HUMAN RIGHTS COUNCIL HOLDS PANEL DISCUSSION ON PREVENTABLE MATERNAL MORTALITY AND MORBIDITY AND HUMAN RIGHTS

The Human Rights Council this afternoon held a panel discussion on preventable maternal mortality and morbidity as a human rights priority for all States, including in the context of the implementation of the 2030 Agenda for Sustainable Development.

In opening remarks, Kate Gilmore, United Nations Deputy High Commissioner for Human Rights, reminded that every day, 800 women and girls died of pregnancy and childbirth. It was a loss that represented waste in an era of scarcity, and a tragedy in an era when the international community needed no more. Greater honesty, courage, and political will were essential to eliminate preventable maternal mortality and morbidity. At the same time, the consistent implementation of a human rights-based approach accompanied by political will could transform the prospects for all women everywhere.

Beatriz Londoño Soto, Permanent Representative of Colombia to the United Nations Office at Geneva, served as the panel’s moderator. The panelLists were Babatunde Osotimehin, Executive Director of the United Nations Population Fund; Carmen Barroso, Co-Chair of the Independent Accountability Panel; Arzu Rana Deuba, Member of Parliament, Nepal; and Flavia Bustreo, Assistant Director-General for Family, Women's and Children's Health, World Health Organization.

Ms. Londoño Soto noted that the discussion about maternal mortality and morbidity had to go beyond politics in order to make a real impact on the ground, especially for the most marginalized women and girls, indigenous women, those of African descent and those who did not have access to adequate services. She hoped the panel discussion would propose concrete actions.

Babatunde Osotimehin, Executive Director of the United Nations Population Fund, noted that high maternal mortality and morbidity was a tragic consequence of depriving women and girls of their human rights, including the right to the highest attainable standards of sexual reproductive health, and the right to decide if, when and how often to reproduce, free of discrimination, coercion and violence. Stronger health systems and key interventions, such as universal access to voluntary family planning and information, were vital for saving and improving lives.

Carmen Barroso, Co-Chair of the Independent Accountability Panel, underlined that States should implement the Technical Guidance on reducing preventable maternal mortality and morbidity and disseminate them more widely. Quality health care was no longer considered charity, but a right of every human being. The Council needed to do all in its power to make the Technical Guidance a household tool used by all countries. Another major contribution of the Council had been the effort to clarify the role of accountability for the fulfilment of human rights.

Arzu Rana Deuba, Member of Parliament of Nepal, noted that it was important for the people doing the advocacy work to believe that they could make a change. It was also key to have dialogue from the lowest to the highest levels. When devising programmes, she said, it was important to allocate resources for the mobilisation of people affected by the issue.

Flavia Bustreo, Assistant Director-General for Family, Women's and Children's Health at the World Health Organization, stressed that the health sector was key in enabling women to make informed decisions. It was crucial to address inequalities in accessing the necessary services. Globally, there was a huge inequality in access to pre- and post-natal services that could save the lives of women, she said, adding that the health sector had to be vigilant in this regard.

During the ensuing discussion, speakers highlighted structural reasons behind the high rates of maternal mortality and morbidity, such as the lack of access to appropriate health services, poverty, malnutrition, harmful practices, gender inequality and discrimination, and lack of sexual and reproductive health education and family planning services. Distributing the Technical Guidance as widely as possible at all levels was an integral part of reducing maternal mortality and morbidity. It was important to identify measures to decrease maternal mortality and morbidity rates in line with States’ human rights obligations.

Taking the floor were the European Union, Tunisia on behalf of the African Group, Uruguay on behalf of a group of countries, Sweden on behalf of a group of countries, Colombia on behalf of a group of countries, Portugal, Australia, Brazil, Viet Nam, Indonesia, Sudan, Venezuela, United States, New Zealand, Chile, Botswana, El Salvador, Fiji, India, Bolivia, Ecuador, Israel, Mongolia and Switzerland.

Also speaking were the following civil society organizations: Associazione Comunitá Papa Giovanni XXIII, Amnesty International, Action Canada for Populations and Development, Swedish Association for Sexuality Education, Alliance Defending Freedom, and Plan International.

The Council will meet on Friday, 10 March at 9 a.m. to hold an enhanced interactive dialogue on migrants.

Opening Statements

MOUAYED SALEH, Vice-President and Rapporteur of the Human Rights Council, said the Council would now proceed with the panel discussion on preventable maternal mortality and morbidity as a human rights priority for all States, including in the context of the implementation of the 2030 Agenda for Sustainable Development. He welcomed Kate Gilmore, Deputy High Commissioner for Human Rights, who would be delivering her opening statement, as well as the rest of the panellists. He noted that the panel would be made accessible to persons with disabilities.

KATE GILMORE, Deputy High Commissioner for Human Rights, noted that the Council had emphasized on a number of occasions the intimate relationship between maternal mortality and morbidity and human rights. Those truths were affirmed in the 2030 Agenda for Sustainable Development and the Addis Ababa Action Agenda of the Third International Conference on Financing for Development. The panel discussion would aim to generate concrete recommendations for actions to accelerate progress in reducing maternal mortality. Maternal mortality was preventable. Those who were dying were women and girls from minority communities, the very young, and the very poor. Every day, 800 women and girls died of pregnancy and childbirth. It was a loss that represented waste in an era of scarcity, and a tragedy in an era when the international community needed no more. Lack of data was a major problem; the scale of child marriage as a problem was not understood without better rates of marriage registration. The thread running through all those violations was disrespect for the dignity and autonomy of women and girls. Greater honesty, courage, and political will were essential to eliminate preventable maternal mortality and morbidity. A global roadmap for women’s, children’s and adolescents’ health had been laid out in the United Nations Secretary-General’s Global Strategy for 2016-2030. In addition, the High Commissioner for Human Rights and the World Health Organization Director General had established a landmark high-level working group on the health and human rights of women, children and adolescents. Systematic, consistent and comprehensive implementation of a human rights-based approach accompanied by political will could transform the prospects for all women everywhere.

Statements by the Panel Moderator and the Panellists

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, drew attention to the fact that many women and girls died every minute around the world. The lives of women and girls had to be saved. Ms. Londoño Soto also drew attention to early pregnancies. The discussion about those issues had to be political, but it also had to go beyond politics in order to make a real impact on the ground. It had to make a difference for the most marginalized women and girls, especially for indigenous women, those of African descent, and those who did not have access to adequate services. The panel discussion should propose concrete actions. There should also be more accountability for what was done and what was not done at the international and national level. Based on the work of the United Nations Population Fund, the moderator asked what were the key lessons learned in order to accelerate the reduction of maternal mortality and morbidity while upholding human rights?

BABATUNDE OSOTIMEHIN, Executive Director of the United Nations Population Fund, said he wanted to point out before his prepared remarks the difference between the Millennium Development Goals and the Sustainable Development Goals. The Millennium Development Goals did not speak to human rights, they had eight things that were in silos and talked about maternal mortality without human rights. The reduction of maternal mortality did not look at the other issues that were needed to put it into context. Technical guidance and a series of Council resolutions on maternal mortality and morbidity had made it clear that it was indeed a human rights issue. It was a tragic consequence of depriving women and girls of their human rights, including the right to the highest attainable standards of sexual reproductive health, and the right to decide if, when and how often to reproduce, free of discrimination, coercion and violence. Stronger health systems and key interventions such as universal access to voluntary family planning and information were vital for saving and improving lives. In most cases, maternal death and morbidity were the consequence of gender inequalities, health inequity and a failure to address the impediments to the realization of women’s human rights. Women were often unable to access care because they lacked financial resources or the decision-making power to challenge harmful, stigmatising or discriminatory social norms that kept them from accessing services and information.

The United Nations Population Fund had been at the forefront of implementing the Technical Guidance on reducing preventable maternal mortality and morbidity and had rolled out pilot initiatives in Malawi, Tanzania, Uganda and Zambia for applying a human-rights based approach to sexual, reproductive, maternal and child health. At the global level, the Technical Guidance was influencing the Fund’s work in ensuring that contraceptive services were designed and delivered in accordance with human rights standards. The principles contained in the Technical Guidance provided invaluable operational guidance for infusing a human rights perspective in other sectors and components of the 2030 Agenda. Including the voices of those who would be affected by policy decisions, including young women and girls, was essential. The Human Rights Council had a unique role to play in translating the human rights-based, people centred vision of the Sustainable Development Goals into reality. If the international community was serious in stating that development and human rights went hand-in-hand; if they believed that the United Nations Charter pillars of human rights, development and peace and security were indeed the foundations of one single endeavour for humanity, this was the time to prove it, he concluded.

CARMEN BARROSO, Co-Chair of the Independent Accountability Panel for Every Woman, Every Child, Every Adolescent, praised the Human Rights Council for establishing the linkage between human rights and maternal health in its resolutions and the Technical Guidance on reducing preventable maternal mortality and morbidity. States should implement the Technical Guidance and disseminate them more widely. Today, quality health care was no longer considered charity, but a right of every human being. The Council needed to do all in its power to make the Technical Guidance a household tool used by all countries. Another major contribution of the Council had been the effort to clarify the role of accountability for the fulfilment of human rights. Noting that national accountability mechanisms were usually weak, and that sexual and reproductive health was seldom high in their crowded agendas, Dr. Barosso wondered what more the Council could do to ensure that its recommendations were effectively implemented in countries around the world. Finally, Dr. Barosso recommended to elevate access to contraceptives, for all women and adolescent girls who needed and wanted them, to a central policy for human rights and public health. Meeting the demand for contraception was one of the most effective ways to reduce maternal mortality, by as much as one third. There was no need to re-invent the wheel, it was enough to start from the excellent General Comment 22 of the Committee on Economic, Social and Cultural Rights, and the World Health Organization and United Nations Population Fund implementation guide on ensuring human rights in contraceptive services.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator asked the panellist about her thoughts and insights on why mobilising communities could be helpful in strengthening accountability.

ARZU RANA DEUBA, Member of Parliament from Nepal, said her journey working on this issue was personal as she had almost died during childbirth. It was a home grown process and had nothing to do with grassroots work. As she learned more about what was happening in her country, she realised that a woman was dying from childbirth every minute. That was how she became an activist, with an urge to speak out. When she got started, she realised that Nepal had made a commitment in the area of maternal mortality and morbidity but it was not a priority for the Government. Therefore, she had created a group of people who knew the issue and that was also how the group began working on safe abortion. The group was formed because its members wanted to save the lives of women in Nepal. It was a challenge because not many people discussed the issue at the time. Nevertheless, people come out in droves and the Government then started to prioritise the issue. The group started a childbirth centre and that was how their journey had started. The agenda that the Human Rights Council had picked up was excellent, she said, because it affected half the people in the world. In terms of her recommendations for mobilisation, it was important for the people doing the advocacy work to believe they could make a change. It was also key to have dialogue from the lowest to highest levels. The issue of accountability was also relevant. Unless people were mobilized, how would they know that they had the right policies? When they made programmes, they should put something in for the mobilisation of the people affected by the issue.

FLAVIA BUSTREO, Assistant Director-General for Family, Women's and Children's Health, World Health Organization, at the outset, commended the Human Rights Council for its inspiring role in reducing maternal deaths. Dr. Bustreo reminded the delegations that two major causes of maternal deaths were severe bleeding following delivery, or postpartum haemorrhage, and postpartum infections, while a significant proportion of deaths was attributable to gestational diabetes, high blood pressure during pregnancy, and unsafe abortion. The health sector was key in enabling women to make informed decisions, stressed Dr. Bustreo, and was also crucial in addressing inequality in accessing the necessary services. Globally, there was a huge inequality in access to pre- and post-natal services that could save the lives of women, and the health sector must be very vigilant in this regard. The health sector also had a key role to play in ensuring accountability for those deaths, including through the collection of data, information and statistics. In Rwanda for example, every time a woman died in labour or after giving birth, the Minister of Health would receive an sms, following which she would trigger maternal death surveillance and response, an investigative mechanism which enabled health authorities to understand what had happened. Finally, the health sector needed to raise awareness about root causes of maternal deaths such as lack of information, lack of education, poverty – the health sector could not do it directly, and that was why it needed to work with other partners, including human rights institutions.

Discussion

European Union said that 800 women died every day from childbirth. Despite the link between maternal mortality and morbidity and the denial of human rights to girls, identifying the root causes was not yet a common practice. The European Union asked the panel how to overcome the cultural practices in addressing the root causes of maternal mortality and morbidity. Tunisia, speaking on behalf of the African Group, stated that maternal mortality and morbidity was very important for Africa, which had one of the largest recorded maternal death rates in the world. Investment in saving the lives of women was not just a moral imperative; it was the duty of States to create and improve mechanisms for innovative financing. Uruguay, speaking on behalf of a group of countries, said that it welcomed progress made on maternal mortality and morbidity, however a lot remained to be done. It was particularly concerned about maternal mortality and morbidity among adolescent girls. Sweden, speaking on behalf of a group of countries, noted that too many girls perished while undergoing unsafe abortions. It put women’s and girls’ lives at risk every day, but it was preventable. Sexual and reproductive rights were not an optional extra, but were needed for the full enjoyment of human rights. Colombia, speaking on behalf of a group of countries, said that most maternal deaths were the result of deep inequalities. Countries had to adopt a cross-cutting human rights based approach to tackle that problem. Colombia asked the panel what could be done to reduce deaths of refugee women in childbirth.

Response by a Panellist

BABATUNDE OSOTIMEHIN, Executive Director of the United Nations Population Fund, responded to a question from the European Union on how to overcome cultural issues. The most important activity that worked with the United Nations Population Fund was male involvement, he said. When males understood what the issue was, a different response was achieved. In various parts of Africa, the Population Fund had gathered men for a “husband school”, where they were taken through all the issues having to do with reproduction. The result was that the men allowed their women to go to clinics to deliver, take family planning, have antenatal care, and a reduction in maternal mortality was seen. There was also a drop in child mortality. Male involvement was important because men in all circumstances were the gatekeepers, and involving them made a difference. He said that 60 per cent of maternal mortality occurred among displaced people, and it was important to reach such groups and provide them with family planning services. The cause of maternal death was known, and what was needed was implementing solutions.

Discussion

Portugal noted that the progress achieved was impressive, but the most vulnerable women and girls were still at risk of maternal mortality and morbidity due to gender discrimination and lack of sexual and reproductive health education, informed choice and family planning services. Australia stated that its progress in reducing maternal mortality and morbidity was not even, as it was higher among aboriginal women. Australia remained committed to the protection of sexual and reproductive health rights. Brazil said that the lack of access to appropriate health services, poverty, malnutrition, harmful practices, gender inequality and discrimination were some of the factors leading to high maternal mortality and morbidity. It was important to identify measures to decrease those rates in line with human rights obligations. Viet Nam noted that distributing Technical Guidance on reducing preventable maternal mortality and morbidity as widely as possible and at all levels was an integral part of reducing maternal mortality and morbidity. The Government had strong political commitment to addressing the existing inequalities in access to adequate reproductive health services in the country.

Indonesia stressed that ensuring universal access to health services remained a priority for the Government. At the national level, the Government was developing Sustainable Development Goals targets with respect to family planning and wellbeing of mothers and children. Sudan appreciated the efforts by the World Health Organization and other relevant organizations to prevent maternal mortality and morbidity. It reaffirmed Sudan’s commitment to work with partners at the national, regional and international levels to remove all barriers to reproductive health education and services. Venezuela said that providing comprehensive care to pregnant women was a priority, and Venezuela was pleased to inform that in the context of its second Universal Periodic Review it had undertaken a voluntary commitment to prevent early and unwanted pregnancies.

Associazione Comunita Papa Giovanni XXIII, on behalf of severals NGOs¹, recalled that 830 women died every day from preventable causes related to pregnancy and childbirth, and 99 per cent of those deaths occurred in the developing countries, mostly in Sub-Saharan Africa and South Asia. A crucial and concrete action in preventing maternal mortality and morbidity would be overcoming a political impasse on the right to development. Amnesty International stressed the importance of identifying and eliminating all barriers in law, policy and practice which were linked to gender and intersectional discrimination, including laws criminalizing abortion, same-sex sexual activity, and adolescent sexuality. Action Canada for Population and Development noted that denial of safe abortion, lack of comprehensive sexuality education, limited or no choice in contraception, impunity for sexual violence and punishment for the exercise of sexuality outside of marriage were all symptoms of deeply entrenched gender inequality that prevented progress on eliminating maternal mortality and morbidity.

Remarks by the Panel Moderator and the Panellists

ARZU RANA DEUBA, Member of Parliament, Nepal, said that in some societies, the mothers-in-law were very powerful, and to talk to them was very important. It was also important to talk to the stars, such as Bollywood stars, as well as political leaders, because they often acted as points of reference. The other group that could make changes was women themselves. If issues were discussed in the private sphere, that could create momentum and there could be a way to move forward.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, said that the root causes of death of many women was poverty, exclusion and discrimination, asking how to deal with a structural scarcity of resources.

CARMEN BARROSO, Co-Chair of the Independent Accountability Panel, said it was important to address gender norms, noting that she had recently visited a village in Peru where a woman had died just a few weeks before. She had lived very close to a hospital, but had not dared to walk to that hospital because her husband had not been home. Gender norms still prevailed, she noted, adding that the way to change them was what civil society had been doing for decades. The present moment was an opportunity to guarantee to civil society the enabling environment where it could work freely, which was fundamental with regard to adolescents, as it was in adolescence that gender norms were fixated. Women had to defend their own rights and be convinced they were entitled to human rights, she said, underscoring that among women, there was still a considerable lack of a sense of entitlement as human beings. The mobilization of civil society for a cultural revolution was thus very important.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, asked how to get medical personnel motivated and interested in the issue of maternal mortality and morbidity from the point of view of human rights, and about ways to translate human rights guidelines into their practice.

FLAVIA BUSTREO, Assistant Director-General for Family, Women's and Children's Health at the World Health Organization, noted that medical personnel very often did not ask women whether they had suffered domestic violence, especially violence during pregnancy. Professional associations, particularly midwives, were very vocal and vital in receiving not only technical guidance but also human rights guidance. The mobilization of health care professionals and providers was required in order to focus on the human rights of their patients. There was no doubt that there was a link between the level of development and the rate of maternal mortality and morbidity. If States had no means to provide health services, they could not work to reduce those rates.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, noted that millions of girls were becoming mothers before the age of 15, and asked how best to talk about contraception and empowerment with such young girls.

CARMEN BARROSO, Co-Chair of the Independent Accountability Panel for Every Woman, Every Child, Every Adolescent, said that adolescent girls were neglected even in the Sustainable Development Goals, which mentioned them only once. There were differences between adolescent boys and girls, and also differences between adolescent girls depending on their age; thus collecting age segregated data on groups aged 10 to 14, and 14 and above was very important to understand their situations. Comprehensive sexuality education used age-appropriate information very early on, and there were examples of such education even in preschool, said Ms. Barosso, noting that children needed to be educated very early, not only to prevent the abuse. It was important to educate parents and make them human rights defenders of their girls and not sell them in marriage. Lack of progress in adolescent pregnancy over the past three decades was very striking, particularly in developing countries, and among poor and rich populations.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, asked what would be a concrete recommendation for the use of traditional and social media to promote sexual and reproductive health rights.

ARZU RANA DEUBA, Member of Parliament from Nepal, stated that the use of social media was crucial for disseminating information in countries where openly talking about sexual and reproductive health rights was difficult. Another important way to educate children was to train teachers, who were often embarrassed and confused themselves, and who could not appropriately teach sexual and reproductive health. Ms. Deuba suggested that another important topic for sexual and reproductive health education and information programmes was the question of motherhood and maternal health in post-disaster situations: following the earthquake in Nepal in 2015, many women were requesting abortion as they did not deem it safe to have babies.

Discussion

United States said that incidents of maternal mortality and morbidity were of grave concern. Noting that Sustainable Development Goal 3.1 addressed maternal mortality, the United States asked the panellists how the international community could leverage work toward the other Sustainable Development Goals to help eliminate preventable maternal mortality and morbidity. New Zealand said that delivering on the Sustainable Development Goals ambition to reduce maternal mortality required a grounding in international human rights law, among many other factors. The panel was asked for its views on the biggest challenges to achieving the relevant Sustainable Development Goals. Chile said that measures that States could take to speed up reductions in maternal mortality and morbidity were crucial, and States were obliged to respect human rights. Reduction in morbidity required States to achieve the Sustainable Development Goals.

Botswana said that, like many developing countries, it invested heavily in training health personnel, but those efforts were undermined by the relocation of critical human resources to developed countries. El Salvador said reducing maternal mortality was a main priority for the Government, and the percentage of births attended by health care staff had risen dramatically. Fiji said that, in 2015, the Pacific Health Ministers had signed an important document on devising a health strategy for the health of women, children and adolescents, during climate change, a strategy which acknowledged that health challenges were especially acute among mobile populations and among those living on islands suffering from the effects of climate change.

India said that India was one of the first countries to adopt a comprehensive “continuum of care” approach to maternal health by launching the Reproductive, Maternal, Newborn, Child, Plus Adolescent Health Strategy, which paid equal attention to all stages of a woman’s life. It was taking resolute steps towards eliminating preventable maternal deaths by 2030. Bolivia shared concern about the link between maternal mortality and the lack of infrastructure and development. Bolivia had launched subsidies for preventative healthcare for girls under the age of 12. Bolivia was looking for recommendations on what it could do to speed up the reduction of maternal mortality and morbidity in preventable cases. Ecuador said that it was important to look at the deep structural problems related to maternal mortality and morbidity, including poverty and the lack of reliable statistics to work in a cross-cutting way on programmes. Ecuador had carried out research on maternal deaths and had extended the child-bearing age to decrease the number of maternal deaths.

Israel said that cases of maternal mortality and morbidity in Israel were relatively rare. Progress in medical technologies and lifestyle changes had resulted in a significant drop, and the Government had taken a number of key healthcare initiatives, including the expansion of healthcare services to certain communities. Mongolia said that maternal and children’s health had always been at the top of the list of the Government programmes. Thanks to the continued efforts, the maternal mortality rate in Mongolia had decreased significantly in the last two decades. Switzerland said that the causes and consequences of maternal mortality and morbidity were well known and almost always preventable. Switzerland stressed the importance of providing girls and boys with access to information and sexual and reproductive health services, as well as addressing structural challenges.

Swedish Association for Sexuality Education called on States to implement the Technical Guidance and to effectively address maternal mortality by protecting women and girls’ rights to have full control over their sexuality and sexual and reproductive health. Alliance Defending Freedom stated that authentic solutions to the problem of maternal mortality were eradication of poverty, education and access to medical care. Maternal death was linked to the inability to access obstetric care, lack of information, and lack of health workers. Plan International reminded that limited attention had been given to very young adolescent girls, who faced the greatest risk of complications and death from pregnancy and childbirth. Governments had to provide comprehensive sexuality education from an early age.

Concluding Remarks

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, asked the panellists to highlight exemplary State policies or practices for the reduction of maternal mortality.

FLAVIA BUSTREO, Assistant Director-General for Family, Women's and Children's Health, World Health Organization, said that Italy was the country with the lowest maternal mortality rate in the world, and this was because Italy had recognized the right to health in its Constitution since 1948. Further, the health care reform was explicitly shaped by human rights, and access to health services, including abortion services, was granted according to the law. The third factor was access to education and information.

CARMEN BARROSO, Co-Chair of the Independent Accountability Panel for Every Woman, Every Child, Every Adolescent, highlighted the example of Canada which had brought $600 million to the table, because resources were so critical for the implementation of initiatives, especially if they were non-conditional and could be used according to the needs. Dr. Barroso also highlighted the need for accountability in the use of resources and ensuring they reached their intended recipients.

ARZU RANA DEUBA, Member of Parliament from Nepal, underlined the importance of the mobilization of men and the role of female community health care volunteers, who were equipped with knowledge and education and who were the ones to mobilize. Also important was the mobilization for safe abortion, said Dr. Deuba.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, on safe abortion, asked what needed to be done.

CARMEN BARROSO, Co-Chair of the Independent Accountability Panel for Every Woman, Every Child, Every Adolescent, said that it necessary to rely on data, and data showed that safe abortions saved lives. This must be done in conditions where there were no obstacles and women had choices. The best way to reduce the number of abortions was to legalise abortion, increase access to contraceptives, and ensure education and information.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, noted that the prevention of unsafe abortions should be done through the provision of information and contraception to young people, and through equipping healthcare workers to provide safe abortions.

ARZU RANA DEUBA, Member of Parliament of Nepal, said that unsafe abortions existed everywhere in the world and that women were silently dying from them. The best form of prevention was through a comprehensive package of family planning and advice. Unfortunately, funds for family planning had been cut.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, turned to the issue of information submitted by countries and regions. The percentage of countries without good statistical information was worrying. If there was no measurement, there was no problem.

FLAVIA BUSTREO, Assistant Director-General for Family, Women's and Children's Health at the World Health Organization, said that a very small number of countries could measure maternal deaths. A large number of countries measured them indirectly and came up with estimates. It was thus important for States to establish maternal mortality surveillance and response systems. As for the broad social and environmental determinants of maternal deaths, among the countries that were able to achieve the Millennium Development Goals on maternal death, 50 per cent reduction was due to interventions in the health sector, and the rest in other sectors. Those other sectors were education, transportation, energy, and water supply. Those were all elements of development. The Government as a whole should be accountable for taking relevant measures.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, with respect to maternal mortality, asked what were the panellists’ recommendations on dealing with indigenous cultures?

CARMEN BARROSO, Co-Chair of the Independent Accountability Panel, said it was important for healthcare providers to respect indigenous cultures as they did not always have an understanding on these cultures. Challenges associated with reducing maternal mortality and morbidity were aggravated with indigenous peoples. She recommended incorporating and hiring people from indigenous cultures to work as health practitioners and advocates. This was complicated and expensive, but very much needed.

BEATRIZ LONDOÑO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and discussion moderator, asked what were some recommendations to keep in mind with respect to maternal mortality and morbidity and migrant populations?

ARZU RANA DEUBA, Member of Parliament, Nepal said that migrant populations were the least serviced because they were not registered anywhere. They also did not know where to go. Only in a crisis situation did people wake up and realize that they were there. From a human rights perspective, it was necessary to design something that would capture them coming into the system. They did not have access to anything. She asked fellow panellists what they had seen in other countries.

FLAVIA BUSTREO, Assistant Director-General for Family, Women's and Children's Health, World Health Organization, said in these fragile cases, the World Health Organization saw higher cases of maternal deaths. The international community needed to work with countries receiving refugees. A country like Jordan could not provide access to service delivery to refugees if it could not provide such services to its own people.

CARMEN BARROSO, Co-Chair of the Independent Accountability Panel, said there was a need to focus on adolescents and sexual violence because many times even peacekeeping forces in charge of protecting the rights of people in conflict situations were accused of committing crimes. Adolescents deserved special attention because they were most vulnerable and it was a catastrophe in many countries. The international community’s approach toward refugees needed to be rethought completely.

BEATRIZ LONDONO SOTO, Permanent Representative of Colombia to the United Nations Office at Geneva and panel moderator, thanked the panellists for their commitment and examples, and for bringing concrete recommendations. They had the possibility to make a change, she concluded.

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¹Joint statement: Associazione Comunita Papa Giovanni XXIII; Caritas Internationalis (International Confederation of Catholic Charities); Company of the Daughters of Charity of St. Vincent de Paul; Dominicans for Justice and Peace - Order of Preachers; Marist International Solidarity Foundation; Istituto Internazionale Maria Ausiliatrice delle Salesiane di Don Bosco; International Volunteerism Organization for Women, Education and Development – VIDES; Mouvement International d'Apostolate des Milieux Sociaux Independants; Association Points-Cœur; World Union of Catholic Women's Organizations; and New Humanity.



For use of the information media; not an official record

HRC17/029E