Historic UN Ruling: States Must Ensure Access to Maternal Health Care

Governments have a human rights obligation to guarantee women’s access to timely and nondiscriminatory maternal health services, according to a recent ruling by a major United Nations human rights body.

The UN Committee on the Elimination of Discrimination Against Women (CEDAW) issued the Aug. 10 ruling, concluding the first maternal death case ever to be decided by an international human rights body.

The case began in 2002 with the tragic death of Alyne da Silva Pimentel, a 28-year-old Brazilian of African descent. Alyne was denied timely care at a public health facility and later died after giving birth to a stillborn baby. Five years later, her mother brought the case to CEDAW, stating the government of Brazil violated her daughter’s right to life and health by failing to meet its obligation to ensure the health and rights of her daughter.

In her complaint, Maria de Lourdes da Silva Pimentel invoked Articles 2 and 12 of the Convention on the Elimination of All Forms of Discrimination Against Women, which call on the government to pursue all appropriate means to eliminate discrimination against women in the field of health care.

Brazil is an emerging economic power in South America. While the country has dramatically reduced maternal deaths in the last 10 years, the progress at the national level belies the extreme disparities in maternal health care that still exist based on race, socioeconomic status and geography.

The ruling sends a powerful message in the international arena and demands that the government compensate Alyne's family and take steps to ensure women's rights to safe motherhood and health care. More broadly, it establishes that maternal health is a human rights responsibility of governments that must be taken seriously and that applies to all women, including indigenous, impoverished women who are most affected by maternal mortality.

Created in 1982, the Committee is made up of 23 experts on women’s issues worldwide. The Committee mandate is to monitor progress for women in countries that are parties to the Convention. Members review national reports to assess the steps being taken to improve situations for women—a process that itself enables continuous dialogue and focus on anti-discrimination policies.

Photo by C. Ngongo/EngenderHealth

Insights from 2011 Int’l AIDS Society Conference

Back from Rome where they participated in this year’s International AIDS Society (IAS) Conference, Mark Barone and Jared Nyanchoka, Technical Advisors at EngenderHealth, took time to share highlights from the annual meeting:

Q: What were some research highlights from the conference?

A: Two major research advancements drew much attention at the conference: 1) treatment as prevention and 2) pre-exposure prophylaxis, known as PrEP. In the first case, a large, randomized study showed that when people living with HIV begin antiretroviral (ARV) treatment before they normally would, their chances of transmitting the virus are reduced by an astounding 96%. The second breakthrough involved two randomized studies among heterosexual couples in Botswana, Kenya, and Uganda, which showed that a daily dose of ARV drugs for HIV-negative men and women reduced the risk of contracting HIV by 60-70%.

Another interesting study addressed male circumcision for HIV prevention, one of EngenderHealth’s HIV focus areas. A study from South Africa showed for the first time that male circumcision reduced the number of new HIV infections within a population. Among 15- to 34-year-old men, there was a 76% reduction in new HIV infections between 2007 and 2010 in the Orange Farm area outside of Johannesburg.

Q: What are the key issues emerging in light of the recent findings involving HIV treatment for prevention?

A: Treatment as prevention took center stage at this year’s IAS conference in Rome. While everyone seems very excited about these amazing results, many debates have surfaced about the practical issues that must be addressed before this approach can become a reality.

Currently, in Africa, as in other parts of the world, many people need treatment now, yet are unable to get it because of lack of availability and resources. How can we begin giving anti-HIV drugs to people who do not need them yet clinically, even though we know that doing so will decrease the chances of passing HIV to others? Treatment-as-prevention approaches are extremely expensive, and stigma is an obstacle to getting tested and accessing treatment. There are also concerns about human rights issues surrounding drug distribution in limited resource settings. These are only a few of the many issues that complicate this discovery.

It is also important for people to keep in mind that treatment as prevention and PrEP have a major behavioral component. People actually need to take the drugs. With past prevention measures (condom use, reduction in sexual partners, safe drug injection practices), we have seen that behavior change is not easy. We must not be lulled into thinking that these prevention approaches using ARV drugs will be any more likely to succeed without significant efforts.

The ethics of using placebos in future HIV research were also debated at the conference, particularly with regard to developing an HIV vaccine. How ethical will it be to give placebo medication in place of other near effective biomedical approaches such as treatment as prevention and PrEP when researching effectiveness?

Q: What new HIV-related research did EngenderHealth present at the conference?

A: EngenderHealth gave two poster presentations on our male circumcision work in Kenya, both of which were very well-received. One demonstrated that male circumcision provided by non-physicians (nurses and clinical officers) is safe, effective, and acceptable, when the providers are well trained and facilities have the required equipment and supplies. The second confirmed the safety and acceptability of the Shang Ring, a novel device for adult male circumcision that EngenderHealth is researching in Africa. Participants were eager to use the findings as a lobbying tool to push their governments to support male circumcision.

Q: What role do you think this and similar conferences play in knowledge sharing and advancement?

A: Scientific conferences are crucial for knowledge sharing. They provide a forum for presenting the latest developments and advances in the field, for exchanging ideas about projects, and for immersing oneself in the latest work in many different subfields of HIV research. Conferences allow researchers to present their data and solicit input from others, as well as provide input on others’ work. They allow for critical discourse, discussion and debate that help to move the field forward and provide an opportunity to network with colleagues and to develop new collaborations with people from around the world.

Obama Administration Requires Zero Copay for Birth Control

In a historic decision announced today, the Obama administration has required health insurance plans to cover the cost of birth control without copayments from patients. The rule will likely go into effect in January 2013.

Department of Health and Human Services Secretary Kathleen Sebelius announced the new rule, after the Institute of Medicine, a leading medical advisory panel, recommended that contraceptives be included as part of women’s preventive health care.

In addition to birth control, insurance providers will be required to pay for breast pumps, HIV testing, annual physicals, screening for domestic violence, counseling for breastfeeding, and other procedures that qualify as “preventive healthcare” services. Insurance premiums are expected to rise to cover the increased costs to insurance companies.

The requirement will only apply to insurance plans designed on or after Aug. 1, 2012. A provision in the new rule also allows some employers to opt out of the requirement on grounds of religion.

Sebelius called the guidelines “historic” and “based on science.” Previously there has never been an established set of guidelines for women’s health and preventive care, and according to the Institute, almost half of all pregnancies in the United States are unintended; 40% of them end in abortion.

Expanding access to contraceptives is critical for women’s health and rights, not just in the United States, but in developing countries across the world. Currently, EngenderHealth works to improve and expand access to quality family planning services, with a focus on long-acting and permanent methods in Africa and Southeast Asia.