Can a rights-based approach reduce maternal mortality? Can its focus on equity improve health outcomes for poor women? This review, by the UK Department for International Development (DFID), argues that rights-based approaches can add impetus to reducing maternal mortality. It argues that policy actors in government and civil society should find ways of addressing the economic, social, cultural and political forces that prevent poor women from asserting their right to maternal health.
Although improving maternal health is one of the Millennium Development Goals, few countries have progressed in reducing maternal mortality during the last 20 years. Unacceptably high maternal mortality rates prevail. This can be attributed to the status of women, the systematic violation of their basic human rights and failing health systems. Rights-based approaches can uncover the power dynamics that perpetuate these inequities, and suggest strategic interventions such as the reallocation of resources, changing accountability mechanisms within health systems and communities and challenging existing hierarchies in health facilities.
Evidence indicates that supporting maternal health services in an isolated way will not make an impact on maternal mortality rates as a whole. More systemic change is needed.
- Health services, and health systems, play a role in reducing maternal mortality. Change will only occur by tackling health policy at a national level to influence resource allocation.
- The concepts of obligation and accountability provide entry points to influence how decisions are taken about what services to finance. They can also support providers in delivering a service that women can use.
- A rights-based analysis of access to care would highlight those women who are not currently using services. It would also reveal the underlying social and cultural factors that perpetuate their inability to do so.
- Rights-based interventions at the community level need to respond to local context and resonate with locally respected values.
- Participatory capacity-building processes appear central to enabling local stakeholders to redefine and negotiate new norms and practices.
- These need to be done in parallel with programmes that help communities hold government and service providers to account.
DFID must match its commitment to applying a rights-based approach to maternal mortality with a recognition of, and advocacy for, the benefits of doing so.
- The political dimensions of rights-based work must be clearly acknowledged: a rights-based approach addresses powerful people’s interest in maintaining the status quo. These people may be alienated.
- The language should be contextualised within local values that mirror principles such as equity and non-discrimination.
- Principles that derive their legal legitimacy from international human rights treaties must resonate with rights identified and defined at community level.
- Rights-based approaches need a multi-sectoral analysis and response. Activities should be prioritised and resources reallocated.
- Further research is needed to determine how to complement and add value to existing initiatives in rights-based approaches to reducing maternal deaths. Gaps in the evidence base should be addressed.