Being pregnant should be a beautiful experience and not a matter of life and death for a woman. But for too many women around the world, it is
Every year over a quarter of a million pregnant women and girls lose their lives and another 10-15 million suffer permanent damages every day as a result of childbirth and pregnancy complications. Pregnancy is becoming one of the scariest and risky phases that a woman has to go through. Being pregnant should be a beautiful experience and not a matter of life and death. But for too many women around the world, it is. Nearly all of these deaths are preventable because they are a result of hemorrhages, sepsis, hypertensive disorders (particularly eclampsia), pro- longed or obstructed labor and unsafe abortions.
Right to life
Maternal Death directly infringes upon a cluster of rights (life, health, equality, bodily integrity) guaranteed to a woman. Women’s ability to exercise their right to life hinges upon their ability to exercise other rights, including the right to health, equality, and non-discrimination. These rights are interdependent and intertwined. This is why the exercise of reproductive rights of women is fundamental for women to be able to exercise all other rights. Recognizing this, major international human rights treaties establish that governments have a duty to uphold rights that prevent women from dying needlessly during pregnancy and childbirth.
Article 6 of International Covenant on Civil and Political Rights (ICCPR) guarantees right to life. Similarly, Article 3 of Universal Declaration of Human Rights recognizes right to life as a fundamental human right. Right to life is a non-derogable right meaning that the state cannot be relieved of its duty to protect this right under any circumstance whether during the state of emergency or war. The inclusion of maternal death as a violation of right to life has been elaborated by Human Rights Committee (HRC Committee) and Committee on the Elimination of Discrimination against Women (CEDAW) has framed maternal mortality as a violation of women’s right to life. HRC further elaborated that the state doesn’t only have the negative duty of preventing arbitrary killing but also has a positive duty to adopt measures to protect right to life including taking steps to prevent unnecessary maternal deaths. To ensure full enjoyment of right to life for women, the states should ensure women’s accessibility to health services and emergency obstetric care. International human rights jurisprudence is clear that ensuring availability of adequate trained health workers, providing access to contraceptives and sex education to help women avoid unintended pregnancies, protecting women from forced clandestine abortions endangering lives and right of a woman to access abortion are of paramount importance for women to exercise right to life.
Improving maternal health is one of the seventeen Sustainable Development Goals (SDGs). Under SDG31.1, Nepal committed to end preventable maternal mortality and to achieve a maternal mortality ratio of less than 70. To reach this goal, Nepal should decrease its maternal mortality by two-thirds. Aim of reducing maternal mortality even to 125 by 2020 is a target Nepal is failing to achieve, thanks to our perception on maternal deaths as a biological phenomenon. So an ambitious target of less than 70 by the year 2030 looks a far cry given Nepal’s current initiatives directed to that effect.
Mothers are dying
Maternal Mortality in Nepal is 229 per 100,000. This is a pretty high number and regrettable because these deaths could be prevented if Nepal fulfilled its obligations under its constitution and international laws. What adds to this shame is the fact that maternal deaths are considered a normal phenomenon. These deaths are considered a medical story and a biological happening. Questions regarding a woman’s death during pregnancy or childbirth not only go unanswered, often they are not even asked. Maternal deaths are seen as a matter of pity rather than a violation of a woman’s right. It is only recently that maternal deaths have received the attention as a violation of right rather than an accepted fate. In a few recent instances, however, courts around the globe and treaty bodies have examined circumstances of women’s pregnancy-related deaths according to human rights standards.
In those cases, they found that precipitating violations of states’ voluntarily assumed legal duties to protect the most basic of all the rights that human beings should possess—right to life. The CEDAW Committee has linked high rates of maternal mortality to lack of access to and insufficient availability of comprehensive reproductive health services. The Committee on the Rights of the Child has frequently attributed maternal mortality to unsafe or illegal abortion, insufficient prenatal care and assistance at birth, insufficient resources dedicated to maternal health care and lack of access to reproductive health services. According to these treaty bodies, whatever the reason, maternal death provides evidence of the victim’s loss of right to life and state failure to protect her life to the standard required by human rights law. These are the examples Nepali jurisprudence on women’s rights should follow and incorporate but unfortunately issues of Maternal Mortality do not even reach our courts.
Where the governments, courts and religious institutions invoke right to life of the unborn child to oppose a woman’s right to abortion, those very institutions often regard pregnancy related deaths with low priority, consider it as an unfortunate incident and consequently fail to strengthen means to prevent it. The reason for the states to fail to allocate resources to protect women’s right to life is due to the lack of genuine effort to consider that a woman is not liable to survive her child-birth but the state is equally liable to assure that she survives.
Around 229 women lose their lives during pregnancy or childbirth. This is not considered as a national emergency. If the same number died in military defense, the government would perhaps consider it an emergency, invoke right to defense and allocate sufficient resources. However, they pay no attention when a woman dies due to the state’s inability to protect her very right to life. Her death goes without investigation. Similarly, when a woman is shot dead, it is a violation of her right to life. But when she dies while giving birth to a child, it is considered her fate or a simple biological phenomenon. If a woman dies a preventable death—whether preventable murder or maternal death, it is a violation of her right to life.
Thus it is urgent that we guarantee the constitutional right to life by defining maternal death as a violation of this right.
The relationship between maternal deaths and right to life of a woman has always been controversial. Governments around the world (Nepal is no exception) have had hard times accepting that they are responsible for the deaths of a woman during pregnancy where such deaths are preventable.
When a woman dies a preventable death, one death is too many.
The author is a registered attorney at law