Authors: Nelly Warega* and Tomiwa Ilori**
*Legal Advisor, Women’s Link Worldwide
**Doctoral researcher, Centre for Human Rights, University of Pretoria
On 17 April 2020, a Twitter user tweeted about a hospital in Lagos that demanded personal protective equipment (PPE) from a woman seeking to give birth at the facility. The incident, according to the user happened at the General Hospital, Ikorodu, under the Lagos State Government Health Service Commission. The PPEs have become important for health workers given the surge in transmission COVID-19 across the world. However, despite the rising demand and scarcity of PPEs, a conversation on the propriety of placing the burden of procurement of PPEs on expectant mothers is vital.
A case currently before the Constitutional Court of Uganda is providing an interesting test for how far courts can go in protecting basic human rights. Human rights are rights inherent to all human beings. Every person is equally entitled to them without discrimination. They are interrelated, interdependent and indivisible.
Universal human rights are often guaranteed by law through treaties and various sources of international law which generally oblige governments to respect, protect and fulfill human rights and fundamental freedoms of individuals or groups.
Apart from international obligations, countries have various ways of entrenching human rights. Most contemporary constitutions entrench basic human rights. Such constitutions include the 1996 Constitution of South Africa and the 2010 Kenyan Constitution. Likewise, the 1995 Constitution of Uganda contains the Bill of Rights that guarantees fundamental freedoms and basic rights including the rights to health and to life.
Maternal mortality is one of the shocking failures of development and a dreadful social injustice. According to recent UN official figures, 536,000 women die every year during pregnancy and birth. This is one death every minute. Out of the 536,000 maternal deaths, 99% are experienced by women in developing countries. The highest maternal mortality rates are in Africa; with a lifetime risk of 1 in 16. Maternal death is often the result of policy decisions that directly or indirectly discriminate against women. Maternal death is also often an indication of inequalities between men and women in their enjoyment of the right to the highest attainable standard of health. Below I illustrate how other rights are either implicated by or essential in combating maternal mortality.
Maternal mortality rates reflect disparities between wealthy and poor women, and between developed and developing countries. [i] Frequently, whether women survive pregnancy and childbirth is related to their social, economic and cultural status. The poorer and more marginalized a woman is, the greater her risk of death. [ii] Ninety–nine per cent (99%) of maternal deaths occur in developing countries, and most of these deaths are preventable. [iii]
While worldwide maternal mortality has declined – in 2013, the global maternal mortality ratio (MMR) was 210 maternal deaths per 100,000 live births, down from 380 maternal deaths in 1990 (a 45 per cent reduction) [iv] – unfortunately in Kenya maternal mortality has decreased very little, i.e., from 490 to 400[v] in the period between 1990 and 2013, compared to the Millennium Development Goal No. 5 (MDG) target [vi] of 147 per 100,000 births. [vii]
It is a universal and timeless reality that women face the risk of death in the process of giving life. In recent years, this risk has been virtually eliminated for those who have access to the necessary prenatal care and emergency medical assistance. Contrary to the global trend, Zimbabwe has seen a stark increase in its number of maternal deaths and currently sits with a figure that is 50% higher than the sub-Saharan average.
This state of affairs is not surprising in light of the disintegrated nature of Zimbabwe’s public health system, which reached its lowest point in 2008. At that time, government policies led to the closure of public hospitals and a medical school in Harare. Basic resources and emergency care have not been consistently available and the government’s failure to remunerate healthcare professionals with set salaries left many of them with no choice but to leave the country. The continuing epidemic of deaths which could have been prevented indicates an alarming disregard for a variety of rights and obligations on the part of the Zimbabwean government. Questions arise as to whether the government is taking appropriate measures to address the plight of Zimbabwean women.
Sometime in May 2013, the Republic of Kenya, together with two of her counterparts, Zambia and The Gambia, received the prestigious Resolve Award from the Global Leaders Council for Reproductive Health. Briefly, the Resolve Award was launched in 2011 as an annual award issued by the Aspen Institute. The Award recognises countries that are surmounting various challenges to bring essential reproductive health services to their people and celebrates progress made by governments towards delivering on the promise of universal access to reproductive health. We must therefore begin by celebrating our nation’s achievement. Indeed, impressing a Council comprising of 18 sitting and former heads of states amongst others, the Honourable Mary Robinson, Her Excellency Joyce Banda, Honourable Gro Harlem, Vice Admiral Regina Benjamin and Honourable Tarja Haloren is by no means an easy step.
The Award comes at an opportune time when mothers all over Kenya are celebrating the reprieve granted by the Jubilee Coalition which on 1 June 2013 issued a directive waiving all fees payable by mothers for maternal services at public health facilities. In recent times, we have in addition seen other efforts by the Kenyan government aimed at transforming access to reproductive health services and lowering maternal mortality. First, there is the constitutional recognition of reproductive health as a fundamental human right under Article 43(1)(a). There is also the enactment of many visionary policies and guidelines, including the National Reproductive Health Policy and the comprehensive Population Policy for National Development which places family planning at the centre of Kenya’s development agenda. Additionally, there is also the Child Survival and Development Strategy and the National Road Map for accelerating the attainment of the Millennium Development Goals (MDGs) related to maternal and newborn health in Kenya.
The latest global and regional estimates of the incidence of unsafe abortion and associated mortality bring no comfort to the African region. What is disconcerting about the estimates is not only that unsafe abortion continues to account for 13 per cent of maternal mortality, but also that, from a regional perspective, Africa’s share of unsafe abortion-related maternal mortality remains quite disproportionate. Africa stands out as the region least positioned to meet the Millennium Development Goal to reduce maternal mortality by three-quarters by 2015.