Lisa Hallgarten, RHM

The Brazilian government has agreed to pay compensation for the death of a pregnant woman in 2002. The decision could have implications for governments around the world where women are dying from preventable deaths in pregnancy, childbirth and abortion. The Brazilian government’s move follows landmark decisions by the Committee on the Elimination of Discrimination against Women (CEDAW) in Brazil and Peru – reported in Reproductive Health Matters. CEDAW confirmed that all states have a human rights obligation to: guarantee good quality maternal health care; guarantee access to abortion when a woman’s mental or physical health is threatened by continuation of her pregnancy; and decriminalise abortion when the pregnancy results from rape or abuse.

The case of of Alyne da Silva Pimentel v. Brazil was taken up by CEDAW in 2011. Alyne died following a stillbirth towards the end of her second trimester of pregnancy as a result of misdiagnosis, inadequate treatment in her local health centre, failure of the centre to refer her for timely emergency obstetric care and inadequate care when she was finally referred. CEDAW found that she was a victim of discrimination because she was a woman, poor and of African descent. Following the CEDAW Committee’s recommendations, the Brazilian government has agreed to pay compensation for Alyne’s death in childbirth, and is to set up an inter-ministerial enquiry into where responsibility lies for the chain of events that result in a maternal death. It also plans to organise a seminar on the issue for lawyers and health professionals.

In the case of L.C. v. Peru, a young girl had been repeatedly raped by different men in her neighbourhood over a period of four years. At the age of 13 she learned that she was pregnant and made a suicide attempt which failed, but left her at risk of paralysis and in urgent need of spinal surgery. She was refused the surgery she needed because she was pregnant, and was also refused an abortion. Three months later she miscarried and doctors agreed to perform the surgery. Unfortunately the delay meant the intervention was unsuccessful and L.C. is now quadriplegic. Peruvian law already permits abortion in cases where a woman’s health or life is at risk. CEDAW ruled that access to abortion in these cases should be guaranteed.

CEDAW’s findings come in the context of legal and civil actions around the world aimed at making governments accountable for women’s health and lives in pregnancy, childbirth and abortion. We hope that the announcement from Brazil that it will act on CEDAW’s recommendations may encourage Peru to do so too, and will  help to reinforce the fundamental principle that women’s rights are human rights.

Other cases highlighted in RHM

Alyne’s case and the negligent, callous and discriminatory treatment she experienced, has echoes in stories we have published from all over the world including the testimony of a doctor in a sub-Saharan African country on this blog. Papers in May’s issue of Reproductive Health Matters demonstrate that failure to provide good quality, equitable and accessible maternal health care is widespread. Increasingly however, lawyers, families and health professionals have had some success in holding their governments and health services to account.

In India an investigation into maternal deaths in Madhya Pradesh documented lack of accountability, and discrimination against poor women, particularly tribal women. However, the authors report that since presenting the report some of their recommendations have been taken up. In another article from India authors explore the successful legal case made for compensation and accountability for the death of Shanti Dev in Haryana State.

Another article reports on opportunities for progress that could be learned from the success of HIV activism in sub-Saharan Africa where health professionals and civil society activists have formed alliances to demand constitutional rights to health care for people living with HIV. A recent attempt by health activists in Uganda to use the courts to establish the constitutional rights of women to quality maternal health care failed, but the NGOs involved have promised to appeal…watch this space.

Read the full editorial of RHM’s recent issue Maternal mortality or women’s health: time for action