The United Nations (UN) has affirmed that maternal health care is an international human right – a right of all women, regardless of their race, ethnicity, income, or citizenship status. In its landmark decision on the case Alyne da Silva Pimentel v. Brazil, the United Nations Committee on the Elimination of Discrimination Against Women established that governments have an obligation to guarantee that all women in their country have access to adequate and timely maternal health care, including emergency services, even if the government outsources health care to private institutions.
The 1979 Convention on the Elimination of All Forms of Discrimination Against Women established that governments must ensure that women receive appropriate prenatal and postnatal services (Article 12), but a maternal death case had never been brought before the UN. In 2007, the Center for Reproductive Rights brought a case against Brazil before the UN committee, and this month this first ever case involving maternal death was decided by an international human rights body. The case involved the 2002 death of a 28-year-old Afro-Brazilian woman who died in her sixth month of pregnancy from preventable complications because of misdiagnosis and delayed treatment. The UN Committee concluded that Brazil had violated the international human rights of women through discriminatory maternal health practices made clear by its history of inequitably distributing maternal health care facilities across regions, a practice that ultimately resulted in Ms. Pimentel’s untimely and preventable death. The decision signals a commitment by the UN to uphold women’s rights to maternal health services and reaffirmed that it is a human right to receive appropriate, adequate, and timely maternal health care.
The case laid bare the stark injustice women and girls face in seeking quality health care in Brazil and around the world. The inequitable distribution of maternal health care facilities in Brazil led to disproportionately low concentrations of adequate maternal health in low-income areas and areas with high concentrations of people of color. Although Brazil’s overall maternal death rate has decreased – recent numbers place it at 58 per 100,000 live births – significant disparities remain along the lines of race, economic status, and region.
Unfortunately, Brazil is not alone in having starkly disparate maternal death rates based on race. In the United States, African American women, regardless of income, are four times more likely than white women to die of pregnancy-related complications (page 1). This has resulted in an overall maternal death rate for African American women of 26.5 per 100,000 live births (table 34) and rates as high as 83.6 per 100,000 live births in New York City (page 4). Indeed, the U.S. women most likely to die of pregnancy-related complications are low-income women of color.
Compared to other industrialized countries, however, all women in America have high maternal death rates. With an overall maternal death rate of 12.7 per 100,000 live births (table 34), the United States ranks 50th in the world. This is an embarrassingly low rank for a country that spends the most money on health care in the world and the largest percentage of its health care costs on maternal health. To put this in perspective, a woman in the United States, regardless of race or income, is three times more likely to die in childbirth than a woman in Spain, and five times more likely to die in childbirth than a woman in Greece (page 1).
For the United States, the problem is not necessarily quality of health care, but rather access to it. Federal and state governments have programs in place to serve pregnant women and provide them with appropriate care. Many low-income pregnant women, regardless of race, age, or citizenship status are eligible for Medicaid, which allows women to receive health coverage for pre-natal and post-natal medical treatment. Indeed 42 percent of all births are covered by Medicaid, and no woman in active labor can be turned away from a hospital because of her ability to pay. Many women, however still face barriers to receiving adequate health care under Medicaid, such as transportation concerns, inflexible appointment hours, and difficulty taking time off work. Doctors, too, may be unwilling or unable to take Medicaid because of the low fees and high costs involved (page 5).
The Patient Protection and Affordable Care Act moves the right to health care forward by requiring insurers to provide some preventive services for women at no cost, such as well-women visits, and expanding Medicaid coverage. These provisions will mean that thousands more pregnant women will receive the health care they need. But estimates indicate that thousands more women will still be in need. Many women who will now qualify for Medicaid will still face barriers in receiving quality maternal care. With the Alyne da Silva Pimentel v. Brazil decision, the UN has reinforced that maternal health care is a fundamental human right. The United States must reaffirm its commitment to women and help lead the way to lower the unacceptably high rate of preventable maternal deaths within its own borders by ending discriminatory practices and ensuring quality maternal health care for all women.
This post was coauthored by Hannah Green.