A/HRC/45/19 I. Introduction 1. In September 2012, the Human Rights Council adopted resolution 21/6, in which it welcomed the technical guidance on the application of a human rights-based approach to the implementation of policies and programmes for the reduction of preventable maternal mortality and morbidity. Follow-up implementation reports have been produced, in 2014 (A/HRC/27/20), in 2016 (A/HRC/33/24) and in 2018 (A/HRC/39/26), as requested by the Council. In September 2018, in its resolution 39/10, the Human Rights Council requested the United Nations High Commissioner for Human Rights to prepare a follow-up report on good practices and challenges to respecting, protecting and fulfilling all human rights in the elimination of preventable maternal mortality and morbidity, including through the utilization of the technical guidance. The present report is submitted in response to that request. 2. The present report includes details of initiatives, good practices and challenges related to the implementation of the technical guidance and a human rights-based approach more generally. It is based on submissions received in response to a note verbale circulated on 11 November 2019, and on research and information obtained from relevant stakeholders.1 Section IV, which also draws from the submissions received, combined with research, provides an analysis of maternal morbidity as a human rights concern, a dimension that has often been neglected in policies and programmes on preventing maternal mortality and morbidity. The High Commissioner concludes with recommendations on the implementation of a human rights-based approach to maternal mortality and morbidity, with a particular focus on maternal morbidity. II. Implementation of a human rights-based approach to the reduction of preventable maternal mortality and morbidity 3. The technical guidance on the implementation of a human rights-based approach to the application of policies and programmes for the reduction of preventable maternal mortality and morbidity provides detailed guidance on the steps required to develop, implement and evaluate policies and programmes on maternal health. It follows the policy cycle of planning, budgeting, implementation, monitoring, review and oversight, and remedies. Through the identification of rights holders and their entitlements and corresponding duty bearers and their obligations, a human rights-based approach aims to identify potential human rights concerns, establish who is responsible for taking corrective action and determine how action is most appropriately taken. The examples provided in the submissions, as documented below, are important illustrations of how this approach may be operationalized. 4. Since 2018, numerous efforts have been documented to implement a rights-based approach to the reduction of preventable maternal mortality and morbidity, including through the implementation of the technical guidance. Tools developed based on the technical guidance, such as the reflection guides, 2 have been widely disseminated in meetings with relevant ministries, civil society organizations and United Nations entities, as well as with targeted stakeholder groups, such as national human rights institutions and representatives of the judiciary. At the global level, numerous publications and other documents have referred to the technical guidance, facilitating its use. 3 1 2 3 For the complete list of submissions, see www.ohchr.org/EN/Issues/Women/WRGS/Pages/ TechnicalGuidanceMMM.aspx. See www.ohchr.org/EN/Issues/Women/WRGS/Pages/MaternalAndChildHealth.aspx. See A/74/137; Alicia Ely Yamin and Paola Bergallo, “Narratives of essentialism and exceptionalism: the challenges and possibilities of using human rights to improve access to safe abortion”, Health and Human Rights Journal, vol. 19, No. 1 (June 2017); Uchenna Emelonye, Abigail Uchenna Emelonye and Uchenna Ponfa Emelonye, “Preventing maternal mortality in Nigeria: a human rights imperative”, US-China Law Review, vol. 16, No. 4 (2019); Agegnehu Bante and others, “Respectful maternity care and associated factors among women who delivered at Harar hospitals, eastern Ethiopia: a cross 3