MDG 5, HUMAN RIGHTS, AND MATERNAL HEALTH IN AFRICA
3. 9 percent of all maternal deaths in the region.212 If this is correct, it
renders the value of Art. 14( 2)(c) of the Maputo Protocol dubious unless
one’s appraisal of it involves the idea that any number of preventable
mortalities, abortion-related or otherwise, that are prevented represents an
achievement in the fight against poor maternal health in the region.
An important element of maternal health underscored in General
Comment No. 14 is underlying or social determinants of health.213 These
include access to safe and potable water and adequate sanitation; an
acceptable supply of safe food; nutrition; housing; healthy occupational and
environmental conditions; and access to health-related education and
information.214 Social determinants of health also include facilitating the
participation of the population in all health-related decision-making at the
community, national, and international levels.215 Underlying or social
determinants of health consist of the “structural determinants and conditions
of daily life”; that is, “the conditions in which people are born, grow, live,
work, and age.”216 Emphasis on the integration of social health
determinants as vital to advancing maternal health recognizes that success
in reversing MMR is not entirely dependent on availability of health care.
More than anything else, including access to medicine and hospital
services, the conditions under which women live and work are greater
contributors to maternal health as these conditions determine morbidities
and mortalities, or absence thereof, amongst women.217 Moreover,
involving women in decisions regarding their health is a surefire way to
start getting a handle on the scourge of ill health and unremitting suffering
amongst this vulnerable population. The maxim “who feels it knows it”
powerfully validates the idea that as the primarily affected party, women
know best what their problems are and the approaches and strategies that
would lead to success. The benefit of integrating such interests into policy
decisions, particularly in the realm of health and health care, is self-evident
and empowering. As argued elsewhere, “the kernel of individual
empowerment is that it reduces exposure to [health] problems, saving the
individual from the pain, suffering and expenses to which he could have
212. See Khan et al., supra note 42.
213. General Comment No. 14, supra note 149, para. 11.
216. COMM. ON SOC. DETERMINANTS OF HEALTH, CLOSING THE GAP IN A GENERATION:
HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH, Part 1 (2008).
217. See id. (containing a comprehensive account of the value and impact of underlying
health determinants on health).