A/HRC/18/27 the fact that contraception is less commonly used to delay first births than it is to delay later births.”9 11. Pregnancy-related complications are the main cause of death for young women, with girls being twice as likely to die from childbirth as women in their twenties.10 The average age of obstetric fistula patients is below 25 years old, with many as young as 13 or 14 years.11 12. Marriage often entails an expectation to start a family. A woman’s right to choose if, when and whom to marry is a fundamental human right, secured under a number of international human rights instruments. According to the Committee on the Elimination of Discrimination against Women, the minimum age of marriage should be 18 years, an idea supported by other treaty bodies.12 While most countries claim that national laws comply, however, customs and tradition in reality do not, and laws on minimum age of marriage are not enforced. 13. Reflecting the correlation between early pregnancy and risk, a human rights-based approach involves promoting secondary school education, preventing early marriage by enforcing a set minimum legal age of marriage of at least 18 years, and delaying first births by postponing the onset of sexual activity and by using effective methods of contraception. 2. Inadequate nutrition 14. Inadequate nutrition can greatly increase the risks of preventable maternal mortality and morbidity.13 In many countries, women and girls are greatly affected by lack of food, and family feeding patterns often leave women and girls last to be fed. Malnourishment hinders their pelvic growth, leading to obstructed labour, causing maternal mortality and obstetric fistula. A human rights-based approach requires States to address any traditional practice not allowing women to eat until men are fully fed,14 and requires States to respect, protect and promote the right of women and girls to nutritional well-being.15 3. Violence against women 15. Violence against women and girls is a consistent barrier to good maternal health outcomes. Violence during pregnancy is associated with an increased risk of miscarriage, stillbirth, abortion and low birth weight.16 A human rights-based approach requires States to eliminate such violence and to provide training to recognize its signs using appropriate approaches for treatment and counselling, and involving communities. 9 World Health Day, Safe Motherhood 1998. Delay childbearing, available from www.who.int/docstore/world-health-day/en/pages1998/whd98_04.html. 10 World Bank, “Maternal mortality at a glance: why address maternal mortality?”, May 2006. Available from http://siteresources.worldbank.org/INTPHAAG/Resources/AAGMatMort06.pdf. 11 Medical Collaboration Committee submission. 12 See Committee on the Elimination of Discrimination against Women, general recommendation No. 21, para. 36; Committee on Economic, Social and Cultural Rights, general comment No. 16; Human Rights Committee, general comment No. 28, para. 23; and Committee on the Rights of the Child, general comment No. 4, para. 9. 13 A/HRC/14/39, para. 18. 14 See Committee on Social, Economic and Cultural Rights, general comment No. 14, para. 28; and Human Rights Committee, general comment No. 6. 15 Committee on the Elimination of Discrimination against Women, general recommendation No. 24, para. 7. 16 World Health Organization (WHO), “Addressing violence against women and achieving the Millennium Development Goals”; see www.who.int/gender/documents/women_MDGs_report/en/index6.html. 6