An official website of the United States government

Ambassador Donahoe on Maternal Mortality, Human Rights And Accountability
September 3, 2010

Ambassador Donahoe

September 2, 2010

Remarks of United States Representative to the Human Rights Council
Ambassador Eileen Chamberlain Donahoe

At an International Roundtable on
Maternal Mortality, Human Rights And Accountability

Geneva Business Center
Geneva, Switzerland

I would like to thank the organizers of this panel, Clemens Nathan Research Centre, the International Initiative on Maternal Mortality and Human Rights, SAHAYOG, CARE Peru, the Health Equity Group, and the Essex University Human Rights Center and Dr. Paul Hunt, as well as all of the distinguished panelists for their important insights on maternal mortality and human rights.

As the U.S. representative to the Human Rights Council, it is an honor for me to have the opportunity to learn from experts who devote their time, energy and professional lives to protecting and promoting human rights, particularly the rights of women and girls, something that is very close to me.

Today’s roundtable has made clear how far we still have to go to effectively combat maternal mortality. Globally, maternal mortality is one of the leading causes of death of women and girls of child bearing age. Every year, hundreds of thousands of women die from largely preventable complications in pregnancy or childbirth. For every woman who dies, scores more suffer from pregnancy-related injury, or infection. Thirty four percent of maternal deaths stem from unintended pregnancies, and yet over 215 million women still lack access to modern forms of contraception and so cannot control their fertility.

And while most of these deaths occur in developing nations, where UNICEF estimates that a woman may face a 1 in 76 lifetime risk of death during pregnancy and childbirth, this is by no means solely a problem of the developing world. In the United States, we too have struggled and continue to struggle with these challenges.

I would like to use this time with you to highlight three areas – 1)What governments are doing at the Human Rights Council to address this issue; 2) How we view the important intersection of the human rights and public health contexts; and 3) What the United States is doing to address maternal mortality domestically and globally, and how we hope that governments will join us in this effort.

In June 2009 the Human Rights Council adopted—by consensus—a landmark resolution on “Preventable maternal mortality and morbidity and human rights.” In this resolution, governments expressed grave concern for the unacceptably high rates of maternal mortality and morbidity, acknowledged that this is a human rights issue, and committed to enhance their efforts at the national and international level to protect the lives of women and girls worldwide.

Over 70 UN member states co-sponsored this resolution, and the United States was proud to join them. Colombia and New Zealand led this resolution and continue to be at the forefront of this issue at the Council. In June of this year, they organized a joint statement on maternal mortality that drew over 100 co-signatories. I thank them for their commitment, and the energy that they bring to this issue.

The June 2009 resolution identified a range of liberties that are directly impinged upon by maternal mortality and morbidity: the “rights to life, to be equal in dignity, to education, to be free to seek, receive and impart information, to enjoy the benefits of scientific progress, to freedom from discrimination, and to enjoy the highest attainable standard of physical and mental health, including sexual and reproductive health.”

The June 2009 resolution also requested that the Office of the High Commissioner prepare a study, which was presented at the June 2010 Council session. The issues that have been focused on here today—the intersection of the human-rights based approach and public health through monitoring and accountability were highlighted.

I would like to quote from OHCHR’s study: “It is clear that human rights have an important role to play in developing effective approaches to addressing this global problem through public health schemes. A number of steps that are essential to effectively address maternal mortality and morbidity have been identified as part of human rights standards, including the establishment of accessible, transparent and effective mechanisms of monitoring and accountability and of ensuring women’s rights to participate in decision-making processes that affect their pregnancy and childbirth.”

What the global community needs—and what we hope to bring to this issue—is a strong commitment to do more to strengthen health systems to better respond to women’s health needs.

The persistently high maternal mortality rate does not stem from uncertainty about how to save the lives of women. We know that providing proven, evidence-based interventions—such as skilled birth attendance, access to emergency obstetric care, pre- and post-natal care, and access to family planning—will help save women’s lives.

Rather, what has been lacking are the will and resources to tackle this pervasive problem. We need to elevate this issue in our development programs and diplomatic portfolios, particularly as we approach the Millennium Development Goal Summit this month. Millennium Development Goal Five, aimed at reducing maternal mortality by three quarters and ensuring universal access to reproductive health by 2015, is critical to and interconnected with every other development goal. But we in the global community have made less progress toward fulfilling that goal than any other.

We need to strengthen our health systems to better respond to women’s health needs by, for example, ensuring an adequate supply of trained health providers and access to adequate health facilities, as well as providing training in gender-sensitive care.

We need to ensure that maternal and reproductive health care is integrated throughout our public health programs. A pregnant woman who seeks HIV/AIDS treatment to prevent mother-to-child transmission of the HIV virus, for example, should also have access to family planning information and pre- and post-natal care. Our goal should be to deliver an integrated package of essential health services, including sexual and reproductive health, child health, and control of communicable diseases while emphasizing efforts to strengthen the basic health care system, with full protection of human rights, to make services accessible, available, affordable, and of high quality.

Furthermore, this unacceptably high rate of maternal mortality is directly linked to persistent gender inequalities. Such inequalities are tied into gender-based violence, harmful traditional practices, lack of education, lack of economic opportunity, and unequal access to adequate health services. We need to address the myriad economic, cultural, social and legal barriers that impede women’s access to needed health care.

We in the United States government strive to tackle the issues of maternal mortality and morbidity by integrating maternal and reproductive health care throughout our domestic and global public health approaches.

Domestically, we have put in place many tools to address this issue. In addition to the new health care reform legislation that will expand coverage and improve access to preventive care, the United States has programs such as “Healthy Start”, which provides primary and preventive care to high-risk pregnant women.

Abroad, we are linking our health programs to our wider development efforts to address the underlying political, economic, social, and gender disparities that can prevent women from having access to necessary care. We are also partnering with governments, civil society, and health care professionals to make sure that the health needs of women and girls is seen as a critical part of any nation’s strategic planning. We applaud the renewed commitment in countries everywhere to health, and we are working closely with our counterparts worldwide—not only in the office of the health minister, but the foreign minister, the defense minister, the finance minister, and especially at the top, in the offices of prime ministers and presidents.

In 2009, the United States renewed funding of reproductive healthcare through the United Nations Population Fund and the U.S. Congress has appropriated more than $648 million in foreign assistance to family planning and reproductive health programs worldwide, the largest allocation in more than a decade.

In addition to new funding, we’ve launched a new program that is a centerpiece of our foreign policy — the Global Health Initiative. The Global Health Initiative commits the United States to spending $63 billion to improve global health by investing in efforts to reduce maternal and child mortality, prevent millions of unintended pregnancies, and averting millions of new HIV infections, among other goals. Through the Global Health Initiative, we will provide integrated and essential health services for women and their children, including not only skilled care during pregnancy, childbirth and the post-partum period, but also family planning, prevention and treatment of HIV/AIDS, TB, and malaria, and essential child health interventions.

Our commitment to this initiative, combating maternal mortality and to promoting the health of women and girls is a commitment not only to women, but to local communities and the global community. When a woman’s health suffers, her family suffers and there is a ripple effect. The survival of women in pregnancy or childbirth is important not only for women themselves but for the entire family. According to the World Health Organization, some one million children are left motherless each year, and these children are 10 times more likely to die within two years of their mothers’ death.

Maternal and child health are also important indicators of broader progress. One of the most constant predictors for political upheaval is the rate of infant mortality. In places where the rate of infant mortality is high, the quality of life is low because investment in and access to healthcare are often out of reach. We also know that child mortality is closely connected with maternal mortality. When a mother dies, her children are at much greater risk of dying as well.

We are willing to invest our money, our time, and our expertise to improve women’s health worldwide and we hope that other governments can demonstrate their commitment in terms of political commitment, human resources, serious pledges to build capacity and where feasible, financial support.

The United States knows that focusing on improving the health of women and girls is not only the right thing to do—it is the smart thing to do. Improving the health of women and girls enhances their productivity, their participation, and acts as a positive multiplier, benefiting the development and health of future generations.

I would like to quote Secretary of State Hillary Clinton, “If we believe that human rights are women’s rights and women’s rights are human rights, then we cannot accept the ongoing marginalization of half the world’s population. We cannot accept it morally, politically, socially, or economically.”

This year presents a unique moment for the world to join together in a renewed effort to reduce the incidence of preventable maternal mortality and morbidity around the world. The U.S. welcomes the opportunity to address this issue throughout the UN system, and we look forward to working with the Secretary General and the important partners he has brought together.

Thank you for this opportunity to address you to today. I would like to again applaud the many distinguished panelists gathered today, the delegations of Colombia and New Zealand, and our fellow member of the Human Rights Council for addressing this important human rights-related issue.