A/HRC/45/19 systems are also a major factor in undermining maternal health rights, manifested for instance by delays in access to adequate emergency obstetric care.18 35. Ensuring that health workers are equipped to apply human rights-based approaches is another difficulty reported. Ethiopia reported that gaps remained in the capacity of health-care professionals in integrating rights into maternal health programming at all levels of the health system. In some places, poor-quality care and biased attitudes of health professionals were signalled as problems for advancing human rights-based approaches. IV. Maternal morbidity as a human rights issue A. Overview of maternal morbidities 36. Understanding maternal mortality and morbidity as a matter of human rights requires recognition that the deaths and grievous injuries sustained by women during pregnancy and childbirth are not inevitable events, but rather a direct result of discriminatory laws and practices, failures to establish and maintain functioning health systems and services, and a lack of accountability. 37. Efforts to improve maternal health globally are often focused primarily on measures to avoid maternal death, with less attention devoted to the problem of maternal morbidity. Maternal morbidity is an overarching term that has been defined by the WHO Maternal Morbidity Working Group as “any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman’s wellbeing”.19 38. Maternal morbidities vary in duration and severity and cover a broad range of diagnoses requiring a wide variety of treatments. 20 WHO has identified 121 conditions21 that can be characterized as direct or indirect maternal morbidities, including obstetricrelated complications such as prolonged or obstructed labour, complications of unsafe abortion, obstetric haemorrhage and hypertensive disease. If not managed properly, or untreated, these conditions can lead to a variety of outcomes, including issues such as uterine prolapse, obstetric fistula, infertility, incontinence or postpartum depression. Certain risk factors, such as anaemia, HIV, obesity and female genital mutilation, make some women and girls more vulnerable to suffering a maternal morbidity.22 39. Precise data on maternal morbidities globally are not available. The fact that data on morbidities is generally unavailable signals that the issue has not been prioritized. The lack of data is also connected to difficulties surrounding the definition and measurement of maternal morbidity, which poses challenges for obtaining comparable data. 40. Although the exact prevalence of maternal morbidity is not known, recent research suggests that global severe maternal morbidity rates are increasing.23 Maternal morbidities or disabilities are estimated to affect between 15 million and 20 million women worldwide 18 19 20 21 22 23 See submission from UNFPA. Tabassum Firoz and others, “Measuring maternal health: focus on maternal morbidity”, Bulletin of the World Health Organization (2013), p. 795. “Maternal morbidity can be conceptualized as a spectrum ranging, at its most severe, from a ‘maternal near miss’ – defined by the World Health Organization as the near death of a woman who has survived a complication occurring during pregnancy or childbirth or within 42 days of the termination of pregnancy – to non-life threatening morbidity.” Ibid., p. 794. Doris Chou and others, “Constructing maternal morbidity – towards a standard tool to measure and monitor maternal health beyond mortality”, BMC Pregnancy and Childbirth (2016). Robert E. Black and others, Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (vol. 2) (Washington, D.C., International Bank for Reconstruction and Development, 2016). Stacie E. Geller and others, “A global view of severe maternal morbidity: moving beyond maternal mortality”, Reproductive Health, vol. 15, supplement 1 (2018), pp. 31–32. 9