A/HRC/18/27 (c) Strengthening health systems and primary health care to improve access to, and use of, skilled birth attendants and emergency obstetric care for complications; (d) Addressing unsafe abortion for women; (e) Improving monitoring and evaluation of State obligations to ensure the accountability of all actors and to implement policies. A. Enhancing the status of women by removing barriers to an effective human rights-based approach to eliminate maternal mortality and morbidity 6. Maternal mortality and morbidity is a consequence of gender inequality, discrimination, health inequity and a failure to guarantee women’s human rights. The slow progress with regard to Millennium Development Goal 5 is testimony to the low value placed on women’s and girls’ lives and to their limited voice in setting public priorities. The inequality and discrimination suffered by women throughout their lifetimes is perpetuated by formal laws, policies and harmful social norms and practices. Women, especially young women, those living in poverty, and/or socially marginalized women, are often unable to have access to care because of harmful, stigmatizing or discriminatory laws and practices. Consequently, many women and adolescent girls cannot obtain the full range of sexual and reproductive health services and information to which they are entitled.8 7. Poor and less educated women and girls and those living in rural areas are far less likely to have access to health services or to give birth in the presence of a skilled health worker owing to physical inaccessibility and the prohibitive costs of a birthing facility, restrictive abortion services, patriarchal household decision-making processes and poor quality and/or disrespectful care, including poor health-care provider attitudes towards pregnant women living with HIV. 8. The risk increases further for women facing intersecting discrimination, for example, on the basis of age, marital status, disability, HIV/AIDS status, women of lower caste or socio-economic status, living in rural areas or slum dwellings, or indigenous, minority, migrant, displaced or refugee women. A human rights-based approach requires taking measures to identify and address reasons behind specific women’s heightened inability to have access to adequate and timely health-care interventions and services. 9. A comprehensive human rights-based approach to maternal mortality and morbidity must ensure women’s equality in decision-making through a series of interventions, including legislative, policy and operational measures. Political commitment, enabling policies and the promotion of cross-sectoral linkages are needed to reduce poverty, improve women’s education and nutritional status, improve water and sanitation, infrastructure and transportation, empower women and address gender-based violence and harmful practices. 1. Early marriage 10. Early marriage exposes young girls to greater risk of maternal mortality and morbidity. According to WHO, although not all childbearing occurs within marriage, age at marriage is closely linked to first birth due to cultural norms and expectations, and due to 8 UNICEF, UNFPA, WHO, Addressing the human rights dimension of preventing maternal mortality and morbidity: a joint report to the Human Rights Council, UNICEF submission, p. 1. 5