FACT SHEET: Motherhood and Human Rights

Do all pregnant women have the right to live?

Fact sheet prepared by the Media and Communications Branch of UNFPA, the United Nations Population Fund. August 2009. Main sources for this fact sheet: The Lancet’s Maternal Survival and Women Deliver Series (2006/2007); the 2005 World Health Report; and Meeting the Need, 2006, by UNFPA and Path

Every minute, a woman dies in pregnancy or childbirth and another 20-30 women suffer serious injury or disability. Almost all of these women die in developing countries of preventable or treatable complications, complications that rarely kill in rich countries.

The stark contrast – several orders of magnitude -- in the dangers faced by pregnant women in rich and poor countries underscores the inequality of the situation. Survival rates among the rich and poor women within countries show wide disparities as well. Being able to give birth safely, which is a human rights entitlement in principle, is in fact a privilege of the rich in many regions.

The strategies and techniques for preventing nearly all maternal death and disability are widely recognized and relatively inexpensive. Therefore, high rates of maternal death represent a terrible injustice, reflect entrenched discrimination against women and imply a failure at some level to fulfill the human rights of pregnant women.

Their subordinate position, within the home or community, leaves many women unable to negotiate contraception or demand their right to quality care. Many others receive inadequate care during pregnancy and childbirth because of their youth, poverty or ethnic background. Unsafe abortions kill 68,000 women each year.

In recent years, the understanding of maternal death as a human rights issue has deepened. Women have the right to survive childbirth, and working towards this end is a human rights imperative.

Historically, a greater emphasis has been placed on civil and political rights rather than on social, economic and cultural rights, which are central to women’s everyday lives. However in 1993 the Vienna Declaration on Human Rights asserted that there is no hierarchy in human rights, all have equal status in international law.

In addition to obligation to save women’s lives from a human rights perspective, doing so is an excellent investment. Every year, the world misses out on $15 billion in lost productivity by letting women die or become disabled as a result of childbearing. It would cost $6 billion to provide the health services to save women's lives.
 

Contents

Get the Facts

  • Every minute, another woman dies from pregnancy-related causes. This adds up to 536,000 women per year, and more than 10 million women over a generation.
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  • Three measures could save the lives of 90 per cent of the women who die giving life: Access to contraceptives for all women, skilled personnel at the time of birth and prompt emergency obstetric care if things go wrong.
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  • While the means to ensure safe motherhood are straightforward, implementing them can be complex, as it requires overall shoring up of health systems, a major undertaking.
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  • Complications during pregnancy or childbirth are the leading cause of death for women in Africa.
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  • Every year, more than a million children are left motherless and vulnerable because of maternal death. Children who have lost their mothers are up to 10 times more likely to die prematurely than those who haven’t.
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  • The risk of a woman dying as a result of pregnancy or childbirth during her lifetime is about 1 in 7 in Niger and about 1 in 7,300 in developed countries. This differential is the highest of any public health indicator monitored by the World Health Organization.
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  • Ten to 15 million women each year suffer severe or long-lasting illnesses or disabilities caused by complications during pregnancy or childbirth. These range from obstetric fistula and uterine prolapse to infertility, chronic infection and depression.
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  • The leading direct causes for maternal deaths are haemorrhage, infections, unsafe abortions, high blood pressure leading to seizures and obstructed labour.
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  • Countries with the highest initial levels of mortality have made virtually no progress over the past 15 years.

Contraception and Unsafe Abortions

  • Worldwide, every year there are an estimated:
    • 210 million pregnancies;
    • 80 million unwanted pregnancies;
    • 50 million induced abortions;
    • 20 million unsafe abortions;
    • 68,000 deaths from unsafe abortion;
    • 20 million infections and disabilities following childbirth.
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  • One in three deaths related to pregnancy and childbirth could be avoided if women who wanted effective contraception had access to it.
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  • 200 million women want to delay or avoid pregnancy but are not using effective family planning.
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  • About 90 per cent of abortion-related deaths and disabilities worldwide could be avoided if all women had access to effective contraception.
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  • Barriers to contraception are legion. They include high prices, unreachable outlets, misinformation about the dangers of contraception, lack of appropriate methods, medical rules that make it difficult to procure contraceptives, religious constraints, family tensions and confidentiality issues.

Skilled birth assistance and emergency obstetric care

  • The number of maternal deaths is highest in countries where women are least likely to have skilled attendance at delivery.
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  • Almost all births in developed countries have the benefit of a skilled birth attendant. In less developed countries, the figure is 57 per cent. In least developed countries it falls to only 34 per cent.
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  • Mortality is highest during labour and the two days following a birth.
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  • Women who undergo infibulation—a radical form of female genital cutting/ mutilation (a procedure that violates the rights of girls and women)—are at higher risk of complications during and following childbirth.

Young people

  • Girls aged 15-20 are estimated to be twice as likely to die in childbirth as those in their twenties.
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  • Girls under the age of 15 are five times more likely to die from maternal causes.
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  • Girls aged 15-19 account for one in four unsafe abortions—which adds up to five million each year.
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  • Complications during pregnancy or childbearing are the leading cause of death for girls aged 15-19 in developing countries.
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  • Less than 20 per cent of all sexually active young people in Africa use contraception.
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  • Child marriage is a form of violence and sexual exploitation against girls and a violation of their right to 'free and full' consent to marriage, as recognized in the Universal Declaration of Human Rights.
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  • Because the lives of women and their children are so closely entwined, the rights of newborns and surviving siblings are compromised when their mothers die or are injured.

Pregnancy-related disability

  • Obstetric fistula, caused by prolonged obstructed labour, is one of the worst pregnancy outcomes. It leaves women incontinent, and they often end up ostracized by their families and communities. A million women are thought to be living with the condition.
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  • Two to 10 per cent (depending on countries) of women of reproductive age suffer from prolapsed uterus (commonly referred to as ‘fallen womb’). Severe cases require surgical interventions, which are often beyond the means of women in low-income countries to access.
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  • Perinatal depression is a severe disorder associated with maternal physical morbidity, substance abuse and suicide. The consequences of maternal depression affect children as well.
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  • Complications from unsafe abortion account for the largest proportion of hospital admissions for gynaecological services in the world. According to the Guttmacher Institute, five million women each year are admitted to hospital for treatment of unsafe abortion complications, including trauma to the vagina, uterus and abdominal organs, reproductive tract infections, shock, and infertility.

 The rights of women

  • Article 12 of Convention on the Elimination of all Forms of Discrimination Against Women requires States parties to “ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period …”
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  • Preventable maternal death compromises a number of established rights: to life, to health, to family and to education, among others.
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  • International law does not expect countries to instantaneously provide all goods, services and facilities needed to protect the right to health. What is expected depends on the resources available. Countries are expected to take concrete and deliberate steps to progressively realize this right, with the assistance of higher-income countries.
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  • In societies where men traditionally control household finances, the health of women is often not considered a priority.
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  • Though the right to decide if, when and with whom to marry, and to determine the number, spacing and timing of children is well-established, women are frequently not able to exercise these rights.
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  • In countries with similar levels of economic development, maternal mortality is inversely proportional to women's status—that is, the higher the status the lower the mortality rates.
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  • The poorer the household, the greater the risk of maternal death.
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  • Early marriage, female genital mutilation/cutting, un-wanted childbirths and violence constitute violations of a woman’s right to make decisions regarding her own body.
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  • In a joint statement delivered to the Human Rights Council in March 2009, 83 countries called for action to address the unacceptably high number of maternal deaths.
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  • Good practices in many developing countries (such as China, Cuba, Egypt, Jamaica, Malaysia, Sri Lanka, Thailand and Tunisia) have reversed the rate of maternal mortality and morbidity showing that it is possible to make a difference by strengthening healthcare systems. Many of these countries have halved their maternal deaths in the space of a decade, showing what can be accomplished when the political will and resources are in place.

What Must Be Done?

Efforts to prevent maternal deaths and to achieve access to reproductive health for all requires broad partnerships as well as political and financial commitments to long-term and targeted efforts to strengthen health systems. More specifically:

  • Advocate for the right of women and their children to survive pregnancy and childbirth.
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  • Use the quick win: family planning to prevent unintended or too closely spaced births. Every additional birth multiplies a woman’s risk of dying.
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  • Invest in midwives: Hundreds of thousands of lives could be saved by getting midwives in communities.
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  • Ensure that all women experiencing complications have prompt access to quality emergency obstetric care.
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  • Bolster the training and incentives of health care workers so that skilled attendance at birth is available to all women.
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  • Make sure that necessary supplies, equipment and logistical systems to ensure quality care during pregnancy and childbirth are available to birth attendants.
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  • Provide young people with the opportunity to make informed choices regarding their sexual lives, marriage and pregnancy.

Links between the ICPD and the Millennium Development Goals

At the 1994 International Conference on Population and Development (ICPD), the participating countries agreed to reduce maternal mortality to 75 per cent below 1990 levels by 2015.

In 2000, the international community used this same benchmark as an indicator for the Millennium Development Goal 5 (improve maternal health). In 2005, the international community acknowledged the need to do more to protect maternal health, by adding universal access to reproductive health as another target.

Among the eight goals, progress on MDG5 is lagging furthest behind. Globally, the rate of death from pregnancy and childbirth has declined just one percent between 1990 and 2005. Meeting the target would have required an annual decline of 5.5 per cent.

Real Stories

"Where Life's Start is a Deadly Risk"

“The young woman had already been in labor for two days by the time she reached the hospital here. Now two lives were at risk, and there was no choice but to operate and take the baby right away”.

Read More: The New York Times, May 23, 2009. http://www.nytimes.com/2009/05/24/health/24birth.html

“Leonora Pocaterrazas and Albina Chambe, Bolivia”

“In Bolivia, indigenous tradition often means women give birth at home, fully clothed, squatting on the floor, with only family members to help. When Albina Chambe, 15, went into labour in a poor suburb of La Paz, her fiancé Grover, only 18 himself, wanted to take his wife to a hospital. But Albina’s mother had delivered 13 children at home, without skilled assistance”.

Read More: Women Deliver, October 2007. http://www.womendeliver.org/fact/Real_Faces_Real_Stories_%20factsheet_(A4).pdf

“Save My Wife”

“Prudence Lemokouno was lying motionless on a bed in the bleak hospital here, her stomach swelled with a fetus that had just died, her eyes occasionally flickering with fright but mostly dull and empty”.

Read More: The New York Times, September 17, 2006. http://select.nytimes.com/2006/09/17/opinion/17kristof.html?_r=1&partner=rssnyt&emc=rss 

Videos

“Maternal Death in Haiti and the Dominican Republic”

“Danger of Home Births in Ethiopia”

“High-risk Pregnancy in Rural Bolivia"