A/HRC/35/10 CERD/C/HRV/CO/8; CERD/C/USA/CO/6; CERD/C/IND/CO/19; CERD/C/304/Add.109, para. 9; CERD/C/SVK/CO/9-10, para. 11; CCPR/C/MKD/CO/2; CCPR/C/USA/CO/3/Rev.1; CCPR/CO/72/CZE; CRC/C/CZE/CO/3-4, para. 65, E/C.12/UKR/CO/6, para. 25), the Working Group on the Universal Periodic Review (A/HRC/32/15, para. 120.76; A/HRC/26/12, para. 110.131; A/HRC/22/3, para. 94.113; and A/HRC/17/17, para. 77.49) and the Independent Expert on minority issues (A/HRC/19/56/Add.2) have addressed the educational segregation of refugee women and girls or on the basis of their ethnicity or work and descent in States such as Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Estonia, Germany, India, Latvia, Serbia, Slovakia, the former Yugoslav Republic of Macedonia, Ukraine and the United States of America. The Committee on the Elimination of Discrimination against Women has also drawn attention to the fact that girls in Bosnia and Herzegovina are discriminated by mono-ethnic school systems, which have a negative impact on their education opportunities (CEDAW/C/BIH/CO/4-5, para. 31). C. Health 25. Factors such as race, work and descent or ethnicity have an impact on the access of the women and girls to sexual and reproductive health services and information, and the quality of medical treatment they receive. For ethnic minority women in Viet Nam, more than 60 per cent of all childbirths are without prenatal care, twice as many as for the majority Kinh women.13 26. Evidence shows that women with low social status or women who are economically excluded are disproportionately affected by maternal death. In the case of Alyne da Silva Pimentel Teixeira (deceased) v. Brazil, the victim, a woman of African descent, died after a stillbirth and serious postnatal complications owing to the denial of access to quality health care. The Committee on the Elimination of Discrimination against Women concluded that Alyne da Silva Pimentel Teixeira was discriminated against not only on the basis of her sex but also of her status as a woman of African descent and her socioeconomic background (CEDAW/C/49/D/17/2008, para. 7.7). According to the Gender Equality Observatory for Latin America and the Caribbean, in 2013, maternal mortality in the region Ngöbe-Buglé, in Panama, was 344 deaths per 100,000 births, against a national average of 71.14 27. Poverty is often aggravated by the absence of universal health care, which can further marginalize low-income groups. The Working Group on discrimination against women in law and in practice found that, in the United States of America, 28 per cent of people living in poverty were still uninsured in 2015; African-American and Hispanic women were disproportionally affected (A/HRC/32/44/Add.2, para. 61). 28. Women and girls affected by intersecting forms of violence and discrimination often lack access to information about the availability of services, their rights and entitlements. Intercultural and gender-sensitive services are often not available. Qualitative interviews with health providers servicing indigenous communities in Latin America found that providers themselves expressed difficulties in assisting indigenous women, often because of 13 14 World Development Report 2012: Gender Equality and Development (World Bank, Washington, D.C., 2011), p. xxi. Observatorio de Igualdad de Género de América Latina y el Caribe, Mujeres indígenas en América Latina: Dinámicas demográficas y sociales en el marco de los derechos humanos, 2013, p. 66. 7