Human Rights
Human rights and maternal and newborn mortality
The world has failed to ensure that all women and newborns have access to life-saving emergency obstetric care (EmOC). Each day, this shameful injustice costs 1000 women their lives and many more their health and dignity. This almost always occurs in developing countries.
EmOC is not just one good idea among many. Its provision is an obligation. AMDD is working to ensure that access to EmOC is viewed as a basic human right, not just a health concern. Our work is guided by the firm belief that achieving the right to health includes working towards health systems that provide access to EmOC for all women and newborns.
Making change: Using a human rights approach
Human rights guide program change in Peru
In 2000, AMDD partnered with CARE to initiate the five-year FEMME Project to improve EmOC services in Ayacucho, Peru. Many women had been reluctant to utilize EmOC facilities. They felt services paid little attention to their needs and showed little sensitivity toward local culture.
In response, the project focused on human rights to improve quality of care and access to EmONC. The facilities redesigned their labor and delivery wards to respect women’s privacy during childbirth. All staff began referring to the women by name and not their bed number. The project also made specific efforts to ensure it was providing non-discriminatory services to indigenous clients. They rewrote signs in both Spanish and the local language. One health team redesigned the birthing chairs to accommodate the vertical birthing positions that most women preferred. In the end, the project’s human rights approach likely saved many lives. Women felt more respected and found the health system more acceptable. In turn, many more women utilized the EmOC services they had once avoided. AMDD's work in Ayacucho made an impact on policies and programs related to EmOC throughout the region.
Read the published article on the project.
AMDD’s approach to human rights
AMDD uses human rights principles to shape health programs and policies that put EmOC services and systems in place. We do not focus on naming and shaming violators of human rights. Nor do we limit our work to denouncing the injustice of death in pregnancy and childbirth. Rather, we use human rights to form meaningful, focused strategies that respect, protect, and fulfill rights. We use human rights as a tool to guide what we do as public health practitioners – and how we do it.
The health system and human rights
AMDD’s approach to reducing maternal and newborn death is rooted in our belief that a country’s health system does more than simply deliver medical care. The health system is a core social institution that plays a central role in people’s lives and communities. Indeed, today, the experience of abuse and marginalization by the health system is part of the very experience of what it means to be poor in many countries in both the North and South. By providing equitable, respectful, and high-quality maternal and newborn care, health systems can advance social justice and reaffirm the worth and dignity of the people they serve.
How AMDD uses human rights to focus programs and policies: Some examples
When AMDD works with ministries of health to evaluate the coverage, quality, and use of EmOC services through needs assessments, the human rights principle of non-discrimination is used as a guide. The needs assessments enable us to look at whether certain groups (defined by race, class, or religion) have access to functioning health facilities.
In our human resources for maternal survival work we examine whether health workers are being treated with the dignity and respect they deserve. We know that it may be difficult for health workers to treat their patients with respect if they themselves are not respected. AMDD works with countries to improve their training, working conditions, and compensation.
We also partner worldwide with maternal health organizations to bring a human rights perspective to their work. We work with human rights groups, such as Amnesty International and Human Rights Watch, so that they can come to understand the importance of maternal and newborn health as a fundamental human right. On the global level, AMDD engages with donors and decision makers to encourage them to see the value of employing a human rights approach to policy-making.
Filling the gap: Expanding the way we look at maternal and newborn mortality
From our very beginning in 1999, AMDD set out to help the world move beyond viewing access to EmOC as simply a health concern. We worked to encourage policymakers, donors, and civil society groups to take a human rights approach to maternal and newborn mortality.
After our first five years, a Gates Foundation-sponsored evaluation had this to say about our work around human rights:
"AMDD was responsible for framing access to emergency obstetric care as a human rights issue... This was the most experimental aspect of the program, but it has had a large impact on how the issue is framed in international and national discussions."
Five years later, we continue to meaningfully build upon this change by using human rights values and principles to shape maternal and newborn health programs and policy.
AMDD helped found the first civil society human rights effort aimed at reducing maternal mortality
In 2007, AMDD helped to found The International Initiative on Maternal Mortality and Human Rights (IIMMHR), which works to promote government accountability and increased resources for reducing maternal mortality. The Initiative also provides expertise to address maternal mortality as a human rights issue.
AMDD is a member of the IIMMHR steering committee along with several other international, regional, and national civil society organizations.
“It is precisely the role of human rights to identify the workings of power that keep unacceptable things as they are, and to challenge that power with a different vision of human well-being.”
-Lynn Freedman, AMDD Director
“Women don’t die because of illnesses that we cannot treat. They die because society still hasn’t decided that their lives are worth saving.”
-Professor Mahmoud Fthalla, Former Dean of the Medical School at Assiut University, Egypt, and Chair of the WHO Advisory Committee on Health Research