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PLOS BLOGS Speaking of Medicine and Health

Maternal mortality, human rights, and accountability

Dr Rhona MacDonald, freelance editor, rhonamacdonald@gmail.com

On the bus on the way to the International Roundtable on maternal mortality, human rights, and accountability organised by Professor Paul Hunt, former UN Special Rapporteur on the right to health in Geneva last week, ironically, the front page of the free transport newspaper was about a doctor who was being sued after a woman bled to death after giving birth. If only such deaths could make front page news in other parts of the world. Although recently disputed, it is beyond doubt that at least 500 000 women die every year from the complications of pregnancy and childbirth. In fact, the overall figure is probably much more as demonstrated by participants (from around the world) at the round table who described how, in their experience, for every one recorded maternal death, there are at least 3 more.

These tragic and preventable deaths are the culmination of human rights violations against women and girls in many aspects of their lives and at all levels of health decision-making. Ending these human right violations is essential for preventing maternal death and was the focus of the round table discussion—which was timed to take place the week before the UN Human Rights Council is likely to consider maternal mortality and morbidity and the MDG summit review in New York.

However, rather than only being a talking shop about human rights, the day included lively presentations from workers on the ground in Peru, Sri Lanka, Kenya, India, and Bangladesh about how they are using the human rights as a practical tool to measure maternal mortality and morbidity. Most importantly, some sort of accountability is an essential component of any human rights framework. Paul Hunt explained that there are three parts to accountability: monitoring, reviewing whether pledges, promises and commitments have been upheld, and the opportunity for redress or remedy. Later in the day, participants discussed whether this redress should be punitive or not (the consensus was no, not against individual health workers but rather against the “system” ie the state) and agreed that there is a pressing need to strengthen international accountability for maternal mortality.

As one participant remarked: “The days of “save the woman, save the child” are over. A woman has a right to life whether or not she is a mother.”

Editors note: To find out more about maternal, newborn and child health, you might be interested to check out the recent PLoS Medicine series on maternal, newborn, and child health in sub-Saharan Africa.

  1. Rhona wrote: “In fact, the overall figure is probably much more as demonstrated by participants (from around the world) at the round table who described how, in their experience, for every one recorded maternal death, there are at least 3 more.”
    This is shocking. Does anyone know of further evidence – anecdotal or otherwise – to support the suggestion that maternal mortality could be much, much higher than officially reported?

    Dr Neil Pakenham-Walsh MB,BS, DCH, DRCOG
    Coordinator, HIFA2015
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