A/HRC/18/27 Restrictions on access to certain contraceptive methods and coercive family planning policies impair the ability of women to make informed, autonomous decisions and to determine the number, spacing and timing of their children. 20. Many barriers prevent young people, married and unmarried, from obtaining contraception and having access to services, including HIV prevention, denial that young people may be sexually active, requirements of parental or spousal consent, cost and location of services, and lack of privacy and confidentiality. The Committee on the Rights of the Child, in its general comment No. 4, found that the realization of the right to health of adolescents was dependent on the development of youth-sensitive health care that respects confidentiality and privacy and includes appropriate sexual and reproductive health services. C. Strengthening health systems to increase access to and use of skilled care 21. While many factors contribute to maternal deaths and disabilities, one of the most effective means of preventing them is to improve health systems and primary health care to ensure the availability of skilled attendance at all levels and access to 24-hour emergency obstetric care. Most maternal deaths and disabilities could have been prevented had the women been assisted by a health-care professional with the necessary skills, equipment and medicines to prevent and manage complications. 22. Interventions have traditionally been neglected in favour of increasing the supply of skilled birth attendants, whereas a human rights-based approach to reduce maternal mortality and morbidity recognizes that the availability of services alone is insufficient; they must also be accessible and affordable to all, of high quality, and should be provided in a way that is both culturally acceptable and responsive to women’s needs. Overcoming such obstacles necessitates a human rights-based approach, as it requires creating an environment that is conducive the empowerment of women to demand these rights. Families and communities need to be able to recognize when complications arise and be able to take action. 23. A functioning health system requires adequate supplies, equipment and infrastructure, as well as an efficient and effective system of communication, referral and transport. The strengthening of these systems, however costly, is beneficial to all citizens, not just women, thereby illustrating the interlinkages among development, human rights and public health. 24. According to the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, the right to health gives rise to a responsibility of international assistance and cooperation on developed States to assist developing States to realize the right to health. Developed States should support developing States efforts’ to reduce maternal mortality. This responsibility is reflected in Millennium Development Goal 8, which is a commitment to develop a global partnership for development,27 and is further articulated in the Global Strategy for Women’s and Children’s Health. Accountability thus begins with State obligations, but the global community also has a responsibility to provide international cooperation and assistance to strengthen health systems. 27 8 A/61/338, para. 19.