MDG 5, HUMAN RIGHTS, AND MATERNAL HEALTH IN AFRICA
otherwise been exposed”.218 It is this sort of empowerment that is
envisaged by the CESCR.
However, empowering individuals and communities would only be
beneficial if other actors, particularly public authorities, are prepared to
work toward the same goal. In this context, there are specific obligations
imposed upon States Parties to the ICESCR.219 They are required to pay
attention to the following essential elements of maternal health: availability,
accessibility, acceptability, and quality (AAAQ).220 Availability, as the
term implies, simply means that public health and health care facilities as
well as ancillary goods and services will have to be made available in
sufficient quantity for use of the population within the country.221 Inclusive
within this heading are underlying determinants of health.222 The second
element, accessibility, requires that everyone should have access to health
facilities, goods and services without discrimination of any kind.223 While
it is essential that facilities, as well as goods and services necessary for
enjoyment of maternal health, are available and accessible, it is also
necessary that they be acceptable to the communities whose needs are
intended to be served. Acceptability connotes an obligation that health
services must be consistent with applicable medical ethics and respectful of
the cultural sensibilities of the people.224 Finally, it is also required that
available health facilities, goods, and services must be of good quality.225
The ability of States Parties to structure and operationalize their national
health policy frameworks in accordance with the AAAQ guideline is a key
indicator of compliance with their human rights obligations relating to
maternal health. Obviously, and this is very important, the compliance
level itself is a product of resources at the disposal of each contracting State
Party. This is not problematic since the general obligation on States Parties
is of a progressive kind, with implementation keyed to resource
availability.226 Where difficulty arises is when States Parties move at a
218. Nnamuchi, The Nigerian Social Health Insurance System, supra note 139, at 156-
219. General Comment No. 14, supra note 149, para. 12.
221. Id. para. 12(a).
223. Id. para. 12(b). This element has four overlapping dimensions, namely, nondiscrimination, physical accessibility, economic accessibility, and information accessibility).
225. Id. para. 12(d).
226. Id. paras. 30-31 (“The progressive realization of the right to health over a period of
time should not be interpreted as depriving States Parties obligations of all meaningful