A/HRC/21/22 and branches of government, for reviewing findings and taking appropriate action to address identified problems. 55. The two examples in the section below are merely illustrative. The effective application of a rights-based approach requires a contextualized understanding of the particular issues and challenges, including the availability, accessibility, acceptability and quality of goods, services and facilities, as well as of the underlying causes of maternal mortality and morbidity. A. Example of identified problem: women arriving late or failing to seek emergency obstetric care 56. The first step is to analyse the cause of delays and failure to seek care. A human rights-based approach places responsibility on the State for ensuring available, accessible, acceptable and quality facilities, goods and services to address lifethreatening delays. Delays in the decision to seek care or opting out of the health system entirely are treated not as idiosyncratic, personal choices or immutable cultural preferences but as human rights failures. They are affected by the inequitable and sometimes discriminatory distribution of health-care facilities, goods and services that makes emergency obstetric care both unavailable and physically inaccessible, as well as by a lack of awareness of the emergency signs among family and community members and the lack of empowerment of women to make decisions about their own well-being. Delays in arrival can also be attributable to out-of-pocket costs, lack of transportation or communications, and/or poor infrastructure. Lack of cultural sensitivity and acceptability of care at facilities, including language and provision for traditional birthing customs, also leads to a reluctance to seek care. If abortion laws are overly restrictive, responses by providers, police and other actors can discourage care-seeking behaviour. Lastly, when the population perceives that care quality is poor – even if not directly related to sexual and reproductive health – including lack of respectful treatment at facilities, it also affects decisions to seek care and undermines the health system as a core social institution. 57. The second step is to identify responsibility for each specific factor leading to delays or failure to seek care. For example, if a lack of a constant supply of medication or supplies is identified as undermining quality of care and generating distrust in the health system, it may be attributable to a variety of causes, including lack of adequate recordkeeping at the facility, regional and/or national level that does not permit allocation formulas for inputs to reflect actual needs; a lack of local warehousing to ensure stockpiles of medications at the district and/or regional level; a flawed national procurement process not permitting equitable or timely distribution of quality medicines; corruption at any level; illicit or unscrupulous pricing practices by private manufacturers; or a combination of the above. These issues are not just technical ones; they affect the effective enjoyment of women’s sexual and reproductive health rights. 58. The third step is to suggest and prioritize actions by different duty-bearers required for each factor causing the problem. For example, if the national procurement process for medicines is flawed, the Ministry of Health may need to examine procedures followed to award contracts and for quality control; and ineffective or ideologically-based policies regarding the selection of medicines, including contraception. In addition, budgets may need to be modified by the Ministry, together with other ministries, to meet actual needs and address pre-existing disparities or exclusion of certain subpopulations; institutional oversight may need to be strengthened at the facility, district, regional and national levels to promote robust quantification of needs and reduce corruption; funding may need to be secured from donors to integrate information technologies into the health system; or a combination of the above. 12