RES/39/10 Preventable maternal mortality and morbidity and human rights in humanitarian settings

GE.18-16418(E)



Human Rights Council Thirty-ninth session

10–28 September 2018

Agenda item 3

Resolution adopted by the Human Rights Council on 27 September 2018

39/10. Preventable maternal mortality and morbidity and human rights in

humanitarian settings

The Human Rights Council,

Guided by the purposes and principles of the Charter of the United Nations,

Reaffirming the Universal Declaration of Human Rights, and recalling relevant

international instruments, including the International Covenant on Economic, Social and

Cultural Rights, the International Covenant on Civil and Political Rights, the Convention on

the Elimination of All Forms of Discrimination against Women, the Convention on the

Rights of the Child, the International Convention on the Elimination of All Forms of Racial

Discrimination and the Convention on the Rights of Persons with Disabilities,

Recalling the Geneva Conventions of 12 August 1949, the Additional Protocols

thereto of 8 June 1977, and the Convention relating to the Status of Refugees,

Recalling also General Assembly resolution 72/132 of 11 December 2017 on

international cooperation on humanitarian assistance in the field of natural disasters, from

relief to development,

Recognizing that preventing maternal mortality and morbidity is one of the human

rights priorities for all States, and reaffirming that all human rights are universal, indivisible,

interrelated, interdependent and mutually reinforcing,

Recalling previous Human Rights Council resolutions on preventable maternal

mortality and morbidity and human rights,

Reaffirming the Beijing Declaration and Platform for Action and the Programme of

Action of the International Conference on Population and Development, and their review

conferences and outcome documents, and reaffirming also the resolutions and agreed

conclusions of the Commission on the Status of Women and the resolutions of the

Commission on Population and Development,

Recalling the Secretary-General’s renewed Global Strategy on Women’s, Children’s

and Adolescents’ Health, and recognizing the important role it can play in reducing

preventable maternal mortality and morbidity,

Welcoming the efforts of the World Health Organization, the United Nations

Population Fund and other United Nations agencies, funds and programmes, within their

respective mandates, to prevent maternal mortality and morbidity, and recalling the global

United Nations A/HRC/RES/39/10

commitment to the reduction of maternal mortality and to promote sexual and reproductive

health and reproductive rights, in accordance with the Beijing Declaration and Platform for

Action and the Programme of Action of the International Conference on Population and

Development and their review conferences and outcome documents,

Taking note of the efforts of the Inter-agency Working Group on Reproductive

Health in Crises of the Inter-agency Standing Committee Reference Group on Principled

Humanitarian Action to expand and strengthen access to quality sexual and reproductive

health-care services for people in humanitarian settings,

Taking note also of the report and the recommendations of the High-level Working

Group on the Health and Human Rights of Women, Children and Adolescents,1 the

cooperation framework between the World Health Organization and the Office of the

United Nations High Commissioner for Human Rights and that between the Office of the

High Commissioner and the United Nations Population Fund, and also of the draft articles

on the protection of persons in the event of disasters, adopted by the International Law

Commission,2

Recognizing the importance of strengthening coordination between all relevant

United Nations agencies, entities providing humanitarian assistance and civil society

organizations in accordance with their respective mandates, and the need for States to

ensure fully respect for and the protection and fulfilment of sexual and reproductive health

and reproductive rights, in accordance with the Beijing Declaration and Platform for Action

and the Programme of Action of the International Conference on Population and

Development and their review conferences and outcome documents, in reducing

preventable maternal mortality and morbidity in humanitarian settings,

Acknowledging that international humanitarian law and international human rights

law are complementary and mutually reinforcing, and recognizing that persons affected by

disasters are entitled to the respect for and protection of their human rights in accordance

with international law,

Reaffirming that States have an obligation to take steps to achieve the full realization

of the right of everyone to the enjoyment of the highest attainable standard of physical and

mental health, including sexual and reproductive health, free from discrimination, including

in humanitarian settings,

Recognizing that a human rights-based approach to the elimination of preventable

maternal mortality and morbidity is underpinned by the principles of, inter alia,

accountability, participation, transparency, empowerment, sustainability, non-

discrimination and international cooperation,

Stressing that reducing maternal mortality and morbidity with full respect of States’

human rights obligations and commitments will require integrated efforts across the 2030

Agenda for Sustainable Development and the Addis Ababa Action Agenda of the Third

International Conference on Financing for Development and in the means of

implementation of the 2030 Agenda,

Recognizing that respect for and the protection and fulfilment of the full enjoyment

of human rights by all women and girls and the full implementation of all Goals and targets

of the 2030 Agenda, including Goal 5 on achieving gender equality and empower all

women and girls and target 3.1 on reducing global maternal mortality, are interrelated and

mutually reinforcing,

Recognizing that sexual and reproductive health and reproductive rights are integral

to the realization of the right of everyone to the enjoyment of the highest attainable standard

of physical and mental health and that comprehensive sexual and reproductive health-care

services must have the interrelated and essential elements of availability, accessibility,

1 Leading the Realization of Human Rights to Health and through Health, report of the High-level

Working Group on the Health and Human Rights of Women, Children and Adolescents (Geneva,

World Health Organization, 2017).

2 See A/71/10.

acceptability and quality, on the basis of non-discrimination and formal and substantive

equality, including by addressing multiple and intersecting forms of discrimination,

Deeply concerned that there are continuing violations of the right of everyone to the

enjoyment of the highest attainable standard of physical and mental health, including sexual

and reproductive health, which have a negative impact on rates of maternal mortality and

morbidity, and that the full enjoyment of this right remains a distant goal for many women

and girls throughout the world,

Recognizing that violations of the right of everyone to the enjoyment of the highest

attainable standard of physical and mental health, including sexual and reproductive health,

such as inadequate emergency obstetric services and unsafe abortion, can cause high levels

of maternal morbidity, including obstetric fistula, leading to ill health and death for women

and girls of childbearing age in many regions of the world, and particularly in humanitarian

settings, and that a dramatic and sustainable scaling up of quality treatment and health-care

services, including high-quality emergency obstetric services and also of the number of

trained, competent fistula surgeons and midwives, is needed to significantly reduce

maternal and new-born mortality and to eradicate obstetric fistula,

Recognizing also that humanitarian settings may exacerbate pre-existing patterns

and structures of discrimination and inequalities and further undermine access to health

care, information and services, housing, water, sanitation, education and employment for

women and girls, and that in affected areas access to essential services, such as health-care

services, including sexual and reproductive health-care services, is disrupted owing to

inadequate infrastructure, lack of professional health-care workers, basic medicines and

health-care supplies and survivor-centred referral pathways for all survivors of sexual and

gender-based violence,

Recognizing further that, in humanitarian settings, disintegrating judicial systems,

gender-based discrimination and discrimination against refugees in host countries, fear of

reprisals against their families or themselves, and the stigma associated with sexual and

gender-based violence all prevent women and girl survivors of sexual and gender-based

violence and those denied access to sexual and reproductive health-care services from

reporting sexual violence and seeking justice, accountability and remedies for the violations

they have endured,

Deeply concerned that women and girls living in humanitarian settings are

disproportionately exposed to a high risk of violation of their rights, including through

trafficking, sexual and gender-based violence, systematic rape, sexual slavery, forced

sterilization, forced pregnancy, harmful practices such as child, early and forced marriage,

and lack of accessible and appropriate sexual and reproductive health-care services,

evidence-based information and education, including comprehensive sexuality education

consistent with the evolving capacities of the child, lack of access to perinatal care,

including skilled birth attendance, and emergency obstetric care, poverty,

underdevelopment, all types of malnutrition, lack of access to medicines and medical

equipment, human and material shortages facing health-care systems, humanitarian and

funding shortages affecting hospitals, technical assistance, capacity-building and training

needs, and lack of access to water and sanitation, resulting in heightened risks of unwanted

pregnancies, unsafe abortion and maternal mortality and morbidity,

Reaffirming that human rights include the right to have control over and to decide

freely and responsibly on matters relating to sexuality, including sexual and reproductive

health, free of coercion, discrimination and violence, and that equal relationships in matters

of sexual relations and reproduction, including full respect for dignity, integrity and bodily

autonomy, require mutual respect, consent and shared responsibility for sexual behaviour

and its consequences,

Recognizing that there are large disparities in maternal mortality and morbidity rates

between countries, but also within countries, and between women and girls facing multiple

and intersecting forms of discrimination, and noting with concern that the risk of maternal

mortality is higher for adolescents and highest for adolescent girls under 15 years of age,

and that complications in pregnancy and childbirth are a leading cause of death among

adolescent girls in developing countries, which creates the need to address all social,

economic and environment determinants of health in order to reduce the aforementioned

disparities,

Deeply concerned that in countries affected by humanitarian situations, the

estimated lifetime risk of maternal mortality is 1 in 54 compared to 1 in 180 globally, and

that the majority of preventable maternal deaths have occurred in settings of armed conflict,

natural disasters and displacement,

Convinced that greater political will and commitment, international cooperation and

technical assistance at all levels are urgently required to reduce the unacceptably high

global rate of preventable maternal mortality and morbidity, both globally and in

humanitarian settings, and that the integration of a human rights-based approach to the

provision of sexual and reproductive health-care services can contribute positively to the

common goal of reducing that rate,

Recognizing the need for further disaggregated data on maternal mortality and

morbidity rates and for access to sexual and reproductive health-care services in

humanitarian settings,

Acknowledging that the failure to prevent maternal mortality and morbidity is one of

the most significant barriers to the empowerment of women and girls in all aspects of life,

the full enjoyment of their human rights, their ability to reach their full potential and to

sustainable development in general, and recognizing the need to bridge the humanitarian-

development divide,

1. Urges all States to eliminate preventable maternal mortality and to respect,

protect and fulfil sexual and reproductive health and reproductive rights, in accordance with

the Beijing Platform for Action and the Programme of Action of the International

Conference on Population and Development and their review conference and outcome

documents, and the right to have full control over and decide freely and responsibly on all

matters relating to sexuality and sexual and reproductive health, free from discrimination,

coercion and violence, including through the removal of legal barriers and the development

and enforcement of policies, good practices and legal frameworks that respect bodily

autonomy and guarantee universal access to sexual and reproductive health-care services,

evidence-based information and education within a human rights-based approach, including

for family planning, safe and effective methods of modern contraception, emergency

contraception, universal access to health care, including quality maternal health care, such

as skilled birth attendance and emergency obstetric care, safe abortion in accordance with

international human rights law and where not against national law, the prevention and

treatment of reproductive tract infections, sexually transmitted infections, HIV and

reproductive cancers, and the integration of sexual and reproductive health into national

health strategies and programmes for all women and girls, including adolescents;

2. Urges States, in accordance with obligations under relevant provisions of

international human rights law, including the right to the enjoyment of the highest

attainable standard of physical and mental health, including sexual and reproductive health,

to ensure the availability, accessibility, acceptability and quality of health-care services,

including mental health care and psychosocial services and sexual and reproductive health-

care services, free of coercion, discrimination and violence;

3. Calls upon States to pay special attention to the particular situation of

adolescent girls in humanitarian settings who may have to assume adult responsibilities and

are exposed to higher risks of sexual and gender-based violence, child, early and forced

marriage and trafficking, and are likely to be denied education, skills training, safe

employment opportunities and access to sexual and reproductive health-care services and

information, and to face isolation, discrimination and stigma, mental health issues and risk-

taking behaviour;

4. Encourages all stakeholders to consider promoting and using the Inter-

Agency Standing Committee’s Guidelines for Integrating Gender-based Violence

Interventions in Humanitarian Action, the its Gender Handbook and the Inter-agency Field

Manual on Reproductive Health in Humanitarian Settings, and to ensure delivery of the

Minimum Initial Service Package for Reproductive Health at the onset of humanitarian

emergencies, with particular attention to women and girls facing multiple and intersecting

forms of discrimination and in situations of vulnerability, and to ensure a transition, as soon

as possible, towards comprehensive sexual and reproductive health-care services,

information and evidence-based education;

5. Encourages Governments, local authorities, the United Nations system and

regional organizations, and invites donors and other assisting countries, to address the

vulnerabilities and capacities of women and girls through gender-responsive programming,

including with regard to sexual and reproductive health needs and the means to address

sexual and gender-based violence and various forms of exploitation during emergencies and

in post-disaster environments, and the allocation of resources in their disaster risk reduction,

response and recovery efforts in coordination with the Governments of affected countries;

6. Strongly urges States and all parties to armed conflict to take effective

measures to prevent and address acts of violence, attacks and threats against medical

personnel and humanitarian personnel exclusively assigned to medical duties, their means

of transport and equipment, as well as hospitals and other medical facilities in armed

conflict, including through the development of domestic legal frameworks to ensure respect

for their relevant international legal obligations;

7. Takes note with appreciation of the report of the Office of the United Nations

High Commissioner for Human Rights on the follow-up on the application of the technical

guidance on the application of a human rights-based approach to the implementation of

policies and programmes to reduce preventable maternal mortality and morbidity, 3 and

encourages all stakeholders to consider the recommendations contained therein;

8. Requests States and other relevant actors to give renewed emphasis to

maternal mortality and morbidity initiatives in their development partnerships and

international assistance and cooperation arrangements, including by strengthening technical

cooperation to address maternal mortality and morbidity, including through the transfer of

expertise, technology and scientific data and exchanging good practices with developing

countries, while honouring existing commitments, and to integrate a human rights-based

perspective into such initiatives, addressing the impact that discrimination against women

and girls has on maternal mortality and morbidity;

9. Urges States to ensure that laws, policies and practices respect women’s

bodily autonomy and privacy and the equal right to decide autonomously in matters

regarding their own lives and health by bringing laws and policies concerning sexual and

reproductive health, including international assistance policies, into line with international

human rights law and repealing discriminatory laws relating to third-party authorization for

health information and health-care services, and combating gender stereotypes, norms and

behaviours that are discriminatory;

10. Also urges States to ensure access to justice and accountability mechanisms

and timely and effective remedies for the effective implementation and enforcement of laws

aimed at preventing violations of the right of everyone to the enjoyment of the highest

attainable standard of physical and mental health, including sexual and reproductive health,

including those aimed at preventing maternal mortality and morbidity, including in

humanitarian settings, such as by informing women of their rights under relevant

international and domestic law and by improving legal and health infrastructure and

removing all barriers in access to legal counselling, assistance and remedies;

11. Further urges States to ensure accountability and gender-sensitive, prompt

and effective remedies for the violation of the rights of women and girls in relation to

maternal mortality and morbidity in humanitarian settings by including transparent forms of

monitoring, review and oversight of humanitarian programmes and policies, including the

monitoring of inequities;

12. Calls upon States to support gender equality and women’s rights and the

rights of the child, including within families, through awareness-raising initiatives,

3 A/HRC/39/26.

including in schools and in displaced and refugee camps and settlements, especially

education and public awareness-raising, including through the media and online, the

incorporation of curricula on all women’s and girls’ rights into teacher training courses,

including the prevention of sexual and gender-based violence and discrimination, and

ensuring universal access to evidence-based comprehensive sexuality education consistent

with the evolving capacities of the child;

13. Urges States and encourages other relevant stakeholders, including national

human rights institutions and non-governmental organizations, to take action at all levels,

utilizing a comprehensive human rights-based approach to address the interlinked causes of

maternal mortality and morbidity, such as lack of accessible, affordable and appropriate

health-care services for all, and of information and education, lack of access to medicine

and medical equipment, all types of malnutrition, lack of access to safe drinking water and

sanitation, poverty, underdevelopment, human and material shortages facing health-care

systems, humanitarian and funding shortages affecting hospitals, technical assistance,

capacity-building and training needs, harmful practices, including child, early and forced

marriage and female genital mutilation, early childbearing, gender-based inequalities and

all forms of discrimination and violence against women and girls, to take concrete measures

to eliminate all forms of violence against women and girls, especially adolescent girls, and

to ensure access to accountability for survivors of sexual and gender-based violence,

including effective reparations and guarantees of non-recurrence, such as the prosecution of

sexual and gender-based violence committed in humanitarian settings, while ensuring the

meaningful and effective participation of women and girls in the relevant processes;

14. Calls upon all relevant actors, including Governments, regional organizations,

relevant United Nations agencies, national human rights institutions, entities providing

humanitarian assistance and civil society organizations to, within their respective mandates,

strengthen their efforts to reduce preventable maternal mortality and morbidity in

humanitarian settings when designing, implementing and reviewing policies and evaluating

programmes to reduce preventable maternal mortality and morbidity, while ensuring the

meaningful participation of women and girls in all decisions that affect them;

15. Calls upon States to ensure a more holistic and coordinated approach to the

humanitarian-development nexus that places the individual woman and girl at the centre of

humanitarian preparedness and response, and recognizes the need to overcome siloed

approaches and fragmented programming;

16. Also calls upon States to ensure the effective and meaningful participation of

women and girls, including through civil society and feminist networks and women’s rights

organizations, in identifying and determining needs, priorities for funding and service,

processes for access and delivery, and crisis response, in recognition of their agency;

17. Urges States to strengthen their statistical capacity and to promote reliable

transparent, collaborative and disaggregated data collection on the availability, accessibility,

acceptability and quality of sexual and reproductive health-care services for all women and

girls in affected populations, including host populations;

18. Invites States to consider the systematic integration of sexual and

reproductive health as an integral part of the right of everyone to the enjoyment of the

highest attainable standard of physical and mental health into the mandates of investigative

bodies established by the Human Rights Council, including commissions of inquiry and

fact-finding missions, and to address human rights violations suffered by women in

humanitarian settings;

19. Requests the High Commissioner to prepare, from within existing resources,

in consultation with States, United Nations agencies and all other relevant stakeholders, a

follow-up report on good practices and challenges to respecting, protecting and fulfilling all

human rights in the elimination of preventable maternal mortality and morbidity, including

through the utilization of the technical guidance by States and other relevant actors,

including the United Nations Population Fund, the United Nations Development

Programme, the United Nations Entity for Gender Equality and the Empowerment of

Women (UN-Women) and the World Health Organization, and to present it to the Human

Rights Council at its forty-fifth session;

20. Also requests the High Commissioner, in collaboration with the Inter-agency

Working Group on Reproductive Health in Crises, the United Nations Population Fund, the

World Health Organization, the United Nations Entity for Gender Equality and the

Empowerment of Women and other United Nations specialized agencies, funds and

programmes, international human rights mechanisms, entities providing humanitarian

assistance and civil society organizations, to organize a two-day meeting in 2019 to discuss

good practices, gaps and challenges in the application of a human rights-based approach to

the implementation of policies and programmes to reduce preventable maternal mortality

and morbidity in humanitarian settings, and to submit a summary report thereon to the

Human Rights Council at its forty-second session;

21. Decides to remain seized of the matter.

39th meeting

27 September 2018

[Adopted without a vote.]