Ensuring human rights in the provision of contraceptive information and services

WHO recently released new guidance on integrating human rights considerations into the provision of contraceptive information and services. The guidance notes that international and regional human rights treaties, national constitutions, and laws provide guarantees related to contraceptive access. The guidance includes several references to EC, making the following recommendations:

  • EC should be included in essential medicine supply chains and national formularies. Within this context, the guidance notes that sometimes ideology-based policies drive the lack of availability of contraceptive supplies. It highlights in particular that in some countries EC is not available on the false grounds that it causes abortion.
  • Special efforts should be made to provide comprehensive EC information and services to displaced populations, those in crisis settings, and survivors of sexual violence. The guidance mentions that women’s access to contraceptive information and services, especially EC, may be jeopardized by health-care providers’ refusal to provide services due to conscientious objection. The guidance states that while international human rights law protects this freedom, it also stipulates that in the professional sphere conscientious objection might be subject to limitations necessary to protect patients’ rights, including the right to access reproductive health care.
  • Every individual should have the opportunity to make an informed decision about using modern contraception, including EC, without discrimination.

This new guidance complements existing WHO recommendations for sexual and reproductive health programs, including guidance on family planning. Read the full report HERE

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Latin American and Caribbean (LAC) Regional Caucus at Women Deliver

The Regional Task Force on Maternal Mortality Reduction in Latin America and the Caribbean (GTR)  is pleased to invite you to a Latin American and Caribbean (LAC) Regional Caucus at Women Deliver. This is one of the few opportunities at Women Deliver for colleagues from LAC to meet and discuss regional initiatives and priorities for improving reproductive, maternal, newborn and child health (RMNCH). The Day 1 caucus (May 29th) will focus on quality of care; and the Day 2 (May 30th)  caucus on tracking commitments and promoting accountability in RMNCH. Each day will feature three brief presentations followed by open discussion:

Download and see information related to this event

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A manifesto for maternal health post-2015

Ana Langer, Richard Horton, Guerino Chalamilla

On Jan 15—17, 2013, over 800 experts in maternal health came together in Arusha, Tanzania, to present the latest evidence on improving the quality of care for women during pregnancy and childbirth. The past 25 years of the safe motherhood movement have seen extraordinary successes—notably a 33% reduction in maternal mortality from 409 053 in 1990 to 273 465 in 2011. These achievements have motivated and mobilised a welcome new generation of political and financial commitments to maternal health.

But with the era of the Millennium Development Goals (MDGs) drawing to a close in 2015, a moment of uncertainty hangs over the fate of more than 200 million women who become pregnant each year. As the world moves towards the next set of development goals, will the gains of the past for women be protected, and can the unfinished business for the future be addressed? As a contribution to the process of redefining human development for women after 2015, participants at the Arusha conference supported writing a manifesto for maternal health based on the best available evidence, the lessons of safe motherhood from the past 25 years, and the more recent experience of the MDGs. We welcome a vigorous debate about this manifesto.

Panel

A manifesto for maternal health

  • The global health community must build on past successes and accelerate progress towards eliminating all preventable maternal mortality within a time-bound period. To this end, a new and challenging goal for maternal mortality reduction is needed within the development goal framework for the post-2015 era, one that is led and owned by countries not donors.
  • This maternal mortality goal must be broadened to embrace the progressive realisation of political, economic, and social rights for women. One critical lesson from the history of women's health is that maternal health will not be improved to its full potential by focusing on maternal health alone.
  • As maternal mortality declines, the world must now focus on both prevention and treatment of maternal morbidities, the measurement of which is challenging but critical to tackle for the health, productivity, and dignity of the women involved.
  • The successful framework of the continuum of care must be redefined to make women more central to our notions of reproductive, maternal, newborn, and child health. The continuum needs to be more inclusive of frequently neglected elements — e.g., quality of care, integration with HIV and malaria programmes, non-communicable diseases, and the social determinants of health, such as poverty, gender disparities, sexual and gender-based violence, water and sanitation, nutrition, and transportation.
  • The global health community must devise a responsive financing mechanism to support countries in implementing their plans to reduce maternal mortality and improve sexual and reproductive health.
  • A much greater emphasis must be put on reaching the unseen women who are socially excluded because of culture, geography, education, disabilities, and other driving forces of invisibility. If we are serious about redressing gender and access inequities, we have to ask fundamental and difficult questions about the nature of our societies and the value, or sometimes lack of value, we ascribe to individuals, especially women, in those societies.
  • One critically important element to address women's health and needs is attention to improving comprehensive quality of care. Respectful maternal health care for all women is an ethical imperative, not an option.
  • The maternal health community must invite, include, and incorporate the voices of women themselves into writing the future of maternal health. Too often, women's voices are silenced, ignored, or reported only second hand. Women must be given the platform and power to shape their own futures in the way they wish.
  • For the mother, her newborn child is a precious and indissoluble part of her life and her future. Maternal health outcomes cannot be fully addressed without attacking the appalling global toll of preterm births, preventable stillbirths, and newborn deaths.
  • A critical gap that threatens the future health of women and mothers is the catastrophic failure to have reliable information on maternal deaths and health outcomes within and across countries. This gap in measurement, information, and accountability must be a priority now and post-2015.
  • A tremendous opportunity lies in technology. Mobile and electronic health technologies must ensure that women are effectively and safely connected to the health system, from education to emergencies, referral for routine antenatal care to skilled birth attendance. Putting the right technologies in the hands of women offers one compelling opportunity to make empowerment of those women a reality.
  • Finally, we must fulfill all of these actions sustainably, which means universal access to high-quality health services free at the point of demand, within a strong health system, supportive of the fully trained front-line worker—from family planning, to safe abortion, to emergency obstetric care, with respect for both providers and women.
  • Agnes Binagwaho, Rwanda's Minister of Health, opened the conference in Arusha by looking back at the genocide that overtook Rwanda in 1994. “We believed in the promise of our future”, she said. The maternal health community, a vital part of the movement for women's and children's health embodied in the UN Secretary-General's Every Woman, Every Child initiative, also believes in the promise of a future for women and mothers. This manifesto is one small contribution towards that future.
  • AL and GC co-chaired the Global Maternal Health Conference 2013, which was convened by the Maternal Health Task Force, the flagship project of the Women and Health Initiative at the Harvard School of Public Health and Management and Development for Health, a Tanzanian non-profit organisation.

Reference

1  Lozano R, Wang H, Foreman KJ, et al. Progress towards MDGs 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 2011; 378: 1139-1165.  Summary |  Full Text |  PDF(7166KB)  | CrossRef  | PubMed

a Women and Health Initiative, Maternal Health Task Force, Harvard School of Public Health, Boston, MA 02115, USA
b The Lancet, London NW1 7BY, UK
c Management and Development for Health, Dar es Salaam, Tanzania

Source: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960259-7/fulltext

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Trends in Maternal Mortality:1990-2010

Globally, the total number of maternal deaths decreased by from 543 000 in 1990 to 287 000 in 2010. Likewise, the global maternal mortality ratio (MMR) declined from 400 maternal deaths per 100 000 live births in 1990 to 210 in 2010, representing an average annual decline of 3.1 per cent.

All developing regions experienced a decline in MMR between 1990 and 2010, with the highest reduction in the 20-year period in Eastern Asia (69 per cent) followed by Northern Africa (66 per cent), Southern Asia (64 per cent), Sub-Saharan Africa (41 per cent), Latin America and the Caribbean (41 per cent), Oceania (38 per cent) and finally Caucasus and Central Asia (35 per cent). Although the latter region experienced the lowest decline, its already low MMR of 71 maternal deaths per 100 000 live births in 1990 made it more challenging to achieve the same decline as another region with a higher 1990 MMR value.

Chapter 2 provides an overview of the definitions and approaches for measuring maternal mortality. Chapter 3 is a detailed description of the methodology employed in generating the estimates and a brief comparison with alternative approaches for estimating the global burden of maternal mortality. Chapter 4 presents the estimates and interpretation of the findings. Chapter 5 assesses the progress towards MDG 5 and the importance of improved data quality for estimating maternal mortality. The annexes and appendices present the sources of data for the country estimates, as well as MMR estimates for the different regional groupings used by the contributing agencies.

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Transforming health systems to serve the wellbeing of indigenous and minority populations

We have included in our publication section the report: Transforming Health Systems to Serve the Wellbeing of Indigenous and Minority Peoples published by the Royal Tropical Institute and the Institute of Development Studies under the Bellagio Center. This publication brings together the conclusions of the conference that was held in June 2012 at the Bellagio Study Center around three themes:
1. Territory, mobility, and access;
2. Traditional medical knowledge and intercultural, cultural sensitivity, health care and
3. Gender and sexual and reproductive health, including maternal and child health.

Download it HERE or click the image

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New United Nations Human Rights Council Resolution on Maternal Mortality

Here we have published the latest Resolution on Maternal Mortality approved by the United Nations Human Rights Council on September 21, 2012. The resolution calls on member States to renew their political commitment to eliminate preventable maternal mortality and morbidity in the local, regional, national, and international levels and to renew their efforts to guarantee the full and effective implementation of human rights.

See also: Technical guidelines on the application of a human rights-based approach to reduce maternal mortality and morbidity.
 

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Respectful Maternal Care

We have included on our webpage the materials produced by the White Ribbon Alliance for respectful maternal care and universal rights of women of reproductive age. According to these publications, “the concept of safe motherhood should expand beyond just preventing maternal mortality; it must include respect for fundamental human rights of women, including respect for women’s autonomy, dignity, feelings, decisions, and preferences, including support for maternal care.”

 

These publications focus on “interpersonal aspects of care for women seeking maternity services. The relationship of women with maternity care providers and the system of maternal care during pregnancy and birth is vital. These meetings are not only the vehicle for essential health services with the potential to save lives, but the experiences of a woman with health personnel during this period of time can empower, support, or cause lasting damage or emotional trauma, adding to or reducing their confidence and self esteem. Either way, a woman’s memories of her experience at the time of delivery will be with her for a lifetime and are often shared with other women, contributing to an atmosphere of trust or distrust of motherhood.”

 

Download here:

 •Publication about respectful maternal care and universal rights of women of reproductive age

 •Brochure

 •Poster

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Meeting on the harmonization of maternal mortality estimates in LAC: pilot study advances

Measuring maternal mortality is complicated by problems in the collection and processing of data. As is the case with other health statistics, the countries with the highest incidence of maternal mortality rates have the same serious problems in terms of reliability and accuracy of data. Social scientists have turned to alternative sources and statistical techniques to estimate maternal mortality in the absence of adequate data. The accuracy of these estimates is supported by assumptions made on the basis of limited evidence and in some cases, no evidence at all. Therefore, estimates have a wide range of uncertainty, which makes monitoring and follow up difficult.

To address this issues, in the context of the GTR 2012 workplan, the Latin American and Caribbean Demographic Center (CELADE)-Population Division of the Economic Commission for Latin America and the Caribbean (ECLAC), in conjunction with the Latin American Center for Perinatology, Women’s and Reproductive Health (CLAP) of the Pan American Health Organization (PAHO) prepared a technical paper on Maternal Mortality Estimates in Latin America and the Caribbean. The paper explains and compares the different approaches in measuring maternal mortality and provides general recommendations regarding the interpretation of the various maternal mortality estimates in Latin America and the Caribbean, in particular national estimates, those from the Interagency Group for Maternal Mortality Estimation (MMEIG) and the figures published by the Institute for Health Metrics and Evaluation in Health (IMHE). Since then, CELADE/ECLAC with funding from UNFPA and in partnership with CLAP/PAHO, has undertaken a pilot study to shed light on the  differences in estimates.

In 2013, CELADE/ECLAC and UNFPA are organizing a meeting to share results from the pilot study, present the differences found in the methodologies used by the various institutions to attain estimates, and facilitate discussion leading to a harmonization of the results. The conclusions of the meeting will be the basis for the expansion of the pilot study to all countries in the region.

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In Health in the Americas 2012

In Health in the Americas, 2012 the Pan American Sanitary Bureau presents and analyzes the data and information from every country in the Region of the Americas. In drafting the publication, it has used data from many domestic and international, as well as unofficial, sources, trying as much as possible to identify and eliminate any discrepancies.

Download this document from PAHO's site

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Technical guidance on the application of a human rights- based approach to reduce preventable maternal morbidity and mortality

We have included in our publications section the document: Technical guidance on the application of a human rights based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality.

"The present report contains concise technical guidance, in accordance with the request made by the Human Rights Council in its resolution 18/2. The aim of the report is to assist policymakers in improving women’s health and rights by providing guidance on implementing policies and programmes to reduce maternal mortality and morbidity in accordance with human rights standards. It highlights the human rights implications for multiple actors in the policymaking, implementation and review cycle, as well as the need for robust enforcement mechanisms and international assistance and cooperation."

Download the document

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