In November 2010, Commissioner Luz Patricia Mejía, the Rapporteur on the Rights of Women of the Inter-American Commission on Human Rights (Commission) presented a report addressing the link between women’s human rights and access to pre-natal, childbirth, and post-partum health care services. Commissioner Mejía presented the thematic report to a group of government officials and civil society organizations in El Salvador. The report stresses states’ obligations to provide equal access to maternal health services and reproductive health information in accordance with the right to humane treatment as protected by Article 5 of the American Convention on Human Rights (American Convention). The report also stresses that many maternal and infant mortalities could be prevented through better information and medical care, and that poor, indigenous, and Afro-descendant women are disproportionately affected. During its October 2010 hearings, the Commission emphasized the need to improve marginalized populations’ access to health services and information.
The report cites several Inter-American Court of Human Rights (Inter-American Court) decisions in which adequate health care was deemed a key factor in preserving the right to humane treatment under the American Convention. In its 2006 Ximenes-Lopes v. Brazil decision, the Court linked the right to health care to the basic respect for dignity that all people deserve. Similarly, the Court linked health care with the rights to life and humane treatment in its 2007 decision on Albán-Cornejo et al. v. Ecuador. The connection of the fundamental right to health with the American Convention is key, since only the Additional Protocol to the American Convention in the Area of Economic, Social and Cultural Rights specifically addresses the right to health in Article 10. Approximately half the states in the Americas have adopted the protocol.
The Commission relies heavily upon a 2007 report by the Pan American Health Organization (PAHO) for data on maternal health. PAHO’s report highlights the region’s challenges of providing adequate, universal, and culturally-appropriate health care services. It cites World Health Organization (WHO) estimates of 22,680 maternal deaths in the Americas in 2003 and emphasizes that the risk of maternal death is 21 times higher in Latin America and the Caribbean than in Canada. Moreover, the maternal mortality rate of indigenous Guatemalan women is three times higher than that of non-indigenous Guatemalans.
The Commission is especially concerned with structural and cultural barriers to maternal health, especially for indigenous and Afro-descendant women. High health care fees, lack of information, adequate equipment, supplies, and properly trained personnel, and limited clinic access prevent women from getting appropriate care. Barriers also include a lack of interpretation services, a dearth of culturally-sensitive medical personnel, and the denial of care due to gender, marital status, or education level. Regional examples of such barriers include cases of forced sterilization due to ethnic and economic status, and refusal to provide abortion services to a victim of sexual violence.
The thematic report recommends that states strengthen their institutional capacities to guarantee adequate maternal health care and training of providers, establish referral mechanisms to deal with obstetrical emergencies, revise legislation to ensure conformity with regional and international standards, and eliminate obstacles to health services, in particular for marginalized populations. The Commission also commends countries that have already initiated health care reform by expanding services to vulnerable groups.
The Commission’s report demonstrates concern regarding the disproportionate access that poor women, particularly indigenous or Afro-descendant women, have to adequate, affordable, and timely health care. It also indicates the commitment of the Inter-American system to complying with the Millennium Development Goal of improving maternal health. Finally, it further entrenches the right to health as a fundamental right that goes hand in hand with the right to life, humane treatment, and respect of human dignity.