CEDAW Decision on Brazil
International judicial precedent on maternal mortality was set at United Nations level in August 2011, when the CEDAW Committee became the first UN human rights body to issue a decision on maternal mortality. In the case of Alyne da Silva Pimentel v. Brazil (WHO, 2012) the committee established that States have a human rights obligation to guarantee women of all racial and economic backgrounds timely and non-discriminatory access to appropriate maternal health services. The Committee also established that governments outsourcing services to private health-care institutions remain directly responsible for, and must regulate and monitor the actions of, these institutions.
The aforementioned case concerned Alyne da Silva Pimentel, a Brazilian woman of African descent who died from pregnancy-related causes after her local health centre misdiagnosed her symptoms and delayed providing her with emergency obstetric care. Her mother took the case to the CEDAW Committee, arguing that national authorities had made no effort to establish professional responsibility and that she had been unable to obtain justice in Brazil. Alyne’s death exemplifies circumstances that are all too common everywhere: preventable maternal deaths seem to be concentrated among marginalised groups of women and they are marked by a lack of accountability. The Committee found violations of the right to access health care and effective judicial protection in the context of non-discrimination. These rights are guaranteed by the Convention on the Elimination of all forms of Discrimination against Women (CEDAW) in the 187 countries that are party to it and legally bound by its provisions, as well as by most countries’ constitutions and laws. Cases of this kind, therefore, furnish opportunities for international and domestic accountability.
In its authoritative interpretation of States’ obligations under the CEDAW, the Committee made several general recommendations intended to reduce preventable maternal deaths. They were: (i) to ensure women’s right to safe motherhood and affordable access to emergency obstetric care; (ii) to provide adequate professional training for health workers; (iii) to ensure that private health-care facilities comply with national and international reproductive health-care standards; (iv) to implement Brazil’s National Pact for the Reduction of Maternal and Neonatal Mortality, which includes the establishment of more maternal mortality committees to monitor maternal deaths; and (v) to ensure women’s access to effective remedies when their reproductive rights have been violated. The Committee also recommended that Brazil provides reparation, including monetary compensation, to Alyne’s family.
While there is no similar precedent at country level, the Committee’s recommendations with regard to maternal mortality and access to effective remedies illustrate how a human rights approach can strengthen accountability for maternal deaths at the national level. International mechanisms can enhance accountability where national mechanisms are inaccessible, ineffective or absent. For example, UN treaty monitoring bodies, which independently oversee the implementation of international human rights treaties, review national reports periodically submitted by States parties and issue recommendations accordingly. Some of them, like the CEDAW Committee, also oversee complaints procedures such as the one described herein.