A/HRC/27/31 81. Access to early postnatal care for mothers and newborns within two days of birth has a major impact on newborn health and can be enhanced through the elimination of user fees for maternal and neonatal health services that might pose a barrier to service uptake. 82. The availability of skilled health workers who are motivated, adequately equipped and appropriately distributed is critical to ensuring access to services. Providing extra care to babies with low birth weight is particularly important to reduce newborn mortality, and health personnel need to be given the capacity and a clear mandate to support those babies and their mothers. Ensuring that midwifery curricula meet global standards and that students acquire the necessary competencies to deliver good-quality services with confidence can help ensure an adequately skilled health workforce. 83. Appropriate care during labour, birth and in the immediate postnatal period can prevent the onset of complications or enable their early detection and prompt management. Ensuring the acceptability of maternal and neonatal health services requires, for example, ensuring that women are treated with dignity and respect, that pain management is provided for mothers and newborns, and that there is no unnecessary separation of mothers and newborns. 84. Ensuring the quality of maternal and neonatal services for all women and infants without discrimination may increase their uptake and have a positive impact on neonatal mortality. 85. Alongside the expansion of service delivery, a human rights-based approach requires addressing the underlying legal, policy and practical reasons, for example poverty, low levels of education, gender inequality, disability and discrimination, why access to neonatal health services remains constrained for some populations. 86. The principles of equality and non-discrimination demand attention to why neonatal mortality remains a problem and which groups of infants are most affected. They require that national policies and programmes prioritize improving access for the most marginalized populations. Those groups will vary according to the context, which again highlights the need for appropriately disaggregated data as a tool for identifying groups that may require special attention. 87. To ensure accountability at the health facility level, feedback mechanisms should be in place for health workers and clients to identify any shortcomings in service provision, such as drug stock-outs or poor quality of care, that managers should review and take appropriate action on in a timely fashion. Community-level interventions 88. Involving communities in child health-related activities can reduce neonatal mortality and help ensure that interventions are appropriate and effective.45 A recent review found benefits for maternal and child health outcomes from attention to participation, particularly in combination with additional human rights principles.46 89. Community health committees, whose membership combines local citizens and community health workers, are an example of a mechanism through which community participation can help improve neonatal health outcomes by sharing responsibility for ensuring that services maintain a certain standard of performance. The human rights 45 46 M. Rosato and others, “Community participation: lessons for maternal, newborn, and child health”, in The Lancet, Vol. 372, Issue 9642, 13 September 2008. F. Bustreo and others, “Women’s and children’s health”, footnote 4. 19