as the Council emphasized in the Maternal Mortality Resolution.
For example, the government has already taken positive steps to increase international assistance and cooperation on sexual and reproductive rights, by repealing the Global Gag Rule and restoring funding for UNFPA. President Obama also recently proposed to expand the funding for international family planning and reproductive health programs. The U.S. should continue strengthening these efforts to support sexual and reproductive health programs and policies abroad.
The Maternal Mortality Resolution is certainly a groundbreaking step towards the elimination of this grave violation of women’s human rights. What is needed now is to transform this commitment into concrete action to eliminate preventable maternal death and disease worldwide. And the U.S. has an opportunity to be a leader on this front, both at home and around the world.
[i] Human Rights Council, Preventable maternal mortality and morbidity and Human Rights, UN Doc. A/HRC/11/L.16/Rev.1 (2009).
[ii] Concluding Observations of the Committee on the Elimination of Racial Discrimination: United States of America, 72nd Sess., para. 33, U.N. Doc. CERD/C/USA/CO/6 (2008).