Maternal and neonatal mortality have barely declined in the past two decades. The most recent estimates indicating that about 536 000 women die every year from pregnancy-related causes demonstrate that, at the global level, maternal mortality has decreased at less than 1% annually between 1990 and 2005. (1) This is far below the 5.5% annual decline necessary to achieve the Millennium Development Goal (MDG) of improving women's health by reducing maternal mortality. Ninety-nine percent of these deaths occur in developing countries. Likewise, even as the under-five and infant mortality rates have dropped considerably in many developing countries, the rates for neonates (infants in the first 4 weeks of life) and, in particular, early neonatal mortality (infants in the first week of life) have declined much more slowly and in some regions have remained static. (2) An estimated 4 million babies die during their first 4 weeks, of which 3 million die in the first week. (3) Maternal and neonatal health are central for the MDGs, the global roadmap for eradicating poverty and improving human well-being by the year 2015. (4)
While the right of parents to determine freely and responsibly the number and spacing of their children was first articulated in the 1968 UN International Conference on Human Rights, the right of women to go through pregnancy and childbirth safely was first made explicit only in 1994 as part of the Programme of Action of the UN International Conference on Population and Development (ICPD). The definition of reproductive health included "the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant". (5) Subsequently, three organizations--WHO, United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) declared that:
"The right to life is a fundamental human right, implying not only the right to protection against arbitrary execution by the state but also the obligations of governments to foster the conditions essential for life and survival. Human rights are universal and must be applied without discrimination on any grounds whatsoever, including sex. For women, human rights include access to services that will ensure safe pregnancy and childbirth." (6)
These commitments were built upon a foundation laid by authoritative sources. For example, the UN Human Rights Committee, which monitors implementation of the International Covenant on Civil and Political Rights, had previously confirmed that, in international law, the right to life not only applies to ensuring that capital punishment is not imposed in an arbitrary way but also requires that States adopt positive measures to ensure survival and development. (7) In 2000, the Committee elaborated its General Comment 28 on the equality of rights between men and women which, among other things, requires States to report their progress and to provide data on birth rates and on pregnancy and childbirth-related deaths of women. (8)
Human rights are used by international organizations, governments, nongovernmental organizations, civil society groups and individuals in their work with respect to health in many different ways. These can broadly be categorized as: advocacy, application of legal standards, and programming, including service delivery. Some use one approach while others apply a combination in their work. (9-12)
To understand the historical context which shaped the rationale and approach of linking health and human rights to improving maternal and neonatal health, we summarize how maternal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods.
For most women living in industrialized countries, the experience of death and/or severe injury during childbirth is remote, both statistically and historically. …