against Maternal Mortality
by Dr. Maria Cristina Calderon
complications from pregnancy and childbirth result in the deaths of over
500,000 mothers every year, one woman every minute.
Roughly 99 per cent of these fatalities occur in developing
health services fail to reach the poorest women.
It is estimated that more than two-thirds of these deaths could be
prevented with proper health care.
have a vital role to play in the fight to improve maternal health and
enable mothers to give birth under the care and guidance of modern family
As spokespersons for their constituencies, parliamentarians
represent a potent expression of public will. They
are able to serve as women's beacons of hope, focusing popular support for
women's health into a political force for change.
Moreover, the strength of their influence gives parliamentarians a
responsibility to act.
Mothers around the world depend on them to lead the fight for
Andean Region, Bolivia in particular, exhibits the highest level of
maternal mortality in the Western Hemisphere.
Where the most critical threat to a healthy pregnancy stem from
inadequate medical care, there exists in the region a wide range of
social, cultural and legal hazards that imperil the health - and life- of
women as well.
In the arena of legal change, parliamentarians play a fundamental
mother's death is the result of a sequence of discrimination suffered by
women during their entire life.
From infancy, they cannot enjoy the same educational opportunities
The proper feeding and nutrition of female children is neglected
out of an intense favouritism of male children.
An anaemic or undernourished pregnant woman, for example, runs a
high risk of haemorrhaging at the moment of childbirth, one of the most
common causes of maternal mortality.
Women do not have the same job opportunities, receive less pay for
the same work and, when they become pregnant or are already a mother, are
not able to claim maternity or nursing leave from their work.
They are most likely to be fired.
For fear of losing the job that enables them to feed their
children, and unwilling to bring another child into world of misery and
poverty, they seek an abortion. Under adequate technical and sanitary
conditions, abortion can be practiced safely, but when illegal and unsafe,
it becomes a hazardous and even deadly procedure.
The Andean Safe Motherhood Conference, held
in Santa Cruz de la Sierra, Bolivia (29 March - 2 April 1993), signalled
the level of international concern for maternal mortality rates in that
region, and sounded the alarm for legislative action and advocacy efforts.
The parliamentary session organised by Family Care International,
"Legislacion y Mortaladid Materna : Accion Parliamentaria en Salud
Reproductiva" ("Legislation and Maternal Mortality.
Opportunities for Parliamentary Action in Reproductive
Health") on March 31 1993 brought together political leaders in the
women's field, as well as presidents of commissions on health, social
welfare and maternal nursing.
Participants attending the session came from Bolivia, Columbia and
required at the parliamentary level include the following:
must understand the international agreements recognised by their
respective countries, as well as the commitments made by each nation to
women's health, reproductive rights, and the reduction of maternal
Eliminate All Forms of Discrimination Against Women, CEDAW,
offers a suitable starting point for legislative action.
This centrepiece international treaty specifically targets women's
health issues, but is ultimately a document advocating basic human rights.
the fact that all Andean countries have adopted the Convention, there is
evidence that legal discrimination against women persists on a wide scale.
The realities of the legal system can have serious repercussions for
maternal health. Considering the subtle forms of discrimination present in
regional legal structures, the fulfillment of relevant international
obligations is vital to progress in maternal health.
of signatory countries must abide by the provisions of the Convention,
enacting appropriate regulations to ensure that non-discriminatory
policies will be effectively enforced.
Existing national laws must comply with the Convention,
and no new laws may be enacted in violation of its spirit.
motherhood is closely linked to the fullest exercise of women's
reproductive rights. A woman's pregnancy should be hoped for and timely,
that is, the prospective mother should be in emotionally and physically
healthy at the time of the inception.
planning services and information must be available at affordable cost for
both men and women of low-income families, starting from adolescence, in
rural as well as urban districts.
Information and services should aim at educating young people in
sexual health, enabling them to become familiar with their bodies, genital
organs, fertility cycles, sexually-transmitted diseases, and the diverse
manifestations of human sexuality.
Post-natal and post-abortion services for women must be available
the high incidence of rapes, which result in unwanted pregnancies, the
following must be taken into account: Increasing street safety should be a
high policy priority.
may often be force to have sexual relations with their husbands or
boyfriends against their will. These rapes are usually accompanied by
violence or blackmail by the perpetrator to silence the rape victim.
To increase women's safety within the household, such behaviour
ought to be strictly penalised.
legislation should seek to ensure that there is an adequate maternal
health system in place, so that women can give birth in clean and safe
conditions, by making access to emergency, pre- and post-natal services
social role of motherhood should be clearly recognised.
Legislation must therefore make it easy for parents to care for
their children during child-rearing, granting maternity leave for mothers,
providing for kindergarten facilities and inducing men to sharing more
fully in parental responsibilities.
and private international agencies such as the Inter-American
Parliamentarian Groups (IPG), Family Care International (FCI), the
International Planned Parenthood Federation (IPPF), PAHO/WHO and UNICEF
provide technical assistance on these issues to Government officials and
Budget allocations for social issues, which have suffered sharp
cutbacks in most countries in recent years, must be substantially
increased if the strengthening of local capacity on population and family
planning issues is to be at all effective.
Family Planning and Contraception:
amend any law that limits the access to family-planning services to
adolescents and adult women, by requiring the consent of parents or
introduce sexual education courses for boys and girls since the early
years of schooling;
make family-planning counselling as well as post-delivery and
post-abortion services available on demand;
overrule legal norms restricting access to information on family
planning to the general public;
bring family-planning services to low-income communities, especially
in rural areas, where most high-risk population is concentrated;
increase national budget allocations for family-planning programmes;
raise the minimum age to marry without parental consent.
provide timely and adequate treatment for complications related to
spontaneous or induced abortions;
amend national laws in order to decriminalise abortion, bearing in
mind the large number of clandestine abortions as well as the high
mortality rate resulting from them.
the need to improve women's socio-economic situation to give them equal
rights and opportunities.
recognise the value of women's domestic work in the National Accounts;
guarantee women's access to land ownership, credit and education;
legislate women's maternity leave, making sure that no woman is
dismissed during pregnancy or as a result of it;
mandate the establishment of kindergarten facilities in the workplace;
make every woman eligible for social-security benefits;
promote the sharing of responsibilities for child-rearing and domestic
activities among spouses;
ban gender-based, discriminatory stereotypes in textbooks and
advertisements, so that women are not portrayed in an inferior or
promote massive information and sensitisation campaigns on women's
violence against women, the most outrageous form of gender discrimination:
streamline and expedite procedures to control and sanction sexual
harassment in the workplace as well as domestic violence, especially
that among spouses and partners, establishing mandatory programmes to
re-educate the perpetrators;
set up special police units especially sensitized and trained to deal
with domestic violence, and reform the criminal justice system so as
to make it easier for the victim and her relatives to report any
sponsor the establishment of shelters for victims of social and
promote a nation-wide debate on the issue of violence against women,
seeking to raise the public consciousness on its status as a criminal
support the efforts of the Organization of American States (O.A.S.) to
enact an Inter-American Convention to prevent, sanction and eradicate
all forms of violence against women.
set up interdisciplinary commissions to formulate a legislative agenda on
family-planning issues, with the participation of women's and private
groups with substantive knowledge and expertise on women's reproductive
amend national laws in order to bring them in line with international
agreements ratified by each country;
increase funding for comprehensive health and welfare programmes targeted
establish multi-sectoral parliamentary committees with representatives from
such Commissions as Women, Education, Communications, Finance, Population
and Health, to co-ordinate and oversee progress on implementation of
family-planning and reproductive health programmes;
sponsor high-level meetings to co-ordinate policy implementation in the
health sector, especially as regards reproductive-health policies;
evaluate the possibility of creating a Ministry of Women's Affairs, to be
vested with executive authority over all issues affecting women;
it is highly recommended that parliamentarians take it upon themselves to
periodically prepare National Reports on
administrative and other measures" adopted by Member Countries, to be
submitted to the U.N. Secretary General every four years in accordance with
the provisions of the Convention on the Elimination of All Forms of
Discrimination Against Women (Art.19).
by Alejandra Meglioli
:Inter-American Parliamentary Group on population and development